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A woman who has had a child with congenital complete heart block is pregnant again and concerned that this child may also have congential complete heart block.  Which test would you order for the newborn baby?

A.

ANA

B.

ENAs

C.

C-ANCA

D.

Antimitochondrial antibodies

E.

Anti-smooth muscle antibodies

A 55 yaer old man has been taking allopurinol 300mg/day for gout prophylaxis.  He presents with acute gout of the right wrist and left knee.  Uric acid normal, creatinine 0.185  What is the best management?

A.

Stop allopurinol and start colchicine 1.2mg initially then 0.6 mg hourly until relief or diarrhoea occurs

B.

Stop allopurinol and start prednisone 30mg/day

C.

Stop allopurinol and start naproxen, restart allopurinol 100mg/day once symptoms settle

D.

Continue allopurinol 300mg/day and start prednisone 30 mg/day

E.

Reduce allopurinol to 100mg/day and start naproxen 500 mg b.d.

What clinical feature best differentiates polymyositis from inclusion body myositis?

A.

Deltoid muscle weakness

B.

Weakness of long finger flexors

C.

Quadriceps weakness

D.

Weakness of torso

E.

Weakness of periorbital muscles

Gastroenterology

A 35 year old man is found to have a low platelet count and , on examination, splenomegaly.  He is asymptomatic.  Past medical history is unremakable except that he suffere a severe beating to the abdomen aged 17, resulting in pancreatitis.  A CT of the abdomen is shown (CT confirms splenomegaly, there is an irregular, spiculated, 4 cm heavily calcified mass in the abdomen, 10 cm anterior to the aorta )

What is the cause of his thrombocytopaenia?

A.

Pancreatic pseudocyst

B.

Cholangiocarcinoma

C.

Colorectal carcinoma

D.

Portal vein thrombosis

E.

Immune thrombocytopaenic purpura

A patient with Crohn’s disease is trested with prednisone and goes into remission.  Which drug is best for keeping the patient in remission?

A.

Prednisone

B.

Salazopyrin

C.

Metronidazole

D.

Azatioprine

E.

Indomethacin

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