MRCP 1 Flashcards
(266 cards)
1
Q
On a CT scan of the thorax, which structure is found posteriorly (behind) to the left main bronchus?
A
Descending aorta
2
Q
What illicit drugs can cause drug induced psychosis?
A
Amphetamines
3
Q
The low or high Urine sodium suggest of SIADH?
A
High above 20 mmol/L
Low serum sodium and osmolality with raised urinary osmolality and urinary sodium above 20 mmol/L is diagnostic for SIADH.
4
Q
What is the antibodies for systemic sclerosis?
A
Anticentromere antibodies and antitopoisomerase I antibodies
CREST syndrome (calcinosis, Raynauds’ phenomenon, oeosophageal dysmotility, sclerodactyly, telangiectasia).
5
Q
AntiDNA antibodies are associated with
A
SLE
6
Q
Antimitochondrial antibodies are seen in
A
Primary biliary cirrhosis
7
Q
Antimyeloperoxidase antibodies are seen in
A
vasculitis (pANCA)
8
Q
What is the cause of a returning traveller with intermittent diarrhoea, strong smelling bowel gas and abdominal bloating? With Trophozoites in the fresh stool sample.
A
Giardiasis
A single dose of tinidazole or a course of metronidazole is the treatment of choice.
Schistosomiasis presents with rash as well as the above mentioned symptoms.
Shigellosis presents with blood stained diarrhoea.
Tropical sprue does not have Trophozoites present in the stool sample.
Whipple’s disease is caused by Tropheryma whipplei leading to GI upset and arthralgia.
9
Q
Lifestyle characteristic associated with IgA nephropathy
A
Alcohol excess
10
Q
A 45 man presented with night sweat, fatigue, weight loss, chronic cough, bilateral parotid swelling, uveitis, 7th facial nerve palsy. What is the cause?
A
Heerfordt’s syndrome is an acute presentation of sarcoidosis, which presents with fever, uveitis, swelling of the parotid and other salivary and lacrimal glands.
11
Q
45/F with 3 months Hx of sweat and weight gain. Sweat worsen in the morning with exercise and feels light-headed. What is the cause?
Glucagonomas / Insilinoma / pheochromocytoma
A
Insulinoma: weakness, memory loss, sweating, hunger, and weight gain.
Glucagonomas: hyperglycaemia, diarrhoea and a characteristic rash known as necrolytic migratory erythema.
Phaeochromocytoma: weight loss and hypertension
12
Q
STD: symptoms of gonorrhea and treatment
A
Symptom: Man urethritis and in women cervicitis or urethritis. Persistent urethral discharge
Ix: Gram negative intracellular Diplococci.
Tx: ceftriaxone, 250 mg as an intramuscular injection.
13
Q
STD: Symptoms and treatment of chlamydia trachomatis
A
Symptoms: non-specific urethritis (NSU), can coinfect with gonorrhea
Mx: either doxycycline or erythromycin for 7-14 days
14
Q
First line treatment of cirrhosis related large, symptomatic ascites v.s. small ascites
A
large, symptomatic ascites: large volume therapeutic paracentesis.
not sufficient to warrant paracentesis: first line treatment is dietary salt restriction (to no more than 90 mmol/day) and spironolactone.
15
Q
MoA of octreotide for treatment of acromegaly
A
Octreotide is a somatostatin analogue and directly inhibits growth hormone secretion through interaction with Stimulation of the somatostatin (SMS) receptor
It is also used in the treatment of neuroendocrine tumours such as carcinoid tumours again through interaction with somatostatin receptors.
16
Q
2025 Jan Q26
MoA of Pioglitazone
A
Enhance insulin sensitivity in peripheral tissues
17
Q
2025 Jan Q1
45/M with HT, DM, Obesity with nephrotic syndrome. What is the diagnosis ?
A
Focal and segmental glomerulosclerosis
18
Q
For primary TB, how long does tuberculin skin test become positive?
A
Between three weeks and three months after primary infection
Primary TB is usually asymptomatic with miliary TB most likely to occur in young children.
Pleural and pericardial infections (which can result in effusions) occur at or shortly after primary infection.
19
Q
What is Modified Duke Criteria for diagnosis of infective endocarditis?
A
Major
* +ve blood culture: S aureus, S bovis, HACEK group
* Echo: vegetation, abscess
Minor
* Predispose: IVDU
* Fever > 38C
* Vascular sign: Janeway lesion, septic PE
* Immune sign: Osler nodes
* +ve blood culture with organisms not included above
20
Q
Rice water colour watery painless diarrhea in returning traveller. What is the cause and what is the treatment?
A
Cholera
Tx: Doxycycline
21
Q
What are the 3 major characteristics of VIPoma?
A
Verner-Morrison syndrome
with watery diarrhoea,
hypokalemia, achlorhydria (unable to produce gastric acid due to gastric atrophy)
With a pancreatic mass (neuroendocrine tumour)
22
Q
Mortality in severe acute pancreatitis
A
20%
23
Q
What is the mechanism of methotrexate?
A
- an inhibitor of dihydrofolate reductase.
- acts by inhibiting purine synthesis
24
Q
What enzyme does Selegiline act on for additional treatment for parkinsonism?
A
Monoamine oxidase
Selegiline is a MAO-B inhibitor.
25
Where is the lesion when patient presents with an incongruous homonymous hemianopia?
Optic tract lesion prior to geniculate body
26
Where is the lesion if patient has a central scotoma?
Optic nerve damage (e.g. optic neuritis)
27
Where is the lesion if patient has homonymous superior quadrantanopia?
Temporal lobe lesion
28
Where is the lesion if patient has homonymous inferior quadrantanopia ?
parietal lobe lesion
29
Where is the lesion if patient has dense homonymous hemianopia with
macular sparing?
posterior occipital lobe lesion
30
A 58-year-old male presents with painful breast tissue. Six weeks previously he was treated for atrial fibrillation and had a number of drugs commenced. What drug cause this problem?
Spironolactone
* causes gynaecomastia
* spironolactone may be used if the patient is thought to be in heart failure in setting of AF
31
What drugs are contraindicated with sildenafil?
Nicorandil (nitrates): potentiate hypotensive effects of nitrates
32
# 2025 January Q2
A 50-year-old woman is referred with a two week history of difficulty walking and weakness in her arms.
On examination, there was proximal and distal limb weakness which was more marked in the legs than the arms. All tendon reflexes were absent and the plantar responses were flexor. There was no sensory loss.
Blood pressure in the supine position was 140/78 mmHg (lying) and was 110/70 mmHg on standing.
What is the most likely diagnosis?
Guillain-Barre: gradual development of ascending weakness with autonomic involvement.
33
# 2025 January Q3
24/F obese patient on OC pills presented with vertex headache and blurry vision. Fundoscopy revealed bilateral extensive papilloedema with a lot of flame shaped haemorrhages around and on the optic discs.
What is the best long term management of this patient?
This patient has idiopathic intracranial hypertension. The best long term management is weight reduction, which can improve her symptoms.
Changing the combined oral contraceptive pill to a more oestrogen based one can worsen the symptoms.
Lumbar puncture and acetazolamide can help improve the symptoms, but should not be considered as long term management.
34
# 2025 January Q4
CURB-65
* confusion
* urea >7 mmol/L
* respiratory rate ≥30/min
* blood pressure: systolic <90 or diastolic ≤60 mmHg, and age ≥65 years.
Tx
* Low severity CAP (CURB 0-1) can be treated with amoxicillin 500 mg TDS PO.
* CURB 2 CAP should be treated with amoxicillin 500 mg-1g TDS and clarithromycin 500 mg BD.
* High severity CAP (CURB 3-5) should be treated as soon as possible with co-amoxiclav 1.2 g TDS and clarithromycin 500 mg BD.
35
# 2025 January 5
Tx of class IV lupus nephritis
Cyclophosphamide and high-dose corticosteroids
Class IV lupus nephritis requires aggressive immunosuppression with high-dose corticosteroids and cyclophosphamide or mycophenolate mofetil to prevent progression to kidney failure.
36
# 2025 January Q6
Tx of bacterial meningitis in patients with penicillin allergy
Chloramphenicol
37
# 2025 January Q7
Treatment of progressive muscles weakness and bladder urge incontinence, underlying MND
Oral tolterodine: antimuscarinic agent that reduce bladder muscle contractions and decrease urinary frequency / urgency
38
# 2025 January Q8
In what phase of cell cycle does DNA replication occur?
S phase
39
# 2025 January Q9
Smoker with right upper lobe lung mass and high calcium. What is the most likely histological type?
Squamous cell carcinoma
* SCC: peripheral mass with hypercal
* SCLC: central mass with SIADH and ACTH
* AdenoCa: nonsmoker
* Carcinoid tumour: rare neuroendocrine tumor in lungs
40
Hepatiits B causes what kind of nephrotic syndrome?
Membranous glomerulonephritis
41
# 2025 January Q12
65/M construction site worker with 6 months history of SOBOE and dry cough. P/E: Digital clubbing and bibasal end inspiratory crackles.
What is the cause?
Asbestosis / Sarcoidosis / COPD
Asbestosis
* latency period can be several decades
* SOBOE and dry cough
* IPF has similar symptoms and P/E findings, but usually no occupational exposure and younger (~50yo)
42
# 2025 Jan Q13
34/F with left cheek recurrent rash. Erythematous scaly and sometimes itchy. Gets worse with sun exposure and improves when stay indoor. What is the cause?
Discoid lupus erythematosus
43
Organism that causes cat scratch disease (tender axillary LN with fever)
Bartonella hanselae
Tx: supportive
44
What is the common organisam causing impetigo, erysipelas, cellulitis
Streptococcus pyogenes (Group A Strept)
45
# 2025 Jan Q15
34/F 3 weeks Hx of neck pain, fever, fatigue with thyroid goitre.
Ix: Low TSH, high T4
What is the management?
NSAIDs
* Treat pain in subacute thyroiditis, a self limiting condition triggered by viral infection.
45
# 2025 Jan Q16
What is the genetic mechanism of disease with genetic abnormality on chromosome 4?
Trinucleotide repeat expansion
Huntington's disease
46
A 68-year-old woman with chronic kidney disease (CKD) stage 3b and heart failure is being managed on an angiotensin-converting enzyme (ACE) inhibitor and spironolactone. She has had multiple episodes of mild hyperkalaemia (serum potassium between 5.5 and 5.9 mmol/L). Despite dietary counselling and optimal diuretic therapy, her potassium levels remain elevated.
