1. Which of the following stimulates the secretion of gastrin?
A. High level of gastric acid in stomach
B. Fasting
C. Low gastric ph
D. Somatostatin
E. Amino acids
Answer: E. amino acids
Gastroenterology
● Protein, peptides, and amino acids are specific components which will
stimulate gastrin release.
Explanation
Gastrin is released from specialised endocrine cells, called G cells, in response to a
meal. Protein, peptides, and amino acids are specific components which will
stimulate gastrin release.
Fasting and increased gastric acid in the stomach both inhibit the release of gastrin.
High gastric pH is a strong stimulus for the secretion of gastrin.
G cells are tightly regulated by two hormones: gastrin-releasing peptide has a
stimulatory effect causing the secretion of gastrin, while somatostatin is inhibitory.
2. Which one of the following is true regarding acute pulmonary embolism?
a. Thrombolysis administered through a peripheral vein is as effective as
through a pulmonary artery catheter
b. Heparin is as effective as thrombolytic therapy
c. The presence of hypoxaemia is an indication for thrombolysis
d. Embolectomy is more effective than thrombolysis in improving survival
e. A normal ECG excludes the diagnosis
Answer: A
Explanation:
Key learning points
Cardiology, Respiratory Medicine
● Thrombolytic therapy is indicated for pulmonary embolism when circulation is
severely compromised, and is as effective delivered peripherally.
,Explanation
Embolectomies are rarely done nowadays due to the excellent results with
thrombolysis.
Thrombolytic therapy is reserved for those with severely compromised circulation
(equally effective through peripheral vein or via catheter in pulmonary artery).
Heparin reduces risk of further embolism (anticoagulant) and reduces pulmonary
vasoconstriction.
3. A 35-year-old male, morbidly obese with a BMI of 40 kg/m2, is assessed by a
multi-disciplinary team prior to undergoing bariatric surgery with gastric bypass
(Roux-en-Y procedure). Assessment of nutritional status and vitamins
pre-operatively shows no deficiency.
Six months after the procedure on routine follow-up it is noted the patient has a
haemoglobin of 80 g/L with macrocytosis. The patient admits that he has not been
fully compliant with the supplementation suggested by his caring team.
Which is the most probable nutritional deficiency accounting for this presentation?
A. Vitamin b12 deficiency
B. Vitamin a
C. Vitamin d
D. Thiamine
E. Selenium
Answer: A
Explanation:
Key learning points
Haematology
● Vitamin B12 deficiency following gastric bypass is a common complication
which must be actively tackled with supplementation, to avoid the
repercussions from haematological, neurological and cognitive complications.
Explanation
Bariatric patients are at an increased risk of developing vitamin B12 deficiency
because their digestive tracts have been altered in such a way as to interfere with
,the natural absorption of this vitamin. In patients who have had gastric bypass
surgery, most of the stomach and duodenum are bypassed, limiting the breakdown
of vitamin B12 and its subsequent binding with intrinsic factor.
Deficiencies of folate, zinc, vitamin D, calcium and thiamine have also been
observed in those undergoing bariatric surgery, but would not solely account for the
clinical presentation described above as they would present with skin rashes (zinc),
beriberi and Wernicke-Korsakoff syndrome (thiamine) or osteomalacia (vitamin D).
4. A 49-year-old man with a long history of alcoholism presents with cough,
haemoptysis and pleuritic chest pain. He has had night sweats and 10 kg weight loss
in the last three months. On chest x ray there is a subtle nodular pattern throughout
the lung.
He underwent a transbronchial biopsy which showed multinucleated giant cells,
epithelioid cells and necrotic debris.
Which of the following is the most likely diagnosis?
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Aspergilliosis
D. Tuberculosis
E. Pneumocystis jirovecii pneumonia(PCP)
Answer: D
Explanation:
Key learning points
Infectious Diseases, Respiratory Medicine
● A history of night sweats, haemoptysis and miliary shadowing in an alcoholic
is highly suggestive of TB.
Explanation
The history, in itself, of night sweats, haemoptysis and the miliary shadowing in an
alcoholic is highly suggestive of TB.
The giant cells, part of granulomas would again be supportive of TB.
Aspergillosis would not typically present with haemoptysis.
, PCP would normally present with progressive shortness of breath and hypoxia on
exertion.
Small cell and sqaumous cell carcinoma would not present with these chest x ray
findings.
5. Which of the following is not a component of the cardiac electrical conduction
pathway?
A. Bundle of His
B. Purkinje fibres
C. Atrioventricular node
D. Sinoatrial node
E. Sarcomere
Answer: E
Key learning points
Cardiology
● Coordinated electrical conduction pathway of the heart allows the passage of
blood through the heart and the rest of the body.
Explanation
To enable the circulation of blood through the heart, and through the body, the heart
requires coordinated muscular contraction. This is made possible because of the
electrical conduction pathway of the heart. An understanding of the anatomy and
physiology of the conducting system is important to allow the interpretation of ECGs
and the diagnosis of arrhythmias.
The electrical signal starts off at the sinoatrial node (SAN); it then passes to the
atrioventricular node (AVN) depolarising the left and right atrium whilst it passes
through, thus enabling contraction.
At the atrioventricular node, a short delay occurs, allowing the atrium to start
relaxing, before the impulse travels down the bundle of His, and divides along the left
and right bundle branches, where it causes depolarisation of the right and left
ventricles, and thus ventricular contraction.
