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Question 1
Incorrect
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A 78-year-old woman is admitted from her nursing home after experiencing a fall resulting in a displaced intracapsular hip fracture. She has a history of hypertension, mild cognitive impairment, and osteoarthritis. Typically, she requires a zimmer frame for mobility and appears frail. What is the appropriate surgical approach for her condition?
Your Answer: Total hip replacement
Correct Answer: Cement hemiarthroplasty
Explanation:The patient’s decreased mobility, cognitive impairment, and general frailty make her unsuitable for a total hip replacement. Instead, a cement hemiarthroplasty is the recommended treatment for her fractured hip, with the goal of restoring her normal function. The appropriate surgical management for a hip fracture depends on both the location of the fracture and the patient’s normal function.
For an intracapsular fracture, which involves the femoral head and insertion of the capsule into the joint, replacement arthroplasty is recommended for patients with a displaced fracture who are clinically eligible. Eligibility criteria include the ability to walk independently, no cognitive impairment, and medical fitness for both anesthesia and the procedure. If a patient does not meet these criteria, a cemented hemiarthroplasty is preferred.
For extracapsular fractures, such as trochanteric or subtrochanteric fractures, different treatments are recommended. A sliding hip screw is appropriate for trochanteric fractures, while subtrochanteric fractures should be fixed using an intramedullary nail.
The ultimate goal of hip replacement after a fracture is to allow the patient to return to their normal function by enabling them to fully weight bear postoperatively.
Hip fractures are a common occurrence, particularly in elderly women with osteoporosis. The femoral head blood supply runs up the neck, making avascular necrosis a potential risk in displaced fractures. Symptoms of a hip fracture include pain and a shortened and externally rotated leg. Patients with non-displaced or incomplete neck of femur fractures may still be able to bear weight. Hip fractures can be classified as intracapsular or extracapsular, with the Garden system being a commonly used classification system. Blood supply disruption is most common in Types III and IV fractures.
Intracapsular hip fractures can be treated with internal fixation or hemiarthroplasty if the patient is unfit. Displaced fractures are recommended for replacement arthroplasty, such as total hip replacement or hemiarthroplasty, according to NICE guidelines. Total hip replacement is preferred over hemiarthroplasty if the patient was able to walk independently outdoors with the use of a stick, is not cognitively impaired, and is medically fit for anesthesia and the procedure. Extracapsular hip fractures can be managed with a dynamic hip screw for stable intertrochanteric fractures or an intramedullary device for reverse oblique, transverse, or subtrochanteric fractures.
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This question is part of the following fields:
- Musculoskeletal
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Question 2
Incorrect
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A 50-year-old woman comes to you with a thyroid lump and you suspect she may have follicular carcinoma of the thyroid. What is the most appropriate course of action in this scenario?
Your Answer: Fine needle aspiration cytology can differentiate between follicular adenoma and carcinoma
Correct Answer: Spreads mainly via blood
Explanation:Thyroid Carcinoma: Diagnosis and Management
Thyroid carcinoma is a type of cancer that affects the thyroid gland. There are different types of thyroid carcinoma, including follicular, papillary, anaplastic, and medullary carcinomas. The spread of the cancer varies depending on the type of carcinoma.
Follicular carcinoma spreads mainly via the bloodstream, while papillary and medullary carcinomas spread via the lymphatic system. Anaplastic cancer spreads locally. The prognosis for thyroid carcinoma is generally good, with a 90% survival rate at 10 years, especially in young people without local or metastatic spread.
The initial treatment for differentiated thyroid carcinoma, such as follicular and papillary carcinomas, is total or near-total thyroidectomy. Fine needle aspiration cytology can help differentiate between follicular adenoma and carcinoma, but a thyroid lobectomy is often necessary to confirm the diagnosis. The distinguishing features of follicular carcinoma are vascular invasion and capsule invasion, which can only be seen accurately on a full histological specimen.
Solitary thyroid nodules are best investigated using a combination of clinical examination, thyroid function tests, ultrasound and radio-isotope scans, and often FNA. Thyroid tumours can be classified as adenomas, carcinomas, and lymphomas. Carcinomas can be further sub-classified as papillary, follicular, anaplastic, or medullary.
In conclusion, the diagnosis and management of thyroid carcinoma require a multidisciplinary approach. Early detection and treatment can lead to a good prognosis, but accurate diagnosis is crucial for effective management.
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This question is part of the following fields:
- Endocrinology
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Question 3
Incorrect
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A patient is brought into the Resuscitation Room. Paramedics were called after he was found face down, unconscious on the road. He smells strongly of alcohol. He has a nasopharyngeal airway in situ (inserted by the ambulance service). There are no visible injuries, except for a small abrasion on his left knee and another on his left shoulder. He is currently on 15 l of high-flow oxygen via a non-rebreather mask.
In which of the following scenarios is a nasopharyngeal airway indicated for an elderly patient?Your Answer: Base of skull fractures
Correct Answer: Seizures
Explanation:The Use of Nasopharyngeal Airways in Seizure Management
Nasopharyngeal airways are a valuable tool in managing patients with seizures. During a seizure, jaw rigidity can make it difficult to position an oropharyngeal airway, making a nasopharyngeal airway a better option. These airways are used to secure an open airway in patients with a decreased Glasgow Coma Scale (GCS) score and those who cannot tolerate an oropharyngeal airway due to an intact gag reflex. The correct size of the airway is chosen by sizing the width of the patient’s nostril to the circumference of the tube, and insertion is facilitated by using a water-based lubricant. However, nasopharyngeal airways should not be used in patients with a patent airway or those with basal skull fractures and coagulopathy.
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This question is part of the following fields:
- Anaesthetics & ITU
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Question 4
Incorrect
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To visualize the vocal cords, where should the tip of a Macintosh laryngoscope be inserted?
Your Answer: Into the laryngopharynx
Correct Answer: Into the vallecula
Explanation:Macintosh Laryngoscope: A Tool for Visualizing the Vocal Cords
The Macintosh laryngoscope is a medical instrument designed to aid in the visualization of the vocal cords. Its curved blade is specifically shaped to fit into the oral and oropharyngeal cavity. To use it, the blade is inserted through the right side of the mouth and gradually advanced, pushing the tongue to the left and out of view. The blade has a small bulbous tip that is intended to sit in the vallecula, a small depression between the base of the tongue and the epiglottis.
