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  • Question 1 - A 32 year old complains of pain in her hands bilaterally. Which of...

    Correct

    • A 32 year old complains of pain in her hands bilaterally. Which of the following symptoms would point towards an inflammatory joint disease such as rheumatoid arthritis?

      Your Answer: Marked stiffness for more than an hour in the mornings

      Explanation:

      In rheumatoid arthritis (RA), clinical symptoms of joint stiffness, pain, and functional disability are commonly most severe in the early morning. These symptoms closely follow the circadian rhythm of the pro-inflammatory cytokine, interleukin (IL)-6. In RA, the increase in nocturnal anti-inflammatory cortisol secretion is insufficient to suppress ongoing inflammation, resulting in the morning symptoms characteristic of RA. Established diagnostic criteria for RA include prolonged morning stiffness that could last up to an hour. Loss of joint mobility, pain, malaise and swelling of finger joints are features that are not specific to rheumatoid arthritis, and are found in many other conditions.

    • This question is part of the following fields:

      • Rheumatology
      5.6
      Seconds
  • Question 2 - A 73-year-old female is being reviewed in the osteoporosis clinic. She had a...

    Correct

    • A 73-year-old female is being reviewed in the osteoporosis clinic. She had a fracture of her left hip 5 years ago and was started on alendronate. Following the development of persistent musculoskeletal pain, alendronate was replaced with risedronate, which was also stopped for similar reasons. Strontium ranelate was therefore started but was also stopped due to the development of deep vein thrombosis in the right leg. Her current T-score is -4.1. A decision is made to start a trial of denosumab. What is the mechanism of action of denosumab?

      Your Answer: Inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts

      Explanation:

      The principal mechanism by which strontium inhibits osteoclast activity is by enhancing the secretion of osteoprotegerin (OPG) and by reducing the expression of the receptor activator of nuclear factor κB ligand (RANKL) in osteoblasts.

      Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.

      Management:
      Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
      Alendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
      Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.
      Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.

    • This question is part of the following fields:

      • Pharmacology
      30.9
      Seconds
  • Question 3 - A 25-year-old woman was admitted to hospital with a 3 day history of...

    Correct

    • A 25-year-old woman was admitted to hospital with a 3 day history of feeling generally unwell, with fatigue, arthralgia and pruritis. She had recently finished a 5 day course of antibiotics for a urinary tract infection but there was no other significant past medical history. She had no significant findings on clinical examination except for a widespread erythematous rash. Investigation results are below: Haemoglobin (Hb) 12.6 g/dL, White cell count (WCC) 13.0 × 109/l (eosinophilia) Platelets 390 × 109/L, Creatinine 720 μmol/L, Na+ 135 mmol/L, K+ 5.2 mmol/L, Urea 22.0 mmol/L, Urinalysis Protein ++ blood + What is the most important investigation to establish the diagnosis?

      Your Answer: Renal biopsy

      Explanation:

      There is a strong suspicion of drug-induced acute tubulo-interstitial nephritis with the classic triad of symptoms of rash, joint pain and eosinophils in the blood, associated with non-specific symptoms of fever and fatigue. This can be confirmed with renal biopsy showing interstitial oedema with a heavy infiltrate of inflammatory cells and variable tubular necrosis.

    • This question is part of the following fields:

      • Nephrology
      28.8
      Seconds
  • Question 4 - A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She...

    Correct

    • A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She mentioned that she has an uncle with previous parathyroid gland excision and a cousin who has recently been diagnosed with insulinoma. On examination, her BP is 135/72 mmHg, her pulse is 70/min and regular, her BMI is 20. Cardiovascular, respiratory and abdominal examinations are unremarkable. Investigations show: Hb 12.6 g/dL, WCC 5.4 x109/L, PLT 299 x109/L, Na+ 139 mmol/L, K+ 4.4 mmol/L, Creatinine 121 ىmol/L, Albumin 37 g/l, Ca++ 2.95 mmol/L, PTH 18 (normal<10). Which of the following is the most likely cause of her raised calcium?

