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  • Question 1 - A 4-year-old girl presents to the emergency department with a cough and noisy...

    Correct

    • A 4-year-old girl presents to the emergency department with a cough and noisy breathing after experiencing coryzal symptoms for 2 days. Upon examination, she has intercostal recession, a cough, and harsh vibrating noise during inspiration. Although she is afebrile, her symptoms are concerning. What is the probable causative organism?

      Your Answer: Parainfluenza virus

      Explanation:

      Understanding Croup: A Respiratory Infection in Infants and Toddlers

      Croup is a type of upper respiratory tract infection that commonly affects infants and toddlers. It is characterized by a barking cough, fever, and coryzal symptoms, and is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses are the most common cause of croup. The condition typically peaks between 6 months and 3 years of age, and is more prevalent during the autumn season.

      The severity of croup can be graded based on the presence of symptoms such as stridor, cough, and respiratory distress. Mild cases may only have occasional barking cough and no audible stridor at rest, while severe cases may have frequent barking cough, prominent inspiratory stridor at rest, and marked sternal wall retractions. Children with moderate or severe croup, those under 6 months of age, or those with known upper airway abnormalities should be admitted to the hospital.

      Diagnosis of croup is usually made based on clinical presentation, but a chest x-ray may show subglottic narrowing, commonly referred to as the steeple sign. Treatment for croup typically involves a single dose of oral dexamethasone or prednisolone, regardless of severity. In emergency situations, high-flow oxygen and nebulized adrenaline may be necessary.

      Understanding croup is important for parents and healthcare providers alike, as prompt recognition and treatment can help prevent complications and improve outcomes for affected children.

    • This question is part of the following fields:

      • Paediatrics
      14.4
      Seconds
  • Question 2 - A 27-year-old woman comes to the clinic eight weeks after giving birth with...

    Correct

    • A 27-year-old woman comes to the clinic eight weeks after giving birth with a painful, swollen, and red right breast. During the examination, there is fluctuance in the upper outer quadrant of the right breast near the nipple areolar complex. The overlying skin is tender and red. What is the best course of action for this patient?

      Your Answer: Ultrasound guided needle aspiration followed by antibiotics

      Explanation:

      Post-Partum Breast Abscess in Breastfeeding Mothers

      Post-partum breast abscess is a common occurrence in breastfeeding mothers. It is caused by Staphylococcus aureus, which enters through cracks in the nipple-areolar complex. The abscesses are usually located peripherally and can also occur during weaning due to breast engorgement or the child developing teeth. Early infections can be treated with antibiotics, but when pus forms, ultrasound-guided needle aspiration is the preferred treatment. Mammography is not recommended as it requires compression of the painful breast. Surgical incision and drainage are only necessary if the abscess is very loculated, fails to respond to repeated guided aspirations, or if the overlying skin is necrotic. It is important to seek medical attention promptly to prevent complications. For further information, refer to Dixon JM’s article on breast infection in the BMJ.

    • This question is part of the following fields:

      • Surgery
      27.9
      Seconds
  • Question 3 - What structures are located inside the carpal tunnel? ...

    Incorrect

    • What structures are located inside the carpal tunnel?

      Your Answer: Abductor pollicis brevis

      Correct Answer: Flexor pollicis longus

      Explanation:

      Anatomy of the Carpal Tunnel

      The carpal tunnel is a narrow passageway located in the wrist that contains several important structures. These include the median nerve, which provides sensation to the thumb, index, middle, and half of the ring finger, as well as motor function to some of the muscles in the hand. Additionally, the carpal tunnel houses the tendons of the flexor digitorum profundus and superficialis muscles, which are responsible for flexing the fingers. The flexor pollicis longus, which controls movement of the thumb, is also found within the carpal tunnel, along with its synovium.

      In the most radial (first) dorsal wrist compartment, the abductor pollicis longus and extensor pollicis brevis are located. These structures are responsible for abduction and extension of the thumb, respectively.

    • This question is part of the following fields:

      • Clinical Sciences
      11.2
      Seconds
  • Question 4 - A 79-year-old man is brought to see his general practitioner by his daughter...

    Correct

    • A 79-year-old man is brought to see his general practitioner by his daughter who has noticed that he is becoming increasingly forgetful and unsteady on his feet. Unfortunately his daughter does not know anything about his previous medical history or whether he takes any medications. Routine investigations reveal:
      Investigation Result Normal Value
      Haemaglobin 105 g/l 135–175 g/l
      Mean corpuscular value 101 fl 76–98 fl
      White cell count 7.2 × 109/l 4–11 × 109/l
      Platelets 80 × 109/l 150–400 x 109/
      Sodium 132 mmol/l 135–145 mmol/l
      Potassium 4.8 mmol/l 3.5–5.0 mmol/l
      Urea 1.3 mmol/l 2.5–6.5 mmol/l
      Creatinine 78 μmol/l 50–120 µmol/l
      Random blood sugar 6.1 mmol/l 3.5–5.5 mmol/l
      Given these results, which is the most likely cause of his symptoms?

      Your Answer: Alcohol excess

      Explanation:

      Possible Diagnoses for Abnormal Blood Results: Alcohol Excess, Hypothyroidism, B12 Deficiency, Myelodysplasia, and Phenytoin Toxicity

      The patient’s blood results suggest a diagnosis of alcohol excess, which can cause confusion and increase the risk of subdural hematomas and recurrent falls. The macrocytosis, thrombocytopenia, mild hyponatremia, and low urea are all consistent with excess alcohol. Hypothyroidism can also cause macrocytosis and hyponatremia, but not thrombocytopenia or low urea. B12 deficiency may cause pancytopenia and marked macrocytosis, making it the next most likely option after alcohol excess. Myelodysplasia typically presents with shortness of breath and fatigue, and may show macrocytosis and thrombocytopenia on blood results. Phenytoin toxicity may cause macrocytosis and ataxia, as well as a range of other symptoms and signs such as fever and gingival hyperplasia.

    • This question is part of the following fields:

      • Neurology
      175.3
      Seconds
  • Question 5 - A 35-year-old man has been experiencing muscle weakness and cramps, and after extensive...

    Correct

    • A 35-year-old man has been experiencing muscle weakness and cramps, and after extensive investigation, it has been determined that he has a rare form of myopathy. His family history reveals that his mother, maternal grandmother, brother, maternal aunt, and her two sons are all affected by the same condition. Interestingly, his maternal uncle has the disease, but none of his children do. There is no evidence of the disease on the paternal side, and his wife has no family history of the disorder. What is the likelihood that his biological children will inherit the myopathy from him?

      Your Answer: 0%

      Explanation:

      Mitochondrial Diseases: Inheritance and Histology

      Mitochondrial diseases are caused by mutations in the small amount of double-stranded DNA present in the mitochondria. This DNA encodes protein components of the respiratory chain and some special types of RNA. Mitochondrial inheritance has unique characteristics, including inheritance only via the maternal line and none of the children of an affected male inheriting the disease. However, all of the children of an affected female will inherit the disease. These diseases generally encode rare neurological diseases and have a poor genotype-phenotype correlation due to heteroplasmy, where different mitochondrial populations exist within a tissue or cell.

