00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 58-year-old psychologist with small cell lung cancer complains of muscle weakness. Each...

    Correct

    • A 58-year-old psychologist with small cell lung cancer complains of muscle weakness. Each one of the following are features of Lambert-Eaton syndrome, except:

      Your Answer: Repeated muscle contractions lead to decreased muscle strength

      Explanation:

      In myasthenia gravis, repeated muscle contractions lead to reduced muscle strength. The opposite is however classically seen in the related disorder Lambert-Eaton syndrome. Lambert-Eaton myasthenic syndrome is seen in association with small cell lung cancer, and to a lesser extent breast and ovarian cancer. It may also occur independently as an autoimmune disorder. Lambert-Eaton myasthenic syndrome is caused by an antibody directed against pre-synaptic voltage gated calcium channel in the peripheral nervous system.

    • This question is part of the following fields:

      • Neurology
      429.3
      Seconds
  • Question 2 - A 34-year-old woman is admitted to the oncologist clinic for further investigations. She...

    Incorrect

    • A 34-year-old woman is admitted to the oncologist clinic for further investigations. She has experienced fever, sometimes glandular and night sweats. Clinical examination reveals lymphadenopathy and a biopsy is performed. The biopsy reveals the presence of Reed-Sternberg cells, confirming what was suspected to be a Hodgkin's lymphoma. Which cell surface marker is associated with this condition?

      Your Answer:

      Correct Answer: CD15

      Explanation:

      The CD15 antigen, also known as Lewis (hapten)X, serves as an immuno-phenotypic marker for Reed-Sternberg cells and its expression has diagnostic, but also prognostic significance in Hodgkin Lymphoma.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 3 - A 27-year-old woman is admitted on the medical intake. She is 10 weeks...

    Incorrect

    • A 27-year-old woman is admitted on the medical intake. She is 10 weeks postpartum and has been generally unwell for two weeks with malaise, sweating and anxiety. On examination, she is haemodynamically stable and clinically euthyroid. TFTs show the following: Free T4 33 pmol/L (9-23), Free T3 8 nmol/L (3.5-6), TSH <0.02 mU/L (0.5-5). What is the appropriate management?

      Your Answer:

      Correct Answer: Propranolol 20 mg tds

      Explanation:

      The patient is most likely to have Postpartum thyroiditis which goes through 2 phases; hypothyroid and a hyperthyroid phase.
      The hyperthyroid phase of postpartum thyroiditis occurs between 2 and 10 months postpartum. Most commonly, it presents at 3 months. Symptoms more common in women with hyperthyroid postpartum thyroiditis include palpitations, fatigue, heat intolerance, and irritability/nervousness. The frequency of asymptomatic hyperthyroidism is 33%.
      Untreated, the hyperthyroidism resolves spontaneously within 2–3 months. This phase is diagnosed by the combination of a low serum TSH concentration in the presence of thyroid peroxidase antibodies, in women who are TSH receptor antibody-negative. Free T4 levels are typically elevated but may be normal.
      Treatment of hyperthyroidism, when necessary, is based on symptom severity and should be a joint decision of patient and physician. Beta-blockers such as propranolol are given to alleviate palpitations, irritability, and nervousness. The morbidity associated with treatment is the side effects of beta-blockade. The downside of withholding treatment is allowing the woman to remain symptomatic. Antithyroid medicines (thioureas) are not a potential treatment alternative, because the hyperthyroidism is caused by destructive thyroiditis resulting in the release of preformed thyroid hormone.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 4 - A 25-year-old pregnant mother who is known to have hepatitis B gave birth...

    Incorrect

    • A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?

      Your Answer:

      Correct Answer: HepB full vaccine and Ig

      Explanation:

      Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 5 - A patient with a history of asthma presents with worsening of her symptoms...

    Incorrect

    • A patient with a history of asthma presents with worsening of her symptoms and dyspnoea. She recently started taking a new medicine and she feels it might have aggravated her symptoms. Which of the following is likely responsible for her symptoms?

      Your Answer:

      Correct Answer: Timolol eye drops

      Explanation:

      β-blockers are the class of drug most often chosen to treat glaucoma, although other medical therapies are available. Systemic absorption of timolol eye drops can cause unsuspected respiratory impairment and exacerbation of asthma. Physicians should be alert to the possibility of respiratory side-effects of topical therapy with β-blockers. Leukotriene antagonists and salbutamol are used in asthma treatment. HRT and ferrous sulphate do not lead to the exacerbation of asthma.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 6 - A 36 year old female who has been suffering from depression for the...

    Incorrect

    • A 36 year old female who has been suffering from depression for the past 5 years was recently admitted to the psychiatric intensive care unit. She is currently being managed on Sertraline. In clinic she was observed to be sitting in a fixed position for several hours, awake but unable to move. What would be an appropriate treatment for this patient?