      Your Answer: Parathyroid hyperplasia

      Explanation:

      The combination of Insulinoma and Parathyroid diseases is suggestive of MEN 1 syndrome.
      Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumour syndrome inherited in an autosomal dominant manner and characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, entero-pancreatic, and anterior pituitary origin, as well as non-endocrine neoplasms.
      Other endocrine tumours in MEN1 include foregut carcinoid tumours, adrenocortical tumours, and rarely pheochromocytoma. Nonendocrine manifestations include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas.

      Primary hyperparathyroidism (PHPT), due to parathyroid hyperplasia is the most frequent and usually the earliest expression of MEN-1, with a typical age of onset at 20–25 years.

    • This question is part of the following fields:

      • Endocrinology
      31.2
      Seconds
  • Question 5 - A 21 year-old male, who is a known alcoholic, presents with a fever,...

    Correct

    • A 21 year-old male, who is a known alcoholic, presents with a fever, haemoptysis, green sputum and an effusion clinically. There is concern that it may be an empyema.   Which test would be most useful to resolve the suspicion?

      Your Answer: Pleural fluid pH

      Explanation:

      If a pleural effusion is present, a diagnostic thoracentesis may be performed and analysed for pH, lactate dehydrogenase, glucose levels, specific gravity, and cell count with differential. Pleural fluid may also be sent for Gram stain, culture, and sensitivity. Acid-fast bacillus testing may also be considered and the fluid may be sent for cytology if cancer is suspected.

      The following findings are suggestive of an empyema or parapneumonic effusion that will likely need a chest tube or pigtail catheter for complete resolution:
      -Grossly purulent pleural fluid
      -pH level less than 7.2
      -WBC count greater than 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
      -Glucose level less than 60 mg/dL
      -Lactate dehydrogenase level greater than 1,000 IU/mL
      -Positive pleural fluid culture

      The most often used golden criteria for empyema are pleural effusion with macroscopic presence of pus, a positive Gram stain or culture of pleural fluid, or a pleural fluid pH under 7.2 with normal peripheral blood ph.

    • This question is part of the following fields:

      • Respiratory
      15.7
      Seconds
  • Question 6 - A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of...

    Correct

    • A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of the following is in keeping with a diagnosis of haemochromatosis?

      Your Answer: Transferrin saturation 78% (20-50)

      Explanation:

      A high transferrin saturation is seen in hemochromatosis, as well as a high iron level (>30), a high ferritin level, and a LOW TIBC (<20). Think of it like the opposite findings of iron deficiency anaemia which is a low iron, low ferritin, high TIBC.

    • This question is part of the following fields:

      • Gastroenterology
      22.5
      Seconds
  • Question 7 - A 25-year-old female patient presents with massive haemorrhage. After grouping, her blood sample...

    Correct

    • A 25-year-old female patient presents with massive haemorrhage. After grouping, her blood sample comes out to be B RhD negative. You work in the hospital's blood bank and are asked to prepare two units each of red blood cells (RBCs) and fresh frozen plasma (FFP). You manage to obtain the RBCs but not the Group B FFP as it is unavailable. Therefore, out of the following, FFP from a donor of which blood group would be best to transfuse?

      Your Answer: AB RhD negative

      Explanation:

      Group AB donors are the universal donors of FFP. This is because they produce neither anti-A nor anti-B antigens in their plasma and are, therefore, compatible with all ABO groups.

      The aforementioned patient’s blood group is B meaning, thereby, she naturally produces anti-A antigens in her plasma and would need to receive plasma that does not have anti-B antigens in it. Hence, she can only receive FFP from donors of group B or AB. Moreover, as she is of childbearing age, she must receive RhD negative blood in order to avoid problems with future pregnancies if her foetus would be RhD positive.

    • This question is part of the following fields:

      • Haematology & Oncology
      30.5
      Seconds
  • Question 8 - What percentage of values lie within 3 standard deviations of the mean in...

