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?

Acute haemorrhagic pancreatitis

Diabetes Type II

Diabetes Type I

Congenital islet atrophy

Normal pancreas

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

Explanation

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

2. 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?

Sub-dural haemorrhage

Pulmonary thromboembolism

Perforated duodenal ulcer

Coronary artery atherosclerosis

Pancreatic duct obstruction

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.

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.

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

Neuropathic ulcer

Ischemic ulcer

Amyotrophy

Infected wound

Venous ulcer.

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.

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.

4. 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?

Pyolonephritis

Renal papillary necrosis

Kimmelstein Wilson lesion

Renal artery atherosclerosis

Insulitis

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.

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.

5. 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?

Membranous glomerulonephritis

Proliferative glomerulonephritis

Nodular glomerulosclerosis

Pyelonephritis

Membranoprolierative glomerulonephritis

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.

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.

6. 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?

Lymphocytic infiltrates in islets

Atrophy of the islets of pancreas

Well differentiated adenoma of the islet

Amyloid deposition in the islets

AGE deposition in the basement area

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.

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.

7. 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?

Diabetes

Increased serum HDL on recent blood tests

Excessive alcohol consumption

Smoking

A history of rheumatic fever

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.

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.

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?

Retinal microaneurysms

Nodular amyloid deposits

Deposition of AGE protein

Sorbitol accumulation

Retinal detachment

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.

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.

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?

Myocardial infarction

Hypoglycemic coma

Hyperosmolar coma

Diabetic ketoacidosis

Uremia due to renal failure

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.

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.

10. 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?

Mesangial proliferation

Inflammation

Amyloid deposition

AGE deposition

Arteriolosclerosis

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

Explanation

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

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

Mesangial proliferation

Inflammation

Amyloid deposition

AGE deposition

Arteriolosclerosis

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.

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.