-
Question 1
Incorrect
-
A 26-year-old woman presents to her GP with worsening lower abdominal pain over the past 48 hours. The pain is located in the suprapubic area and slightly to the left. She experienced some vaginal bleeding this morning, which she describes as light. The patient also reports shoulder pain that started after playing tennis. Her last menstrual period was seven weeks ago and was normal. She has a history of Chlamydia infection and admits to not practicing safe sex. On examination, she is tender in the left iliac fossa. Her blood pressure is 98/62 mmHg, and her pulse is 100/min. What is the most likely diagnosis?
Your Answer: Miscarriage
Correct Answer: Ruptured ectopic pregnancy
Explanation:Ectopic pregnancy presents with amenorrhoea, abdominal pain, vaginal bleeding, and shoulder tip pain indicating peritoneal bleeding.
Understanding Ectopic Pregnancy
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus. This condition is characterized by lower abdominal pain and vaginal bleeding, typically occurring 6-8 weeks after the start of the last period. The pain is usually constant and may be felt on one side of the abdomen due to tubal spasm. Vaginal bleeding is usually less than a normal period and may be dark brown in color. Other symptoms may include shoulder tip pain, pain on defecation/urination, dizziness, fainting, or syncope. Breast tenderness may also be reported.
During examination, abdominal tenderness and cervical excitation may be observed. However, it is not recommended to examine for an adnexal mass due to the risk of rupturing the pregnancy. Instead, a pelvic examination to check for cervical excitation is recommended. In cases of pregnancy of unknown location, serum bHCG levels >1,500 may indicate an ectopic pregnancy. It is important to seek medical attention immediately if ectopic pregnancy is suspected as it can be life-threatening.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 2
Incorrect
-
What is a risk factor for the development of surfactant deficient lung disease in a neonate?
Your Answer: Maternal asthma
Correct Answer: Maternal diabetes mellitus
Explanation:Surfactant Deficient Lung Disease in Premature Infants
Surfactant deficient lung disease (SDLD), previously known as hyaline membrane disease, is a condition that affects premature infants. It occurs due to the underproduction of surfactant and the immaturity of the lungs’ structure. The risk of SDLD decreases with gestation, with 50% of infants born at 26-28 weeks and 25% of infants born at 30-31 weeks being affected. Other risk factors include male sex, diabetic mothers, Caesarean section, and being the second born of premature twins.
The clinical features of SDLD are similar to those of respiratory distress in newborns, including tachypnea, intercostal recession, expiratory grunting, and cyanosis. Chest x-rays typically show a ground-glass appearance with an indistinct heart border.
Prevention during pregnancy involves administering maternal corticosteroids to induce fetal lung maturation. Management of SDLD includes oxygen therapy, assisted ventilation, and exogenous surfactant given via an endotracheal tube. With proper management, the prognosis for infants with SDLD is generally good.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 3
Incorrect
-
A 55-year-old woman presents with urgency and frequency. Three weeks ago she consulted with a colleague as she felt 'dry' during intercourse. She has been treated for urinary tract infections on multiple occasions in the past but urine culture is always negative. Her only medication is continuous hormone replacement therapy. A vaginal examination is performed which shows no evidence of vaginal atrophy and no masses are felt. An ultrasound is requested:
Both kidneys, spleen and liver are normal size. Outline of the bladder normal. 6 cm complex ovarian cyst noted on left ovary. Right ovary and uterus normal
What is the most appropriate next step?Your Answer: Pelvic floor muscle training
Correct Answer: Urgent referral to gynaecology
Explanation:Investigation is necessary for any ovarian mass found in a woman who has undergone menopause.
Ovarian enlargement is typically diagnosed through ultrasound imaging, which can determine whether the cyst is simple or complex. Simple cysts are unilocular and more likely to be benign, while complex cysts are multilocular and more likely to be malignant. Management of ovarian enlargement depends on the patient’s age and symptoms. Younger women may be treated conservatively if the cyst is small and simple, with a repeat ultrasound scheduled in 8-12 weeks. Postmenopausal women, however, should always be referred to a gynecologist for assessment, as physiological cysts are unlikely in this population. It’s important to note that ovarian cancer can present with vague symptoms, leading to delayed diagnosis.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 4
Incorrect
-
A 20-year-old woman who is 8 weeks into her first pregnancy presents with vaginal bleeding and is seen in the early pregnancy assessment unit. The ultrasound scan confirms a viable intrauterine pregnancy, but the high vaginal swab has isolated group B streptococcus (GBS). What is the appropriate management for her?
Your Answer: Treat immediately with oral erythromycin & intrapartum intravenous benzylpenicillin
Correct Answer: Intrapartum intravenous benzylpenicillin only
Explanation:GBS is a type of bacteria commonly found in the vagina of many women. While it is generally harmless, it can cause serious infections in newborns, leading to significant health problems and even death.
If GBS is detected during pregnancy, it does not require immediate treatment as it will not reduce the likelihood of transmission to the baby during delivery. However, intravenous benzylpenicillin or clindamycin is necessary during labor to reduce the risk of transmission. This applies to GBS found in vaginal swabs and urine, and appropriate antibiotics are required for GBS urinary tract infections during pregnancy.
There is currently no screening program for GBS in the UK, and vaginal swabs should only be taken when clinically necessary. Women who have had a previous baby infected with GBS are offered intrapartum intravenous benzylpenicillin in future pregnancies.
(Source – RCOG guidelines, GBS in pregnancy).
Group B Streptococcus (GBS) is a common cause of severe infection in newborns. It is estimated that 20-40% of mothers carry GBS in their bowel flora, which can be passed on to their infants during labor and lead to serious infections. Prematurity, prolonged rupture of membranes, previous sibling GBS infection, and maternal pyrexia are all risk factors for GBS infection. The Royal College of Obstetricians and Gynaecologists (RCOG) has published guidelines on GBS management, which include not offering universal screening for GBS to all women and not offering screening based on maternal request. Women who have had GBS detected in a previous pregnancy should be offered intrapartum antibiotic prophylaxis (IAP) or testing in late pregnancy and antibiotics if still positive. IAP should also be offered to women with a previous baby with GBS disease, women in preterm labor, and women with a fever during labor. Benzylpenicillin is the preferred antibiotic for GBS prophylaxis.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 5
Incorrect
-
A 58-year-old man complains of recurrent episodes of vertigo and dizziness. These episodes are usually triggered by a change in head position and usually last for about 30 seconds. The examination of the cranial nerves and ears shows no abnormalities. His blood pressure is 122/80 mmHg while sitting and 118/76 mmHg while standing. Assuming that the diagnosis is benign paroxysmal positional vertigo, what is the most suitable course of action to confirm the diagnosis?