    Correct

    • What percentage of values lie within 3 standard deviations of the mean in a normal distribution?

      Your Answer: 99.70%

      Explanation:

      Normal distribution describes the spread of many biological and clinical measurements. Usually, 68.3% lies within 1 standard deviation (SD) of the mean, 95.4% lies within 2 SD of the mean and 99.7% lies within 3 SD of the mean.

    • This question is part of the following fields:

      • Clinical Sciences
      10.2
      Seconds
  • Question 9 - A 32 year old male who has recently returned from a trip to...

    Correct

    • A 32 year old male who has recently returned from a trip to Thailand presents with congestion of eyes and swelling of the knee joint. He completed a course of antibiotics for dysentery 4 weeks back. He experiences no dysuria and urine examination is normal. Which further information would be most useful in establishing a diagnosis?

      Your Answer: History and physical examination

      Explanation:

      The patient most likely has reactive arthritis which is usually diagnosed on history and clinical examination. The classic triad of symptoms include conjunctivitis, urethritis and arthritis. Arthritis and conjunctivitis may occur 4-6 weeks after a gastrointestinal or genitourinary infection. Arthritis usually occurs acutely, mostly involving the lower limb and is asymmetrical. Blood culture, urine culture and arthrocentesis (joint aspiration) will not yield positive results.

    • This question is part of the following fields:

      • Rheumatology
      34.5
      Seconds
  • Question 10 - A 45-year-old female presented with weight loss, night sweats and abdominal pain for...

    Correct

    • A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?

      Your Answer: Mycobacterium tuberculosis

      Explanation:

      Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.

    • This question is part of the following fields:

      • Infectious Diseases
      3.6
      Seconds
  • Question 11 - A 68-year-old male patient presents with central chest pain and associated flushing. He...

    Correct

    • A 68-year-old male patient presents with central chest pain and associated flushing. He claims the pain is crushing in character. ECG reveals T wave inversion in II, III and AVF. Blood exams are as follows: Troponin T = 0.9 ng/ml. Which substance does troponin bind to?

      Your Answer: Tropomyosin

      Explanation:

      Troponin T is a 37 ku protein that binds to tropomyosin, thereby attaching the troponin complex to the thin filament.

    • This question is part of the following fields:

      • Clinical Sciences
      3.3
      Seconds
  • Question 12 - A 42-year-old man with a 6 month history of progressive weakness of both...

    Correct

    • A 42-year-old man with a 6 month history of progressive weakness of both lower limbs, complains of lethargy and of difficulties climbing stairs. He also claims he's experienced muscle loss in his lower limbs. History reveals type 2 diabetes mellitus and heavy alcohol use for the last 4 years. Clinical examination reveals marked loss of fine touch and proprioception. The distribution is in a stocking manner and bilateral. However, no evidence of ataxia is present. What is the most probable diagnosis?

      Your Answer: Dry beriberi

      Explanation:

      Hypovitaminosis B1, consistent with dry beriberi is crucially a treatable condition, although sometimes with incomplete recovery, but it is probably under-recognized yet increasingly common given increasing levels of alcohol abuse in the western world. Dry beriberi or ‘acute nutritional polyneuropathy’ is considered to be rare in the western world. Rapid deterioration can occur, typically with weakness, paraesthesia and neuropathic pain. Striking motor nerve involvement can occur, mimicking Guillain-Barré syndrome (GBS). In the context of increasing alcohol abuse in the western world, it is possible that alcoholic neuropathy associated with abrupt deterioration due to concomitant nutritional hypovitaminosis B1 may be seen increasingly often.

    • This question is part of the following fields:

      • Clinical Sciences
      3.3
      Seconds
  • Question 13 - A 48-year-old hairdresser presented to her GP complaining of tingling in the right...

