1. Which of the following is true of the anticonvulsant levetiracetam?
A. Is used as monotherapy for the treatment of generalised convulsions
B. Acts via the gamma-aminobutyric acid (GABA) receptor
C. Is well absorbed via the oral route
D. Is associated with increased plasma concentrations of sodium valproate
E. Is associated with induction of hepatic cytochrome p450 enzymes
Answer: C
Explanation:
Key learning points
Neurology, Therapeutics
● Levetiracetam (Keppra) is rapidly absorbed orally, it does not affect hepatic
enzymes but dose reduction is required in renal failure.
Explanation
Levetiracetam (Keppra) is an adjunctive treatment for partial seizures with or without
secondary generalisation. Its mechanism of action is unknown.
It is rapidly absorbed orally, it does not affect hepatic enzymes but dose reduction is
required in renal failure.
The drug appears to be well tolerated with few side effects.
Keppra works hrough binding to the synaptic vesicle protein SV2A in the brainand
modulating neurotransmitter release.
It does not induce cytochrome p450 like other anti-epileptics
2. A 70-year-old male with a history of syncope and hypertension is found to have
runs of non-sustained ventricular tachycardia during telemetry.
Investigations show a serum magnesium of 0.4 mmol/L (0.75-1.05).
Which one of the following is most likely to be responsible for this biochemical
abnormality?
A. Hyperphosphatemia
B. Elevated PTH concentration
C. Diuretic therapy
D. Ranitidine therapy
E. Chronic renal failure
,Answer: C
Explanation: Key learning points
Cardiology, Endocrinology, Pharmacology
● Hypomagnesaemia may be due to diuretic use.
Explanation
Diuretic therapy is a common cause of hypomagnesaemia due to increased renal
excretion. It is not seen in hyperparathyroidism.
Chronic renal failure is a cause of hypermagnesaemia. Ranitidine (unlike Proton
pump inhibitors) is unlikely to cause hypomagnasemia.
Hypophosphataemia is seen in association with hypomagnesaemia.
3. A 46-year-old father of three has just been diagnosed with Huntington's disease.
His oldest daughter is 21-years-old and thinking about starting a family soon.
He asks you what the chances are of his daughter also having Huntington's disease?
A. She will not have it as it is X linked.
B. There is a 25% chance that she will have it.
C. There is a 50% chance that she will have it.
D. She will be a carrier as it is X linked.
E. She will definitely inherit it.
Answer: C
Explanation:
Key learning points
Neurology
● Huntington's disease is a neurodegenerative genetic disorder that is
autosomal dominant.
Explanation
Huntington's disease is a neurodegenerative genetic disorder that is autosomal
dominant.
Therefore she has a 50% chance of having the disease as she needs only to inherit
one mutant gene, from her father.
,The features are of choreiform movements, psychiatric illness and eventually
dementia.
4. A 73-year-old female is diagnosed with Cushing's disease.
Which of the following is correct?
A. Adrenalectomy would be treatment of choice
B. Yttrium implantation is an effective treatment
C. Recurrence of Cushing's disease after transsphenoidal surgery is less than
5%
D. op-DDD is a treatment if unfit for surgery
E. Ketoconazole may be used as a treatment if unfit for surgery
Answer: E
Explanation: Key learning points
Endocrinology
● Ketaconazole may be used in Cushing's disease for patients unfit for surgery.
Explanation
Transphenoidal hypophysectomy/adenomectomy would be the initial treatment of
choice to remove the pituitary gland.
Laparoscopic adrenalectomy would be advised where pituitary surgery has failed.
Ketoconazole may be an effective treatment for patients unfit for surgery by inhibition
of various enzymes which in turn blocks ACTH production and secretion.
opDDD is used for adrenal carcinomas.
Yttrium implantation has been abandoned even for acromegaly as is pretty useless.
The recurrence rate for Cushing's disease after surgery is of the order of 20-30% in
most series and depends on the size of the tumour with macroadenomas having a
higher rate of relapse.
5. A 76-year-old woman has had Paget's disease of bone for at least 15 years. She
has complained of a worsening pain at rest around her lower back and hip area. You
arrange an X ray which shows a destructive mass in the bony pelvis.
, What is the most likely diagnosis?
A. Osteosarcoma
B. Chondrosarcoma
C. Osteoma
D. Exostosis
E. Multiple myeloma
Answer: A
Key learning points
Oncology
● Osteogenic sarcoma complicates 5% of cases of Paget's disease.
Explanation
Paget's disease of bone usually occurs in later life.
In Paget's disease the continual repair process of bone is disturbed and ends at the
stage of vascular osteoid bone. Bones are very weak.
Osteogenic sarcoma complicates 5% of cases.
Student BMJ: Introduction to imaging: Bone and joint
Royal College of Physicians: Adult Paget's disease of bone
6. During which age range is IgA nephropathy usually diagnosed?
A. 70+ years
B. 40-60 years
C. 20-40 years
D. 60-70 years
E. 10-20 years
Answer: C
Key learning points
Nephrology
● IgA nephropathy usually presents in the age range of 20-40 years.