      Your Answer:

      Correct Answer: ECT

      Explanation:

      Catatonia is a state of apparent unresponsiveness to external stimuli and apparent inability to move normally in a person who is apparently awake. Catatonia can be acute and occur in severely ill patients with underlying psychiatric or other medical disorders.

      A history of behavioural responses to others usually includes the presence of the following:
      – Mutism (absence of speech)
      – Negativism (performing actions contrary to the commands of the examiner)
      – Echopraxia (repeating the movements of others)
      – Echolalia (repeating the words of others)
      – Waxy flexibility (slight, even resistance to positioning by examiner)
      – Withdrawal (absence of responses to the environment).

      In the presence of a catatonic state, both first and second generation antipsychotics (SGA) may contribute to maintaining or worsening the catatonic state and increase the risk of developing NMS (neuroleptic malignant syndrome).

      Electroconvulsive therapy (ECT) is effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient’s medical condition.

      Electroconvulsive therapy (ECT) is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 7 - Which of the following types of reactions are a part of the phase...

    Incorrect

    • Which of the following types of reactions are a part of the phase II metabolism of a drug?

      Your Answer:

      Correct Answer: Conjugation

      Explanation:

      Drug metabolism can be broadly classified into:
      Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.

      Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 8 - Which of the following statements regarding macular degeneration is true? ...

    Incorrect

    • Which of the following statements regarding macular degeneration is true?

      Your Answer:

      Correct Answer: Wet macular degeneration carries the worst prognosis

      Explanation:

      Traditionally two forms of macular degeneration are seen:
      – Dry (geographic atrophy) macular degeneration is characterized by drusen – yellow round spots in Bruch’s membrane.
      – Wet (exudative, neovascular) macular degeneration is characterized by choroidal neovascularization. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. This carries the worst prognosis.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 9 - A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He...

    Incorrect

    • A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2–3 white blood cells/mm3.   What is the most probable diagnosis?

      Your Answer:

      Correct Answer: IgA nephropathy

      Explanation:

      IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 10 - A patient complaining of nocturnal cough and wheeze is investigated for asthma. Which of...

    Incorrect

    • A patient complaining of nocturnal cough and wheeze is investigated for asthma. Which of the following tests would be most useful in aiding the diagnosis?

      Your Answer:

      Correct Answer: ANCA

      Explanation:

      Churg-Strauss disease (CSD) is one of three important fibrinoid, necrotizing, inflammatory leukocytoclastic systemic small-vessel vasculitides that are associated with antineutrophil cytoplasm antibodies (ANCAs).
      The first (prodromal) phase of Churg-Strauss disease (CSD) consists of asthma usually in association with other typical allergic features, which may include eosinophilia. During the second phase, the eosinophilia is characteristic (see below) and ANCAs with perinuclear staining pattern (pANCAs) are detected. The treatment would therefore be different from asthma. For most patients, especially those patients with evidence of active vasculitis, treatment with corticosteroids and immunosuppressive agents (cyclophosphamide) is considered first-line therapy

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 11 - A 33-year-old man presents with recurrent episodes of abdominal pain associated with weakness...

    Incorrect

    • A 33-year-old man presents with recurrent episodes of abdominal pain associated with weakness of his arms and legs. Which one of the following urine tests would best indicate lead toxicity?

      Your Answer:

      Correct Answer: Coproporphyrin

      Explanation:

      Lead poisoning is characterised by abdominal pain, fatigue, constipation, peripheral neuropathy (mainly motor), and blue lines on gum margin in 20% of the adult patients (very rare in children).

      For diagnosis, the level of lead in blood is usually considered with levels greater than 10 mcg/dL being significant. Furthermore, the blood film shows microcytic anaemia and basophilic stippling of red blood cells. Urinary coproporphyrin is increased (urinary porphobilinogen and uroporphyrin levels are normal to slightly increased). Raised serum and urine levels of delta-aminolaevulinic acid may also be seen, making it sometimes difficult to differentiate from acute intermittent porphyria.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 12 - A 34-year-old Nigerian woman who is a known case of sickle cell anaemia...

    Incorrect

    • A 34-year-old Nigerian woman who is a known case of sickle cell anaemia presents with fever and worsening of recurrent back pain. There is no history of weight loss or night sweats. The investigations done on her arrival show: Hb: 7.8 g/dL, WCC: 10.1 x10^9/L, Plts: 475 x10^9/L, Reticulocytes: 12%, Serum total bilirubin: 88 μmol/L. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Vaso-occlusive event

      Explanation:

      This patient is having vaso-occlusive event/crisis (thrombotic crisis) which is a type of sickle cell crisis. It may be associated with ostealgia.

      There is no evidence of an aplastic crisis in this case as the haemoglobin level is reasonable with a good reticulocyte count. Conversely, the haemoglobin is not low enough and reticulocyte count and bilirubin are not high enough for a haemolytic crisis.

