CPC Exam Hardest Trivia Questions Quiz

1.

A 16-year-old Indigenous boy from the Torres Strait islands presented in an unconscious stage to a primary health facility. Past history from his mother revealed a gradual onset of fatigue and attacks of fainting. The boy died before the transport could be arranged. Biopsy from the tail of pancreas showed the following image. What is the most likely diagnosis?

A.

Acute haemorrhagic pancreatitis
B.

Diabetes Type II
C.

Diabetes Type I
D.

Congenital islet atrophy
E.

Normal pancreas

Correct Answer
C. Diabetes Type I

Explanation
Note lymphocyte infiltration limited to islets around cells suggestive of immune reaction targeted at islet cells. Typical picture in Type I diabetes.

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2.

A 63-year-old patient died due to chronic diabetes and renal failure. He was not responding to several changes of oral antidiabetic drugs. His pancreatic biopsy showed the following image. Which description best describes the image?

A.

Lymphocytic infiltrates in islets
B.

Atrophy of the islets of pancreas
C.

Well differentiated adenoma of the islet
D.

Amyloid deposition in the islets
E.

AGE deposition in the basement area

Correct Answer
D. Amyloid deposition in the islets

Explanation
Note the center of the islet is without any nuclei suggesting the loss of cells repaced by homogenous pink material (amyloid). This is Beta-cell atrophy in the late stage of diabetes Type 2 when patients do not respond to oral antidiabetic drugs - and need insulin.

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3.

The photograph shows chronic foot ulcer of a 42-year-old diabetic male. Most likely diagnosis is,

A.

Neuropathic ulcer
B.

Ischemic ulcer
C.

Amyotrophy
D.

Infected wound
E.

Venous ulcer.

Correct Answer
A. Neuropathic ulcer

Explanation
Note neuropathic ulcers are common due to loss of sensation due to myelin degeneration. In this question, option D can also be argued to be correct, but simple pressure would not be a common cause of chronic ulcer in a diabetic patient.

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4.

A 56-year-old male with chronic diabetes and hypertension presented with gradually failing kidney function. Microscopic image from his kidney biopsy is shown below. What is the feature labeled A?

A.

Mesangial proliferation
B.

Inflammation
C.

Amyloid deposition
D.

AGE deposition
E.

Arteriolosclerosis

Correct Answer
D. AGE deposition

Explanation
Nodular deposits of advanced glycosylation end products occur typically in diabetic nephropathy known as KW Lesion.

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5.

Referring to the previous image (shown again below), what is the feature labeled B?

A.

Mesangial proliferation
B.

Inflammation
C.

Amyloid deposition
D.

AGE deposition
E.

Arteriolosclerosis

Correct Answer
E. Arteriolosclerosis

Explanation
Arrow B shows an arteriole at the side of the glomerulus, with the markedly thickened wall by homogenous pink material (AGE proteins) also known as diabetic microangiopathy.

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6.

A 60-year-old man with a long-standing history of poorly controlled diabetes and non-healing ulcers at the base of his foot dies in his sleep. Which of the following lesions is most likely to be found at autopsy?

A.

Sub-dural haemorrhage
B.

Pulmonary thromboembolism
C.

Perforated duodenal ulcer
D.

Coronary artery atherosclerosis
E.

Pancreatic duct obstruction

Correct Answer
D. Coronary artery atherosclerosis

Explanation
The 60-year-old man had a long-standing history of poorly controlled diabetes, which is a major risk factor for the development of coronary artery atherosclerosis. Atherosclerosis is the build-up of plaque within the arteries, leading to narrowing and obstruction of blood flow. This can result in the development of coronary artery disease, which increases the risk of heart attacks. Given the patient's age, history of poorly controlled diabetes, and the fact that he died in his sleep, it is likely that the cause of death was related to atherosclerosis of the coronary arteries.

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7.

A 58-year-old female diabetic patient presents with slowly progressive renal failure. The following image is from her kidney biopsy and shows the appearance of a glomerulus. What is the most likely pathologic feature shown in the glomerulus?

A.

Pyolonephritis
B.

Renal papillary necrosis
C.

Kimmelstein Wilson lesion
D.

Renal artery atherosclerosis
E.