Your Answer:
Correct Answer: Dix-Hallpike manoeuvre
Explanation:Understanding Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV) is a common condition that causes sudden dizziness and vertigo triggered by changes in head position. It typically affects individuals over the age of 55 and is less common in younger patients. Symptoms include vertigo triggered by movements such as rolling over in bed or looking upwards, and may be accompanied by nausea. Each episode usually lasts between 10-20 seconds and can be diagnosed through a positive Dix-Hallpike manoeuvre, which involves the patient experiencing vertigo and rotatory nystagmus.
Fortunately, BPPV has a good prognosis and often resolves on its own within a few weeks to months. Treatment options include the Epley manoeuvre, which is successful in around 80% of cases, and vestibular rehabilitation exercises such as the Brandt-Daroff exercises. While medication such as Betahistine may be prescribed, it tends to have limited value. However, it is important to note that around half of people with BPPV will experience a recurrence of symptoms 3-5 years after their initial diagnosis.
Overall, understanding BPPV and its symptoms can help individuals seek appropriate treatment and manage their condition effectively.
-
This question is part of the following fields:
- ENT
-
-
Question 6
Incorrect
-
You assess a 65-year-old man with chronic obstructive pulmonary disease (COPD) who receives approximately 7-8 rounds of oral prednisolone annually to manage infectious exacerbations of his condition. What is one of the potential negative consequences associated with prolonged steroid use?
Your Answer:
Correct Answer: Avascular necrosis
Explanation:Osteopaenia and osteoporosis are associated with prolonged use of corticosteroids, not osteomalacia.
Understanding Corticosteroids and Their Side-Effects
Corticosteroids are commonly prescribed therapies used to replace or augment the natural activity of endogenous steroids. They can be administered systemically or locally, depending on the condition being treated. However, the usage of corticosteroids is limited due to their numerous side-effects, which are more common with prolonged and systemic therapy.
Glucocorticoid side-effects include impaired glucose regulation, increased appetite and weight gain, hirsutism, hyperlipidaemia, Cushing’s syndrome, moon face, buffalo hump, striae, osteoporosis, proximal myopathy, avascular necrosis of the femoral head, immunosuppression, increased susceptibility to severe infection, reactivation of tuberculosis, insomnia, mania, depression, psychosis, peptic ulceration, acute pancreatitis, glaucoma, cataracts, suppression of growth in children, intracranial hypertension, and neutrophilia.
On the other hand, mineralocorticoid side-effects include fluid retention and hypertension. It is important to note that patients on long-term steroids should have their doses doubled during intercurrent illness. Longer-term systemic corticosteroids suppress the natural production of endogenous steroids, so they should not be withdrawn abruptly as this may precipitate an Addisonian crisis. The British National Formulary suggests gradual withdrawal of systemic corticosteroids if patients have received more than 40mg prednisolone daily for more than one week, received more than three weeks of treatment, or recently received repeated courses.
-
This question is part of the following fields:
- Endocrinology/Metabolic Disease
-
-
Question 7
Incorrect
-
A 6-year-old girl is brought to her pediatrician by her father. He is worried that his daughter has been refusing to eat for 3 days and has been more irritable than usual. When asked, the girl points to her neck and complains of soreness. She has no significant medical history and is up to date with her vaccinations.
During the examination, the girl has a temperature of 38.7ºC. Her tonsils are enlarged and inflamed, and her throat is red. There are palpable lymph nodes in the anterior cervical chain that are tender to the touch. The rest of her examination is normal, and Kernig's sign is negative.
What is the most appropriate treatment to prescribe for this 6-year-old girl?Your Answer:
Correct Answer: Phenoxymethylpenicillin
Explanation:Antibiotic treatment should be given to individuals who are likely to have Streptococcus species isolated. However, Amoxicillin is not the most appropriate antibiotic for tonsillitis. Chlorhexidine mouthwash is not indicated for the treatment of tonsillitis. Dexamethasone is primarily used for the management of croup, which is characterized by a barking cough and is more common in the winter months.
Sore throat is a term used to describe various conditions such as pharyngitis, tonsillitis, and laryngitis. According to Clinical Knowledge Summaries, throat swabs and rapid antigen tests should not be routinely carried out for patients with a sore throat. Pain relief can be managed with paracetamol or ibuprofen, and antibiotics are not typically necessary. However, in cases where there is marked systemic upset, unilateral peritonsillitis, a history of rheumatic fever, an increased risk from acute infection, or when three or more Centor criteria are present, antibiotics may be indicated. The Centor and FeverPAIN scoring systems can be used to determine the likelihood of isolating Streptococci. If antibiotics are necessary, phenoxymethylpenicillin or clarithromycin (for penicillin-allergic patients) can be given for a 7 or 10 day course. It is worth noting that a single dose of oral corticosteroid may reduce the severity and duration of pain, although this has not yet been incorporated into UK guidelines.
-
This question is part of the following fields:
- ENT
-
-
Question 8
Incorrect
-
A 70-year-old man presents with central chest pain that has been ongoing for 2 hours. The pain is radiating to his left arm. He has a medical history of hypertension and hypercholesterolemia.
Upon examination, the patient appears uncomfortable and sweaty. His vital signs are as follows:
- Heart rate: 90 bpm
- Respiratory rate: 20 breaths/min
- Peripheral oxygen saturation: 95% on room air
- Blood pressure: 136/78 mmHg
- Temperature: 37.0ºC
An ECG performed by the paramedics shows ST depression in leads II, III, and aVF, as well as T-wave inversion.