By lifting the laryngoscope up and forwards, the larynx is elevated, allowing for a clear view of the vocal cords. This tool is commonly used in medical settings, such as during intubation procedures or when examining the airway. Its design allows for a safe and effective way to visualize the vocal cords, aiding in the diagnosis and treatment of various medical conditions.
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This question is part of the following fields:
- Anaesthetics & ITU
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Question 5
Incorrect
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An 80-year-old man comes to the clinic with painless, symmetrical swellings in his neck. He reports no other symptoms. Laboratory tests show a haemoglobin level of 100 g/l and a white cell count of 23 × 109/l. A blood film reveals smear cells, with more than 60% of the cells being small mature lymphocytes. What is the probable diagnosis?
Your Answer: Hodgkin’s lymphoma
Correct Answer: Chronic lymphocytic leukaemia
Explanation:Differentiating Leukaemia and Lymphoma: Understanding CLL and Other Types
Leukaemia and lymphoma are two types of blood cancers that can present with similar symptoms. However, each type has distinct characteristics that can help differentiate them. Among the different types of leukaemia and lymphoma, B-cell chronic lymphocytic leukaemia (B-CLL) is the most common leukaemia in adults. It is characterized by peripheral blood lymphocytosis and uncontrolled proliferation of B cell lymphocytes in the bone marrow, lymph nodes, and splenomegaly. Patients with CLL are often asymptomatic, and the condition is often picked up incidentally.
In contrast, acute lymphoblastic leukaemia is a common leukaemia of children aged 2–5 years and is very rare in adults. Multiple myeloma, on the other hand, is the uncontrolled proliferation of plasma cells and presents with bone pain, hypercalcaemia, renal failure, and neutropenia. Chronic myeloid leukaemia tends to present with more systemic, B symptoms in a slightly younger age group, and a classic symptom is massive hepatosplenomegaly.
While lymphoma is a possibility in this age group, CLL is the most likely diagnosis as it is more common in this age group and in the western world. Further investigation would be used to confirm the diagnosis. Understanding the characteristics of each type of leukaemia and lymphoma can aid in accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Haematology
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Question 6
Incorrect
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An 85-year-old female presents to the emergency department with complaints of pain in the left hemithorax after a fall at home. The patient has a history of chronic obstructive pulmonary disease and osteoarthritis. Upon examination, there is visible bruising and tenderness upon palpation over the left hemithorax. A chest x-ray confirms a complete disruption of the bony contour of the left 6th rib, without disruption of the pleura or lung parenchyma. What is the most appropriate management for this injury?
Your Answer: Conservative management with rib belt
Correct Answer: Conservative management with adequate analgesia
Explanation:Simple rib fractures are typically treated conservatively, with appropriate pain relief measures such as NSAIDs, opioids, and intercostal nerve blocks. It is crucial to manage pain effectively to prevent breathing difficulties and complications like atelectasis and pneumonia. Rib belts should not be used as they can hinder respiratory function. Chest x-rays do not reveal any intrathoracic complications like haemothorax or pneumothorax, so chest drains are unnecessary. IV bisphosphonates are not useful in treating traumatic rib fractures, but oral bisphosphonates may be considered later on to address any loss of bone mineral density in the patient.
A rib fracture is a break in any of the bony segments of a rib. It is commonly caused by blunt trauma to the chest wall, but can also be due to underlying diseases that weaken the bone structure of the ribs. Rib fractures can occur singly or in multiple places along the length of a rib and may be associated with soft tissue injuries to the surrounding muscles or the underlying lung. Risk factors include chest injuries in major trauma, osteoporosis, steroid use, chronic obstructive pulmonary disease, and cancer metastases.
The most common symptom of a rib fracture is severe, sharp chest wall pain, which is often more severe with deep breaths or coughing. Chest wall tenderness over the site of the fractures and visible bruising of the skin may also be present. Auscultation of the chest may reveal crackles or reduced breath sounds if there is an underlying lung injury. In some cases, pain and underlying lung injury can result in a reduction in ventilation, causing a drop in oxygen saturation. Pneumothorax, a serious complication of a rib fracture, can present with reduced chest expansion, reduced breath sounds, and hyper-resonant percussion on the affected side. Flail chest, a consequence of multiple rib fractures, can impair ventilation of the lung on the side of injury and may require treatment with invasive ventilation and surgical fixation to prevent complications.
Diagnostic tests for rib fractures include a CT scan of the chest, which shows the fractures in 3D as well as the associated soft tissue injuries. Chest x-rays may provide suboptimal views and do not provide any information about the surrounding soft tissue injury. In cases of pathological fractures secondary to tumour metastases, a CT scan to look for a primary (if not already identified) is also required. Management of rib fractures involves conservative treatment with good analgesia to ensure breathing is not affected by pain. Inadequate ventilation may predispose to chest infections. Nerve blocks can be considered if the pain is not controlled by normal analgesia. Surgical fixation can be considered to manage pain if this is still an issue and the fractures have failed to heal following 12 weeks of conservative management. Flail chest segments are the only form of rib fractures that should be urgently discussed with cardiothoracic surgery as they can impair ventilation and result in significant lung trauma. Lung complications such as pneumothorax or haemothorax should be managed as necessary.
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This question is part of the following fields:
- Musculoskeletal
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Question 7
Incorrect
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A 25-year-old man presents to the emergency department after taking an overdose of paracetamol. He ingested 70 tablets within 2 hours and arrived at the hospital within 30 minutes of taking the last tablet. The patient appears to be in poor health and is immediately started on treatment.