Explanation
A. Is used as monotherapy for the treatment of generalised convulsions
B. Acts via the gamma-aminobutyric acid (GABA) receptor
C. Is well absorbed via the oral route
D. Is associated with increased plasma concentrations of sodium valproate
E. Is associated with induction of hepatic cytochrome p450 enzymes
Answer: C
Explanation:
Key learning points
Neurology, Therapeutics
● Levetiracetam (Keppra) is rapidly absorbed orally, it does not affect hepatic
enzymes but dose reduction is required in renal failure.
Explanation
Levetiracetam (Keppra) is an adjunctive treatment for partial seizures with or without
secondary generalisation. Its mechanism of action is unknown.
It is rapidly absorbed orally, it does not affect hepatic enzymes but dose reduction is
required in renal failure.
The drug appears to be well tolerated with few side effects.
Keppra works hrough binding to the synaptic vesicle protein SV2A in the brainand
modulating neurotransmitter release.
It does not induce cytochrome p450 like other anti-epileptics
2. A 70-year-old male with a history of syncope and hypertension is found to have
runs of non-sustained ventricular tachycardia during telemetry.
Investigations show a serum magnesium of 0.4 mmol/L (0.75-1.05).
Which one of the following is most likely to be responsible for this biochemical
abnormality?
A. Hyperphosphatemia
B. Elevated PTH concentration
C. Diuretic therapy
D. Ranitidine therapy
E. Chronic renal failure
,Answer: C
Explanation: Key learning points
Cardiology, Endocrinology, Pharmacology
● Hypomagnesaemia may be due to diuretic use.
Explanation
Diuretic therapy is a common cause of hypomagnesaemia due to increased renal
excretion. It is not seen in hyperparathyroidism.
Chronic renal failure is a cause of hypermagnesaemia. Ranitidine (unlike Proton
pump inhibitors) is unlikely to cause hypomagnasemia.
Hypophosphataemia is seen in association with hypomagnesaemia.
3. A 46-year-old father of three has just been diagnosed with Huntington's disease.
His oldest daughter is 21-years-old and thinking about starting a family soon.
He asks you what the chances are of his daughter also having Huntington's disease?
A. She will not have it as it is X linked.
B. There is a 25% chance that she will have it.
C. There is a 50% chance that she will have it.
D. She will be a carrier as it is X linked.
E. She will definitely inherit it.
Answer: C
Explanation:
Key learning points
Neurology
● Huntington's disease is a neurodegenerative genetic disorder that is
autosomal dominant.
Explanation
Huntington's disease is a neurodegenerative genetic disorder that is autosomal
dominant.
Therefore she has a 50% chance of having the disease as she needs only to inherit
one mutant gene, from her father.
,The features are of choreiform movements, psychiatric illness and eventually
dementia.
4. A 73-year-old female is diagnosed with Cushing's disease.
Which of the following is correct?
A. Adrenalectomy would be treatment of choice
B. Yttrium implantation is an effective treatment
C. Recurrence of Cushing's disease after transsphenoidal surgery is less than
5%
D. op-DDD is a treatment if unfit for surgery
E. Ketoconazole may be used as a treatment if unfit for surgery
Answer: E
Explanation: Key learning points
Endocrinology
● Ketaconazole may be used in Cushing's disease for patients unfit for surgery.
Explanation
Transphenoidal hypophysectomy/adenomectomy would be the initial treatment of
choice to remove the pituitary gland.
Laparoscopic adrenalectomy would be advised where pituitary surgery has failed.
Ketoconazole may be an effective treatment for patients unfit for surgery by inhibition
of various enzymes which in turn blocks ACTH production and secretion.
opDDD is used for adrenal carcinomas.
Yttrium implantation has been abandoned even for acromegaly as is pretty useless.
The recurrence rate for Cushing's disease after surgery is of the order of 20-30% in
most series and depends on the size of the tumour with macroadenomas having a
higher rate of relapse.
5. A 76-year-old woman has had Paget's disease of bone for at least 15 years. She
has complained of a worsening pain at rest around her lower back and hip area. You
arrange an X ray which shows a destructive mass in the bony pelvis.
, What is the most likely diagnosis?
A. Osteosarcoma
B. Chondrosarcoma
C. Osteoma
D. Exostosis
E. Multiple myeloma
Answer: A
Key learning points
Oncology
● Osteogenic sarcoma complicates 5% of cases of Paget's disease.
Explanation
Paget's disease of bone usually occurs in later life.
In Paget's disease the continual repair process of bone is disturbed and ends at the
stage of vascular osteoid bone. Bones are very weak.
Osteogenic sarcoma complicates 5% of cases.
Student BMJ: Introduction to imaging: Bone and joint
Royal College of Physicians: Adult Paget's disease of bone
6. During which age range is IgA nephropathy usually diagnosed?
A. 70+ years
B. 40-60 years
C. 20-40 years
D. 60-70 years
E. 10-20 years
Answer: C
Key learning points
Nephrology
● IgA nephropathy usually presents in the age range of 20-40 years.
Explanation
