Questions Flashcards

Question

Which of the following treatments for prostate cancer works is an GnRH agonist? Cytoproterone acetate Degarelix Goserelin Bicalutamide Abiraterone

Answer 1

Which of the following treatments for prostate cancer works is an GnRH agonist? Cytoproterone acetate Degarelix **Goserelin** Bicalutamide Abiraterone

Answer 2

Which of the following treatments for prostate cancer is normally the option for the treatment of hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated? Cytoproterone acetate Degarelix Goserelin Bicalutamide **Abiraterone**

Answer 3

Which of the following treatments for prostate cancer works by preventing DHT binding from intracytoplasmic protein complexes? **Cytoproterone acetate** Degarelix Goserelin Bicalutamide Abiraterone

Answer 4

**Renal cancer**

Answer 5

NVH: **Renal USS tract**

Answer 6

Patient with severe abdominal pain. What does the image show? **Rigler’s/ double wall sign** **Free gas (pneumoperitoneum)** can be seen on both sides of the bowel wall. This is Rigler’s sign or the double wall sign. Whenever sharp points or triangles of low density are seen adjacent to loops of bowel, pneumoperitoneum should be suspected. Note: In patients with an acute abdomen an erect chest X-ray is more sensitive for small volumes of free gas.

Answer 7

Patient with severe abdominal pain. What does the image show? Ascites Lead pipe colon Normal gas pattern Rigler’s/ double wall sign **Thumbprinting** **Inflammation of the bowel wall leads to thickening of the haustral folds.** This results in the radiological sign of thumbprinting, a **characteristic finding in patients with active ulcerative colitis.**

Answer 8

What is the cause of the abnormal calcification? **Staghorn renal calculus**

Answer 9

24-year-old patient with suspected appendicitis. What does the image show? **Small bowel obstruction** Dilated loops of bowel with valvulae conniventes – lines crossing the full width of the bowel – indicates small bowel obstruction.

Answer 10

Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray? **Caecal volvulus** Normal appearances Pneumoperitoneum Small bowel obstruction Toxic megacolon

Answer 11

What is the artifact shown in this image? Biliary stent Colonic stent External tubing Percutaneous nephrostomy tube **Ureteric stent**

Answer 12

Patient with abdominal pain and vomiting. What is the radiological diagnosis? Caecal volvulus **Large bowel obstruction** Small bowel obstruction Bowel perforation Normal

Answer 13

What is the radiological diagnosis? Sigmoid volvulus Normal **Ascites** Small bowel obstruction Pneumoperitoneum

Answer 14

What is the cause of the abnormal calcification in this image? Calcified gallstones Calcified mesenteric lymph nodes **Pancreatic calcification** Malignant calcification Calcified uterine fibroid

Answer 15

Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis? **Caecal volvulus** Sigmoid volvulus Small bowel obstruction Perforation Normal

Answer 16

What is the cause of the area of increased density in the pelvis? Calcified pelvic kidney Calcified abdominal lymph node **Calcified uterine fibroid** Ingested barium Calcified adrenal gland

Answer 17

History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis? **Small bowel obstruction** Post-operative ileus Normal Perforation Sigmoid volvulus

Answer 18

If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action? Place an abdominal drain Request abdominal ultrasound Request abdominal MRI **Resuscitate the patient and inform the surgeons** Take a break ## Footnote A large volume of free gas is present under the diaphragm. In the context of acute abdominal pain this finding indicates perforation. Emergency resuscitation and informing the surgeons would be the most appropriate action.

Answer 19

Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances? Pneumoperitoneum Ascites Psoas abscess Small bowel obstruction **Normal**

Answer 20

Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances? Large bowel obstruction **Sigmoid volvulus** Caecal volvulus Perforation Small bowel obstruction

Answer 21

Normally **only the inner wall** of the bowel is visible If there is **pneumoperitoneum** **both** **sides** of the **bowel** **wall** may be visible

Answer 22

When **perforation** of a **duodenal** **ulcer** **occurs**, and results in a **pneumoperitoneum**: **Gas** collects in **Morison's pouch** (the hepato-renal space), and **rise on the supine film to the anterior abdominal wall outlining the edge of the liver** diagnostic of duodenal perforation.

Answer 23

**False Rigler's/double wall sign** * Be careful not to mistake the gas within two adjacent bowel segments for Rigler's sign. * Gas seen on both sides of the bowel wall is contained within adjacent bowel * There are no black triangles or sharp angles on the outside of the bowel wall

Answer 24

**Small bowel obstruction - features** **Centrally located** multiple dilated loops of gas filled bowel (arrowheads) **Valvulae conniventes** (arrow) are visible - confirming this is small bowel

Answer 25

**Large bowel obstruction** * Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon. * Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow). * An obstructing colon carcinoma was confirmed on CT and at surgery.

Answer 26

**Mucosal thickening - 'thumbprinting'** This patient presented with an exacerbation of symptoms of **ulcerative colitis.**

Answer 27

**Lead pipe colon** This patient with **ulcerative** **colitis** has a featureless segment of transverse colon with loss of the normal haustral markings. This 'lead pipe' appearance is associated with longstanding ulcerative colitis.

Answer 28

**Toxic megacolon** The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of **ulcerative colitis.** The clinical features and X-ray appearances are consistent with toxic megacolon.

Answer 29

**Bladder stones** form in the bladder as a result of **urinary stasis**, e.g. **bladder outflow obstruction** (enlarged prostate) or in **patients with a neurogenic bladder** (loss of bladder function due to spinal cord injury/disease)

Answer 30

**Vascular calcification** There is striking calcification of the aorta and iliac vessels **This is a sign of generalised atherosclerosis elsewhere in the body**

Answer 31

**Abdominal aortic aneurysm - AAA** There is calcification of the dilated aortic wall Frequently only one side of the aneurysm is visible - as in this image - the other being projected over the spine

Answer 32

What is the cause of the abnormal calcification? **Adrenal calcification** Appendicolith Gallstones Pancreatic calcification Staghorn renal calculus

Answer 33

What is the cause of the abnormal calcification? Adrenal calcification Appendicolith Gallstones **Pancreatic calcification** Staghorn renal calculus

Answer 34

**Appendicolith** Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain ## Footnote Appendicoliths are calcific masses in the appendix, formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix

Answer 35

**Inferior vena cava (IVC) filter** An IVC filter may be used to reduce the risk of large pulmonary emboli

Answer 36

**Colonic stent** Large bowel obstruction can be treated with placement of a metallic colonic stent This is often used as a temporary measure allowing a patient to recover from the effects of obstruction prior to definitive colonic resection

Answer 37

**Pig-tail (JJ) stent** A ureteric stent has been placed to relieve ureteric obstruction The catheter has loops (pig-tails) at both ends which hold it in place

Answer 38

**Naso-jejunal tube** Placed for the purpose of enteral feeding The tube passes through the stomach and forms a C-shape as it navigates the 4 parts of the duodenum (D1-4) The tube tip lies beyond the duodenojejunal flexure which lies on the left

Answer 39

**Ascites** There is generalised hazy density of the entire abdomen In the presence of ascites gas within bowel is located centrally

Answer 40

A 45-year-old man presents with symptoms of urinary colic. In the history he has suffered from recurrent episodes of frank haematuria over the past week or so. On examination he has a left loin mass and a varicocele. The most likely diagnosis is: **Renal adenocarcinoma** Renal cortical adenoma Squamous cell carcinoma of the renal pelvis Retroperitoneal fibrosis Nephroblastoma

Answer 41

**Bilateral idiopathic adrenal hyperplasia** is the most common cause of primary hyperaldosteronism

Answer 42

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels? Internal jugular vein and hepatic vein Internal jugular vein and portal vein Hepatic artery and hepatic vein Hepatic artery and portal vein **Hepatic vein and portal vein**

Answer 43

Which of the following stone type appears as a stag-horn on x-ray? Urate **Magnesium ammonium phosphate** Calcium oxalate Calcium phosphate Cystine

Answer 44

A 28-year-old female presents with jaundice. The following results are available: HBsAg +ve, HBeAg +ve, HBeAb −ve, HBc IgM +ve Which of the following interpretations is most accurate? Susceptible to hepatitis B Chronic hepatitis B with low infectivity **Chronic hepatitis B with high infectivity** Previous immunisation against hepatitis B Natural immunity against hepatitis B

Answer 45

A patient with a history of abdominal surgery develops abdominal pain. A plain abdominal X-ray shows dilated bowel loops. There are lines on the dilated parts of the bowel which cross it. What is the most likely underlying cause? Gallstones Inguinal hernia **Adhesions** Caecal carcinoma Sigmoid carcinoma

Answer 46

A 25-year-old male has presented to the Emergency Department with fever, jaundice and malaise for the past three days. Initial laboratory studies show raised liver enzymes and a low platelet count. He has no recent travel history. A diagnosis of autoimmune hepatitis is being considered. Which of the following antibodies are most specific for this condition? **Anti-smooth muscle antibodies**

Answer 47

Which of the following is the most appropriate antibiotic for this patient’s infected pressure ulcer? **Flucloxacillin** The patient has an infected sacral pressure sore. The infection is likely to be superficial with no extension to the underlying bone (which would be concerning for osteomyelitis). Along with cleaning and dressing the wound, culture swabs of the fluid should be taken so antibiotics can be tailored according to microbial sensitivities. Superficial infections are typically treated with oral antibiotics such as flucloxacillin as this is likely to provide coverage for gram-positive bacteria that reside on the skin surface, such as **Staphylococcus aureus**. As the patient is bed-bound, he should also be assessed for an air mattress.

Answer 48

Gilbert’s syndrome is an **autosomal recessive condition** associated with **intermittent raised unconjugated bilirubinaemia**, resulting from a **defective glucuronyl transferase**. This is the **enzyme** involved in **conjugation** of **bilirubin**, and so the **ability** of **patients** to **conjugate bilirubin is significantly reduced.**

Answer 49

The condition is defined by the four following characteristics, necessary for diagnosis: * **unconjugated hyperbilirubinaemia** * **normal liver function** * **no haemolysis** * **no evidence of liver disease**

Answer 50

*In unaffected individuals following conjugation, conjugated bilirubin is released into the bile and is either excreted in the faeces as stercobilin or reabsorbed in the circulation and excreted by the kidneys in the urine in the form of urobilinogen* In Gilberts: there is a defective glucuronyl transferase. This is the enzyme involved in conjugation of bilirubin, and so the ability of patients to conjugate bilirubin is significantly reduced. **Unconjugated bilirubin is non-water-soluble; therefore, it cannot be excreted in the urine.**

Answer 51

A 55-year-old male alcoholic with known cirrhotic liver disease is admitted to the Gastroenterology Ward with a distended abdomen, jaundice and confusion. On examination, he is clinically jaundiced and has a massively distended abdomen with evidence of a fluid level on percussion. An aspirate of fluid is taken from his abdomen and sent for analysis. Results indicate the fluid is an exudate. Which of the following is an exudative cause of ascites? **Malignancy** Ascites is defined as an accumulation of fluid within the peritoneal cavity. The causes can be classified according to the **protein content of the fluid: < 30 g/l transudate, >30 g/l exudate**. The most common causes of an exudative ascites are infection or malignancy. The above patient scenario would be more in keeping with a malignant cause.

Answer 52

What imaging modility is first line for non-pregnant patients for suspected kidney stones? MRI XR-KUB **CT-KUB** US

Answer 53

What imaging modility is first line for pregnant patients for suspected kidney stones? MRI XR-KUB CT-KUB **US**

Answer 54

What is the first line treatment for pregnant person with stone? [1] Open surgery Percutaneous nephrolithotomy (PCNL) **Ureteroscopy (URS)** Shockwave lithotripsy (SWL)

Answer 55

What is the first line treatment for pregnant person with stone size of less than 2cm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) **Shockwave lithotripsy (SWL)** Watchful waiting

Answer 56

What is the first line treatment for pregnant person with stone size of < 5mm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) Shockwave lithotripsy (SWL) **Watchful waiting**

Answer 57

What is the first line treatment for person with stone size of 12 mm? Open surgery Percutaneous nephrolithotomy (PCNL) Ureteroscopy (URS) **Shockwave lithotripsy (SWL)** Watchful waiting

Answer 58

What is the first line treatment for person with stone size of 24 mm? Open surgery **Percutaneous nephrolithotomy (PCNL)** Ureteroscopy (URS) Shockwave lithotripsy (SWL) Watchful waiting

Answer 59

Which of the following are related to urinary tract infections Uric acid stones Cystine stones Calcium oxalate stones Calcium carbonate stones **Magnesium carbonate stones**

Answer 60

A 48-year-old women presents with recurrent loin pain and fevers. Investigation reveals a staghorn calculus of the left kidney. Infection with which of the following organisms is most likely? Staphylococcus saprophyticus **Proteus mirabilis** Klebsiella E-Coli Staphylococcus epidermidis

Answer 61

Proteus mirabilis is most likely to cause what type of stone? Uric acid stones Cystine stones Calcium oxalate stones Calcium carbonate stones **Magnesium carbonate stones**

Answer 62

Which of the following type of UTIs is most likely to have spread haematogenously? **Candida albicans** AND **Staph. aureus; M. tb**

Answer 63

Which following treatment for UTIs may cause neonatal haemolysis? Cefalexin Trimethoprim Amoxicillin Co-amoxiclav **Nitrofurantoin**

Answer 64

Which following treatment for UTIs may cause spina bifida? Cefalexin **Trimethoprim** Amoxicillin Co-amoxiclav Nitrofurantoin

Answer 65

Which following treatment for UTIs should be avoided in the third trimester of pregnancy? Cefalexin Trimethoprim Amoxicillin Co-amoxiclav **Nitrofurantoin**

Answer 66

Which following treatment for UTIs should be avoided in the first trimester of pregnancy? Cefalexin **Trimethoprim** Amoxicillin Co-amoxiclav Nitrofurantoin

Answer 67

Which following treatment for UTIs should be avoided in patients with renal impairment? Cefalexin Trimethoprim Amoxicillin Co-amoxiclav **Nitrofurantoin**

Answer 68

A 60-year-old man attends the surgical day unit for a loop ileostomy following rectal cancer surgery. He is informed that he will be left with a stoma and that the stoma nurses will explain how this is to be cared for. What are the correct features of this stoma? **Right iliac fossa, spouted appearance with liquid output** Colon has a role in the absorption of water from the gastrointestinal tract, with it being bypassed, the stool will be looser and therefore present as a liquid. As the stool is liquid and rich in digestive enzymes it is more likely to irritate the skin, therefore a spout is preferred so that it can drain directly into the stoma bag. It is often located in the right iliac fossa as the ileocecal junction (the connection between the ileum and cecum) is located in the right iliac fossa. Creating an ileostomy in this area allows for the least disruption of the natural digestive process.