After 24 hours, the following investigations are performed:
- pH: 7.28 (normal range: 7.35 - 7.45)
- pCO2: 4.6 kPa mmol/L (normal range: 4.5 - 6.0 kPa)
- pO2: 12.0 kPa mmol/L (normal range: 10 - 14 kPa)
- Bicarbonate: 10 mmol/L (normal range: 22 - 28 mmol/L)
- Lactate: 5 mmol/L (normal range: <2 mmol/L)
- Creatinine: 796 μmol/L (normal range: 55-120 μmol/L)
- ALT: 2662 IU/L (normal range: 3-40 IU/L)
- Prothrombin time: 20 s (normal range: 2 - 17 s)
- Paracetamol level: 8 mg/L (normal range: <6 mg/L)
What specific history finding would indicate the need for a liver transplant in this patient?Your Answer: Her creatinine
Correct Answer: Her pH
Explanation:The most important prognostic factor for liver transplant qualification in individuals with paracetamol overdose is a pH <7.30. Other factors such as prothrombin time, encephalopathy, and creatinine levels are also associated with a poorer prognosis, but not to the same extent as metabolic acidosis. ALT levels are not considered in the liver transplant criteria as they can vary significantly depending on the degree of hepatocyte damage. Similarly, paracetamol levels are not part of the criteria as they can vary depending on individual factors and timing of presentation. Acute kidney injury may occur but is not a standalone criterion for liver transplant qualification. Paracetamol overdose management guidelines were reviewed by the Commission on Human Medicines in 2012. The new guidelines removed the ‘high-risk’ treatment line on the normogram, meaning that all patients are treated the same regardless of their risk factors for hepatotoxicity. However, for situations outside of the normal parameters, it is recommended to consult the National Poisons Information Service/TOXBASE. Patients who present within an hour of overdose may benefit from activated charcoal to reduce drug absorption. Acetylcysteine should be given if the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity. Acetylcysteine is now infused over 1 hour to reduce adverse effects. Anaphylactoid reactions to IV acetylcysteine are generally treated by stopping the infusion, then restarting at a slower rate. The King’s College Hospital criteria for liver transplantation in paracetamol liver failure include arterial pH < 7.3, prothrombin time > 100 seconds, creatinine > 300 µmol/l, and grade III or IV encephalopathy.
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This question is part of the following fields:
- Pharmacology
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Question 8
Incorrect
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Which statement accurately reflects the results of a randomized controlled trial comparing sunscreen A and placebo for skin cancer prevention, where 100 patients were assigned to each group and 10% of patients in group A developed skin cancer with a relative risk of 0.7 compared to placebo?
Your Answer: The absolute risk reduction for sunscreen A is 3%
Correct Answer: The relative risk reduction for sunscreen A is 0.3
Explanation:When analyzing the results of a sunscreen study, it is important to consider the relative risk reduction. This value is calculated by subtracting the relative risk from 1. If the relative risk reduction is greater than 0, it means that the group receiving the sunscreen had a lower risk of skin cancer compared to the placebo group. However, without performing a statistical test, it is difficult to determine if the sunscreen is truly effective in preventing skin cancer.
Additionally, it is helpful to look at the absolute risk of skin cancer in the placebo group. In the given example, the absolute risk of skin cancer in group B was 14.2%. This value can be used to calculate the absolute risk reduction, which is the difference between the absolute risk of the placebo group and the absolute risk of the sunscreen group. In this case, the absolute risk reduction was 4.2%.
Overall, these values can provide insight into the effectiveness of a sunscreen in preventing skin cancer. However, it is important to note that further statistical analysis may be necessary to draw definitive conclusions.
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This question is part of the following fields:
- Clinical Sciences
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Question 9
Correct
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A 6-year-old girl walks with a limp due to right hip pain, which is relieved by rest and made worse by walking or standing. Her vital signs are normal. The Trendelenburg sign presents when she stands on her right leg.
X-rays reveal periarticular right hip swelling in soft tissue. A bone scan reveals reduced activity in the anterolateral right capital femoral epiphysis.
What is the most likely diagnosis?Your Answer: Legg-Calvé-Perthes disease
Explanation:Understanding Legg-Calvé-Perthes Disease and Differential Diagnoses
Legg–Calvé–Perthes disease is a condition that occurs due to vascular compromise of the capital epiphysis of the femur. The exact cause of this self-limiting disease is unclear, but it may be related to developmental changes in the hip’s blood supply. The compromised blood flow leads to ischaemic necrosis of the epiphysis. The retinacular arteries and their branches are the primary source of blood to the head of the femur, especially between the ages of 4 and 9 when the epiphyseal plate is forming. During this time, the incidence of Legg-Calvé-Perthes disease is highest.
Differential diagnoses for this condition include a slipped capital femoral epiphysis, septic arthritis, and epiphyseal dysplasia. A slipped capital femoral epiphysis would be visible on hip radiography, which is not the case in this scenario. Septic arthritis would cause systemic inflammatory responses, which are not present in this case. Epiphyseal dysplasia is a congenital defect that would typically present when the child starts to walk.
In addition to Legg-Calvé-Perthes disease, there is radiological evidence of synovitis and hip joint effusion in this scenario. However, synovitis is a non-specific sign and not a specific diagnosis. Understanding these differential diagnoses can help healthcare professionals provide accurate diagnoses and appropriate treatment plans for patients with hip joint issues.
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This question is part of the following fields:
- Paediatrics
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Question 10
Correct
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You have been referred a 14-year-old girl who appears very upset by her parents’ ongoing divorce. She has begun to engage in self-injurious behaviour by banging her head against walls at times of stress. Her intelligence quotient (IQ) has been assessed by her school as 62.
With which of the following is this score most consistent?Your Answer: Mild learning disability
Explanation:Understanding Learning Disabilities: Levels of Intelligence Quotient (IQ)
Learning disabilities are diagnosed through a combination of intelligence testing and functional assessments. The intelligence quotient (IQ) level is used to determine the severity of the learning disability. A score of 70 is considered within the normal range, while a score between 50-69 indicates a mild learning disability. A score of 35-49 is classified as a moderate learning disability, and a score of 20-34 is considered a severe learning disability. Scores below 20 indicate a profound learning disability. It’s important to note that a score of 60 falls within the mild learning difficulty range, which is still considered a learning disability. Understanding IQ levels can help individuals and their families better understand and manage their learning disabilities.
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This question is part of the following fields:
- Psychiatry
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Question 11
Correct
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An 80-year-old male is experiencing cognitive impairment and has been diagnosed with dementia. What is the likely cause of his dementia?
Your Answer: Alzheimer’s disease
Explanation:Dementia: Types and Symptoms
Dementia is a clinical condition that involves the loss of cognitive function in multiple domains beyond what is expected from normal ageing. This condition affects areas such as memory, attention, language, and problem-solving. Alzheimer’s disease is the most common form of dementia, accounting for about two-thirds of all cases. The initial symptom of Alzheimer’s disease is usually forgetfulness for newly acquired information, followed by disorientation and progressive cognitive decline with personality disruption.
