9 OO You are advising a patient who has recently been diagnosed with chronic kidney disease stage 4 with regards to her diet. Which one of the following foods should she eat in moderation due to the high potassium content? A. Tomatoes B. Plums C. Cranberry juice D. Grapes —E. Green beans TomatoesA 24-year-old man presents with a three day history of painful ulcers on the shaft of his penis and dysuria. He has had no similar previous episodes. A clinical diagnosis of primary genital herpes is made. What is the most appropriate management? Topical famciclovir No treatment is indicated Topical podophyllotoxin Topical valaciclovir Oral aciclovir mOOD> Oral aciclovirEach one of the following is an acute phase protein, except: A. Haptoglobin B. Alpha-1 antitrypsin Cc. CRP D. Ferritin E. ESR ESRQ-32 A 54-year-old man is brought to the Emergency Department after being found collapsed in the street. He is known to have a history of alcoholic liver disease. Blood tests reveal the following: Calcium 1.62 mmol/l Albumin33 g/l Which one of the following is the most appropriate management of the calcium result? 10ml of 10% calcium chloride over 10 minutes 20% albumin infusion 10ml of 10% calcium gluconate over 10 minutes No action 10ml of 10% calcium chloride over 4 hours moOOm> 10m of 10% calcium gluconate over 10 minutesA 43-year-old man has a routine medical for insurance purposes. The following result is obtained: Uric acid622 umol/I (210 - 480) He is well with no significant past medical history. What is the most appropriate test to perform next? Lipid profile Thyroid function test Calcium Parathyroid hormone Pyrophosphate levels moom@> Lipid profile Hyperuricaemia may be associated with both hyperlipidaemia and hypertension. It may also be seen in conjunction with the metabolic syndromeA 27-year-old female presents to her General Practitioner with severe morning headaches associated with nausea. She is referred for an MRI head scan that reveals a large tumour arising from the falx cerebri and pushing on the brain. There is a well-defined border between the tumour and the brain parenchyma. What is the most likely diagnosis? A. Glioblastoma B. Metastasis C. Low-grade glioma D. Meningioma ES Craniopharyngioma MeningiomaA 43-year-old homeless lady has been referred to gastroenterology as the GP was concerned of a possible malabsorption syndrome. She complains of weakness and longstanding diarrhoea. On examination you note enlarged and bleeding gums. She takes no medications. Which of the following deficiency syndromes can lead to gum hypertrophy? A. Pellagra B. Beri-Beri C. Menkes Disease D. Scurvy E. Osteomalacia ScurvyWhich one of the following is only secreted by the adrenal medulla? A. Noradrenaline B. Aldosterone C. Metadrenaline D. Cortisol E. Adrenaline AdrenalineWhich one of the following is associated with increased lung compliance? A. Kyphosis B. Pulmonary oedema C. Emphysema D. Pulmonary fibrosis E. Pneumonectomy EmphysemaA 54-year-old woman with a history of rheumatoid arthritis presents with a one week history of bloody diarrhoea. This has been associated with fever and abdominal pain. Her rheumatoid is normally well controlled with methotrexate. A stool sample is sent which shows Campylobacter jejuni. What is the most appropriate management? A. Fluids alone B. Fluids + metronidazole C. Fluids + ciprofloxacin D. Fluids + clarithromycin E. Fluids + mebendazole Fluids + clarithromycinA 68-year-old man presents with headaches at the sides of his head, worse on chewing and yawning. Which of the following findings would exclude giant cell arteritis? poral artery B. Normal plasma viscosity op o OPYUMPuly myalgia rheumatica D. Norns cipal artery biopsy E. Normal temperatureAldosterone is secreted by the: Juxtaglomerular apparatus Zona glomerulosa Posterior pituitary Zona reticularis Zona fasciculata Zona glomerulosa mON@OpDA 45-year-old female presents with ptosis and muscle weakness which worsens towards the end of the day. She has a past medical history of hypothyroidism. On examination you note fatigable ptosis and proximal limb weakness. You suspect a diagnosis of myasthenia gravis. Which receptor is involved in the pathophysiology? Muscarinic acetylcholine receptors Nicotinic acetylcholine receptors Beta 1 adrenoceptor Beta 2 adrenoceptor Alpha 1 adrenoceptor Nicotinic acetylcholine receptors mOO@PDA 33-year-old female is referred to the endocrine clinic. She has missed her last two periods