      Histologically, muscle biopsy shows red, ragged fibers due to an increased number of mitochondria. Some examples of mitochondrial diseases include Leber’s optic atrophy, MELAS syndrome (mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes), MERRF syndrome (myoclonus epilepsy with ragged-red fibers), Kearns-Sayre syndrome (onset in patients < 20 years old, external ophthalmoplegia, retinitis pigmentosa, and ptosis may be seen), and sensorineural hearing loss.

    • This question is part of the following fields:

      • Paediatrics
      21.1
      Seconds
  • Question 6 - A 56-year-old carpenter presents to the general practitioner (GP) with an acutely swollen...

    Incorrect

    • A 56-year-old carpenter presents to the general practitioner (GP) with an acutely swollen and painful left thumb. The pain came on rapidly over the course of 24 hours, without history of trauma or injury. The patient describes the thumb as being extremely painful and particularly tender to touch. The patient is a type 2 diabetic, which is well controlled with metformin. He does not smoke, but drinks around ten pints of beer at weekends.
      Examination reveals a swelling, erythema and tenderness over the first metacarpophalangeal joint. The clinician suspects a possible crystal arthropathy.
      With regard to gout, which of the following statements is true?

      Your Answer: A diagnosis of gout is made if there are positively birefringent crystals in the joint aspirate

      Correct Answer: Gout may be seen in patients with chronic haemolytic anaemia

      Explanation:

      Mythbusting Gout: Clarifying Common Misconceptions

      Gout is a painful and often misunderstood condition. Here are some common misconceptions about gout, and the truth behind them:

      1. Gout may be seen in patients with chronic haemolytic anaemia.
      2. Gout may occur in those with elevated urate levels (although levels may be normal during an acute attack) such as those with haemolytic anaemia.
      3. Gout only affects the first metacarpophalangeal (MCP) joint.
      4. Gout most commonly affects the first metatarsophalangeal joint. However, it is not the only joint affected.
      5. Allopurinol is effective in the treatment of acute gout.
      6. Acute gout is treated with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or prednisolone, but not allopurinol. Allopurinol is effective in the prevention of gout because it reduces serum urate levels by blocking urate production (xanthine oxidase inhibition).
      7. A diagnosis of gout is made if there are positively birefringent crystals in the joint aspirate.
      8. Gout is an inflammatory arthritis that occurs as a result of deposition of negatively birefringent urate crystals in the joint.
      9. All cases of acute gout have an elevated serum urate.
      10. Although a raised serum urate can be used to support the diagnosis, many will not be raised. Similarly, if a patient has a raised serum urate, they do not automatically have the clinical picture of gout.

      In conclusion, it is important to dispel these common myths about gout in order to properly diagnose and treat this painful condition.

    • This question is part of the following fields:

      • Rheumatology
      35.4
      Seconds
  • Question 7 - Which of the following characteristics is not typically associated with Marfan's syndrome? ...

    Correct

    • Which of the following characteristics is not typically associated with Marfan's syndrome?

      Your Answer: Learning difficulties

      Explanation:

      Understanding Marfan’s Syndrome

      Marfan’s syndrome is a genetic disorder that affects the connective tissue in the body. It is caused by a defect in the FBN1 gene on chromosome 15, which codes for the protein fibrillin-1. This disorder is inherited in an autosomal dominant pattern, meaning that a person only needs to inherit one copy of the defective gene from one parent to develop the condition. Marfan’s syndrome affects approximately 1 in 3,000 people.

      The features of Marfan’s syndrome include a tall stature with an arm span to height ratio greater than 1.05, a high-arched palate, arachnodactyly (long, slender fingers), pectus excavatum (sunken chest), pes planus (flat feet), and scoliosis (curvature of the spine). In addition, individuals with Marfan syndrome may experience cardiovascular problems such as dilation of the aortic sinuses, mitral valve prolapse, and aortic aneurysm. They may also have lung issues such as repeated pneumothoraces. Eye problems are also common, including upwards lens dislocation, blue sclera, and myopia. Finally, dural ectasia, or ballooning of the dural sac at the lumbosacral level, may also occur.

      In the past, the life expectancy of individuals with Marfan syndrome was around 40-50 years. However, with regular echocardiography monitoring and the use of beta-blockers and ACE inhibitors, this has improved significantly in recent years. Despite these improvements, aortic dissection and other cardiovascular problems remain the leading cause of death in individuals with Marfan syndrome.

    • This question is part of the following fields:

      • Musculoskeletal
      10.1
      Seconds
  • Question 8 - A nursing student faints in the dissection room, falling straight backwards and hitting...

    Incorrect

    • A nursing student faints in the dissection room, falling straight backwards and hitting her head hard on the floor. She admits that she had no breakfast prior to attending dissection, and a well-meaning technician gives her a piece of chocolate. She complains that the chocolate tastes funny and vomits afterwards. Formal neurological assessment reveals anosmia, and computerised tomography (CT) of the head and neck reveals an anterior base of skull fracture affecting the cribriform plate of the ethmoid bone.
      What is the level of interruption to the olfactory pathway likely to be in a nursing student?

      Your Answer: The piriform cortex of the frontal lobe

      Correct Answer: The first-order sensory neurones

      Explanation:

      The Olfactory Pathway: Neuronal Path and Potential Disruptions

      The olfactory pathway is responsible for our sense of smell and is composed of several neuronal structures. The first-order sensory neurones begin at the olfactory receptors in the nasal cavity and pass through the cribriform plate of the ethmoid bone to synapse with second-order neurones at the olfactory bulb. A fracture of the cribriform plate can disrupt these first-order neurones, leading to anosmia and a loss of taste sensation. However, the olfactory bulb is supported and protected by the ethmoid bone, making it less likely to be affected by the fracture. The second-order neurones arise in the olfactory bulb and form the olfactory tract, which divides into medial and lateral branches. The lateral branch terminates in the piriform cortex of the frontal lobe, which is further from the ethmoid bone and less likely to be disrupted. Understanding the neuronal path of the olfactory pathway can help identify potential disruptions and their effects on our sense of smell and taste.

    • This question is part of the following fields:

      • Trauma
      26.7
      Seconds
  • Question 9 - A 50-year-old woman is brought to the Emergency Department after falling down the...

    Incorrect

    • A 50-year-old woman is brought to the Emergency Department after falling down the stairs at home. She complains of ‘rib pain’ and is moved to the resus room from triage, as she was unable to complete full sentences due to shortness of breath. Sats on room air were 92%. You are asked to see her urgently as the nursing staff are concerned about her deterioration.
      On examination, she appears distressed; blood pressure is 85/45, heart rate 115 bpm, respiratory rate 38 and sats 87% on air. Her left chest does not appear to be moving very well, and there are no audible breath sounds on the left on auscultation.
      What is the most appropriate next step in immediate management of this patient?

