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Question 1
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An 82 year old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?
Your Answer: Osteosarcoma
Explanation:Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.
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This question is part of the following fields:
- Rheumatology
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Question 2
Incorrect
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A 23-year-old designer is requesting the combined oral contraceptive pill. During the history taking, she states that in the past she has had migraines with aura. She asks why the combined oral contraceptive pill is contraindicated. Which of the following is the most appropriate response?
Your Answer: Increased frequency of migraines
Correct Answer: Significantly increased risk of ischaemic stroke
Explanation:SIGN produced guidelines in 2008 on the management of migraines. Key points include that if patients have migraines with aura then the combined oral contraceptive (COC) is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72).
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This question is part of the following fields:
- Neurology
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Question 3
Incorrect
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A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows the foetus large for dates. She has an oral glucose tolerance test (OGTT) which was requested due to a combination of her Asian ethnicity and background of obesity. The following results are obtained: (Time (hours) : Blood glucose (mmol/l)), 0 : 9.2, 2 : 14.2. What is the most appropriate management?
Your Answer: Start metformin
Correct Answer: Start insulin
Explanation:Insulin remains the standard of care for the treatment of uncontrolled gestational diabetes. Tight control maintained in the first trimester and throughout pregnancy plays a vital role in decreasing poor fetal outcomes, including structural anomalies, macrosomia, hypoglycaemia of the new-born, adolescent and adult obesity, and diabetes.
The baby is already large for dates so nutritional therapy can not be used alone. -
This question is part of the following fields:
- Endocrinology
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Question 4
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: Viral hepatitis serology
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 5
Incorrect
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A 45-year-old man presents with tiredness and central weight gain. He underwent pituitary surgery for a non-functional pituitary tumour two years ago. Although he recovered from his pituitary surgery well, he has been found to have complete anterior hypopituitarism. Accordingly he is receiving stable replacement therapy with testosterone monthly injections, thyroxine and hydrocortisone. On examination, there are no specific abnormalities, his vision is 6/9 in both eyes and he has no visual field defects. From his notes, you see that he has gained 8 kg in weight over the last six months and his BMI is 31. His blood pressure is 122/72 mmHg. Thyroid function tests and testosterone concentrations have been normal. A post-operative MRI scan report shows that the pituitary tumour has been adequately cleared with no residual tissue. Which of the following is the most likely cause of his current symptoms?
Your Answer: Somatisation disorder
Correct Answer: Growth hormone deficiency
Explanation:The somatotroph cells of the anterior pituitary gland produce growth hormone (GH).
GH deficiency in adults usually manifests as reduced physical performance and impaired psychological well-being. It results in alterations in the physiology of different systems of the body, manifesting as altered lipid metabolism, increased subcutaneous and visceral fat, decreased muscle mass, decreased bone density, low exercise performance, and reduced quality of life. -
This question is part of the following fields:
- Endocrinology
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Question 6
Incorrect
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A 30-year-old man presented with polydipsia and polyuria for the last two years. Investigations reveal: Serum urea 9.5 mmol/L (2.5-7.5), Serum creatinine 108 mol/L (60-110), Serum corrected calcium 2.9 mmol/L (2.2-2.6), Serum phosphate 0.7 mmol/L (0.8-1.4), Plasma parathyroid hormone 6.5 pmol/L (0.9-5.4). Which of the following is directly responsible for the increase in intestinal calcium absorption?
Your Answer: Parathyroid hormone
Correct Answer: 1,25 Dihydroxy vitamin D
Explanation:This patient has hypercalcaemia due to hyperparathyroidism. However, the intestinal absorption of calcium is mainly controlled by 1,25 dihydroxy-vitamin D. Under the influence of calcitriol (active form of vitamin D), intestinal epithelial cells increase their synthesis of calbindin (calcium-binding carrier protein) necessary for active calcium ion absorption.
