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Question 1
Incorrect
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A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a BP of 160/90mmHg and proteinuria++ revealed a decrease in size of the kidneys with smooth borders and normal pelvic calyceal system. What is the cause of hypertension in the patient?
Your Answer: Bilateral renal artery stenosis
Correct Answer: Chronic glomerulonephritis
Explanation:Causes of hypertension in bilateral renal artery stenosis are as follows: 90% probable cause is atherosclerosis with manifestations of CAD, TIA or stroke. The other less common cause is fibromuscular dysplasia that includes carotid and vertebral artery with manifestations of headache, TIA, and stroke.
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This question is part of the following fields:
- Gastrointestinal
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Question 2
Correct
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A woman suffering from severe psoriasis has been undergoing treatment for it for the last 3 years. She now presents with lethargy and dizziness. Her blood film shows large red blood cells. What is the cause of these symptoms in this woman?
Your Answer: Methotrexate
Explanation:Methotrexate is also known as a DMARD (Disease Modifying Anti Rheumatic Drug). It reduces inflammation and suppresses the immune system, and is thought to cause folic acid deficiency leading to megaloblastic anaemia.
NSAIDS and Sulfasalazine are known to cause haemolytic but not megaloblastic anaemia.
Chronic disease might be accompanied with normocytic or microcytic anaemia as opposed to the macrocytic anaemia this patient is suffering from.
Steroids are not known to cause anaemia. -
This question is part of the following fields:
- Pharmacology
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Question 3
Incorrect
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Which among these are the most prevalent organic causes of anxiety symptoms?
Your Answer: Phaeochromocytoma
Correct Answer: Hypoglycaemia
Explanation:The more common anxiety causes that are organic include: paroxysmal supraventricular tachycardias, withdrawal from alcohol or with thyroxine, and drug intoxication. Pheochromocytoma is rare. Anxiety is not caused by carcinoid syndrome, whereas, depression is most likely caused by carcinoma of the bronchus and hyperparathyroidism.
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This question is part of the following fields:
- Mental Health
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Question 4
Correct
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A 61-year-old man presents post seizure. On examination, he is oriented and alert with hyper-reflexia of the left arm, and inattention on the left side of the body. What is the most probable diagnosis?
Your Answer: Cerebral tumour
Explanation:Brain tumour symptoms include gradual paralysis on one side of the body, extreme headaches, and seizures. Hyperreflexia is defined as overactive reflexes including twitching or spastic tendencies, which are indicative of upper motor neuron disease.
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This question is part of the following fields:
- Neurology
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Question 5
Correct
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Which of the following serum tumour markers is the most essential for monitoring the clinical progression of a man with teratoma of the testis following chemotherapy?
Your Answer: Alpha-fetoprotein
Explanation:Testicular teratomas are best monitored with the following tumour markers: Alpha-fetoprotein (AFP), beta-hCG, and PLAP (placental like isoenzyme of alkaline phosphatase). For ovarian tumours, we use CA125, pancreatic tumours we use CA19-9, CA15-3 for breast carcinoma and carcinoembryonic antigen (CEA) for colonic tumours.
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This question is part of the following fields:
- Urology
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Question 6
Correct
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A 6 month old child was brought in after choking on a foreign body, which had resulted in the child having difficulty breathing. The best possible site for the incision would be?
Your Answer: Cricoid cartilage
Explanation:Cricothyroidectomy is done in life threatening condition, where an incision is made in cricothyroid membrane to establish a patent airway.
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This question is part of the following fields:
- ENT
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Question 7
Correct
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A 40-year-old male presented to the OPD complaining of dysphagia. General physical examination revealed creamy white patches on the tongue as well as on the inner side of the cheeks. There was slight bleeding when an attempt was made to scrape off the white patches. What is the most likely diagnosis in this case?
Your Answer: Candida albicans
Explanation:Candida Albicans is a pathogenic yeast which forms a thrush in the oral cavity. Candida also causes infection in the oesophagus, known as oesophageal candidiasis, that can manifest as dysphagia.
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This question is part of the following fields:
- ENT
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Question 8
Correct
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An 18 year old boy was admitted with severe pain and swelling of his scrotum following a kick to the groin. What is the most appropriate management that can be done at this stage?
Your Answer: Exploratory surgery
Explanation:The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.
