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  • Question 1 - In a 16-year-old girl with severe weight loss, which of the following would...

    Correct

    • In a 16-year-old girl with severe weight loss, which of the following would be a common finding in association with anorexia nervosa (AN)?

      Your Answer: Increased excessive physical activity

      Explanation:

      Features and Diagnostic Criteria of Anorexia Nervosa

      Anorexia Nervosa (AN) is a serious eating disorder characterized by a distorted body image and an intense fear of gaining weight. Here are some features and diagnostic criteria of AN:

      Increased excessive physical activity: Patients with AN tend to exercise excessively to lose weight.

      Low plasma cortisol levels: AN patients have low levels of cortisol, a hormone that helps regulate metabolism and stress response.

      Buccal pigmentation: This is not a typical feature of AN.

      Raised gonadotrophin levels: Gonadotrophin levels are usually reduced in AN, leading to amenorrhoea in women and loss of sexual interest in men.

      Hyperkalaemia: AN patients may have high levels of potassium in their blood.

      Diagnostic criteria: According to the ICD-10, a definite diagnosis of AN requires body weight maintained at least 15% below the expected, self-induced weight loss, body image distortion, endocrine disorder involving the hypothalamic–pituitary–gonadal axis, and delayed or arrested pubertal events if onset is prepubertal.

      Understanding Anorexia Nervosa: Features and Diagnostic Criteria

    • This question is part of the following fields:

      • Psychiatry
      36.8
      Seconds
  • Question 2 - A 3-day-old baby boy is experiencing cyanosis during feeding and crying, leading to...

    Incorrect

    • A 3-day-old baby boy is experiencing cyanosis during feeding and crying, leading to suspicion of congenital heart disease. What could be the probable reason?

      Your Answer: Patent ductus arteriosus

      Correct Answer: Transposition of the great arteries

      Explanation:

      When it comes to congenital heart disease, TGA and Fallot’s are the most common causes of cyanotic heart disease. However, TGA is more commonly seen in newborns, while Fallot’s typically presents a few months after a murmur is detected. VSD is the most common cause of acyanotic congenital heart disease.

      Congenital heart disease can be categorized into two types: acyanotic and cyanotic. Acyanotic heart diseases are more common and include ventricular septal defects (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, and aortic valve stenosis. VSD is the most common acyanotic heart disease, accounting for 30% of cases. ASDs are less common than VSDs, but they are more frequently diagnosed in adult patients as they tend to present later. On the other hand, cyanotic heart diseases are less common and include tetralogy of Fallot, transposition of the great arteries (TGA), and tricuspid atresia. Fallot’s is more common than TGA, but TGA is the more common lesion at birth as patients with Fallot’s generally present at around 1-2 months. The presence of cyanosis in pulmonary valve stenosis depends on the severity and any other coexistent defects.

    • This question is part of the following fields:

      • Paediatrics
      29.6
      Seconds
  • Question 3 - A geriatric patient presents with chronic heart failure.
    Which of the following drugs should...

    Correct

    • A geriatric patient presents with chronic heart failure.
      Which of the following drugs should be used as a first-line treatment for heart failure?

      Your Answer: Enalapril

      Explanation:

      Heart Failure Medications: Uses and Recommendations

      Heart failure is a serious condition that requires proper management and treatment. There are several medications available for heart failure, each with its own specific uses and recommendations.

      Enalapril is an ACE inhibitor that works by reducing levels of angiotensin II, a potent vasoconstrictor, resulting in reduced vasoconstriction and a reduction in left ventricular afterload. It is recommended as a first-line treatment for all patients with heart failure due to left ventricular systolic dysfunction.

      Digoxin is recommended for worsening or severe heart failure due to left ventricular systolic dysfunction despite first- and second-line treatment for heart failure.

      Aspirin should be prescribed for patients with heart failure and atherosclerotic arterial disease, including coronary heart disease. It is not useful in monotherapy for the treatment of heart failure.

      Furosemide is a diuretic that is routinely used for the relief of congestive symptoms and fluid retention in patients with heart failure. It should be titrated according to need after the initiation of subsequent heart failure therapies.

      Spironolactone is an aldosterone antagonist that forms the second-line treatment in patients with heart failure. It is important to closely monitor potassium and creatinine levels and the estimated glomerular filtration rate (eGFR). Specialist advice should be sought if the patient develops hyperkalaemia or renal function deteriorates.

      In summary, the appropriate medication for heart failure depends on the individual patient’s condition and needs. It is important to consult with a healthcare professional for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Cardiovascular
      19.7
      Seconds
  • Question 4 - A 6-month-old is brought in by a concerned mother. She reports her baby...

    Correct

    • A 6-month-old is brought in by a concerned mother. She reports her baby crying after feeds and drawing his legs to his chest for several weeks. His growth is good and examination unremarkable.
      Which of the following is the best treatment option?

      Your Answer: Supportive advice and reassurance

      Explanation:

      Managing Infantile Colic: Supportive Advice and Reassurance

      Infantile colic can be a challenging condition for both parents and babies. While there is little evidence for treating colic, there are some strategies that can help manage the symptoms. Nursing the baby upright after feeds, bathing the infant in warm water, using white noise, gentle movement of baby, eg rocking the crib, holding baby during an episode, winding well and offering reassurance when needed can all be helpful.

      However, it’s important to note that medications such as Infacol, Colief, Gaviscon, and Ranitidine are not recommended as first-line treatments due to lack of evidence. Maternal diet modification, probiotic supplements, herbal supplements, and manipulative strategies are also not recommended.

      If your baby is experiencing colic, know that you are not alone and that supportive advice and reassurance can go a long way in managing the symptoms.

