2020 Set A Flashcards
(56 cards)
3
A female patient (in her 30s) presents with weight loss, diarrhea and some other symptoms of carcinoid syndrome. CT abdomen found a mass in her distal pancreas with multiple liver nodules. Which of the following is true?
A. The most common site of neuroendocrine tumour is the pancreas
B. The mass has likely originated first in the liver
C. Resection of the pancreatic tumour is indicated to prevent carcinoid syndrome
D. Somatostatin analogue (eg. octreotide) is indicated for symptoms of diarrhea and flushing
E. 5-HIAA >1000 is diagnostic of this condition
In this case, we are dealing with a female patient exhibiting symptoms consistent with carcinoid syndrome, alongside imaging findings of a mass in the distal pancreas and multiple liver nodules. Let’s analyze the options provided to determine which statement is true.
Option Analysis:
A. The most common site of neuroendocrine tumour is the pancreas
- False. Although pancreatic neuroendocrine tumors (PNETs) are significant, the most common site for neuroendocrine tumors is the gastrointestinal tract, particularly the small intestine.
B. The mass has likely originated first in the liver
- False. Carcinoid tumors typically arise from neuroendocrine cells in the gastrointestinal tract and can metastasize to the liver. In this case, the mass is in the pancreas, which suggests it is the primary tumor. Therefore, it is more likely that the pancreatic mass is primary, and the liver nodules are secondary metastases.
C. Resection of the pancreatic tumour is indicated to prevent carcinoid syndrome
- Partially True but Misleading. While resection of the primary tumor can alleviate symptoms in some cases, the presence of liver metastases complicates the situation. Resection may not prevent carcinoid syndrome if the liver metastases continue to secrete hormones.
D. Somatostatin analogue (eg. octreotide) is indicated for symptoms of diarrhea and flushing
- True. Somatostatin analogues like octreotide are commonly used to manage symptoms of carcinoid syndrome, such as diarrhea and flushing. They inhibit hormone secretion from neuroendocrine tumors and can significantly improve the patient’s quality of life.
E. 5-HIAA >1000 is diagnostic of this condition
- False. While elevated levels of 5-Hydroxyindoleacetic acid (5-HIAA) can indicate carcinoid syndrome, the threshold for diagnosis typically is >50 µg/24 hours in urine, not specifically >1000. High levels may suggest more severe disease but are not a strict diagnostic criterion.
Conclusion:
The correct answer is D. Somatostatin analogue (eg. octreotide) is indicated for symptoms of diarrhea and flushing. This option aligns with the current understanding of the management of carcinoid syndrome, where symptom relief is prioritized, particularly for diarrhea and flushing, which are common symptoms in these patients.
If you have any further questions or need clarification on any part of this case, feel free to ask!
8
An elderly man collapsed at home, regained consciousness and was sent to the A&E. At A&E, he collapsed again. ECG shows monomorphic VT. what is your management?
A. Adenosine
B. Amiodarone
C. Temporary pacing
D. Cardioversion
E. Carotid massage
In the scenario presented, an elderly man has collapsed twice and is found to have monomorphic ventricular tachycardia (VT) on ECG. The management of monomorphic VT depends on the patient’s hemodynamic stability and the presence of symptoms. Since the patient collapsed, we can infer that he is likely unstable, warranting immediate intervention.
Option Analysis:
A. Adenosine
- Not Suitable. Adenosine is primarily used for the treatment of paroxysmal supraventricular tachycardia (SVT) and is not effective for monomorphic VT. It also may have limited efficacy in unstable patients.
B. Amiodarone
- Considered but Not First-Line in Unstable VT. Amiodarone is an antiarrhythmic that can be used to treat monomorphic VT, particularly in stable patients. However, in the case of unstable VT, immediate intervention is required before considering medications.
C. Temporary pacing
- Not First-Line. Temporary pacing may be indicated in certain bradyarrhythmias or in cases of symptomatic heart block, but it is not the first-line treatment for monomorphic VT.
D. Cardioversion
- Correct Choice. Synchronized cardioversion is the appropriate management for unstable monomorphic VT. It provides an immediate restoration of normal sinus rhythm, especially in a patient who has collapsed and is likely experiencing hemodynamic instability.
E. Carotid massage
- Not Appropriate. Carotid massage is typically used for certain forms of SVT but is not appropriate for monomorphic VT, especially in an unstable patient.
Conclusion:
The correct management in this situation is D. Cardioversion. This intervention is critical for restoring normal heart rhythm and ensuring the patient’s hemodynamic stability. In cases of unstable VT, immediate synchronized cardioversion is essential to prevent further complications.
If you have further inquiries about this case or any related topics, please feel free to ask!
- Old woman presented with gallop heart sound (S1 S2 S3), systolic murmur over the mitral area and a deviated apex. Chest X-ray showed cardiac enlargement. What is the likely diagnosis:
A) dilated cardiomyopathy
B) hypertrophic cardiomyopathy
C) constrictive cardiomyopathy
D) ischaemic cardiomyopathy
E) stress-induced cardiomyopathy
12 Middle age woman presented with APO & exertional dyspnea. She describes features of typical angina. Previously can walk some stairs, now only one block. ECG show inverted T waves over inferior leads. No pain on resting. What’s the most likely diagnosis?
A. Chronic exertional angina
B. Dressler’s syndrome
C. Coronary artery spasm
D. Unstable angina
E. Subendocardial infarction
- A 65 man with hepatocarcinoma. Sorafenib was given for systemic treatment. One week later, he developed painful erythematous vesicles on his palm and feet. What is the likely diagnosis?