What is the most appropriate next step in the long-term management of her hyperkalaemia?
Add potassium binders, such as patiromer or sodium zirconium cyclosilicate, allow patients with chronic hyperkalaemia to continue RAAS inhibitor therapy by effectively lowering serum potassium levels.
47
A preterminal patient was given haloperidol for vomiting. Her husband has noticed she seems restless and cannot keep still. Why?
Haloperidol is a cause of drug-induced parkinsonism.
This can occur when drugs with dopamine receptor antagonist (D2) activity are initiated as antiemetics. Commonly used drugs which fall into this category include haloperidol, domperidone and metoclopramide.
48
A rheumatoid arthritis patient on methotrexate and biological DMARDS, presents with worsening pain and deformity in her right wrist, despite optimal medical management. What is the next step?
Refer for a specialist surgical opinion for possible joint replacement
Patients with rheumatoid arthritis who experience persistent pain, joint deformity, and loss of function despite optimal medical management should be referred for surgical intervention to improve function and prevent further joint damage.
49
A 60-year-old man with breathlessness, fever, and headache is suspected of having farmer's lung.
A CXR shows diffuse nodular shadowing predominantly in the mid and lower zones.
Which of the following would be the most useful diagnostic test?
Serum precipitating antibodies to Saccharopolyspora rectivirgula
Dx: Hypersensitivity pneumonitis
In farmer's lung, precipitins to Saccharopolyspora rectivirgula or Thermoactinomyces vulgaris are found in 75-100% of cases during an acute episode.
50
First line treatment of post-herpetic neuralgia
amitriptyline or pregabalin
51
What TB drugs cause gout?
Pyrazinamide
52
# 2025 January Q17
A patient come back from Oman presented with persistent diarrhea, night sweats, abdominal pain. What is the diagnosis?
Intestinal tuberculosis (Tips: come back from Oman)
Dx by CT showing bowel wall thickening, biopsy shows granuloma
53
# 2025 January Q19
Which nerve root is involved?
* Back pain radiate to lateral leg and dorsum of foot
* Weakness of foot dorsiflexsion and numbness
* Decrease strength of extensor hallucis longus
* Diminish sensation over 1st web space
L5
54
Which nerve root is affected?
* Weakness of hip adduction
* Numbness in upper thigh
L2
55
Which nerve route is involved?
* Quadricep affected
* Weakness in knee extension
* Numbness of knee
* Abnormal patellar reflex
L3
56
# 2025 January Q19
Which nerve route is affected?
* Weakness in knee extension and ankle dorsiflexion
* Numbness at medial leg
L4
57
# 2025 January Q19
Which nerve route is involved?
* Numbness at lateral foot and heel
* Weakness in plantarflexion
S1
58
# 2025 January Q20
What is the cardiac disease?
* Large V wave in JVP
* Holosystolic murmur at LLSB
Tricuspid regurgitation
59
Ejection systolic murmur best heard in aortic area, radiate to carotid neck.
What disease is that?
Aortic stenosis
60
A 28/M young man presenting with renal failure, haematuria and liver and renal masses. What is the cause and what cardiac disease is most likely associated?
Polycystic kidney disease
Mitral valve prolapse
Associated liver cysts are found in around 80% of individuals with polycystic kidney disease.
Up to 25% of patients may have some degree of mitral valve prolapse.
MODY 5 is associated with hepatic and renal cysts and diabetes mellitus, but that is less likely to be the diagnosis here in the presence of a normal glucose.
61
Which physiological change will directly contribute to increased Mean arterial pulse pressure?
Low aortic compliance
Pulse pressure is the difference between the systolic and diastolic pressure. If the aorta is less compliant (stiffer and less able to contract), there will be a higher systolic pressure and therefore increased pulse pressure.
Reduced stroke volume, high aortic compliance, reduced venous return, and reduced peripheral resistance all result in reduced pulse pressure.
62
Which of the following is the mechanism of action of ciprofloxacin?
Interference with DNA replication
63
# 2025 January Q21
A patient with Hx of CHF on furosemide presented with signs of volume depletion, Ix showed hypokalemia and metabolic alkalosis. Why?
Due to use of diuretic therapy (increase renal excretion of Na, Cl, K and water)
64
# 2025 January Q22
What is the MoA and side effect of methotrexate?
MoA: Dihydrofolate reductase inhibition
S/E: Pancytopenia, mucositis, alopecia due to decreased cell turnover
65
# 2025 Jan Q24
In cases of organ donation, what is the probablity that siblings are a complete HLA match?
25%
66
# 2025 January Q25
What med most likely cause prolong QT?
Amiodarone / Digoxin / furosemide / lisinopril / metoprolol
Amiodarone
67
# 2025 January Q27
Where is the location of stroke?
* Sudden onset left hemiplegia and difficult moving right eye laterally
* P/E: weakness of left arm and leg, and right eye cannot abduct past the midline
Right pons
* Right pons contain nuclei of CN 6 (control lateral rectus responsible for eye abduction) and CN 7 (facial nerve palsy)
68
Where is the location of stroke
* Right hemiplegia
* Cranial nerves not affected
Left frontal lobe
69
# 2025 January Q27
Where is the location of lesion?
* right homonymous hemianopia
Left occipital lobe
70
Where is the location of stroke?
* Left facial numbness
* Left cerebella ataxia
* Left eye ptosis
* Dysphagia, dysarthria, dysphonia
* Right UL and LL numbness
Left lateral medulla (affect CN 5,7,9,12)
71
# 2025 January Q28
A 5 year old boy presented with 3 days diarrhea then signs of meningitis. What is the causative agent?
Listeria monocytogenes
foodborne disease from contaminated dairy products
72
# 2025 January Q31
What is the best initial test to diagnose H pylori in a patient presented with crhonic epigastric pain and dyspepia?
Faecal antigen test: non invasice, high sensitivity and specificity
Serum antibody test cannot distinguish between past exposure and current active infection.
73
# 2025 Jan Q32
A coal miner presented with SOB and chronic cough.
P/E Find crackles at lung bases
CXR: diffuse small rounded opacities in upper lobes
What is the diagnosis?
Coal worker pneumonoconiosis (black lung disease)
74
# 2025 Jan Q33
A 62 year old man presented with persistent back pain, recurrent infection, hepatosplenomegaly.
Ix: Anaemia, ESR 75, Ca 2.87 (H)
What is the next step?
Serum protein electrophoresis to r/o multiple myeloma
75
# 2025 Jan Q34
MoA of dabigatran
Direct inhibition of thrombin
76
MoA of apixaban and rivaroxaban
Direct inhibition of factor Xa
77
MoA of enoxaparin
Indirect inhibition of factor Xa via antithrombin activation
Enoxaparin is a LMWH
78
MoA of Warfarin
Inhibit vitamin K depended clotting factors (II, VII, IX and X)
79
MoA of clopidogrel
Platelet adenosine diphosphate receptor blockade
80
# 2025 January Q35
Which coronary artery is most likely occluded?
* STE in lead II, III, aVF
Right coronary artery
Inferior myocardial infarction
81
Which coronary artery is most likely occluded?
* STE in lead V1-4
Left anterior descending artery: supplies anterior wall and septum of left ventricle
82
Which coronary artery is most likely occluded?
* STE in lead I, aVL, V5, V6
Left circumflex artery: supplied lateral and sometimes posterior wall of left ventricle, cause inferolateral or inferoposterolateral ischemia
83
Which coronary artery is most likely occluded?
* STE in lead V7-9
* Reciprocal STD in V1-3
Posterior descending artery
84
# 2025 January Q36
49/M with fatigue muscle weakness and recurrent kidney stones.
What is the most likely cause of his condition?
Bartter syndrome / Distal RTA (type 1) / Fanconi syndrome / Primary hyperaldosterodium / Type 4 RTA
Distal renal tubular acidosis (Type 1)
- Disorder of renal tubules, kidney failed to acidify urine due to reduced hydrogen ion excretion in distal tubule
- Leads to increase calcium excretion and hypercalcuria
- Causes: Autoimmune D (Sjogren syndrome); Drugs (lithium), renal disease (urinary tract obstruction); hypercalciuric condition ( hyperPTH)
Fanconi syndrome: Type 2 RTA leading to glycouria, phophaturia, hypoPO4
Primary hyperaldosterodium (Conn's syndrome): hypertension, hypoK
Type 4 RTA: Due to aldosterone deficiency, cause hyperK
85
Presented with bone pain, GI disturbance, fatique
Ix: hypercalcemia, low phosphate, high ALP
Primary hyperparathyroidism
Causes:
* Solitary parathyroid adenoma (~85%)
* Hyperplasia (~10-15%)
* Double adenomas (1-2%)
* Parathyroid carcinoma (~1%)
S/S: asymptomatic in ≥80%, classical ‘bones, stones, groans, psychic overtones’ picture rare
86
# 2025 Jan Q37
35/F presented with headache, dizziness, vision disturbances. FHx of RCC and brain tumours.
P/E: hypertension, cerevellar ataxia and retinal angiomas.
What is the genetic test to confirm the suspected diagnosis?
VHL gene analysis to diagnose VHL syndrome (develop multiple tumours and cysts in various organs)
Von Hippel-Lindau syndrome (VHL): Phaeochromocytoma, Clear cell renal cell carcinoma, cerebral haemangioblastoma
Multiple endocrine neoplasia-2 (RET): One gene, 3 syndromes
* MEN2A – Medullary thyroid carcinoma, phaeochromocytoma, primary hyperparathyroidism
* MEN2B – MTC, Phaeochromocytoma, Mucosal neuroma, intestinal ganglioneuroma, colonic
dysfunction, marfanoid habitus
* FMTC – Familial medullary thyroid carcinoma
87
What is the gene mutation related to MTC, Phaeochromocytoma, Mucosal neuroma, intestinal ganglioneuroma, colonic
dysfunction, marfanoid habitus
MEN 2B
88
What are the 3 diseases related to MEN 2A mutation?
1. Medullary thyroid carcinoma
2. Pheochromocytoma
3. Primary hyperparathyroidism
89
# 2025 January Q38
After blood transfusion in C section, woman presented with hypodention, fever, flank pain, haematuria.
What is the cause and what is the diagnostic test?
Haemolytic transfusion reaction
Ix: Direct antiglobulin test (direct Coombs test) to detect antibodies or comlement proteins attached to surface of RBC.
90
# 2025 January Q39
After thyroidectomy presented with hypocalcemia. What is the cause?