Answer 69

**Loop ileostomy** The presence of two lumens in this stoma suggests that it is indeed a loop stoma; end stomas characteristically have only one lumen

Answer 70

**loop stoma**; **two lumens** **end stomas** characteristically have only **one lumen**

Answer 71

A 76-year-old woman presents to the outpatient colonoscopy department following a referral from her GP due to a positive faecal immunochemical test (FIT). Colonoscopy reveals a 3x2 cm mass at the distal end of the transverse colon near the splenic flexure. Histology from a biopsy confirms an isolated adenocarcinoma. Following a multidisciplinary team (MDT) discussion, she is scheduled for surgical resection of the tumour. What is the most likely surgery that will be performed? Hartmann's procedure **Left hemicolectomy** Total colectomy Transverse colectomy: - It is generally reserved for tumours situated centrally within the transverse colon, whereas lesions at either end are more appropriately managed with right or left hemicolectomies respectively. Wide-local excision of the tumour

Answer 72

Question 8 of 113 A 67-year-old man presents to clinic with a history of blood in the stools and weight loss. He was referred for an urgent colonoscopy, which showed a mass in the distal transverse colon. Biopsy confirmed adenocarcinoma. Further investigation reveals no lymph node involvement or distant metastasis. What surgery should be offered? Hartmann's procedure High anterior resection **Left hemicolectomy** Right hemicolectomy Total colectomy

Answer 73

A 78-year-old man presents to the emergency department with intense abdominal pain. He has not passed faeces or wind in the last 48 hours. When asked, he mentions that he has lost some weight recently and in the weeks preceding this event he has been feeling constipated. The team suspects a large bowel obstruction due to cancer and orders a CT scan, that shows a mass in the hepatic flexure. Which one of the following surgical management plans is the most appropriate for the patient? Hartmann's procedure High anterior resection Left hemicolectomy Low anterior resection **Right hemicolectomy**

Answer 74

Right hemicolectomy: - involves removal of the caecum, ascending and proximal transverse colon. Left hemicolectomy: - involves removal of the distal transverse and descending colon. High anterior resection: - involves removing the sigmoid colon (may be called a sigmoid colectomy). Low anterior resection: - involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus. Abdomino-perineal resection (APR): - involves removing the rectum and anus (plus or minus the sigmoid colon) and suturing over the anus. It leaves the patient with a permanent colostomy. Hartmann’s procedure:

Answer 75

Which of the following involves removal of the distal transverse and descending colon? Hartmann's procedure High anterior resection Left hemicolectomy Low anterior resection **Right hemicolectomy**

Answer 76

Which of the following involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus? Hartmann's procedure High anterior resection Left hemicolectomy **Low anterior resection** Right hemicolectomy

Answer 77

Which of the following involves removing the sigmoid colon? Hartmann's procedure **High anterior resection** Left hemicolectomy Low anterior resection Right hemicolectomy

Answer 78

Which of his medications could lead to a reduced awareness of the symptoms of a hypoglycemic event following his insulin use? **Beta-blocker** Hypotension Bradycardia HYPOGLYCEMIA Hypothermia

Answer 79

**Cullens sign** Cullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. This is also known as peri-umbilical ecchymosis. It is most often recognised as a result of **haemorrhagic pancreatitis.**

Answer 80

**Grey-Turner's sign** Classically it correlates with **severe acute necrotizing pancreatitis**

Answer 81

A 61-year-old library assistant has an increasing frequency of episodes of intermittent abdominal discomfort and bloating. She also complains of associated episodes of diarrhoea, with mucus in the stool but no blood. The pain usually worsens after meals and improves after opening her bowels. She has not lost weight and continues to have a good appetite. She has had a knee replacement for osteoarthritis but no other significant medical history of note. Investigation of the patient’s symptoms reveals diverticular disease. Which of the following complications is this patient most at risk of developing? **Colovesical fistulae** **A colovesical fistula is an abnormal connection between the bladder and the colon. It presents with pneumaturia and other lower urinary tract symptoms.**

Answer 82

Which of the following is considered the most common underlying cause of colovesical fistula? appendicitis **diverticulitis** colorectal cancer Crohn disease radiotherapy trauma

Answer 83

A 36-year-old female with a history of ulcerative colitis (UC) for seven years seeks guidance on the frequency of colonoscopies in UC. Her UC is currently well-managed, and there is no family history of malignancy. She underwent a routine colonoscopy slightly over one year ago. What would be the most appropriate date for her next colonoscopy appointment? **In four years** National Institute for Health and Care Excellence (NICE) guidelines recommend a surveillance colonoscopy every five years. Patients at intermediate risk have a surveillance colonoscopy every three years and patients in the high-risk group annually.

Answer 84

A 74-year-old male is seen by his General Practitioner with a one-month history of pain on passing urine. His urine dip is positive for blood but negative for leukocytes and nitrites, and he is started on nitrofurantoin for suspected urinary tract infection. His urine culture is negative. Two weeks later, he continues to experience pain in passing urine. His urine dip results are unchanged; blood tests reveal a raised white cell count. **Refer to Urology on the two-week wait pathway** Referral of this patient under the suspected cancer pathway to Urology is necessary due to suspicious features suggestive of bladder cancer. According to the pathway criteria, patients aged 45 and above should be referred if they present with unexplained visible haematuria without urinary tract infection, visible haematuria that persists or reoccurs after urinary tract infection treatment, or unexplained non-visible haematuria in combination with raised serum white cell count or dysuria (for those over 60 years old). In this case, the persistent dysuria and elevated white cell count raise potential malignancy concerns.

Answer 85

A surgeon performing his first appendectomy could not identify the base of the appendix due to massive adhesions in the peritoneal cavity. The consultant suggested identifying the caecum first and then localising the base of the appendix. Which anatomical structure(s) on the caecum would he have used to find the base of the appendix? Omental appendages Haustra coli Ileal orifice Semilunar folds **Teniae coli** The Taeniae coli are three bands of longitudinal muscle on the surface of the large intestine. The large intestine does not have a continuous layer of longitudinal muscle; it has taeniae coli. **These three bands meet at the appendix, which projects from the dependent portion of the caecum.**

Answer 86

A 56-year-old male presents with a high spiking fever for the past two weeks and dull abdominal pain in the right upper quadrant. Blood cultures were negative for the growth of any organisms. The patient gives a poor history, but on imaging, there is noted to be a collection in the liver. Ultrasound-guided biopsy reveals pus, which is described as anchovy sauce. What is the most likely diagnosis? **Amoebic abscess** An amoebic liver abscess causes right upper quadrant pain, swinging fever and tenderness. This can occur following amoebic dysentery but does not always do so. Amoebic dysentery causes slowly increasing diarrhoea which can be profuse and bloody. Anchovy sauce pus in the liver is consistent with an amoebic abscess and is the key to this answer.

Answer 87

A 55-year-old female presents with a thyroid lump and you have a clinical suspicion of follicular carcinoma of the thyroid. Which of the following is the best option that fits such a case? **Spreads mainly via blood** Follicular carcinoma is a carcinoma that spreads via the haematogenous route. Papillary and medullary carcinomas spread via the lymphatic system; anaplastic cancer spreads locally.

Answer 88

What sign indicated global, rather than localised, peritonitis? **Absent bowel sounds** **Other signs of generalised peritonitis are tenderness to percussion of the abdomen and a generalised rigid, ‘board-like’ abdomen.**

Answer 89

A 60-year-old male patient is admitted complaining of severe abdominal pain. He is diagnosed with mesenteric vascular occlusion. The small bowel becomes gangrenous and resection is performed. Which of the following is a complication of this procedure? Your answer was incorrect Constipation Scurvy Weight gain **Nephrolithiasis** Achlorhydria

Answer 90

A 33-year-old female is found to have a blood pressure of 180/130 mmHg incidentally on three separate occasions. Her General Practitioner completes the rest of her cardiovascular examination, which was unremarkable. Secondary hypertension causes are investigated, and an abdominal computed tomography (CT) angiogram is performed. This shows a significantly smaller left kidney compared to the right, with the left renal artery displaying a ‘string of beads’ appearance. What would be the most appropriate management option for this patient? **Balloon angioplasty** Kidney transplantation Nephrectomy Statins Surgical revascularisation

Answer 91

A 72-year-old female with a history of diverticular disease undergoes emergency abdominal surgery. When examining this patient after her surgery, you notice she has an end colostomy. What feature would suggest that this patient has had a Hartmann’s procedure and not an abdominoperineal (AP) resection? **Presence of rectum** **Complete excision** of the **rectum** and **anus** is carried out as part of an **AP resection**. Therefore, the presence of the rectum excludes an AP resection.

Answer 92

Critical limb ischaemia

Answer 93

A patient describes pain in their lower limb. After you ask them to describe the pain more they describe a cramping in their legs after walking 300 m in distance. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 94

A patient describes pain in their lower limb. After you ask them to describe the pain more they describe a cramping in their legs when they're resting. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 95

A patient describes pain in their lower limb. After a clinical exam you find that they have pain walking around the room, but have no rest pain. What is their Fontaine classification? Stage I Stage IIa Stage IIb **Stage III** Stage IV

Answer 96

Buergers test for PAD

Answer 97

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.8. This PAD can be classified as Normal **Mild** Moderate Severe ## Footnote 0.9 – 1.3 is normal 0.6 – 0.9 indicates mild peripheral arterial disease 0.3 – 0.6 indicates moderate to severe peripheral arterial disease Less than 0.3 indicates severe disease to critical ischaemic

Answer 98

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.5. This PAD can be classified as Normal Mild **Moderate** Severe

Answer 99

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.2. This PAD can be classified as Normal Mild Moderate **Severe**

Answer 100

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.7. This PAD can be classified as Normal **Mild** Moderate Severe

Answer 101

A patient has their ABPI measured due to suspeted PAD. The ratio is found to be 0.4 This PAD can be classified as Normal Mild **Moderate** Severe

Answer 102

Greater than **1.3** due to **calcification**

Answer 103

Which of the following presentations is classical for an aortic dissection? * Central crushing chest pain, radiating down the left arm, with tachycardia and hypertension * **A tearing central chest pain, new onset cardiac murmur, and tachycardia** * Sudden onset dyspnoea with widespread crackles and wheeze * A burning pain, spreading from the epigastrium to the central chest, worse when lying down, normal clinical examination

Answer 104

What is the gold standard imaging modality for first line investigation of a suspected aortic dissection? ECHO CT Chest-Abdo-Pelvis CXR **CT Angiogram**

Answer 105

Type IIIa Type III – originates distal to the subclavian artery in the descending aorta Further subdivided into IIIa which extends distally to the diaphragm and IIIb which extends beyond the diaphragm into the abdominal aorta

Answer 106

What is Debakey classification for aortic dissection is this? Type I Type II **Type IIIa** Type IIIB

Answer 107

What is Debakey classification for aortic dissection is this? Type I Type II Type IIIa **Type IIIB**

Answer 108

What is Debakey classification for aortic dissection is this? **Type I** Type II Type IIIa Type IIIB

Answer 109

What is Debakey classification for aortic dissection is this? Type I **Type II** Type IIIa Type IIIB

Answer 110

A 65-year-old man attends an abdominal aortic aneurysm (AAA) screening offered by his GP. On ultrasound, it is revealed that he has a supra-renal aneurysm that is 4.9 cm in diameter. When questioned he says he has no symptoms. How should this patient be managed? 12-monthly ultrasound assessment **3-monthly ultrasound assessment** 6-monthly ultrasound assessment Referral to stop smoking services Urgent referral to vascular surgery

Answer 111

A 55-year-old lady with claudication is assessed and an ABPI is performed. Results show an ABPI value of 1.3. Which of the following conditions may lead to this abnormal result? Hypothyroidism Hypercalcaemia **Type 2 diabetes** Peripheral arterial disease Previous deep vein thrombosis

Answer 112

Open bypass graft

Answer 113

**Endovascular revascularization** Peripheral arterial disease with critical limb ischaemia: high-risk patients with short segment stenosis are more suited to endovascular revascularization

Answer 114

Acromegaly Obesity Hypothyroidism Pregnancy RA

Answer 115

Which of the following descriptions of benign or malignant focal lung opacities is correct? **benign: much wider than tall, with scalloped margins** benign: taller than wide, with rounded margins malignant: microlobulated margins, with sparse, angulated radiations malignant: polygonal margins, with indrawing of the fissure

Answer 116

thyroid transcription factor 1 (TTF-1) is expressed in most lung cancer except [] cancer **squamous cell lung cancer** small cell lung cancer large cell lung cancer lung adenocarcinoma

Answer 117

Which of the following lung cancers is NOT associated with cigarette smoking? adenocarcinoma **adenoid cystic carcinoma** adenosquamous carcnioma large-cell lung cancer small-cell lung cancer squamous cell carcinoma

Answer 118

**Trachea and main bronchi** Localized plaques associated with asbestos exposure are most frequently reported in both hemidiaphragms, the lateral chest wall and along the mediastinum.

