Stage 4 Quiz 1 (50 Questions - Dr Dark)

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Question 1 of 1

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A recent episode of a crime drama featured a victim that was strangled. In manual strangulation what is the best estimate of the time interval from compression of the jugular veins to loss of consciousness?

Select the correct answer(s).

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Explanation

This question was not felt to be fully congruent with the curriculum even though trauma, sudden death, autopsy are. This question was excluded from the examination but illustrates the style of question. There is no clinical scenario introduction. Research indicates that testing knowledge is more authentic when set in the appropriate clinical context. Therefore all questions (even those testing scientific foundation knowledge) should be led in by a patient history.

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A 13-year-old boy presented to the paediatric clinic for cognitive assessment. He had poor motor skills, dysarthria, dysphagia, ataxia and spasticity. The geneticist was concerned that he may have hexosaminidase A deficiency (Tay–Sachs disease) and recommended molecular analysis. What DNA mutation is most likely to be lethal?

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Explanation

The clinical scenario sets the scene but does not really influence the question. This is testing the candidate’s application of knowledge of molecular biology. Option A would remove an entire amino acid from the resulting protein. Options C-E would change the amino acid that is incorporated into the protein and may cause a loss or change in function. Option B creates a frame shift mutation and can result in very long proteins being synthesised. This can be the most dangerous. Option B is the best answer. This is a question that provides details of an unusual condition and very good candidates might know that it is associated with a frame-shift mutation. However, it is worded such that this knowledge is not essential as the question is asking which of the listed options is most dangerous. If you can apply your knowledge you can work it out. Remember that questions are written carefully to test the application of your knowledge and not just factual recall. This tests whether you really know something.

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A 35-year-old man presented to the neurology clinic for follow up of a degenerative neurological disease. Epidemiological studies of affected persons indicated that most cases occur in the spring, are isolated (i.e. no neighbours or relatives are affected) and occur equally in men and women. However, a subset of cases consisted of two affected siblings in a family. What is the best description of this condition in the two affected siblings?

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Explanation

This is testing the candidates understanding of terminology. The fact that most studies do not show a trend suggests that this is unlikely to have a genetic basis. Option A relates to the process of birth. Option C implies a genetic basis. Option E is random and does not fully explain the clustering in one family. Option B is the best term to describe the pattern in the family, where the disease in a population does not appear to have a genetic basis. Not a great question.... hence excluded from the examination.

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A 42-year-old man presented to the cardiology clinic. On examination he had a tall, thin body habitus, loose joints, and arachnodactyly. Eye examination revealed lens dislocation. An echocardiogram identified dilation of the aortic root. His parents were normal but his paternal grandfather and great-grandfather died in their forties from dissecting aortic aneurysm and were known to have had lens dislocation. His sister was found to have a similar body habitus, dilation of the aortic root but normal lenses. What is the best explanation of the different findings in siblings with the same inherited disease?

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Explanation

Option C relates to whether the gene is expressed or not and if it is, all the features manifest in the phenotype. Option E means that the gene is expressed but not all the features appear in the phenotype. This is testing understanding of terminology.

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A 42-year-old man presented to the cardiology clinic. On examination he had a tall, thin body habitus, loose joints, and arachnodactyly. Eye examination revealed lens dislocation. An echocardiogram identified dilation of the aortic root. His parents were normal but his paternal grandfather and great-grandfather died in their forties from dissecting aortic aneurysm and were known to have had lens dislocation. His sister was found to have a similar body habitus, dilation of the aortic root but normal lenses. What mechanism is the most likely cause of this phenotype?

Select the correct answer(s).

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Explanation

This question is relating to Marfan Syndrome. This is a very difficult question that was excluded from the examination as even the examiners got it wrong.... It is too hard, does not test knowledge from the curriculum and therefore was unsuitable. It is included here as an example of question format and being a difficult question. Questions need to be orientated around the appropriate strands of the curriculum and should test important knowledge and be of relevance to the requirements of students progressing into a foundation post. It is possible that even cardiology trainees would find this one very hard, and therefore this is not relevant to a stage 4 examination. This process of correlation with the curriculum is essential and testing of important concepts is more realistic to the workplace that students will be operating in after graduation. A careful review of all questions is completed before the examination is run and the best advice is for students to carefully review the learning objectives for the course being assessed. NOTE: Look carefully at the question lead-in text. It is identical to that used in a previous practice question. Therefore it is possible to construct a series of questions that use the same wording but ask a different focus (what is the diagnosis, what test would you do, what drug would you give, what complication is most likely etc.). Therefore, the question might appear similar to one you have seen before (even in these practice questions) but what is being tested will be different. Make no assumptions and READ THE QUESTION CAREFULLY....!