What is the immediate treatment that should be given?Your Answer:
Correct Answer: Aspirin, nitrate, morphine
Explanation:The appropriate combination in this scenario is aspirin, nitrate, and morphine. The addition of oxygen is not necessary and may even be inappropriate. Ramipril and bisoprolol are not recommended for acute treatment but may be used for long-term management of ACS. Therefore, aspirin, nitrate, and oxygen is an incorrect combination, and morphine should also be included due to the patient’s significant pain. Oxygen should not be administered as the patient’s oxygen saturation levels are already adequate.
Managing Acute Coronary Syndrome: A Summary of NICE Guidelines
Acute coronary syndrome (ACS) is a common and serious medical condition that requires prompt management. The management of ACS has evolved over the years, with the development of new drugs and procedures such as percutaneous coronary intervention (PCI). The National Institute for Health and Care Excellence (NICE) has updated its guidelines on the management of ACS in 2020.
ACS can be classified into three subtypes: ST-elevation myocardial infarction (STEMI), non ST-elevation myocardial infarction (NSTEMI), and unstable angina. The management of ACS depends on the subtype. However, there are common initial drug therapies for all patients with ACS, such as aspirin and nitrates. Oxygen should only be given if the patient has oxygen saturations below 94%, and morphine should only be given for severe pain.
For patients with STEMI, the first step is to assess eligibility for coronary reperfusion therapy, which can be either PCI or fibrinolysis. Patients with NSTEMI/unstable angina require a risk assessment using the Global Registry of Acute Coronary Events (GRACE) tool to determine whether they need coronary angiography (with follow-on PCI if necessary) or conservative management.
This summary provides an overview of the NICE guidelines for managing ACS. The guidelines are complex and depend on individual patient factors, so healthcare professionals should review the full guidelines for further details. Proper management of ACS can improve patient outcomes and reduce the risk of complications.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 9
Incorrect
-
A 45-year-old woman presents to her General Practitioner with an acutely red and swollen left great toe, with no history of trauma. A diagnosis of gout is suspected.
Which of the following risk factors make it most likely that the patient will develop this condition?Your Answer:
Correct Answer: Alcohol excess
Explanation:Understanding the Risk Factors for Gout
Gout is a painful condition caused by hyperuricaemia, which can be influenced by various risk factors. While the cause of hyperuricaemia is multifactorial, certain factors have been identified as predisposing individuals to gout. These include high BMI, male gender, cardiovascular disease, renal disease, diabetes, and the use of certain drugs such as diuretics. Additionally, alcohol excess, particularly from spirits and beer, has been shown to increase the risk of gout. However, eczema and smoking are not recognized as risk factors for gout. Interestingly, gout is more common in men and rare in premenopausal women, and being overweight, rather than underweight, has been proposed as a risk factor for gout. Understanding these risk factors can help individuals take steps to prevent or manage gout.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 10
Incorrect
-
A 42-year-old man with irritable bowel syndrome (IBS) is struggling to manage his symptoms through dietary changes alone. He is primarily bothered by abdominal discomfort and bloating.
What is the most suitable next step in his treatment plan?Your Answer:
Correct Answer: Mebeverine hydrochloride
Explanation:Pharmacological Management of Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects 10-20% of the population, with women being more susceptible than men. The condition is characterized by abdominal pain, bloating, and altered bowel habits without any specific organic pathology. Management of IBS involves psychological support, dietary measures, and pharmacological treatment for symptom relief.
Antispasmodics, such as mebeverine hydrochloride, are commonly used to alleviate pain and bloating in IBS patients. Loperamide is the first choice of antimotility agent for diarrhea, while laxatives are recommended for constipation. Tricyclic antidepressants (TCAs), such as amitriptyline, are considered a second-line treatment option for IBS patients who do not respond to other medications. However, the use of opioids, such as tramadol, is not recommended due to the risk of constipation, dependence, and tolerance.
In conclusion, pharmacological management of IBS should be tailored to the individual patient’s symptoms and needs, with a focus on providing relief from pain, bloating, and altered bowel habits. Regular review and adjustment of medication dosages are necessary to ensure optimal treatment outcomes.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 11
Incorrect
-
Which of the following statements best describes bladder cancer?
Your Answer:
Correct Answer: Survival correlates well with TNM staging at diagnosis.
Explanation:Bladder Cancer: Prognostic Factors, Staging, and Treatment Options
Bladder cancer is a common malignancy that affects the urinary system. Survival rates are closely linked to the TNM staging at diagnosis, with non-muscle invasive bladder cancer having a good prognosis and decreasing survival rates with increasing stage. The most significant prognostic factors for bladder cancer are grade, depth of invasion, and the presence of carcinoma in situ. Chemotherapy for metastatic disease is seldom used and has limited effectiveness. Cisplatin-based chemotherapy regimens are the standard treatment for metastatic bladder cancer, with a median overall patient survival of 13-15 months and a 2-year survival rate of 15-20%. Careful follow-up is necessary for non-muscle invasive bladder cancer due to the high rate of disease recurrence and progression.
-
This question is part of the following fields:
- Renal Medicine/Urology
-
-
Question 12
Incorrect
-
A 28-year-old law student visits his primary care physician complaining of ear pain. He suspects that this is related to the same issue causing dryness in his scalp and beard, as well as eczema-like patches in his nasolabial folds. He has been using non-prescription topical treatments to manage these symptoms but seeks guidance for his earache. What is the probable diagnosis that connects all of this patient's symptoms?
Your Answer:
Correct Answer: Seborrhoeic dermatitis
Explanation:Seborrhoeic dermatitis can lead to common complications such as otitis externa and blepharitis. The patient is experiencing eczema-like plaques and dry skin in areas rich in sebum, which he has been treating with over-the-counter antifungal shampoos. However, his complaint of earache may be due to otitis externa, which is associated with seborrhoeic dermatitis. A full ear examination should be performed to rule out other diagnoses. Contact dermatitis is unlikely to present in this distribution and would not cause otalgia. Eczema herpeticum is a severe primary infection by herpes-simplex-virus 1 or 2, commonly seen in children with atopic eczema. Guttate psoriasis commonly affects children after Streptococcal upper respiratory tract infection and will clear over the course of ,3 months without treatment. Irritant dermatitis is unlikely to cause such focal areas of irritation.
