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  • Question 1 - A 42 year old male arrives at the clinic due to cough and...

    Correct

    • A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?

      Your Answer: Lungs

      Explanation:

      Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
      Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases).

    • This question is part of the following fields:

      • Rheumatology
      11.7
      Seconds
  • Question 2 - A 24 year old female, 28 weeks pregnant presents to the clinic complaining...

    Incorrect

    • A 24 year old female, 28 weeks pregnant presents to the clinic complaining of shortness of breath and right sided pleuritic chest pain. The doctor suspects pulmonary embolism. Which of the following statements is incorrect regarding the management of this case?

      Your Answer: D-dimer levels are of no use

      Correct Answer: Ventilation-perfusion scanning exposes the foetus to less radiation than computed tomographic pulmonary angiography

      Explanation:

      V/Q scanning carries a slightly increased risk of childhood cancer compared with CTPA – 1/280,000 versus less than 1/1,000,000 – but carries a lower risk of maternal breast cancer. The rest of the options are true.

    • This question is part of the following fields:

      • Respiratory
      61.7
      Seconds
  • Question 3 - A 24-year-old waiter applies for a job at a cafeteria. He gives a...

    Incorrect

    • A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?

      Your Answer: Vi agglutination test

      Correct Answer: Culture of intestinal secretions

      Explanation:

      The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.

    • This question is part of the following fields:

      • Gastroenterology
      20.1
      Seconds
  • Question 4 - A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy...

    Incorrect

    • A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy is reviewed on the haematology ward. Six days ago, she was admitted with a fever of 38.9°C and was immediately started on piperacillin + tazobactam (Tazocin). Her blood picture on arrival was as follows: Haemoglobin: 10.1 g/dL, Platelets: 311 x 10^9/L, White cell count: 0.8 x 10^9/L, Neutrophils: 0.35 x 10^9/L, Lymphocytes: 0.35 x 10^9/L. After 48 hours, she remained febrile and tachycardic. Tazocin was stopped and meropenem in combination with vancomycin was prescribed. She still remains unwell today with a temperature of 38.4°C, heart rate of 96 bpm, and blood pressure of 102/66 mmHg. Respiratory examination is consistently unremarkable and blood and urine cultures have failed to show any cause for the fever. Which of the following is the most appropriate next step of management?

      Your Answer: Add G-CSF

      Correct Answer: Add amphotericin B

      Explanation:

      This patient meets the diagnostic criteria for neutropenic sepsis, which is a relatively common complication of cancer therapy – usually chemotherapy occurring 7–14 days after. It is defined as a neutrophil count of <0.5 x 10^9/L in a patient undergoing anticancer treatment and who has either a temperature higher than 38°C or has other features consistent with clinically significant sepsis. Management approach is the same as mentioned in this case. However, if the patient still remains unwell, then an antifungal such as amphotericin B is started after risk-stratifying the patient and carrying out investigations (e.g. HRCT and Aspergillus PCR) to determine the likelihood of systemic fungal infection.

    • This question is part of the following fields:

      • Haematology & Oncology
      3.3
      Seconds
  • Question 5 - 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 6 - A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and...

    Incorrect

    • A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and says she is keen on becoming pregnant. Which of the following is most likely to make you ask her to defer pregnancy at this stage?

      Your Answer:

      Correct Answer: Hb A1C 9.4%

      Explanation:

      Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.
      Successful management of pregnancy in a T1DM patient begins before conception. Research indicates that the implementation of preconception counselling, emphasizing strict glycaemic control before and throughout pregnancy, reduces the rate of perinatal mortality and malformations.
      The 2008 bulletin from the National Institute for Health and Clinical Excellence recommends that preconception counselling be offered to all patients with diabetes. Physicians are advised to guide patients on achieving personalized glycaemic control goals, increasing the frequency of glucose monitoring, reducing their HbA1C levels, and recommend avoiding pregnancy if the said level is > 10%.
      Other sources suggest deferring pregnancy until HbA1C levels are > 8%, as this margin is associated with better outcomes.

    • This question is part of the following fields:

      • Endocrinology
      0
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  • Question 7 - A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He...

    Incorrect

    • A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He has recently switched from ranitidine to omeprazole. What is the main benefit of omeprazole compared to ranitidine?

      Your Answer:

      Correct Answer: Irreversible blockade of H+/K+ ATPase

      Explanation:

      Proton pump inhibitors can reduce gastric acid secretion by up to 99%. Acid production resumes following the normal renewal of gastric parietal cells.

