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Question 1
Incorrect
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A 71 year-old dentist is seen in clinic with a history of worsening memory problems and confusion. His wife had noted that his sleep was becoming more disturbed and he complains of vivid nightmares and visual hallucinations. Over the past few weeks, he has had increasing difficulty in dressing himself, and his mobility has deteriorated. On examination, he is bradykinesic with a resting tremor and rigidity affecting his arms and legs. His Mini-Mental-State Examination (MMSE) is 18/30. Which of the following is the most likely diagnosis?
Your Answer: Parkinson’s disease
Correct Answer: Lewy body disease
Explanation:Lewy body dementia is the second most common cause of dementia in the elderly after Alzheimer’s disease. The core feature is a progressive dementia, but other characteristic features include Parkinsonism, visual hallucinations, fluctuating cognitive abilities and executive function, and an increased risk of falls or autonomic failure.
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This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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A 40-year-old woman presents to the ED with palpitations and shortness of breath. Recent thyroid function tests on the hospital computer reveal thyroid-stimulating hormone (TSH) of <0.05 mU/l and a markedly elevated T4. You arrange blood gas testing. Which of the following findings would be most consistent with Grave’s disease?
Your Answer: Respiratory acidosis
Correct Answer: Decreased pa(CO2)
Explanation:Hyperthyroid patients show significantly lower resting arterial CO2 tension, tidal volume and significantly higher mean inspiratory flow and pa(O2) than healthy patients. This may of course lead to misdiagnosis of patients with hyperthyroidism as having hyperventilation syndrome.
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This question is part of the following fields:
- Endocrinology
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Question 3
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly commonly on the extensor surfaces. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. Psoriatic arthritis affects up to 30% of individuals with psoriasis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells
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This question is part of the following fields:
- Dermatology
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Question 4
Incorrect
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A 55 yr. old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?
Your Answer: 70% stenosis of the left anterior descending artery
Correct Answer: Complete occlusion of the left anterior descending artery
Explanation:The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.
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This question is part of the following fields:
- Cardiology
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Question 5
Correct
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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: 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.
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This question is part of the following fields:
- Clinical Sciences
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Question 6
Incorrect
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A 53-year-old cashier with a history of chronic back pain presents for a check-up. He is aware of a dragging feeling affecting his left foot when he tries to walk. This has developed since a minor injury to his left knee. On examination, he has weakness of dorsiflexion and eversion of the left foot. The right is unaffected and plantar flexion and inversion are normal on the left. MRI of the spinal cord shows degenerative disc changes at multiple levels, but no evidence of cord or nerve root impingement. Nerve conduction studies and EMG results are pending. Which of the following sensory loss patterns would you expect to find in association with this motor defect?
Your Answer: Sensory loss over the plantar aspect of the foot
Correct Answer: Sensory loss over the dorsum of the foot and anterolateral leg
Explanation:This patient presentation is unlikely to be an L5 nerve root lesion given the results of the MRI scan. Therefore, the most likely diagnosis is a mononeuritis affecting the left common peroneal nerve. This would lead to sensory loss over the dorsum of the foot and anterolateral leg on the left.
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This question is part of the following fields:
- Neurology
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Question 7
Incorrect
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An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance. He is eager to know its relation to his future health. Which of the following statements is correct?
Your Answer: 40% of patients with MGUS go on to develop myeloma over 10 years
Correct Answer: 10% of patients with MGUS go on to develop myeloma over 10 years
Explanation:Monoclonal gammopathy of undetermined significance (MGUS, also known as benign paraproteinemia and monoclonal gammopathy) is a pre-malignant condition not necessarily leading to its malignant form—multiple myeloma. Around 10% of patients eventually develop myeloma over 10 years, with 50% at 15 years. MGUS causes paraproteinemia and is usually asymptomatic. It is not associated with ostealgia or increased risk of infections. It is often mistaken for multiple myeloma, differing from the latter in, no immunosuppression, normal levels of beta-2 microglobulin, and stable lower levels of paraproteinemia.
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This question is part of the following fields:
- Haematology & Oncology
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Question 8
Incorrect
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Which of the following is the most common route of hepatitis B transmission worldwide?
Your Answer: Sexual transmission
Correct Answer: Perinatal transmission
Explanation:Perinatal transmission is the most common cause of Hepatitis B infection worldwide. Post-exposure prophylaxis should be provided, which consists of hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. Without this, about 40% will develop chronic infection.
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This question is part of the following fields:
- Gastroenterology
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Question 9
Correct
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Which treatment of chronic obstructive pulmonary disease (COPD) increases the long-term prognosis in patients?
Your Answer: Long-term domiciliary oxygen therapy
Explanation:COPD is commonly associated with progressive hypoxemia. Oxygen administration reduces mortality rates in patients with advanced COPD because of the favourable effects on pulmonary hemodynamics.
Long-term oxygen therapy improves survival 2-fold or more in hypoxemic patients with COPD, according to 2 landmark trials, the British Medical Research Council (MRC) study and the US National Heart, Lung and Blood Institute’s Nocturnal Oxygen Therapy Trial (NOTT). Hypoxemia is defined as PaO2 (partial pressure of oxygen in arterial blood) of less than 55 mm Hg or oxygen saturation of less than 90%. Oxygen was used for 15-19 hours per day.
Therefore, specialists recommend long-term oxygen therapy for patients with a PaO2 of less than 55 mm Hg, a PaO2 of less than 59 mm Hg with evidence of polycythaemia, or cor pulmonale. Patients should be evaluated after 1-3 months after initiating therapy, because some patients may not require long-term oxygen.
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This question is part of the following fields:
- Respiratory
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Question 10
Correct
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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: 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.
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This question is part of the following fields:
- Clinical Sciences
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