CME Medical Masterclass (122612): self-assessment ­questionnaire

Format

Candidates are asked to choose the best answer from the five possible answers. This best of five format is used in many medical examinations.

The answering process

1. Go to www.rcplondon.ac.uk/SAQ

2. Log on using your usual RCP username and password

3. Select the relevant CME question paper

4. Answer all 10 questions by selecting the best answer from the options provided

5. Once you have answered all the questions, click on Submit

Registering your external CPD credits

Carrying out this activity allows you to claim two external CPD credits. These will be automatically transferred to your CPD diary, where you can review the activity and claim your points.

1. A 68-year-old woman presented with bone pain and was found to have renal impairment. Further investigation established a diagnosis of myeloma.Which factors are used to determine the stage of myeloma in the International Staging System?

   1. Albumin and β2-microglobulin

   2. β2-microglobulin and creatinine

   3. Calcium and creatinine

   4. Calcium and haemoglobin

   5. Haemoglobin and albumin

2. A 72-year-old man presented with general malaise and breathlessness. He was found to have anaemia and hypercalcaemia, and a diagnosis of myeloma was made. He was treated with combination chemotherapy including lenalidomide.Which is the most important side effect of lenalidomide?

   1. Gastrointestinal bleeding

   2. Hepatitis

   3. Pulmonary fibrosis

   4. Skin rash

   5. Thromboembolism

3. A 38-year-old asymptomatic woman was found to have an abnormal ECG on routine screening, with T wave inversion in the lateral leads. An echocardiogram revealed asymmetric septal hypertrophy with systolic anterior motion of the mitral valve, but there was no significant left ventricular outflow tract obstruction. A 24-hour ECG recording was normal.What treatment does she require?

   1. Amiodarone

   2. Bisoprolol

   3. Diltiazem

   4. Implantable cardioverter-defibrillator

   5. None

4. A 32-year-old man presented with exertional chest pain and palpitations. On examination he had a jerky pulse and an ejection systolic murmur that was heard widely over the praecordium. An echocardiogram showed appearances consistent with hypertrophic cardiomyopathy. He had three children and was concerned that they might have inherited the condition from him.What is the typical inheritance pattern of hypertrophic cardiomyopathy?

   1. Autosomal dominant

   2. Autosomal recessive

   3. Mitochondrial

   4. Polygenic

   5. X-linked

5. A 34-year-old woman had bronchiectasis due to cystic fibrosis. In the past year she had suffered three acute chest infections requiring antibiotic treatment. She was now well, but culture of her sputum on two occasions 3 months apart revealed that she was colonised with Pseudomonas aeruginosa.What is the most appropriate treatment?

   1. Intravenous ciprofloxacin

   2. Intravenous tobramycin

   3. Nebulised ciprofloxacin

   4. Nebulised tobramycin

   5. Oral ciprofloxacin

6. A 42-year-old man presented with a 6-month history of worsening cough, sputum production and breathlessness. Examination of the chest revealed bilateral coarse crackles. A diagnosis of allergic bronchopulmonary aspergillosis was established.Aside from oral steroid, which drug is indicated?

   1. Amphotericin

   2. Caspofungin

   3. Fluconazole

   4. Itraconazole

   5. Voriconazole

7. A 28-year-old woman presented with paroxysmal attacks of sweating and tachycardia. A diagnosis of phaeochromocytoma was made. Her mother had also been diagnosed with phaeochromocytoma.Mutation in which gene is the most likely cause of her familial phaeochromocytoma?

   1. Dopamine β-hydroxylase

   2. Erythropoietin

   3. Fumarate hydratase

   4. Phenylethanolamine N-methyltransferase

   5. Succinate dehydrogenase

8. A 56-year-old man presented with severe hypertension due to a phaeochromocytoma.

   What is the most appropriate initial anti-hypertensive drug?

   1. Amlodipine

   2. Bisoprolol

   3. Labetalol

   4. Phenoxybenzamine

   5. Propanolol

9. A 32-year-old woman presented with a diarrhoeal illness complicated by a microangiopathic haemolytic anaemia and acute kidney injury. A diagnosis of diarrhoea-associated haemolytic–uraemic syndrome (dHUS) was made.

   What is the most likely infection to have caused this presentation?

   1. Campylobacter jejuni

   2. Escherichia coli

   3. Giardia lamblia

   4. Salmonella enteritidis

   5. Staphylococcus aureus

10. A 28-year-old man presented with malaise and bleeding from his nose. Examination revealed petechiae and purpura. Laboratory investigation demonstrated anaemia, thrombocytopenia and acute kidney injury. A diagnosis of atypical haemolytic–uraemic syndrome (aHUS) was suspected, later confirmed by demonstration of an inherited defect in a protein that regulates complement activation.

    What is the best treatment?

    1. Adalimumab

    2. Basiliximab

    3. Eculizumab

    4. Infliximab

    5. Omalizumab

CME Neurology SAQ

Answers to the CME SAQ published in Clinical Medicine in October 2018

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10

(c) (b) (c) (b) (b) (d) (c) (a) (c) (b)