Understanding Seborrhoeic Dermatitis in Adults
Seborrhoeic dermatitis is a chronic skin condition that affects around 2% of the general population. It is caused by an inflammatory reaction related to the overgrowth of a fungus called Malassezia furfur, which is a normal inhabitant of the skin. The condition is characterized by eczematous lesions that appear on the sebum-rich areas of the body, such as the scalp, periorbital, auricular, and nasolabial folds. It can also lead to the development of otitis externa and blepharitis.
Seborrhoeic dermatitis is often associated with other medical conditions, such as HIV and Parkinson’s disease. The management of the condition depends on the affected area. For scalp disease, over-the-counter preparations containing zinc pyrithione and tar are usually the first-line treatment. If these are not effective, ketoconazole is the preferred second-line agent. Selenium sulphide and topical corticosteroids may also be useful.
For the face and body, topical antifungals such as ketoconazole and topical steroids are often used. However, it is important to use steroids for short periods only to avoid side effects. Seborrhoeic dermatitis can be difficult to treat, and recurrences are common. Therefore, it is important to work closely with a healthcare provider to manage the condition effectively.
-
This question is part of the following fields:
- Dermatology
-
-
Question 13
Incorrect
-
Which of the following tests would be most beneficial in diagnosing heart failure?
Your Answer:
Correct Answer: B-type natriuretic peptide (BNP)
Explanation:Understanding Cardiac Biomarkers: Importance of BNP in Heart Failure Diagnosis
When it comes to diagnosing heart failure, healthcare professionals rely on various cardiac biomarkers to aid in their assessment. Among these biomarkers, B-type natriuretic peptide (BNP) is considered the primary investigation according to the National Institute for Health and Care Excellence (NICE) guidelines.
Unlike other biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), BNP is specific to heart failure and is not affected by inflammation. On the other hand, troponin T is useful in diagnosing acute coronary syndromes, while creatine phosphokinase is primarily used to detect muscle breakdown and rhabdomyolysis.
It is important to note that certain factors such as obesity and medications like angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) can falsely lower BNP levels. Therefore, if BNP levels are elevated, patients should be referred for an echocardiogram to confirm the diagnosis of heart failure.
In summary, understanding the role of cardiac biomarkers such as BNP in heart failure diagnosis is crucial in providing accurate and timely treatment for patients.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 14
Incorrect
-
A 10-year-old boy visits his General Practitioner a week after experiencing an upper-respiratory tract infection. He reports developing erythema around his left eye and pain on eye movement since waking up this morning.
Upon examination of his left eye, the boy displays proptosis, restricted eye movements, reduced visual acuity, and a relative afferent pupillary defect (RAPD). However, his right eye appears normal.
What is the most probable diagnosis?
Choose the SINGLE most likely diagnosis from the options below.Your Answer:
Correct Answer: Orbital cellulitis
Explanation:Eye Infections and Inflammations: Symptoms and Differences
Eye infections and inflammations can cause a range of symptoms, but it is important to differentiate between them to ensure appropriate treatment. Here are some common eye conditions and their distinguishing features:
Orbital Cellulitis: This is a serious condition that can cause erythema (redness) around the eye, pain on eye movements, restricted eye movements, proptosis (bulging of the eye), reduced visual acuity, and a relative afferent pupillary defect (RAPD). It is usually caused by the spread of infection from sinuses or trauma to the orbit. Treatment involves antibiotics and surgery if there is an orbital collection.
Conjunctivitis: This is a common condition that can accompany upper respiratory tract infections. It causes redness and discharge from the eye, but does not usually cause proptosis, restricted eye movements, or a RAPD.
Anterior Uveitis: This is an inflammation of the iris and ciliary body that causes a painful red eye, photophobia, increased lacrimation, and blurred vision. It does not usually cause erythema or proptosis.
Preseptal Cellulitis: This is a less serious condition that causes swelling and erythema of the eyelid, but does not cause proptosis, visual changes, or a RAPD. It is often confused with orbital cellulitis, but can be differentiated by the absence of these symptoms.
Blepharitis: This is an inflammation of the eyelid that causes swelling, erythema, and flakiness or scaliness of the eyelids. It does not usually cause proptosis or visual changes.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 15
Incorrect
-
You are assessing an 80-year-old man who has a medical history of hypothyroidism, Parkinson's disease, and depression. His conditions are well-managed with levothyroxine, co-careldopa, and citalopram. He reports experiencing symptoms indicative of gastroesophageal reflux disease. What medication should be avoided to manage his symptoms effectively?
Your Answer:
Correct Answer: Metoclopramide
Explanation:Patients with Parkinsonism should not take metoclopramide due to its dopamine antagonist properties, which can exacerbate their symptoms.
Metoclopramide is a medication that is commonly used to manage nausea. It works by blocking D2 receptors in the chemoreceptor trigger zone, which helps to alleviate feelings of sickness. In addition to its antiemetic properties, metoclopramide also has other uses, such as treating gastro-oesophageal reflux disease and gastroparesis caused by diabetic neuropathy. It is often combined with analgesics to treat migraines, which can cause gastroparesis and slow the absorption of pain medication.
However, metoclopramide can have some adverse effects, such as extrapyramidal effects, acute dystonia, diarrhoea, hyperprolactinaemia, tardive dyskinesia, and parkinsonism. These side effects are particularly problematic in children and young adults. It is important to note that metoclopramide should not be used in cases of bowel obstruction, but it may be helpful in cases of paralytic ileus.
Although metoclopramide primarily works as a D2 receptor antagonist, its mechanism of action is quite complex. It also acts as a mixed 5-HT3 receptor antagonist and 5-HT4 receptor agonist. The antiemetic effects of metoclopramide are due to its D2 receptor antagonist activity in the chemoreceptor trigger zone, while its gastroprokinetic effects are mediated by both D2 receptor antagonist and 5-HT4 receptor agonist activity. At higher doses, the 5-HT3 receptor antagonist activity also comes into play.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 16
Incorrect
-
A 30-year-old female who is 36 weeks pregnant comes in with a painful and swollen right calf. After a Doppler scan, it is confirmed that she has a deep vein thrombosis. What anticoagulant is recommended?
Your Answer:
Correct Answer: Subcutaneous low molecular weight heparin
Explanation:While the first trimester poses a higher risk of teratogenic effects from warfarin, most healthcare providers would opt for low molecular weight heparin in such cases. Additionally, the possibility of peripartum hemorrhage and the difficulty in reversing the effects of warfarin in such a scenario should also be taken into account.
