Q-1)A previously well 27-year-old woman presents with a history of transient ischaemic attack affecting her right side and speech. She had returned to the United Kingdom from a holiday in New Zealand two days previously. On examination there was nothing abnormal to find. An ECG, chest x ray, CT brain scan, and routine haematology and biochemistry were all normal. Which is the most likely underlying abnormality?
Atrial myxoma
Carotid artery stenosis
Embolus from paroxysmal atrial fibrillation
Patent foramen ovale
Subarachnoid haemorrhage
Q-2) A 57-year-old man develops deep venous thrombosis during a hospitalisation for prostatectomy. He exhibits decreased mental status with right hemiplegia, and a CT scan of the head suggests an acute cerebral infarction in the distribution of the left middle cerebral artery.
A chest x ray reveals cardiac enlargement and prominence of the main pulmonary arteries that suggests pulmonary hypertension. His serum troponin I is <0.4 ng/ml. Which of the following lesions is most likely to be present on echocardiography?
Coarctation of the aorta
Dextrocardia
Pulmonary stenosis
Tetralogy of Fallot
Ventricular septal defect
A 48-year-old lady is seen in the diabetes clinic with uncontrolled blood sugars ranging from 14 mmol/L to 22 mmol/L. She has a past medical history of type 2 diabetes, ischaemic heart disease, rheumatoid arthritis and recurrent episodes of thrush alongside chronic obstructive pulmonary disease. Her body mass index is 30. Which medical co-morbidity is the strongest contraindication to starting an SGLT2 (sodium glucose transport protein 2) inhibitor class of drugs?
a.ischemic heart disease
b. copd
c. type 2 diabetes
d. rheumatoid arthritis
e. recurrent thrush
A 52-year-old man with a history of alcohol dependence is admitted with fever and feeling generally unwell. An admission chest x-ray shows consolidation in the right upper lobe with early cavitation. What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Legionella pneumophilia
C. Staphylococcus Aureus
D. Klebsiella pneumoniae
E.Mycoplasma pneumoniae
Which of the following is true regarding rheumatoid factor?
a.It is usually an IgM molecule reacting against patient’s own IgG
b. High titres are not associated with severe disease
c. Rose-Waaler test involves agglutination of IgG coated latex particles
d. 80% of SLE patients are RF positive
e. 50% of patients with Sjogren’s syndrome are RF positive
A 48-year-old Afro-Caribbean female is admitted with a fever and painful red eyes bilaterally. On examination, her temperature is 38.3ºC, heart rate 85bpm, respiratory rate 26/min, and oxygen saturation 93% on room air. Closer examination reveals bilateral swelling of her parotid glands.
A chest x-ray is performed, which reveals bilateral hilar lymphadenopathy. What is the most likely unifying diagnosis?
a. HIV
b. Tuberculosis
c. Heerfordt syndrome
d. Lymphoma
e. Mumps
A 74-year-old woman with thyroid cancer is admitted due to shortness of breath. What is the best investigation to assess for possible compression of the upper airways?
a. Arterial blood gas
b. Forced vital capacity
c. Transfer factor
d. Peak expiraory flow rate
e. Flow volume loop
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?
a. Hyperkalaemia
b. Hypocalcaemia
c. Metabolic acidosis
d. Hypophosphataemia
e. Hypermagnesemia
A patient is commenced on isoniazid and is a fast acetylator.
Which of the following is this patient more likely to develop than a slow acetylator?
1- Hepatotoxicity
2- Nausea
3- Treatment failure
4- None of these
5- Peripheral Neuropathy
what is the most common cardiac defect in pt s with Down’s syndrome ?
A . ventricular septal defect
b. endocardual coushion defect
c. secundum atrial septal defect
d. tetralogy of fallot
e. patent ductus arteriosus
A 33-year-old woman presents with weight loss and excessive sweating. her partner reports that she is ‘on edge’ all the time and during the consultation you notice a fine tremor. Her pulse rate is 96/min. A large, non-tender goitre is noted. Examination of her eyes is unremarkable with no evidence of exophthalmos.
Free T4 26 pmol/l
Free T3 12.2 pmol/l (3.0-7.5)
TSH < 0.05 mu/l
What is the most likely diagnosis?
a. Toxic multinodular goitre
b. Hashimoto’s thyroiditis
c. T3-secreting adenoma
d. De Quervain’s thyroiditis
e. Graves’ disease