Hypoparathyroidism (complication of thyroidectomy)
91
# 2025 January Q39
Prost renal transplant for 6 months, presented with fever, reduce urine output, leucopenia, thrombocytopenia
CMV infection
92
# 2025 Jan Q43
45 min after ingesting 50 panadol. What is the next step?
Activated charcoal within 1h of injection
93
What is the antidote of benzodiazepine?
Flumazenil: a bennzodiazepine antagonist by competitive inhibition
94
# 2025 Jan Q44
Lateral elbow pain, exacerbated by wrist extension and gripping activities
Tennis elbow (lateral epicondylitis)
95
Treatment of multiple small, hypopigmented macules on upper trunk and arms with mild pruritis, fine scale with scraped
Topical clotramizole to treat tinea versicolor
96
# 2025 Jan Q46
42/M presented with recurrent peptic ulcers and chronic diarrhoea. He has a positive FHx of endocrine tumour. What is the initial test to confirm Dx?
Fasting serum gastrin level to diagnose gastrinomas.
FHx strongly suggestive of Zollinger-Ellison syndrome.
MEN I: gastrinomas, parathyroid adenomas, pituitary tumours
97
# 2025 January Q47
45/M presented with fatigue, weight loss, night sweats for 3 months
P/E: Splenomegaly and pallor
Ix: anaemia, WCC 120, thrombocytosis, differential show increased granulocytes at all stages of maturation
Chronic myeloid leukemia
* full spectrum of granulocytic celss from blasts to mature neutrophils
* chronic: splenomegaly
AML
* fatigue, bleeding, infection
* only blasts (immature cells)
98
# 2025 January Q48
What is the benefit of using colchicine in pericarditis?
Reduce reduction rate: Helps by controlling inflammation of pericardial sac
99
# 2025 January Q49
Which of the following opioid is less likely to cause constipation?
* codeine
* fentanyl
* hydromorphone
* morphine
* oxycodone
fentanyl (due to high lipid solubility)
100
# 2025 January Q51
Radioactive iodine uptake test: assess Grave's Disease as it measures how much iodine your thyroid gland absorbs from your bloodstream, which can indicate hyperthyroidism cause.
101
# 2025 Jan Q52
55/M presented with sudden LOC and regain consciousness after few seconds. No preceding neurological symptoms. BP 110/80 and HR is 40bpm and regualr. What is the diagnosis?
Third degree heart block
- Complete dissociation between atrial and ventricular activitiy leading to slow ventricular rate.
102
# 2025 Jan Q53
51/M with Hx of cirrhosis presented with increase abdominal distension. Decrease urine output and significant fatique.
P/E: marked ascites, peripheral oedema and mild jaundice. What is the next step in managing renal condition
Start terlipressin therapy
Dx: Hepatorenal syndrome type 1
* Rapid renal failure due to splanchnic vasodilation in patient with severe liver disease such as cirrhosis.
* Terlipressin is a vasopressor that helps constrict splanchnic vessels, improve renal perfusion and function.
102
# 2025 Jan Q56
52/M, Hx of alcoholic liver disease, presented with distended abdomen, pancytopenia, splenomegaly. What is the cause?
Hypersplenism
* associated with cirrhosis which leads to portal hypertension.
* Increase pressure in portal venous system causes splenomegaly, resulting in sequestration and destruction of blood cells and pancytopenia
103
# 2025 Jan Q57
29/F presented with joint pain and facial rash.
Anti-Smith Ab +ve
What is the diagnosis?
SLE
104
# 2025 Jan Q59
Patient 58/M presented with acute SOB and chest pain. Hx of HT and CKD.
P/E: BP 180/110, and bilateral pitting edema.
What is the mechanism by which angiotensin II is contributing to this patient's symptoms?
Direct vasoconstriction of arterioles
105
# 2025 January Q61
49/M with FHx of early onset cardiovascular disease and elevated cholesterol levels, presented with yellowish mobile firm nodules over achilles tendons bilaterally. What is the most likely diagnosis? (Hint: familial disease)
Familial hypercholesterolaemia
* autosomal dominant discorder with high LDL and increase risk of cardiovascular disease.
* Tendon xanthomas in achilles tendons are hallmark feature of FH due to deposition of cholesterol rich material.
106
# 2025 January Q62
After consume undercooked chicken, presented with abdominal pain, large volume bloody diarrhea and fever. What is the causative organism?
Campylobacter jejuni
* most common cause of bacterial GE and is frequently asso with undercooked poultry or contaminated water.
107
# 2025 January Q62
After consuming undercooked poultry, presented with non bloody diarrhea, nausea, vomiting, cramping. What is the causative agent?
Salmonella enteritidis
108
# 2025 January Q63
72/M presented with LUTS symptoms, elevated PSA and DRE showed irregular hard prostate. What is the step for definitive diagnosis?
Abd USG / CT A+P / prostate biopsy / Transurethral resection of prostate
Prostate biopsy
109
# 2025 January Q64
38/F with fatigue, weight gain and elevated cholesteral. Also cold intolerance, constipation and dry skin. What is the cause of dyslipidemia?
Hypothyroidism: decrease clearance of LDL as thyroid hormone stimulates LDL-C degradation.
110
# 2025 January Q65
45/M difficulty open mouth and back spasm. He reports recent puncture wound on foot while gardening. No signs of infection at the wound site. What is the causative organism?
Clostridium
* C. botulinum
* C. difficile
* C. perfringens
* C. tetani
S aureus
C. tetani
* C. botulinum: descending flaccid paralysis with CN palsy to generalised weakness
* C. difficile: diarrhea
* C. perfringens: gas gangrene with pain, swelling and gas production in tissue
111
# 2025 January Q66
35/F with Hx of multiple sclerosis complaint of urinary urgency and incontinence. What is the initial treatment?
Amitriptyline / Desmopressin / Oxybutynin / Propanolol
Oxybutynin: anticholingergic med to relax bladder's smooth muscles, to reduce symptoms of detrusor hyperreflexia or overactive bladder.
Amitriptyline: For anxiety, postherpetic pain and depression
Desmopression: Reduce nocturnal urine in DM and nocturnal enuresis
112
# 2025 January Q67
What is the treatment of previously resected HER2 breast cancer and adj chemoT, later developed lung metastasis?
* ChemoT: doxorubicin
* Targetted T: trastuzumab
* Hormonal T: Tamoxifen
* Palliative
Trastuzumab: targetted therapy (monoclonal antibody)
* ChemoT doxorubicin: not specific to HER2
* Hormonal T Tamoxifen: in hormone receptor positive breast cancer
113
# 2025 January Q68
24h after home-canned food party, 53/F presented with progressive muscle weakness, double vision and difficult swallowing. Ptosis, facial weakness and diminshed reflex. What is the diagnosis?
* acute MG
* Botulism
* GBS
Botulism caused by a neurotoxin produced by Clostridium botinum, asso with improperly canned or preserved food.
114
# 2025 January Q70
Bitemporal hemianopia. Where is the sight?
Optic chiasm
115
# 2025 Jan Q71
Diagnostic test of daytime sleepiness and snoring
Polysomnography
116
# 2025 January Q72
Bilateral fingertip numbness after chemotherapy (vincristine and doxorubicin). What is the cause?
B12 deficiency / carpel tunnel / peripherial neuropathy
Peripheral neuropathy: common side effect of vincristine
117
# 2025 January Q73
HIV patient not on antivirals, presented with floaters and right eye visual disturbance.
P/E: fluffy white rentinal lesions.
What is the diagnosis?
* CMV retinitis
* Herpes simplex keratitis
* Syphilitic uveitis
* Toxoplasmic retinochoiditis
* TB uveitis
Toxoplasmic retinochoiditis: focal necrotising retinitis with "headlight in the fog".
* CMV retinitis: necrotizing retinitis and painless visual loss with pizza pie / cottage cheese with ketchup
118
HIV patient not on antivirals, presented with floaters and right eye painless visual disturbance.
P/E: pizza pie / cottage cheese with ketchup
What is the diagnosis?
* CMV retinitis
* Herpes simplex keratitis
* Syphilitic uveitis
* Toxoplasmic retinochoiditis
* TB uveitis
CMV retinitis
119
HIV patient with eye problem as below, what is the diagnosis ?
* CMV retinitis
* Herpes simplex keratitis
* Syphilitic uveitis
* Toxoplasmic retinochoiditis
* TB uveitis
Syphilitic uveitis: involve anterior and posterior segments, presents with institial keratitis, iris nodules and "salt and pepper" fundus.
120
# 2025 Jan Q74
47/F with deen painless loss of left eye vision.
P/E: swollen optic disc and retinal haemorrhages
What is the diagnosis?
Central retinal artery occlusion / central retinal vein occlusion / optic neuritis
Central retinal vein occlusion: sudden painless loss of vision, retinal haemorrhage, swollen optic disc, dilated tortuous retinal veins (blood and thunder appearance).
RFs: age, HTN, DM, smoking, obesity, hypercoagulable state,
glaucoma, retinal a. disease
Mx: vision usu does not improve
* Aim: aim to ↓neovascularization if retina ischaemic or to ↓macular oedema if present
* Control RFs, eg. DM control, HTN control, smoking cessation
* Observe if no ischaemic retina or macular oedema
121
50/M with Hx of DM and HT. Sudden painless loss of vision with opthaloscope cherry red spot on macula with pale retina. What is the cause?
Central rentinal artery / vein occlusion
Central retinal artery occlusion = 眼中風
Aetiology: usually embolic in origin
□ Carotid artery atherosclerosis: most common → Important to identify due to stroke risk
□ Cardiogenic embolism: more important in younger pts
□ Small artery disease at central retinal a., eg. DM
□ Vasculitis, eg. GCA
Acute Mx: ophthalmic emergency!
→ Ocular massage
→ IV acetazolamide, mannitol or topical eyedrops to ↓IOP
→ AC paracentesis: needle decompression of anterior chamber to ↓IOP rapidly
(risk of AACG in shallow AC due to pupillary block)
→ Rebreathe into paper bag or 95% O2 + 5% CO2 to ↑pCO2 to induce vasodilatation
122
# 2025 Jan Q77
35/M IVDA, presented with painful rash at injectino side asso with trismus and back hyperextension.
What is the causative agent?