      Your Answer:

      Correct Answer: Needle thoracocentesis of left chest

      Explanation:

      Needle Thoracocentesis for Tension Pneumothorax

      Explanation:
      In cases of traumatic chest pain, it is important to keep an open mind regarding other injuries. However, if a patient rapidly deteriorates with signs of shock, hypoxia, reduced chest expansion, and no breath sounds audible on the affected side of the chest, a tension pneumothorax should be suspected. This is an immediately life-threatening condition that requires immediate intervention.

      There is no time to wait for confirmation on a chest X-ray or to set up a chest drain. Instead, needle thoracocentesis should be performed on the affected side of the chest. A large-bore cannula is inserted in the second intercostal space, mid-clavicular line, on the affected side. This can provide rapid relief and should be followed up with the insertion of a chest drain.

      It is important to note that there is no role for respiratory consultation or nebulisers in this scenario. Rapid intervention is key to preventing cardiac arrest and improving patient outcomes.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 10 - A 50-year-old woman is admitted to hospital with fever, dyspnoea and consolidation at...

    Incorrect

    • A 50-year-old woman is admitted to hospital with fever, dyspnoea and consolidation at the left lower base. She is commenced on antibiotics. A few days later, she deteriorates and a chest X-ray reveals a large pleural effusion, with consolidation on the left side.
      What is the most important investigation to perform next?

      Your Answer:

      Correct Answer: Pleural aspiration

      Explanation:

      Appropriate Investigations for a Unilateral Pleural Effusion

      When a patient presents with a unilateral pleural effusion, the recommended first investigation is pleural aspiration. This procedure allows for the analysis of the fluid, including cytology, biochemical analysis, Gram staining, and culture and sensitivity. By classifying the effusion as a transudate or an exudate, further management can be guided.

      While a blood culture may be helpful if the patient has a fever, pleural aspiration is still the more appropriate next investigation. A CT scan may be useful at some point to outline the extent of the consolidation and effusion, but it would not change management at this stage.

      Bronchoscopy may be necessary if a tumour is suspected, but it is not required based on the information provided. Thoracoscopy may be used if pleural aspiration is inconclusive, but it is a more invasive procedure. Therefore, pleural aspiration should be performed first.

      In summary, pleural aspiration is the recommended first investigation for a unilateral pleural effusion, as it provides valuable information for further management. Other investigations may be necessary depending on the specific case.

    • This question is part of the following fields:

      • Respiratory
      0
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  • Question 11 - A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for...

    Incorrect

    • A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for enteral feeding. What is the primary method to verify the NG tube's secure placement before starting feeding?

      Your Answer:

      Correct Answer: Aspirate 10 ml and check the pH

      Explanation:

      Methods for Confirming Correct Placement of Nasogastric Tubes

      Nasogastric (NG) tubes are commonly used in medical settings to administer medication, nutrition, or to remove stomach contents. However, incorrect placement of an NG tube can lead to serious complications. Therefore, it is important to confirm correct placement before using the tube. Here are some methods for confirming correct placement:

      1. Aspirate and check pH: Aspirate 10 ml of fluid from the NG tube and test the pH. If the pH is less than 5.5, the tube is correctly placed in the stomach.

      2. Visual inspection: Do not rely on visual inspection of the aspirate to confirm correct placement, as bronchial secretions can be similar in appearance to stomach contents.

      3. Insert air and auscultate: Injecting 10-20 ml of air can help obtain a gastric aspirate, but auscultation to confirm placement is an outdated and unreliable technique.

      4. Chest X-ray: If no aspirate can be obtained or the pH level is higher than 5.5, a chest X-ray can be used to confirm correct placement. However, this should not be the first-line investigation.

      5. Abdominal X-ray: An abdominal X-ray is not helpful in determining correct placement of an NG tube, as it does not show the lungs.

      By using these methods, healthcare professionals can ensure that NG tubes are correctly placed and reduce the risk of complications.

    • This question is part of the following fields:

      • Gastroenterology
      0
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  • Question 12 - An 80-year-old woman comes to eye casualty with painless partial vision loss on...

    Incorrect

    • An 80-year-old woman comes to eye casualty with painless partial vision loss on the left side. Over the past two weeks, she has experienced a temporal headache on the left side with tenderness in the left scalp. Additionally, she has noticed pain in her left jaw when chewing. The patient reports low-grade fever and fatigue. She has no prior medical or ophthalmological history.

      What would be the expected findings on fundoscopy, given the probable cause of the vision loss?

      Your Answer:

      Correct Answer: Swollen pale optic disc with blurred margins

      Explanation:

      The correct fundoscopic appearance for anterior ischemic optic neuropathy is a swollen pale optic disc with blurred margins. This condition is often seen in patients with temporal arthritis and can cause sudden unilateral vision loss. The patient in this case has classic symptoms of temporal arthritis, including new temporal headache, scalp tenderness, jaw claudication, and constitutional symptoms. Anterior ischemic optic neuropathy is caused by inflammation in the posterior ciliary artery, which leads to occlusion and subsequent ischemia to the head of the optic nerve.

      A pale retina with a ‘cherry red’ spot is not the typical fundoscopic appearance for temporal arthritis. This is the typical finding in central retinal artery occlusion, which is not typically inflammatory and is more similar to a stroke. Cupping of the optic disc is also not seen in anterior ischemic optic neuropathy, as this is a typical finding in neuropathy due to glaucoma. Hazy fundus with an absent red reflex is also not related to temporal arthritis, as this is the typical finding in vitreous hemorrhage, which is often caused by bleeding from neovascularization in proliferative diabetic retinopathy, trauma, or retinal detachment.

      Temporal arthritis, also known as giant cell arthritis, is a condition that affects medium and large-sized arteries and is of unknown cause. It typically occurs in individuals over the age of 50, with the highest incidence in those in their 70s. Early recognition and treatment are crucial to minimize the risk of complications, such as permanent loss of vision. Therefore, when temporal arthritis is suspected, urgent referral for assessment by a specialist and prompt treatment with high-dose prednisolone is necessary.

      Temporal arthritis often overlaps with polymyalgia rheumatica, with around 50% of patients exhibiting features of both conditions. Symptoms of temporal arthritis include headache, jaw claudication, and tender, palpable temporal artery. Vision testing is a key investigation in all patients, as anterior ischemic optic neuropathy is the most common ocular complication. This results from occlusion of the posterior ciliary artery, leading to ischemia of the optic nerve head. Fundoscopy typically shows a swollen pale disc and blurred margins. Other symptoms may include aching, morning stiffness in proximal limb muscles, lethargy, depression, low-grade fever, anorexia, and night sweats.

