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  • Question 1 - Which of the following features is characteristic of immune thrombocytopenic purpura? ...

    Incorrect

    • Which of the following features is characteristic of immune thrombocytopenic purpura?

      Your Answer: Infants born to a woman with ITP often presents with bleeding diathesis in the first 48 hours

      Correct Answer: Autoimmune haemolytic anaemia is a recognised association

      Explanation:

      Immune thrombocytopenic purpura (ITP) refers to thrombocytopaenia occurring in the absence of toxic exposure or other diseases associated with low platelets and involves IgG-type antibodies. It is characterised by normal or increased marrow megakaryocytes, shortened platelet survival, and the absence of splenomegaly. Autoimmune haemolytic anaemia (AIHA) occurs commonly in association with ITP. Leukemic transformation, however, does not occur in ITP.

      In neonatal ITP, IgG antibodies are passively transferred across the placenta. The infant platelet count may be normal at birth but decreases within 12–24 hours. It is rarely severe enough to induce bleeding diathesis in the infant.

    • This question is part of the following fields:

      • Haematology & Oncology
      16.4
      Seconds

  • Question 2 - The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:...

    Incorrect

    • The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:

      Your Answer: Twice the risk

      Correct Answer: 50 - 100 times risk

      Explanation:

      Barrett’s oesophagus is the transformation of the normal squamous epithelium of the oesophagus to columnar, intestinal type epithelium. It is often seen in patients with reflux and there is a 50-100 fold increased risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus.

    • This question is part of the following fields:

      • Gastroenterology
      16.9
      Seconds

  • Question 3 - A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to...

    Correct

    • A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to the acute medical unit for pneumonia. This is his fourth admission for pneumonia in the past six months. Which of the following factors is most likely to be responsible?

      Your Answer: Hypogammaglobulinaemia

      Explanation:

      Hypogammaglobulinemia is a complication of chronic lymphocytic leukaemia (CLL) that leads to recurrent infections.

      CLL is a type of cancer caused by monoclonal proliferation of well-differentiated lymphocytes, typically B cells (99%). Onset of the disease is usually asymptomatic and later constitutes anorexia, weight loss, bleeding, and recurrent infections. Lymphadenopathy is more marked in CLL than in chronic myelogenous leukaemia (CML).

      Investigations to diagnose CLL include blood film and immunophenotyping. Smudge cells (also known as smear cells) seen on the blood film point towards CLL. Complications of the disease include hypogammaglobulinemia leading to recurrent infections, autoimmune haemolytic anaemia in 10–15% of the patients, and transformation to high-grade lymphoma (Richter’s transformation).

    • This question is part of the following fields:

      • Haematology & Oncology
      25.5
      Seconds

  • Question 4 - A 68 year old man is admitted with an infective exacerbation of chronic...

    Correct

    • A 68 year old man is admitted with an infective exacerbation of chronic obstructive pulmonary disease (COPD). Investigations: blood gas taken whilst breathing 28% oxygen on admission: pH 7.30 p(O2) 7.8 kPa p(CO2) 7.4 kPa Which condition best describes the blood gas picture?

      Your Answer: Decompensated type-2 respiratory failure

      Explanation:

      The normal partial pressure reference values are:
      – PaO2 more than 80 mmHg (11 kPa)
      – PaCO2 less than 45 mmHg (6.0 kPa).
      This patient has an elevated PaCO2 (7.4kPa)
      Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
      The pH is also lower than 7.35 at 7.3

      Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build-up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
      – Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
      – Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
      – A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
      – Neuromuscular problems (Guillain–Barré syndrome, motor neuron disease)
      – Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.

    • This question is part of the following fields:

      • Respiratory
      68
      Seconds

  • Question 5 - A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old...

    Correct

    • A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?

      Your Answer: Herpes simplex virus

      Explanation:

      The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.

    • This question is part of the following fields:

      • Infectious Diseases
      10
      Seconds

  • Question 6 - A 60-year-old male is under treatment with azathioprine after a renal transplant. During...

    Incorrect

    • A 60-year-old male is under treatment with azathioprine after a renal transplant. During his review, he complains of pain and swelling over his left great toe. Investigations reveal hyperuricemia. Suspecting gout, he was started on allopurinol. Subsequently, he develops aplastic anaemia. Which of the following is the most appropriate reason for his bone marrow failure?

      Your Answer: Acute viral infection

      Correct Answer: Mercaptopurine toxicity

      Explanation:

      The cause for bone marrow suppression in this patient is most probably mercaptopurine toxicity.
      Azathioprine is metabolized to 6-mercaptopurine (6-MP), which itself is metabolized by xanthine oxidase.
      Xanthine oxidase inhibition by allopurinol leads to the accumulation of 6-MP which then precipitates bone marrow failure.
      This may be potentially fatal if unrecognized.
      Clinical presentation:
      Toxicity symptoms include gastrointestinal symptoms, bradycardia, hepatotoxicity, myelosuppression.

    • This question is part of the following fields:

      • Pharmacology
      49.9
      Seconds

  • Question 7 - A 11-year-old boy is referred to you following his seventh course of antibiotics...

    Incorrect

    • A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream. His full blood count (FBC) report shows: Hb: 13.9 g/dL, Plts: 65 x 10^9/L, WCC: 12.3 x 10^9/L. Which of the following genes should you expect an abnormality in?

      Your Answer: CFTR

      Correct Answer: WASP

      Explanation:

      The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.

      The other listed options are:
      1. PKD1: polycystic kidney disease
      2. CFTR: cystic fibrosis
      3. HFE1: haemochromatosis
      4. RET: multiple endocrine neoplasia, Hirschsprung’s disease

    • This question is part of the following fields:

      • Haematology & Oncology
      41.1
      Seconds

  • Question 8 - A 50 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 50 yr. old male with a history of type II diabetes mellitus and hypertension presented with exertional dyspnoea and chest pain for 2 weeks. On examination his blood pressure was 145/80 mmHg. On auscultation reversed splitting of the second heart sound and bibasal crepitations were detected. What would be the most likely finding on his ECG?

      Your Answer: Right bundle branch block

      Correct Answer: Left bundle branch block

      Explanation:

      When closure of the pulmonary valve occurs before the aortic valve, reversed splitting occurs. The causes of reversed splitting are aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker.

    • This question is part of the following fields:

      • Cardiology
      41.2
      Seconds

  • Question 9 - A 4 year old child was brought in by his mother with complaints...

    Incorrect

    • A 4 year old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?

      Your Answer: Rubella

      Correct Answer: Coxsackie

      Explanation:

      This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.

    • This question is part of the following fields:

      • Dermatology
      42.6
      Seconds

  • Question 10 - A 28 yr. old male was admitted with palpitations and chest discomfort for...

    Correct

    • A 28 yr. old male was admitted with palpitations and chest discomfort for the past 1 hour. On examination his pulse rate was 200 bpm and blood pressure was 80/50 mmHg. His ECG revealed narrow complex tachycardia with a heart rate of 200 bpm. Which of the following is the most appropriate management of this patient?

      Your Answer: Synchronised DC synchronised cardioversion

      Explanation:

      Narrow complex tachycardia with hypotension is a medical emergency. Immediate synchronized cardioversion is the ideal management.

    • This question is part of the following fields:

      • Cardiology
      34.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology & Oncology (1/3) 33%
Gastroenterology (0/1) 0%
Respiratory (1/1) 100%
Infectious Diseases (1/1) 100%
Pharmacology (0/1) 0%
Cardiology (1/2) 50%
Dermatology (0/1) 0%
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