Apart from Alzheimer’s disease, other types of dementia include blood vessel disease (multi-infarct dementia), dementia with Lewy bodies, and frontotemporal dementia (Pick’s disease). These types of dementia account for 20%, 15%, and less than 5% of cases, respectively. The remaining cases result from a variety of less common disorders, such as Creutzfeldt-Jakob disease, progressive supranuclear palsy, Huntington’s disease, and AIDS-associated dementia.
It is important to understand the different types of dementia and their symptoms to provide appropriate care and support for individuals with this condition. Early diagnosis and intervention can also help manage the symptoms and improve the quality of life for those affected.
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This question is part of the following fields:
- Miscellaneous
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Question 12
Incorrect
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An 81-year-old woman presents to Accident and Emergency with recurrent chest infections over the last year. She has suffered from rheumatoid arthritis for a long time and is on methotrexate and sulfasalazine. On examination, there are some crepitations at the right lung base and splenomegaly. She has some abnormal discolouration on her legs.
Full blood counts showed:
Investigation Result Normal value
Haemoglobin (Hb) 96 g/l 115–155 g/l
White cell count (WCC) 3.2 × 109/l 4–11 × 109/l
Neutrophils 0.8 × 109/l 1.7–7.5 × 109/l
Lymphocytes 1.5 × 109/l 1.0–4.5 × 109/l
Eosinophils 0.6 × 109/l 0.0–0.4 × 109/l
Which of the following is the most likely diagnosis?Your Answer: Chronic lymphocytic leukaemia
Correct Answer: Felty syndrome
Explanation:Differential diagnosis for a patient with rheumatoid arthritis, splenomegaly, neutropenia, and skin changes
Felty syndrome and other potential diagnoses
Felty syndrome is a rare complication of rheumatoid arthritis that affects about 1% of patients. It is characterized by the presence of three main features: splenomegaly (enlarged spleen), neutropenia (low white blood cell count), and recurrent infections. Skin changes on the lower limbs, such as ulcers or nodules, are also common in Felty syndrome. The exact cause of this syndrome is unknown, but it is thought to be related to immune dysregulation and chronic inflammation.
Other conditions that may present with similar symptoms include chronic lymphocytic leukemia (CLL), non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and drug-induced neutropenia. CLL is a type of blood cancer that affects mainly older adults and causes the accumulation of abnormal lymphocytes in the blood, bone marrow, and lymph nodes. However, in this case, the patient’s white blood cell count is low, which is not typical of CLL. Non-Hodgkin’s lymphoma and Hodgkin’s lymphoma are types of cancer that affect the lymphatic system and may cause lymphadenopathy (enlarged lymph nodes), fever, night sweats, and weight loss. However, there is no evidence of lymph node involvement or systemic symptoms in this scenario.
Drug-induced neutropenia is a potential side effect of methotrexate, which is a commonly used medication for rheumatoid arthritis. However, splenomegaly is not a typical feature of methotrexate toxicity, and respiratory complications are more common than hematological ones. Therefore, the most likely diagnosis in this case is Felty syndrome, which requires close monitoring and management of the underlying rheumatoid arthritis. In severe cases, splenectomy (surgical removal of the spleen) may be considered to improve neutropenia and reduce the risk of infections.
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This question is part of the following fields:
- Rheumatology
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Question 13
Correct
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Which ONE of the following women has gestational hypertension?
Rewritten: Which ONE of the following women, who are all 35 years old, has gestational hypertension?Your Answer: 22 weeks gestation and BP 150/100 and no proteinuria
Explanation:If high blood pressure occurs after 20 weeks gestation and there is no proteinuria, it is considered gestational hypertension. However, if high blood pressure is present before 20 weeks, it is likely pre-existing hypertension.
Hypertension during pregnancy is a common occurrence that requires careful management. In normal pregnancies, blood pressure tends to decrease in the first trimester and then gradually increase to pre-pregnancy levels by term. However, in cases of hypertension during pregnancy, the systolic blood pressure is usually above 140 mmHg or the diastolic blood pressure is above 90 mmHg. Additionally, an increase of more than 30 mmHg systolic or 15 mmHg diastolic from the initial readings may also indicate hypertension.
There are three categories of hypertension during pregnancy: pre-existing hypertension, pregnancy-induced hypertension (PIH), and pre-eclampsia. Pre-existing hypertension refers to a history of hypertension before pregnancy or elevated blood pressure before 20 weeks gestation. PIH occurs in the second half of pregnancy and resolves after birth. Pre-eclampsia is characterized by hypertension and proteinuria, and may also involve edema.
The management of hypertension during pregnancy involves the use of antihypertensive medications such as labetalol, nifedipine, and hydralazine. In cases of pre-existing hypertension, ACE inhibitors and angiotensin II receptor blockers should be stopped immediately and alternative medications should be prescribed. Women who are at high risk of developing pre-eclampsia should take aspirin from 12 weeks until the birth of the baby. It is important to carefully monitor blood pressure and proteinuria levels during pregnancy to ensure the health of both the mother and the baby.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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As you review your daily results, you come across a cervical smear test for a 32-year-old patient. The result indicates that it is a repeat test and states that she is 'high-risk human papillomavirus (hrHPV) negative'. Upon further examination of her medical records, you discover that this is her second repeat test after an abnormal result during a routine screening two years ago. Her last test was 12 months ago, where she tested 'hrHPV positive. Cytologically normal'. Interestingly, she has never been invited for a colposcopy. What would be the most appropriate next step in this situation?
Your Answer: Return to routine recall (in 3 years)
Explanation:If a patient’s 2nd repeat smear at 24 months is now negative for high-risk human papillomavirus (hrHPV), the correct course of action is to return to routine recall in 3 years. This assumes that the patient had an initial abnormal smear 2 years ago, which showed hrHPV positive but normal cytology, and a repeat test at 12 months that was also hrHPV positive but cytologically normal. If the patient had still been hrHPV positive, they would have been referred for colposcopy. However, since they are now negative, they can go back to routine recall. The latest cervical screening programme does not require cytology to be performed if hrHPV is negative, so it would be inappropriate and impractical for the GP to request cytology on the sample. There is no need to repeat the smear in 4 weeks or 12 months, as transient hrHPV infection is common and self-resolves, and does not necessarily indicate a high risk of cervical cancer.