      Sickle cell anaemia is characterised by periods of good health with intervening crises. The four main types of sickle cell crises are thrombotic crisis (painful or vaso-occlusive crisis), sequestration crisis, aplastic crisis, and haemolytic crisis.

      Thrombotic crisis is precipitated by infection, dehydration, alcohol, change in temperature, and deoxygenation. Sequestration crisis is characterised by acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates). Aplastic crisis is characterised by a sudden fall in haemoglobin without marked reticulocytosis. It usually occurs secondary to parvovirus infection. In haemolytic crisis, a fall in haemoglobin occurs secondary to haemolysis. It is a rare type of sickle cell crisis.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 13 - A 56-year-old male was admitted to the in-patient psychiatric unit last night. He...

    Incorrect

    • A 56-year-old male was admitted to the in-patient psychiatric unit last night. He is a poor historian, answering most questions minimally and stating he does not need to be here as he is deceased, and hospitals should be for living patients. What is the type of delusion in this patient and what is it commonly associated with?

      Your Answer:

      Correct Answer: Cotard syndrome and Major Depressive Disorder

      Explanation:

      The most probable diagnosis of this patient is Cotard syndrome with major depressive disorder.

      Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary. Cotard syndrome is often associated with severe depression and psychotic disorders (like schizophrenia).

      Other delusional syndromes:
      – Othello syndrome is a delusional belief that a patients partner is committing infidelity despite no evidence of this. It can often result in violence and controlling behaviour.
      – De Clerambault syndrome (otherwise known as erotomania), is where a patient believes that a person of higher social or professional standing is in love with them. Often this presents with people who believe celebrities are in love with them.
      – Capgras syndrome is characterised by a person believing their friend or relative had been replaced by an exact double.
      – Couvade syndrome is also known as ‘sympathetic pregnancy’. It affects fathers, particularly during the first and third trimesters of pregnancy, who suffer the somatic features of pregnancy.
      – Ekbom syndrome is also known as delusional parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin. This can vary from the classic psychosis symptoms in narcotic use where the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 14 - A 35-year-old gentleman presents to the Emergency Department with abdominal pain. This started...

    Incorrect

    • A 35-year-old gentleman presents to the Emergency Department with abdominal pain. This started earlier on in the day and is getting progressively worse. The pain is located on his left flank and radiates down into his groin. He has no history of this pain or any other condition. Examination reveals a gentleman who is flushed and sweaty but is otherwise unremarkable. What is the most suitable initial management?

      Your Answer:

      Correct Answer: IM diclofenac 75 mg

      Explanation:

      Because of the patient’s presentation with flank pain that radiates to the groin, we are suspecting renal colic. We should follow guidelines for acute renal management and prescribe IM diclofenac for immediate relief of pain.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 15 - A 16-year-old female presents with a two day history of right iliac fossa...

    Incorrect

    • A 16-year-old female presents with a two day history of right iliac fossa pain, nausea and loss of appetite. You suspect that she has acute appendicitis. Which scoring system could you use to lend support to your diagnosis?

      Your Answer:

      Correct Answer: Alvarado score

      Explanation:

      The prompt is suggestive of acute appendicitis. The Alvarado score is a clinical scoring system used to determine the likelihood of appendicitis, so this is the correct answer. A score greater than 6 is generally considered at risk for having acute appendicitis. It has 8 different criteria included (symptoms, signs, and lab results) and divides patients into appendicitis unlikely, possible, probable, and definite. The Center Score is a score to access the likelihood that pharyngitis is due to Strep. The Child-Pugh score predicts prognosis in liver cirrhosis. The Glasgow score is two different scores– the Glasgow coma score in trauma, which estimates level of consciousness, essentially, and The Glasgow Imrie Criteria which determines the severity of acute pancreatitis based on 8 lab values. The MELD score predicts the severity of end-stage liver disease.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 16 - A 27-year-old gentleman presents with a 2 year history of involuntary neck movements....

    Incorrect

    • A 27-year-old gentleman presents with a 2 year history of involuntary neck movements. There is no history of trauma. He is on no drugs. There is no relevant family history. On examination he has an episodic right torticollis. The rest of his neurological examination is normal. MRI of his cervical spine is normal. The neurologist in the Movement Disorders Clinic has diagnosed cervical dystonia. Which of the following treatments will be most beneficial?

      Your Answer:

      Correct Answer: Botulinum toxin

      Explanation:

      Botulinum toxin is a neurotoxic protein from Clostridium botulinum that causes flaccid paralysis as it acts by preventing the release of Ach at the neuromuscular joint. It is the first-line treatment for cervical dystonia (torticollis) because the condition is a neurological disorder characterised by unusual muscle contractions of the neck. With the use of Botulinum toxin, the contractions would be released.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 17 - A 30-year-old lawyer presents with non-specific symptoms of tiredness. Blood tests reveal normal...