Answer 119

Patients with proliferative diabetic retinopathy and no macular involvement should be treated with **panretinal photocoagulation.**

Answer 120

**15 x 10^9**

Answer 121

**Restless leg syndrome: IDA**

Answer 122

**Iron**: PICA Pica is the abnormal craving or appetite for non-food substances, such as soil, ice, paint, or clay. It has been reported in up to 55% of patients with IDA.[86] Ingestion of some materials, such as clay, has chelating effects, which can impair the absorption of iron. These cravings correct within 2 weeks of iron replacement.

Answer 123

Heinz bodies on a blood film would indicate which cause of anaemia **G6PD deficiency** Pernicious anaemia Hereditary spherocytosis Sickle cell anaemia

Answer 124

**G6PD deficiency** - Heinz bodies

Answer 125

According to NICE guidelines, what hemoglobin level is indicative of anemia in adult males? A. < 12 g/dL **B. < 13 g/dL** C. < 14 g/dL D. < 15 g/dL

Answer 126

In the context of macrocytic anemias, which laboratory test is crucial for differentiating between vitamin B12 deficiency and folate deficiency? **A. Methylmalonic acid (MMA)** B. Homocysteine levels C. Serum vitamin B12 D. Reticulocyte count

Answer 127

Which type of anemia is characterized by a low serum iron, low total iron-binding capacity (TIBC), and a high transferrin saturation? A. Iron deficiency anemia **B. Anemia of chronic disease** C. Sideroblastic anemia D. Thalassemia

Answer 128

According to NICE guidelines, what is the primary confirmatory test for **hereditary hemochromatosis?** A. Liver biopsy B. Serum ferritin **C. Genetic testing (HFE mutations)** D. Iron studies

Answer 129

Which form of thalassemia is characterized by a microcytic hypochromic anemia with target cells on peripheral blood smear? A. Beta-thalassemia major B. Alpha-thalassemia minor **C. Beta-thalassemia minor** D. Alpha-thalassemia major

Answer 130

In the diagnosis of aplastic anemia, which parameter is typically reduced in the peripheral blood count? A. Reticulocyte count B. White blood cell count **C. Platelet count** D. Hematocrit

Answer 131

What is the primary screening test for sickle cell anemia in newborns, as recommended by NICE guidelines? A. Hemoglobin electrophoresis B. High-performance liquid chromatography (HPLC) **C. Sickle solubility test** D. Complete blood count (CBC)

Answer 132

Which type of anemia is characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction? A. Sickle cell anemia **B. Hemolytic-uremic syndrome** C. Aplastic anemia D. Polycythemia vera

Answer 133

According to NICE guidelines, what is the recommended initial test for suspected hemoglobinopathies in newborns? A. Complete blood count (CBC) B. High-performance liquid chromatography (HPLC) C. Osmotic fragility test **D. Hemoglobin electrophoresis**

Answer 134

**Acute myeloid leukaemia**

Answer 135

Which of the following is most associated with : exposure to certain toxins (e.g. benzene and organochlorine insecticides) **Acute myeloid leukaemia** Acute lymphoblastic leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 136

**Acute myeloid leukaemia**

Answer 137

Alpha thalassemia can result from the deletion of alpha-globin genes. What is the most common alpha thalassemia genotype associated with clinical manifestations? a) αα/αα b) --/αα c) --/-- **d) α-/α-**

Answer 138

**c) Folic Acid supplementation**

Answer 139

Individuals with alpha thalassemia trait (silent carrier) typically have two affected alpha-globin genes. How does NICE recommend managing asymptomatic individuals with alpha thalassemia trait during pregnancy? a) Iron supplementation **b) Genetic counseling** c) Folate supplementation d) Regular blood transfusions

Answer 140

**b) Chorionic villus sampling (CVS)**

Answer 141

NICE recommends screening for alpha thalassemia in newborns. What is the primary screening test used for this purpose? a) Hemoglobin electrophoresis b) Complete Blood Count (CBC) **c) DNA analysis** d) Serum Ferritin

Answer 142

After the diagnosis of alpha thalassemia, what is the recommended frequency of follow-up monitoring for individuals with alpha thalassemia trait, according to NICE? a) Every 6 months **b) Annually** c) Biennially d) Only as needed based on symptoms

Answer 143

**d) Molecular genetic testing**

Answer 144

In beta thalassemia major, NICE recommends regular blood transfusions to maintain hemoglobin levels. What is the target pre-transfusion hemoglobin level, according to NICE? a) 8-9 g/dL **b) 9-10 g/dL** c) 10-11 g/dL d) 11-12 g/dL

Answer 145

Individuals with beta thalassemia major are at risk of iron overload due to frequent transfusions. How often does NICE recommend monitoring serum ferritin levels for these patients? **a) Every 3 months** b) Every 6 months c) Annually d) Biennially

Answer 146

To manage iron overload in beta thalassemia major, NICE recommends chelation therapy. Which chelator is commonly used in this setting? a) Deferoxamine b) Deferiprone c) Desferrioxamine **d) Deferasirox**

Answer 147

NICE recommends folate supplementation in beta thalassemia major. What is the purpose of folate supplementation in these patients? a) Stimulate erythropoiesis b) Prevent neural tube defects c) Enhance iron chelation **d) Reduce oxidative stress**

Answer 148

In beta thalassemia major, allogeneic bone marrow transplantation is considered a curative option. What is a key requirement for a successful bone marrow transplant? a) Age over 50 years **b) HLA-matched sibling donor** c) Presence of iron overload d) Chronic liver disease

Answer 149

NICE suggests the use of hydroxyurea in beta thalassemia intermedia to reduce transfusion requirements. What is the mechanism of action of hydroxyurea in this context? **a) Stimulation of fetal hemoglobin** b) Inhibition of iron absorption c) Prevention of bone marrow suppression d) Induction of erythropoiesis

Answer 150

Beta thalassemia major can lead to complications such as endocrine dysfunction. Which endocrine complication is commonly associated with beta thalassemia major, according to NICE? a) Thyroid dysfunction b) Diabetes mellitus **c) Growth hormone deficiency** d) Adrenal insufficiency

Answer 151

Beta thalassemia major can lead to cardiac complications. How often does NICE recommend cardiac monitoring, including echocardiography, for these patients? **a) Every 2 years** b) Every 5 years c) Annually d) Only when symptoms arise

Answer 152

According to NICE guidelines, which imaging modality is recommended for the initial staging of Hodgkin's lymphoma? a) X-ray b) Computed Tomography (CT) c) Magnetic Resonance Imaging (MRI) **d) Positron Emission Tomography (PET)**

Answer 153

**c) Excisional lymph node biopsy**

Answer 154

NICE provides guidance on follow-up monitoring for Hodgkin's lymphoma survivors. How often does NICE recommend follow-up appointments during the first two years after treatment? a) Every 3 months **b) Every 6 months** c) Annually d) Biennially

Answer 155

Hodgkin's lymphoma survivors are at risk of late effects from treatment. What is a common late effect that NICE emphasizes for monitoring? a) Osteoporosis **b) Cardiomyopathy** c) Peripheral neuropathy d) Diabetes

Answer 156

In relapsed or refractory Hodgkin's lymphoma, what is a commonly used salvage chemotherapy regimen according to NICE? a) ABVD b) BEACOPP **c) CHOP** d) EPOCH

Answer 157

As part of the treatment for NAFLD, NICE recommends the prescription of which following vitamin, due to increased clinical outcomes? Vitamin A Vitamin B Vitamin C Vitamin D **Vitamin E**

Answer 158

Which of the following best describes *occurs when a person develops angina when lying down (not necessarily only at night) and is without any apparent cause* St Vincent's angina Stable angina **Decubitus angina** Prinztmetal angina

Answer 159

Which of the following best describes *results from a spasm of one of the large coronary arteries on the surface of the heart.* St Vincent's angina Stable angina Decubitus angina **Prinztmetal / variant angina**

Answer 160

Which of the following has a risk of GI ulceration? Ivabradine **Nicorandil** Digoxin Amlodopine Verapamil

Answer 161

severe coronary artery spasm is which type of MI Type I **Type II** Type III Type IV

Answer 162

Myocardial infarction associated with percutaneous coronary intervention (PCI) or stent thrombosis would be classified as: Type I Type II Type III **Type IV**

Answer 163

Myocardial infarction associated with tachyarrhythmias would be classified as: Type I **Type II** Type III Type IV

Answer 164

Myocardial infarction associated with hypotension would be classified as: Type I **Type II** Type III Type IV

Answer 165

which of these findings would be consistent with a ventricular septal defect? Pulsus paradoxus Early diastolic murmur Displaced apex beat Split S1 **Pansystolic murmur**

Answer 166

Burkitt's lymphoma is associated with which one of the following genetic changes: Cyclin D1-IGH gene translocation TEL-JAK2 gene translocation Bcl-2 gene translocation **C-myc gene translocation** BCR-Abl1 gene translocation

Answer 167

**chronic myeloid leukaemia (CML)** is associated with which one of the following genetic changes: Cyclin D1-IGH gene translocation TEL-JAK2 gene translocation Bcl-2 gene translocation C-myc gene translocation **BCR-Abl1 gene translocation**

Answer 168

**myelofibrosis** is associated with which one of the following genetic changes: Cyclin D1-IGH gene translocation **TEL-JAK2 gene translocation** Bcl-2 gene translocation C-myc gene translocation BCR-Abl1 gene translocation

Answer 169

**follicular lymphoma** is associated with which one of the following genetic changes: Cyclin D1-IGH gene translocation TEL-JAK2 gene translocation **Bcl-2 gene translocation** C-myc gene translocation BCR-Abl1 gene translocation

Answer 170

Which of the following medications are known to cause QTc prolongation? Bisoprolol Diazepam Salbutamol **Sotalol** Carvedilol

Answer 171

M - Methadone E - Erythromycin T - Terfenadine H - Haloperidol C - Chloroquine / Citalopram A - Amiodarone T - Tricyclics S - Sotalol

Answer 172

Which of the following is the most cause of endocarditis in patients following prosthetic valve surgery? **Staphylococcus epidermidis** Streptococcus viridans Staphylococcus aureus Streptococcus bovis Streptococcus sanguinis

Answer 173

Which of the following is the most cause of endocarditis in patients with colorectal cancer? Staphylococcus epidermidis Streptococcus viridans Staphylococcus aureus **Streptococcus bovis** Streptococcus sanguinis

Answer 174

Which of the following is associated most with poor dental hygiene / following a dental procedure? Staphylococcus epidermidis **Streptococcus viridans** Staphylococcus aureus Streptococcus bovis Streptococcus sanguinis

Answer 175

Which of the following is associated most with patients with no prior past medical history? Staphylococcus epidermidis Streptococcus viridans **Staphylococcus aureus** Streptococcus bovis Streptococcus sanguinis

Answer 176

Which of the following is associated most with IVDU who present acutely? Staphylococcus epidermidis Streptococcus viridans **Staphylococcus aureus** Streptococcus bovis Streptococcus sanguinis

Answer 177

Which of the following is associated most with IE in the first 2 months following prosthetic valve surgery **Staphylococcus epidermidis** Streptococcus viridans Staphylococcus aureus Streptococcus bovis Streptococcus sanguinis

Answer 178

Is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications? A. Verapamil B. Amlodipine C. Nifedipine **D. Bisoprolol** E. Nicorandil F. Isosorbide mononitrate

Answer 179

Patients may develop tolerance to this medication necessitating a change in dosing regime A. Verapamil B. Amlodipine C. Nifedipine D. Bisoprolol E. Nicorandil **F. Isosorbide mononitrate**

Answer 180

**Acute endocarditis** is most commonly caused by **Staphylococcus** **Subacute** cases are most commonly caused by **Streptococcus species.**