      Investigations for temporal arthritis include raised inflammatory markers, such as an ESR greater than 50 mm/hr and elevated CRP. A temporal artery biopsy may also be performed, and skip lesions may be present. Treatment for temporal arthritis involves urgent high-dose glucocorticoids, which should be given as soon as the diagnosis is suspected and before the temporal artery biopsy. If there is no visual loss, high-dose prednisolone is used. If there is evolving visual loss, IV methylprednisolone is usually given prior to starting high-dose prednisolone. Urgent ophthalmology review is necessary, as visual damage is often irreversible. Other treatments may include bone protection with bisphosphonates and low-dose aspirin.

    • This question is part of the following fields:

      • Musculoskeletal
      0
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  • Question 13 - A patient presents with diarrhoea and vomiting; she is jaundiced. Hepatitis A infection...

    Incorrect

    • A patient presents with diarrhoea and vomiting; she is jaundiced. Hepatitis A infection is diagnosed.
      Which one of the following modes of transmission is most likely?

      Your Answer:

      Correct Answer: Contaminated food

      Explanation:

      Modes of Transmission for Hepatitis A Virus

      Hepatitis A virus is a self-limiting RNA virus that causes hepatitis. It is primarily acquired orally through contaminated food or water, or through contact with the feces of an infected individual. The incubation period is between two and six weeks, and symptoms may include flu-like and gastrointestinal symptoms during the prodromal phase, and jaundice, pruritus, fatigue, and hepatomegaly during the icteric phase. Unlike hepatitis B, C, D, and E, hepatitis A does not cause chronic infection and usually confers lifelong immunity.

      Mosquitoes and ticks do not transmit hepatitis A, but different mosquito species act as vectors for diseases such as malaria, dengue, chikungunya, and yellow fever, while hard and soft ticks transmit rickettsial infections like Rocky Mountain spotted fever. Hepatitis B, C, and D can be transmitted sexually, and hepatitis B, C, D, and E can be transmitted through blood transfusion. In rare cases, hepatitis A may also be transmitted sexually.

      Understanding the Modes of Transmission for Hepatitis A Virus

    • This question is part of the following fields:

      • Microbiology
      0
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  • Question 14 - As a locum GP, you have a pregnant patient who denies symptoms or...

    Incorrect

    • As a locum GP, you have a pregnant patient who denies symptoms or urinary tract infection. What urinalysis results might be expected for patients A, B, C, D, and E?

      Patient A:
      - Haemoglobin: Negative
      - Urobilinogen: Negative
      - Bilirubin: Negative
      - Protein: Negative
      - Glucose: +++
      - Nitrites: Negative
      - Leucocytes: +

      Patient B:
      - Haemoglobin: Negative
      - Urobilinogen: Negative
      - Bilirubin: Negative
      - Protein: Negative
      - Glucose: Negative
      - Nitrites: ++
      - Leucocytes: ++

      Patient C:
      - Haemoglobin: Negative
      - Urobilinogen: Negative
      - Bilirubin: Negative
      - Protein: Negative
      - Glucose: Negative
      - Nitrites: +++
      - Leucocytes: +++

      Patient D:
      - Haemoglobin: Negative
      - Urobilinogen: Negative
      - Bilirubin: Negative
      - Protein: Negative
      - Glucose: Negative
      - Nitrites: Negative
      - Leucocytes: Negative

      Patient E:
      - Haemoglobin: +++
      - Urobilinogen: +
      - Bilirubin: +
      - Protein: Negative
      - Glucose: Negative
      - Nitrites: Negative
      - Leucocytes: Negative

      Your Answer:

      Correct Answer: A

      Explanation:

      Urinalysis in Pregnancy: Common Abnormalities and Importance of Monitoring

      Urinalysis is a crucial diagnostic tool for detecting renal diseases and other medical conditions. During pregnancy, even asymptomatic women may exhibit abnormalities on urinalysis. These abnormalities include small amounts of glucose, increased protein loss associated with pre-eclampsia, and the presence of ketones only during fasting. Pregnant women are also prone to sterile pyuria and non-specific changes in leukocytes.

      Monitoring for urinary infections is particularly important during pregnancy, as it has been linked to premature labor. However, minor and non-specific changes on urinalysis can sometimes falsely reassure clinicians. Pregnant women are at a higher risk of UTIs due to their immunosuppressed state, and may present with atypical symptoms or unusual urinalysis features. Therefore, urine should be sent for culture if there are any concerns.

      In summary, urinalysis is an essential tool for monitoring the health of pregnant women. the common abnormalities associated with pregnancy and the importance of monitoring for urinary infections can help clinicians provide the best care for their patients.

    • This question is part of the following fields:

      • Nephrology
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  • Question 15 - A 28-year-old Afro-Caribbean lady undergoes a routine chest X-ray during a career-associated medical...

    Incorrect

    • A 28-year-old Afro-Caribbean lady undergoes a routine chest X-ray during a career-associated medical examination. The chest X-ray report reveals bilateral hilar lymphadenopathy. On closer questioning the patient admits to symptoms of fatigue and weight loss and painful blue-red nodules on her shins.
      What is the most likely diagnosis in this case?

      Your Answer:

      Correct Answer: Sarcoidosis

      Explanation:

      Differential Diagnosis for a Patient with Hilar Lymphadenopathy and Erythema Nodosum

      Sarcoidosis is a condition characterized by granulomas affecting multiple systems, with lung involvement being the most common. It typically affects young adults, especially females and Afro-Caribbean populations. While the cause is unknown, infections and environmental factors have been suggested. Symptoms include weight loss, fatigue, and fever, as well as erythema nodosum and anterior uveitis. Acute sarcoidosis usually resolves without treatment, while chronic sarcoidosis requires steroids and monitoring of lung function, ESR, CRP, and serum ACE levels.

      Tuberculosis is a potential differential diagnosis, as it can also present with erythema nodosum and hilar lymphadenopathy. However, the absence of a fever and risk factors make it less likely.

      Lung cancer is rare in young adults and typically presents as a mass or pleural effusion on X-ray.

      Pneumonia is an infection of the lung parenchyma, but the absence of infective symptoms and consolidation on X-ray make it less likely.

      Mesothelioma is a cancer associated with asbestos exposure and typically presents in older individuals. The absence of exposure and the patient’s age make it less likely.

    • This question is part of the following fields:

      • Respiratory
      0
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  • Question 16 - A father brings his 4-month-old daughter to the emergency department worried about her...

    Incorrect

    • A father brings his 4-month-old daughter to the emergency department worried about her vomiting green liquid. Moreover, she has been crying and pulling her legs up on and off for the past day. The father mentions that she has always been fussy during feeding, but she has not eaten anything in the last 24 hours and has not had a bowel movement. What is the probable diagnosis for this infant?

      Your Answer:

      Correct Answer: Intestinal malrotation

      Explanation:

      It is highly probable that the infant is suffering from intestinal malrotation, which has led to a volvulus. This condition is characterized by symptoms such as bilious vomiting, abdominal pain and cramping, lethargy, poor appetite, and infrequent bowel movements. Upon examination, the infant may have a swollen, firm abdomen, and possibly a fever, with reduced urine output. Acute appendicitis is rare in children under three years old and would not cause bilious vomiting. Hirschsprung disease would have been evident at birth, with delayed passage of meconium and abdominal distension. Mesenteric adenitis, on the other hand, is inflammation of the lymph nodes in the abdomen and is typically preceded by an upper respiratory tract infection. It would not result in bilious vomiting but may cause abdominal pain and fever, usually in an older child or teenager.