    Correct

    • A 48-year-old hairdresser presented to her GP complaining of tingling in the right palm and right wrist pain. She had intermittently experienced these symptoms; however, recently they had been keeping her awake all night. She had noticed a reduction in grip and was struggling to work at the salon. Otherwise, she felt well in herself and had not noticed any weakness in the other hand or lower limb. Her weight was stable, and she denied any neck problems or swallowing difficulties. She had a past medical history of hypothyroidism and hypertension and took regular thyroxine, Bendroflumethiazide and ibuprofen. She was a non-smoker and rarely drank alcohol. On examination, she appeared alert and orientated. Fundoscopy and cranial nerve examination were all normal and neck movements were full. On examination of the upper limb, there was wasting over the right thenar eminence and fasciculations with a small burn over the right index finger. There was weakness of thumb abduction and opposition, with loss of pinprick and light touch sensation over the thumb, index and middle finger in the right hand. Nerve conduction studies showed absent sensory action potential in right median palmar branches and denervation of the right abductor pollicis brevis. What is the most likely diagnosis?

      Your Answer: Median nerve palsy

      Explanation:

      The history is consistent with carpal tunnel syndrome (CTS) arising as a result of pressure on the median nerve in the carpal tunnel. The median nerve supplies the muscles of the thenar eminence: the abductor pollicis (C7, C8), flexor pollicis brevis and opponens pollicis, and the lateral two lumbricals. The nerve conduction studies confirm marked denervation and absent sensory potentials within the median nerve territory.

    • This question is part of the following fields:

      • Neurology
      7.5
      Seconds
  • Question 14 - A 28-year-old female admitted for a course of chemotherapy, has been taking high...

    Correct

    • A 28-year-old female admitted for a course of chemotherapy, has been taking high dose steroids for a few days. The nurses report that she is very agitated and talks about trying to open the window of her room and jump out from the fourth floor. You review her notes and see that she admits to drinking a few glasses of wine per week and has smoked cannabis on a few occasions. On examination her BP is 145/88 mmHg, her pulse is 80 bpm. Blood investigations reveal: Haemoglobin: 12.1 g/dL (11.5-16.5) WBC count: 16.2 x 103/dL (4-11) Platelets: 200 x 109/L (150-400) C-reactive protein: 9 nmol/l (<10) Sodium: 140 mmol/l (135-146) Potassium: 3.9 mmol/l (3.5-5) Creatinine: 92 μmol/l (79-118) Which of the following is the most likely diagnosis?

      Your Answer: Corticosteroid-related psychosis

      Explanation:

      Agitation, hypomania and suicidal intent within a few days after initiating corticosteroid therapy is highly suggestive of a diagnosis of corticosteroid-induced psychosis.

      In some patients corticosteroid related psychosis has been diagnosed up to 12 weeks or more after commencing therapy.

      Euphoria and hypomania are considered to be the most common psychiatric symptoms reported during short courses of steroids.
      During long-term treatment, depressive symptoms were the most common.
      Higher steroid doses appear to carry an increased risk for such adverse effects; however, there is no significant relationship between dose and time to onset, duration, and severity of symptoms.

      Management: Reduction or cessation of corticosteroids is the mainstay of treatment for steroid psychosis. For those patients who cannot tolerate this reduction/cessation of steroids, mood stabilizers may be of some benefit.

    • This question is part of the following fields:

      • Pharmacology
      5.1
      Seconds
  • Question 15 - A 28-year-old woman with a history of recurrent pulmonary emboli (PE) has been...

    Correct

    • A 28-year-old woman with a history of recurrent pulmonary emboli (PE) has been identified as having factor V Leiden. How does this particular inherited thrombophilia increase her risk of venous thromboembolic events?

      Your Answer: Activated factor V is inactivated much more slowly by activated protein C

      Explanation:

      In patients with factor V Leiden, inactivation of the active factor V (a clotting factor) by active protein C occurs 10x more slowly than normal. Therefore, this condition is also called activated protein C resistance.

      Factor V Leiden is the most commonly inherited thrombophilia, being present in around 5% of the UK’s population. It occurs due to gain-of-function mutation in the Factor V Leiden protein.