C botulinum / C tetani / S aureus / S pyogenes / Vibrovulnificus
Clostridium tetani: cause tetanus, muscle rigidity and spasms like trismus and opisthotonos (back hyperextension)
* C botulinum: des flaccid paralysis
* S aureus: cause skin infections like abscess
* S pyogenes: Cellulisi / erysipelas
* Vibrio vulnificus: realted to exposure to seawater / raw seafood, cuase acute GE / soft tiisue infection
123
# 2025 Jan Q78
68/M with parkinson's disease reports multiple times of fainting upon standing.
P/E: dry skin, distended bladder.
What is the test to confirm the diagnosis?
BP monitor / CTB / ECHO / ECG / Tilt table test
Tilt table test
PD + fainting spells = autonomic dysfunction leading to orthostatic hypotension.
Urinary retention + decrease sweating also features of autonomic failure
PD treatment:
* Young: Dopamine agonist (e.g. Rotigotine, Rotinirole) to prevent S/E of levo such as confusion and visual hallucination
* Old: Levodopa (i/e/ Sinemet = levodopa + carbidopa) to reduce motor symptoms
124
# 2025 Jan Q79
24/F with Hx of congenital heart disease presented with reduced exercise tolerance and SOB.
P/E: Distended JVP, holosystolic murmur at LLSB.
What is the cause of symptoms?
ASD / Ebstein anomaly / HOCM / MCP / Tetralogy of Fallot
Ebstein anomaly
* Significant TR: holosystolic murmur at LLSB
* RAE: Distended JVP
ASD: Fixed 2nd heart sound
HOCM: ESM increase in Valsalva manoeuvre
MVP: mid systolic click and last systolic murmur
125
# 2025 Jan Q80
45/F with strong family history of breast and ovarian cancer. What genetic mutation most likely associated with her family history?
BRAC1 / APC / EGRF / KRAS / TP53
BRAC1: also increase risk of prostate CA
126
45/F with strong family history of non small cell lung cancer. What genetic mutation most likely associated with her family history?
BRAC1 / APC / EGRF / KRAS / TP53
EGRF
127
45/F with strong family history of lung, CRC, prostate. What genetic mutation most likely associated with her family history?
BRAC1 / APC / EGRF / KRAS / TP53
KRAS
128
45/F with strong family history of colonic polyps. What genetic mutation most likely associated with her family history?
BRAC1 / APC / EGRF / KRAS / TP53
APC
129
# 2025 Jan Q81
Acromegaly diagnostic test
Growth hormone suppression test
Cause: GH-secreting pituitary adenoma (vast majority)
Mx:
□ Transsphenoidal surgery (1st line): 80-90% curative for micro-, <50% for macroadenoma
□ Medical Rx if not a surgical candidate or incomplete clearance
→ Somatostatin analogues, eg. octreotide, lanreotide
→ GH receptor antagonist, eg. pegvisomant
→ Dopamine agonist if co-secrete prolactin
130
# 2025 Jan Q82
52/F with 6 months Hx of fatigue and pruritis.
Ix: Elevated ALP, Positive AMA, no biliary obstruction
Initial treatment to control itching?
Rifampicin / Ursodeoxycholic acid / Colestipol / Cholestyramine / Hydroxyzing
Cholestyramine: Bile acid dequestrant that binds bile acid in intestine to reduce reabsorption and promote secretion in stool. Tx of pruritis asso with PBC.
PBC
* Pruritis is the most common symptoms
* Diagnostic criteria: at least two of
□ Elevated ALP with a level of ≥1.5× ULN
□ Presence of AMA with titres at ≥1:40
□ Histological evidence: non-suppurative destructive cholangitis
and destruction of interlobular bile duct
Mx:
Specific treatment:
* Ursodeoxycholic acid (UDCA): first-line therapy for PBC
* Obeticholic acid: 2nd line if suboptimal response to UDCA
* Liver transplantation
Symptoms treatment of pruritis:
* Cholestyramine: drug of choice if not relieved by UDCA
* Rifampin: 2nd line, uncommonly used
131
# 2025 January Q83
35/M recurrent haematuria following with URTI. Reports mild flank pain and recent onset of hypertension.
Urinarlysis: RBC cast and mild proteinuria.
What is the cause and diagnostic test?
IgA nephropathy with renal biopsy
132
# 2025 January Q84
62/M complained SOB after undergoing right pneumonectomy for non small cell lung cancer. What is the finding of lung function test?
Decrease FVC/ FEV1
Decrease TLC
Increase DLCO
Increase peak expiratory flow rate
Decrease total lung capacity (TLC)
Decrease FVC/ FEV1: in obstructive D
Increase DLCO: should be decrease in pneumonectomy
133
# 2025 January Q85
Reviewing several studies to determine the most reliable relative risk for CVS disease in individual with similar risk factors/ Which study is the most reliable and representative?
Cohort study with 2000 ppl and confidence interval between 0.5 - 1.8
Cohort study with 3000 ppl and confidence interval between 1.2 - 1.6
Cohort study with 3000 ppl and confidence interval between 1.2 - 1.6
The cofidence interval of 1.2-1.6 does not cross 1, indicating a statistically significant association between risk factors and cardiovascular disease.
134
# 2025 January Q87
28/F, Hx of cystic fibrosis presented with cough and sputum with fever. What is the cause?
What is the most common bacterial causing pneumonia in this case?
Pseudomonas aurogenosa
135
# 2025 January Q90
After starting on a new drug for newly diagnosed T2DM, developed diarrhea, abdominal pain and bloating. Why?
Acute pancreatitis / DM gastroparesis / lactic acidosis / metformin-induced GI side effects / small bowel obstruction
Metformin induced GI side effects
DM gastroparesis: early satiety, N&V, usually in long standing DM
135
# 2025 January Q92
Initial treatment of OA hands with bony swelling
Panadol / NSAIDS / Occup
Panadol (NSAID is not first line)
136
# 2025 January Q93
32/F presented with severe abdominal pain and vomiting 1 day after ingesting a large amount of iron tablets. Blood test showed significant iron level. Tx?
Deferasiros / Deferoxamine / IV fluid / Whole bowel irrigation
Deferoxamine
Deferasiros: oral tablet for chronic iron overload
137
# 2025 January Q95
A study reports a new antihypertensive drug has a number needed to treat (NNT) of 50 over 5 years. What is the more appropriate interpretation of the NNT in this context?
50 patient needed to be treated for 5 years to prevent a stroke
50 patients needed to be treated to reduce risk of stroke by 50 %
50 patient needed to be treated for 5 years to prevent a stroke
The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.).
138
# 2025 January Q96
45/F with episodic headaches, sweating and palpitation. With hypertension and unexplained weight loss. Diagnosis?
Hyperthyroidism / Cushing syndrome / Adrenal incidentaloma / Primary hyperaldosteronism / pheochromocytoma
Pheochromocytoma
Common symptoms “PHE”
- Palpitation
- Headache
- Excessive sweating (diaphoresis)
- Secondary DM
Ix: Urinary catecholamine & metabolite
(metamephrine and nonmetamephrine)
Surgery: Adrenalectomy
- Pre-op: Full alpha & beta blockade for hypertensive prophylaxis
* Initial alpha blockade w/ Phenoxybenzamine (long acting; non-competitive)
* Then beta-blockade w/ Propranolol
* For 2 weeks
139
# 2025 January Q97
27/F fever neck stiffness photophobia. CSF shows elevated WCC, normal glucose and mildly elevated protein. What is the diagnosis?
Viral meningitis
140
# 2025 Jan Q98
45/M working on care engines in a poorly ventilated garage, presented with headache, dizziness and nausea. He has cherry-red discolouration of skin.
What is the diagnosis?
Carbon monoxide poisoning / heat stroke / hypoglycemia / pneumonia
Carbon monoxide poisoning
Carbon monoxide poisoning: treatment with 100% oxygen to displace CO from haemoglobin
Heat stroke: hyperthermia, altered mental status and dry skin
141
# 2025 January Q99
42/F , 3 months progressive muscle weakness affect shoulder and hips. Difficult climbing stairs and lift objects above head. Proximal muscle tenderness but no joint swelling. Blood test: elevated CK.
What is the diagnosis?
Dermatomyositis / Multiple sclerosis / Myasthenia gravis / Polymyositis
Polymyositis
Dx: 2 out of 3 of CK, EMG abnormalities and +ve muscle Bx
Mx:
* Systemic glucocorticoids: typically start prednisone 1mg/kg/d
* Steroid-sparing agents: methotrexate, azathioprine to allow tapering steroids
* Other strategies: IVIg, plasmapheresis, rituximab, MMF, calcineurin inhibitor
Dermatomyositis: should have skin involvement
Multiple sclerosis: visual disturbance, sensory deficits, motor weakness, no elevated CK
Myasthenia gravis: affect ocular muscles, no elevated CK
142
# 2023 Oct Q1
It has been hypothesised that useing an artificial sweetener that has been available for the past 15 years increases incidence of type II diabetes. What is the optimal way to study its impact on diabetes risk?
Interventional study / Cohort study / Single dose study in humans with glucose tolerance testing
Cohort study
Cohort study is a kind of observational study. They are longitudinal and typically observe a specific patient subgroup, eg those with
chronic kidney disease. Cohort
studies are most commonly used to identify risk factors for the development of disease.
Other observational study:
* Case-control studies
* Cross-sectional studies: consider relationships between exposure and outcome at a single time point,
and are therefore commonly used to describe disease prevalence.
143
# 2023 October Q2
Patient on pakinsonism was given subcutaneous apomorphine. What is the primary MoA of apomorphine?
* 5-HT2a receptor agonist
* 5-HT2a receptor antagonist
* Dopamine D1 and D2 receptor agonist
* Dopamine D1 and D2 receptor antagonist
Dopamine D1 and D2 receptor agonist (for young to reduce mental fluctuations, prefer L-dopa for old)
144
# 2023 Oct Q4
67/M with SOB for 6 months. He is a retired stonemason and active smoker.
P/E: inspiratory crackles
CXR: Reticulonodular shadowing, eggshell LN calcification
What is the diagnosis?
Asbestosis / Sarcoidosis / Silicosis / COPD / IPF
Silicosis (due to exposure of silica dust)
145
66/M shipyard worker presented with exertional breathlessness.
P/E: inspiratory crackles
CXR: pleural plaques
What is the diagnosis?
Asbestosis / Sarcoidosis / Silicosis / COPD / IPF
Asbestosis
40% develop CA lung, 10% mesothelioma
146
66/M presented with exertional breathlessness.
P/E: inspiratory crackles
CXR: mediastinal LN
What is the diagnosis?