    Incorrect

    • A 30-year-old lawyer presents with non-specific symptoms of tiredness. Blood tests reveal normal thyroid function, cortisol, growth hormone and gonadotrophins. Pituitary MRI reveals a 0.8cm microadenoma. Which of the following represents the most appropriate course of action?

      Your Answer:

      Correct Answer: Observation and reassurance

      Explanation:

      The patient has a non-functioning pituitary tumour as her hormone profile is normal.
      Non-functioning pituitary tumours are relatively common. A large number of these tumours are incidentally found pituitary microadenomas (<1 cm) and are usually of no clinical importance.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 18 - A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 19 - A 65 yr. old man with hypertension presented with sudden onset right arm...

    Incorrect

    • A 65 yr. old man with hypertension presented with sudden onset right arm weakness which resolved after 10 hrs. He has had 2 similar episodes during the last 6 weeks. On examination his blood pressure was 140/80 mmHg and pulse rate was 88 bpm. His ECG showed atrial fibrillation and the CT scan of his brain was normal. Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      Score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 4, so he needs life-long warfarin to prevent a stroke.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 20 - A 45-year-old man who had a liver transplant just over 3 months ago,...

    Incorrect

    • A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin. He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Donor-acquired cytomegalovirus

      Explanation:

      The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 21 - The following are commonly recognized disease syndromes associated with Clostridium species, except: ...

    Incorrect

    • The following are commonly recognized disease syndromes associated with Clostridium species, except:

      Your Answer:

      Correct Answer: exfoliative skin rash

      Explanation:

      Clostridium species do not present with an exfoliative skin rash. C. perfringens is a common aetiology in necrotizing infections (gas gangrene) as well as food poisoning, which often also includes diarrhoea. C. difficle causes diarrhoea. C. tetany and C. botulinum have neurotoxins that can lead to paralysis.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 22 - What is the mechanism of action (MOA) of cisplatin? ...

    Incorrect

    • What is the mechanism of action (MOA) of cisplatin?

      Your Answer:

      Correct Answer: Causes cross-linking in DNA

      Explanation:

      Cisplatin is a cytotoxic agent that acts by causing cross-linking in DNA. Its adverse effects include ototoxicity, peripheral neuropathy, hypomagnesaemia, etc.

      The causative cytotoxic agents acting through the other aforementioned MOAs are as follows:

      1. Doxorubicin: Stabilizes DNA topoisomerase II complex and inhibits DNA and RNA synthesis.

      2. Hydroxyurea (hydroxycarbamide): Inhibits ribonucleotide reductase, decreasing DNA synthesis.

      3. Mercaptopurine (6-MP): Purine analogue that is activated by HGPRTase, decreasing purine synthesis.

      4. Vincristine, vinblastine: Inhibits formation of microtubules.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 23 - A 21-year-old woman presents with lethargy and confusion. On examination, you note a...

    Incorrect

    • A 21-year-old woman presents with lethargy and confusion. On examination, you note a purpuric rash covering the abdominal wall and thighs, and a fever of 38C. Investigations reveal haemolytic anaemia, thrombocytopenia, and acute kidney injury.   Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?

      Your Answer:

      Correct Answer: Confusion

      Explanation:

      Confusion in the patient refers to neurological symptoms that are more associated with thrombotic thrombocytopenic purpura than with haemolytic uremic syndrome. All the other symptoms present in both conditions similarly.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 24 - A 28 year old female presents to her GP with joint pain ,...

    Incorrect

    • A 28 year old female presents to her GP with joint pain , fever, a butterfly rash and fatigue. She has marked peripheral oedema. She is found to be hypertensive, in acute renal failure, low albumin levels and proteinuria.   A renal biopsy is performed and reveals focal glomerulonephritis with subendothelial and mesangial immune deposits.   What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Lupus nephritis Class III

      Explanation:

      This case presents with characteristic symptoms of SLE and with her renal biopsy results of focal glomerulonephritis, this is clearly Class III SLE.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 25 - If a patient has HIV what is the most likely cause of persistent...

    Incorrect

    • If a patient has HIV what is the most likely cause of persistent watery diarrhoea?

      Your Answer:

      Correct Answer: Cryptosporidium

      Explanation:

      When you have a patient with HIV and diarrhoea on the exam, think Cryptosporidium. In those who are immunocompetent this organism doesn’t usually cause symptoms, but in immunocompromised people like those with HIV, it causes infection and diarrhoea. Typically those with CD4 counts of <100 cells/µL1 have the greatest risk for prolonged, severe, or extraintestinal cryptosporidiosis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 26 - A 68 yr. old male with history of poorly controlled hypertension was admitted...