and has been lactating. She has gained weight and complains of vaginal dryness. The endocrinologist chooses to measure her prolactin levels. Which hormone is responsible for inhibiting prolactin release from the pituitary gland? Thyrotropin releasing hormone Oestrogen Gonadotropin releasing hormone Luteinising hormone Dopamine Dopamine moOOppEach one of the following causes of hyponatraemia is associated with a urinary sodium of less than 20 mmol/L, except: Diarrhoea Psychogenic polydipsia Burns Secondary hyperaldosteronism Syndrome of inappropriate ADH mOoORp> Syndrome of inappropriate ADH Syndrome of inappropriate ADH is associated with urinary sodium > 20 mmol/lQ-129 Where is the majority of iron found in the body? A. Bone B. Haemoglobin C. Ferritin and haemosiderin D. Myoglobin E. Plasma iron Haemoglobin137 -year-old male is admitted to the Emergency Department following a collapse while running a marathon. His blood results are as follows: Nat 121 mmol/l K+ 3.4 mmol/I Urea 3.2 mmol/l Creatinine 68 umol/I During assessment he becomes increasingly obtunded and goes on to have multiple tonic clonic seizures. What is the most appropriate treatment from the list below to improve his neurological status? Decompressive craniotomy Demeclocycline Intravenous normal saline Hypertonic saline Mannitol MOORp Hypertonic saline Acute hyponatraemia is that which occurs within a duration of 48 hours.Q-157 Which one of the following types of blood vessel is first to vasoconstrict in the presence of hypoxia? Muscle arteries Skin arteries Hepatic arteries Renal arteries Pulmonary arteries Pulmonary arteries monp>Which one of the following is in direct anatomical contact with the left kidney? A. Stomach B. Distal part of small intestine C. Spleen D. Pancreas E. Duodenum PancreasQ-191 Which one of the following organisms is most contagious? Varicella zoster virus Epstein Barr virus Rotavirus Herpes simplex virus Haemophilus influenzae Varicella zoster virus moopp>Q-202 Which one of the following drugs is contra-indicated whilst breast feeding? Aminophylline Carbamazepine Sodium valproate Methyldopa Amiodarone Amiodarone mong>Which of the following features is not associated with patent ductus arteriosus? Continuous ‘machinery’ murmur Bisferiens pulse Heaving apex beat Wide pulse pressure Left subclavicular thrill Bisferiens pulse MOND >A 19-year-old female with a history of anorexia nervosa is admitted to hospital. Her BMI has dropped to 16. She has agreed to be fed by nasogastric tube. Which one of the following electrolyte disturbances is most likely to occur? Hyperkalaemia Hypocalcaemia Metabolic acidosis Hypophosphataemia Hypermagnesemia Hypophosphataemia mOODm>———————— Which one of the following statements is true regarding the radial nerve? A. B. c. D. E. Damage at the axilla would lead to wrist drop Damage at the wrist leads to wasting of the thenar muscles It supplies the lateral 2 lumbricals It supplies sensation to the lateral one and a half fingers It is derived from C6-8 and T1 Damage at the axilla would lead to wrist dropQ-223 43-year-old man requests a 'medical' as he is concerned about his risk of heart disease. His father died at the age of 45-years following a myocardial infarction. His lipid profile is as follows: HDL 1.4mmol/I LDL 5.7 mmol/l Triglycerides 2.3 mmol/l Total cholesterol 8.2 mmol/l Clinical examination reveals tendon xanthomata around his ankles. What is the most likely diagnosis? Familial hypercholesterolaemia (heterozygous) Nephrotic syndrome Mixed hyperlipidaemia Familial hypercholesterolaemia (homozygous) E. Hypothyroidism pORP Familial hypercholesterolaemia (heterozygous)per) A 22 year-old man is referred to clinic with refractory hypertension. Potassium 2.7mmol/I Other U&E, FBC, calcium and LFTs are normal. Which would be the most appropriate next investigation? CT abdomen MR angiography renal tract 24 hour urinary catecholamines USS abdomen Plasma renin and aldosterone levels moOORpD Plasma renin and aldosterone levels The differential for hypertension with low potassium includes Conn's, Cushing's, renal artery stenosis and Liddle's. The first step in this case should be further simple investigations. Quantifying the renin and angiotensin levels will help to distinguish the cause here, before going on to more specialised tests. Cushing's and Conn's would be associated with a high aldosterone and a low renin, renal artery stenosis would be associated with a high