During pregnancy, the body undergoes changes that make it more prone to blood clots. This is known as a hypercoagulable state and is most common in the last trimester. The increase in factors VII, VIII, X, and fibrinogen, along with a decrease in protein S, contribute to this state. Additionally, the growing uterus can press on the inferior vena cava, leading to venous stasis in the legs.
When it comes to managing deep vein thrombosis (DVT) or pulmonary embolism (PE) during pregnancy, warfarin is not recommended due to its potential harm to the fetus. Instead, subcutaneous low-molecular-weight heparin is preferred over intravenous heparin as it has a lower risk of bleeding and thrombocytopenia. It is important for pregnant women to be aware of the signs and symptoms of DVT/PE, such as leg swelling, pain, and shortness of breath, and to seek medical attention promptly if they experience any of these symptoms.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 17
Incorrect
-
A 42-year-old woman who is six weeks pregnant presents to the Cardiovascular Clinic with a swollen right leg. Doppler studies confirm a deep vein thrombosis (DVT). She has no signs or symptoms of a pulmonary embolism (PE) and is haemodynamically stable. What is the most appropriate management choice in this case?
Your Answer:
Correct Answer: Start subcutaneous low molecular weight heparin (LMWH) throughout pregnancy and change to warfarin in the postpartum period
Explanation:Treatment Options for Deep Vein Thrombosis in Pregnancy
Start subcutaneous low molecular weight heparin (LMWH) throughout pregnancy and change to warfarin in the postpartum period: LMWH is recommended for the treatment of DVT during pregnancy. Treatment should be continued for at least three months and until six weeks postpartum. Warfarin can be used after day five of the postpartum period. Both LMWH and warfarin are safe to use while breastfeeding.
Elastic band compression of the affected leg, bedrest, and foot elevation: These measures have no benefit in treating DVT and may even increase the risk of developing a pulmonary embolism (PE) or another DVT.
Commence intravenous (IV) heparin: IV heparin can be used for the treatment of a shocked patient with PE if thrombolysis is not possible. It should not be used for DVT alone.
Oral anticoagulation with warfarin daily throughout pregnancy and the postpartum period: Warfarin is not recommended during pregnancy as it can cross the placenta and increase the risk of congenital malformations and bleeding.
Aspirin 300 mg daily throughout pregnancy and the postpartum period: Aspirin is not effective in treating DVT or PE as it is an antiplatelet drug, not an anticoagulant.
Treatment Options for Deep Vein Thrombosis in Pregnancy
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 18
Incorrect
-
A 42-year-old woman has been asked to come back for a follow-up cervical smear by her GP. She had her routine cervical smear done a year ago which revealed the presence of high-risk HPV but no abnormal cytology. Her follow-up cervical smear still shows positive for high-risk HPV with no cytological abnormalities.
What is the best course of action for managing this patient?Your Answer:
Correct Answer: Repeat cervical smear in 12 months
Explanation:If the 1st repeat smear at 12 months is still positive for high-risk strains of human papillomavirus (hrHPV), the correct course of action is to repeat the smear 12 months later (i.e. at 24 months). Colposcopy is not indicated in this case, as it would only be necessary if this was her 3rd successive annual cervical smear that is still positive for hrHPV but with no cytological abnormalities. Repeating the cervical smear after 3 months is also not necessary, as this is only indicated if the first smear is inadequate. Similarly, repeating the cervical smear in 3 years is not appropriate, as hrHPV has been detected. Repeating the cervical smear after 6 months is also not necessary, as this is usually done as a test of cure following treatment for cervical intraepithelial neoplasia.
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.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 19
Incorrect
-
Which of the following is true when considering an exacerbation of chronic bronchitis in patients with COPD?
Your Answer:
Correct Answer: Moraxella catarrhalis is not commonly isolated on culture
Explanation:Exacerbations of chronic obstructive pulmonary disease (COPD) are a common occurrence and can be caused by various factors, including bacterial infections. In a bacterial acute exacerbation of chronic obstructive pulmonary disease, the most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Since the introduction of the pneumococcal conjugate vaccine, the most common bacterial pathogen may be changing from Streptococcus pneumoniae to Haemophilus influenzae and Moraxella catarrhalis. Mycoplasma pneumoniae and Chlamydia pneumoniae are also relatively common. An elevated white cell count may indicate exacerbation, but a lack of prominent leukocytosis is common. Clinical judgement is crucial, and a C-reactive protein (CRP) test may be useful, but it lags behind by 24-48 hours.
Exacerbations of COPD are characterized by episodes of acutely increased dyspnea and cough, often with a change in the characteristics of the sputum. Despite fever and other signs and symptoms, the clinical presentation is mild to moderate in most cases. Patients with COPD often develop type 2 respiratory failure, which can escalate into respiratory acidosis, a potentially serious complication that may require non-invasive or invasive ventilation. An arterial blood gas analysis should be performed early in every patient presenting with a possible exacerbation of COPD.
Treatment options for bacterial infections in exacerbations of COPD include trimethoprim-sulfamethoxazole (Septrin) combinations. However, resistance to this combination has been frequently reported in cases of infection with M. catarrhalis. The vast majority of cases of infection with M. catarrhalis are also penicillin-resistant due to their production of beta-lactamase. Co-amoxiclav is usually the antibiotic of choice, with macrolides being good alternatives. In most cases, the initial antibiotic treatment is empirical and mainly guided by known local sensitivities and the patient’s previous history of exacerbations. Gram stain can be quite useful to identify broad classes of bacteria. If the gram stain is inconclusive, blood cultures should be performed if the patient is pyrexial.
-
This question is part of the following fields:
- Respiratory Medicine
-
-
Question 20
Incorrect
-
A 72 year old man presents with a 6 day history of vomiting and diarrhoea. His blood results show Na+ 142 mmol/l, K+ 5.9 mmol/l, urea 14 mmol/l, and creatinine 320 mmol/l. His renal function was normal on routine blood tests 2 months ago. What finding is most indicative of acute tubular necrosis in this patient?