A. High level of gastric acid in stomach
B. Fasting
C. Low gastric ph
D. Somatostatin
E. Amino acids
Answer: E. amino acids
Gastroenterology
● Protein, peptides, and amino acids are specific components which will
stimulate gastrin release.
Explanation
Gastrin is released from specialised endocrine cells, called G cells, in response to a
meal. Protein, peptides, and amino acids are specific components which will
stimulate gastrin release.
Fasting and increased gastric acid in the stomach both inhibit the release of gastrin.
High gastric pH is a strong stimulus for the secretion of gastrin.
G cells are tightly regulated by two hormones: gastrin-releasing peptide has a
stimulatory effect causing the secretion of gastrin, while somatostatin is inhibitory.
2. Which one of the following is true regarding acute pulmonary embolism?
a. Thrombolysis administered through a peripheral vein is as effective as
through a pulmonary artery catheter
b. Heparin is as effective as thrombolytic therapy
c. The presence of hypoxaemia is an indication for thrombolysis
d. Embolectomy is more effective than thrombolysis in improving survival
e. A normal ECG excludes the diagnosis
Answer: A
Explanation:
Key learning points
Cardiology, Respiratory Medicine
● Thrombolytic therapy is indicated for pulmonary embolism when circulation is
severely compromised, and is as effective delivered peripherally.
,Explanation
Embolectomies are rarely done nowadays due to the excellent results with
thrombolysis.
Thrombolytic therapy is reserved for those with severely compromised circulation
(equally effective through peripheral vein or via catheter in pulmonary artery).
Heparin reduces risk of further embolism (anticoagulant) and reduces pulmonary
vasoconstriction.
3. A 35-year-old male, morbidly obese with a BMI of 40 kg/m2, is assessed by a
multi-disciplinary team prior to undergoing bariatric surgery with gastric bypass
(Roux-en-Y procedure). Assessment of nutritional status and vitamins
pre-operatively shows no deficiency.
Six months after the procedure on routine follow-up it is noted the patient has a
haemoglobin of 80 g/L with macrocytosis. The patient admits that he has not been
fully compliant with the supplementation suggested by his caring team.
Which is the most probable nutritional deficiency accounting for this presentation?
A. Vitamin b12 deficiency
B. Vitamin a
C. Vitamin d
D. Thiamine
E. Selenium
Answer: A
Explanation:
Key learning points
Haematology
● Vitamin B12 deficiency following gastric bypass is a common complication
which must be actively tackled with supplementation, to avoid the
repercussions from haematological, neurological and cognitive complications.
Explanation
Bariatric patients are at an increased risk of developing vitamin B12 deficiency
because their digestive tracts have been altered in such a way as to interfere with
,the natural absorption of this vitamin. In patients who have had gastric bypass
surgery, most of the stomach and duodenum are bypassed, limiting the breakdown
of vitamin B12 and its subsequent binding with intrinsic factor.
Deficiencies of folate, zinc, vitamin D, calcium and thiamine have also been
observed in those undergoing bariatric surgery, but would not solely account for the
clinical presentation described above as they would present with skin rashes (zinc),
beriberi and Wernicke-Korsakoff syndrome (thiamine) or osteomalacia (vitamin D).
4. A 49-year-old man with a long history of alcoholism presents with cough,
haemoptysis and pleuritic chest pain. He has had night sweats and 10 kg weight loss
in the last three months. On chest x ray there is a subtle nodular pattern throughout
the lung.
He underwent a transbronchial biopsy which showed multinucleated giant cells,
epithelioid cells and necrotic debris.
Which of the following is the most likely diagnosis?
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Aspergilliosis
D. Tuberculosis
E. Pneumocystis jirovecii pneumonia(PCP)
Answer: D
Explanation:
Key learning points
Infectious Diseases, Respiratory Medicine
● A history of night sweats, haemoptysis and miliary shadowing in an alcoholic
is highly suggestive of TB.
Explanation
The history, in itself, of night sweats, haemoptysis and the miliary shadowing in an
alcoholic is highly suggestive of TB.
The giant cells, part of granulomas would again be supportive of TB.
Aspergillosis would not typically present with haemoptysis.
, PCP would normally present with progressive shortness of breath and hypoxia on
exertion.
Small cell and sqaumous cell carcinoma would not present with these chest x ray
findings.
5. Which of the following is not a component of the cardiac electrical conduction
pathway?
A. Bundle of His
B. Purkinje fibres
C. Atrioventricular node
D. Sinoatrial node
E. Sarcomere
Answer: E
Key learning points
Cardiology
● Coordinated electrical conduction pathway of the heart allows the passage of
blood through the heart and the rest of the body.
Explanation
To enable the circulation of blood through the heart, and through the body, the heart
requires coordinated muscular contraction. This is made possible because of the
electrical conduction pathway of the heart. An understanding of the anatomy and
physiology of the conducting system is important to allow the interpretation of ECGs
and the diagnosis of arrhythmias.
The electrical signal starts off at the sinoatrial node (SAN); it then passes to the
atrioventricular node (AVN) depolarising the left and right atrium whilst it passes
through, thus enabling contraction.
At the atrioventricular node, a short delay occurs, allowing the atrium to start
relaxing, before the impulse travels down the bundle of His, and divides along the left
and right bundle branches, where it causes depolarisation of the right and left
ventricles, and thus ventricular contraction.
