Sample BOF From Pastest

8/11/2019 Sample BOF From Pastest

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Sample BOF from pastest

Which of the following is a feature of MEN-1?

A. Marfanoid features

B. PhaeochromocytomaC. Medullary carcinoma of the thyroid Your answer

D. Parathyroid hyperplasia Correct answer

E. Mucosal neuromas

MEN-1 (multiple endocrine neoplasia type-1 Werner!s syndrome" in#ol#es the three

P!s$ parathyroid% pituitary% pancreas&

Parathyroid 'yperparathyroidism is the most common manifestation in MEN-1

Pituitary Prolactinomas are most common in the pituitary gland

Pancreasecond most common in#ol#ement in MEN-1& Pancreatic tumours are

associated with$(a" pancreatic polypeptide ()*+,*"

(." gastrin (/ollinger+Ellison syndrome" + recurrent peptic ulcers

(c" insulinoma + hypoglycaemia

(d" glucagonoma + hyperglycaemia and s0in rash (necrolytic migratory

erythema"

(e" 2Poma (#asoacti#e intestinal polypeptide-secreting tumour" + erner+

Morrison syndrome or watery diarrhoea hypo0alaemia achlorhydria

(W3'4 syndrome"

MEN-5 usually in#ol#es the thyroid and parathyroid glands and phaeochromocytoma&6he mode of inheritance in MEN-1 is autosomal-dominant& MEN-54 is characterised

.y medullary thyroid carcinoma% parathyroid hyperplasia7adenoma and

phaeochromocytoma& 2n addition% MEN-58 (ipple!s syndrome" has mucosal and

gastrointestinal (92" neuromas and marfanoid features&

4 :*-year-old woman with ulcerati#e colitis is admitted with a history of ;aundice%

pruritus and intermittent a.dominal pain& E


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interlo.ular and ad;acent septal .ile ducts& 4n E>CP will demonstrate the multiple

strictures& 6reatment is unsatisfactory + methotre


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the 6 wa#e& 2t is seen in the right #entricular leads 1 and 5& (Bontaine named the

wa#es epsilon! since epsilon follows delta in the 9ree0 alpha.et&">ight #entricular

dysplasia is characterised .y the displacement of myocytes .y fat& 6his delays the

e


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are ad#anced age% hypo3W 51 WCC

)&5 J 1ID7mmD platelets *I1 J 1ID7mmD&

'er li#er function and renal function are normal% as is her prothrom.in time& Which isthe most useful in#estigation to perform ne


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partial throm.oplastin time (4P66"& With a normal platelet count (hence a .one

marrow differential is less helpful" the defect either lies in the le#el of factors that

affect the 4P66 or in platelet function& Platelet dysfunction is more commonly

acGuired due to renal or li#er disease% drugs and myeloproliferati#e disease& 2nherited

causes include 9lanmann!s throm.aesthenia (lac0 of glycoprotein (gp" 22.7222a

e


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4& 8one marrow aspirate

8& 4utoanti.ody profile

C& Erythropoietin le#el

3& 4ntiglo.ulin test Correct answer

E& Arinary haemosiderin

4naemia in C== has se#eral causes including marrow infiltration% marrow

suppression from chemotherapeutic agents% hypersplenism and haemolysis (which is

e


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cell clone& 4 significant proportion of patients with PN' goes on to de#elop aplastic

anaemia or acute leu0aemia&

4 D*-year-old man attends the haematology clinic ha#ing found a lump in his nec0&

'e feels generally unwell .ut has no past history& 6here is a


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C& 9out

3& Non-'odg0in!s lymphoma

E& 4utoimmune throm.ocytopenia

Pyoderma gangrenosum start as inflammatory pustules or papules that appear on thelim.s and trun0& 6hey enlarge rapidly to produce large necrotic ulcers with a sloughy

.ase% which undermines a raised purplish prominent rim& 2t is associated with multiple

myeloma% acute leu0aemia% inflammatory .owel disease% polycythaemia #era and

rheumatoid arthritis& No cause can .e found in *I of patients&

4 5*-year-old pregnant woman complains she has had painful nodules on her shins

for o#er 5 wee0s& he suffers from asthma% which is well controlled and is D5 wee0s!