Your Answer:
Correct Answer: Raised urinary sodium
Explanation:The patient is experiencing acute kidney injury, which can be categorized into three causes: pre-renal, renal, and post-renal. Pre-renal causes are due to inadequate renal perfusion, such as dehydration, haemorrhage, heart failure, or sepsis. In this case, the kidneys are still able to concentrate urine and retain sodium, resulting in high urine osmolality and low urine sodium. Renal causes are most commonly caused by acute tubular necrosis, which damages tubular cells due to prolonged ischaemia or toxins. In this scenario, the kidneys are unable to concentrate urine or retain sodium, leading to low urine osmolality and high urine sodium. Acute glomerulonephritis and acute interstitial nephritis are rarer causes of renal injury. Post-renal causes are due to obstruction of the urinary tract, which can be identified through hydronephrosis on renal ultrasound.
Distinguishing between Acute Tubular Necrosis and Prerenal Uraemia in Acute Kidney Injury
Acute kidney injury can be caused by various factors, including prerenal uraemia and acute tubular necrosis. It is important to distinguish between the two in order to provide appropriate treatment. Prerenal uraemia occurs when the kidneys hold on to sodium to preserve volume, leading to decreased blood flow to the kidneys. On the other hand, acute tubular necrosis is caused by damage to the kidney tubules, often due to ischemia or toxins.
To differentiate between the two, several factors can be considered. In prerenal uraemia, urine sodium levels are typically less than 20 mmol/L, while in acute tubular necrosis, they are usually greater than 40 mmol/L. Urine osmolality is also a useful indicator, with levels above 500 mOsm/kg suggesting prerenal uraemia and levels below 350 mOsm/kg suggesting acute tubular necrosis.
Fractional sodium excretion and fractional urea excretion are also important measures. In prerenal uraemia, the fractional sodium excretion is typically less than 1%, while in acute tubular necrosis, it is usually greater than 1%. Similarly, the fractional urea excretion is less than 35% in prerenal uraemia and greater than 35% in acute tubular necrosis.
Other factors that can help distinguish between the two include response to fluid challenge, serum urea:creatinine ratio, urine:plasma osmolality, urine:plasma urea ratio, and specific gravity. By considering these factors, healthcare providers can accurately diagnose and treat acute kidney injury.
-
This question is part of the following fields:
- Renal Medicine/Urology
-
-
Question 21
Incorrect
-
A 65-year-old man is brought to the emergency department due to self-neglect and suspected neurological event causing motor function loss. Upon examination, he presents with hypothermia and weakness on the right side. The patient reports discontinuing his regular medications and experiencing dizziness, restlessness, and electric shock sensations throughout his body. Which medication cessation is most likely responsible for these symptoms?
Your Answer:
Correct Answer: Paroxetine
Explanation:Discontinuation syndrome, characterized by dizziness, electric shock sensations, and anxiety, is a common occurrence when SSRIs are abruptly stopped. This is why it is recommended to gradually taper off the medication. The patient in this scenario stopped their medication abruptly due to a suspected neurological event, leading to the onset of discontinuation syndrome. Atorvastatin, bisoprolol, and gabapentin are not typically associated with these symptoms when stopped abruptly.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used as the first-line treatment for depression. Citalopram and fluoxetine are the preferred SSRIs, while sertraline is recommended for patients who have had a myocardial infarction. However, caution should be exercised when prescribing SSRIs to children and adolescents. Gastrointestinal symptoms are the most common side-effect, and patients taking SSRIs are at an increased risk of gastrointestinal bleeding. Patients should also be aware of the possibility of increased anxiety and agitation after starting a SSRI. Fluoxetine and paroxetine have a higher propensity for drug interactions.
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning regarding the use of citalopram due to its association with dose-dependent QT interval prolongation. As a result, citalopram and escitalopram should not be used in patients with congenital long QT syndrome, known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval. The maximum daily dose of citalopram is now 40 mg for adults, 20 mg for patients older than 65 years, and 20 mg for those with hepatic impairment.
When initiating antidepressant therapy, patients should be reviewed by a doctor after 2 weeks. Patients under the age of 25 years or at an increased risk of suicide should be reviewed after 1 week. If a patient responds well to antidepressant therapy, they should continue treatment for at least 6 months after remission to reduce the risk of relapse. When stopping a SSRI, the dose should be gradually reduced over a 4 week period, except for fluoxetine. Paroxetine has a higher incidence of discontinuation symptoms, including mood changes, restlessness, difficulty sleeping, unsteadiness, sweating, gastrointestinal symptoms, and paraesthesia.
When considering the use of SSRIs during pregnancy, the benefits and risks should be weighed. Use during the first trimester may increase the risk of congenital heart defects, while use during the third trimester can result in persistent pulmonary hypertension of the newborn. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 22
Incorrect
-
Which of the following is not a risk factor for developing osteoporosis?
Your Answer:
Correct Answer: Obesity
Explanation:An elevated risk of developing osteoporosis is linked to low body mass, not obesity.
Understanding the Causes of Osteoporosis
Osteoporosis is a condition that affects the bones, making them weak and brittle. It is more common in women and older adults, with the prevalence increasing significantly in women over the age of 80. However, there are many other risk factors and secondary causes of osteoporosis that should be considered. Some of the most important risk factors include a history of glucocorticoid use, rheumatoid arthritis, alcohol excess, parental hip fracture, low body mass index, and smoking. Other risk factors include a sedentary lifestyle, premature menopause, certain ethnicities, and endocrine disorders such as hyperthyroidism and diabetes mellitus.
There are also medications that may worsen osteoporosis, such as SSRIs, antiepileptics, and proton pump inhibitors. If a patient is diagnosed with osteoporosis or has a fragility fracture, further investigations may be necessary to identify the cause and assess the risk of subsequent fractures. Recommended investigations include blood tests, bone densitometry, and other procedures as indicated. It is important to identify the cause of osteoporosis and contributory factors in order to select the most appropriate form of treatment. As a minimum, all patients should have a full blood count, urea and electrolytes, liver function tests, bone profile, CRP, and thyroid function tests.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 23
Incorrect
-
A 60-year-old man came to your GP clinic complaining of blurred vision for the past month. He has a history of type 2 diabetes mellitus. During direct ophthalmoscopy, you observed a ring of hard exudates at the fovea, but the rest of the retina appeared normal. What is the probable diagnosis for his vision blurring?