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This question is part of the following fields:
- Endocrinology
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Question 7
Correct
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A 30-year-old lawyer presents with a one-day history of a painful, red left eye. She describes how her eye is continually streaming tears. On examination, she exhibits a degree of photophobia in the affected eye and application of fluorescein demonstrates a dendritic pattern of staining. Visual acuity is 6/6 in both eyes. What is the most appropriate management?
Your Answer: Topical acyclovir
Explanation:This patient has a dendritic corneal ulcer. Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer. Topical acyclovir and ophthalmology review is required. Giving a topical steroid in this situation could be disastrous as it may worsen the infection.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Incorrect
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A 30 yr. old male with Down's Syndrome was found to have a systolic murmur during routine clinical examination. Which of the following is the most common cardiac defect associated with Down's Syndrome which will explain this finding?
Your Answer: Patent ductus arteriosus
Correct Answer: Endocardial cushion defect
Explanation:Atrioventricular septal defect (AVSD) also known as endocardial cushion defect is the most common cardiac abnormality in Down’s Syndrome.
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This question is part of the following fields:
- Cardiology
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Question 9
Correct
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A 72 yr. old female patient with a history of atrial fibrillation was admitted with recurrent episodes of syncopal attacks. Her ECG showed torsade de pointes. What is the drug which does not cause the above presentation?
Your Answer: Omeprazole
Explanation:Drugs causing torsades de pointes are Amiodarone, Chlorpromazine, Clarithromycin, Disopyramide, Dofetilide, Erythromycin, Haloperidol, Methadone, Procainamide, Quinidine, Sotalol, Levofloxacin, Moxifloxacin, Nilotinib, Ondansetron, Ranolazine, Sunitinib, Ziprasidone, Amitriptyline, Ciprofloxacin, Imipramine, Chlorthalidone, Dasatinib, Hydrochlorothiazide, Furosemide.
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This question is part of the following fields:
- Cardiology
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Question 10
Incorrect
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Which of the following is MOST suggestive of a lesion of the sciatic nerve?
Your Answer: Intervertebral disc prolapse at L2/L3 levels
Correct Answer: Foot drop
Explanation:The sciatic neve originates in the sacral plexus, mainly from spinal segments L5-S2. It supplies muscles that cause extension of the thigh and flexion of the leg. It divides into two main branches, the tibial nerve and common peroneal nerve, which are responsible for all foot movements. Anterior thigh and medial leg sensory loss is typical of a femoral nerve lesion. The femoral nerve also mediates flexion of the hip.
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This question is part of the following fields:
- Neurology
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Question 11
Incorrect
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A study is performed to assess a new proton pump inhibitor (PPI) in 120 elderly patients who are receiving aspirin. A control group of 240 elderly patients is given the standard PPI. The final evaluation after five years revealed that 24 individuals receiving the new PPI experienced an upper GI bleed. What is the absolute risk reduction if 60 individuals receiving the standard PPI experienced the same condition?
Your Answer: 12
Correct Answer: 5%
Explanation:Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. Absolute risk reduction = (Control event rate) – (Experimental event rate) = 0.05 = 5% reduction
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This question is part of the following fields:
- Clinical Sciences
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Question 12
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 13
Correct
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An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the most significant long-term risk following this infection?
Your Answer: Cervical cancer
Explanation:Human-papilloma virus (HPV) can lead to cervical cancer. There are many different types, but the types associated with cervical cancer most commonly are 16, 18, 31, 33, and 35. The vaccination against HPV protects against the most common types of HPV that are seen in cervical cancer and is recommended for children/young teens. Cervical cancer has a clear association with HPV, making this the best answer over all of the other answer choices.
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Incorrect
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A 66-year-old baker presents to the oncology clinic with six-month history of weight loss and anorexia. Tumour marker profile shows an elevated level of bombesin. Out of the following, which is the most likely cancer to account for this result?