    • This question is part of the following fields:

      • Haematology & Oncology
      6.5
      Seconds
  • Question 16 - A 15-year-old boy presents with hypertension and acute renal failure after an episode...

    Correct

    • A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?

      Your Answer: Haemolytic–uraemic syndrome

      Explanation:

      The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.

    • This question is part of the following fields:

      • Nephrology
      18.8
      Seconds
  • Question 17 - A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting...

    Correct

    • A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting of the hypothenar eminence and weakness of finger abduction and thumb adduction. The lesion is most probably located at:

      Your Answer: Ulnar nerve

      Explanation:

      Patients with compressive neuropathy of the ulnar nerve typically describe numbness and tingling of the ulnar-sided digits of the hand, classically in the small finger and ulnar aspect of the ring finger. Among the general population, symptoms usually begin intermittently and are often worse at night, particularly if the elbow is flexed while sleeping. As the disease progresses, paraesthesia may occur more frequently and during the daytime.

    • This question is part of the following fields:

      • Clinical Sciences
      12.5
      Seconds
  • Question 18 - Using DEXA, which of the following bone mineral density values indicates osteoporosis in...

    Correct

    • Using DEXA, which of the following bone mineral density values indicates osteoporosis in the measured site?

      Your Answer: A T score of -2.6

      Explanation:

      Osteopenia is an early sign of bone weakening that is less severe than osteoporosis.
      The numerical result of the bone density test is quantified as a T score. The lower the T score, the lower the bone density. T scores greater than -1.0 are considered normal and indicate healthy bone. T scores between -1.0 and -2.5 indicate osteopenia. T scores lower than -2.5 indicate osteoporosis.
      DEXA also provides the patient’s Z-score, which reflects a value compared with that of person matched for age and sex.
      Z-score values of –2.0 SD or lower are defined as below the expected range for age and those above –2.0 SD as within the expected range for age.

    • This question is part of the following fields:

      • Endocrinology
      15.9
      Seconds
  • Question 19 - A 50 year old man undergoes a colonoscopy due to the finding of...

    Incorrect

    • A 50 year old man undergoes a colonoscopy due to the finding of blood in his stools. The colonoscopy revealed four polyps which were variable in size from one at 0.5cm, 2 at approximately 1.5cm and one at 2 cm. When should this patient have a follow up colonoscopy?

      Your Answer: 1 year

      Correct Answer: 3 years

      Explanation:

      For the question, you need knowledge of the British Society of Gastroenterology guidelines. This patient has 3-4 adenomas with 3 of them > 1 cm. This places him at medium risk and the recommendation if for a 3-year follow up period.

    • This question is part of the following fields:

      • Gastroenterology
      24.6
      Seconds
  • Question 20 - Primary hyperaldosteronism is characterized by which of the following features? ...

    Correct

    • Primary hyperaldosteronism is characterized by which of the following features?

      Your Answer: Muscular weakness

      Explanation:

      Primary hyperaldosteronism, also known as Conn’s Syndrome, is one of the most common causes of secondary hypertension (HTN).
      The common clinical scenarios in which the possibility of primary hyperaldosteronism should be considered include the following:
      – Patients with spontaneous or unprovoked hypokalaemia, especially if the patient is also hypertensive
      – Patients who develop severe and/or persistent hypokalaemia in the setting of low to moderate doses of potassium-wasting diuretics
      – Patients with treatment-refractory/-resistant hypertension (HTN)
      Patients with severe hypokalaemia report fatigue, muscle weakness, cramping, headaches, and palpitations. They can also have polydipsia and polyuria from hypokalaemia-induced nephrogenic diabetes insipidus. Long-standing HTN may lead to cardiac, retinal, renal, and neurologic problems, with all the associated symptoms and signs.

    • This question is part of the following fields:

      • Endocrinology
      121.3
      Seconds
  • Question 21 - Which of following does not promote the release of endothelin? ...

    Incorrect

    • Which of following does not promote the release of endothelin?