    • This question is part of the following fields:

      • Pharmacology
      0
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  • Question 8 - Which one of the following statements regarding minimal change glomerulonephritis is incorrect? ...

    Incorrect

    • Which one of the following statements regarding minimal change glomerulonephritis is incorrect?

      Your Answer:

      Correct Answer: Hypertension is found in approximately 25% of patients

      Explanation:

      Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.

    • This question is part of the following fields:

      • Nephrology
      0
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  • Question 9 - All of the following are true regarding carcinoid syndrome, except? ...

    Incorrect

    • All of the following are true regarding carcinoid syndrome, except?

      Your Answer:

      Correct Answer: Pharmacological blockade is clinically useful in only 10% of patients

      Explanation:

      For medical management of carcinoid syndrome, there are two somatostatin analogues available, Octreotide and Lanreotide. Somatostatin is an amino acid peptide which is an inhibitory hormone, which is synthesized by paracrine cells located ubiquitously throughout the gastrointestinal tract. Both somatostatin analogues provide symptom relief in 50% to 70% of patients and biochemical response in 40% to 60% patients. Many studies have shown that Octreotide and Lanreotide also inhibit the proliferation of tumour cells.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 10 - A urine culture of a 50-year-old patient with urosepsis has isolated a multi-drug...

    Incorrect

    • A urine culture of a 50-year-old patient with urosepsis has isolated a multi-drug resistant Escherichia coli. What is the most likely reason for the multi-drug resistance?

      Your Answer:

      Correct Answer: Extended spectrum beta-lactamase (ESBL) production

      Explanation:

      Extended-spectrum beta-lactamases (ESBL) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. Extended spectrum beta-lactamase (ESBL) production is the main reason for multi-drug resistance among E.coli. Commonly used medications to treat ESBL-involved infections include carbapenems (imipenem, meropenem, and doripenem), cephamycins (cefoxitin and cefotetan), Fosfomycin, nitrofurantoin, beta-lactamase inhibitors (clavulanic acid, tazobactam, or sulbactam), non-beta-lactamases and colistin (if all other medications have failed.)

    • This question is part of the following fields:

      • Infectious Diseases
      0
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  • Question 11 - A 72 year old retired fisherman presents with weakness of shoulders and hips...

    Incorrect

    • A 72 year old retired fisherman presents with weakness of shoulders and hips over the last four months. Finger flexion is also weak but the extension is normal. There has been some difficulty swallowing liquids. Past medical history is not significant except for sexually transmitted disease that he caught some 40 years ago in South Pacific and got treated with antibiotics. He smokes and drinks one or two tots of rum at the weekend. Creatine kinase level is 125. Which of the following investigations is most significant in establishing a diagnosis?

      Your Answer:

      Correct Answer: Muscle biopsy with electron microscopy

      Explanation:

      Inclusion body myositis (IBM) is a progressive muscle disorder characterized by muscle inflammation, weakness, and atrophy (wasting). It is a type of inflammatory myopathy. IBM develops in adulthood, usually after age 50. The symptoms and rate of progression vary from person to person. The most common symptoms include progressive weakness of the legs, arms, fingers, and wrists. Some people also have weakness of the facial muscles (especially muscles controlling eye closure), or difficulty swallowing (dysphagia). Muscle cramping and pain are uncommon, but have been reported in some people. The underlying cause of IBM is poorly understood and likely involves the interaction of genetic, immune-related, and environmental factors. Some people may have a genetic predisposition to developing IBM, but the condition itself typically is not inherited. Elevated creatine kinase (CK) levels in the blood (at most ,10 times normal) are typical in IBM. Muscle biopsy may display several common findings including; inflammatory cells invading muscle cells, vacuolar degeneration, inclusions or plaques of abnormal proteins.

    • This question is part of the following fields:

      • Rheumatology
      0
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  • Question 12 - A 40-year-old female patient with a history of rheumatoid arthritis is diagnosed with...

    Incorrect

    • A 40-year-old female patient with a history of rheumatoid arthritis is diagnosed with type 1 renal tubular acidosis. What is the most probable sequela of this condition?

