OBA

45 years old women present with weight gain and recurrent dizziness. Over the past 4 months she has gained 20kg weight and "dizziness" episode occur on daily basis with blurring of vision, sweating, headaches nd palpitation. She went to KK and blood sugar record 1.4 mmol/L and it was persistently low even after correction. What is the single most useful test?

• Thyroid function test

• Glucagon Stimulation test

• C Peptide

• Short ACTH test

• Cortisol level

Answer explanation

the patient suffered from Insulinoma

32 Years old woman who is at 24 weeks pregnant with her 3rd child come to the clinic for review. she has been diagnosed with gestational diabetes mellitus and a fasting plasma glucose following 2 weeks adherence to lifestyle changes is 6.8mmol/L. Her blood pressure is 122/82mmHg, Her BMI 25. Her sister suffers from diabetic type 1. Which following is the most appropriate treatment

• S/c Glargine

• Dapaglifozin

• Metformin

• Glibenclamide

• Insulin Pump

52 years old woman in the ED with dyspnea accompanied by nausea and vomiting. She is suffering from DM type 2, hypertension, and obesity. Her current medication is metformin 1g bd, canagliflozin 100 mg od, ramipril 10 mg od and amlodipine 10 mg od. On examination RR 25 breath per min, and O2 saturation is 98% under room air. Other examination is unremarkable except she has epigastric tenderness. Blood result as per attachment. What is the most likely diagnosis?

• small bowel obstruction

• Metformin induce Lactic acidosis

• Starvation ketosis

• Euglycemic diabetic ketoacidosis

• Pancreatitis

20years old man presents with a nine months history weight gain. Prior to this, he was of normal weight. On examination of his, BMI is 36, BP 150/90, he is noted to have abdominal striae and some degree of myopathy. Blood investigation as per attachment. what is the next best investigation?

• Plasma ACTH

• 24 Hour urine cortisol

• Renal:Aldosterone ratio

• thyroid fucntion test

• Insulin growth factor

23 years old man with severe Chron's disease has been put on complete bowel rest for an indefinite period of time whilst he in-patient recovery. he received total parenteral nutrition for past few weeks. recently his skin become dry and scaly with mouth ulcers and lip swelling. what cause of this changes

• Cheilitis

• Extra bowel manifestation of Chrons

• folliculitis

• Palisaded neutrophilic and granulomatous dermatitis

• Acrodermatitis herpetiform

64 years old man present with severe mucosal ulceration associated with the development of blistering lesions over his torso and arm. On examination, the blisters are flaccid and easily ruptured when touched. What is the most likely diagnosis?

• Pemphigoid

• Dermatitis herpetiformis

• Psoriasis

• Pemphigus Vulgaris

• Epidermolysis bullosa

43 years old man has schizophrenia with interspersed with periods of depression. Presented with above skin lesion. What is the most likely drug cause this skin lesion?

• sodium valproate

• quetiapine

• valproic acid

• fluoxetine

• lithium

28 years old man who has recently emigrated from Thailand presents with a penile ulcer. It initially started as papule which later progressed to become painful ulcer with an undermined ragged edge. Examination of the testes was unremarkable but tender inguinal lymphadenopathy was noted. What is the most likely diagnosis?

• Chancroid

• Lymphogranuloma Venerum

• Syphilis

• Herpes Simplex

• Granuloma inguinale

35 years old man was diagnosed with HIV and is stable on antiretroviral therapy. He has a new regular partner and is concern about transmission of the disease to him. What is the factor is most likely to increase the risk of transmission?

• Circumcision

• Low CD4 Count

• Genital warts

• Diabetes

• Mucosal ulceration

A 38 years old woman presents to the clinic with a history of hypertension since 10 years ago. Currently, she is on amlodipine and ramipril. On examination, the heart rate is 80 bpm, and blood pressure is 180/110mmHg. What is the most likely cause of her hypertension?

• Bartter Syndrome

• Bilateral renal artery stenosis

• Gitelman syndrome

• Primary hyperaldosteronism

• Acromegaly