Answer 181

**Native valve endocarditis**

Answer 182

**vancomycin + meropenem** is the treatment for: native valve endocarditis with severe sepsis, penicillin allergy or suspected methicillin-resistent staphylococcus aureus (MRSA) Native valve endocarditis Prosthetic valve endocarditis **NVE with severe sepsis and risk factors gram negative infection**

Answer 183

**Prosthetic valve endocarditis**

Answer 184

vancomycin + gentamicin is the treatment for **native valve endocarditis with severe sepsis, penicillin allergy or suspected methicillin-resistent staphylococcus aureus (MRSA)** Native valve endocarditis Prosthetic valve endocarditis NVE with severe sepsis and risk factors gram negative infection

Answer 185

Which of the following would you use to treat native valve endocarditis? vancomycin + gentamicin vancomycin + meropenem vancomycin, gentamicin + rifampacin **amoxicillin + gentamicin**

Answer 186

Which of the following would you use to treat MRSA +ve endocarditis? **vancomycin + gentamicin** vancomycin + meropenem vancomycin, gentamicin + rifampacin amoxicillin + gentamicin

Answer 187

Which of the following would you use to treat **NVE with severe sepsis and risk factors gram negative infection**? vancomycin + gentamicin **vancomycin + meropenem** vancomycin, gentamicin + rifampacin amoxicillin + gentamicin

Answer 188

Which of the following would you use to treat **prosethetic valve endocarditis**? vancomycin + gentamicin vancomycin + meropenem **vancomycin, gentamicin + rifampacin** amoxicillin + gentamicin

Answer 189

**Ivabradine** **sacubitril-valsartan** **digoxin** **hydralazine in combination with nitrate** **cardiac resynchronisation therapy**

Answer 190

**Hydralazine and nitrate**

Answer 191

**Ivabradine** - sinus rhythm > 75/min and a left ventricular fraction < 35% **sacubitril-valsartan**: - criteria: left ventricular fraction < 35% - is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs **digoxin** **hydralazine in combination with nitrate** - this may be particularly indicated in Afro-Caribbean patients **cardiac resynchronisation therapy** - indications include a widened QRS (e.g. left bundle branch block) complex on ECG

Answer 192

* **hydralazine in combination with nitrate**

Answer 193

A patient has chronic heart failure. You iniate an ACEin and a BB as first line treatment. This does not resolve their EF. You next trial and aldosterone antagonist. This does also not help. They have a widened QRS on their ECG. What is the appropriate third line treatment? * Ivabradine * sacubitril-valsartan * digoxin * hydralazine in combination with nitrate * **cardiac resynchronisation therapy**

Answer 194

A patient has chronic heart failure. You iniate an ACEin and a BB as first line treatment. This does not resolve their EF. You next trial and aldosterone antagonist. This does also not help. They have LVEF < 35% and symptomatic What is the appropriate third line treatment? **sacubitril-valsartan**

Answer 195

A patient has chronic heart failure. You iniate an ACEin and a BB as first line treatment. This does not resolve their EF. You next trial and aldosterone antagonist. This does also not help. They have LVEF < 35% and a sinus rhythm of 90bpm What is the appropriate third line treatment? **Ivabradine**

Answer 196

Which of the following requires 0 bridging time after LMWH treatment for PE? Warfarin Edoxaban **Rivaroxaban** Dabigatran

Answer 197

A pregnant patient suffers a PE. What treatment would you give them? Warfarin - teratogenic Edoxaban **LMWH** Rivaroxaban Dabigatran

Answer 198

A pregnant patient suffers from anti-phospholipid syndrome What treatment would you give them? Warfarin Edoxaban **LMWH** Rivaroxaban Dabigatran

Answer 199

. A 35-year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old. Which investigation should the GP request first? Bronchoscopy Full blood count Mantoux test Serum interferon-gamma release assay **Sputum for acid fast bacillus**

Answer 200

**Pulmonary HTN**

Answer 201

**Modification of the bacterial RNA polymerase, the target of the drug**

Answer 202

**Aminoglycosides**

Answer 203

**Blocking epinephrine, serotonin reuptake pumps**

Answer 204

A patient has recently started a new medication that has caused them to have decreased free T3/4 levels. What medication could it be? **Interaction with calcium carbonate** * Interaction with amlodipine * Iodine deficiency * Interaction with aspirin * Poor adherence to levothyroxine

Answer 205

What is the most common endogenous cause of this Cushings? Adrenal adenoma - adrenal adenoma (5-10%) Adrenal carcinoma Glucocorticoid therapy Micronodular adrenal dysplasia **Pituitary adenoma**

Answer 206

A 34 year old woman presents with weight loss, irregular menstrual cycles and anxiety. On examination she has a fine tremor, a diffuse goitre, and mild proptosis. On examination, she has a skin condition. Which is the most likely skin condition be present? Acanthosis nigricans Erythema nodosum Granuloma annulare Pyoderma gangrenosum **Vitiligo**

Answer 207

A 25 year old man is admitted with severe headache, and is noted to have a blood pressure of 204/110 mmHg, with a pulse rate of 120 BPM, regular. He mentions about getting episodes of headache, anxiety and sweating 3-4 times per month, which last around 30 minutes. His GP has commenced him on propranolol, but his symptoms have worsened. He is now being commenced on another treatment from the list of bendroflumethiazide, doxazosin, losartan, moxonidine and ramipril. Which treatment should be the most appropriate one to commence initially? Bendroflumethiazide **Doxazosin** - alpha blocker Losartan Moxonidine Cross Ramipril

Answer 208

A 67 year old man is admitted with confusion and severe dehydration. Urgent blood tests show an acute kidney injury, but normal liver function and full blood count. Corrected serum calcium is 3.45 mmol/L (2.3-2.7). Serum parathyroid hormone is 1.0 pmol/l (5-12). Chest x-ray is normal. He has undergone several investigations including CT chest abdomen and pelvis, X ray lumbar spine, serum lactate dehydrogenase, serum parathyroid hormone related peptide and serum vitamin D. Which investigation is most likely to help determine the cause of his serum calcium result? **CT chest abdomen and pelvis** X ray Lumbar spine Serum lactate dehydrogenase Serum parathyroid hormone related peptide Serum vitamin D

Answer 209

A patient presents with these changes to their nails. You find they are suffering from micocytic anaemia. What is the most likely cause? Thalassemia Anemia of chronic disease Iron deficiency **Lead poisoning** Sideroblastic anemia.

Answer 210

A patient presents with hypoalbuminemia. Which nail changes are you likely to see Clubbing Koilonychia **Leuconychia** Mees' lines Onycholysis

Answer 211

A patient has stage 4 CKD. What nail change might you expect to see Clubbing Koilonychia **Leuconychia** Mees' lines Onycholysis

Answer 212

Koilonychia refers to spoon-shaped nails. Can be caused by: * Iron deficiency anaemia (e.g. Crohn’s disease) * Lichen planus * **Rheumatic fever**: therefore **Streptococcus pyogenes**

Answer 213

A patient has been diagnosed with lung cancer and are recieving chemotherapy. . What nail change might you expect to see Clubbing Koilonychia **Leuconychia** - chemotherapy can cause Mees' lines Onycholysis

Answer 214

Routine blood tests are unnecessary

Answer 215

A 23 year old woman has a 2-day history of headache. She has multiple symptoms including visual aura, intermittent tingling sensation in the legs, stiff neck, ongoing rash on the face and an episode of loss of vision in the right eye 10 years ago. She is otherwise well. She is diagnosed as having migraine. Which symptom is most supportive of the diagnosis of migraine? Loss of vision in the right eye Neck stiffness Rash on the face Tingling in both legs **Visual aura**

Answer 216

**After a first episode**

Answer 217

What is the treatment for large, external haemorrhoids? stapled haemorroidopexy botulinum toxin lateral internal sphincterotomy topical GTN or diltiazem **Milligan Morgan style conventional haemorroidectomy**

Answer 218

What is the definitive treatment for fissure in ano? stapled haemorroidopexy botulinum toxin **lateral internal sphincterotomy** topical GTN or diltiazem Milligan Morgan style conventional haemorroidectomy

Answer 219

What is the usual first line therapy for fissure in ano? stapled haemorroidopexy botulinum toxin lateral internal sphincterotomy **topical GTN or diltiazem** Milligan Morgan style conventional haemorroidectomy

Answer 220

What is the usual third line therapy for fissure in ano? stapled haemorroidopexy botulinum toxin **lateral internal sphincterotomy** topical GTN or diltiazem Milligan Morgan style conventional haemorroidectomy

Answer 221

What is the usual second line therapy for haemorrhoids? **stapled haemorroidopexy** botulinum toxin lateral internal sphincterotomy topical GTN or diltiazem Milligan Morgan style conventional haemorroidectomy

Answer 222

Treatment failures which fail topical therapy will usually go on to have what treatment fpr fissure in ano? stapled haemorroidopexy **botulinum toxin** lateral internal sphincterotomy topical GTN or diltiazem Milligan Morgan style conventional haemorroidectomy

Answer 223

Which of the following is associated with a risk of change in libido Beta blocker **Spironolactone** ACEin Digoxin SGLT-2 in

Answer 224

Which of the following is associated with a risk of blurred vision? Beta blocker Spironolactone ACEin **Digoxin** SGLT-2 in

Answer 225

**Imatinib**

Answer 226

Biological agents: Which of the following is used when treating renal transplants? **Basiliximab** Etanercept Bevacizumab Adalimumab Cetuximab

Answer 227

Biological agents: Which of the following is used when treating EGF positive colorectal cancers? Basiliximab Etanercept Bevacizumab Adalimumab **Cetuximab** | C for Colorectal

Answer 228

Biological agents: Which of the following is used intreating Crohns? Basiliximab **Etanercept** Bevacizumab **Adalimumab** Cetuximab

Answer 229

Basiliximab is used to treat renal transplants What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF Epidermal growth factor inhibitor **IL2 binding site**

Answer 230

Cetuximab is used to treat EGF +ve colorectal cancers. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF **Epidermal growth factor inhibitor** IL2 binding site

Answer 231

Bevacizumab is used to treat colorectal cancer and renal and glioblastomas. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor **Anti VEGF** Epidermal growth factor inhibitor IL2 binding site

Answer 232

A 48-year-old man notices that he is becoming increasingly dizzy when he plays squash, in addition he has also developed cramping pain in his left arm. One day he is inflating his car tyre with a hand held pump, he collapses and is brought to hospital. **Subclavian steal syndrome** * Due to proximal stenotic lesion of the subclavian artery * Results in retrograte flow through vertebral or internal thoracic arteries * The result is that decrease in cerebral blood flow may occur and produce syncopal symptoms * A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned

Answer 233

A 24-year-old lady from Western India presents with symptoms of lethargy and dizziness, worse on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur. **Takayasu's arteritis** - Takayasu's arteritis most commonly affects young Asian females.** Pulseless peripheries are a classical finding**. The CNS symptoms may be variable.

Answer 234

A 25-year-old junior doctor has a chest x-ray performed as part of a routine insurance medical examination. The x-ray shows evidence of rib notching. Auscultation of his chest reveals a systolic murmur which is loudest at the posterior aspect of the fourth intercostal space. Subclavian steal syndrome Takayasu's arteritis Cervical rib Aortic coarctation **Patent ductus arteriosus** - Untreated patients develop symptoms of congestive cardiac failure

Answer 235

Out of the following, which disease is most associated with anal fistula formation? Anal fissure Rectal prolapse **Anal abscess** Lichen sclerosus

Answer 236

Which of the following is NOT a major risk factor for anal fistula? History of radiation therapy to the anal region Crohn's disease History of trauma to the anal region **Constipation**

Answer 237

What is the most common type of perianal fistula? **Intersphincteric** Transsphincteric Suprasphincteric Extrasphincteric

Answer 238

Mutations in ABL gene are associated with AML **CML** - BCR-ABL (9:22) ALL CLL

Answer 239

Philadelphia chromosome is associated with AML **CML** - BCR-ABL (9:22) ALL CLL | TS - Im feeling 22

Answer 240

This symptom is most likely associated with **AML** CML ALL CLL

Answer 241

electroylte disturbances seen in TLS **Hypocalcaemia** - Low Ca2+; High K; P; Uric acid

Answer 242

Which is most associated with Richter transformation to a lymphoma? AML CML ALL **CLL**

Answer 243

**Anaemia**

Answer 244

**BCR-ABL fusion protein** *The Philadelphia chromosome is present in more than 95% of patients with chronic myeloid leukaemia (CML). It is due to a translocation between the long arm of chromosome 9 and 22 - t(9:22)(q34; q11). This results in part of the ABL proto-oncogene from chromosome 9 being fused with the BCR gene from chromosome 22. The resulting BCR-ABL gene codes for a fusion protein that has tyrosine kinase activity in excess of normal.*

Answer 245

**t(9:22)**

Answer 246

**Decreased leukocyte alkaline phosphatase**

Answer 247

inhibitor of the tyrosine kinase associated with the BCR-ABL defect

Answer 248

**hypogammaglobulinaemia**

Answer 249

What is the first line therapy for patients with CML? Hydroxyurea FCR **Imatinib** R-CHOP Ibrutinib

Answer 250

**R-CHOP**

Answer 251

Which of the following is used in HL? FOLFOX FOLFIRI FOLFIRINOX **ABVD** R-CHOP

Answer 252

A 55 yr old is having chemotherapy for her NHL. Days after treatment, she notices blood in her urine. Which treatment is most likely to have caused this? Doxorubicin Vincristine **Cyclophosphomide** - causes **haemorrhagic cystitis** Cisplatin Bleomcyin

Answer 253

A patient is diagnosed with CML What is the first line treatment? - Infliximab **- Imatinib** - Vincristine - Ritixumab

Answer 254

- most common genetic change is **the deletion in chromosome 13** - **TP53 mutation** - **Trisomy 12**: presence of an extra 12th chromosome - **Overexpression of BCL2 proto-oncogene:** suppresses programmed cell death (i.e. increases cell survival)

Answer 255

What is the most common cytogenetic feature seen in ALL? t(4;11) **t(12;21)** t(9;22) Hypodiploid karyotype Hypodiploid karyotype

Answer 256

a. Regular monitoring of which parameter is crucial for assessing the response to treatment and detecting relapse in CML? A. Hemoglobin levels B. Platelet count **C. BCR-ABL transcript levels** D. Liver function tests

Answer 257

a. What is the characteristic molecular marker for CML? **A. BCR-ABL fusion gene** B. FLT3-ITD mutation C. JAK2 mutation D. MPL mutation

Answer 258

**Chronic lymphocytic leukaemia**

Answer 259

Which of the following is most associated with warm haemolytic anaemia **Chronic lymphocytic leukaemia** Warm hemolytic anemia is a type of autoimmune hemolytic anemia (AIHA), which is a condition where the body's immune system attacks and destroys its own red blood cells123. Warm hemolytic anemia is caused by IgG antibodies that bind red blood cells at normal body temperature12. The diagnosis is confirmed by the direct antiglobulin (direct Coombs) test1.