      Your Answer: ADH

      Correct Answer: Prostacyclin

      Explanation:

      Prostacyclin (PGI2) generated by the vascular wall is a potent vasodilator, and the most potent endogenous inhibitor of platelet aggregation so far discovered. Prostacyclin inhibits platelet aggregation by increasing cyclic AMP levels. Prostacyclin is a circulating hormone continually released by the lungs into the arterial circulation. Circulating platelets are, therefore, subjected constantly to prostacyclin stimulation and it is via this mechanism that platelet aggregability in vivo is controlled.

    • This question is part of the following fields:

      • Clinical Sciences
      38
      Seconds
  • Question 22 - A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic...

    Correct

    • A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic complaining of passing faeces per urethra. Cystoscopy confirms a fistula between his bladder and bowel. Which treatment is most likely to be effective?

      Your Answer: surgery

      Explanation:

      The best treatment for a colovesicular fistula is surgery. This is the only definitive treatment. If the patient is a poor surgical candidate, there can be an attempt to manage them non-operatively, but this is absolutely NOT the MOST EFFECTIVE therapy.

    • This question is part of the following fields:

      • Gastroenterology
      35.4
      Seconds
  • Question 23 - A 20-year-old boy returning from vacation in India presented with a history of...

    Correct

    • A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?

      Your Answer: IV normal saline

      Explanation:

      The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.

    • This question is part of the following fields:

      • Infectious Diseases
      40.2
      Seconds
  • Question 24 - A 3-year-old boy presents with recurrent urinary tract infections. What is the most...

    Correct

    • A 3-year-old boy presents with recurrent urinary tract infections. What is the most common cause for this problem in a child of this age?

      Your Answer: Vesicoureteric reflux

      Explanation:

      Vesicoureteral reflux is the condition when the urine flows backwards from the bladder into the kidneys, which is the most common cause of UTI in patients this age.

    • This question is part of the following fields:

      • Nephrology
      48.8
      Seconds
  • Question 25 - Which of the following is not associated with atrial myxoma? ...

    Incorrect

    • Which of the following is not associated with atrial myxoma?

      Your Answer: Clubbing

      Correct Answer: J wave on ECG

      Explanation:

      J waves in an ECG is associated with hypothermia, hypercalcemia, the Brugada syndrome, and idiopathic ventricular fibrillation. The other responses are all associated with atrial myxoma

    • This question is part of the following fields:

      • Cardiology
      11.6
      Seconds
  • Question 26 - A 39 year-old engineer presents with progressive weakness of his hands. Upon examination,...

    Incorrect

    • A 39 year-old engineer presents with progressive weakness of his hands. Upon examination, you notice wasting of the small muscles of the hand. A diagnosis of syringomyelia is suspected. Which one of the following features would most support this diagnosis?

      Your Answer: Fasciculation of the small muscles of the hand

      Correct Answer: Loss of temperature sensation in the hands

      Explanation:

      Syringomyelia is a development of a cavity (syrinx) within the spinal cord. Signs and symptoms include loss of feeling, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. Symptoms typically vary depending on the extent and, often more critically, on the location of the syrinx within the spinal cord.

    • This question is part of the following fields:

      • Neurology
      48.3
      Seconds
  • Question 27 - A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain....

    Incorrect

    • A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain. Which of the following is the pain most likely linked to?

      Your Answer: Ulcerative colitis

      Correct Answer: Meconium ileus equivalent syndrome

      Explanation:

      Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%.

      The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.

    • This question is part of the following fields:

      • Respiratory
      23.9
      Seconds
  • Question 28 - A 55-year-old man with a three-year history of type 2 diabetes comes to...