      Your Answer:

      Correct Answer: Nephrocalcinosis

      Explanation:

      Distal renal tubular acidosis is due to defective proton secretion from the alpha intercalated cells of the distal tubule caused by dysfunction of the H+/K+ antiporter on the apical membrane. This leads to failure of H+ excretion thereby causing systemic acidosis and potassium depletion. Inability to lower the urine pH below 5.3 in the presence of systemic acidosis is the diagnostic hallmark of type I or distal renal tubular acidosis. Hypercalciuria, hypocitraturia and elevated urinary pH observed in distal renal tubular acidosis can lead to nephrocalcinosis and may cause renal calculi, obstructive uropathy and renal failure necessitating surgical or endoscopic stone extraction.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 13 - A 55 year old female presents with progressive dyspnoea, dry cough and fever....

    Incorrect

    • A 55 year old female presents with progressive dyspnoea, dry cough and fever. She started methotrexate therapy six weeks ago. The current regimen includes methotrexate 15 mg/ week, folic acid 5 mg/day and aspirin 75 mg/day. There is no history of any other chronic illness. Vitals are as follows: Temp: 37.8C, pulse: 100 beats/min, BP: 110/80mmHg and SaO2: 90% on air. Examination reveals synovitis in both wrists, and metacarpophalangeal joints. On auscultation, there are scattered crepitations. Blood test reports are given below: Haemoglobin: 13.1g/dl (13.0 – 18.0 g/dL), WBC: 8.2 x109/l (4 – 11 x 109/l), Neutrophils: 5.1×109/l (1.5 – 7 x 109/l), Platelets: 280 x109/l (150 – 400 x 109/L), ESR: 48 mm/hr (0 – 30 mm/1st hr), Urea, electrolytes and creatinine: normal. CXR: patchy airspace shadows bilaterally What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Methotrexate pneumonitis

      Explanation:

      Pneumonitis is a serious and unpredictable side-effect of treatment with methotrexate (MTX) that may become life-threatening. The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever. Hypoxaemia and tachypnoea are always present and crackles are frequently audible. Chest radiography reveals a diffuse interstitial or mixed interstitial and alveolar infiltrate, with a predilection for the lower lung fields. Pulmonary function tests show a restrictive pattern with diminished diffusion capacity. Lung biopsy reveals cellular interstitial infiltrates, granulomas or a diffuse alveolar damage pattern accompanied by perivascular inflammation. Most patients present in the first few months of starting methotrexate. It is important that all patients receiving methotrexate be educated concerning this potential adverse reaction and instructed to contact their physicians should significant new pulmonary symptoms develop while undergoing therapy. If methotrexate pneumonitis is suspected, methotrexate should be discontinued, supportive measures instituted and careful examination for different causes of respiratory distress conducted. This may be treated with corticosteroids once underlying infection has been excluded.

    • This question is part of the following fields:

      • Rheumatology
      0
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  • Question 14 - A 45-year-old male is brought to the emergency department after being found collapsed,...

    Incorrect

    • A 45-year-old male is brought to the emergency department after being found collapsed, outside a nightclub. The ER team found an empty bottle of amyl nitrate in his pocket. The patient is hypoxic with an O2 saturation of 84% and is confused. Which of the following is the best treatment for this patient?

      Your Answer:

      Correct Answer: Methylene blue

      Explanation:

      The best treatment for the patient in question would be methylene blue.
      The most probable diagnosis in this patient is methemoglobinemia due to the ingestion of amyl nitrate.

      Amyl nitrate promotes the formation of methaemoglobin, which avidly conserves oxygen and leads to decreased tissue oxygen saturations.

      Treatment of choice includes methylene blue and vitamin C.

      Adverse effects:
      Benign side effects include green or blue discoloration of urine and patients should be forewarned.
      Significant side effects are based on methylene blue, itself, being an oxidizing agent and an inhibitor of monoamine oxidase A (MAO-A).
      As an oxidizing agent, methylene blue can actually precipitate methemoglobinemia or haemolysis in high doses or when ineffectively reduced.
      Methylene blue administration in a patient taking a serotonergic agents may predispose to serotonin syndrome.

      Note: Although methylene blue administration is controversial in the setting of G6PD-deficiency due to reduced levels of NADPH, it is not contraindicated and should be administered cautiously and judiciously.

    • This question is part of the following fields:

      • Pharmacology
      0
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  • Question 15 - A 62 year old patient presents to the ophthalmology OPD with progressive deterioration...

    Incorrect

    • A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?

      Your Answer:

      Correct Answer:

      Explanation:

      Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.

      Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 16 - An iv-drug abuser sustains an open head injury and is admitted overnight for...