Insulitis

Correct Answer
C. Kimmelstein Wilson lesion

Explanation
The most likely pathologic feature shown in the glomerulus is a Kimmelstein Wilson lesion. This is suggested by the clinical presentation of slowly progressive renal failure in a diabetic patient. Kimmelstein Wilson lesion refers to the characteristic findings of nodular glomerulosclerosis, which is a common manifestation of diabetic nephropathy. It is characterized by the deposition of hyaline material within the glomerulus, leading to progressive renal damage.

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8.

A 55-year-old male with a 30-year history of diabetes presents with diminishing bilateral vision. His record shows Haemoglobin A1c values between 7% and 10%. On examination, both eyes show cataract formation. Which of the following pathologic mechanisms most likely explains his diminishing vision?

A.

Retinal microaneurysms
B.

Nodular amyloid deposits
C.

Deposition of AGE protein
D.

Sorbitol accumulation
E.

Retinal detachment

Correct Answer
D. Sorbitol accumulation

Explanation
The most likely explanation for the patient's diminishing vision is sorbitol accumulation. In diabetes, excess glucose is converted to sorbitol by the enzyme aldose reductase. Sorbitol accumulation can lead to osmotic damage and fluid accumulation in the lens of the eye, causing cataract formation. This mechanism is supported by the patient's long history of diabetes and the presence of cataracts on examination. The other options, such as retinal microaneurysms, nodular amyloid deposits, deposition of AGE protein, and retinal detachment, are not directly related to the formation of cataracts.

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9.

A 30-year-old man is brought to the ER in a state of unconsciousness. He has tachycardia and tachypnoea. Blood pressure is 90/60mmHg. Laboratory studies show a high level of plasma insulin and a lack of c-peptide. His urine exam shows no blood, protein or glucose, only 4+ ketonuria. Which of the following conditions is likely to be responsible for this patient’s condition?

A.

Myocardial infarction
B.

Hypoglycemic coma
C.

Hyperosmolar coma
D.

Diabetic ketoacidosis
E.

Uremia due to renal failure

Correct Answer
D. Diabetic ketoacidosis

Explanation
The patient's presentation of tachycardia, tachypnea, hypotension, and laboratory findings of high plasma insulin, lack of c-peptide, and 4+ ketonuria are consistent with the diagnosis of diabetic ketoacidosis (DKA). DKA is a serious complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. In DKA, there is a relative insulin deficiency leading to uncontrolled lipolysis and ketone production. The absence of blood, protein, and glucose in the urine suggests that the patient does not have renal failure or other conditions such as myocardial infarction or hypoglycemic coma. Therefore, the most likely explanation for the patient's condition is diabetic ketoacidosis.

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10.

A 51-year-old female diabetic patient presents with fever and dysuria and a history of progressive oliguria and increasing serum creatinine levels. The below image shows the microscopic appearance of her kidney biopsy. What is the most likely diagnosis?

A.

Membranous glomerulonephritis
B.

Proliferative glomerulonephritis
C.

Nodular glomerulosclerosis
D.

Pyelonephritis
E.

Membranoprolierative glomerulonephritis

Correct Answer
C. Nodular glomerulosclerosis

Explanation
Based on the given information, the patient is a 51-year-old female diabetic with symptoms of fever, dysuria, and a history of progressive oliguria and increasing serum creatinine levels. The microscopic appearance of her kidney biopsy shows nodular glomerulosclerosis. Nodular glomerulosclerosis is a characteristic finding in diabetic nephropathy, which is a common complication of diabetes. Therefore, the most likely diagnosis for this patient is nodular glomerulosclerosis.

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11.

A 42-year-old Indigenous man presents with atypical chest pain that has been increasing in frequency over the last month. Your physical examination is unremarkable and there are no acute changes on his ECG. Of the following features from his history, which would make you more suspicious that the pain may be of ischaemic origin?

A.

Diabetes
B.

Increased serum HDL on recent blood tests
C.

Excessive alcohol consumption
D.

Smoking
E.

A history of rheumatic fever

Correct Answer
A. Diabetes

Explanation
Diabetes is a risk factor for the development of cardiovascular disease, including ischemic heart disease. Individuals with diabetes have an increased risk of developing atherosclerosis, which can lead to reduced blood flow to the heart and subsequent chest pain. Therefore, the presence of diabetes in this patient's history would make the healthcare provider more suspicious that the chest pain may be of ischemic origin.

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