    Correct

    • A 55-year-old man with a three-year history of type 2 diabetes comes to the clinic for review. He is currently managed with metformin 1 g BD and feels that his home blood glucose monitoring has deteriorated over the past few months. There is a history of hypertension and dyslipidaemia for which he takes Ramipril 10 mg daily and atorvastatin 20 mg. On examination, his BP is 155/82 mmHg, his pulse is 71 and regular. His chest is clear. His BMI is 32. Investigations show: Haemoglobin 12.9 g/dl (13.5 – 17.7), White cell count 5.0 x109/l (4 – 11), Platelets 180 x109/l (150 – 400), Sodium 140 mmol/l (135 – 146), Potassium 5.0 mmol/l (3.5 – 5), Creatinine 123 mmol/l (79 – 118), HbA1c 8.0% (<7.0). He would like to start sitagliptin. Which of the following adverse effects would you warn him about?

      Your Answer: Pancreatitis

      Explanation:

      Sitagliptin-induced pancreatitis can occur at any time after the initiation of therapy, even after several years. Patients taking sitagliptin who present with signs and symptoms of mild or severe pancreatitis should immediately discontinue sitagliptin and use an alternate medication regimen for control of type 2 diabetes.
      In response to pancreatitis reported in post-marketing surveillance through the Adverse Event Reporting System (AERS), the FDA has issued revised prescribing information for sitagliptin stating that cases of acute pancreatitis have been reported with use, to monitor closely for signs and symptoms of pancreatitis, and to use sitagliptin with caution in patients with a history of pancreatitis.

    • This question is part of the following fields:

      • Endocrinology
      67.9
      Seconds
  • Question 29 - Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction...

    Incorrect

    • Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction and non-fatal stroke when added to standard treatment plans in patients with type 2 diabetes mellitus. This information was shared in 2015 by The New England Journal of Medicine and the results were expressed per 1000 patient years. In fact, empagliflozin had an event rate of 37.3/1000 patient years and placebo an event rate of 43.9/1000 patient years. How many patients who are at high cardiovascular risk need to be treated with empagliflozin to prevent a cardiovascular death, a non-fatal myocardial infarction or a non-fatal stroke?

      Your Answer: 200

      Correct Answer: 150

      Explanation:

      The number needed to treat (NNT) is an absolute effect measure that has been used to assess beneficial and harmful effects of medical interventions. In this case the NNT can be calculated as follows: NNT = 1/ Absolute risk reduction (ARR). ARR=(Control event rate expressed per 1000 patient years) – (Experimental event rate expressed per 1000 patient years) = 43.9-37.3 = 6.6/1000 patient years

      NNT=(Patient years)/ARR = 1000/ 6.6 = 151.5. The closest to 151.5 is 150, thus it is the correct answer.

    • This question is part of the following fields:

      • Clinical Sciences
      43.1
      Seconds
  • Question 30 - A 40-year-old man complains of impotence and reduced libido for 4 months. He...

    Incorrect

    • A 40-year-old man complains of impotence and reduced libido for 4 months. He has been married for 15 years and has two children. He smokes five cigarettes per day and drinks approximately 12 units of alcohol weekly. Examination reveals an obese man who is phenotypically normal with normal secondary sexual characteristics. Investigations are as follows: Hb 13.4 g/dl (13.0-18.0), WCC 6 x 109/l (4-11), Platelets 210 x 109/l (150-400), Electrolytes Normal, Fasting glucose 5.6 mmol/l (3.0-6.0), LFTs Normal, T4 12.7 pmol/l (10-22), TSH 2.1 mU/l (0.4-5), Prolactin 259 mU/l (<450), Testosterone 6.6 nmol/l (9-30), LH 23.7 mU/l (4-8), FSH 18.1 mU/l (4-10). What is the next investigation needed for this patient?

      Your Answer:

      Correct Answer: Ultrasound examination of the testes

      Explanation:

      The patient has primary Hypogonadism.
      Since he already had two children, Klinefelter syndrome is excluded and the patient does not need karyotyping.
      His lab results are normal indicating normal pituitary gland functions.
      So the next step is testicular ultrasound as testicular tumour, infiltration or idiopathic failure is suspected.

    • This question is part of the following fields:

      • Endocrinology
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