The cervical cancer screening program has evolved to include HPV testing, which allows for further risk stratification. A negative hrHPV result means a return to normal recall, while a positive result requires cytological examination. Abnormal cytology results lead to colposcopy, while normal cytology results require a repeat test at 12 months. Inadequate samples require a repeat within 3 months, and two consecutive inadequate samples lead to colposcopy. Treatment for CIN typically involves LLETZ or cryotherapy. Individuals who have been treated for CIN should be invited for a test of cure repeat cervical sample 6 months after treatment.
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This question is part of the following fields:
- Gynaecology
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Question 15
Incorrect
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A 25-year-old male blood donor presents with the following blood results:
Bilirubin 41 µmol/L
ALP 84 U/L
ALT 23 U/L
Albumin 41 g/L
Dipstick urinalysis normal
He has been experiencing symptoms of a cold, including a runny nose and dry cough. What is the probable diagnosis?Your Answer: Hepatitis C infection
Correct Answer: Gilbert's syndrome
Explanation:Gilbert’s syndrome is typically characterized by a rise in bilirubin levels in response to physiological stress. Therefore, it is likely that a 22-year-old male with isolated hyperbilirubinemia has Gilbert’s syndrome. Dubin-Johnson and Rotor syndrome, which both result in conjugated bilirubinemia, can be ruled out based on a normal dipstick urinalysis. Viral infections are often responsible for triggering a bilirubin increase in individuals with Gilbert’s syndrome.
Gilbert’s syndrome is a genetic condition that affects the way bilirubin is processed in the body. It is caused by a deficiency of UDP glucuronosyltransferase, which leads to unconjugated hyperbilirubinaemia. This means that bilirubin is not properly broken down and eliminated from the body, resulting in jaundice. However, jaundice may only be visible during certain situations such as intercurrent illness, exercise, or fasting. The prevalence of Gilbert’s syndrome is around 1-2% in the general population.
To diagnose Gilbert’s syndrome, doctors may look for a rise in bilirubin levels after prolonged fasting or the administration of IV nicotinic acid. However, treatment is not necessary for this condition. The exact mode of inheritance for Gilbert’s syndrome is still a matter of debate.
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This question is part of the following fields:
- Medicine
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Question 16
Correct
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A 42-year-old woman returns to her GP after attempting lifestyle modifications and pelvic floor exercises for four months without success in managing her urinary stress incontinence. She expresses a desire for additional treatment options but prefers to avoid surgery. What is the next appropriate step in managing this patient?
Your Answer: Prescription of duloxetine
Explanation:If pelvic floor muscle exercises are ineffective and surgical intervention is not desired, duloxetine may be used to manage stress incontinence, as per NICE guidance from 2019. It should be noted that bladder retraining is not recommended for this type of incontinence, and oxybutynin is only indicated for urge incontinence if bladder retraining has failed. Referral for urodynamics testing is also not recommended, with urogynaecology being the preferred option for secondary care. Additionally, NICE does not recommend continuing pelvic floor exercises for an additional 3 months.
Understanding Urinary Incontinence: Causes, Classification, and Management
Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.
Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.
In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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A woman in her mid-thirties arrives at the haemodialysis clinic for her regular appointment. Before the session, a typical amount of unfractionated heparin is given. What is the drug's mechanism of action?
Your Answer: Activates antithrombin II
Correct Answer: Activates antithrombin III
Explanation:Unfractionated heparin works by activating antithrombin III, which then inhibits the formation of fibrin and the activation of thrombin and factors Xa, Ixa, XIa, and XIIa. This process can be reversed with protamine sulphate. Antithrombin III is the most clinically important form of antithrombin, and historically, it has been divided into I, II, III, and IV based on different stages of thrombin activity.
Understanding Heparin and its Adverse Effects
Heparin is a type of anticoagulant that comes in two forms: unfractionated or standard heparin, and low molecular weight heparin (LMWH). Both types work by activating antithrombin III, but unfractionated heparin inhibits thrombin, factors Xa, IXa, XIa, and XIIa, while LMWH only increases the action of antithrombin III on factor Xa. However, heparin can cause adverse effects such as bleeding, thrombocytopenia, osteoporosis, and hyperkalemia.
Heparin-induced thrombocytopenia (HIT) is a condition where antibodies form against complexes of platelet factor 4 (PF4) and heparin, leading to platelet activation and a prothrombotic state. HIT usually develops after 5-10 days of treatment and is characterized by a greater than 50% reduction in platelets, thrombosis, and skin allergy. To address the need for ongoing anticoagulation, direct thrombin inhibitors like argatroban and danaparoid can be used.
Standard heparin is administered intravenously and has a short duration of action, while LMWH is administered subcutaneously and has a longer duration of action. Standard heparin is useful in situations where there is a high risk of bleeding as anticoagulation can be terminated rapidly, while LMWH is now standard in the management of venous thromboembolism treatment and prophylaxis and acute coronary syndromes. Monitoring for standard heparin is done through activated partial thromboplastin time (APTT), while LMWH does not require routine monitoring. Heparin overdose may be reversed by protamine sulfate, although this only partially reverses the effect of LMWH.
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This question is part of the following fields:
- Pharmacology
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Question 18
Incorrect
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A 29-year-old electrician was referred to the hospital by his doctor. He had visited his GP a week ago, complaining of malaise, headache, and myalgia for three days. Despite being prescribed amoxicillin/clavulanic acid, his symptoms persisted and he developed a dry cough and fever. At the time of referral, he was experiencing mild dyspnea, a global headache, myalgia, and arthralgia. On examination, he appeared unwell, had a fever of 39°C, and had a maculopapular rash on his upper body. Fine crackles were audible in the left mid-zone of his chest, and mild neck stiffness was noted.
The following investigations were conducted: Hb 84 g/L (130-180), WBC 8 ×109/L (4-11), Platelets 210 ×109/L (150-400), Reticulocytes 8% (0.5-2.4), Na 129 mmol/L (137-144), K 4.2 mmol/L (3.5-4.9), Urea 5.0 mmol/L (2.5-7.5), Creatinine 110 µmol/L (60-110), Bilirubin 89 µmol/L (1-22), Alk phos 130 U/L (45-105), AST 54 U/L (1-31), and GGT 48 U/L (<50). A chest x-ray revealed patchy consolidation in both mid-zones.