A. Allergic skin reaction
B. Pemphigoid
C. Paraneoplastic syndrome
D. Herpes Simplex disease
E. Hand foot skin disease due to sarafenib
- Which of the following drugs does not require dosage adjustment in renal disease?
A. Digoxin
B. Fenofibrate
C. Atorvastatin
D. Sitagliptin
E. Vancomycin
- A middle age gentleman with DM is currently taking SGLT-2 inhibitor, insulin, gliptin and metformin. He is admitted because of severe dehydration and drowsiness. BG normal with pH<7.2. What is most likely cause of this presentation?
A. SGLT2 inhibitor
B. Insulin
C. Gliptins
D. GLP-1 agonist
E. Pioglitazone
- A 64 years-old gentleman with DM taking SGLT-2 inhibitor, insulin, metformin… He will have a colonoscopy which he needs to have 2 days of low fibre diet and bowel preparation with PEG. What is the most appropriate action to take before the colonoscopy?
A. Stop SGLT-2 inhibitor 2 days before the colonoscopy
B. Reduce the dose of insulin
C. Advise him to drink plenty of water before and after the colonoscopy
D. Increase the frequency of glucose monitoring before the colonoscopy
E. Stop metformin 2 days before the colonoscopy
- Which of the following has the least drug drug interaction?
A. Ciprofloxacin
B. Verapamil
C. Erythromycin
D. Rifampicin
E. Augmentin
- A 36-year-old man developed refractory seizures and multi-organ failure, suspected to be caused by rodenticides poisoning. Which of the followings is the most likely culprit?
A. Bromodialone
B. Cholecalceferol
C. Tetramine
D. Fluoroacetamide
E. Thallium
- A man was given uric acid-lowering therapy. 5 days later start to have rash start from trunk spread to legs. Has facial edema, febrile. Examination shows non-blanchable patches and plaque everywhere. Nikolsky sign negative. Involve around 40-50% of the body. Elevated eosinophil on the blood test. Most likely DX:
A. Erythema multiforme
C. TEN
D. Measles infection
E. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
35
Man with GPH has a few episodes of itchy rashes on his arms which subside spontaneously after a few hours without consequences. What is the likely dx?
A. Insect bite
B. Acute Urticaria
C. Chronic urticaria
D. Angioedema
E. Contact dermatitis
38
A man presented with lethargy and ask for the suitable investigation ?
A) thyroid function test
B) (sorry really no time to memorise other ans before the paper was taken away 🙈)
42
Guy with SIADH after thoracotomy for lung cancer
A) iv 0.45saline
B) iv 0.9 saline
C) restrict fluid to 800ml/day
D) ct brain
E) petrosal sinus sampling
set A 45
presented with multiple neuroma, hx of hypertension
thyroid nodule
1. Medullary thyroid Ca
2. Papillary
3. Follicular
4. Anaplastic
5. Thyroid adenoma
Set A 47
Man with hypertension 180/100 , responded to Amlodipine BP back to 150/90. Serum noradrenaline elevated. MIBG scan arranged, what will be the management in the mean time?
A. Continue Amlodipine
B. Switch to phynoxybenzamine
C. Low salt diet
- Elderly with COPD, repeated admission for chest infection, BW 35kg height 1.5m, depressive. Which of the following is correct
A. His BMI is normal
B. Low albumin is not a poor prognostic factor
C. He will gain weight after hospital admission
D. He should be given more food
E. High risk for pressure sore
Set A Q53
Man presents with generalised pruritus, especially during the winter months. What is your advice?
a) topical steroids
b) topical emollients
c) investigate with LFT
d) give scabies treatment
e) sorry forgot the last one
- A 91yo lady with 3 year progressive dementia, recently worsened. paranoid ideation, will not allow family to go to sleep. Family considers institutionalizing her
What is the most appropriate treatment?
A. Benzodiazepine
B. Zopiclone
C. L-DOPA
D. Atypical antipsychotics
E. Haloperidol
- A 75 year old man was brought to the GP with progressive memory decline for 2 years. Short term memory was particularly affected. He occasionally sees strangers in his house that his family members do not see. What is the most likely diagnosis?
A. Alzheimer’s disease
B. Vascular dementia
C. Lewy body dementia
D. Creutzfeld Jacob disease
E. Frontotemporal dementia
- A 28 year old woman has recurrent bloody diarrhea and abdominal pain over the past year. PE: She has generalized tenderness of the abdomen but no rebound. Sigmoidoscopy: colitis from rectum to splenic flexure.
What is the most likely diagnosis?
A. Traveller’s diarrhea
B. Infective colitis
C. Ulcerative colitis
D. Crohn’s disease
E. Drug, toxin induced colitis
- A 42-year-old woman presents with an 8-month history of abdominal discomfort that is improved following defaecation. She complains of a regular change in her bowel habit, alternating between constipation and loose motions with water and mucus. On examination, her abdomen is soft and nontender. There are no obvious masses, and bowel sounds are present
A. diverticula disease
B. Crohn’s disease
C. irritable bowel syndrome
D. infective colitis
E. ulcerative colitis
- A 60-year old lady is admitted because of 2 episodes of vomiting fresh blood. BP 114/76 P 92 SaO2 93. Physical exam reveals jaundice, distended abdomen and flapping tremor. The best management is:
A. Propanolol
B. Endoscopic variceal ligation
C. Distal splenorenal stenting
D. TIPS
E. Sengstaken tube
- Jaundice, fever, high ALP and bilirubin
A. Acute cholecystitis
B. Hepatitis A
C. Acute cholangitis