Answer 260

Which of the following is most associated with Downs syndrome Acute myeloid leukaemia **Acute lymphoblastic leukaemia** Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 261

Which of the following is most associated with the Philadelphia chromosome Acute myeloid leukaemia Acute lymphoblastic leukaemia **Chronic myeloid leukaemia** Chronic lymphocytic leukaemia

Answer 262

Which of the following is most associated with three phases Acute myeloid leukaemia Acute lymphoblastic leukaemia **Chronic myeloid leukaemia** Chronic lymphocytic leukaemia

Answer 263

Which of the following is most associated with Auer rods **Acute myeloid leukaemia** Acute lymphoblastic leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 264

**Auer rods** **Acute myeloid leukaemia** Acute lymphoblastic leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 265

**Chronic lymphocytic leukaemia** = Richter’s transformation

Answer 266

**Acute myeloid leukaemia**

Answer 267

Which of the following is most associated with : exposure to certain toxins (e.g. benzene and organochlorine insecticides) **Acute myeloid leukaemia** Acute lymphoblastic leukaemia Chronic myeloid leukaemia Chronic lymphocytic leukaemia

Answer 268

**Acute myeloid leukaemia**

Answer 269

**Congenital disorders:** - **Congenital** **neutropenia** - **Fanconi** **anaemia** **Radiation exposure** **Myeloproliferative disorders**: - **polycythaemia ruby vera** - **myelofibrosis** **Previous chemotherapy**: - Alkylating agents - topoisomerase-II inhibitors **Toxins** - Insecticides

Answer 270

Features are largely related to bone marrow failure: * **anaemia** (fatigue; pallor; angina) * **fever** (due to infections) * **splenomegaly** & **hepatomegaly** * **recurrent** **infections** (neutropenia) * **thrombocytopenia** (petechiae; nose bleeds; bruising; ecchymosis; gingivial bleeding) * **bone pain** (sternal discomfort; aching in extremities) * **leukaemia cutis** (nodular, violaceous lesions on the skin) * **gingivial hypertrophy** * **CNS involvement**: headaches; visual changes; nerve palsies

Answer 271

* **Lymphadenopathy** * **Hepatosplenomegaly** * **Bone pain** * **Gum hypertrophy** * **Violaceous skin deposits** * **Testicular enlargement**

Answer 272

Bone marrow aspirate and biopsy is required for formal diagnosis of AML **≥ 20% myeloblasts** in the bone marrow confirm the diagnosis

Answer 273

**LDH** a non-specific marker of increased cell turnover may be raised in leukaemia.

Answer 274

According to NICE, what is the standard induction chemotherapy regimen for adults under 60 years old with AML who are fit for intensive treatment? a) Azacitidine b) Decitabine **c) Daunorubicin and Cytarabine** d) Midostaurin

Answer 275

According to NICE, what is the recommended duration of thromboprophylaxis in AML patients receiving intensive chemotherapy? a) 7 days **b) 14 days** c) 21 days d) Until complete remission is achieved

Answer 276

A patient presents with these changes to their nails. You find they are suffering from micocytic anaemia. What is the most likely cause? Thalassemia Anemia of chronic disease Iron deficiency **Lead poisoning** Sideroblastic anemia.

Answer 277

A patient presents with hypoalbuminemia. Which nail changes are you likely to see Clubbing Koilonychia **Leuconychia** Mees' lines Onycholysis

Answer 278

A patient has stage 4 CKD. What nail change might you expect to see Clubbing Koilonychia **Leuconychia** Mees' lines Onycholysis

Answer 279

**Psoriasis**

Answer 280

Koilonychia refers to spoon-shaped nails. Can be caused by: * Iron deficiency anaemia (e.g. Crohn’s disease) * Lichen planus * **Rheumatic fever**: therefore **Streptococcus pyogenes**

Answer 281

A patient has been diagnosed with lung cancer and are recieving chemotherapy. . What nail change might you expect to see Clubbing Koilonychia **Leuconychia** - chemotherapy can cause Mees' lines Onycholysis

Answer 282

A patient has C. diff They have their WCC measured - it's 13 x10^9 What is their level of C. diff? Mild **Moderate** < 15 x10^9 Severe - > 15 Life threatening

Answer 283

Aspirational pneumonia in a COPD patient is most likely to be **Streptococcus pneumoniae** Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa Klebsiella | Not specific to COPD - just that not an alcoholic

Answer 284

**Imatinib**

Answer 285

Biological agents: Which of the following is used when treating renal transplants? **Basiliximab** Etanercept Bevacizumab Adalimumab Cetuximab

Answer 286

Biological agents: Which of the following is used when treating EGF positive colorectal cancers? Basiliximab Etanercept Bevacizumab Adalimumab **Cetuximab** | C for Colorectal

Answer 287

Biological agents: Which of the following is used intreating Crohns? Basiliximab **Etanercept** Bevacizumab **Adalimumab** Cetuximab

Answer 288

Basiliximab is used to treat renal transplants What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF Epidermal growth factor inhibitor **IL2 binding site**

Answer 289

Cetuximab is used to treat EGF +ve colorectal cancers. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF **Epidermal growth factor inhibitor** IL2 binding site

Answer 290

Bevacizumab is used to treat colorectal cancer and renal and glioblastomas. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor **Anti VEGF** Epidermal growth factor inhibitor IL2 binding site

Answer 291

**fluid resuscitation** * aggressive early hydration with crystalloids. In severe cases 3-6 litres of third space fluid loss may occur aim for a urine output of > 0.5mls/kg/hr **intravenous opioids** are normally required to adequately control the pain patients should **not** routinely be made 'nil-by-mouth' unless there is a clear reason e.g. the patient is vomiting - enteral nutrition should be offered to anyone with moderately severe or severe acute pancreatitis within 72 hours of presentation NICE state the following: '**Do not offer prophylactic antimicrobials to people with acute pancreatitis'**: - Even though they present with raised WCC **Surgery if indicated**

Answer 292

A patient has suspected acute pancreatitis. Imaging reveals they have gallstones. What surgery is indicated ERCP **Early cholecystectomy** Radiological drainage or surgical necrosectomy Debridement

Answer 293

A patient has suspected acute pancreatitis. Imaging reveals they an obstructed biliary tree. What surgery is indicated? **ERCP** Early cholecystectomy Radiological drainage or surgical necrosectomy Debridement

Answer 294

Which of the following drug for transplantation immunosuppression is a risk factor for hyperlipidaemia? **Tacrolimus** Ciclosporin Mycophenolate mofetil (MMF) Sirolimus (rapamycin)

Answer 295

Which drug is a risk factor for NODAT? **Tacrolimus** & (ciclosporin, but less) Prednisilone Mycophenolate mofetil (MMF) Sirolimus (rapamycin)

Answer 296

Which drug used in kidney transplant. inhibits proliferation of B and T cells? Tacrolimus Ciclosporin Pred. **Mycophenolate mofetil (MMF)** Sirolimus (rapamycin)

Answer 297

A patient has HCV. Which drug class is the choice for treatment? Integrase inhibitor **Protease inhibitor** NRTI NNRTI

Answer 298

The doctor thinks that another medication he is taking might be reducing the effectiveness of clopidogrel. What medication would that be? Allopurinol Amiodarone Metronidazole **Omeprazole** Trimethoprim

Answer 299

Inhibits DC maturation and enhance Tregs

Answer 300

Which drug / drug class works by the following mechanism to prevent graft rejection? *Inhibits purine synthesis and clonal expansion of lymphocytes* Aziothropine Corticosteroids Calcineurin inhibitors Rapamycin **MMF**

Answer 301

Which drug / drug class works by the following mechanism to prevent graft rejection? *inhibits DC maturation* Aziothropine Corticosteroids Calcineurin inhibitors **Rapamycin** MMF

Answer 302

Which drug / drug class works by the following mechanism to prevent graft rejection? *inhibits macrophages* Aziothropine **Corticosteroids** Calcineurin inhibitors Rapamycin MMF

Answer 303

Which drug / drug class works by the following mechanism to prevent graft rejection? *kills rapidly dividing cells* **Aziothropine** Corticosteroids Calcineurin inhibitors Rapamycin MMF

Answer 304

A patient is diagnosed with alcoholic liver disease. What Ig would you expect to be raised? **IgA** IgG IgM IgD IgE | **A**lcoholic = Ig**A**

Answer 305

A patient is diagnosed with autoimmune hepatitis What Ig would you expect to be raised? IgA **IgG** IgM IgD IgE

Answer 306

Which is the most rapid acting P2Y12 inhibitor? Pragrusel **Ticagrelor** Clopidogrel Aspirin

Answer 307

A 52 year old man complains of tiredness and nocturia. His blood test shows a glycated haemoglobin of 64 mmol/mol (8.0%) (normal range 30-47 mmol/mol or 4.8 – 6.4%). The next most appropriate step is his management is to: A. Repeat glycated haemoglobin B. Commence metformin 1000mg twice daily C. Refer to a hospital diabetes clinic D. **Refer to a diabetes education programme** E. Refer to a podiatrist

Answer 308

**130/80 mmHg** - has diabetic eye complications

Answer 309

A 24 year old white woman with Type 1 diabetes for 12 years complains of a pink discoloration over her left anterior tibia of two months duration. This is likely to be: A. Livedo Reticularis B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. **Necrobiosis Lipidoica Diabeticorum**

Answer 310

A 24 year old white woman with Type 1 diabetes for 12 years complains of a one or more skin coloured or red bumps form rings in the skin over joints, particularly the knuckles.. This is likely to be: A. Livedo Reticularis B. Diabetic dermopathy C. **Granuloma Annulare** D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 311

A 24 year old white woman with Type 1 diabetes for 12 years complains ofmottled discolouration of the skin. This is likely to be: A. **Livedo Reticularis** B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 312

This image shows A. Livedo Reticularis B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. **Necrobiosis Lipidoica Diabeticorum**

Answer 313

This image shows A. **Livedo Reticularis** B. Diabetic dermopathy C. Granuloma Annulare D. Acanthosis Nigricans E. Necrobiosis Lipidoica Diabeticorum

Answer 314

**Diabetic dermopathy**

Answer 315

**Granuloma Annulare**

Answer 316

A 43 year old woman with type 1 diabetes complains of diplopia on looking to the left. On examination she is unable to abduct her left eye. The likely cranial nerve involved is: **VI** IV III II VII

Answer 317

**Non functioning pituitary tumour**

Answer 318

**1st pregnancy after age 30**

Answer 319

In Afro-Caribbeans, the estimated Glomerular fitration rate estimated using the MDRD formula should be corrected by multiplying by : Question 33Select one or more: A. 2.01 B. **1.21** C. 1.51 D. 1.01 E. 2.51 Feedback

Answer 320

**Warfarin therapy** - due to bleeding risk

Answer 321

You do a FBC and notice a patient is anaemic. On inspection they are also moving their legs a lot. What is the most likely cause of their anaemia? B12 deficiency **IDA** Folate deficiency Lead poisoining

Answer 322

**Hyperpigmented nails - B12**

Answer 323

Which drug used in SCA management targets P-selectin, preventing sticking of RBC to vessel walls L-glutamine hydroxycarbamide **crizanlizumab** voxelotor

Answer 324

In the diagnosis of aplastic anemia, which parameter is typically reduced in the peripheral blood count? A. Reticulocyte count B. White blood cell count **C. Platelet count** D. Hematocrit

Answer 325

**Hypospadias** - CI for circumcision

Answer 326

Diverticular disease

Answer 327

This type of cancer is characterized by cyclical episodes of high fever lasting for several days, followed by afebrile periods (without fever) of similar duration. **Pel-Ebstein fever is most associated with Hodgkin lymphoma.**

Answer 328

"Popcorn cells" are associated with **Nodular Lymphocyte-Predominant Hodgkin Lymphoma**

Answer 329

ABVD is the treatment of choice for NHL **HL** CML CLL AML

Answer 330

ALL in general occurs in: - Spleen - Liver - Blood - **Bone marrow** - Lymph

Answer 331

Which of the following has a bimodal age distribution? NHL **HL** CML CLL AML

Answer 332

Which of the following is most associated with TLS? Hypokalaemia **Hypocalcaemia** Hypophosphatemia Hyporuricemia | Hyperkalaemia; hyperP; hyeruricemia; hypocalcaemia

Answer 333

**Nodular sclerosis**

Answer 334

Which of the following types of classical HL has the worst prognosis? **Lymphocyte-depleted**

Answer 335

Which of the following types of classical HL has the best prognosis? **Lymphocyte-rich**

Answer 336

**Lymphocyte-depleted**

Answer 337

Which of the following types of classical HL is most associated with older patients **Lymphocyte-rich**

Answer 338

**Nodular sclerosis**

Answer 339

**Mixed cellularity**

Answer 340

Which of the following types of classical HL is most associated with retroperitoneal adenopathy and abdominal lymphadenopathy? **Lymphocyte-depleted**

Answer 341

**Mixed cellularity** **Lymphocyte-depleted**

Answer 342

**Leukaemias** tend to have **high circulating serum WCCs** **Lymphomas** tend not to have circulating cells; **have solid tumours; enlarged LN with high WCC**

Answer 343

Which of the following areas during B cell development is where B cells start the ability to make immunoglobulins Bone marrow Blood **Lymphoid tissue** Marrow

Answer 344

**Mycosis fungoides**: skin lesions including an eczematous reaction which proceeds to form plaques, tumours, and fungating ulcers.