Your Answer: Rectal carcinoma
Correct Answer: Small cell lung carcinoma
Explanation:Bombesin is a tumour marker elevated in small cell lung carcinomas, as well as in gastric carcinomas and retinoblastomas.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 15
Incorrect
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A 28-year-old woman presents with easy bruising. She has no history of mucosal bleeding and is generally well apart from occasional diarrhoea. She has previously attended a psychiatric unit for self-harming behaviour and is now brought in by her mother having consumed a number of pills. Her mother has had recurrent venous thromboses, but there is no family history of a bleeding disorder. Her full blood count (FBC) is normal, but her coagulation profile shows: Activated partial thromboplastin time (APTT): 60 secs (28–38 secs), Prothrombin time (PT): no clot after 120 secs (10–14 secs), Fibrinogen: 3.6 g/L (2–4 g/L). What is the most likely explanation?
Your Answer: Inherited factor VII deficiency
Correct Answer: Warfarin overdose
Explanation:Warfarin inhibits the vitamin K-dependent procoagulants II, VII, IX, and X as well as anticoagulant protein C and S. It is highly protein-bound and can be displaced by a wide variety of drugs. It has a half-life of 36–48 hours.
Bleeding is the major side effect. Easy bruising, as seen in this case, is commonly seen in patients of warfarin overdose. Grossly prolonged PT and lesser increase in APTT may be seen in such cases.
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This question is part of the following fields:
- Haematology & Oncology
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Question 16
Incorrect
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An 84-year-old retired police officer presents to the neurology clinic with double vision and unsteadiness whilst walking. He has a past medical history of hypertension, hypercholesterolemia and type 2 diabetes. On examination, you notice a right partial ptosis and miosis. The patient also has notable right facial loss of pain and temperature sensation with left sided truncal sensory loss contralateral to the face. In the clinic, apraclonidine eye drops are added to the affected eye, which causes a dilatation, whilst in the opposite eye, a pupil constriction occurs. After the eye drops have been eliminated from the body, 1% hydroxyamphetamine eye drops are then instilled. One hour after instillation, both pupils dilate. Which order of neurons is most likely affected in the sympathetic pathway?
Your Answer:
Correct Answer: First order
Explanation:Apraclonidine eye drops are initially used to confirm a Horner’s pupil. Apraclonidine stimulates both alpha-1 and alpha-2 receptors. When added to the affected eye, it causes pupil dilation by >2mm because of the relative super sensitivity of this pupil to alpha-1 receptor activity. In a normal pupil, however, it causes constriction due to the more potent activity at the alpha-2 receptor which triggers re-uptake of noradrenaline in the synaptic cleft.
Hydroxy amphetamine is then used to distinguish between first/second or third order neurones. In other words, it will distinguish either a lesion in the brainstem, cervical cord, chest or neck and one affecting above the superior cervical ganglion at the carotid bifurcation. In a normal pupil or a first/second order Horner’s, the pupil will dilate secondary to increased levels of noradrenaline released from the post-synaptic neurones. In a third order neurone, this will not occur. There is no fourth or fifth order neurone.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness in the right eye. Which part of the eye is causing these symptoms in this case?
Your Answer:
Correct Answer: Sclera
Explanation:Rheumatoid Scleritis is a painful inflammatory condition of the sclera in patients with rheumatoid arthritis. It might be diffuse, nodular, or necrotizing in nature. This occurs mostly in the sixth decade of life and mostly when the rheumatoid disease is in remission. Sclera is the first ocular manifestation in a patient of rheumatoid arthritis. This inflammation might later spread to the adjacent ocular structures like the cornea, causing keratitis, the uveal tract causing uveitis and the lens causing cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Incorrect
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A 28 year old woman presents with painful genital ulceration. She reports that these attacks have been recurrent over the past 4 years. She has been treated previously with oral acyclovir but this has had little effect on the duration of her symptoms. Over the past year, she has noticed almost weekly attacks of mouth ulcers that heal slowly. Past medical history is significant for treatment of thrombophlebitis two years ago. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Behcet's syndrome
Explanation:Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. The systemic manifestations can be variable. Ocular disease has the greatest morbidity, followed by vascular disease generally from active vasculitis. Cutaneous manifestations can occur in up 75% of patients with Behcet disease and can range from acneiform lesions, to nodules and erythema nodosum. GI manifestations can be severe. Differentiating Behçet disease from active inflammatory bowel disease can be clinically difficult. Herpes would have ideally responded to acyclovir. Sarcoidosis does not have genital and oral ulcerations.