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This question is part of the following fields:
- Seriously Ill
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Question 9
Incorrect
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A 40-year-old female presented with chronic pelvic pain for 6 months, which was aggravated by standing and walking. The pain was worst at the end of the day, during the pre-menstrual period and following sexual intercourse. Which of the following can be the most likely cause of this presentation?
Your Answer: Endometriosis
Correct Answer: Pelvic congestion syndrome
Explanation:The pelvic pain which is aggravated by changes in posture, during the pre menstrual period and towards the end of the day favours the diagnosis of pelvic congestion syndrome. Pelvic congestion syndrome is a condition of pelvic varicosities in women with unexplained pelvic pain. PID, endometriosis and adenomyosis are causes for chronic pelvic pain but they don’t match with the given clinical picture.
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This question is part of the following fields:
- Genitourinary
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Question 10
Incorrect
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Cytochrome p450 enzymes expressed in hepatocytes serve to?
Your Answer: Facilitate phase 2 of liver drug metabolism.
Correct Answer: Facilitate oxidations or hydrolysis of drugs.
Explanation:Cytochrome p 450 are a family of proteins involved in drug metabolism which accounts for about 75% of the total metabolism. Most drugs are deactivated directly or by facilitated excretion from the body.
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This question is part of the following fields:
- Hepatobiliary
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Question 11
Incorrect
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Regarding haemochromatosis, which of the following is true?
Your Answer: Haemochromatosis is an autosomal dominant condition
Correct Answer: Haemochromatosis may be treated with therapeutic phlebotomy
Explanation:Haemochromatosis is an abnormally high rate of the production of haemoglobin. It is an autosomal recessive disease copied on chromosome 6. It is associated with hepatic disorders, cardiac diseases and skin pigmentation. It is treated by regular venesection.
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This question is part of the following fields:
- Haematology
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Question 12
Correct
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A 70-year old man presents with difficulty speaking and has a history of weakness in his facial muscles, as well as in his right arm and leg. What is the most appropriate prophylactic regimen in this case?
Your Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
Explanation:Left-sided hemiparesis along with slurred speech are strong indications of stroke in the right cerebral hemisphere. This occurs due to poor blood flow to the brain from the heart. Aspirin 300mg has analgesic, antipyretic, and anti-inflammatory properties that can address the acute symptoms of stroke like migraine and neuralgic pain. With a reduced dose of 75mg of Aspirin, its anti-platelet effect can inhibit further thrombus formation and prevent another stroke. Dipyridamole 200mg is an anti-coagulant preventing clot formation in the blood.
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This question is part of the following fields:
- Pharmacology
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Question 13
Correct
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A 6 month old infant has developed jaundice from breast milk. He is otherwise healthy with no signs of dehydration. His LFTs will most likely show which of the following pattern?
Your Answer: Total bilirubin: 40, conjugated bilirubin < 5%
Explanation:Breast milk jaundice is a type of jaundice associated with breast-feeding. It typically occurs one week after birth. The condition can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It’s safe to continue breast-feeding.
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This question is part of the following fields:
- Mental Health
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Question 14
Correct
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A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?
Your Answer: Hyponatremia
Explanation:In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.
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This question is part of the following fields:
- Genitourinary
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Question 15
Incorrect
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A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?
Your Answer: Proceed with standard immunization schedule
Correct Answer: Defer immunization for two weeks
Explanation:Vaccines should not be given to a feverish child.
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This question is part of the following fields:
- Child Health
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Question 16
Incorrect
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A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?
Your Answer: Abdominal US
Correct Answer: Serum B-HCG
Explanation:The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.
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This question is part of the following fields:
- Gynaecology
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Question 17
Correct
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A 4 year old boy is wetting his bed at night or whenever he gets excited. His parents are concerned. What is the best strategy?
Your Answer: Behavioural therapy
Explanation:Generally, bed-wetting before age 7 isn’t a concern as the child may still be developing night-time bladder control. The child is less than 5 years and most children will outgrow bed-wetting on their own. Therefore only reassurance and behavioural therapy are suggested at this stage.
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This question is part of the following fields:
- Child Health
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Question 18
Incorrect
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Cocaine abuse has many serious side effects. Which of the following is not a notable side effect of chronic cocaine abuse?
Your Answer: Hypersomnia
Correct Answer: Hyponatraemia
Explanation:Chronic cocaine abuse can produce many serious side effects such as erectile dysfunction, ejaculatory dysfunction, hypersomnia, anxiety, hallucinations etc.
