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  • Question 1 - Choose the wrong statement regarding hypocalcaemia: ...

    Incorrect

    • Choose the wrong statement regarding hypocalcaemia:

      Your Answer: Most features are a result of neuromuscular excitability

      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
      34.7
      Seconds
  • Question 2 - A 63 year old man presents to the clinic complaining of a 6-month history...

    Correct

    • A 63 year old man presents to the clinic complaining of a 6-month history of shortness of breath on exertion and a non-productive cough.   On examination there is clubbing, and crepitations heard at the lung bases. Lung function tests show a reduced vital capacity and an increased FEV1/FVC ratio.   What is his diagnosis?

      Your Answer: Idiopathic pulmonary fibrosis

      Explanation:

      Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult.
      The most common signs and symptoms of idiopathic pulmonary fibrosis are shortness of breath and a persistent dry, hacking cough. Many affected individuals also experience a loss of appetite and gradual weight loss.

      The clinical findings of IPF are bibasilar reticular abnormalities, ground glass opacities, or diffuse nodular lesions on high-resolution computed tomography and abnormal pulmonary function studies that include evidence of restriction (reduced VC with an increase in FEV1/FVC ratio) and/or impaired gas exchange (increased P(A-a)O2 with rest or exercise or decreased diffusion capacity of the lung for carbon monoxide [DLCO]).

    • This question is part of the following fields:

      • Respiratory
      28.7
      Seconds
  • Question 3 - A 33-year-old artist who recently arrived in the UK from New York presents...

    Incorrect

    • A 33-year-old artist who recently arrived in the UK from New York presents in ED. He has a past history of insulin-dependant diabetes mellitus. He describes a few days of fever, headache and myalgia. Admission was prompted by worsening headache and back pain. While waiting in the medical receiving unit, he becomes progressively drowsier. Examination revealed flaccid paralysis and depressed tendon reflexes. He was reviewed by the intensive care team and arrangements were made for ventilation. A computerised tomography (CT) brain is performed that is normal. Cerebrospinal fluid examination reveals: Protein 0.9 g/l (<0.45 g/l) Glucose 4 mmol/L, White cell count (WCC) 28/mm3 (mostly lymphocytes) Blood testing reveals: Haemoglobin (Hb) 14 g/dl (13–18) Platelets 620 x 109/l (150–400 x 109) WCC 12 x 109/l (4–11 x 109) Sodium 135 mmol/l (137–144) Potassium 4.6 mmol/l (3.5–4.9) Urea 8 mmol/l (2.5–7.5) Creatinine 120 mmol/l (60–110) Glucose 6 mmol/L, Which of the following is the most likely infective process?

      Your Answer: Human immunodeficiency virus

      Correct Answer: West Nile disease

      Explanation:

      West Nile virus (WNV) is a single-stranded RNA flavivirus transmitted via the culex mosquito. This previously ‘tropical’ disease has became topical in recent years following a large scale outbreak in the New York area. Incidence of neurological involvement is around 1%, although some suggest that the incidence of meningoencephalitis in America is higher than in other parts of the world. Risk factors for neurological involvement include increasing age, and immunosuppression. The usual picture is of sudden onset fever and myalgia with nausea and vomiting and a non-specific rash. Transient meningitis is occasionally seen. Frank meningoencephalitis is seen in two-thirds of cases with neurological involvement; 15% progress to coma. A flaccid paralysis similar to acute Guillain–Barré is increasingly recognised.
      Diagnosis is initially clinical with subsequent serological confirmation. Treatment is supportive; results from trials of antivirals have yielded disappointing results.

    • This question is part of the following fields:

      • Neurology
      6.2
      Seconds
  • Question 4 - Which of the following skin conditions is not associated with diabetes mellitus? ...

    Incorrect

    • Which of the following skin conditions is not associated with diabetes mellitus?

      Your Answer: Malum perforans

      Correct Answer: Sweet's syndrome

      Explanation:

      Diabetic dermadromes constitute a group of cutaneous conditions commonly seen in people with diabetes with longstanding disease. Conditions included in this group are:
      – Acral dry gangrene
      – Carotenosis
      – Diabetic dermopathy
      – Diabetic bulla
      – Diabetic cheiroarthropathy
      – Malum perforans
      – Necrobiosis lipoidica
      – Limited joint mobility
      – Scleroderma
      – Waxy skin is observed in roughly 50%.

      Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia. It is not associated with diabetes mellitus.

    • This question is part of the following fields:

      • Dermatology
      6
      Seconds
  • Question 5 - A 33-year-old woman has missed her last two periods and has been lactating....

    Incorrect

    • A 33-year-old woman has missed her last two periods and has been lactating. Upon anamnesis, she claims she's lost weight and she's been suffering from vaginal dryness. The endocrinologist suggests that she checks her prolactin levels. Which of the following inhibits prolactin release from the hypophysis?

      Your Answer: Oestrogen

      Correct Answer: Dopamine

      Explanation:

      Dopamine (DA) holds a predominant role in the regulation of prolactin (PRL) secretion. Through a direct effect on anterior pituitary lactotrophs, DA inhibits the basally high-secretory tone of the cell. It accomplishes this by binding to D2 receptors expressed on the cell membrane of the lactotroph, activation of which results in a reduction of PRL exocytosis and gene expression by a variety of intracellular signalling mechanisms.

    • This question is part of the following fields:

      • Clinical Sciences
      11.7
      Seconds
  • Question 6 - Which of the following is a good prognostic factor in chronic lymphocytic leukaemia?...

    Incorrect

    • Which of the following is a good prognostic factor in chronic lymphocytic leukaemia?

      Your Answer: Raised LDH

      Correct Answer: Female sex

      Explanation:

      Good prognosis of chronic lymphocytic leukaemia (CLL) is associated with deletion of the long arm of chromosome 13 (del 13q). This is the most common abnormality, seen in around 50% of all CLL patients. Poor prognosis of the disease is related to deletion of part of the short arm of chromosome 17 (del 17p). This is seen in around 5-10% of the patients suffering from CLL.

      Poor prognostic factors of CLL include:
      1. Male sex
      2. Age >70 years
      3. Lymphocyte count >50
      4. Prolymphocytes comprising more than 10% of blood lymphocytes
      5. Lymphocyte doubling time <12 months
      6. Raised LDH
      7. CD38 expression positive

    • This question is part of the following fields:

      • Haematology & Oncology
      3.6
      Seconds
  • Question 7 - A 42-year-old man with a 6 month history of progressive weakness of both...

    Correct

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

      Your Answer: Dry beriberi

      Explanation:

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

    • This question is part of the following fields:

      • Clinical Sciences
      11.5
      Seconds
  • Question 8 - Choose the correct definition regarding the standard error of the mean: ...

    Correct

    • Choose the correct definition regarding the standard error of the mean:

      Your Answer: Standard deviation / square root (number of patients)

      Explanation:

      The SEM is an indicator of how close the sample mean is to the population mean. In reality, however, only one sample is extracted from the population. Therefore, the SEM is estimated using the standard deviation (SD) and a sample size (Estimated SEM). The SEM computed by a statistical program is an estimated value calculated via this process.

      Estimated Standard Error of the Mean (SEM)=SDn√

    • This question is part of the following fields:

      • Clinical Sciences
      4
      Seconds
  • Question 9 - In a patient with Hashimoto's thyroiditis, which of the following is most specific...

    Incorrect

    • In a patient with Hashimoto's thyroiditis, which of the following is most specific to the disease?

      Your Answer: Raised ESR

      Correct Answer: Anti-thyroid peroxidase antibodies

      Explanation:

      Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs) and is characterized by the destruction of thyroid cells by various cell- and antibody mediated immune processes. It usually presents with hypothyroidism, insidious in onset, with signs and symptoms slowly progressing over months to years.

      The diagnosis of Hashimoto thyroiditis relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features.

    • This question is part of the following fields:

      • Endocrinology
      11.6
      Seconds
  • Question 10 - What is northern blotting used for? ...

    Correct

    • What is northern blotting used for?

      Your Answer: Detect RNA

      Explanation:

      Northern blotting’s purpose is to measure the size and amount of RNA transcribed from a specific gene of interest.

    • This question is part of the following fields:

      • Clinical Sciences
      3.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Clinical Sciences (3/5) 60%
Respiratory (1/1) 100%
Neurology (0/1) 0%
Dermatology (0/1) 0%
Haematology & Oncology (0/1) 0%
Endocrinology (0/1) 0%
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