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This question is part of the following fields:
- Rheumatology
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Question 19
Incorrect
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A 48-year-old hairdresser presented to her GP complaining of tingling in the right palm and right wrist pain. She had intermittently experienced these symptoms; however, recently they had been keeping her awake all night. She had noticed a reduction in grip and was struggling to work at the salon. Otherwise, she felt well in herself and had not noticed any weakness in the other hand or lower limb. Her weight was stable, and she denied any neck problems or swallowing difficulties. She had a past medical history of hypothyroidism and hypertension and took regular thyroxine, Bendroflumethiazide and ibuprofen. She was a non-smoker and rarely drank alcohol. On examination, she appeared alert and orientated. Fundoscopy and cranial nerve examination were all normal and neck movements were full. On examination of the upper limb, there was wasting over the right thenar eminence and fasciculations with a small burn over the right index finger. There was weakness of thumb abduction and opposition, with loss of pinprick and light touch sensation over the thumb, index and middle finger in the right hand. Nerve conduction studies showed absent sensory action potential in right median palmar branches and denervation of the right abductor pollicis brevis. What is the most likely diagnosis?
Your Answer:
Correct Answer: Median nerve palsy
Explanation:The history is consistent with carpal tunnel syndrome (CTS) arising as a result of pressure on the median nerve in the carpal tunnel. The median nerve supplies the muscles of the thenar eminence: the abductor pollicis (C7, C8), flexor pollicis brevis and opponens pollicis, and the lateral two lumbricals. The nerve conduction studies confirm marked denervation and absent sensory potentials within the median nerve territory.
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This question is part of the following fields:
- Neurology
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Question 20
Incorrect
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A 46-year-old woman was referred to the endocrinology department with hypercalcemia and raised parathyroid hormone levels. Her blood tests are highly suggestive of primary hyperparathyroidism. She has type 2 diabetes controlled by metformin alone. Her albumin-adjusted serum calcium level is 3.5 mmol/litre. Which of the following is the most important reason for her referral?
Your Answer:
Correct Answer: Albumin-adjusted serum calcium level of 3.5 mmol/litre
Explanation:Indications for surgery for the treatment of primary hyperparathyroidism:
1. Symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation
2. End-organ disease (renal stones, fragility fractures or osteoporosis)
3. An albumin-adjusted serum calcium level of 2.85 mmol/litre or above. -
This question is part of the following fields:
- Endocrinology
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Question 21
Incorrect
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You are a ST1 doctor working on a medical ward. You are struggling to cope with the workload and often leave the ward late. Who is the most appropriate action to take?
Your Answer:
Correct Answer: Speak to your consultant
Explanation:Speaking to your consultant is the most appropriate first action to take in this scenario. They are best placed to be able to take action to try and amend the situation. The consultant is also ultimately responsible for patient care and hterefore have a right to know if you are struggling, as this may affect patient care.
Arriving early and taking time off sick do not address the problem. -
This question is part of the following fields:
- Clinical Sciences
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Question 22
Incorrect
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A 4-year-old boy is admitted to the hospital after developing hemarthrosis in his right knee whilst playing in the garden. Following blood results are obtained: Plts: 220 x 10^9/L, PT: 11 secs, APTT: 76 secs, Factor VIIIc activity: Normal. What is the most likely diagnosis?