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This question is part of the following fields:
- Seriously Ill
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Question 19
Correct
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A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Rheumatology
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Question 20
Correct
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A 39-week pregnant patient presents with acute epigastric pain and general signs of malaise. She has a normal body temperature but clinical examination shows RUQ tenderness. Blood tests revealed a mild anaemia, high liver enzyme values, low platelets and haemolysis. What is the most possible diagnosis?
Your Answer: HELLP syndrome
Explanation:HELLP syndrome stands for haemolysis, elevated liver enzyme levels, and low platelet levels and is a very severe condition that can happen during pregnancy. Management of this condition requires immediate delivery of the baby.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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A 30 year old previously well male presented with dysuria and lower abdominal pain. He also complained of passage of air bubbles when he urinated. His urine sample had faecal matters. The abdomen was soft with mild suprapubic tenderness. Which of the following is the most likely pathology?
Your Answer: Crohn's disease
Explanation:Passage of faecal matters in the urine is suggestive of a fistula. Crohn’s disease is the most common cause of an ileovesical fistula. The diagnostic features of a fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Cystoscopy will confirm the diagnosis.
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This question is part of the following fields:
- Colorectal
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Question 22
Correct
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A young boy presents with a soft swelling in the midline neck that moves with tongue protrusion. The swelling is present between the thyroid cartilage and the tongue. Which of the following is the most likely diagnosis?
Your Answer: Thyroglossal cyst
Explanation:The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during the developmental stages.
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This question is part of the following fields:
- Mental Health
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Question 23
Incorrect
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A 45 year old male suffers multiple injuries in a road traffic accident. He complains of inability to urinate for the past 4 hours. Radiological examination reveals a fractured pelvis. Which of the following will be the most appropriate step in the management of this patient?
Your Answer: Urethral catheter
Correct Answer: Suprapubic catheter
Explanation:When faced with urethral trauma, initial management decisions must be made in the context of other injuries and patient stability. These patients often have multiple injuries, and management must be coordinated with other specialists, usually trauma, critical care, and orthopaedic specialists. Life-threatening injuries must be corrected first in any trauma algorithm. Initial emergent treatment remains controversial, but mainstays of therapy include drainage of the urinary bladder, often with placement of a suprapubic catheter (SPT) and primary endoscopic realignment of the urethra if possible.
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This question is part of the following fields:
- Genitourinary
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Question 24
Incorrect
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An 86 year old woman accidentally inhaled her hearing aid due to her advanced Alzheimer's dementia. Upon clinical examination, her respiratory rate is found to be 35, and thus a bronchoscopy is recommended. According to which of the following would you obtain consent for this patient?
Your Answer: If the mini mental score is above 20/30, consent can be taken from patient
Correct Answer: The procedure does not require a written consent
Explanation:This is an emergency case regarding a patient with impaired cognitive functioning. This is why the procedure does not require a written consent. In any other case where the patient has a normal mental capacity, the consent would be obtained as an informed written consent. In this case however, the suggested procedure is almost a matter of life and death, the doctor being required to act on behalf of the patient to her optimal advantage. Under English law no other person can consent to treatment on behalf of an adult, though it is desirable that next of kin are consulted before treating an adult without consent. Recent legislation gives legal authority to people appointed by the patient, or by the state, or a relative or carer, to consent (or refuse) on behalf of the patient. A mini-mental score may not adequately identify those unable to give consent.
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This question is part of the following fields:
- Older Adult
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Question 25
Correct
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Osteopetrosis occurs as a result of a defect in:
Your Answer: Osteoclast function
Explanation:It is a metabolic bone disease caused by defective osteoclastic resorption of immature bone. Osteopetrosis is also known as marble bone disease. Osteoclasts are unable to adequately acidify bone matrix. Impaired bone resorption leads to overly dense bone that is more likely to fracture. It is usually treated with bone marrow transplant and high dose calcitriol.
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This question is part of the following fields:
- Rheumatology
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Question 26
Incorrect
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A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting for 6 days. What is the appropriate initial investigations?
Your Answer: CBC
Correct Answer: Urea and electrolytes
Explanation:The most commonly requested biochemistry tests for renal function are the urea and electrolytes. They supply important information when it comes to homeostasis and excretion. Glomerular filtration rate is also the essential standard marker of kidney health and is assessed by checking the creatinine levels. In this case as the child has lost fluids and electrolytes, this test will indicate the extent of the loss and allow for more appropriate replacement.