      Paediatric Gastrointestinal Disorders

      Pyloric stenosis is more common in males and has a 5-10% chance of being inherited from parents. Symptoms include projectile vomiting at 4-6 weeks of life, and diagnosis is made through a test feed or ultrasound. Treatment involves a Ramstedt pyloromyotomy, either open or laparoscopic.

      Acute appendicitis is uncommon in children under 3 years old, but when it does occur, it may present atypically. Mesenteric adenitis causes central abdominal pain and URTI, and is treated conservatively.

      Intussusception occurs in infants aged 6-9 months and causes colicky pain, diarrhea, vomiting, a sausage-shaped mass, and red jelly stool. Treatment involves reduction with air insufflation.

      Intestinal malrotation is characterized by a high caecum at the midline and may be complicated by the development of volvulus. Diagnosis is made through an upper GI contrast study and ultrasound, and treatment involves laparotomy or a Ladd’s procedure.

      Hirschsprung’s disease occurs in 1/5000 births and is characterized by delayed passage of meconium and abdominal distension. Treatment involves rectal washouts and an anorectal pull through procedure.

      Oesophageal atresia is associated with tracheo-oesophageal fistula and polyhydramnios, and may present with choking and cyanotic spells following aspiration. Meconium ileus is usually associated with cystic fibrosis and requires surgery to remove plugs. Biliary atresia causes jaundice and increased conjugated bilirubin, and requires an urgent Kasai procedure. Necrotising enterocolitis is more common in premature infants and is treated with total gut rest and TPN, with laparotomy required for perforations.

    • This question is part of the following fields:

      • Paediatrics
      0
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  • Question 17 - A 50-year-old woman presents with complaints of lower back pain, constipation, headaches, low...

    Incorrect

    • A 50-year-old woman presents with complaints of lower back pain, constipation, headaches, low mood, and difficulty concentrating. Which medication is most likely responsible for her symptoms?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      Hypercalcaemia, which is indicated by the presented signs and symptoms, can be a result of long-term use of lithium. The mnemonic ‘stones, bones, abdominal moans, and psychic groans’ can be used to identify the symptoms. The development of hyperparathyroidism and subsequent hypercalcaemia is believed to be caused by lithium’s effect on calcium homeostasis, leading to parathyroid hyperplasia. To diagnose this condition, a U&Es and PTH test can be conducted. Unlike lithium, other psychotropic medications are not associated with the development of hyperparathyroidism and hypercalcaemia.

      Lithium is a medication used to stabilize mood in individuals with bipolar disorder and as an adjunct in treatment-resistant depression. It has a narrow therapeutic range of 0.4-1.0 mmol/L and is primarily excreted by the kidneys. The mechanism of action is not fully understood, but it is believed to interfere with inositol triphosphate and cAMP formation. Adverse effects may include nausea, vomiting, diarrhea, fine tremors, nephrotoxicity, thyroid enlargement, ECG changes, weight gain, idiopathic intracranial hypertension, leucocytosis, hyperparathyroidism, and hypercalcemia.

      Monitoring of patients taking lithium is crucial to prevent adverse effects and ensure therapeutic levels. It is recommended to check lithium levels 12 hours after the last dose and weekly after starting or changing the dose until levels are stable. Once established, lithium levels should be checked every three months. Thyroid and renal function should be monitored every six months. Patients should be provided with an information booklet, alert card, and record book to ensure proper management of their medication. Inadequate monitoring of patients taking lithium is common, and guidelines have been issued to address this issue.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 18 - A 16-year-old male undergoes an elective right hemicolectomy. During the 24-hour postoperative period,...

    Incorrect

    • A 16-year-old male undergoes an elective right hemicolectomy. During the 24-hour postoperative period, he is administered a total of 6 liters of 0.9% sodium chloride solution. What potential complications may arise from this treatment?

      Your Answer:

      Correct Answer: Hyperchloraemiac acidosis.

      Explanation:

      Administering too much intravenous fluid can lead to tissue swelling and even heart failure. Overuse of sodium chloride can cause hyperchloraemic acidosis, so it may be better to use Hartmann’s solution when giving large amounts of fluid.

      Guidelines for Post-Operative Fluid Management

      Post-operative fluid management is a crucial aspect of patient care, and the composition of intravenous fluids plays a significant role in determining the patient’s outcome. The commonly used intravenous fluids include plasma, 0.9% saline, dextrose/saline, and Hartmann’s, each with varying levels of sodium, potassium, chloride, bicarbonate, and lactate. In the UK, the GIFTASUP guidelines were developed to provide consensus guidance on the administration of intravenous fluids.

      Previously, excessive administration of normal saline was believed to cause little harm, leading to oliguric postoperative patients receiving enormous quantities of IV fluids and developing hyperchloraemic acidosis. However, with a better understanding of this potential complication, electrolyte balanced solutions such as Ringers lactate and Hartmann’s are now preferred over normal saline. Additionally, solutions of 5% dextrose and dextrose/saline combinations are generally not recommended for surgical patients.

      The GIFTASUP guidelines recommend documenting fluids given clearly and assessing the patient’s fluid status when they leave theatre. If a patient is haemodynamically stable and euvolaemic, oral fluid intake should be restarted as soon as possible. Patients with urinary sodium levels below 20 should be reviewed, and if a patient is oedematous, hypovolaemia should be treated first, followed by a negative balance of sodium and water, monitored using urine Na excretion levels.

      In conclusion, post-operative fluid management is critical, and the GIFTASUP guidelines provide valuable guidance on the administration of intravenous fluids. By following these guidelines, healthcare professionals can ensure that patients receive appropriate fluid management, leading to better outcomes and reduced complications.

    • This question is part of the following fields:

      • Surgery
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  • Question 19 - A 9-year-old girl is brought to the pediatrician with her parents. She has...

    Incorrect

    • A 9-year-old girl is brought to the pediatrician with her parents. She has a history of bedwetting and has been using an enuresis alarm which has been helping her. However, she expresses her fear of going to a sleepover because she doesn't want her friends to know about her bedwetting. Her mother is hesitant to let her go without the alarm. Upon examination, the girl appears healthy and a urine dipstick test is normal.

      What is the most appropriate course of action in this situation?

      Your Answer:

      Correct Answer: Offer a short course of desmopressin

      Explanation:

      Desmopressin is a suitable option for managing enuresis in the short term. Starting a short course of desmopressin may be beneficial if the priority is to improve bed wetting. However, commencing long-term use of desmopressin is not recommended in this case, as the patient has been responding well to an enuresis alarm and requires a short-term solution. Encouraging the parents to pack the enuresis alarm may not be helpful, as it could cause the patient further distress and worsen their nocturnal enuresis. Similarly, recommending a short-term rewards system is not the best option, as reward systems are designed for longer-term use and may not address the immediate concern.