Asbestosis / Sarcoidosis / Silicosis / COPD / IPF
Sarcoidosis
147
# 2023 Oct Q5
45/M with end stage alcoholic cirrhosis presented with seizure after alcohol withdrawal for 48h. How to treat?
Chlordiazepoxide / Chlormethiazole / Chlorpromazine / Haloperidol / Risperidone
Chlordiazepoxide: a kind of BZD to treat delirium tremens
* Chlormethiazole: also for alcohol withdrawal but will accumulate in paitents in liver disease and cause sedation
* Chlorpromazine: dopamine antagonist antipsychotic
* Haloperidol: dopamine antagonist antipsychotic
* Risperidone: atypical antiphychotic
148
# 2023 October Q6
34/F after kidney transplant on tacrolimus found to have AKI. She was given fluconazole for oral candidiasis few weeks ago.
What causes her AKI?
Renal artery thrombosis / Renal vein thrombosis / Fungal UTI / Tacrolimus toxicity / acute organ rejection
Tacrolimus toxicity
Tacrolimus and fluconazole are both CYP3A4 inhibitor.
149
# 2023 October Q8
72/F developed acute delirium when being treated for pneumonia and AKI in ward. What is the treatment?
Diazepam / Haloperidol / Chlordiazepoxide
Haloperidol (safe in renal impairment)
Diazepem / Chlordiazepoxide: not safe in renal impairment
150
# 2023 Oct Q9
72/M stroke.
* Loss of pain and temperature on right face and left body
* Nystagmus
* Tend to fall on right
Where is the lesion? Left / right?
Right posterior inferior cerebellar artery
151
# 2023 Oct Q13
62/M shipyard worker, smoker presented with SOB.
Ix: Na 129
CXR: Left hilarious mass, small left pleural effusion, no pleural thickening
What is the cause?
AdenoCa lung / Small cell lung cancer / Squamous cell lung cancer / Mesothelioma
Small cell lung cancer
* Small cell lung cancer: SIADH + Cushing
* Squamous cell: HyperCa (PTHrP)
* NSCLC: Pancoast syndrome (pain at inner arm + small hand muscle wasting)
152
# 2023 October Q14
72/M bumping to objects to right side.
Right inferior quadrantopia
Where is the lesion?
Left parietal lobe (換邊)
153
# 2023 Oct Q15
67/M right handed after stroke, has anomia with impaired repititian, but speech is fluent and good comprehension. Where is the location of lesion?
* Left frontoparietal lesion including Broca's area
* Left temporoparietal area including Wernicke's area
* Left temporoparietal area including Broca's and Wernicke's area
* Subcortical lesion near the left superior temporal gyrus
Subcortical lesion near the left superior temporal gyrus = Conduction aphasia
Conduction aphasia: 複誦障礙，也有命名上的困難，但卻有不錯的聽覺和閱讀理解能力。
Broca's: 表達相當費力、常會猶豫不決及停頓，缺乏文法結構。在命名和複誦上也有障礙，但在一般的會話上有不錯理解力。
Wernickes: 流暢型失語症，患者常能滔滔不絕和人交談，但說話的意義不能連貫
154
# 2023 Oct Q16
45/F after 3 days of total thyroidectomy developed frequent muscles cramps. Ix: Ca 1.97. What is the intervention?
Observe and review / Calcium and Vit D
PO calcium and Vit D ( because symptomatic)
155
# 2023 Oct Q18
Why were some member of a family with BRAC1 gene unaffected by breat cancer?
Exon skipping / Genetic anticipation / incomplete penetrance
Incomplete penetrance: a proportion of people who carry the gene mutation may never develop the resultant disease.
156
A family with KRAS gene.
Grandfather developed CA at 88 years old.
Father developed CA at 68 years old.
Son developed CA at 33 years old.
What is this phenomenon called?
Exon skipping / Genetic anticipation / incomplete penetrance
Genetic anticipation: seen in trinucleotide repeat disorders where clinical features of disease are seen at a younger age with each generation. Huntington's chorea is an example.
157
# 2023 Oct Q19
23/F with abdominal pain and diarrhea with blood and mucus. Hb 9.4, CRP 72
What is the useful test to investigate diarrhea?
Anti-tissue transglutaminase / Fecal calprotectin / Fecal elastase / Hydrogen breath test / TSH
Fecal calprotectin (ulcerative colitis)
* Anti-tissue transglutaminase (coliec disease)
* Fecal elastase (Pancreatic insufficiency)
* Hydrogen breath test (bacterial overgrowth syndrome)
158
Blood test to diagnose coliec disease
Anti-tissue transglutaminase
159
25/F presented with fatty stool that are difficulty to flush away. What is the most useful test to investigate this patient's symptoms?
Fecal calprotectin for pancreatic insufficiency
160
# 2023 Oct Q22
62/M presented with progressive proximal muscles weakness.
P/E: Absent reflex. Following period of muscle activation, LL reflexes are present.
CXR: left hilar mass
What is the underlying disease and the appropriate treatment?
Prednisolone / Pyridostigmine / Plasma exchange / Amifampridine / IVIG
Amifampridine
Amifampridine (3,4-diaminopyridine): improve muscle strength by increase acetylcholine consentration at NMJ.
Dx: Small cell lung cancer with Lambert-Eaton myasthenic syndrome
Pyridostigmine: 2nd line for LEMS, 1st line for MG
Plasma exchange / IVIG: For myasthenic crisis
161
How to monitor myasthenic crisis and what is the treatment?
Monitor FVC, SpO2, ABG
Treatment: IVIg and prednisolone
162
# 2023 Oct Q23
What is the most common side effect of IVIg for GBS treatment?
Headache / Dizziness . Tremor / Venous thromboembolism
Headache
163
# 2023 Oct Q24
18/M recurrent meningitis. Wha component of immune system is most likely be deficient?
C1 esterase inhibitor / C4 / C5 / Immunoglobulin A / Immunoglobulin D
C5
164
18/M recurrent non puritis non pitting submucosal or subcutaneous edema. Wha component of immune system is most likely be deficient?
C1 esterase inhibitor / C4 / C5 / Immunoglobulin A / Immunoglobulin D
C1 esterase inhibitor deficiency results in hereditary angio-oedema
165
# 2023 Oct Q26
Cellulitis related to DM treatment
Clindamycin / Co-amoxiclav / Doxyxyline / Erythromycin / Flucloxacillin and gentamicin
Co-amoxiclav
166
# 2023 Oct Q28
22/F frequent UTI and renal stones. Mother also suffered from recurrent renal stones. Abd soft no mass
Cr 100
What is the best way to diagnose cause of symptomes ?
CT urography / Cystoscopy / Urinary cystine level
CT urography to diagnose medullary sponge kidney
Cystoscopy for persistent haematuria
167
# 2023 Oct Q29
22/F half marathon runner presented with dull aching pain affecting lateral hip and radiate down the thigh. Pain wheen lies on her side and running. P/E: point tenderness over greater trochanter.
What is the cause?
Iliopsoas tendonitis / Gluteus medius tendonitis / Trochanteric bursitis
Trochanteric bursitis
168
# 2023 Oct Q32
35/F complaints about frequent facial flushing after drinks alcohol and hot drink.
P/E: dry skin, telangiectasia over foreheada and cheeks.
What is the most appropriate initial intervention?
Topical Benzoyl peroxide / Topical Brimonidine / PO oxytetracycline / PO Propanolol
Topical Brimonidine (alpha 2 adrenergic agonist to reduce peripheral arteriolar dilatation in this patient with rosacea)
* Topical Benzoyl peroxide: For acne
* PO oxytetracycline: for more secere rosacea with papules and pustules.
* PO Propanolol: for transient flushing, but in this case already become permanent erythema.
169
# 2023 Oct Q33
Infective endocarditis treatment
Amoxicillin and gentamicin
170
# 2023 Oct Q34
What is CSF absorbed ?
Arachnoid granulation / Choroid plexi / Dural venous sinuses / Pia mater
Arachnoid granulation: transport of CSF
Choroid plexi: Production of CSF by ependyma
Dural venous sinuses: one way valve distal to arachnoid granulation
Pia mater: innermost layer to protect CNS
171
What is CSF produced ?
Arachnoid granulation / Choroid plexi / Dural venous sinuses / Pia mater
Choroid plexi: Production of CSF by ependyma
* Arachnoid granulation: transport of CSF
* Dural venous sinuses: one way valve distal to arachnoid granulation
* Pia mater: innermost layer to protect CNS
172
What is the MoA of ibandronate? (a kind of bisphosphonate)
Calcimimetic / Impair osteoclast bone adherence / inhibit osteoblast activity / Increase hydroxylation of Vit D / RANK ligand inhibitor
Impair osteoclast bone adherence
173
What is the MoA of teriparatide?
Calcimimetic / Impair osteoclast bone adherence / upregulate osteoblast activity / Increase hydroxylation of Vit D / RANK ligand inhibitor
upregulate osteoblast activity
Synthetic PTH analogue
174
What is the MoA of denosumab (prolia) ?
Calcimimetic / Impair osteoclast bone adherence / upregulate osteoblast activity / Increase hydroxylation of Vit D / RANK ligand inhibitor
RANK ligand inhibitor, downregulates osteoclast activity, increase osteoclast apoptosis
175
19/F recurrent haematuria after URTI 48h earlier. CRP 72. That is the cause?
IgA nephropathy
176
# 2023 Oct Q38
35/M presented with extreme agitation, sweating and central chest pain after a muscle festifal.
P/E: Hypertension and HR 102. Bilateral dilated pupil
ECG: anterior and inferior ST elevation.
Aspirin given by ambulence.
What is the next step?
Bisoprolol / Clopidogrel / Glyceryl trinitrate / Morphine / PCI
Glyceryl trinitrate IV to refuce BP and control ischemic chest pain
Dx: Cocaine overdose with significant coronary artery spasm.
PCI is next step once pain and agitation have been controlled.
177
# 2023 Oct Q39
27/F Migrane everytime before menstruation. Analgesics and triptans acutely used, but not useful. What is the treatment?
Amitriptyline prophylasix / BOTOX / COCP / Rimengepant prophylaxis on days when migranes expected / Zolmitriptan prophylaxis on days when migranes expected
Zolmitriptan prophylaxis on days when migranes expected
* Amitriptyline: can be sedating, and for unpredictable attacks
* BOTOX: if resistent to >= 2 trials
* COCP: increase stroke risk in migraine pt.
* Rimengepant: acute treatment
178
# 2023 Oct Q42
What is the MoA of raltegravir to treat HIV?