What is the most likely cause of his abnormal blood count?Your Answer: IgG directed against P antigen complex
Correct Answer: IgM anti-i antibodies
Explanation:The patient has pneumonia, hepatitis, and haemolytic anaemia, which can be caused by Mycoplasma pneumonia. This condition can also cause extrapulmonary manifestations such as renal failure, myocarditis, and meningitis. Haemolysis is associated with the presence of IgM antibodies, and sepsis may cause microangiopathic haemolytic anaemia. Clavulanic acid can cause hepatitis, and some drugs can induce haemolysis in patients with G6PD deficiency.
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This question is part of the following fields:
- Respiratory
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Question 19
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A 15-year-old Scottish resident presents to your Scottish Emergency Department with a 10-hour history of acute right-sided abdominal pain. On examination, she has acute appendicitis. She is keen to proceed with the recommended surgery. You are unable to contact a parent or any other contact given by the patient.
What do you need in order to proceed?Your Answer: Nothing; in Scotland, a 16-year-old person is deemed capable of consenting to treatment
Explanation:Capacity to Consent to Treatment in Scotland for 16-Year-Olds
In Scotland, the Age of Legal Capacity (Scotland) Act 1991 states that all people aged 16 and over are presumed in law to have the capacity to consent to treatment unless there is evidence to the contrary. This means that a 16-year-old person is deemed capable of consenting to treatment without the need for a court order or assessment of competence.
Furthermore, social workers do not have the power to consent on behalf of any patient, regardless of age. It is important to note that even if it is believed to be in the best interests of the person to have the surgery performed, it cannot be done without their consent if they are over 16 and have capacity.
Overall, the law in Scotland is clear regarding the age at which a person is deemed to have capacity to consent, providing clarity and protection for 16-year-olds seeking medical treatment.
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This question is part of the following fields:
- Ethics And Legal
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Question 20
Incorrect
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A 68-year-old woman came to the Heart Failure Clinic complaining of shortness of breath. During the examination, a loud pansystolic murmur was heard throughout her chest. The murmur was more audible during inspiration than expiration, and it was difficult to determine where it was loudest. Additionally, she had distended neck veins and an elevated jugular venous pressure (JVP). What is the most probable diagnosis?
Your Answer: Mitral regurgitation
Correct Answer: Tricuspid regurgitation (TR)
Explanation:Differentiating Heart Murmurs: A Guide
Heart murmurs are abnormal sounds heard during a heartbeat and can indicate underlying heart conditions. Here is a guide to differentiating some common heart murmurs:
Tricuspid Regurgitation (TR)
TR presents with a loud pan-systolic murmur audible throughout the chest, often loudest in the tricuspid area. The most common cause is heart failure, with regurgitation being functional due to myocardial dilation. Patients may have raised JVPs, distended neck veins, and signs of right-sided heart failure.Aortic Sclerosis
Aortic sclerosis is a loud murmur early in systole, with normal S1 and S2. It does not affect pulse pressure, and there is no radiation to the right carotid artery. Right-sided murmurs are louder on inspiration.Aortic Stenosis
Aortic stenosis is a mid-systolic ejection murmur, heard best over the aortic area or right second intercostal space, with radiation into the right carotid artery. It may reduce pulse pressure to <40 mmHg, and S2 may be diminished. Pulmonary Stenosis
Pulmonary stenosis gives a crescendo-decrescendo ejection systolic murmur, loudest over the pulmonary area. It is not pan-systolic, and S2 splitting is widened due to prolonged pulmonic ejection.Mitral Regurgitation
Mitral regurgitation is a pan-systolic murmur heard best over the mitral area, radiating to the axilla. It is not increased on inspiration.Remember to listen carefully to S1 and S2, check for radiation, and consider associated symptoms to differentiate heart murmurs.
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This question is part of the following fields:
- Cardiology
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Question 21
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A 65-year-old woman comes to your GP clinic complaining of increased urinary frequency and embarrassing leakage. She reports that it disrupts her work in the office as she has to constantly go to the toilet. However, she denies any association of the leakage with coughing or laughing. The patient's BMI is 32kg/m², and a vaginal examination shows no pelvic organ prolapse and an ability to initiate voluntary contraction of the pelvic floor muscles.
What initial investigations would you include for this patient?Your Answer: Urine dipstick and culture
Explanation:When dealing with patients who have urinary incontinence, it is crucial to eliminate the possibility of a UTI and diabetes mellitus as underlying causes. The first step in investigating urinary incontinence would be to conduct a urine dipstick and culture test, which can be easily done in a GP’s office. Other initial investigations include keeping a bladder diary for at least three days and undergoing urodynamic studies. It is important to note that the reliability of urine dip tests is questionable in women over 65 years of age and those who have catheters. A three-day bladder diary is necessary for initial investigations, and a one-day diary would not suffice. CT scans are not typically used to investigate urinary incontinence but are useful in detecting renal pathology such as ureteric calculi. Cystoscopy is not appropriate for this patient and is usually reserved for cases where bladder cancer is suspected.
Understanding Urinary Incontinence: Causes, Classification, and Management
Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.
Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.
In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.
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This question is part of the following fields:
- Gynaecology
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Question 22
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A 39-year-old man comes to his GP complaining of sudden headaches accompanied by sweating and palpitations. Upon examination, the patient appears anxious and has a pale complexion. His blood pressure measures 240/200 mmHg, and a 24-hour urine collection shows increased levels of catecholamines. What is the probable cause of this man's hypertension?
Your Answer: Phaeochromocytoma
Explanation:Differentiating Causes of Hypertension: A Brief Overview
Hypertension, or high blood pressure, is a common medical condition that affects millions of people worldwide. While there are many possible causes of hypertension, some are more common than others. In this article, we will discuss some of the most common causes of hypertension and how to differentiate them.
Phaeochromocytoma is a tumour of the adrenal gland that can cause hypertension, headache, sweating, and anxiety. It is often associated with the 10% rule, which states that 10% of cases are extramedullary, 10% are malignant, 10% are familial, and 10% are bilateral.
Conn syndrome, or primary aldosteronism, is characterized by hypertension, hypokalaemia, and metabolic alkalosis. The most common causes are aldosterone-producing adenomas and bilateral adrenal hyperplasia.
Renal artery stenosis (RAS) is a major cause of renovascular hypertension. However, it is not associated with elevated catecholamines or the symptoms described.