      Nocturnal enuresis, or bedwetting, is when a child involuntarily urinates during the night. Most children achieve continence by the age of 3 or 4, so enuresis is defined as the involuntary discharge of urine in a child aged 5 or older without any underlying medical conditions. Enuresis can be primary, meaning the child has never achieved continence, or secondary, meaning the child has been dry for at least 6 months before.

      When managing bedwetting, it’s important to look for any underlying causes or triggers, such as constipation, diabetes mellitus, or recent onset UTIs. General advice includes monitoring fluid intake and encouraging regular toileting patterns, such as emptying the bladder before sleep. Reward systems, like star charts, can also be helpful, but should be given for agreed behavior rather than dry nights.

      The first-line treatment for bedwetting is an enuresis alarm, which has a high success rate. These alarms have sensor pads that detect wetness and wake the child up to use the toilet. If short-term control is needed, such as for sleepovers, or if the alarm is ineffective or not acceptable to the family, desmopressin may be prescribed. Overall, managing bedwetting involves identifying any underlying causes and implementing strategies to promote continence.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 20 - A 35-year-old man comes to the Emergency Department (ED) with a fever of...

    Incorrect

    • A 35-year-old man comes to the Emergency Department (ED) with a fever of 40 °C, vomiting and diarrhea, and is extremely restless. He has hyperthyroidism but is known to not take his medication regularly. The ED registrar suspects that he is experiencing a thyroid storm.
      What is the most probable statement about a thyrotoxic crisis (thyroid storm)?

      Your Answer:

      Correct Answer: Fluid resuscitation, propranolol and carbimazole are used in the management of a thyroid storm

      Explanation:

      When managing a patient with a thyroid storm, it is important to first stabilize them by addressing their presenting symptoms. This may involve fluid resuscitation, a nasogastric tube if vomiting, and sedation if necessary. Beta-blockers are often used to reduce the effects of excessive thyroid hormones on end-organs, and high-dose digoxin may be used with close cardiac monitoring. Antithyroid drugs, such as carbimazole, are then used. Tepid sponging is used to manage excessive hyperthermia, and active warming may be used in cases of myxoedema coma. Men are actually more commonly affected by thyroid storms than women. Precipitants of a thyroid storm include recent thyroid surgery, radioiodine, infection, myocardial infarction, and trauma. Levothyroxine is given to replace low thyroxine levels in cases of hypothyroidism, while hydrocortisone or dexamethasone may be given to prevent peripheral conversion of T4 to T3 in managing a patient with a thyroid storm.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
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  • Question 21 - A 42-year-old woman comes to her doctor complaining of drooling from one side...

    Incorrect

    • A 42-year-old woman comes to her doctor complaining of drooling from one side of her mouth and inability to raise the left corner of her mouth when she smiles. During the examination, the doctor observes dryness and scaling on her left cornea. Which nerve is likely affected in this case?

      Your Answer:

      Correct Answer: Facial nerve

      Explanation:

      The Facial Nerve: Anatomy and Function

      The facial nerve is a crucial nerve responsible for controlling the muscles of facial expression. It originates from the pons as two separate motor and sensory roots before joining to form the facial nerve. Along its path, it gives off branches that provide parasympathetic fibers to glands, motor fibers to muscles, and sensory fibers to the tongue. The nerve exits the cranium through the stylomastoid foramen and branches into various muscles of the face, controlling facial expression. A lesion to the facial nerve can result in loss of motor control of facial muscles. It is important to differentiate the facial nerve from other nerves, such as the trigeminal nerve, maxillary nerve, occipital nerve, and lacrimal nerve, which have different functions and innervations.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 26-year-old man on the Medical Ward develops status epilepticus. He is immediately...

    Incorrect

    • A 26-year-old man on the Medical Ward develops status epilepticus. He is immediately attended by the Foundation Year One Doctor who notices that his airway has been compromised. The patient is immediately examined and found to be haemodynamically stable, with a history of hypertension and asthma. The anaesthetist immediately performs a rapid sequence induction and intubation (RSII) to clear the patient’s airway.
      Which of the following inducing agents used in RSII is most likely to be used in this patient?

      Your Answer:

      Correct Answer: Propofol

      Explanation:

      Common Inducing Anaesthetic Agents and Their Uses

      Propofol, etomidate, ketamine, midazolam, and thiopental are all commonly used inducing anaesthetic agents with varying properties and uses.

      Propofol is the drug of choice for RSII procedures in normotensive individuals without obvious cardiovascular pathology. It has amnesic, anxiolytic, anticonvulsant, and muscle relaxant properties, but no analgesic effects.

      Etomidate provides haemodynamic stability without histamine activity and minimal analgesic effects. It is used in RSI procedures in patients with raised intracranial pressure and cardiovascular conditions, often in combination with fentanyl.

      Ketamine is a non-competitive glutamate N-methyl-D-aspartate (NMDA) receptor blocker that produces dissociative anaesthesia. It can be used for induction of anaesthesia in patients with hypotension, status asthmaticus, and shock, but is avoided in hypertensive patients due to relative contraindications.

      Midazolam is a benzodiazepine with anticonvulsive, muscle relaxant, and anaesthetic actions. At higher doses or in combination with other opioids, it induces significant cardiovascular and respiratory depression.

      Thiopental is administered intravenously as an inducing anaesthetic agent or as a short-acting anaesthetic. It is also used as an anticonvulsant agent and to decrease intracranial pressure in neurosurgical procedures.

    • This question is part of the following fields:

      • Anaesthetics & ITU
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  • Question 23 - A 70-year-old male presents with severe, sharp pain on defecation. He has suffered...

    Incorrect

    • A 70-year-old male presents with severe, sharp pain on defecation. He has suffered from constipation for several years but recently has had a few weeks of constant loose stools. He denies nausea or vomiting but does report intermittent blood in his stools and some possible weight loss over the past few months.

      He is independent and lives with his wife. His past medical history includes hypertension, for which he takes amlodipine once a day. He is also allergic to penicillin. On examination, you see an anal fissure at the 3 o'clock position.

      What is the initial step in the management plan?

      Your Answer:

      Correct Answer: Refer to colorectal surgeons via 2 week wait pathway

      Explanation:

      If a patient presents with an anal fissure, the location of the fissure can provide important information about the cause. A fissure located posteriorly is likely a primary fissure caused by constipation or straining, and a high-fiber diet may be recommended as part of the management plan. However, if the fissure is located laterally, it suggests a secondary cause and further investigation is necessary, especially if the patient has experienced changes in bowel habits, weight loss, or blood in their stools. In this case, an urgent referral to a specialist team is required, and a routine colonoscopy is not appropriate.

      For an acute, primary anal fissure caused by constipation or straining, a combination of bulk-forming laxatives, a high-fiber diet, lubricants, and analgesia may be recommended to make passing stools easier while the fissure heals. However, if the fissure is caused by persistent loose stools, this management plan would not be appropriate.