Your Answer:
Correct Answer: Diabetic maculopathy
Explanation:Diabetic maculopathy refers to any structural anomaly in the macula caused by diabetes. The patient in this case had hard exudates in the macula, which resulted in blurred vision. As there were no abnormalities in the rest of the retina, options 1-3 (background, pre-proliferative and proliferative diabetic retinopathies) are incorrect. Although vitreous hemorrhage can cause blurred vision in cases of proliferative retinopathy, there is no indication of it in the given history.
Understanding Diabetic Retinopathy
Diabetic retinopathy is a leading cause of blindness among adults aged 35-65 years old. The condition is caused by hyperglycemia, which leads to abnormal metabolism in the retinal vessel walls and damage to endothelial cells and pericytes. This damage causes increased vascular permeability, resulting in exudates seen on fundoscopy. Pericyte dysfunction predisposes to the formation of microaneurysms, while neovascularization is caused by the production of growth factors in response to retinal ischemia.
Patients with diabetic retinopathy are classified into those with non-proliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy. NPDR is further classified into mild, moderate, and severe, depending on the presence of microaneurysms, blot hemorrhages, hard exudates, cotton wool spots, venous beading/looping, and intraretinal microvascular abnormalities. PDR is characterized by retinal neovascularization, which may lead to vitreous hemorrhage, and fibrous tissue forming anterior to the retinal disc. Maculopathy is based on location rather than severity and is more common in Type II DM.
Management of diabetic retinopathy involves optimizing glycaemic control, blood pressure, and hyperlipidemia, as well as regular review by ophthalmology. Treatment options include intravitreal vascular endothelial growth factor (VEGF) inhibitors for maculopathy, regular observation for non-proliferative retinopathy, and panretinal laser photocoagulation and intravitreal VEGF inhibitors for proliferative retinopathy. Vitreoretinal surgery may be necessary in cases of severe or vitreous hemorrhage.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 24
Incorrect
-
A 56-year-old male patient arrives at the emergency department complaining of back pain and fever that have persisted for two weeks. During the examination, it is discovered that he has weakness in his right lower limb. The patient has a history of stroke and type 2 diabetes mellitus. Although he has not traveled recently, discitis is suspected. What is the probable organism responsible for this condition?
Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Understanding Discitis: Causes, Symptoms, Diagnosis, and Treatment
Discitis is a condition characterized by an infection in the intervertebral disc space, which can lead to serious complications such as sepsis or an epidural abscess. The most common cause of discitis is bacterial, with Staphylococcus aureus being the most frequent culprit. However, it can also be caused by viral or aseptic factors. The symptoms of discitis include back pain, pyrexia, rigors, and sepsis. In some cases, neurological features such as changing lower limb neurology may occur if an epidural abscess develops.
To diagnose discitis, imaging tests such as MRI are used due to their high sensitivity. A CT-guided biopsy may also be required to guide antimicrobial treatment. The standard therapy for discitis involves six to eight weeks of intravenous antibiotic therapy. The choice of antibiotic depends on various factors, with the most important being the identification of the organism through a positive culture, such as a blood culture or CT-guided biopsy.
Complications of discitis include sepsis and epidural abscess. Therefore, it is essential to assess the patient for endocarditis, which can be done through transthoracic echo or transesophageal echo. Discitis is usually due to haematogenous seeding of the vertebrae, which implies that the patient has had a bacteraemia, and seeding could have occurred elsewhere. Understanding the causes, symptoms, diagnosis, and treatment of discitis is crucial in managing this condition and preventing its complications.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 25
Incorrect
-
As a side-effect, which antidepressants cause the cheese effect (a hypertensive reaction)?
Your Answer:
Correct Answer: Monoamine oxidase inhibitors (MAOIs)
Explanation:Differential Diagnosis: Jaundice and Abdominal Symptoms
Gilbert Syndrome:
Gilbert syndrome is an inherited condition that can manifest as jaundice on clinical examination. Patients may also experience non-specific symptoms such as abdominal cramps, fatigue, and malaise. Fasting, febrile illness, alcohol, or exercise can exacerbate jaundice in patients with Gilbert syndrome. Diagnosis is based on a thorough history and physical examination, as well as blood tests that show unconjugated hyperbilirubinaemia.Haemolytic Anaemia:
Haemolysis is the premature destruction of erythrocytes, which can lead to anaemia if bone marrow activity cannot compensate for erythrocyte loss. Mild haemolysis can be asymptomatic, while severe haemolysis can cause life-threatening symptoms such as angina and cardiopulmonary decompensation. Changes in lactate dehydrogenase and serum haptoglobin levels are the most sensitive general tests for haemolytic anaemia.Hepatitis A:
Hepatitis A is a viral infection that results almost exclusively from ingestion, typically through faecal-oral transmission. Symptoms include fatigue, anorexia, nausea, and vomiting. LFT abnormalities are common, and diagnosis is based on serologic testing for immunoglobulin M (IgM) antibody to HAV.Hepatitis B:
Hepatitis B is a viral infection that is transmitted haematogenously and sexually. Symptoms include fatigue, anorexia, nausea, and vomiting. LFT abnormalities are common, and diagnosis is based on serologic testing for hepatitis B surface antigen (HBsAg).Cholecystitis:
Cholecystitis is inflammation of the gall bladder that occurs most commonly because of an obstruction of the cystic duct by gallstones arising from the gall bladder. Symptoms include upper abdominal pain, nausea, vomiting, and fever. Signs of peritoneal irritation may also be present.Conclusion:
In summary, the differential diagnosis of jaundice and abdominal symptoms includes Gilbert syndrome, haemolytic anaemia, hepatitis A, hepatitis B, and cholecystitis. Diagnosis is based on a thorough history and physical examination, as well as blood tests and serologic testing as appropriate. Treatment -
This question is part of the following fields:
- Psychiatry
-
-
Question 26
Incorrect
-
A 56-year-old man with a history of type 2 diabetes mellitus complains of right shoulder pain and limited movement in all directions. What is the probable diagnosis?
Your Answer:
Correct Answer: Adhesive capsulitis
Explanation:The development of adhesive capsulitis is more likely in individuals with diabetes mellitus.
