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Question 1
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A 75-year-old man has presented to the clinic with a complaint of disturbed sleep. The physician has prescribed temazepam. Which of the following best describes the mechanism of action of this drug?
Your Answer: Enhances the effect of gamma-aminobutyric acid
Explanation:Temazepam is an orally available benzodiazepine used in the therapy of insomnia.
The soporific activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA-A receptor.
The recommended initial dose for insomnia is 7.5 mg before bedtime, increasing as needed to a maximum dose of 30 mg.The most common side effects of temazepam are dose-related and include daytime drowsiness, lethargy, ataxia, dysarthria, and dizziness.
Tolerance develops to these side effects, but tolerance may also develop to the effects on insomnia. -
This question is part of the following fields:
- Pharmacology
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Question 2
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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. Â Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?
Your 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.
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This question is part of the following fields:
- Nephrology
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Question 3
Incorrect
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A study is developed to look at the potential of hip protectors to reduce femoral neck fractures in elderly nursing home patients. The study included 800 patients randomly selected with an average age of 82 years of age. The data was collected over a two year period and the patients were randomly put in the standard care group or the hip protector group. From the 400 patients assigned to the hip protector group, 10 had a femoral neck fracture over the two year period. From the 400 patients assigned to the standard care group, 20 had a femoral neck fracture over the two year period. What is the correct value regarding the absolute risk reduction?
Your Answer: 0.5
Correct Answer: 0.025
Explanation:Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8 per cent (20 per cent – 12 per cent = 8 per cent). This means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT). If 8 children out of 100 benefit from treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5). CER = 20 / 400 = 1 / 20 = 0.05, EER = 10 / 400 = 0.025, ARR =CER – EER = 0.025
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This question is part of the following fields:
- Clinical Sciences
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Question 4
Incorrect
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Which of the following features of the jugular venous waveform indicates the closure of the tricuspid valve?
Your Answer: a wave
Correct Answer: c wave
Explanation:The a wave indicates atrial contraction. The c wave indicates ventricular contraction and resulting bulging of the tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of tricuspid valve downward. The y descent indicates the filling of the ventricle after the opening of the tricuspid valve.
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This question is part of the following fields:
- Cardiology
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Question 5
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A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and flatulence. Clinical examination is unremarkable. Faecal occult bloods are negative and haematological and biochemical investigations are unremarkable. Which of the following is the next most appropriate management step?
Your Answer: Trial of dairy-free diet
Explanation:The best next step is to try a dairy-free diet, many patients may develop this in their lifetime. IBS is a diagnosis of exclusion, and one would need to rule lactose intolerance out as a potential aetiology first. She is only 28, and without overt bleeding or signs/sxs/labs suggestive of obstruction or inflammation; colonoscopy, flex sig and a barium enema are not indicated.
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This question is part of the following fields:
- Gastroenterology
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Question 6
Correct
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A 53-year-old gentleman presents with several months’ history of generalised swelling, fatigue, dyspnoea and several episodes of haemoptysis. There is no significant past medical history and he did not take any regular medication. He smokes 20 cigarettes per day and drinks 14 units of alcohol per week. On examination, he is grossly oedematous and has ascites. Cardiorespiratory examination is unremarkable and there are no neurological signs or rashes. Investigation results are below: Haemoglobin (Hb) 10.2 g/dL, White cell count (WCC) 6.0 × 109/L, Platelets 380 × 109/L, Mean corpuscular volume (MCV) 90fl Na+ 145 mmol/L, K+ 3.7 mmol/L, Urea 8.2 mmol/L, Bilirubin 16 μmol/L, Creatinine 180 μmol/L, Albumin 22 g/l Aspartate transaminase 32 iu/l Alkaline phosphatase 120 iu/l Urinalysis: Protein +++ 24 h urinary protein excretion: 5g Chest radiograph: Enlarged right hilum Echocardiogram: Mild left ventricular impairment, no valve lesion Abdominal ultrasound scan: Normal-sized kidneys, no abnormality seen A renal biopsy was performed. What is it most likely to show?
Your Answer: Thickened glomerular basement membrane with deposits of IgG and C3
Explanation:Renal biopsy in this patient will most likely show thickened glomerular basement membrane with deposits of IgG and C3 as a result of membranous glomerulonephritis that has caused the nephrotic syndrome in this patient. Membranous glomerulonephritis in this case is most likely associated with an underlying bronchial carcinoma, consistent with the patient’s smoking history and physical presentation.
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This question is part of the following fields:
- Nephrology
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Question 7
Incorrect
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Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?
Your Answer: Hypopigmentation
Correct Answer: Premature epiphyseal closure
Explanation:Exposure to excessive androgens is usually accompanied by premature epiphyseal maturation and closure, resulting in a final adult height that is typically significantly below that expected from parental heights.
congenital adrenal hyperplasia (CAH) is associated with precocious puberty caused by long term exposure to androgens, which activate the hypothalamic-pituitary-gonadal axis. Similarly, CAH is associated with hyperpigmentation and hyperreninemia due to sodium loss and hypovolaemia.
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This question is part of the following fields:
- Endocrinology
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Question 8
Incorrect
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A 51 year old obese female, with a history of smoking, presents to the clinic with worsening dyspnoea. She is currently on oestrogen therapy for menopausal symptoms. Clinical examination, ECG and radiological findings correspond to right sided heart failure. There are no signs of left ventricular dysfunction. Which of the following is the most likely cause of cor pulmonale?
Your Answer: Carcinoma of the lung
Correct Answer: Recurrent small pulmonary embolisms
Explanation:Postmenopausal oestrogen therapy and hormone therapy are associated with an increased risk of thromboembolism. The relative risk seems to be even greater if the treated population has pre-existing risk factors for thromboembolism, such as obesity, immobilization, and fracture. Cor pulmonale can occur secondary to small recurrent pulmonary embolisms. Pneumonias and bronchiectasis usually present with purulent sputum, and in case of carcinoma there may be other associated symptoms like weight loss, etc.
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This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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Which of the following symptoms are more indicative of mania than hypomania?
Your Answer: Irritability
Correct Answer: Delusions of grandeur
Explanation:The delusion of grandeur is more indicative of mania than hypomania.
While criteria (e.g. ICD-10, DSM-5) vary regarding the diagnosis between hypomania and mania, the consistent difference between mania and hypomania is the presence of psychotic symptoms.Hypomania vs. mania:
The presence of psychotic symptoms such as delusions of grandeur
auditory hallucinations point towards mania rather than hypomania/The following symptoms are common to both hypomania and mania
Mood:
Predominately elevated
IrritableSpeech and thought:
Pressured
Flight of ideas
Poor attentionBehaviour
Insomnia
Loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite -
This question is part of the following fields:
- Psychiatry
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Question 10
Incorrect
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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: Incidence
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.
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This question is part of the following fields:
- Clinical Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