      For a chronic, primary anal fissure, a trial of topical glyceryl trinitrate (GTN) may be recommended, but this would not be appropriate for a case requiring urgent investigation.

      Understanding Anal Fissures: Causes, Symptoms, and Treatment

      Anal fissures are tears in the lining of the distal anal canal that can be either acute or chronic. Acute fissures last for less than six weeks, while chronic fissures persist for more than six weeks. The most common risk factors for anal fissures include constipation, inflammatory bowel disease, and sexually transmitted infections such as HIV, syphilis, and herpes.

      Symptoms of anal fissures include painful, bright red rectal bleeding, with around 90% of fissures occurring on the posterior midline. If fissures are found in other locations, underlying causes such as Crohn’s disease should be considered.

      Management of acute anal fissures involves softening stool, dietary advice, bulk-forming laxatives, lubricants, topical anaesthetics, and analgesia. For chronic anal fissures, the same techniques should be continued, and topical glyceryl trinitrate (GTN) is the first-line treatment. If GTN is not effective after eight weeks, surgery (sphincterotomy) or botulinum toxin may be considered, and referral to secondary care is recommended.

      In summary, anal fissures can be a painful and uncomfortable condition, but with proper management, they can be effectively treated. It is important to identify and address underlying risk factors to prevent the development of chronic fissures.

    • This question is part of the following fields:

      • Surgery
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  • Question 24 - What is the name of the hip examination where the patient stands in...

    Incorrect

    • What is the name of the hip examination where the patient stands in front of you, lifts their good leg off the floor, and you note the tilt of their pelvis while placing your hands on their anterior superior iliac spines?

      Your Answer:

      Correct Answer: Trendelenburg test

      Explanation:

      Clinical Tests for Hip and Knee Examination

      In the clinical examination of the hip, one of the tests used is the Trendelenburg’s test. This test involves having the patient stand on one leg while the abductors of the supporting leg, specifically the gluteus medius and minimus, pull on the pelvis. In a normal test, the pelvis tilts and the opposite side of the pelvis rises. However, a positive Trendelenburg’s test occurs when the opposite side of the pelvis falls. This can be caused by gluteal paralysis or weakness, pain in the hip causing gluteal inhibition, coxa vara, or congenital dislocation of the hip.

      Another test used in the hip examination is the Thomas test, which assesses hip extension. Moving on to the knee examination, there are several tests that can be performed. Lachmann’s, Macintosh’s, and McMurray’s’s tests are commonly used to assess the knee. These tests can help diagnose ligament injuries, meniscal tears, and other knee problems. By performing these clinical tests, healthcare professionals can better understand and diagnose issues related to the hip and knee.

    • This question is part of the following fields:

      • Surgery
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  • Question 25 - Samantha is a 62-year-old woman who visits her GP complaining of painless swelling...

    Incorrect

    • Samantha is a 62-year-old woman who visits her GP complaining of painless swelling of lymph nodes in her left armpit. Upon further inquiry, she admits to experiencing night sweats and losing some weight. Samantha has a history of Sjogrens syndrome and is currently taking hydroxychloroquine. During the examination, a 3 cm rubbery lump is palpable in her left axilla, but no other lumps are detectable. Her vital signs are within normal limits. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Lymphoma

      Explanation:

      Patients who have been diagnosed with Sjogren’s syndrome are at a higher risk of developing lymphoid malignancies. The presence of symptoms such as weight loss, night sweats, and painless swelling may indicate the possibility of lymphoma. Breast cancer is unlikely in this male patient, especially since there is no breast lump. Tuberculosis of the lymph glands is typically localized to the cervical chains or supraclavicular fossa and is often bilateral. While Hidradenitis suppurativa can cause painful abscesses in the axilla, it is an unlikely diagnosis since the lumps in this case are painless.

      Understanding Sjogren’s Syndrome

      Sjogren’s syndrome is a medical condition that affects the exocrine glands, leading to dry mucosal surfaces. It is an autoimmune disorder that can either be primary or secondary to other connective tissue disorders, such as rheumatoid arthritis. The onset of the condition usually occurs around ten years after the initial onset of the primary disease. Sjogren’s syndrome is more common in females, with a ratio of 9:1. Patients with this condition have a higher risk of developing lymphoid malignancy, which is 40-60 times more likely.

      The symptoms of Sjogren’s syndrome include dry eyes, dry mouth, vaginal dryness, arthralgia, Raynaud’s, myalgia, sensory polyneuropathy, recurrent episodes of parotitis, and subclinical renal tubular acidosis. To diagnose the condition, doctors may perform a Schirmer’s test to measure tear formation, check for hypergammaglobulinaemia, and low C4. Nearly 50% of patients with Sjogren’s syndrome test positive for rheumatoid factor, while 70% test positive for ANA. Additionally, 70% of patients with primary Sjogren’s syndrome have anti-Ro (SSA) antibodies, and 30% have anti-La (SSB) antibodies.

      The management of Sjogren’s syndrome involves the use of artificial saliva and tears to alleviate dryness. Pilocarpine may also be used to stimulate saliva production. Understanding the symptoms and management of Sjogren’s syndrome is crucial for patients and healthcare providers to ensure proper treatment and care.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 26 - A 70-year-old man comes to the Emergency Department complaining of double vision that...

    Incorrect

    • A 70-year-old man comes to the Emergency Department complaining of double vision that occurs when both eyes are open. He has a medical history of hypertension and type 2 diabetes mellitus.

      During the examination, his visual acuity is measured at 6/9 in both eyes. The patient has complete drooping of his left eyelid. The size of his left pupil is the same as the right. His left eye is turned outward and slightly downward when looking straight ahead. The patient's left eye movements are limited in most directions except for outward movement.

      What is the next step in investigating this condition?

      Your Answer:

      Correct Answer: Blood tests including full blood count (FBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lipids and blood glucose

      Explanation:

      Investigations for Third-Nerve Palsy: What to Consider

      When presented with a third-nerve palsy, it is important to investigate the potential causes and determine the appropriate course of action. A pupil-sparing complete palsy may suggest a medical cause, such as hypertension or diabetes, which can be assessed through blood tests including FBC, ESR, CRP, lipids, and blood glucose. Once all causes have been investigated and treated, an orthoptic review with Hess charts can help resolve diplopia. CSF testing for oligoclonal bands is not necessary unless a demyelinating cause is suspected. In cases of severe symptoms, an MRI head with MRA is the correct option to rule out a posterior-communicating artery aneurysm. A non-contrast CT head is only necessary if an acute intracranial or subarachnoid bleed is suspected.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 27 - What type of receptor utilizes G protein for downstream signaling? ...

    Incorrect

    • What type of receptor utilizes G protein for downstream signaling?