Polycystic kidney disease (PKD) is a genetic disorder that can cause hypertension due to progressive kidney enlargement. However, patients with PKD do not have elevated catecholamine levels.
Cushing syndrome is caused by prolonged hypercortisolism and can cause centripetal obesity, secondary hypertension, glucose intolerance, proximal myopathy, and hirsutism. Sweating, palpitations, and elevated catecholamines are not typical of hypercortisolism.
In conclusion, hypertension can have many different causes, and it is important to differentiate them to provide appropriate treatment. By understanding the characteristic features of each condition, healthcare professionals can make an accurate diagnosis and provide effective management.
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This question is part of the following fields:
- Endocrinology
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Question 23
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A 30-year-old woman presents with a history of heavy menses since she started menstruating at the age of 13. She has regular periods every 28 days, which last for seven days, during which time she works from home as she needs to change pads every 1–2 hours.
She is in a relationship and does not wish to conceive at present. A full blood count and a pelvic ultrasound are abnormal.
You offer her the levonorgestrel intrauterine system (IUS), as per the National Institute for Health and Care Excellence (NICE) guidelines.
Which of the following is a contraindication to the insertion of levonorgestrel IUS?Your Answer: Distorted fibroid uterus
Explanation:The use of the levonorgestrel IUS as a contraceptive or treatment for menorrhagia is not recommended in women with a distorted fibroid uterus due to the complexity and difficulty of the procedure. Other contraindications include current pregnancy, pelvic inflammatory disease, trophoblastic disease, breast/endometrial/ovarian/cervical cancer, postpartum endometritis, septic abortion/miscarriage in the last three months, and cervical intra-epithelial neoplasia. Migraine with aura is an absolute contraindication to the use of the combined oral contraceptive pill, but the levonorgestrel IUS can be safely used. It is safe to use the levonorgestrel IUS during breastfeeding, and it can be used by women of all ages, regardless of parity. A history of venous thromboembolism is a contraindication to the use of the combined oral contraceptive pill, but the levonorgestrel IUS is safe to use according to NICE guidance.
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This question is part of the following fields:
- Gynaecology
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Question 24
Incorrect
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A 50-year-old man comes to the emergency department complaining of high fever and severe pain in the upper abdomen. He appears disheveled and admits to consuming 50 units of alcohol per week. Despite experiencing symptoms for two days, he delayed seeking medical attention due to a fear of hospitals. What is the most appropriate test to order for the most probable diagnosis?
Your Answer: Amylase
Correct Answer: Lipase
Explanation:Serum lipase is more useful than amylase for diagnosing acute pancreatitis in late presentations (>24 hours). This patient’s lipase level is >3 times normal, confirming the diagnosis. Ultrasound can investigate for bile duct stones, but CT scans are not used for diagnosis.
Understanding Acute Pancreatitis
Acute pancreatitis is a condition that is commonly caused by alcohol or gallstones. It occurs when the pancreatic enzymes start to digest the pancreatic tissue, leading to necrosis. The main symptom of acute pancreatitis is severe epigastric pain that may radiate through to the back. Vomiting is also common, and examination may reveal epigastric tenderness, ileus, and low-grade fever. In rare cases, periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) may be present.
To diagnose acute pancreatitis, doctors typically measure the levels of serum amylase and lipase in the blood. While amylase is raised in 75% of patients, it does not correlate with disease severity. Lipase, on the other hand, is more sensitive and specific than amylase and has a longer half-life. Imaging tests, such as ultrasound and contrast-enhanced CT, may also be used to assess the aetiology of the condition.
Scoring systems, such as the Ranson score, Glasgow score, and APACHE II, are used to identify cases of severe pancreatitis that may require intensive care management. Factors that indicate severe pancreatitis include age over 55 years, hypocalcaemia, hyperglycaemia, hypoxia, neutrophilia, and elevated LDH and AST. It is important to note that the actual amylase level is not of prognostic value.
In summary, acute pancreatitis is a condition that can cause severe pain and discomfort. It is typically caused by alcohol or gallstones and can be diagnosed through blood tests and imaging. Scoring systems are used to identify cases of severe pancreatitis that require intensive care management.
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This question is part of the following fields:
- Surgery
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Question 25
Incorrect
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A 70-year-old woman is being discharged from the Surgical Ward following a midline laparotomy for a perforated duodenal ulcer. She has several surgical staples in situ.
How many days post-surgery should the staples be removed?Your Answer: 5–7 days
Correct Answer: 10–14 days
Explanation:Proper Timing for Suture Removal
The length of time sutures should remain in place varies depending on the location of the wound and the tension across it. Sutures on the chest, stomach, or back should be removed after 10-14 days to prevent wound dehiscence while reducing the risk of infection and scarring. Facial sutures can be removed after 5-7 days, while sutures over the lower extremities or joints typically need removing after 14-21 days. Sutures should not be left in place for more than 21 days due to the increased likelihood of infection, scarring, and difficult removal. It is important to keep wounds dry for the first 24 hours and avoid baths and swimming until sutures are removed.
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This question is part of the following fields:
- Surgery
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Question 26
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At what site does rheumatoid arthritis typically initiate inflammation?
Your Answer: Synovium
Explanation:Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a long-term inflammatory condition that affects the joints and surrounding tissues. The exact cause of RA is unknown, but it is believed to be an autoimmune disorder where the body’s immune system mistakenly attacks its own tissues. The disease typically affects multiple joints, causing pain, stiffness, and swelling. Over time, the condition can progress and lead to joint deformity and limited mobility. This chronic condition can significantly impact a person’s quality of life, making it important to seek early diagnosis and treatment.
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This question is part of the following fields:
- Clinical Sciences
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Question 27
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A 54-year-old female with a history of rheumatoid arthritis visited her GP complaining of redness in her right eye. She mentioned experiencing mild discomfort and irritation with occasional watering of the eye. However, she denied any dryness or significant pain. The examination of her pupils revealed no abnormalities, and she did not experience any discomfort when exposed to light. What is the probable diagnosis?
Your Answer: Scleritis
Correct Answer: Episcleritis
Explanation:Rheumatoid Arthritis and Its Effects on the Eyes
Rheumatoid arthritis is a chronic autoimmune disease that affects various parts of the body, including the eyes. In fact, ocular manifestations of rheumatoid arthritis are quite common, with approximately 25% of patients experiencing eye problems. These eye problems can range from mild to severe and can significantly impact a patient’s quality of life.