pregnant& E


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4& Pityriasis rosea

8& ca.ies

C& =ichen planus Correct answer

3& 3rug reaction

E& Candidiasis

=ichen planus is characterised .y an itchy% purplish% polygonal% flat-topped rash

de#eloping o#er the wrists and an0les& 4 lacy fine networ0 of papules de#elops in

o#er I of the patients& 2t is commonly seen in patients with autoimmune chronic

li#er disease such as primary .iliary cirrhosis and chronic acti#e hepatitis& 6he

presence of Wic0ham!s striae + a fine% white lacy pattern% o#er the papules helps in

diagnosis& 2t usually resol#es in 15+1, months& Patients with widespread disease and

intracta.le itch may reGuire oral prednisolone&

4 DI-year-old woman is e#aluated in the endocrinology clinic for increased urineoutput& he weighs I 0g and has a 5:-hour urine output of D*II ml& 'er .asal urine

osmolality is 51I mFsm70g& he undergoes a fluid depri#ation test and her urine

osmolality after fluid depri#ation (loss of weight D 0g" is D*I mFsm70g& 4 su.seGuent

in;ection of su.cutaneous 334P (desmopressin acetate" did not result in a further

significant rise of urine osmolality after 5 hours (D** mFsm70g"& Which of the

following is the li0ely diagnosis?

4& Normal

8& Primary polydipsia Correct answer

C& Fsmotic diuresis

3& Pituitary dia.etes insipidus

E& Nephrogenic dia.etes insipidus

3ia.etes insipidus (32" is suspected when the urine output is *I ml70g per day

(5III ml for a I-0g female"& 2f the .asal urine osmolality is DII mFsm70g% it

suggests an osmotic diuresis& 2f fluid depri#ation causes a urine osmolality DII

mFsm70g% it suggests psychogenic (primary" polydipsia& 2f not% it is either pituitary or

nephrogenic 32& 6hese are differentiated .y the administration of su.cutaneous

334P which causes an increased urine osmolality DII mFsm70g in pituitary 32&

4 )*-year-old woman who has had type-5 dia.etes mellitus for the last 1* years is

admitted for cataract surgery& he is ta0ing metformin *II mg .id% plain insulin 1I A

at night% ramipril 5&* mg od and .endroflumethiaide (.endrofluaide" 5&* mg od& he

is a smo0er& 2n#estigations showed$ 8M D&I mmol7l urea 1I mmol7l creatinine 1:I

mmol7l Na 1DI mmol7l D&) mmol7l&

=i#er function tests (=B6s" were normal and arterial .lood gas measurements showed

a p' )&D% p(CF5" *&1 0Pa and 'CFD 1) mmol7l& Which one of the following is the

most detrimental in these circumstances and should .e stopped?

4& >amipril Your answer

8& Metformin Correct answerC& 2nsulin


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3& mo0ing

E& 8endroflumethiaide (.endrofluaide"

Metformin is a .iguanide used as an oral hypoglycaemic agent& 6he ma;or to


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8& 2ncreased serum Cl

C& 2ncreased serum 'CFD

3& 2ncreased serum Correct answer

E& 3ecreased serum Ca

2n adrenal destruction% serum Na% Cl and 'CFD le#els are reduced% and serum

potassium is ele#ated& 6he hyponatraemia is due to .oth loss of sodium in the urine

(due to aldosterone deficiency" and to mo#ement into the intracellular compartment&

'yper0alaemia is due to a com.ination of aldosterone deficiency% impaired

glomerular filtration (due to hypotension" and acidosis& Mild to moderate

hypercalcaemia occurs in 1I+5I patients% the cause of which is uncertain&

4 *-year-old man with polycythaemia #era is admitted with acute a.dominal pain%

nausea% #omiting and a.dominal distension& 'e is apyre


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arrhythmias and heart failure& erum iron and serum ferritin le#els are raised& 6he

total iron-.inding capacity is reduced and transferrin saturation is complete (I"&

Patients may de#elop cirrhosis and DI of patients who de#elop cirrhosis can de#elop

hepatocellular carcinoma&

4 :I-year-old man presents with a swollen erythematous finger and right aifampicin L 2N4' L pyrainamide L etham.utol Correct answer