      Your Answer:

      Correct Answer: Metabotropic

      Explanation:

      Classification of Receptors Based on Downstream Signalling Mechanisms

      Receptors are classified based on their mechanism for downstream signalling. There are two main types of receptors: inotropic and metabotropic. Inotropic receptors, such as glutamate receptors, are ion channel receptors that bind to neurotransmitters and cause a direct change in ion flow. On the other hand, metabotropic receptors, such as adrenoreceptors, are coupled to G proteins or enzymes and cause a cascade of intracellular events.

      Metabotropic receptors can be further subdivided into G-protein coupled receptors or enzyme-associated receptors. Some neurotransmitters, like acetylcholine, can bind to both inotropic and metabotropic receptors. However, only metabotropic receptors are used in receptor classification.

      Examples of inotropic receptors include glutamate receptors, GABA-A receptors, 5-HT3 receptors, nicotinic acetylcholine receptors, AMPA receptors, and glycine receptors. Examples of metabotropic receptors include adrenoreceptors, GABA-B receptors, 5-HT1 receptors, muscarinic acetylcholine receptors, dopaminergic receptors, and histaminergic receptors.

      In summary, receptors are classified based on their downstream signalling mechanisms. Inotropic receptors cause a direct change in ion flow, while metabotropic receptors cause a cascade of intracellular events. Only metabotropic receptors are used in receptor classification, and they can be further subdivided into G-protein coupled receptors or enzyme-associated receptors.

    • This question is part of the following fields:

      • Neurology
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  • Question 28 - A 40-year-old woman comes to the Emergency Department complaining of left eye pain...

    Incorrect

    • A 40-year-old woman comes to the Emergency Department complaining of left eye pain for the third time. She reports experiencing blurred vision and a sensation of something being stuck in her eye each time. She typically wears contact lenses and has accidentally scratched her eye multiple times in the past.
      Investigations reveal an epithelial defect with surrounding corneal edema on slit lamp examination, as well as an area of increased uptake on fluorescein examination. What is the most likely diagnosis based on these findings?

      Your Answer:

      Correct Answer: Corneal ulcer

      Explanation:

      Diagnosing Corneal Ulcers in Contact Lens Wearers

      Corneal ulcers are a common complication in contact lens wearers, caused by bacteria adhering to the lens surface and infecting the cornea. Symptoms include pain, photophobia, foreign body sensation, and most importantly, blurred vision. Treatment involves avoiding contact lenses for a few days, re-education on proper application, and topical antibiotics.

      Other potential diagnoses, such as bacterial conjunctivitis, traumatic corneal abrasion, Fuchs’ endothelial dystrophy, and keratitis sicca, can be ruled out based on the patient’s history and examination findings. It is important to accurately diagnose and treat corneal ulcers in contact lens wearers to prevent further complications and vision loss.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 29 - A 42-year-old man presents with a one-month history of tingling sensation in his...

    Incorrect

    • A 42-year-old man presents with a one-month history of tingling sensation in his fingers, toes and around the mouth. Initially, the symptom only affected his fingers but has since spread and gradually worsened. He had a similar symptom a couple of years ago and was diagnosed with low calcium levels. The patient reports no muscle weakness, tremors or other neurological symptoms. He is currently taking esomeprazole for reflux symptoms. His recent blood test showed a calcium level of 2.2 mmol/L (2.1-2.6). What electrolyte abnormality could be causing this patient's presenting symptoms?

      Your Answer:

      Correct Answer: Hypomagnesaemia

      Explanation:

      Hypomagnesaemia can lead to symptoms that are similar to those of hypocalcaemia, such as paresthesia, tetany, seizures, and arrhythmias. This condition can be caused by the use of proton pump inhibitors like lansoprazole and esomeprazole.

      The answer hyperkalemia is incorrect because its symptoms are often non-specific, including breathing difficulty, weakness, fatigue, palpitations, or chest pain, but not paresthesia.

      Similarly, hypermagnesaemia and hypernatremia are also incorrect answers. While hypermagnesaemia can cause weakness, confusion, nausea, vomiting, and shortness of breath, it does not lead to paresthesia. Hypernatremia, on the other hand, can cause lethargy, weakness, confusion, irritability, and seizures, but not paresthesia.

      Understanding Hypomagnesaemia: Causes, Symptoms, and Treatment

      Hypomagnesaemia is a condition characterized by low levels of magnesium in the blood. There are several causes of this condition, including the use of certain drugs such as diuretics and proton pump inhibitors, total parenteral nutrition, and chronic or acute diarrhoea. Alcohol consumption, hypokalaemia, hypercalcaemia, and metabolic disorders like Gitelman’s and Bartter’s can also lead to hypomagnesaemia. The symptoms of this condition may be similar to those of hypocalcaemia, including paraesthesia, tetany, seizures, and arrhythmias.

      When the magnesium level drops below 0.4 mmol/L or when there are symptoms of tetany, arrhythmias, or seizures, intravenous magnesium replacement is commonly given. An example regime would be 40 mmol of magnesium sulphate over 24 hours. For magnesium levels above 0.4 mmol/L, oral magnesium salts are prescribed in divided doses of 10-20 mmol per day. However, diarrhoea can occur with oral magnesium salts. It is important to note that hypomagnesaemia can exacerbate digoxin toxicity.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 30 - Which one of the following statements regarding varicoceles is accurate? ...

    Incorrect

    • Which one of the following statements regarding varicoceles is accurate?

      Your Answer:

      Correct Answer: Over 80% occur on the left side

      Explanation:

      Common Scrotal Problems and Their Features

      Epididymal cysts, hydroceles, and varicoceles are the most common scrotal problems seen in primary care. Epididymal cysts are usually found posterior to the testicle and are separate from the body of the testicle. They may be associated with conditions such as polycystic kidney disease, cystic fibrosis, and von Hippel-Lindau syndrome. Diagnosis is confirmed by ultrasound, and management is usually supportive, although surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts.

      Hydroceles, on the other hand, describe the accumulation of fluid within the tunica vaginalis. They may be communicating or non-communicating, and may develop secondary to conditions such as epididymo-orchitis, testicular torsion, or testicular tumors. Hydroceles are usually soft, non-tender swellings of the hemi-scrotum that transilluminate with a pen torch. Diagnosis may be clinical, but ultrasound is required if there is any doubt about the diagnosis or if the underlying testis cannot be palpated. Management depends on the severity of the presentation, with infantile hydroceles generally repaired if they do not resolve spontaneously by the age of 1-2 years.

      Varicoceles, on the other hand, are abnormal enlargements of the testicular veins that are usually asymptomatic but may be associated with subfertility. They are much more common on the left side and are classically described as a bag of worms. Diagnosis is confirmed by ultrasound with Doppler studies, and management is usually conservative, although surgery may be required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility.

    • This question is part of the following fields:

      • Surgery
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SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (2/2) 100%
Surgery (1/1) 100%
Clinical Sciences (0/1) 0%
Neurology (1/1) 100%
Rheumatology (0/1) 0%
Musculoskeletal (1/1) 100%
Trauma (0/1) 0%
Passmed