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Question 1
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A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?
Your Answer: Varicella zoster virus (VZV)
Explanation:Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A 29 year old graduate student is reviewed after feeling anxious all the time. She states that she is unable to relax and she is not sleeping well. However, her mood is okay and her appetite is good. She has been reviewed for several weeks with the same symptoms and has made no improvement with self-help sessions. Which pharmacological option is likely indicated in her diagnosis?
Your Answer: Selective serotonin reuptake inhibitor (SSRI)
Explanation:Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry. They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.
GAD is diagnosed when a person finds it difficult to control worry on more days than not for at least six months and has three or more symptoms.
Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy. Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents, which have a safer adverse effect profile and higher ease of use than the older tricyclic antidepressants (TCAs), such as selective serotonin reuptake inhibitors (SSRIs).
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This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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A young man complains that he feels paralysed and is unable to move when he wakes up and less often when he is falling asleep. He complains of having hallucinations and sees other strangers in the room. His anxiety has also increased with these episodes. What is his likely diagnosis?
Your Answer: Acute schizophrenia
Correct Answer: Sleep paralysis
Explanation:Sleep paralysis is a temporary inability to move or speak that occurs when you’re waking up or falling asleep. Paralysis is often accompanied by hallucinations
REM is a stage of sleep when the brain is very active and dreams often occur. The body is unable to move, apart from the eyes and muscles used in breathing, possibly to stop the person from acting out the dreams and hurting himself.
It’s not clear why REM sleep can sometimes occur while one is awake, but it has been associated with:
-not getting enough sleep (sleep deprivation or insomnia)
-irregular sleeping patterns – for example, because of shift work or jet lag
-narcolepsy – a long-term condition that causes a person to suddenly fall asleep at inappropriate times
-a family history of sleep paralysis
-sleeping on one’s back -
This question is part of the following fields:
- Psychiatry
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Question 4
Incorrect
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A 54 year old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?
Your Answer: Squamous cell carcinoma
Correct Answer: Basal cell carcinoma
Explanation:Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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In chemotherapy, what is the rationale behind using combinations of chemotherapeutic agents rather than single agents?
Your Answer: Combination therapy can be given over a shorter period of time
Correct Answer: Combination therapy decreases the chances of drug resistance developing
Explanation:There are two main reasons for using combinations of chemotherapeutic agents rather than single agents. First, different drugs exert their effects through different mechanisms, therefore, carefully combining them will increase the number of tumour cells killed in each cycle as well as decrease their chances of developing drug resistance. Second, there may be an even greater effect with drugs that are synergistic.
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This question is part of the following fields:
- Haematology & Oncology
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Question 6
Correct
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A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on the beach. Which is the most appropriate immediate treatment for this patient?
Your Answer: Emollient cream
Explanation:Sun burn reactions usually occur after individuals with a light skin tone have prolonged exposure to the sun. The usual symptoms are redness and itching of the skin. The best treatment plan would be further avoidance of sun exposure and the topical application of emollients. These are Ist degree burns and aggressive therapy is not required in such cases.
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This question is part of the following fields:
- Dermatology
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Question 7
Incorrect
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Which of the following symptoms are more indicative of mania than hypomania?
Your Answer: Predominately elevated mood
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 8
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A 65-year-old man having small cell lung cancer is admitted onto the ward for chemotherapy. He has a history of severe nausea and vomiting secondary to chemotherapy, in the past. The consultant asks you to prescribe a neurokinin 1 (NK1) receptor blocker. Which agent, out of the following, will you choose?
Your Answer: Aprepitant
Explanation:Aprepitant is an anti-emetic which blocks the neurokinin 1 (NK1) receptor and acts as a substance P antagonist. It is licensed for chemotherapy-induced nausea and vomiting (CINV) and for prevention of postoperative nausea and vomiting.
Nausea and vomiting are the common side effects of chemotherapy. Risk factors for the development of these symptoms include age<50 years, anxiety, concurrent use of opioids, and the type of chemotherapy administered.
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This question is part of the following fields:
- Haematology & Oncology
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Question 9
Incorrect
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A 34-year-old woman is admitted to the hospital with a one-week history of dark urine and fatigue. One day before admission, she developed severe abdominal pain and abdominal distension. On examination, she has pallor, jaundice, an enlarged tender liver, and ascites. Her investigations show: Hb: 7.9 g/dL, WCC: 3.2 x 10^9/L, Plts: 89 x 10^9/L, MCV: 101 fL. Peripheral smear: Mild polychromasia, AST: 144 U/L, ALT: 130 U/L, Bilirubin: 54 μmol/L. Urine hemosiderin: ++, Urine urobilinogen +. Abdominal ultrasound reveals an enlarged liver, ascites, and absent flow in the hepatic veins. Which single test would you request to confirm the underlying diagnosis?
Your Answer: Glucose-6-phosphate dehydrogenase (G6PD) assay
Correct Answer: Flow cytometry for CD55 and CD59 expression
Explanation:The patient has paroxysmal nocturnal haemoglobinuria (PNH) complicated by acute hepatic vein thrombosis (Budd–Chiari syndrome).
PNH is an acquired clonal disorder of haematopoietic stem cells, characterised by variable combination of intravascular haemolysis, thrombosis, and bone marrow failure. Diagnosis is made by flow cytometric evaluation of blood, which confirms the CD55 and CD59 deficiencies and deficiency of expression of other GPI-linked proteins. This test is replacing older complement-based assays such as the Ham test and sucrose lysis test.
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This question is part of the following fields:
- Haematology & Oncology
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Question 10
Incorrect
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The chorda tympani of the facial nerve (CN VII) carries:
Your Answer: sympathetic fibres to the submandibular and sublingual glands and taste fibres from the whole of the tongue
Correct Answer: parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue
Explanation:In the petrous temporal bone the facial nerve produces three branches:
1. The greater petrosal nerve, which transmits preganglionic parasympathetic fibres to the sphenopalatine ganglion. These postganglionic fibres supply the lacrimal gland and the glands in the nasal cavity;
2. The nerve to stapedius;
3. Parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue. -
This question is part of the following fields:
- Neurology
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