Answer 345

**Burkitt's lymphoma**

Answer 346

**Lymphoblastic lymphoma**

Answer 347

**Adult T-cell leukaemia-lymphoma**

Answer 348

**Cyclophosphamide**

Answer 349

**Doxorubicin**

Answer 350

Which of the following is most likley to have caused bone marrow suppression? Rituximab **Cyclophosphamide** Doxorubicin Vincristine Prednisolone

Answer 351

Which of the following is most likley to have caused peripheral neuropathy? **Vincristine**

Answer 352

**Vincristine**

Answer 353

**Rituximab**

Answer 354

Which of the following is most likley to cause infertility? Rituximab **Cyclophosphamide** Doxorubicin Vincristine Prednisolone

Answer 355

**Rituximab**

Answer 356

**Burkitt’s lymphoma**

Answer 357

Which of the following is most likley to cause hypogammaglobulinaemia? **Rituximab**

Answer 358

**Either side of diaphragm**

Answer 359

The INR of a patient who has recently started treatment for tuberculosis drops from 2.6 to 1.3. Which one of the following medications is most likely to be responsible? **Rifampicin** Streptomycin Ethambutol Isoniazid Pyrazinamide Rifampicin is a P450 enzyme inducer and will therefore increase the metabolism of warfarin, therefore decreasing the INR.

Answer 360

ADAMS proteins is related to ITP VWD Haem A/B **TTP** HIT

Answer 361

A patient presents with unexplained splenomegaly, leukoerythroblastosis, and peripheral blood cytopenias. Which diagnostic test is most appropriate for confirming the diagnosis of myelofibrosis? **a) Bone marrow biopsy** b) Complete blood count (CBC) c) Serum erythropoietin levels d) JAK2 mutation testing

Answer 362

What constitutional symptoms are commonly associated with myelofibrosis? a) Weight gain and fatigue **b) Night sweats and weight loss** c) Fever and headache d) Hypertension and bradycardia

Answer 363

When should cytoreductive therapy be initiated in myelofibrosis patients, according to NICE guidelines? a) At the time of diagnosis **b) Only if the patient is symptomatic** c) After confirmation of JAK2 mutation d) When platelet count exceeds 500 x 10^9/L

Answer 364

What is the recommended first-line therapy for myelofibrosis with intermediate-2 or high-risk disease, according to NICE guidelines? a) Hydroxyurea **b) Ruxolitinib** c) Interferon-alpha d) Allogeneic stem cell transplant

Answer 365

For a patient with significant splenomegaly causing discomfort and early satiety, what is the first-line approach recommended by NICE? a) Splenectomy b) Radiation therapy **c) Ruxolitinib** d) Supportive care only

Answer 366

Which complication should be actively monitored in myelofibrosis patients receiving long-term hydroxyurea therapy? a) Thrombocytosis b) Pulmonary hypertension c) Gastrointestinal bleeding **d) Secondary malignancies**

Answer 367

ibrutinib is used to treat NHL AML CML **CLL** ALL

Answer 368

FCR is used to treat NHL AML CML **CLL** ALL

Answer 369

A six-year-old boy is brought to the emergency department by his parents who have seen blood in his urine. After a history and examination, a diagnosis of post-streptococcal glomerulonephritis is suspected. What would be the expected histological finding on renal biopsy in this condition? Linear deposition of antibodies along the glomerular basement membrane Epithelial crescents in the glomeruli Longitudinal splitting of the lamina densa of the glomerular basement membrane Effacement of podocyte foot processes **Subepithelial humps in the glomeruli**

Answer 370

Which type of renal tubular acidosis is associated with Fanconi syndrome Type 1 **Type 2** Type 3 Type 4

Answer 371

This patient has received which drug for treating a tachycardia Adenosine **Amiodarone** Atropine Aspirin

Answer 372

**EBV - but monospot test is preffered**

Answer 373

Which of the following is associated with increased oestrogen in the context of liver cirrhosis? Bleeding tendency 1 Jaundice 2 Caput medusae 3 Ascites 4 **Palmar erythema** In liver cirrhosis, an increased oestrogen level induces vascularisation and leads to palmar erythema, a red colouration, particularly in hypothenar and thenar eminences. Other features of increased oestrogen include the development of gynaecomastia and spider naevi.

Answer 374

Which of the following is used in HL? FOLFOX FOLFIRI FOLFIRINOX **ABVD** R-CHOP

Answer 375

A 55 yr old is having chemotherapy for her NHL. Days after treatment, she notices blood in her urine. Which treatment is most likely to have caused this? Doxorubicin Vincristine **Cyclophosphomide** - causes **haemorrhagic cystitis** Cisplatin Bleomcyin

Answer 376

What is the most common cytogenetic feature seen in ALL? t(4;11) **t(12;21)** t(9;22) Hypodiploid karyotype Hypodiploid karyotype

Answer 377

**Chronic lymphocytic leukaemia**

Answer 378

What do you give to reverse poisoining from anti freeze? **formepizone** desferrioxamine flumazenil bicarb

Answer 379

What do you give to reverse poisoining from anti freeze? formepizone desferrioxamine **flumazenil** bicarb

Answer 380

**desferrioxamine**

Answer 381

**Pulmonary thombro-endarterectomy** (PTE)

Answer 382

**a prolonged PR interval**

Answer 383

**Hepatotoxicity**

Answer 384

**Optic neuritis**

Answer 385

**Type IV**

Answer 386

What type of inheritence pattern is DMD? Autosomal dominant Autosomal recessive **X-linked recessive** Y-linked recessive

Answer 387

What type of inheritence pattern is Fragile X syndrome? Autosomal dominant Autosomal recessive X-linked recessive **X-linked dominant**

Answer 388

What is the likelihood of a son being affected by DMD if his mother is a carrier of the DMD gene mutation? A. 25% **B. 50%** C. 75% D. 100% E. 0%

Answer 389

If a father has DMD, what is the probability that his daughter will be a carrier? A. 0% B. 25% C. 50% D. 75% **E. 100%**

Answer 390

Which of the following statements is TRUE regarding the genetic counseling of a family with a history of DMD? A. Male children of a carrier mother have a 25% chance of being affected. B. Female children of an affected father and a non-carrier mother will be affected. C. Male children of an affected father and a non-carrier mother have a 50% chance of being carriers. **D. Female children of a carrier mother have a 50% chance of being carriers.**

Answer 391

A 16 year old male with a history of Cystic Fibrosis presents with diarrhoea and recurrent abdominal pain. He has also experienced significant weight loss during the last six months. What is the most appropriate treatment for this patient? Codeine phosphate 1 Cholestyramine 2 **Creon** 3 Loperamide 4 Octreotide

Answer 392

A 15 year old male presents to the Emergency Department with fever, shortness of breath and a productive cough that has developed over the past week. He is a frequent attender with 5 chest infections in the past year. His past medical history includes bronchiectasis and cystic fibrosis. Examination reveals widespread crackles and rhonchi in both lungs. Which is the most likely causative organism behind his current presentation? Streptococcus pneumoniae 1 Pneumocystis jirovecii 2 **Pseudomonas aeruginosa** 3 Mycoplasma pneumoniae 4 Legionella pneumophila

Answer 393

Which of the following is protective in AD? **APOE2** APOE3 APOE4 APOE5

Answer 394

Which of the following is bad prognostically in AD? APOE2 APOE3 **APOE4** APOE5

Answer 395

cephalosporins (e.g. ceftriaxone) work by which MoA? 50S subunit inhibition 30S subunit inhibition DNA gyrase inhibition **B-lactam cell wall inhibition** DNA directed RNA polymerase inhibition

Answer 396

cephalosporins (e.g. ceftriaxone) have a cross-reactivity with **penicillins** quinolones (ciprofloxacin) tetracyclines (doxy) trimethoprim aminoglycosides (amakacin)

Answer 397

tetracylines work by which MoA? 50S subunit inhibition **30S subunit inhibition** DNA gyrase inhibition B-lactam cell wall inhibition DNA directed RNA polymerase inhibition

Answer 398

aminglycosides work by which MoA? 50S subunit inhibition **30S subunit inhibition** DNA gyrase inhibition B-lactam cell wall inhibition DNA directed RNA polymerase inhibition

Answer 399

Ciprofloxacin and other quinonlones work by which MoA? 50S subunit inhibition 30S subunit inhibition **DNA gyrase inhibition** B-lactam cell wall inhibition DNA directed RNA polymerase inhibition

Answer 400

Macrolides such as erythromycin work by which MoA? **50S subunit inhibition** 30S subunit inhibition DNA gyrase inhibition B-lactam cell wall inhibition DNA directed RNA polymerase inhibition

Answer 401

Which of the following is often used after surgery to encourage gut motility? **Erythromycin** Amakacin Ceftriaxone Cirpofloxacin

Answer 402

**50S subunit inhibition** - macrolides like flucoxacillin

Answer 403

Most common cause of impetigo? Staph. epidermis **Staph. aureus** Strep. pyogenes Strep bovine

Answer 404

Which of the following would cause infective endocarditis due to GI malignancy? Staphylococcus aureus Streptococcus viridans Enterococcus faecalis **Streptococcus gallolyticus** Staphylococcus epidermidis

Answer 405

Which antibiotitc is most associated with causing pulmonary fibrosis? **Nitrofurantonin** Erythromycin Co-trixamazole Rifampicin

Answer 406

Which of the following classically presents in the bladder? **Schistosoma haematobium** Schistosoma mansoni Schistosoma japonicum Schistosoma intercalatum

Answer 407

Schistosoma mansoni & Schistosoma japonicum clasically mature in which organ Bladder Rectum Colon Stomach **Liver** - These worms mature in the liver and then travel through the portal system to inhabit the distal colon

Answer 408

Clostridium tetani inhibits the release of: - Glutamate - Mu receptors - Ach - **GABA** - Adrenaline

Answer 409

Which of the following is associated with a rash with infectious mononucleosis **Amoxicillin** Co-amoxiclav Flucloxacillin Erythromycin Ciprofloxacin Tendonitis

Answer 410

Erythromycin

Answer 411

Which of the following is lowers seizure threshold Amoxicillin Co-amoxiclav Flucloxacillin Erythromycin **Ciprofloxacin**

Answer 412

Which of the following causes tendon rupture Amoxicillin Co-amoxiclav Flucloxacillin Erythromycin **Ciprofloxacin**

Answer 413

Which of the following causes GI upset Amoxicillin Co-amoxiclav Flucloxacillin **Erythromycin** Ciprofloxacin

Answer 414

Which of the following causes prolonged QT Amoxicillin Co-amoxiclav Flucloxacillin **Erythromycin** Ciprofloxacin

Answer 415

Which of the following is used post animal bite? Amoxicillin **Co-amoxiclav** Flucloxacillin Erythromycin Ciprofloxacin

Answer 416

**Metronidazole** - Reaction following alcohol ingestion **Doxycycline** - Photosensitivity **Trimethoprim** - Rashes, including photosensitivity - Pruritus - Suppression of haematopoiesis

Answer 417

Concurrent use of which one of the following would make combined oral contraceptive pill less effective? Fluconazole Sodium valproate Allopurinol Isoniazid **Carbamazepine**