CCR5 inhibitor / Fusion inhibitor / Integrase inhibitor / NNRTI / Protease inhibitor
Integrase inhibitor
Treatment: HAART is started when CD4 < 350 in HK
* Early commencement increase survival to keep CD4 ~500
* Standard regimen: Triple therapy with 2 NRTIs + PI or NNRTI
179
# 2023 Oct Q43
Most commonly found cardiac complication in patient with Down's syndrome
ASD / AVSD / CoA / PDA / ToF
AVSD
* Turner’s syndrome – coarctation of aorta
* Down syndrome – congenital heart diseases (endocardial cushion defects eg. AVSD, VSD)
* Marfan syndrome – aortic regurgitation, mitral regurgitation
180
Most commonly found cardiac complication in patient with Turner's syndrome
ASD / AVSD / CoA / PDA / ToF
Coarctation of aorta
* Turner’s syndrome –
* Down syndrome – congenital heart diseases (endocardial cushion defects eg. AVSD, VSD)
* Marfan syndrome – aortic regurgitation, mitral regurgitation
181
# 2023 Oct Q44
35/M abdominal bloating, cramps and watery diarrhea in Tunisia after using the swimming pool. What is the cause?
Bacillus cereus / Giardia lamblia / Norovirus / Salmonella typhi / Shigella sonnei
Giardia lamblia (Mx; Metronidazole)
182
35/M profuse diarrhea after eating reheated fried rice. What is the cause?
Bacillus cereus / Giardia lamblia / Norovirus / Salmonella typhi / Shigella sonnei
Bacillus cereus
183
35/M diarrhea with blood and mucus, diffuse colicky abdominal pain after travelling. What is the cause?
Bacillus cereus / Giardia lamblia / Norovirus / Salmonella typhi / Shigella sonnei
Shigella sonnei (dysentery 痢疾)
184
# 2023 Oct Q45
24/M rugby player, unbilicated papules affecting lower abdomen and inner thighs. Not painful or itchy. What is the cause?
HSV / HHV6 / HPV / John cunningham virus / molluscum contagiosum virus
molluscum contagiosum virus: spread through sexual contact and contact sports like rugby. No treatment is required.
HSV: cold sores and genital herpes
HHV6: fever and rash in kids
HPV: genital warts
John cunningham: dementia
185
# 2023 Oct Q46
A couple have 2 kids with trisomy 21. They plan for a third child. What is the next step?
Fetal DNA analysis / Karyotyping of both parents / Karyotyping of mother / IVF with embryo selection / Reassurance
Karyotyping of both parents (Robertsonian translocation likely appears)
186
# 2023 Oct Q47
28/F with severe asthma on inhaled steroid, inhaled LABA and montelukast. Still not effective. High eosinophil count. What is the next drug?
Adalimumab
Canakinumab
Mepolizumab
Risankizumab
Rituzimab
Mepolizumab (anti-interleukin-5 monoclonal Ab, lower eosinophil count)
Dx: Eosinophilic asthma.
* Adalimumab: anti-TNF for RA / psoriasis
* Canakinumab: Anti IL 1 Ab for juvenile arthritis
* Risankizumab: Anti- IL23 for COPD
* Rituzimab
187
# 2023 Oct Q48
62/M post PCI for anterior MI developed broad complex tachycardia. Broad QRS of 170ms, uniform complexes and AV dissociation. What is the next step?
Amiodarone / Bisoprolol / Flecainide / Lidocaine / Observation
Amiodarone IV 150mg over 10 min
* Used in post MI medical cardioversion of ventricular tachycardia.
* Class 3 antiarrhythmic agent to prolong action potential bu blocking K channels.
* Bisoprolol: risk of hypotension
* Flecainide: not recommended in patients with structural or ischemic heart as it may increase risk of ventricular arrythmia
* Lidocaine: used as membrane stabiliser in treatment of VT, but may cause hypotension, so it is 2nd line.
188
# 2023 Oct Q49
61/F with endometrial cancer and carcal cancer. FHx of colon and endometrial cancer. What is the gene mutation?
APC / BRCA 1 / MLH 1 / p53 / RET
MLH 1 (HNPCC syndrome)
* APC: FAP
* BRCA 1: breast and ovary CA
* p53: Li-Fraumeni syndrome cause sarcoma, breast, acute leukemia, adrenocortical tumours
* RET: medullary thyroid cancer
189
190
# 2023 Oct Q50
74/F presented with facial flushing, chronic diarrhea, weight loss, palpitation.
P/E: Hepatomegaly with deranged ALT and ALP. What is the cause?
Carcinoid syndrome / Glucagonoma / Somatostatinoma / VIPoma
Carcinoid syndrome: facial flushing, palpitation, diarrhea
Dx: 24h urinary 5-hydrocyindoleacetic acid
Mx: Octreotide
* Glucagonoma: chronic diarrhea, hyperglycemia, skin rash of necrolytic migratory erythema
* Somatostatinoma: diarrhea of fatty stools, gallstones, hyperglycemia
* VIPoma: diarrhea, facial flushing, metabolic acidosis
191
74/F presented with chronic diarrhea, hyperglycemia, skin rash of necrolytic migratory erythema
What is the cause?
Carcinoid syndrome / Glucagonoma / Somatostatinoma / VIPoma
Glucagonoma
192
# 2023 Oct Q51
Where is beta-3 adrenergic receptor located?
Adipose tissue / Bronchial smooth muscles / Pancreatic beta cells / Ureter
Adipose tissue
beta-3 adrenergic receptor are found in adipose tissue and bladder smooth muscles. Agonist such as mirabegron are for treatment of overactive bladder.
193
# 2023 Oct Q54
23/M with FHx of thyroid cancer, presented to endocrine clinic with severe headache, palpitation and hypertension.
K 3.3 Ca 2.6
What is the treatment to control BP?
Amlodipine / Bisoprolol / Phenoxybenzamine / Ramipril / Valsartan
Phenoxybenzamine for treatment of phenochromocytoma (likely underlying FHx of MEN2a cancer with MTC, pheochromocytoma and hyperparathyroidism)
194
# 2023 Oct Q55
COPD on LABA, LAMA and steroid, still SOB. FEV1 40%. Next step?
Benralizumab / Montelukast / Omalizumab/ Prednisolone / Roflumilast
Roflumilast: PDE4 inhibitor
Indication: If >2 exacerbation in previous year and FEV1 < 50%
Benralizumab (IL5 monoclonal Ab) / Montelukast / Omalizumab (IgE monoclonal Ab) : for asthma
195
# 2023 Oct Q58
Chlamydia treatment in pregnancy woman
Ofloxaicin / Penicillin V / Trimethoprim / Azithromycin / Doxycycline
Azithromycin 1g on D1 and 500mg on D2 + D3
(Docycline is contraindicated in pregnancy)
196
# 2023 Oct Q60
32/F presented with headache and loos of vision of left eye over 3 days.
P/E: Central scotoma and palse left optic disc
She was treated with high dose corticosteroid. What is the most likely cause?
Anterior communicating artery aneurysm / Leber's hereditaory optic neuropathy / Acute demyelinating optic neuritis
Acute demyelinating optic neuritis (inflammation of optic nerve)
Signs: RAPD+: ALWAYS occur if the other eye is uninvolved
Clinical diagnosis
Treatment: IV prednisolone 3/7 then PO 11/7
197
# 2023 Oct Q61
68/M with AF and myasthenia gravis. What medication will exacerbate symptoms of muscle weakness?
Amiodarone / atenolol / Digoxin / Indapamide / Lisinopril
Atenolol
Betablocker can directly impair neuromuscular transmission and precipitate myasthenic crisis. Should change to ACEI. Other meds like macrolide, quinolone, statin can precipitate a crisis.
198
# 2023 Oct Q62
A patient was given amoxillicin for pharyngitis, then presented with widespread non blanching maculopapular rash 48h later.
Ix: CRP downtrend, no other significant bloods.
What is the cause of pharyngitis?
EBV / Influenza / Mycoplasma pneumoniae / S pyogenes / H influenzae
EBV
Unknown pathophysio, but EBV + amoxicillin can cause non flanching maculopapular rash
199
# 2023 Oct Q63
Ostium secundum ASD ascultation sound
Fixed split 2nd HS
Mid systolic pulmonary flow murmur
Pansyslotic murmur to axilla
Reversed split 2nd HS
Fixed split 2nd HS
200
# 2023 Oct Q64
DM with visual deterioration
P/E: circinate of hard exudates within 1 disc diameter of macule
What is the intervention?
* Focal laser therapy
* Intravitreal dexamethasone
* Intravitreal teplizumab
* Panretinal photocoagulation
Focal laser therapy (for maculopathy)
* Focal laser therapy
* Intravitreal dexamethasone: less effective than anti-VEGF / focal laser
* Intravitreal teplizumab: teplizumab is anti-CD3 for autoimmune disease
* Panretinal photocoagulation: for retinopathy
Managements
Clinically significant macula edema (CSME):
1. Intravitreal anti-VEGF (ranibizumab / aflibercept)
2. Intravitreal steroid (triamcinolone / ozurdex), e.g. long-term dexamethasone implant.
3. Focal / grid laser if no macula ischemia (Not very effective)
201
# 2023 Oct Q66
after picking rasberries on a farm not open to public, developed blurred vision, muscle weakness and excessive salivation, bradycardia. What is the most likely cause?
ECG： LVH, Q waves in V5, V6, aVL, II, III, aVF
Cyanide poisoning / lewisite poisoning / organophosphate poisoning / poisonous berry ingestion
organophosphate poisoning
202
# 2023 Oct Q68
28/M with unprotected sex, developed large, painless ulcer on the glans penis. Treponemal enzyme immunoassay is positive for IgM and negative for IgG. He is allergic to penicillin. What is the treatment?
Azithromycin
Ceftriazone
Co-amoxiclav
Doxycycline
Levofloxacin
Doxycycline for 14 days (1st line for syphilis)
* Ceftriazone IM 1g single dose for Gonorrhea
203
# 2023 Oct Q70
Mother has Grave's thyroiditis during pregnancy. Newborn baby has neonatal hyperthyroidism. Which antibodies are the most likely cause of neonatal hyperthyroidism?