    Incorrect

    • A 68 yr. old male with history of poorly controlled hypertension was admitted with shortness of breath on exertion, orthopnoea for three months. He was diagnosed with congestive cardiac failure and was started on digoxin 62.5 μg daily, furosemide 80mg daily and amiloride 10mg daily. On admission his lab results showed that his serum urea was 6 mmol/L and serum creatinine was 115 μmol/L. One month later he came for a follow up consultation. On examination he had bilateral ankle oedema. His blood pressure was 138/90 mmHg and pulse rate was 92 bpm. His JVP was not elevated. His apex beat was displaced laterally and he had a few bibasal crepitations on auscultation. There were no cardiac murmurs. His investigation results revealed the following: Serum sodium 143 mmol/L (137-144), Serum potassium 3.5 mmol/L (3.5-4.9), Serum urea 8 mmol/L (2.5-7.5), Serum creatinine 140 μmol/L (60-110), Serum digoxin 0.7 ng/mL (1.0-2.0). CXR showed cardiomegaly and a calcified aorta. ECG showed left ventricular hypertrophy. Which of the following is the most appropriate next step in the management of this patient?

      Your Answer:

      Correct Answer: Add an ACE inhibitor to the current regimen

      Explanation:

      From the given history the patient has NYHA grade III heart failure. He can be safely started on an ACE inhibitor as his serum potassium was towards the lower limit. As there an impairment of renal function, his urea, creatinine and serum electrolytes should be closely monitored after commencing an ACE inhibitor. Adding atenolol will not have any clinical benefit. Increasing the digoxin dose is not needed as the patient is in sinus rhythm. Increasing furosemide will only have symptomatic relief.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 27 - A 45 year old male presents with lower backache and pain in his...

    Incorrect

    • A 45 year old male presents with lower backache and pain in his hips. Blood tests are normal except for elevated serum alkaline phosphatase which is 1200 IU/l (45-105). Radiological examination shows combined osteolytic and osteosclerotic lesions. What is the most common site of occurrence of this disease?

      Your Answer:

      Correct Answer: Pelvis

      Explanation:

      The patient most likely suffers from Paget’s disease of the bone as his radiological examination shows both osteolytic and osteosclerotic lesions. Any bone or bones can be affected, but Paget’s disease occurs most frequently in the pelvis > lumbar spine > femur > thoracic spine > sacrum > skull > tibia.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 28 - A 60-year-old librarian presents for review. She has recently been diagnosed with dry...

    Incorrect

    • A 60-year-old librarian presents for review. She has recently been diagnosed with dry age-related macular degeneration. Which of the following is the strongest risk factor for developing this condition?

      Your Answer:

      Correct Answer: Smoking

      Explanation:

      Age-related macular degeneration is the most common cause of blindness in the UK. Degeneration of the central retina (macula) is the key feature with changes usually bilateral. Smoking and genetic factors are risk factors for macular degeneration. The severity is divided into early, intermediate, and late types. The late type is additionally divided into dry and wet forms with the dry form making up 90% of cases.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 29 - A 30-year-old female presented with upper abdominal pain. She was diagnosed with an...

    Incorrect

    • A 30-year-old female presented with upper abdominal pain. She was diagnosed with an unknown coagulopathy and has a previous history of stroke. She has been on warfarin therapy for the past 4 months. Her international normalised ratio (INR) was stabilised between 2.5 and 3.0. Noticing abnormal coagulation results, her surgeon has requested a medical consult. Her blood investigations revealed: White cell count: 13 × 109/L, Haemoglobin (Hb): 11 g/dL, Activated partial thromboplastin time (APTT): Normal Platelets: 140 × 109/L, INR: 6.0 Pancreatic enzymes and liver function tests were normal. Other investigations: An ultrasound of the abdomen was normal. An upper GI endoscopy revealed mild gastritis. What is the most appropriate step to be taken regarding warfarin therapy?

      Your Answer:

      Correct Answer: Stop warfarin and observe

      Explanation:

      The most appropriate treatment in this patient would be to stop warfarin therapy and keep the patient under observation.

      The drugs that lead to enhanced potency of warfarin include: disulfiram, trimethoprim-sulphamethoxazole, metronidazole, phenylbutazone, aspirin, heparin, and clofibrate.
      Liver disease, thrombocytopenia, hyperthyroidism also increase the oral anticoagulant potency.
      If the patient has minor bleeding and the international normalized ratio (INR) is >6.0, warfarin should be stopped; the INR should be rechecked daily and in addition to the stoppage of warfarin, vitamin K 2.5 mg oral or 0.5 mg intravenously should also be administered.
      In a patient with INR of 2.0 or 3.0, it takes two or three times longer for that individual’s blood to clot than someone who is not taking any anticoagulants. Most patients on warfarin have an INR goal of 2 to 3.

      If there is major bleeding then prothrombin complex concentrates 50 u/kg or fresh-frozen plasma 15 ml/kg may be considered.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 30 - A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father...

    Incorrect

    • A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father has passed away recently at the age of 48 and found to have HOCM during post mortem examination. On examination of this patient his BP was 142/84 mmHg and pulse rate was 68 bpm which was regular. There was a mid systolic murmur and a double apex beat. Echocardiography showed a septal wall thickness of 3.3 cm. What is the factor most closely linked to his 20 year risk of sudden cardiac death?