renin and aldosterone, Liddle's is associated with a low renin and aldosterone.A 23-year-old man presents with a three day history of general malaise and low-grade temperature. Yesterday he developed extensive painful ulceration of his mouth and gums. On examination his temperature is 37.4°C, pulse 84 / min and there is submandibular lymphadenopathy. What is the most likely diagnosis? Epstein Barr virus Lichen planus HIV seroconversion illness Herpes simplex virus infection Oral Candida mOOPP Herpes simplex virus infection This man has gingivostomatitis, a characteristic feature of primary herpes simplex virus infectionforay A 52-year-old man presents to the emergency department with a 5-day history of abdominal pain. He reports a history of recurrent abdominal pain in the right upper abdomen but they have always been self-resolving. On examination, he is jaundiced. Tenderness is elicited on palpating the right upper quadrant. Murphy's sign is negative. His basic observations include temperature 38.7°C, heart rate 100 beats per minute, respiratory rate 24 breaths per minute, blood pressure 110/62 mmHg. What is the first-line investigation for this patient? A. Magnetic resonance cholangiopancreatography (MRCP) B. CT abdomen and pelvis C. Endoscopic retrograde cholangiopancreatography (ERCP) Ultrasound scan (USS) CT abdomen mo Ultrasound scan (USS) USS is the first line investigation for suspected cholangitisYou are called to see a patient overnight who had a total parathyroidectomy earlier in the day for primary hyperparathyroidism. The patient is experiencing perioral tingling and leg cramps. The nurse tells you that his hand clenched into a claw when she took his blood pressure. You suspect an electrolyte imbalance. Which ECG finding are you most likely to see with this electrolyte disorder? A. Tented T waves B. Flattening of the P wave C. Prolongation of the QTc interval D. Prolongation of the QRS interval Torsades de pointes m Prolongation of the QTc interval The most common ECG change in hypocalcaemia is prolongation of the QTc intervalQ-341 Fe You review a 29-year-old woman who is recovering from a fracture of the right olecranon. Since the fracture she has noticed that the little finger on her right hand is numb. Which nerve is likely to have been damaged? Ulnar nerve Radial nerve Axillary nerve Musculocutaneous nerve Median nerve Ulnar nerve moOORpWhich of the following is most likely to cause hypokalaemia associated with alkalosis? Acetazolamide Partially treated diabetic ketoacidosis Diarrhoea Cushing's syndrome Renal tubular acidosis Cushing's syndrome moOO@>err Vitamin D causes which one of the following: Increased plasma phosphate Decreased plasma calcium Decreased osteoclastic activity Decreased gut absorption of calcium Decreased renal tubular absorption of calcium mMOODD> Increased plasma phosphate Vitamin D increases plasma calcium and plasma phosphate levels by promoting renal tubular absorption and gut absorption of calcium and increasing renal phosphate reabsorptionQ-369 A 61-year-old woman is admitted to the Acute Medical Unit as she is generally unwell with muscle twitching. Blood pressure is recorded at 114/78 mmHg, pulse 84/min and she is apyrexial. Blood tests reveal the following: Calcium 1.94 mmol/I Albumin 38 g/I Which one of the following tests is most useful in elucidating the cause of her symptoms? A. Urea B. Vitamin D C. Phosphate D. Parathyroid hormone E. Magnesium Parathyroid hormoneA 64-year-old woman who is reviewed due to multiple non- healing leg ulcers. She reports feeling generally unwell for many months. Examination findings include a blood pressure of 138/72 mmHg, pulse 90 bpm, pale conjunctivae and poor dentition associated with bleeding gums. What is the most likely underlying diagnosis? Thyrotoxicosis Vitamin B12 deficiency Vitamin C deficiency Diabetes mellitus Sarcoidosis Vitamin C deficiency moO pPA 33-year-old woman who is known to have familial hypercholesterolaemia comes for review. She is planning to have children and asks for advice regarding medication as she currently takes atorvastatin 80mg on. What is the most appropriate advice? Switch to atorvastatin 10mg Continue current drug at same dose Stop atorvastatin before trying to conceive Switch to ezetimibe Switch to simvastatin 40mg MOO Dp Stop atorvastatin before trying to conceive Statins should be discontinued in women 3 months before conception due to the risk of congenital defects