Understanding Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis, commonly known as frozen shoulder, is a prevalent cause of shoulder pain that primarily affects middle-aged women. The exact cause of this condition is not yet fully understood. However, studies have shown that up to 20% of diabetics may experience an episode of frozen shoulder. Symptoms typically develop over several days, with external rotation being more affected than internal rotation or abduction. Both active and passive movement are affected, and patients usually experience a painful freezing phase, an adhesive phase, and a recovery phase. In some cases, the condition may affect both shoulders, which occurs in up to 20% of patients. The episode typically lasts between 6 months and 2 years.
Diagnosis of adhesive capsulitis is usually clinical, although imaging may be necessary for atypical or persistent symptoms. Unfortunately, no single intervention has been proven to improve the outcome in the long-term. However, there are several treatment options available, including nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, oral corticosteroids, and intra-articular corticosteroids.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 27
Incorrect
-
You are urgently called to the ward where you encounter a 54-year-old woman in ventricular tachycardia. The patient had a syncopal episode while walking to the restroom with nursing staff and currently has a blood pressure (BP) of 85/56 mmHg. Although she is oriented to time, place, and person, she is experiencing dizziness. What is the most suitable approach to managing this patient's ventricular tachycardia?
Your Answer:
Correct Answer: Synchronised direct current (DC) cardioversion
Explanation:Treatment Options for Ventricular Tachycardia
Ventricular tachycardia is a serious cardiac arrhythmia that requires prompt treatment. The Resuscitation Council tachycardia guideline recommends immediate synchronised electrical cardioversion for unstable patients with ventricular tachycardia who exhibit adverse features such as shock, myocardial ischaemia, syncope, or heart failure. Synchronised cardioversion is preferred over unsynchronised cardioversion as it reduces the risk of causing ventricular fibrillation or cardiac arrest.
In the event that synchronised cardioversion fails to restore sinus rhythm after three attempts, a loading dose of amiodarone 300 mg IV should be given over 10-20 minutes, followed by another attempt of cardioversion. However, in an uncompromised patient with tachycardia and no adverse features, the first-line treatment involves amiodarone 300 mg as a loading dose IV, followed by an infusion of 900 mg over 24 hours.
It is important to note that digoxin and metoprolol are not appropriate treatments for ventricular tachycardia. Digoxin is used in the treatment of atrial fibrillation, while metoprolol is a β blocker that should be avoided in patients with significant hypotension, as it can further compromise the patient’s condition.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 28
Incorrect
-
A 42-year-old man with a 4-week history of a diagnosed anal fissure returns to the general practice surgery for review. He has been regularly using stool softeners along with eating a healthy diet and drinking adequate water. He is still experiencing bleeding and pain on opening his bowels. Examination reveals an anal fissure with no alarming signs.
Which of the following would be the most appropriate management at this stage?Your Answer:
Correct Answer: Topical glyceryl trinitrate (GTN)
Explanation:Management of Primary Anal Fissure: Treatment Options and Referral Guidelines
Primary anal fissure is a common condition that can cause significant pain and discomfort. The National Institute for Health and Care Excellence (NICE) provides guidelines for the management of this condition, which include prescribing rectal topical glyceryl trinitrate (GTN) 0.4% ointment for 6-8 weeks to relieve pain and aid healing. Referral to a colorectal surgeon is warranted if the fissure does not heal after this period. Botulinum toxin injections can be considered in secondary care settings for chronic and recurrent cases, but only after a trial of topical GTN. Taking no action is not recommended, as it can lead to chronic non-healing ulcers. Trying different laxatives, such as senna, is also unlikely to help and should not be the first-line treatment for anal fissure. Overall, early intervention with topical GTN and appropriate referral can improve outcomes for patients with primary anal fissure.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 29
Incorrect
-
You see a 29-year-old woman who has recently become pregnant. She has well-controlled type 1 diabetes and is in good health. At what gestational age should the following be initiated?
Your Answer:
Correct Answer: Aspirin
Explanation:Gestational diabetes is a common medical disorder affecting around 4% of pregnancies. Risk factors include a high BMI, previous gestational diabetes, and family history of diabetes. Screening is done through an oral glucose tolerance test, and diagnostic thresholds have recently been updated. Management includes self-monitoring of blood glucose, diet and exercise advice, and medication if necessary. For pre-existing diabetes, weight loss and insulin are recommended, and tight glycemic control is important. Targets for self-monitoring include fasting glucose of 5.3 mmol/l and 1-2 hour post-meal glucose levels.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 30
Incorrect
-
A 68-year-old man visits his GP after being urged by his son. He reports experiencing left-sided facial drooping four days ago, which he observed in the mirror. He did not seek medical attention at the time and was relieved to see that it disappeared on its own after approximately 40 minutes. He has not had any additional symptoms since then. Besides an immediate referral to specialist services, what should be done about drug treatment?
Your Answer:
Correct Answer: Aspirin 300mg
Explanation:If a patient is suspected of having a TIA and visits their GP within 7 days, they should receive immediate treatment with 300 mg aspirin and be referred to a specialist for review within 24 hours. NICE guidelines also suggest considering gastric protection with a PPI if necessary.
A transient ischaemic attack (TIA) is a brief period of neurological deficit caused by a vascular issue, lasting less than an hour. The original definition of a TIA was based on time, but it is now recognized that even short periods of ischaemia can result in pathological changes to the brain. Therefore, a new ’tissue-based’ definition is now used. The clinical features of a TIA are similar to those of a stroke, but the symptoms resolve within an hour. Possible features include unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, or loss of balance, visual problems, and sudden transient loss of vision in one eye (amaurosis fugax).
NICE recommends immediate antithrombotic therapy with aspirin 300 mg unless the patient has a bleeding disorder or is taking an anticoagulant. If the patient has had more than one TIA or has a suspected cardioembolic source or severe carotid stenosis, specialist review is necessary. Urgent assessment is required within 24 hours for patients who have had a suspected TIA in the last 7 days. Referral for specialist assessment is necessary as soon as possible within 7 days for patients who have had a suspected TIA more than a week previously. Neuroimaging and carotid imaging are recommended, and antithrombotic therapy is necessary. Carotid artery endarterectomy should only be considered if the carotid stenosis is greater than 70% according to ECST criteria or greater than 50% according to NASCET criteria.
-
This question is part of the following fields:
- Neurology
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)