      Your Answer:

      Correct Answer: Septal wall thickness of 3.3 cm

      Explanation:

      There are five prognostic factors which indicate poor prognosis in HOCM:
      -family history of HOCM-related sudden cardiac death
      -unexplained recent syncope
      -large left ventricular wall thickness (MLVWT ≥ 30 mm)
      -multiple bursts of nsVT on ambulatory electrocardiography
      -hypotensive or attenuated blood pressure response to exercise

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 31 - Choose the part of the antibody to which immune cells bind: ...

    Incorrect

    • Choose the part of the antibody to which immune cells bind:

      Your Answer:

      Correct Answer: Fc region

      Explanation:

      Fc Receptors include the IgG receptors (FcγR), high-affinity IgE receptor (FcεRI), IgA and IgA/IgM receptors, and neonatal Fc receptor for IgG (FcRn). In particular, the FcγRs have been well known to play an important role in many biologic processes including those associated with the response to infection and cancer as well as in the pathogenesis of immune-mediated diseases. Fc receptors, the receptors for the Fc region of immunoglobulins, play an essential role in antibody-dependent immune responses. Fc receptors are detected on many types of hematopoietic cells including macrophages, neutrophils, dendritic cells, eosinophils, basophils, mast cells, and NK cells. Plasma cells produce five classes of antibodies, IgA, IgD, IgE, IgG and IgM. Fc receptors with an Ig superfamily related structure exist that correspond to each of these classes of immunoglobulins.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 32 - Choose the correct statement regarding relative risk: ...

    Incorrect

    • Choose the correct statement regarding relative risk:

      Your Answer:

      Correct Answer: It is the usual outcome measure of cohort studies

      Explanation:

      Relative Risk = (Probability of event in exposed group) / (Probability of event in not exposed group). The relative risk is mistaken by some, with the odds ratio and absolute risk. Relative risk is the ratio of the probability of an event occurring with an exposure versus the probability of the event occurring without the exposure. Thus to calculate the relative risk, we must know the exposure status of all individuals (either exposed or not exposed). This implies that relative risk is only appropriate for cases where the exposure status and incidence of disease can be accurately determined such as prospective cohort studies.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 33 - A 47-year-old male with type II diabetes mellitus presents to your clinic with...

    Incorrect

    • A 47-year-old male with type II diabetes mellitus presents to your clinic with a history suggestive of erectile dysfunction. You decide to start him on sildenafil citrate. What is the mechanism of action of this drug?

      Your Answer:

      Correct Answer: Phosphodiesterase type V inhibitor

      Explanation:

      Sildenafil (Viagra) is a phosphodiesterase type V inhibitor used in the treatment of impotence.

      Contraindications:
      – Patients taking nitrates and related drugs such as nicorandil
      – Hypotension
      – Recent stroke or myocardial infarction (NICE recommend waiting 6 months)

      Side-effects:
      Visual disturbances e.g. cyanopsia, non-arthritic anterior ischaemic Neuropathy
      Nasal congestion
      Flushing
      Gastrointestinal side-effects
      Headache

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 34 - A 15-year-old boy presents with hypertension and acute renal failure after an episode...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 35 - Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with...

    Incorrect

    • Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?

      Your Answer:

      Correct Answer: Uraemia

      Explanation:

      Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
      Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 36 - A 65 yr. male patient was started on warfarin for chronic atrial fibrillation...

    Incorrect

    • A 65 yr. male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?

      Your Answer:

      Correct Answer: Factor XII

      Explanation:

      Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 37 - A 25-year-old woman noticed an episode of passing blood instead of urine in...

    Incorrect

    • A 25-year-old woman noticed an episode of passing blood instead of urine in the morning. She looks anaemic, but rest of the examination is normal. Her GP has arranged for a urological examination, which has come out to be normal as well. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      The patient has paroxysmal nocturnal haemoglobinuria (PNH). The classic sign of the disease is red discolouration of the urine due to the presence of haemoglobin and hemosiderin from the breakdown of red blood cells. As the urine is more concentrated in the morning, this is when the colour is most pronounced.

      PNH is an acquired clonal disorder of haematopoietic stem cells, characterised by variable combinations of intravascular haemolysis, thrombosis, and bone marrow failure. Diagnosis is made by flow cytometric evaluation of blood, which confirms the CD55 and CD59 deficiencies and deficiency of expression of other GPI-linked proteins. This test is replacing older complement-based assays such as the Ham test and sucrose lysis test.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 38 - A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of...

    Incorrect

    • A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of the following would favour the diagnosis of Crohn’s disease on rectal biopsy?