8& Ceftriaifampicin L 2N4' (isonicotinic acid hydraide" L pyrainamide L etham.utol are

used to treat tu.erculous meningitis (68M"% which is the most li0ely diagnosis .ased

on the su.acute history% C6 findings and the modest lymphocytic lymphocytosis

accompanied .y se#ere hypoglycorrhacia& 4 negati#e /iehl+Neelsen stain is not

unusual in such cases% e


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reason to suspect fungal meningitis as she has no immunocompromising conditions%

although the CB changes may .e indistinguisha.le from 68M& 'owe#er%

cryptococcal meningitis occasionally presents in a normal host% .ut here the 2ndian-

in0 stain is usually positi#e& 6here is no e#idence that the patient has .enign

intracranial hypertension or collagen #ascular disease% so steroids are not indicated

and are contraindicated for the treatment of infectious meningitis alone& 8acterialmeningitis is treated with ceftria


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Par#o#irus infection produces the typical raised erythema on the chee0s (slapped

chee0!" and usually occurs in young children$ .iarre #ariations in the rash are

sometimes seen& 6he rash of secondary syphilis usually affects the upper trun0% palms

and soles and fle


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6he common peroneal (=*% 1" ner#e arises from the di#ision of the sciatic ner#e in

the popliteal fossa& 2t passes close to the head of the fi.ula and can .e damaged .y

pressure in this area& 2t di#ides into a superficial and a deep .ranch& 6he deep peroneal

ner#e supplies the ti.ialis anterior% e


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4 teacher presents with a two-wee0 history of increasing malaise% tingling in her

hands and feet and difficulty in wal0ing& 6here is symmetrical distal wea0ness that is

worse in her legs% a.sent lower lim. refle


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4 )I-year-old man presents with a gradually worsening% droopy% right upper eyelid&

6here is a right ptosis and anisocoria% greater when the room lights are off than in

light conditions& Which of the following is the .est in#estigation?

4& 4nti-acetylcholine receptor anti.odies

8& 8lood glucoseC& Chest O-ray Correct answer

3& 3ilute pilocarpine eye-drop test

E& 2ntraocular pressure

6he signs are consistent with a right 'orner!s syndrome& 4nisocoria (difference in

pupil sie" that is greater in the dar0 implies interruption of the sympathetic supply to

the pupil& 'orner!s syndrome has se#eral causes% including Pancoast!s tumour of the

lung& 4 222rd ner#e palsy would cause ptosis and an anisocoria& Fld age% smo0ing%

ele#ated .lood pressure and dia.etes are all ris0 factors for micro#ascular ischaemia

that can cause a cranial mononeuropathy& 'owe#er% the anisocoria would .e greater inthe light% as parasympathetic input is affected& Burthermore% in a 222rd ner#e palsy% the

eye is li0ely to .e de#iated in the down and out! position& Myasthenia gra#is causes a

#aria.le .ilateral ptosis that does not affect the pupil& 3iluted pilocarpine drops

(I&1" can .e used to diagnose a 'olmes+4die pupil& 6hese drops will not constrict a

normal pupil% .ut will constrict a 'olmes+4die pupil due to dener#ation sensiti#ity&

Ele#ated intraocular pressure in an acute angle closure glaucoma causes pupillary

dilatation in a red painful eye% and ptosis does not occur% although pain in the eye may

cause intermittent .lepharospasm&

4n optician refers a 5I-year-old asymptomatic man with .ilateral retinal lesions&

6here are se#en o#al% pigmented% flat-loo0ing areas% each approPE are grey or .lac0%

with depigmented lacunas% and are found in one Guadrant of one eye& 6hey do not

affect #ision& 4typical C'>PE ha#e a white fishtail% and are .ilateral& 6hey do not

affect #ision% .ut if there are more than four atypical C'>PE in each eye then familial

adenosis polyposis or 9ardner!s syndrome may .e suspected as an association&

Colonoscopy and eetinitis

pigmentosa causes .one spicule! pigmentation in the retinal mid-periphery% along

with a wa


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dar0 lesions under the retina% often with o#erlying eheumatoid arthritis is associated with dry eyes& 6ear-film integrity

on the corneal surface is reGuired .oth for comfort and to pro#ide an optically smooth

surface for refraction& 6herefore in dry eye% when the tear film cannot pro#ideadeGuate wetting of the corneal surface .etween .lin0s% grittiness and intermittent .lur

occurs& 4 refle< response to irritation of the corneal surface is epiphora% or watering&

ymptoms will .e worse when tear-film e#aporation is greater% for e


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8& 'olmes+4die pupil

C& Bactitious #isual loss

3& Parinaud!s syndrome

E& >etro.ul.ar neuritis Correct answer

4s the optic discs appear normal% and gi#en the transient nature of her pre#ious

symptoms occurring during e


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rarer causes include normal-pressure hydrocephalus% 'untingdon!s disease and