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This question is part of the following fields:
- Child Health
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Question 27
Correct
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A 32 year old female has had an episode of a severe occipital headache. This is accompanied by vomiting and unconsciousness. She has been taken to the emergency department, where she is conscious and completely alert. Her pulse is normal and no abnormal neurological signs are found. From the list of options, choose the next step in her treatment.
Your Answer: CT brain
Explanation:Severe headaches and LOC can be caused by basilar migraines (but here the patient has no neurological deficit and becomes completely alert when recovering from unconscious periods). In order to diagnose basilar migraines, there needs to be a history of at least two other migraine attacks with an aura. The diagnostic criteria of a basilar migraine are not fulfilled and so the patient must not be discharged without a CT scan (or MRI).
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 33 year old lady presented with complaints of heavy menstrual bleeding. She is otherwise well and her US abdomen is normal. What is the best treatment option?
Your Answer: Tranexamic acid
Correct Answer: Mirena coil
Explanation:Mirena coil is used for contraception and for long term birth control. It causes stoppage of menstrual bleeding however, in a few cases there may be inter-menstrual spotting.
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This question is part of the following fields:
- Gynaecology
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Question 29
Correct
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A 34 year old man is complaining of painful vesicles around his right ear. Upon examination he has a facial palsy and the vesicles extend towards his tympanic membrane. Hypoacusis is also present. Choose the most likely diagnosis.
Your Answer: Ramsay-Hunt syndrome
Explanation:Ramsay-Hunt syndrome or herpes zoster oticus presents with painful vesicles which affect the facial nerve and induce hearing loss in the affected ear.
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This question is part of the following fields:
- ENT
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Question 30
Correct
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A 4-year-old boy presents with offensive stool, clubbing of fingers, and recurrent chest pain. Choose the single most appropriate investigation?
Your Answer: Sweat test
Explanation:Cystic fibrosis is a progressive, genetic disease. A defective gene causes a thick, sticky build-up of mucus in the lungs, pancreas, and other organs. In the lungs, the mucus clogs the airways and traps bacteria leading to infections, extensive lung damage, and eventually, respiratory failure. In the pancreas, the mucus prevents the release of digestive enzymes that allow the body to break down food and absorb vital nutrients. Since the digestive enzymes are not being made, the food is not completely digested making them bulky, smelly, and hard to flush away. Finger clubbing is a prominent feature of cystic fibrosis on most patients.
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This question is part of the following fields:
- Child Health
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Question 31
Correct
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A 31 year old female complains of bilateral proximal muscle weakness. There is marked blanching of fingers especially in response to cold weather. Lab results are as follows: Anti Jo-1: positive ANA: positiveCK: 2000 U/LESR: 60mm/hrEMG: myopathic changesPresence of which of the following signifies the worst prognosis?
Your Answer: Interstitial lung disease
Explanation:Polymyositis is an inflammatory disorder causing symmetrical, proximal muscle weakness. It is thought to be a T-cell mediated cytotoxic process directed against muscle fibres. It may be idiopathic or associated with connective tissue disorders. It may also be associated with malignancy for example small cell lung carcinoma.
Dermatomyositis is a variant of the disease where skin manifestations are prominent, for example a purple (heliotrope) rash on the cheeks and eyelids.
It typically affects middle-aged, female: male 3:1. Features include proximal muscle weakness +/- tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia, dysphagia, dysphonia. Investigations: elevated creatine kinase, other muscle enzymes (lactate dehydrogenase (LD), aldolase, AST and ALT) are also elevated in 85-95% of patients, EMG, muscle biopsy. Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever. Interstitial lung disease plays a major role in morbidity and mortality in patients with polymyositis and is considered a major risk factor for premature death in patients with myositis. -
This question is part of the following fields:
- Rheumatology
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Question 32
Correct
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Which is true of the composition of bile in the human hepatic duct?
Your Answer: Contains only actively secreted substances
Explanation:Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.
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This question is part of the following fields:
- Hepatobiliary
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Question 33
Incorrect
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A smoker male presenting with weight loss is found to have a normal chest x-ray but a positive sputum cytology for carcinomatous cells. Which of the following would be the likely TNM classification?
Your Answer: T1, N0, M0
Correct Answer: TX, N0, M0
Explanation:The TNM system is a means to describe the amount and spread of cancer in a patient’s body. T describes the size of the tumour and any spread of cancer into nearby tissue; N describes spread of cancer to nearby lymph nodes; and M describes metastasis (spread of cancer to other parts of the body).
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This question is part of the following fields:
- Respiratory
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Question 34
Correct
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A 62 year old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?
