Multiple Choice Questions MCQ

Question 62# Print Question

A 14-year-old girl is admitted to the Emergency Department. Over the past hour she has developed a painless, non-pruritic erythematous rash associated with severe angioedema. She has a past medical history of recurrent abdominal pain. Her symptoms fail to respond to adrenaline and she is therefore intubated to protect the airway. She is discharged from ITU after three days. During outpatient follow-up two weeks later a diagnosis of hereditary angioedema is suspected.

What is the most appropriate screening test to perform?

A. Serum IgE levels

B. Serum C3 levels

C. Serum tryptase levels

D. Serum C4 levels

E. Serum C1-INH levels

Question 61# Which one of the following best describes the characteristics of a negatively skewed distribution?
A. Median < mode < mean
B. Mean < median < mode
C. Mode < mean < median
D. Median < mean < mode
E. Mean < mode < median
Correct Answer B: Skewed distributions: Alphabetical order: mean - median - mode '>' for positive, '<' for negative Skewed distributions: Normal distributions: mean = median = mode Positively skewed distribution: mean > median > mode Negatively skewed distribution mean < median < mode To remember the above note how they are in alphabetical order, think positive going forward with '>', whilst negative going backwards '<'

Question 63# Which one of the following adrenoceptors cause vasoconstriction and relaxation of GI muscle in response to sympathetic stimulation?
A. Alpha-1
B. Alpha-2
C. Beta-1
D. Beta-2
E. Beta-3
Correct Answer A: Adrenoceptors: Alpha-1: Vasoconstriction Relaxation of GI smooth muscle Salivary secretion Hepatic glycogenolysis Alpha-2: Mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves) Inhibits insulin Platelet aggregation Beta-1: Mainly located in the heart Increase heart rate + force Beta-2: Vasodilation Bronchodilation Relaxation of GI smooth muscle Beta-3: Lipolysis Pathways: All are G-protein coupled Alpha-1:activate phospholipase C --> IP3 --> DAG Alpha-2: inhibit adenylate cyclase Beta-1: stimulate adenylate cyclase Beta-2: stimulate adenylate cyclase Beta-3: stimulate adenylate cyclase

Question 64# A 66-year-old comes for review. He had a prosthetic aortic valve replacement five years ago for which he is warfarinized. Over the past three months he has been complaining of fatigue and a full blood count was requested: Hb 10.3 g/dl MCV 68 fl Plt 356 * 109/l WBC 5.2 * 109/l Blood film Hypochromia INR 3.0 An upper GI endoscopy was reported as normal. What is the most appropriate next investigation?
A. Transthoracic echocardiogram
B. Colonoscopy
C. Three sets of blood cultures
D. Trans-oesophageal echocardiogram
E. Reticulocyte count
Correct Answer B: Any patient of this age with an unexplained microcytic anaemia should have a lower gastrointestinal tract investigation to exclude colorectal cancer. Colorectal cancer: referral guidelines: NICE recommend the following patients are referred urgently (i.e. within 2 weeks) to colorectal services for investigation: Patients > 40 years old, reporting rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for 6 weeks or more Patients > 60 years old, with rectal bleeding persisting for 6 weeks or more without a change in bowel habit and without anal symptoms Patients > 60 years old, with a change in bowel habit to looser stools and/or more frequent stools persisting for 6 weeks or more without rectal bleeding Any patient presenting with a right lower abdominal mass consistent with involvement of the large bowel Any patient with a palpable rectal mass Unexplained iron deficiency anaemia in men or non-menstruating women (Hb < 11 g/dl in men, < 10 g/dl in women)

Question 65# What is the mode of inheritance of vitamin D-resistant rickets?
A. X-linked dominant
B. Autosomal recessive
C. Autosomal dominant
D. Mitochondrial inheritance
E. X-linked recessive
Correct Answer A: Vitamin D-resistant rickets: Vitamin D-resistant rickets is a X-linked dominant condition which usually presents in infancy with failure to thrive. It is caused by impaired phosphate reabsorption in the renal tubules Features: Failure to thrive Normal serum calcium, low phosphate, elevated alkaline phosphotase X-ray changes: cupped metaphyses with widening of the epiphyses Diagnosis is made by demonstrating increased urinary phosphate Management: High-dose vitamin D supplements Oral phosphate supplements

Question 62# A 14-year-old girl is admitted to the Emergency Department. Over the past hour she has developed a painless, non-pruritic erythematous rash associated with severe angioedema. She has a past medical history of recurrent abdominal pain. Her symptoms fail to respond to adrenaline and she is therefore intubated to protect the airway. She is discharged from ITU after three days. During outpatient follow-up two weeks later a diagnosis of hereditary angioedema is suspected. What is the most appropriate screening test to perform?
A. Serum IgE levels
B. Serum C3 levels
C. Serum tryptase levels
D. Serum C4 levels
E. Serum C1-INH levels
Correct Answer D: Hereditary angioedema - C4 is the best screening test in between attacks. Hereditary angioedema: Hereditary angioedema is an autosomal dominant condition associated with low plasma levels of the C1 inhibitor(C1-INH) protein. C1-INH is a multi-functional serine protease inhibitor - the probable mechanism behind attacks is uncontrolled release of bradykinin resulting in oedema of tissues. Investigation: C1-INH level is low during an attack Low C2 and C4 levels are seen, even between attacks. Serum C4 is the most reliable and widely used screening tool Symptoms: Attacks may be proceeded by painful macular rash Painless, non-pruritic swelling of subcutaneous/submucosal tissues May affect upper airways, skin or abdominal organs (can occasionally present as abdominal pain due to visceral oedema) Urticaria is not usually a feature Management: Acute: IV C1-inhibitor concentrate, fresh frozen plasma (FFP) if this is not available Prophylaxis: anabolic steroid Danazol may help

Your-Doctor Multiple Choice Questions (MCQ)

Your-Doctor
Multiple Choice Questions (MCQ)