Your Answer:
Correct Answer: Haemophilia B
Explanation:A grossly elevated APTT may be caused by heparin therapy, haemophilia, or antiphospholipid syndrome. A normal factor VIIIc activity, however, points towards the diagnosis of haemophilia B, which is the deficiency of factor IX in the blood.
Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is due to the deficiency of clotting factor VIII and is more common than haemophilia B, accounting for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.
Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).
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This question is part of the following fields:
- Haematology & Oncology
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Question 23
Incorrect
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Which is NOT a poor prognostic factor for patients with malignant melanoma?
Your Answer:
Correct Answer: Diameter of melanoma > 6 mm
Explanation:Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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A 22-year-old man presents with red and flaky patches at the corners of his mouth. Upon examination, angular cheilitis is diagnosed. Anamnesis reveals a history of excessive drinking and malnutrition. What is the most probable deficiency responsible for his condition?
Your Answer:
Correct Answer: Vitamin B2 deficiency
Explanation:Riboflavin, vitamin B2, is a water-soluble and heat-stable vitamin that the body uses to metabolize fats, protein, and carbohydrates into glucose for energy. Riboflavin deficiency can cause fatigue, swollen throat, blurred vision, and depression. It can affect the skin by causing skin cracks, itching, and dermatitis around the mouth. Hyperaemia and oedema around throat, liver degeneration, and hair loss can also occur along with reproductive issues. Usually, people with riboflavin deficiency also have deficiencies of other nutrients. In most cases, riboflavin deficiency can be reversed unless it has caused anatomical changes such as cataracts.
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This question is part of the following fields:
- Clinical Sciences
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Question 25
Incorrect
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A patient shows reduced central vision upon visual acuity test. He is advised to undergo a fundoscopy, which turns out to be normal. Which drug could be responsible for his symptoms?
Your Answer:
Correct Answer: Corticosteroids
Explanation:Corticosteroids are well known for their ocular complications such as glaucoma and cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 26
Incorrect
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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.
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This question is part of the following fields:
- Neurology
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Question 27
Incorrect
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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.
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This question is part of the following fields:
- Nephrology
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Question 28
Incorrect
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A 52-year-old woman is being reviewed in the oncology clinic following debulking surgery one month ago. She is a known case of primary peritoneal cancer with two liver metastases and has now come in for review prior to adjuvant chemotherapy. During her chemotherapy, which of the following tumour markers would be the most appropriate to monitor her disease progression?
Your Answer:
Correct Answer: CA 125
Explanation:Tumour marker CA 125 is mostly associated with primary peritoneal cancer and ovarian cancer. It can be used to monitor response to chemotherapy, alongside regular CT scans.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 29
Incorrect
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A patient with chronic renal failure, treated with regular haemodialysis, attends the renal clinic. He has been treated for six months with oral ferrous sulphate, 200 mg three times a day. His haemoglobin at this clinic attendance is 7.6. His previous result was 10.6 six months ago. Which of the following is the most appropriate treatment?
Your Answer:
Correct Answer: IV iron and subcutaneous erythropoietin
Explanation:The patient should be prescribed IV iron and subcutaneous erythropoietin to enhance erythropoiesis to address the dropped haemoglobin.
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This question is part of the following fields:
- Nephrology
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Question 30
Incorrect
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A 54-year-old woman, with a long history of inflammatory bowel disease presents to his GP with abnormal liver function tests. She has a raised alkaline phosphatase level but no symptoms of liver disease. Which of the following options is the best set of investigations to confirm the diagnosis?
Your Answer:
Correct Answer: MRCP and liver biopsy
Explanation:In a patient with abnormal LFTs and UC, think primary sclerosing cholangitis (PSC). MRCP and liver biopsy is the best answer. MRCP will show classically beads on a string – intra and extrahepatic stricturing and dilation. Remember this finding!! Liver biopsy is required for official diagnosis (need tissue!).
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This question is part of the following fields:
- Gastroenterology
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SESSION STATS - PERFORMANCE PER SPECIALTY