    Incorrect

    • An iv-drug abuser sustains an open head injury and is admitted overnight for observation. The next morning she is ok and is discharged. A week later she is re-admitted with fluctuating hard neurological signs. Blood results show neutrophilia and raised C-reactive protein (CRP). Which of the following is the best initial treatment step?

      Your Answer:

      Correct Answer: Computed tomography (CT) scan with contrast

      Explanation:

      Increased WBC count and CRP suggest infection. But with the fluctuating hard neurological signs, there is suspicion of the presence of a cerebral mass, which is an indication for requesting for a CT scan with contrast, to rule out an abscess or haematoma. The lumbar puncture can be considered after the CT scan.

    • This question is part of the following fields:

      • Neurology
      0
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  • Question 17 - The mechanism of action of low molecular weight heparin, has the greatest effect...

    Incorrect

    • The mechanism of action of low molecular weight heparin, has the greatest effect on which of the following components of the coagulation cascade?

      Your Answer:

      Correct Answer: Factor Xa

      Explanation:

      Mechanism of action of low molecular weight heparin (LMWH):
      It inhibits coagulation by activating antithrombin III. Antithrombin III binds to and inhibits factor Xa. In doing so it prevents activation of the final common path; Xa inactivation means that prothrombin is not activated to thrombin, thereby not converting fibrinogen into fibrin for the formation of a clot.

      LMHW is a small fragment of a larger mucopolysaccharide, heparin. Heparin works similarly, by binding antithrombin III and activating it. Heparin also has a binding site for thrombin, so thrombin can interact with antithrombin III and heparin, thus inhibiting coagulation.
      Heparin has a faster onset of anticoagulant action as it will inhibit not only Xa but also thrombin, while LMWH acts only on Xa inhibition.

      Compared to heparin, LMWHs have a longer half-life, so dosing is more predictable and can be less frequent, most commonly once per day.

      Dosage and uses:
      LMWH is administered via subcutaneous injection. This has long-term implications on the choice of anticoagulant for prophylaxis, for example, in orthopaedic patients recovering from joint replacement surgery, or in the treatment of DVT/PE.

      Adverse effects:
      The main risk of LMWH will be bleeding. The specific antidote for heparin-induced bleeding is protamine sulphate.
      Less commonly it can cause:
      Heparin-induced thrombocytopenia (HIT)
      Osteoporosis and spontaneous fractures
      Hypoaldosteronism
      Hypersensitivity reactions

    • This question is part of the following fields:

      • Pharmacology
      0
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  • Question 18 - A 55-year-old diabetic male presents with a feeling of generally being unwell. He...

    Incorrect

    • A 55-year-old diabetic male presents with a feeling of generally being unwell. He also has a history of atrial fibrillation and epilepsy. His main complaint is a blue tinge to his vision. Which one of his medications is most likely to be responsible?

      Your Answer:

      Correct Answer: Sildenafil

      Explanation:

      Blue tinge of vision/cyanopsia is caused due to the intake of sildenafil citrate.

      Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction.
      It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.

      Uses:
      It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.

      Adverse effects:
      Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.
      It can also cause hypotension, dizziness, and rhinitis.

      Note: Xanthopsia (yellow-green vision) may occur secondary to treatment with digoxin.

    • This question is part of the following fields:

      • Pharmacology
      0
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  • Question 19 - Which of the following is NOT a cause of onycholysis? ...

    Incorrect

    • Which of the following is NOT a cause of onycholysis?

      Your Answer:

      Correct Answer: Mycoplasma pneumonia

      Explanation:

      Onycholysis is the separation of the distal edge of the nail from the vascular nailbed causing whiteness of the free edge. Causes include:
      – Idiopathic
      – Trauma, excessive manicuring
      – Infection: especially fungal
      – Skin disease: psoriasis, dermatitis
      – Impaired peripheral circulation e.g. Raynaud’s
      – Systemic disease: hyper/hypothyroidism, reactive arthritis, porphyria cutanea tarda
      – Sometimes a reaction to detergents (e.g. washing dishes with bare hands, using detergent-based shampoos or soaps).
      – Patients with hepatocellular dysfunction may develop hair-thinning or hair loss and nail changes such as clubbing, leukonychia (whitening), or onycholysis.

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - Out of the following, which malignant tumour has the highest predilection for dissemination...

    Incorrect

    • Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?