Ro antibodies
Smooth muscles antibodies
Thyroglobulin Ab
Thyroid peroxidase Ab
Thyrotropin receptor Ab
Thyrotropin receptor Ab (stimulate thyroid hormone production cause Grave's Disease)
* Ro antibodies: neonatal heart block in SLE
* Smooth muscles antibodies: autoimmune hepatitis
* Thyroglobulin Ab: Hashimoto thyroiditis
* Thyroid peroxidase Ab: hypothyroidism
204
# 2023 Oct Q71
LL Cellulitis treatment (allergic to penicillin)
IV augmentin
IV flucloxacillin
PO clarithromycin and metronidazole
PO Clindamycin
Topical fusidic acid
PO Clindamycin
* IV augmentin: for cellulitis with DM not allergic to penicillin
* IV flucloxacillin: for cellulitis with no DM not allergic to penicillin
* PO clarithromycin and metronidazole: for facial cellulitis
* Topical fusidic acid
205
# 2023 Oct Q72
What is the most useful next investigation?
* Acid phosphatase level
* Alkaline phosphatase levels
* Alpha-galactosidase levels
* Alpha glucosidase levels
* Hypoxanthin-guanine phosphoribosyltransferase levels
Alpha-galactosidase levels
(Atypical fabry's disease with heart failure, fibrosis and CAD, proteinuria and acroparaesthesiae with pins and needles)
* Acid phosphatase level: measure prostate cancer activity (replased by PSA)
* Alkaline phosphatase levels = ALP
* Alpha glucosidase levels
* Hypoxanthin-guanine phosphoribosyltransferase levels (for diagnosis of Lesch-Nyhan syndrome)
206
# 2023 Oct Q73
What drug with reduce thyroxine absorption in patient on thyroxine replacement?
Amiodarone / Atenolol / Carbamazepine / Digoxin / Omeprazole
Omeprazole
207
# 2023 Oct Q75
3rd admission for SVT reverted with carotid sinus massage. She doesn't want to undergo ablation at this stage. What is the appropriate first line treatment?
Amiodarone / Amlodipine / Flecainide / Metoprolol / Propafenon
Metoprolol
1st line: Betablocker (contraindicated in bronchospasm), verapamil, diltiazem
208
# 2023 Oct Q76
27/F breastfeeding patient with lower UTI. What antibiotic to use?
Cefixime / Erythromycin / Ofloxacin / Trimethoprim
Cefixime
Cephalosporins have no significant adverse effects in children.
209
# 2023 Oct Q77
31/M ulcerative colitis patient, presented with jaundice and hepatomegaly. What is the useful investigations?
CT abdominal/ ERCP / MRCP / liver biopsy / USG abdomen
MRCP to diagnose primary sclerosing cholangitis, which associates with ulcerative colitis
210
# 2023 Oct Q78
TB discitis with no features of CNS involvement. How long is the treatment?
Six months
Discitis = an infection of the intervertebral disc space = TB spine
CNS TB requires 12 months
211
# 2023 Oct Q79
A 79/M presented with
* dementia symptoms
* His wife reports long standing restlessness and movements when sleep.
* Parkinsonism
Which other feature would you expect to find?
Auditory hallucination / Tactile hallucination / Visual hallucination
Visual hallucination
Dx: Lewy body dementia = visual hallucination + PD + REM sleep behaviour disorder
212
# 2023 Oct Q81
Which gene mutation is the most common cause of HOCM?
ACTC / MYH7 / MYL2 / TNNT2 / TPM1
MYH7
213
# 2023 Oct Q82
MoA of pregabalin
Voltage gated calcium channel inhibitor
Voltage gated sodium channel inhibitor
GABAa receptor agonist
GABAb receptor agonist
Synaptic vesicle protein 2A binder
Voltage gated calcium channel inhibitor
* Voltage gated sodium channel inhibitor: Sodium valproate
* GABAa receptor agonist: alcohol, BZD
* GABAb receptor agonist: baclofen
* Synaptic vesicle protein 2A binder: levetiracetam
214
# 2023 Oct Q83
25/M treated for mediastinal non seminomatous germ cell tumour with cisplatin based chemotherapy. 4 months later, developed fever, easy bruising and gum bleeding.
Ix: Anaemia, WCC 22, PLT 34. What is the cause?
AML / CLL / Lymphoma / cisplatin-related bone marrow suppression
AML
1 in 17 patients with mediastinal non seminomatous germ cell tumour will develop AML
215
# 2023 Oct Q87
32/F screening for medullary thyroid carcinoma found elevated calcitonin. What is the physiological effect of calcitonin?
Inhibit osteoblast activity
Inhibit osteoclast activity
Increase appetite
Increase renal tubular Ca reabsorption
Increase renal tubular phosphate absorption
Inhibit osteoclast activity
216
# 2023 Oct Q88
MoA of imatinib (to treat gastric MALToma)
PD1 inhibitor / tyrosine kinase inhibitor / HER2 antagonist
Tyrosine kinase inhibitor
As a targetted therapy for CML
217
# 2023 Oct Q89
Crohn's disease on cortisosteroid, following a 2nd exacerbation of disease. What is the next step?
Azathioprine / Ciclosporin / Infliximab / MTX / Vedolizumab
Azathioprine
Induction therapy:
Mild-moderate procto ± sigmoiditis:
* Low-risk: oral steroids (eg. budesonide 9mg QD) or oral sulfasalazine if colitis
* High-risk: oral/IV steroids; or anti-TNF ± thiopurines (AZA, 6-MP); or other biologics (vedolizumab, natalizumab)
* - Fulminant: IV steroids or anti-TNF
218
# 2023 Oct Q90
Restless leg syndrome treatment
Gabapentin / Bromocriptine / Diazepam / Levodopa / Zolpidem
Gabapentin (block voltage gated calcium channels)
219
# 2023 Oct Q91
25/F developed sudden left leg paralysis after death of her father. Positive Hoover's sign. Why?
Conversion disorder / Malignering / Spinal stenosis
Conversion disorder
220
# 2023 Oct Q94
Where is the site of action of bendroflumethiazide?
Distal convoluted tubule
221
Where is the site of action of spironolactone?
Collecting duct (potassium sparing diuretics)
222
Where is the site of action of loop diuretics?
Thick ascending limb of loop of Henle
Acetazolamide: 預防或治療高山症
223
# 2023 Oct Q95
asthma / emphysema / IPF / pulmonary hypertension
Asthma
associated with large lung volumes leading to increase KCO and TLCO. Obesity also associated with findings like this.
224
# 2023 Oct Q96
SLE patient on HCQ and requires steroid for 3 flares last year. She wants to get pregnant. What should be added to meds?
MTZ / Azathrioprine / MMF / tacrolimus
Azathioprine
225
# 2023 Oct Q98
90.9% (1000/1100)
226
# 2023 Oct Q100
Failed medical treatment of paroxysmal AF with bisoprolol and flecainide. What is the next step?
RFA / RFA combined with pacing / Verapamil / Amiodarone
RFA
* usually after 2 medication failed, then consider RFA
* Pacing is for permanent AF
227
# 2023 Apr Q1
What is the cause?
* Hypoparathyroidism
* Hyperparathyroidism
* Hypothyroidism
* Osteomalacia
* Osteoporosis
Osteomalacia
* Ileal recection leads to malabsorption of Vit D, causing low Ca, high ALP, compensatory high PTH.
* Painful proximal myopathy is a feature.
* Tx: Oral Vit D
228
# 2023 Apr Q4
19/F unprovoked left LL DVT> Functional testing for blood clotting is positive for protein C resistance. What is the most likely cause of DVT?
* Antithrombin III deficieny
* Antiphospholipid antibody syndrome
* Factor V Leiden
* Hyperhomocysteinaemia
* Von Willebrand's disease
Factor V Leiden
* Antithrombin III deficieny: also leads to increase risk of venous thrombosis, by nephrotic syndrome where clotting factors leak into urine
* Antiphospholipid antibody syndrome: prolong APTT
* Hyperhomocysteinaemia: cause venous and arterial thomboses
* Von Willebrand's disease: increase risk of bleeding
229
229
# 2023 Apr Q7
42/F presented with vertigo when rolling over in bed and turn head quickly. Lasts for 20-30 second then resolved. Associated with nausea, no tinnitus or hearing loss. What is the most likely diagnosis?
* Acoustic neuroma
* BPPV
* Meniere's disease
* Vestibular neuronitis
BPPV (diagnosed by Hallpike manoeuvre; treated by Epley manoeuvre / betahistine)
* Acoustic neuroma: with unilateral hearing loss and dizziness
* Meniere's disease: chronic build up fluid within inner ear causing tinnitus, hearing loss, vertigo and loss of balance.
* Vestibular neuronitis: asso with post URTI viral infection causing acute N&V, vertigo, gait disturbance
230
# 2023 Oct Q8
36/F received porcine aortic valve replacement on ramipril, now pregnant. What is the next step?
* Change ramipril to labetolol
* Start enoxaparin
* Start aspirin
* Keep ramipril
Change ramipril to labetolol
* Ramipril is a 2nd trimester teratogen
* Aspirin + LMWH (enoxaparin) is for SLE / antiphospholipid syndrome
231
# 2023 Apr Q9
What type of receptor is the insulin receptor?
* Endoplasmic reticulum receptor
* G protein-coupled receptor
* Ligand-gated ion channel
* Nuclear receptor
* Tyrosine kinase receptor
Tyrosine kinase receptor
* Endoplasmic reticulum receptor: cell division, proliferation and apoptosis
* G protein-coupled receptor: thyroid and PTH hormone receptor
* Ligand-gated ion channel: allow ions to pass through cell membranse
* Nuclear receptor: gene expression, fenofibrate and pioglitazone
Tyrosine kinase inhibitor: imatinib
232
# 2023 Apr Q10
Where is the primary site of action of ADH?
Cortical collecting duct (drives expression of aquaporin 2 channels)
233
# 2023 Apr Q12
What is the primary action of insulin?
* Inhibit gastric emptying
* Inhibit gluconeogenesis
* Inhibit protein synthesis
* Stimulate glycogenolysis
* Stimulate lipolysis
Inhibit gluconeogenesis
* 糖質新生 gluconeogenesis = 非碳水化合物轉變為葡萄糖, driven by glucagon
* 肝糖分解 glycogenolysis = breakdown of glycogen by glucagon (opposite action of insulin)
* insulin stimulates lipogenesis to increase energy storage capacity in muscle and fat
234
# 2023 Apr Q14
Recurrent viral pericarditis on low dose colchicine developed constrictive pericarditis with heart failure, fluid retention and elevated JVP. What is the treatment?