Answer 418

What is the main mechanism of action of ondansetron? Dopamine receptor agonist 5-HT2 receptor antagonist Dopamine receptor antagonist 5-HT2 receptor agonist **5-HT3 receptor antagonist**

Answer 419

A 71-year-old man is started on intravenous gentamicin for a severe Pseudomonas infection. Which of the following side-effects is it most important to monitor him for? Prolonged QT interval + ototoxicity Ototoxicity + deranged liver function tests **Ototoxicity + nephrotoxicity** Prolonged QT interval + deranged liver function tests Prolonged QT interval + nephrotoxicity

Answer 420

A patient is given aspirin 300 mg after developing an acute coronary syndrome. What is the mechanism of action of aspirin to achieve an antiplatelet effect? **Inhibits the production of thromboxane A2** Inhibits ADP binding to its platelet receptor Inhibits the production of prostaglandin H2 Glycoprotein IIb/IIIa receptor antagonist Inhibits the production of prostacyclin (PGI2)

Answer 421

What is the most appropriate dose of adrenaline to give during a cardiac arrest? 1ml 1:100,000 IV 10ml 1:1,000 IV 0.5ml 1:1,000 IM 1ml 1:10,000 IV **10ml 1:10,000 IV**

Answer 422

Which one of the following calcium channel blockers is most likely to precipitate pulmonary oedema in a patient with known chronic heart failure? Amlodipine Diltiazem Felodipine **Verapamil** - most postive inotrope Nifedipine

Answer 423

An I/C patient is recieving a solid organ transplant. Which of the following has a highest risk? **Recipient: CMV-ve; donor CMV +ve** Recipient: CMV+ve; donor CMV +ve Recipient: CMV-ve; donor CMV -ve Recipient: CMV+ve; donor CMV -ve

Answer 424

An I/C patient is recieving a sterm cell transplant. Which of the following has a highest risk? Recipient: CMV-ve; donor CMV +ve Recipient: CMV+ve; donor CMV +ve Recipient: CMV-ve; donor CMV -ve **Recipient: CMV+ve; donor CMV -ve**

Answer 425

Post Transplant Lymphoproliferative Disorder (PTLD) is associated with CMV VZV **EBV** HIV

Answer 426

Which type of transplant is most likely to have Post Transplant Lymphoproliferative Disorder (PTLD) in EBV infection? Heart/lung, lung, pancreatic-renal **Small bowel** Heart, liver Renal, bone marrow

Answer 427

What is a main stay treatment for PTLD **Rituximab** Remdesivir Acyclovir Brincidofovir Ganciclovir

Answer 428

What is a main stay treatment for adenovirus in IC patients? Rituximab Remdesivir Acyclovir **Brincidofovir** Ganciclovir

Answer 429

Which of the following forms part of the treatment for COVID? Rituximab **Remdesivir** (+dexamethasone & CPAP) Acyclovir Brincidofovir Ganciclovir

Answer 430

A 35 year-old woman visits her general practitioner (GP) complaining of a productive cough of 6 weeks duration. On further questioning she has a history of fever and night sweats and lost about 10 kg in weight during this time. She lived in Nigeria until she was 16 years old. Which one of the following investigations should the GP request first? A. bronchoscopy B. full blood count C. Mantoux test D. serum interferon-gamma release assay **E. sputum for acid fast bacilli**

Answer 431

A 38 year-old woman has tiredness, joint aches and joint swelling. She is noted to have this appearance on her skin (see image). Her pulse rate is 80 bpm and regular and her BP 158/102 mmHg. Her investigations are shown below: Urinalysis: Blood ++ Protein ++ Urine microscopy: Red cell casts Creatinine 143 µmol/L (60–120) Which other test is most likely to confirm the diagnosis? **A. anti-nuclear antibodies** - she has **lupus** B. anti-nuclear cytoplasmic antibodies C. erythrocyte sedimentation rate D. gastric parietal antibodies E. rheumatoid factor

Answer 432

A 58-year-old man with Type 2 diabetes mellitus is seen in diabetes clinic for review. He is noted to have good glucose control (HbA1c 52 mmol/mol [30-42]), but has an elevated albumin:creatinine ratio of 30.5 ummol/mg (< 3). His eGFR is 54 ml/min/1.73m2 . He is on metformin 100mg twice daily, ramipril 10mg daily and a statin. Blood pressure is 124/76 mmHg.What is the most appropriate next step in his management? A. add a calcium channel blocker B. add a gliptin **C. add a sodium glucose transporter-2 inhibitor** D. add a sulphonylurea E. no change needed

Answer 433

A 75 year-old man has ongoing severe pain at the site where he had shingles 4 months ago. He is still finding the light touch of clothing painful. What is the most appropriate treatment? A. codeine **B. gabapentin** C. ibuprofen D. morphine E. paracetamol

Answer 434

A seven year-old boy has a fever, sore throat, severe pain on swallowing and lack of appetite. He does not have a cough. His temperature is 39.5°C. He has a bilateral tonsillar exudate and bilateral cervical lymphadenopathy. Which is the most likely causative organism? A. Epstein-Barr virus **B. group A streptococcus** - effects young children more C. Haemophilus influenzae D. paraninfluenza virus E. respiratory syncytial virus

Answer 435

A medical student has a fever, sore throat, severe pain on swallowing and lack of appetite. He does not have a cough. His temperature is 39.5°C. He has a bilateral tonsillar exudate and bilateral cervical lymphadenopathy. Which is the most likely causative organism? **A. Epstein-Barr virus** - glandular fever more common in older teenagers B. group A streptococcus C. Haemophilus influenzae D. paraninfluenza virus E. respiratory syncytial virus

Answer 436

SLE is which type of hypersensitivty? Type 1 Type 2 **Type 3** Type 4

Answer 437

Th1 is good at fighting which type of pathogens **intracellular** helminthic extracellular nematode

Answer 438

Th2 is good at fighting which type of pathogens intracellular **helminthic** extracellular nematode

Answer 439

Th17 is good at fighting which type of pathogens intracellular helminthic **extracellular** nematode

Answer 440

What type of hypersens. reaction is hyperacute graft rejection? Type 1 ** ** Type 3 Type 4 Type 5

Answer 441

What type of hypersens. reaction is SERUM SICKNESS? Type 1 Type 2 **Type 3** Type 4 Type 5

Answer 442

Graves is which type of reaction: Type 1 Type 2 Type 3 Type 4 **Type 5**

Answer 443

Antibody blocking a receptor is which type of hypersens. reaction? Type 1 Type 2 Type 3 Type 4 **Type 5**

Answer 444

Whats the treatment for this patient? **Omalizumab** Rituximab Adalimumab Trastuzumab Bevacizumab

Answer 445

A 5-year-old boy is brought to the emergency department with sudden onset wheezing and swelling of his tongue, face and hands. On assessment there is evidence of airway compromise. What is the correct dose of 1 in 1,000 intramuscular adrenaline to treat this patient? **150 micrograms** 150 milligrams 500 micrograms 500 milligrams 1000 micrograms

Answer 446

Chronic graft rejection is caused by: - direct pathway of allorecognition - semi-direct pathway of allorecognition - **indirect pathway of allorecognition** - extravascular pathway of allorecognition

Answer 447

acute graft rejection is caused by: - **direct pathway of allorecognition** - semi-direct pathway of allorecognition - indirect pathway of allorecognition - extravascular pathway of allorecognition

Answer 448

Which drug would you use to treat GvH disease? Tocilizumab Pembrolizumab Infliximab **Belumosudil** Ustekinumab

Answer 449

Which drug / drug class works by the following mechanism to prevent graft rejection? *Inhibits purine synthesis and clonal expansion of lymphocytes* Aziothropine Corticosteroids Calcineurin inhibitors Rapamycin **MMF**

Answer 450

Which drug / drug class works by the following mechanism to prevent graft rejection? *inhibits DC maturation* Aziothropine Corticosteroids Calcineurin inhibitors **Rapamycin** MMF

Answer 451

Which drug / drug class works by the following mechanism to prevent graft rejection? inhibits macrophages Aziothropine **Corticosteroids** Calcineurin inhibitors Rapamycin MMF

Answer 452

A female enters the haemodialysis clinic for her routine session. A standard dose of unfractionated heparin is administered prior to the session. What is the mechanism of action of this drug? Activates antithrombin I Activates antithrombin II **Activates antithrombin III** Deactivates antithrombin I Deactivates antithrombin III

Answer 453

Low molecular weight heparin has the greatest inhibitory effect on which one of the following proteins involved in the coagulation cascade? Factor IXa Factor XIa **Factor Xa** Thrombin Factor XIIa

Answer 454

1. A 67 year old woman suddenly loses the vision in her left eye. She is in good health with no history of eye disease and is not taking any medication. Her right eye is normal. The left has vision reduced to hand movements only. The left pupil reacts sluggishly to light. Her fundal photograph is shown (see image). Which is the cause of her sudden loss of vision? A. Branch retinal artery occlusion **B. Branch retinal vein occlusion** C. Central retinal artery occlusion D. Central retinal vein occlusion E. Cilioretinal vein occlusion

Answer 455

Which is the cause of her sudden loss of vision? A. Branch retinal artery occlusion B. Branch retinal vein occlusion C. Central retinal artery occlusion **D. Central retinal vein occlusion** E. Cilioretinal vein occlusion

Answer 456

**C. Central retinal artery occlusion**

Answer 457

DI treatment is: V1 receptor agonist V1 receptor antagonist **V2 receptor agonist** V2 receptor antagonist

Answer 458

A patient has acanthosis nigricans. What type of cancer is associated with this? Bowell Oesophageal **Gastric** Spleen Kidney

Answer 459

Biological agents: Which of the following is used when treating renal transplants? **Basiliximab** Etanercept Bevacizumab Adalimumab Cetuximab

Answer 460

Biological agents: Which of the following is used when treating EGF positive colorectal cancers? Basiliximab Etanercept Bevacizumab Adalimumab **Cetuximab** | C for Colorectal

Answer 461

Biological agents: Which of the following is used intreating Crohns? Basiliximab **Etanercept** Bevacizumab **Adalimumab** Cetuximab

Answer 462

Basiliximab is used to treat renal transplants What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF Epidermal growth factor inhibitor **IL2 binding site**

Answer 463

Cetuximab is used to treat EGF +ve colorectal cancers. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor Anti VEGF **Epidermal growth factor inhibitor** IL2 binding site

Answer 464

Bevacizumab is used to treat colorectal cancer and renal and glioblastomas. What is it's MoA? Tyrosine kinase inhibitor TNF alpha inhibitor **Anti VEGF** Epidermal growth factor inhibitor IL2 binding site

Answer 465

A patient has suspected acute pancreatitis. Imaging reveals they have gallstones. What surgery is indicated ERCP **Early cholecystectomy** Radiological drainage or surgical necrosectomy Debridement

Answer 466

A patient has suspected acute pancreatitis. Imaging reveals they an obstructed biliary tree. What surgery is indicated? **ERCP** Early cholecystectomy Radiological drainage or surgical necrosectomy Debridement

Answer 467

A 75-year-old woman presents to the Emergency Department with shortness of breath. Chest radiograph reveals pulmonary oedema and cardiomegaly. Electrocardiogram shows third degree heart block. The patient is admitted and treated for heart failure. How does complete heart block lead to heart failure? **by decreasing contractility** by decreasing heart rate by increasing afterload by increasing preload by increasing stroke volume

Answer 468

**age**, features of shock, endoscopy findings, comorbidities, underlying Dx (e.g. mallory-weiss tear, malignancy)

Answer 469

A 54-year-old man with Type 2 diabetes mellitus for 6 years attends for retinal screening, and is told he has mild background diabetic retinopathy with no other concerning findings. What signs are likely to be seen on his retinal photograph? cotton wool spots throughout retina hard exudates close to the macula **microaneurysms** multiple dot and blot haemorrhages close to the macula new vessel formation

Answer 470

A 45-year-old patient is noted to have an elevated serum calcium and elevated serum parathyroid hormone, and is diagnosed with hyperparathyroidism. Which one of the following is true regarding tertiary hyperparathyroidism? can be treated with bisphosphonates is the commonest form of hyperparathyroidism **is seen in patients following renal transplantation** is treated with vitamin D supplementation is usually associated with chronic kidney disease stage 2

Answer 471

The major reason for the decline in dental caries in children is: availability of electric toothbrushes decline in sugar consumption **fluoridation of toothpaste** frequent visits to the dentist tax on sugary drinks

Answer 472

**patients can use two types of nicotine replacement treatments at the same time**

Answer 473

A 66-year-old woman with HIV develops a cholestatic jaundice whilst being treated on ITU for overwhelming sepsis. Which of the following drugs is most likely responsible? **Co-amoxiclav** Fentanyl Furosemide Gentamicin Tinzaparin

Answer 474

Celiac disease is sometimes classified as which type HS reaction? Type 1 Type 2 Type 3 **Type 4**

Answer 475

A to B is associated with which type of hypersensitivity reaction? Type 1 Type 2 Type 3 **Type 4**

Answer 476

patient x comes into contact with posion ivy and has the following reaction. This is which type of hypersensitivity reaction? Type 1 Type 2 Type 3 **Type 4**