      Your Answer:

      Correct Answer: Prostate

      Explanation:

      Prostate cancer is the most common primary tumour that metastasises to the bone.

      Most common tumours causing bone metastasis (in descending order):
      1. Prostate (32%)
      2. Breast (22%)
      3. Kidneys (16%)
      4. Lungs
      5. Thyroid

      Most common sites of bone metastasis (in descending order):
      1. Spine
      2. Pelvis
      3. Ribs
      4. Skull
      5. Long bones

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 21 - A 60 yr. old patient with hypertension attended his regular clinic. His compliance...

    Incorrect

    • A 60 yr. old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?

      Your Answer:

      Correct Answer: Left ventricular hypertrophy

      Explanation:

      Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.

    • This question is part of the following fields:

      • Cardiology
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  • Question 22 - A 45-year-old male patient who was initially investigated for having an abdominal mass...

    Incorrect

    • A 45-year-old male patient who was initially investigated for having an abdominal mass is diagnosed as having Burkitt lymphoma. He is due to start chemotherapy today. Which one of the following should be given prior to his chemotherapy in order to reduce the risk of tumour lysis syndrome?

      Your Answer:

      Correct Answer: Rasburicase

      Explanation:

      Rasburicase should be given prior to chemotherapy in order to reduce the risk of tumour lysis syndrome (TLS). Rasburicase is a recombinant version of urate oxidase which is an enzyme that metabolizes uric acid to allantoin. Allantoin is 5–10 times more soluble than uric acid, hence, renal excretion is more effective.

      TLS is a potentially fatal condition occurring as a complication during the treatment of high-grade lymphomas and leukaemias. It occurs from the simultaneous breakdown (lysis) of the tumour cells and subsequent release of chemicals into the bloodstream. This leads to hyperkalaemia and hyperphosphatemia in the presence of hyponatraemia. TLS can occur in the absence of chemotherapy, but it is usually triggered by the introduction of combination chemotherapy. Awareness of the condition is critical for its prophylactic management.

      Burkitt lymphoma is a high-grade B-cell neoplasm. There are two major forms:
      1. Endemic (African) form: typically involves maxilla or mandible.
      2. Sporadic form: abdominal (e.g. ileocaecal) tumours are the most common form. More common in patients with HIV.

      Burkitt lymphoma is associated with the c-myc gene translocation, usually t(8;14). The Epstein-Barr virus (EBV) is strongly implicated in development of the African form of Burkitt lymphoma and to a lesser extent, the sporadic form.

      Management of the lymphoma is with chemotherapy. This tends to produce a rapid response which may cause TLS.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 23 - Each one of the following statements regarding atrial natriuretic peptide are true, except:...

    Incorrect

    • Each one of the following statements regarding atrial natriuretic peptide are true, except:

      Your Answer:

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is a 28-amino acid peptide that is synthesized, stored, and released by atrial myocytes in response to atrial distension, angiotensin II stimulation, endothelin, and sympathetic stimulation (beta-adrenoceptor mediated). ANP is synthesized and secreted by cardiac muscle cells in the walls of the atria in the heart. The main physiological actions of natriuretic peptides is to reduce arterial pressure by decreasing blood volume and systemic vascular resistance. It causes a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 24 - A 43 year-old female artist with no past medical history presents to the...

    Incorrect

    • A 43 year-old female artist with no past medical history presents to the emergency department with a 2-day history of pins and needles in the lower limbs, and progressive walking difficulties. She states she had diarrhoea 1 week ago. On examination, there is a loss of pinprick sensation noted to the lower limbs from mid-thigh distally and in the upper limbs from MCP joints distally. There is bilateral weakness of ankle dorsiflexion, noted at 3/5, and knee flexion and extension weakness, noted at 4/5 bilaterally. Power in upper and lower limbs is otherwise normal. Knee and ankle deep tendon reflexes are absent. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      Guillain-Barre syndrome is an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). Characteristic features include progressive weakness of all four limbs, and it is classically ascending, affecting the lower extremities first. Sensory symptoms tend to be mild.

      Functional neurological syndrome can be discounted due to presence of hard neurological signs. Multiple sclerosis can be excluded because of the presence of lower motor neuron signs and absence of upper motor neuron signs. Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Neurology
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  • Question 25 - A 40 year old farmer who is a non-smoker is experiencing increasing shortness...