Anakinra
Furosemide
Pericardectomy
Prednisolone
Rituximab
Anakinra (IL-1 antagonist)
235
# 2023 Apr Q15
MoA of terlipressin to treat end stage cirrhosis with raised creatinine
Splanchnic vasoconstriction
* reduce splanchnic blood flow and portal pressure
* hepatorenal syndrome in this case
236
# 2023 Oct Q16
- Borrelia burgdorferi
- Borrelia mayonii
- Orientia tsutsugamushi
- Rickettsia prowazekii
- Rickettsia rickettsii
Borrelia burgdorferi (lyme disease with typical rash)
- Tx: doxyclcine
- Borrelia mayonii: rarer cause of lyme disease
- Orientia tsutsugamushi: scrub typhus
- Rickettsia prowazekii: epidemic typhus
- Rickettsia rickettsii: rocky mountain spotted fever
237
# 2023 Oct Q19
80/M with mild COPD, HT, DM diagnosed with new onset AF with palpitation. What is the intervention?
* Amiodarone
* Bisoprolol
* Digoxin
* Flecainide
* Verapamil
Bisoprolol (COPD is not a C/I)
* Digoxin: only if patient is sedatory and not tolerate BB / CCB
* Flecainide (class 1c antiarrhythmic) : only if patient is free of ischaemic or structural heart diasease
* Verapamil: a CCB, but BB is a better option
238
# 2023 Oct Q20
19/M with recurrent Neisseria meningitidis meningitis
* C1 inhibitory deficiency
* C1 deficiency
* C5 deficiency
* IgA deficiency
* IgD deficiency
C5 deficiency
* C1 inhibitory deficiency: angioedema
* C1 deficiency: increase risk of autoimmune disease
* C5 deficiency: (C5-9) asso with recurrent infection
* IgA deficiency: increase risk of GI and URT infections
* IgD deficiency: increase risk of infection
239
# 2023 Oct Q21
Pregnant women with all vaccinations done, developed hepatits. What is the type of hepatitis?
Hep E (fulminant hepatitis, transmitted via daecal oral route and no vaccination available. Treatment is supportive)
240
# 2023 Oct Q22
- Alport syndrome
- Anti-GBM syndrome
- EGPA
- GPA
GPA
241
# 2023 Oct Q23
MoA of ticagrelor
P2Y12 receptor inhibitor
242
# 2023 Apr Q24
1. Pemphigoid
2. Pemphigus
3. SJS
SJS (due to carbamezapine)
Genetics:
HLA-B*15:02: related to carbamazepine
HLA-B* 58:01: related to allopurinol
243
# 2023 Apr Q26
21/F with generliased erythematous rash after completing course of amoxicillin for streptococcal throat infection. P/E: erythematous, drop like papules iwth superficial skin scaling. What is the cause?
- Erythema multiforme
- Guttate psoriasis
- HSP
- Post streptococcal GN
Guttate psoriasis
* usually 2 weeks after a streptococcal throat infection
* Lesions resolves over few months, but exposure to sunlight can accelerate healing.
244
# 2023 Apr Q27
45/M weight gain, hypertension, impaired glucose incolerance.
Striae on abdominal exam.
Bicarbonate 33 (H)
What is the next Ix?
* Fasting with exercise provocation test
* Glucose tolerance test
* Insulin like growth factor 1
* Insulin tolerance test
* 24h urinary cortisol
24h urinary cortisol
DDx: Cushing syndrome
* Fasting with exercise provocation test: for insulinoma
* Glucose tolerance test: acromegaly
* Insulin like growth factor 1: acromegaly
* Insulin tolerance test: GH deficiency
245
How to differentiate different causes of Cushing syndrome?
Step by step
(1) HDSST
(2) LDSST
(3) CRH test
(4) Basal ACTH
(5) Basal cortisol
Basal cortisol -> LDSST / ODSST -> Basal ACTH -> HDSST / CRH test
246
# 2023 Apr Q28
47/M complain tiredness and intermittent epigastric pain.
Ix: Anaemia and low serum ferritin
What is the cause?
B12 deficiency / Coeliac disease / GERD / Gastrinoma / PUD
PUD
247
# 2023 Oct Q29
77/F with itchy skin and large tense blisters particularly over skin flexures. Oral cavity spared. What is the cause?
Pemphigoid / Pemphigus / SJS
Pemphigoid
248
# 2023 Oct Q32
72/M following a failed trialed of ramipril for treatment of HFpEF. After 1 week of treatment, a significant increase of creatinine and potassium. What is the most useful investigation to diagnose?
CT angiography / MR angiography / Plasma aldosterone / Renal vein renine / USG renal tract
MR angiography
Dx: renal artery stenosis
ACEI precipitate hyperkalemeia in RTA type 4.
249
# 2023 Oct Q33
Most appropriate test to monitor tumour recurrence of parathyroid carcinoma.
Parathyroid hormone
250
# 2023 Oct Q34
Rectal biospy: intense infiltration of mucosa and submucosa with neutrophils and crypt abscesses; there is globet cell depletion. What is the diagnoses?
Coeliac disease / Crohn's disease / Ulcerative colitis / Pseudomembranous colitis
Ulcerative colitis (shallow ulcers, goblet cells depletion)
251
# 2023 Oct Q35
19/M bruising, gum bleeding, fever, sore throat, petechial haemorrhages, hepatosplenomegaly.
Hb 8.2 (increase reticulcytes, fragmented red cells)
WCC 22 (blast cells with Auer rods)
PLT 54
What is the cause?
ALL / AML / CML / Myelodysplasia / Parvovirus B19
AML
252
# 2023 Oct Q36
HOCM related to what defect?
Myosin-binding protein C
Myosin light chain 3
Tropomyosin alpha 1 chain
Troponin I
Myosin-binding protein C (~40% of HOCM)
(also beta myosin heavy chain 7 mutation (~40% of HOCM))
Myosin light chain 3 (~1% of HOCM)
Tropomyosin alpha 1 chain(~3% of HOCM)
Troponin I
253
# 2023 Oct Q37
Street food then abdominal pain and diarrhea with blood, N&V.
Ix: Hb 8.1 PLT 72 Cr 221
What is the cause?
* E coli O157
* Giardia lamblia
* Salmonella typhi
* Shigella dystenteriae type 2
* Shigella sonnei
E coli O157 (Street foods causing bloody diarrhea and DIC)
* Giardia lamblia: intermittent abdominal bloating and diarrhea
* Salmonella typhi: severe diarrhea, dehydration, prerenal failure
* Shigella dystenteriae type 2: Type 1 cause the above symptoms, but not type 2
* Shigella sonnei: diarrhea in children's daycare centre
254
# 2023 Oct Q38
32/F presented with loss of sensation and pins and needles in both LL. Episode of left optic neuritis 9 months ago given IV methylprednisolone, but opted not for DMARDS. MRI showed multiple demyelination.
What is the treatment?
* Methylprednisolone
* Natalizumab
* Teriflunomide
* Dimethyl fumarate
* Fingolimod
methylpredinosolone 1000mg × 3-5 days
For treatment of multiple sclerosis
* Acute treatment: methylprednisolone
* Prophylactic Tx (disease-modifying treatment):
* Indication: ALL patients with RRMS
* IFN- beta: betaferon
* Other injectional Tx: SC QD glatiramer acetate (copolymer-1), IV q1mo natalizumab
* Other oral Tx: PO BD dimethyl fumarate, PO QD terifluonomide, PO fingolimod
255
# 2023 Oct Q39
What is the MoA of digoxin?
* Inhibit sodium efflux
* Tyrosine kinase activation
* Inhibit calcium influx
* Inhibit chloride influx
* Inhibit PDE5
Inhibit sodium efflux
Inhibit sodium-potassium ATPase to increase intracellular sodium concentration. It increase intracellular Ca concentration to drive improved myocardial contractility
* Inhibit calcium influx: CCB
* Inhibit PDE5: Sildenafil
256
# 2023 Apr Q41
44/M with Hx of ulcerative colitis and is a social drinker presented with abnormal LFT.
AST 205
ALT 98
ALP 131
What is the cause?
* alcoholic liver disease
* Autoimmune hepatitis
* NASH
* Primary biliary cirrhosis
* Primary sclerosing cholangitis
Alcoholic liver disease
AST 205 >ALT 98 indicated on alcoholic liver disease.
* Autoimmune hepatitis: ANA +ve, Both ALT and AST increases
* NASH: asso with obesity and DM
* Primary biliary cirrhosis: AMA + with pruiritis
* Primary sclerosing cholangitis: Obstructive liver enzymes
257
# 2023 Jan
Treatment of amitriptyline overdose with VT
Sodium bicarbonate
258
# 2023 Jan
Self limiting diarrhea and lasted for 72h after going to Portugal.
C difficile / Enterovirus / E coli / Norovirus / Giardia lamblia
E coli (traveller's diarrhea)
Norovirus: projectile vomit + profuse watery diarrhea
Enterovirus: coryzal symptoms
Giardia: prolonged intermittent diarrhea and abd bloating
259
# 2023 Jan
12h after returning from haemodialysis, developed fever with no focal signs of infection. What's the cause?
E coli / Proteus vulgaris / Pseudomonas aeruginosa / Staphylococcus epidermidis / S pneumonia
Staphylococcus epidermidis
S epidermidis and S aureus are common causes of indwelling line infection. Vancomycin is the treatment.
260
# 2023 Jan
Sjogren syndrome woman with 2cm smooth swelling at the angle of left side of jaw. What is the diagnosis?
Parotititis / Parotid lymphadenopathy / Parotid gland stone
Parotid gland stone (a rare complication of Sjogren syndrome, Ix by Sialography, treated conservatively)
Parotitis likely has pus at orifice of parotid gland
261
# 2023 Jan
49/M with history of alcoholism presented with photosensitive erythematous rash with bullae. The lesions heal poorly and skin is fragile. Increase pigmentation and hypertrichosis (excessive hair growth ).
What enzyme is deficient?
Coproporphyrinogen oxidase / Uroporphyrinogen III synthase / Uroporphyrinogen decarboxylase
Uroporphyrinogen decarboxylase
262
# 2023 Jan
49/M bilateral knee pain and stiffness. Hx of DM and dLFT. Appeared tanned. Spider naevi over upper chest
1cm liver edge on palpation
Knee flexion limited by pain and stiffness
Knee XR: bilateral chondrocalcinosis
What is the cause ?
Gout / Ochronosis / OA / RA / Pyrophosphate arthropathy
Pyrophosphate arthropathy