Answer 477

**rapid acting insulin with breakfast, lunch and evening meal, long acting insulin at bedtime**

Answer 478

Which one of the following increases serum LDL cholesterol? cis-unsaturated fatty acids glycerol mono-unsaturated fatty acids plant sterols **trans-unsaturated fatty acids**

Answer 479

A 40-year-old is diagnosed with right basal pneumonia. Which one of the following signs is most consistent with the diagnosis? absent breath sounds **bronchial breath sounds** expiratory wheeze pleural rub vesicular breath sounds

Answer 480

Which of the following statements regarding the use of monoclonal antibodies is correct? biological efficacy is most closely associated to maximal drug concentration (Cmax) development of anti-drug antibodies can be overcome by lowering dose half-life is independent of dose **the normal route of administration is parenteral** there is little inter-individual variance in drug handling

Answer 481

A 76-year-old woman presents with hypertension, thin skin, easy bruising and moon shaped facies. Blood tests reveal a significantly raised midnight cortisol level. Further investigations reveal an adrenal tumour. She is too unwell for surgery. Which drug may be useful in the management of her condition? dexamethasone glucagon **ketoconazole** methyldopa metoclopramide

Answer 482

Which of the following statements about HLA molecules and antigen presentation is correct? **the B locus encodes Class I HLA molecules, which present endogenous antigen to cytotoxic T-lymphocytes** the DR locus encodes Class I HLA molecules which present endogenous antigen to helper T- lymphocytes the A locus encodes Class II HLA molecules which present exogenous antigen to cytotoxic T- lymphocytes the DP locus encodes Class II HLA molecules, which present endogenous antigen to cytotoxic T- lymphocytes the C locus encodes Class II HLA molecules, which present exogenous antigen to helper T- lymphocytes

Answer 483

Which part of the human intestine is most prone to cancer (standardising for length)? ascending colon descending colon **rectum** small intestine transverse colon

Answer 484

Drug A is able to produce a greater magnitude of response than Drug B when stimulating receptor X at maximal doses. Which of the following pharmacodynamic explanations is most accurate? drug A is acting as a partial agonist **drug A is more efficacious** drug A is more potent drug B is an inverse agonist drug B is a positive allosteric modulator potency vs efficacy: Potency denotes the amount of drug needed to produce a given effect. Efficacy: Refers to the relative ability of a drug-receptor complex to produce a maximum functional response

Answer 485

A 35-year-old woman with oligomenorrhea was found to have an elevated prolactin level at 990 mU/l (< 496). She took regular metoclopramide for sickness. Which of the following is the most appropriate treatment? cabergoline L thyroxine oral contraceptives pituitary irradiation **stop metoclopramide** - metoclopramide can cause hyperPRLaemia

Answer 486

While in the upper GI clinic you see a man with recently diagnosed gastric carcinoma. Which of the following is a risk factor? **blood group A** blood group O high caffeine intake intravenous drug use northern latitudes

Answer 487

A patient in the outpatient clinic asks you about the genetics of her Crohn’s disease. What is the most common genetic mutation in Crohn’s disease? FOXM1 HOXA7 NOD1 **NOD2** P53

Answer 488

A 24-year-old woman is diagnosed with Type 1 diabetes mellitus. She is concerned about the chances of her children developing the condition. Which of the following human leucocyte antigen (HLA) genetic loci is associated with higher risk of Type 1 diabetes? B16 B20 B21 DB1 **DR3/4**

Answer 489

**CLL** - no symptoms; high lymphocytes. Watchful waiting

Answer 490

**T cell** - timing indicates type 4 *Contact dermatitis*

Answer 491

**MG** - autoantibodies are **blocking** Ach receptors - stops nerve synaptic transmission In coeliac just use IgA for diagnosis

Answer 492

**HLA-DQ**

Answer 493

Which of the following are associated with psoriasis and anky spond? Th9 Th1 Th2 **Th17** TNFa

Answer 494

RA is associated with HLA-DQ HLA-B27 **HLA-DRB1** HLA-B57

Answer 495

**X-linked recessive** - all the carriers are female; only males are affected

Answer 496

**Pseudomonas**

Answer 497

**Tendon rupture**

Answer 498

In DM neuropathy, which nerve is most commonly impacted? Radial **Median** Ulnar Musculocutaenous Axillary

Answer 499

Which of the following is typical of a Th1 response? histamine **interferon gamma** interleukin 4 interleukin 5 interleukin 13

Answer 500

Which of these is an X-linked recessive single gene disorder? cystic fibrosis **Duchenne muscular dystrophy** Huntingdon disease schizophrenia type 2 diabetes mellitus

Answer 501

An 85-year-old woman visits her general practitioner (GP) as she has been short of breath recently. On examination, the GP notices a third heart sound. What does a third heart sound represent? the atria contracting against a stiff ventricle the closing of the aortic valve the opening of the pulmonary valve the oscillation of blood in a dilated ventricle **the ventricles filling rapidly in diastole ** - blood striking on a compliant ventricle in this context it's likely HF

Answer 502

A 90-year-old woman with a history of palpitations is treated for atrial fibrillation. Which one of the following is a class two anti-arrhythmic drug? amiodarone **atenolol** diltiazem flecainide verapamil

Answer 503

A previously healthy 64-year-old man presents to the emergency department with a 4-hour history of a painful white leg. On examination he is found to have no pulsations below the level of the femoral artery. His heart rate is 112 BPM and irregular, normal heart sounds, BP 142/78 mmHg and his oxygen saturation on air is 98%. What is the most likely initial treatment? angioplasty fem-pop bypass fem-distal bypas **embolectomy** thrombolysis

Answer 504

Risk factors for breast cancer include: **1st pregnancy after age 30** Body Mass Index 18-23 kg/m2 Late menarche Premature menopause Use of progesterone only pill

Answer 505

A 29 year old man is brought to ED with stab wound to his abdomen and has a FAST scan as part of his assessment. What of the following statements is true regarding FAST scan? It is a focussed assessment using X ray to assess if patient is fasting It is a focussed assessment using CT scan to assess nature of trauma **It is a focussed assessment using ultrasound in trauma** It is a primary survey carried out at admission It refers to assessing airway, breathing, circulation of patient

Answer 506

The Declaration of Helsinki refers to the use of placebo control. Select the single best answer describing its position in this matter. placebo control is permitted only in privately sponsored clinical trials. placebo control is permitted only in publicly sponsored clinical trials. **placebo control is permitted under 3 exceptional circumstances.** placebo control is strictly unethical. the efficacy and safety of a new therapeutic/diagnostic method must always be tested against placebo.

Answer 507

Competence (‘mental capacity’) is a complex legal concept. Select the single best statement that relates to this concept. competence must never be presumed; it must always be assessed through a functional test. female patients have consistently been shown to be less competent than male patients. literacy is one of the conditions of competence. **mental capacity is an ‘either-or’ property, not a continuum.** under special circumstances, a 5 years old child may be competent to give consent for medical treatment

Answer 508

A 70-year-old undergoes spirometry as part of the annual visit to a chest clinic. which one of the followings can be measured using spirometry? functional residual capacity gas diffusion **inspiratory capacity** residual volume TLC

Answer 509

A 27 year old patient being treated for lymphoma goes to a party, and subsequently develops a cough and coryza. A viral throat swab is positive for influenza A. It is decided to treat this with an anti-viral drug. Which one of the following drugs would be suitable? acyclovir valgancyclovir lamivudine **oseltamivir** ribavirin

Answer 510

Regarding 5 amino-salicylic acid (5-ASA), Which one of the following statements is true? **is associated with blood dyscrasias** first line for severe UC well absorbed in small bowel little role in prevention of Crohn's flares stimulates leukotriene pathway to reduced inflammation

Answer 511

A 70-year-old undergoes spirometry as part of the annual visit to a chest clinic. which one of the followings can be measured using spirometry? functional residual capacity gas diffusion **inspiratory capacity** residual volume TLC

Answer 512

Two sisters are being evaluated to see if one would be a suitable kidney donor for the other. They match for all their HLA alleles. Which of these statements is most appropriate? they are identical twins they are a four haplotype match **they are a two haplotype match** they are a one haplotype match the cross-match is positive

Answer 513

Which of the following is a retroperitoneal structure? 1st part of duodenum **ascending colon** caecum sigmoid colon transverse colon

Answer 514

What is the primary purpose of adding clavulanic acid to amoxicillin in co-amoxiclav? A. To enhance absorption **B. To inhibit beta-lactamase** C. To increase spectrum of activity against Gram-negative bacteria D. To reduce nephrotoxicity E. To inhibit protein synthesis

Answer 515

Campylobacter jejuni Tx = macrolides

Answer 516

Which of the following has a risk of tendon rupture Erythromycin Rifampicin **Ciprofloxacin** - type of fluoroquinolone Amakicin Vancomycin

Answer 517

Which of the following has a risk of ototoxicity Erythromycin Rifampicin Ciprofloxacin **Amakicin** Vancomycin

Answer 518

Which of the following has a risk of QT prolongation **Erythromycin** Rifampicin Ciprofloxacin Amakicin Vancomycin

Answer 519

Colistin works by which interfering with which part of the bacteria B-lactam DNA gyrase 50S subunit 30S subunit **Cell membrane** | Type of polymyxin

Answer 520

Ciprofloxacin works by which interfering with which part of the bacteria B-lactam **DNA gyrase** 50S subunit 30S subunit Cell membrane

Answer 521

A patient is treated with an antibiotic that subsequently causes tendon rupture What was the MoA of this antibiotic? RNA polymerase inhibitor **DNA gyrase inhibitor** 50S subunit inhibitor 30S subunit inhibitor Cell membrane inhibitor | Quinolones - inhibit DNA gyrase; cause tendon rupture

Answer 522

A patient is treated with an antibiotic that subsequently causes red tears What was the MoA of this antibiotic? **RNA polymerase inhibitor** DNA gyrase inhibitor 50S subunit inhibitor 30S subunit inhibitor Cell membrane inhibitor | Rifampicin

Answer 523

A patient is treated with an antibiotic that subsequently causes ototoxicity What was the MoA of this antibiotic? RNA polymerase inhibitor DNA gyrase inhibitor 50S subunit inhibitor **30S subunit inhibitor** Cell membrane inhibitor | Aminoglycosides

Answer 524

A patient is treated with an antibiotic that subsequently causes QT prolongation What was the MoA of this antibiotic? RNA polymerase inhibitor DNA gyrase inhibitor **50S subunit inhibitor** 30S subunit inhibitor Cell membrane inhibitor | Macrolides, e.g. erythromycin

Answer 525

**Erysipelas** - **flucloxacillin**

Answer 526

Hyponatraemia - can cause **SIADH**

Answer 527

Relative risk

Answer 528

**Stopping smoking**

Answer 529

**FODMAPS diet**

Answer 530

**prescribe antibiotics**

Answer 531

**Pulmonary stenosis** - not *tricuspid stenosis as this is diastolic*

Answer 532

If a patient has a low calcium diet, which is the most likely type of stone? **Calcium Oxalate Stones** Calcium Phosphate Stones Struvite Stones Uric Acid Stones Cystine Stones

Answer 533

If a patient has Crohns which stone are they most likely to have? **Calcium Oxalate Stones** Calcium Phosphate Stones Struvite Stones Uric Acid Stones Cystine Stones

Answer 534

What medication should be prescribed for a patient with calium oxalate stone to prevent re-occurrence? Allopurinol Calcium oxalate Calcium phosphate **Potassium citrate** Tamsulosin

Answer 535

A 73-year-old lady is undergoing chemotherapy for treatment of acute leukaemia. She develops symptoms of renal colic. Her urine tests positive for blood. A KUB x-ray shows no evidence of stones. **Urate** Calcium oxalate Calcium phosphate Struvite Cysteine

Answer 536

**Cysteine**

Answer 537

**Struvite**; treat with: **nephrolithotomy**

Answer 538

Which of the following types of renal stones are radio-lucent? Triple phosphate stones Cystine stones Calcium phosphate **Xanthine stones** Calcium oxalate

Answer 539

Autoantibodies to platelet 4 is the pathophysiology that causes **Heparin Induced Thrombocytopenia** Immune Induced Thrombocytopenia Myelofibrosis Thrombotic thrombocytopenic purpura

Answer 540

Autoantibodies to platelet membrane glycoproteins GPIIb/IIIa is the pathophysiology that causes Heparin Induced Thrombocytopenia **Immune Induced Thrombocytopenia** Myelofibrosis Thrombotic thrombocytopenic purpura

Answer 541

Digoxin has which effect on the heart Decreases HR and contractility Decreases HR and contractility **Decreases HR and increases contractility** (+ve inotrope; -ve chronotrope) Increases HR and decreases contractility

Answer 542

Bidirectional VT would be caused bytoxicty from Amiodarone **Digoxin** Adenosine Flecainide

Answer 543

Lambert-Eaton syndrome occurs due to antibodies agaisnt: - Ach receptor; pre-synaptic membrane - Ach receptor; post-synaptic membrane **- Ca receptor; pre-synaptic membrane** - Ca receptor; post-synaptic membrane

Answer 544

mysanthenia gravis occurs due to antibodies agaisnt: - Ach receptor; pre-synaptic membrane - **Ach receptor; post-synaptic membrane** - Ca receptor; pre-synaptic membrane - Ca receptor; post-synaptic membrane