      Your Answer:

      Correct Answer: Patchy inflammation

      Explanation:

      The correct answer is patchy inflammation. Superficial ulceration as well as non-patchy inflammation are seen in ulcerative colitis (UC) in the colon and rectum; you would expect to see transmural inflammation in Crohn’s disease and it can be patchy and located anywhere from mouth to anus. Crypt distortion and crypt abscesses are seen in both UC and Crohn’s, however they are more common in ulcerative colitis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 39 - A 23 year old male patient presents with urethritis for the last 2...

    Incorrect

    • A 23 year old male patient presents with urethritis for the last 2 weeks that has not responded to antibiotics. Lately he has developed an onset of new range of symptoms that are linked to his HLA B27 positivity. Which of the following signs is not related to Reiter's syndrome?

      Your Answer:

      Correct Answer: A mild fever with a generalised macular rash

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. Dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum)

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 40 - A 55-year-old man with a three-year history of type 2 diabetes comes to...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 41 - A 48-year-old male with a history of bipolar disorder presents with acute confusion....

    Incorrect

    • A 48-year-old male with a history of bipolar disorder presents with acute confusion. In-transit to hospital he had a generalized seizure which terminated spontaneously after around 30 seconds. On arrival to the emergency department, his GCS is 14/15 and he is noted to have a coarse tremor. Suspecting a diagnosis of lithium toxicity, intravenous access is obtained, a blood sample was drawn for investigations and a saline infusion is started. The blood investigations revealed: Lithium level: 4.2 mmol/L, Na+: 136 mmol/L, K+: 4.6 mmol/L, Urea: 8.1 mmol/L, Creatinine: 99 µmol/L, Bicarbonate: 18 mmol/L, What is the most appropriate management for the patient?

      Your Answer:

      Correct Answer: Arrange haemodialysis

      Explanation:

      The presentation of the patient is typical of chronic lithium toxicity (due to the presence of mainly neurological manifestations). Additional to the blood investigations mentioned, urine analysis, electrolyte levels, and renal function should also be performed. A low urine Anion gap and a low urine specific gravity are highly suggestive of lithium toxicity.
      ECG obtained in this patient is likely to show: nonspecific, diffuse ST segment depression with T wave inversion.
      Acute lithium toxicity presents with more GI manifestations while, the clinical features of chronic lithium toxicity are mainly neurological and can include:
      Coarse tremors (fine tremors are seen in therapeutic levels), hyperreflexia, acute confusion, seizures, and coma.
      The management of lithium toxicity is as follows:
      Immediate GI decontamination with gastric lavage (in case of acute intoxication)
      Saline Administrations: the goal of saline administration is to restore GFR, normalize urine output and enhance lithium clearance.
      Haemodialysis remains the mainstay treatment for lithium toxicity as lithium is readily dialyzed because of water solubility, low volume of distribution, and lack of protein binding.
      The Extracorporeal Treatments in Poisoning Workgroup (EXTRIP Workgroup) recommendations for dialysis (extracorporeal treatment) in lithium toxicity include:
      • Impaired kidney function and lithium levels > 4.0 mEq/L
      • Decreased consciousness, seizures, or life-threatening dysrhythmias, regardless of lithium levels
      • Levels are > 5.0 mEq/L, significant confusion is noted, or the expected time to reduce levels to < 1.0 mEq/L is more than 36 hours
      As post-dialysis rebound elevations in lithium levels have been documented, continuous veno-venous hemofiltration (CVVH) has been advocated.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 42 - A 60 yr. old male patient with hypertension presented with acute onset retrosternal...

    Incorrect

    • A 60 yr. old male patient with hypertension presented with acute onset retrosternal chest pain for 3 hours. On examination his pulse rate was 68 bpm, BP was 100/60 mmHg and JVP was seen 3mm from the sternal notch. Respiratory examination was normal. His ECG showed narrow QRS complexes, ST segment elevation of 2mm in leads II, III and aVF and a complete heart block. What is the most immediate treatment from the following answers?

      Your Answer:

      Correct Answer: Chewable aspirin 300 mg

      Explanation:

      The diagnosis is inferior ST elevation myocardial infarction. As the right coronary artery supplies the SA and AV nodes and bundle of His, conduction abnormalities are more common with inferior MIs. The most immediate drug management is high dose Aspirin. Definite treatment is urgent cardiac revascularization.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 43 - A 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs...

    Incorrect

    • A 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs due to:

      Your Answer:

      Correct Answer: Increased release of renin

      Explanation:

      The oedema is an effect of the a decreased cardiac output that increases renin release which leads to vasoconstriction and sodium and water retention.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 44 - A 32-year-old male has recently had a splenectomy following a motorcycle accident. He...

    Incorrect

    • A 32-year-old male has recently had a splenectomy following a motorcycle accident. He is up to date with all vaccinations which were offered as part of his childhood vaccination scheme. It is July. Which of the following vaccinations does he require in the first instance?