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A 78-year-old woman presented to the Emergency Department with swelling of her face and tongue. She had a past medical history of ischaemic heart disease for which she was taking several drugs that she could not recall. On clinical examination, she had urticaria over the neck and wheeze heard throughout the chest. Before her initial examination could be completed, she developed increasing difficulty in breathing with stridor and her blood pressure fell to 80/40 mmHg. What route is the most appropriate route for the administration of epinephrine (adrenaline) for this patient?

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Explanation

An important bit of clinical knowledge and this should be an easy question. Even though this could be very easy for many candidates, testing this ‘critical knowledge’ is still important. There is an expectation in standard setting that a very high percentage of students would get this correct. There are no ‘must pass’ questions in the examination.

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A 52-year-old woman presented to her GP concerned about her risk of cancer from her smoking. She had smoked 20 cigarettes per day for the last 35 years and several of her family members have died of cancer. She was in good health. What site of cancer is most likely to be caused by inhaled carcinogens from cigarette smoke?

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Explanation

This is an example of a question testing a concept and application of knowledge. Inhaled carcinogens are absorbed across the bronchial mucosa and enter the blood stream and are then processed in the liver to become more water-soluble. The metabolised carcinogens are then filtered by the kidney and sit in the bladder for hours. After more than 10 years the risk of bladder cancer is significantly elevated. The same is true for breast cancer, as carcinogens are secreted into the breast ducts, but the incidence of breast cancer caused by this aetiology is not a great as that for bladder cancer. Ovarian cancer is not affected by smoking but the risk of endometrial cancer is lower in smokers than non-smokers. Options C and D have no significant linkage to smoking. The best answer is option A.

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A 49-year-old man attended the cardiovascular risk clinic. His 10-year risk of having a cardiovascular event was 20%. Treatment with statins had been shown to reduce the risk of myocardial infarction in primary prevention trials by 25%. What is the best estimate of the number of patients that need to be treated to prevent 1 cardiovascular event per year?

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Explanation

The calculation of patient numbers, through application of knowledge, is to appreciate that the 10-year risk is reduced by 25%, so instead of 20% it falls to 15%. Therefore the 10-year risk is reduced by 5% which is 0.5% per year (as it is over 10 years), so 0.5 patients per hundred would have their death prevented and therefore 200 patients are required to prevent 1 death. This question is testing application of mathematics and not specific knowledge related to the curriculum.

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An 83-year-old woman was admitted to hospital for terminal care. She was diagnosed with breast cancer 2 years earlier and the disease was widely metastatic to her spine and brain. Her family were concerned that she was not receiving adequate sedation and analgesia. She had long-standing bone pain and had been using a fentanyl patch and hydromorphone orally at home. On admission she had been started on a subcutaneous morphine infusion. On clinical examination, she was cachectic and appeared comfortable in bed. Her blood pressure was 100/60 mmHg, pulse was 76 beats per minute, and respiration rate was 14 breaths per minute. She appeared to be sleeping and comfortable. The family demanded that she be "made to stop suffering" and asked that her morphine infusion be increased. What is the most appropriate course of action?

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Explanation

This question is testing situational judgement and action in an ethical situation. As such this is no longer an outcome for CSIM and therefore this question was not suitable for the examination. It is a good question but not fully aligned with the study guide.

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A 44-year-old man presented to the urology clinic for assessment. He was suspected of having a bladder tumour in the renal tract and the consultant requested a urine cytology specimen. What is the best sample for cytological assessment?

Select the correct answer(s).

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Explanation

Options A and E would allow the cells to die and therefore be unsuitable for cytological assessment. Option D is the best sample for culture as it minimises contamination at the start and end of stream. Option B would have the cells sitting in the bladder overnight and some would die off but this method is best for suspected mycobacterium infection.

Stage 4 Quiz 1 (50 Questions - Dr Dark)

Question 1 of 1

Time Left

A recent episode of a crime drama featured a victim that was strangled. In manual strangulation what is the best estimate of the time interval from compression of the jugular veins to loss of consciousness?

Select the correct answer(s).

(0/0)

Explanation

Select the correct answer(s).

(0/0)

Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

Select the correct answer(s).

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Explanation

A 44-year-old man presented to the urology clinic for assessment. He was suspected of having a bladder tumour in the renal tract and the consultant requested a urine cytology specimen. What is the best sample for cytological assessment?

Select the correct answer(s).

(0/0)

Explanation

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