The most common ocular manifestation of rheumatoid arthritis is keratoconjunctivitis sicca, also known as dry eye syndrome. This condition occurs when the eyes do not produce enough tears, leading to discomfort, redness, and irritation. Other ocular manifestations of rheumatoid arthritis include episcleritis, scleritis, corneal ulceration, and keratitis. Episcleritis and scleritis both cause redness in the eyes, with scleritis also causing pain. Corneal ulceration and keratitis both affect the cornea, with corneal ulceration being a more severe condition that can lead to vision loss.
In addition to these conditions, patients with rheumatoid arthritis may also experience iatrogenic ocular manifestations. These are side effects of medications used to treat the disease. For example, steroid use can lead to cataracts, while the use of chloroquine can cause retinopathy.
Overall, it is important for patients with rheumatoid arthritis to be aware of the potential ocular manifestations of the disease and to seek prompt medical attention if they experience any eye-related symptoms. Early diagnosis and treatment can help prevent vision loss and improve overall quality of life.
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This question is part of the following fields:
- Ophthalmology
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Question 28
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A 42-year-old man presents to the Emergency Department with complaints of severe breathlessness after being exposed to smoke during a house fire. He reports vomiting twice and experiencing a headache and dizziness.
Upon examination, the patient is found to be tachypnoeic with good air entry, and his oxygen saturations are at 100% on air. He appears drowsy, but his Glasgow Coma Scale (GCS) score is 15, and there are no signs of head injury on his neurological examination.
What is the initial step in managing this patient's condition?Your Answer: High-flow oxygen
Explanation:Treatment Options for Smoke Inhalation Injury
Smoke inhalation injury can lead to carbon monoxide (CO) poisoning, which is characterized by symptoms such as headache, dizziness, and vomiting. It is important to note that normal oxygen saturation may be present despite respiratory distress due to the inability of a pulse oximeter to differentiate between carboxyhaemoglobin and oxyhaemoglobin. Therefore, any conscious patient with suspected CO poisoning should be immediately treated with high-flow oxygen, which can reduce the half-life of carboxyhaemoglobin from up to four hours to 90 minutes.
Cyanide poisoning, which is comparatively rare, can also be caused by smoke inhalation. The treatment of choice for cyanide poisoning is a combination of hydroxocobalamin and sodium thiosulphate.
Hyperbaric oxygen may be beneficial for managing patients with CO poisoning, but high-flow oxygen should be provided immediately while waiting for initiation. Indications for hyperbaric oxygen include an unconscious patient, COHb > 25%, pH < 7.1, and evidence of end-organ damage due to CO poisoning. Bronchodilators such as nebulised salbutamol and ipratropium may be useful as supportive care in cases of inhalation injury where signs of bronchospasm occur. However, in this case, compatible signs such as wheeze and reduced air entry are not present. Metoclopramide may provide symptomatic relief of nausea, but it does not replace the need for immediate high-flow oxygen. Therefore, it is crucial to prioritize the administration of high-flow oxygen in patients with suspected smoke inhalation injury. Managing Smoke Inhalation Injury: Treatment Options and Priorities
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This question is part of the following fields:
- Respiratory
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Question 29
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A 32-year-old man with inflammatory bowel disease undergoes emergency surgery involving resection of a portion of his bowel. At the clinico-pathological conference, the histological findings of the operative sample are discussed.
Which of the following features is most indicative of Crohn’s disease?Your Answer: Transmural inflammation
Explanation:Distinguishing Between Crohn’s Disease and Ulcerative Colitis: Histopathological Features
Inflammatory bowel disease (IBD) is a term used to describe two conditions: Crohn’s disease and ulcerative colitis. While both conditions share some similarities, they have distinct differences that can be identified through histopathological examination of surgical specimens.
Transmural inflammation, which affects all layers of the intestinal wall, is a hallmark feature of Crohn’s disease. This type of inflammation is not typically seen in ulcerative colitis. Additionally, Crohn’s disease often presents as skip lesions, meaning that affected areas are separated by healthy tissue. In contrast, ulcerative colitis typically presents as continuous disease limited to the large bowel.
Crypt abscesses, which are collections of inflammatory cells within the crypts of the intestinal lining, are more commonly seen in ulcerative colitis. Mucosal inflammation, which affects only the surface layer of the intestinal lining, is more typical of ulcerative colitis as well.
Other histopathological features that can help distinguish between Crohn’s disease and ulcerative colitis include the presence of rose thorn ulcers (deep ulcers with a characteristic appearance) in Crohn’s disease and lymphoid aggregates in Crohn’s disease but not in ulcerative colitis.
In summary, while Crohn’s disease and ulcerative colitis share some similarities, histopathological examination of surgical specimens can help differentiate between the two conditions based on the presence or absence of certain features.
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This question is part of the following fields:
- Colorectal
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Question 30
Incorrect
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A woman has some blood tests taken by her general practitioner (GP). The results show a Hb of 10.0, MCV of 69 and a ferritin of 9.
Which is the most appropriate management plan for this patient?Your Answer: Treat with ferrous sulphate 200 mg once a day plus folic acid and repeat bloods in three months
Correct Answer: Treat with ferrous sulphate 200 mg three times a day and repeat bloods in three months
Explanation:Understanding Iron Deficiency Anaemia and Treatment Options
Iron deficiency anaemia is a common condition that can present with symptoms such as lethargy, tiredness, and shortness of breath on exertion. It is often seen in women due to menstruation and blood loss associated with it, as well as in pregnant women. However, it is not a common finding in men and should be investigated further if present.
Treatment for iron deficiency anaemia involves the use of ferrous sulfate, typically at a dose of 200 mg two to three times a day for at least three months. Blood tests should be repeated after this time to assess the effectiveness of therapy. Folic acid supplementation may also be necessary in cases of folate deficiency anaemia, which presents with a raised MCV.
It is important to investigate persistent anaemia despite adequate iron supplementation, as it may indicate an underlying malignancy. Men with unexplained iron deficiency anaemia and a haemoglobin level of < 110 g/l should be referred urgently to the gastroenterology team for investigation of upper or lower gastrointestinal malignancy. Overall, understanding the causes and treatment options for iron deficiency anaemia can help improve patient outcomes and prevent complications.
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This question is part of the following fields:
- Haematology
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