      Your Answer:

      Correct Answer: Pneumococcus, meningococcus type B and C, Haemophilus type B

      Explanation:

      Acquired asplenia or hyposlenia can occur following splenectomy. Hyposplenism is used to describe reduced (‘hypo-‘) splenic functioning and is associated with increased risk of sepsis from polysaccharide encapsulated bacteria. In particular, patients are at risk from Streptococcus pneumoniae, Haemophilus influenzae, and meningococcus. The risk is elevated as much as 350–fold.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 45 - Which of the following features occurs very less frequently with drug induced lupus?...

    Incorrect

    • Which of the following features occurs very less frequently with drug induced lupus?

      Your Answer:

      Correct Answer: Glomerulonephritis

      Explanation:

      Drug induced lupus typically presents with pulmonary involvement and no renal or neurological involvement. Hence glomerulonephritis would be highly unlikely in this case. Rash and arthralgias are classic presentations. Pleurisy can be present as pulmonary involvement may occur with DILE.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 46 - A 27-year-old lady presents with severe morning headaches associated with nausea. Head MRI...

    Incorrect

    • A 27-year-old lady presents with severe morning headaches associated with nausea. Head MRI reveals a large compressive tumour arising from the falx cerebri. The tumour is well delineated. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Meningioma

      Explanation:

      Meningiomas are the most common benign tumours of the brain. Their name is derived from the fact that they arise from the dura mater which together with the pia matter and arachnoid mater form the meninges. The chances that a meningioma is benign are almost 98%. They are non-invasive and well delineated, causing sign and symptoms of brain compression.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 47 - A 38-year-old chef is brought into the emergency department by her husband. He...

    Incorrect

    • A 38-year-old chef is brought into the emergency department by her husband. He reports that she has been confused for the last 3 days. She has a long-standing history of severe psoriasis but no other past medical history. Basic observations are all within normal range and a CT head is unremarkable. A fundoscopy exam reveals bilateral papilledema. Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Vitamin A toxicity

      Explanation:

      Vitamin A toxicity is a rare cause of papilledema. In this case, the patient is likely to have been taking retinoids for psoriasis.

      Encephalitis does not usually present with papilledema. Brain abscess, brain tumour and hydrocephalus are all less likely with a normal CT head.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 48 - Choose the wrong statement regarding hypocalcaemia: ...

    Incorrect

    • Choose the wrong statement regarding hypocalcaemia:

      Your Answer:

      Correct Answer: Chvostek's sign is more sensitive and specific than Trousseau's sign

      Explanation:

      Chvostek and Trousseau signs can be elicited in patients with hypocalcaemia. Chvostek sign is the twitching of the upper lip with tapping on the cheek 2 cm anterior to the earlobe, below the zygomatic process overlying the facial nerve. Trousseau sign (a more reliable sign present in 94% of hypokalaemic individuals and only 1% to 4% of healthy people) is the presence of carpopedal spasm observed following application of an inflated blood pressure cuff over systolic pressure for 3 minutes in hypokalaemic patients.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 49 - You want to measure the potential benefit of creating a service dedicated to...

    Incorrect

    • You want to measure the potential benefit of creating a service dedicated to patients with multiple sclerosis in the local area. Which factor would determine how many resources will be required?

      Your Answer:

      Correct Answer: Prevalence

      Explanation:

      To describe how often a disease or another health event occurs in a population, different measures of disease frequency can be used. The prevalence reflects the number of existing cases of a disease. In contrast to the prevalence, the incidence reflects the number of new cases of disease and can be reported as a risk or as an incidence rate. Prevalence and incidence are used for different purposes and to answer different research questions.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 50 - A 56 year old man who is a known alcoholic presents to the...

    Incorrect

    • A 56 year old man who is a known alcoholic presents to the clinic with a fever and cough. Past medical history states that he has a long history of smoking and is found to have a cavitating lesion on his chest x-ray.   Which organism is least likely to be the cause of his pneumonia?

      Your Answer:

      Correct Answer: Enterococcus faecalis

      Explanation:

      Cavitating pneumonia is a complication that can occur with a severe necrotizing pneumonia and in some publications it is used synonymously with the latter term. It is a rare complication in both children and adults. Albeit rare, cavitation is most commonly caused by Streptococcus pneumoniae, and less frequently Aspergillus spp., Legionella spp. and Staphylococcus aureus.

      In children, cavitation is associated with severe illness, although cases usually resolve without surgical intervention, and long-term follow-up radiography shows clear lungs without pulmonary sequelae
      Although the absolute cavitary rate may not be known, according to one series, necrotizing changes were seen in up to 6.6% of adults with pneumococcal pneumonia. Klebsiella pneumoniae is another organism that is known to cause cavitation.

      Causative agents:
      Mycobacterium tuberculosis
      Klebsiella pneumoniae
      Streptococcus pneumoniae
      Staphylococcus aureus

      Enterococcus faecalis was not found to be a causative agent.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (1/1) 100%
Passmed