Your Answer: Blood sugar
Explanation:People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
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This question is part of the following fields:
- Endocrine
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Question 35
Incorrect
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Regarding cranial nerves, which of the following statements is true?
Your Answer: The oculomotor nerve supplies the dilator pupillae muscle
Correct Answer: The vagus nerve supplies the palatal muscles
Explanation:In addition to the pharynx and larynx, the vagus nerve also innervates the palatoglossus of the tongue, and the majority of the muscles of the soft palate.
The lacrimal gland is supplied by the facial nerve.
The glossopharyngeal nerve supplies the parotid salivary gland controlling salivary secretions.
The oculomotor nerve carries parasympathetic efferents to the sphincter pupillae muscle and innervates the superior rectus.
The optic nerve carries sympathetic postganglionic fibres to the dilator pupillae muscle.
The trochlear nerve supplies the superior oblique muscle. -
This question is part of the following fields:
- Neurology
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Question 36
Correct
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A 28-year-old woman is involved in a cycling accident. She has severe pain and swelling of her right upper leg. An x-ray confirms a fracture of neck of fibula. What is the most common associated nerve injury?
Your Answer: Lateral peroneal nerve
Explanation:Lateral peroneal nerve, also known as the superficial peroneal nerve.
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This question is part of the following fields:
- Musculoskeletal
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Question 37
Correct
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A 43 year old man with hemochromatosis presents with a painful and swollen right knee. X-ray shows extensive chondrocalcinosis but no fracture. Given the most likely diagnosis, which of the following would be present in the joint fluid aspirate?
Your Answer: Positively birefringent rhomboid-shaped crystals
Explanation:Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Arthrocentesis should be performed, especially in acute cases.
Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals.
Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils.
X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis).
Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected. -
This question is part of the following fields:
- Rheumatology
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Question 38
Correct
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A 4-year-old child is referred to the chest clinic due to recurrent chest infections. The mother says she has a productive cough with greenish sputum. Chest x-ray shows multiple ringed shadows and thickening of the bronchial walls at both bases. The most appropriate diagnosis is?
Your Answer: Bronchiectasis
Explanation:The x-ray is suggestive of bronchiectasis. The most probable aetiology especially considering recurrent chest infections at such a young age is cystic fibrosis.
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This question is part of the following fields:
- Respiratory
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Question 39
Correct
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A 28 year old man was rushed to the hospital after experiencing sudden onset chest pain while playing football. He has never felt such pain in the past. However, one of his uncles had a similar sudden discomfort at a young age and he passed away following a heart problem. The following vitals are recorded on examination:BP: 101/74 mmHgRR: 22 breaths/minPR: 87 beats/min Physical examination reveals abnormally long fingers and on asking the man to hold the opposite wrist, the thumb and little finger overlap each other. He is not taking any medication regularly and past medical/surgical history is not significant. He admits to smoking half pack of cigarettes/day for the last 10 years but denies abusing any illicit drugs. Which of the following explanation most likely explains the disease process in this man?
Your Answer: A defect of the glycoprotein structure which usually wraps around elastin
Explanation:Aortic dissection is defined as separation of the layers within the aortic wall. Tears in the intimal layer result in the propagation of dissection (proximally or distally) secondary to blood entering the intima-media space. This can be caused as a result of both congenital or acquired factors like chronic uncontrolled hypertension. This patient shows no sign of hypertension but his physical examination hints towards Marfan Syndrome. Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting the microfibrils and elastin in connective tissue throughout the body. MFS is associated with pathological manifestations in the cardiovascular system (e.g., mitral valve prolapse, aortic aneurysm, and dissection), the musculoskeletal system (e.g., tall stature with disproportionately long extremities, joint hypermobility), and the eyes (e.g., subluxation of the lens of the eye). Decreased collagen production occurs in ageing, hydroxylation defects are present in vitamin C deficiency, copper deficiency affecting lysyl oxidase enzyme occurs in Menke’s disease.
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This question is part of the following fields:
- Rheumatology
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Question 40
Correct
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A 50-year-old woman presents with coughing up copious sputum with blood streaks, increased breathlessness, and finger clubbing. She has a history of chronic cough. What is the initial investigation?
Your Answer: Chest x-ray
Explanation:Finger clubbing and past history suggest a chronic pulmonary process going on. A CXR will allow the pathology to be visualised including any infective or cancerous causes.
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This question is part of the following fields:
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