    Incorrect

    • A 40 year old farmer who is a non-smoker is experiencing increasing shortness of breath on exertion. He has been having chest tightness and a non-productive cough which becomes worse when he is at the dairy farm. He has no respiratory history of note. Extrinsic allergic alveolitis is the suspected diagnosis. Which factor would be responsible for this diagnosis?

      Your Answer:

      Correct Answer: Contaminated hay

      Explanation:

      Extrinsic allergic alveolitis (EAA) refers to a group of lung diseases that can develop after exposure to certain substances. The name describes the origin and the nature of these diseases:

      ‘extrinsic’ – caused by something originating outside the body
      ‘allergic’ – an abnormally increased (hypersensitive) body reaction to a common substance
      ‘alveolitis’ – inflammation in the small air sacs of the lungs (alveoli)

      Symptoms can include: fever, cough, worsening breathlessness and weight loss. The diagnosis of the disease is based on a history of symptoms after exposure to the allergen and a range of clinical tests which usually includes: X-rays or CT scans, lung function and blood tests.

      EAA is not a ‘new’ occupational respiratory disease and occupational causes include bacteria, fungi, animal proteins, plants and chemicals.

      Examples of EAA include:

      Farmer’s lung
      This is probably the most common occupational form of EAA and is the outcome of an allergic response to a group of microbes, which form mould on vegetable matter in storage. During the handling of mouldy straw, hay or grain, particularly in a confined space such as a poorly ventilated building, inhalation of spores and other antigenic material is very likely.

      There also appears to be a clear relationship between water content of crops, heating (through mould production) and microbial growth, and this would apply to various crops and vegetable matter, with the spores produced likely to cause EAA.

      Farmer’s lung can be prevented by drying crops adequately before storage and by ensuring good ventilation during storage. Respiratory protection should also be worn by farm workers when handling stored crops, particularly if they have been stored damp or are likely to be mouldy.

    • This question is part of the following fields:

      • Respiratory
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  • Question 26 - A 30-year-old male with a history of premature cardiovascular disease in the family...

    Incorrect

    • A 30-year-old male with a history of premature cardiovascular disease in the family has come for review of his lab investigations. His fasting cholesterol is 8.4 mmol/l with high-density lipoprotein (HDL) of 1.6 mmol/l. You elect to commence him on atorvastatin 20 mg PO daily. Which of the following best describes the mechanism of action of the statins?

      Your Answer:

      Correct Answer: They inhibit HMG CoA reductase

      Explanation:

      Statins are a selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for the conversion of HMG-CoA to mevalonate in the cholesterol synthesis pathway.
      Statins are usually well tolerated with myopathy, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions.
      This is the rate-limiting step in cholesterol synthesis, that leads to increased hepatic low-density lipoprotein (LDL) receptors and reduced hepatic VLDL synthesis coupled with increased very-low-density lipoprotein (VLDL) clearance.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 27 - A patient presented with acute onset of mild right hemiparesis affecting the body....

    Incorrect

    • A patient presented with acute onset of mild right hemiparesis affecting the body. He also has evidence of sensory loss on the right hand side. There is evidence of Horner’s syndrome and sensory loss on the face on the left hand side. Which of the following structures are involved?

      Your Answer:

      Correct Answer: Brain stem

      Explanation:

      The patient is presenting with symptoms of lateral medullary syndrome also known as Wallenberg’s syndrome or posterior inferior cerebellar artery syndrome, where the symptoms are due to an ischemia in the brainstem. The classical symptoms include contralateral sensory deficits of the trunk region paired with ipsilateral facial sensory deficits.

    • This question is part of the following fields:

      • Neurology
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  • Question 28 - A 32 year old complains of pain in her hands bilaterally. Which of...

    Incorrect

    • 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:

      Correct 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
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  • Question 29 - 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
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  • Question 30 - A 42 year old male undergoes a routine cranial nerve examination, which reveals...

    Incorrect

    • A 42 year old male undergoes a routine cranial nerve examination, which reveals the following findings: Rinne's test: Air conduction > bone conduction in both ears Weber's test: Localizes to the right side What do these test results imply?

      Your Answer:

      Correct Answer: Left sensorineural deafness

      Explanation:

      Weber’s test – if there is a sensorineural problem, the sound is localized to the unaffected side (right), indicating a problem on the left side.

    • This question is part of the following fields:

      • Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Rheumatology (1/1) 100%
Respiratory (0/1) 0%
Gastroenterology (0/1) 0%
Haematology & Oncology (0/1) 0%
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