Wilson!s disease&

4 *D-year-old man is admitted for in#estigation of his confusion& 'e is intermittently

coherent and aggressi#e and says the people in the flat needuced .rea0down of dopamine

8& Change in sensiti#ity to dopamine

C& Confusional state due to urosepsis

3& 3irect dopamine agonism Correct answer

E& Coe


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Neuropsychiatric complications of Par0inson!s disease (P3" are common +

e


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4& 3elusion of control

8& Paranoid delusion

C& 3elusion of reference Correct answer

3& 3elusion of replacement

E& 3elusion of guilt

4 delusion is a false .elief that someone refuses to ac0nowledge as false despite

e#idence% and typically they change their other .eliefs to 0eep their whole .elief

system consistent& 4 delusion of reference descri.es the .elief that a special meaning

for that indi#idual lies .ehind something innocent! in the pu.lic domain% such as a

.oo076 programme7newspaper or from the way o.;ects are arranged in a room or

how cars are par0ed in a street& 3elusions of control consist of .eliefs that patients

themsel#es are .eing controlled .y an e


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Mycoplasma pneumonia is a common cause of pneumonia often occurring in young

people& 2t is characterised .y headaches% malaise and cough& Chest O-ray findings

may not correlate with the patient!s condition& 6he white .lood count may .e normal

and cold agglutinins occur in half of the patients& E


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performed a diagnostic tap& Which of the following is an indication to insert a chest

drain?

4& Pleural fluid protein le#el more than *I of serum protein le#el

8& Pleural fluid =3' more than I of serum =3'

C& 'aemorrhagic pleural fluid3& Pleural fluid p' V )&5 Correct answer

E& Pleural fluid glucose V 1& mmol7l

6his woman has a parapneumonic effusion& 6he indications for chest tu.e insertion in

patients with infected pleural effusions are$ presence of organisms on a 9ram stain of

the pleural fluid% a fran0ly purulent pleural fluid% pleural p' V )&5 in the setting of an

infected pleural effusion% loculated pleural effusions and poor clinical progress despite

anti.iotic treatment&

4 *,-year-old woman is admitted to hospital with a history of general musclewea0ness of 15 months! duration& he also gi#es a history of pain in the small ;oints

of her hand of o#er 1, months! duration& 2n addition% there is a history of difficulty in

swallowing& E


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4 :D-year-old man with a past history of hypothyroidism complains he has had pain

and stiffness in the ;oints of his hand and feet for three months& 'e also gi#es a history

of dyspnoea of that started si< wee0s ago& Eheumatoid arthritis is unli0ely to .e the cause of an effusion if theglucose le#el in the fluid is a.o#e 1& mmol7l& =arge amounts of cholesterol can

accumulate in long-standing rheumatoid pleural effusions& Patients should initially .e

treated with non-steroidal anti-inflammatory drugs (N423s"& 3ecortication should

.e considered in patients with thic0ened pleura who are symptomatic with dyspnoea&

4 **-year-old woman 0nown to suffer from se#ere disa.ling rheumatoid arthritis has

a 15-month history of dyspnoea& he also complains of a dry cough of similar

duration& he has ne#er smo0ed and has ne#er .een employed& E4" can affect the lungs in many ways& 8ronchiectasis is0nown to .e associated with >4% as are pleural effusions% lung nodules% interstitial

fi.rosis and Caplan!s syndrome& 8ronchiolitis o.literans is also 0nown to occur in

>4& 2t presents with a non-producti#e cough and dyspnoea& Physical e


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You are as0ed to see a *I-year-old man in the surgical ward at am who underwent

an uncomplicated cholecystectomy for gallstones the day .efore& 'e has de#eloped

eoutine .lood tests show mildlyimpaired renal function& What is the most li0ely diagnosis?

4& Cellulitis

8& 3eep #ein throm.osis

C& eptic arthritis

3& 9out Correct answer

E& >heumatoid arthritis

9out is an a.normality of uric acid meta.olism resulting in the deposition of sodium

urate crystals in ;oints% soft tissue and urinary tract& 2t is due to hyperuricaemiaresulting from the o#erproduction or under-e


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started immediately with appropriate anti.iotics as delays can result in destruction of

the cartilage& 6he ;oint should .e immo.ilised& 6he ;oint should .e drained .y needle

aspiration& 2naccessi.le ;oints such as the hip may reGuire surgical drainage&

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