    • This question is part of the following fields:

      • Paediatrics
      29.2
      Seconds
  • Question 5 - A 30-year-old woman with type 1 diabetes mellitus arrives at the emergency department...

    Incorrect

    • A 30-year-old woman with type 1 diabetes mellitus arrives at the emergency department complaining of blurry vision in her left eye. She reports her vision in that eye as 'hazy and faded' which started a few hours ago. She also experiences pain that worsens with eye movement. There are no visible signs of trauma or infection on her eyes, and her recent HbA1c and capillary blood glucose levels are normal. What clinical manifestation is linked to the suspected diagnosis?

      Your Answer: Absent corneal reflex

      Correct Answer: Relative afferent pupillary defect (RAPD)

      Explanation:

      Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.

    • This question is part of the following fields:

      • Ophthalmology
      70.9
      Seconds
  • Question 6 - A 40-year-old patient presents with sudden monocular visual loss on the left, associated...

    Correct

    • A 40-year-old patient presents with sudden monocular visual loss on the left, associated with pain behind the eye and alteration of depth perception. Examination on the following day reveals a relative afferent pupillary defect (RAPD) in the left eye.
      Which of the following diagnoses is most likely?

      Your Answer: Optic neuritis

      Explanation:

      Understanding Optic Neuritis: Symptoms, Causes, and Differential Diagnosis

      Optic neuritis is a condition characterized by inflammation, degeneration, or demyelination of the optic nerve. It typically presents with sudden-onset unilateral visual loss, retro-orbital pain, and altered color vision, and is more common in women aged 20-40. Patients with optic neuritis have up to a 50% risk of developing multiple sclerosis (MS) after an episode.

      There are three types of optic neuritis: papillitis or anterior optic neuritis, retrobulbar neuritis, and neuroretinitis. Papillitis affects the intraocular portion of the nerve and causes optic disc swelling, while retrobulbar neuritis does not involve the disc and is often associated with MS. Neuroretinitis affects the optic disc and adjacent temporal retina.

      The most common cause of retrobulbar neuritis is MS, but it can also be caused by toxic exposure, vitamin deficiency (especially B12), ischaemia (diabetes, giant cell arteritis), or infection. Symptoms include variable loss of central vision, dull aching pain in the eye, and a central scotoma on examination.

      Cerebral infarction is an unlikely diagnosis in a young patient without significant risk factors. Optic nerve glioma typically presents with gradual reduction in visual acuity, while migraine aura presents with positive visual phenomena and is associated with unilateral headache. Temporal arteritis, which causes sudden loss of vision associated with ischaemic optic neuropathy, is rare in people under 50 and is associated with polymyalgia rheumatica.

      Diagnosis of temporal arteritis requires three of five criteria: >50 years at disease onset, new headache, raised erythrocyte sedimentation rate (ESR), temporal artery abnormality, and abnormal temporal artery biopsy. Understanding the symptoms, causes, and differential diagnosis of optic neuritis is crucial for accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Neurology
      68
      Seconds
  • Question 7 - An increase in alkaline phosphatase can be attributed to any of the following...

    Incorrect

    • An increase in alkaline phosphatase can be attributed to any of the following conditions except?

      Your Answer: Osteomalacia

      Correct Answer: Hypoparathyroidism

      Explanation:

      Understanding Alkaline Phosphatase and Its Causes

      Alkaline phosphatase (ALP) is an enzyme found in various tissues throughout the body, including the liver, bones, and intestines. When the levels of ALP in the blood are elevated, it can indicate a potential health issue. The causes of raised ALP can be divided into two categories based on the calcium level in the blood.

      If both ALP and calcium levels are high, it may indicate bone metastases, hyperparathyroidism, osteomalacia, or renal failure. On the other hand, if ALP is high but calcium is low, it may be due to cholestasis, hepatitis, fatty liver, neoplasia, Paget’s disease, or physiological factors such as pregnancy, growing children, or healing fractures.

      It is important to note that elevated ALP levels do not necessarily indicate a specific condition, but rather serve as a signal for further investigation.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      13.2
      Seconds
  • Question 8 - Wernicke's encephalopathy is caused by a lack of which vitamin? ...

    Correct

    • Wernicke's encephalopathy is caused by a lack of which vitamin?

      Your Answer: Thiamine

      Explanation:

      Vitamins and their Deficiencies: Understanding the Role of Thiamine, B12, Nicotinic Acid, Folic Acid, and Vitamin D

      Thiamine, also known as vitamin B1, plays a crucial role in preventing Wernicke’s encephalopathy, a condition caused by thiamine deficiency. This deficiency can result from inadequate dietary intake, reduced gastrointestinal absorption, decreased hepatic storage, and impaired utilization. Individuals with alcohol-use disorders are at high risk and should receive thiamine supplementation.

      Vitamin B12 deficiency, on the other hand, causes macrocytic (megaloblastic) anemia and various neurological symptoms, including peripheral neuropathy. However, it is not a cause of Wernicke’s encephalopathy.

      Nicotinic acid, also known as vitamin B3 or niacin, deficiency causes pellagra, a disease characterized by dermatitis, diarrhea, and dementia.

      Folic acid, or vitamin B9, deficiency causes macrocytic (megaloblastic) anemia similar to that caused by vitamin B12 deficiency, but not the peripheral neuropathy caused by vitamin B12 deficiency. It is important to check if a patient with megaloblastic anemia and folic acid deficiency is also lacking vitamin B12, as treating only with folic acid replacement can worsen neurological symptoms.

      Vitamin D is involved in calcium metabolism and mainly affects bone homeostasis. Severe deficiency can cause cognitive impairment in older adults, but it is not a cause of Wernicke’s encephalopathy.

      Understanding the role of these vitamins and their deficiencies can help in the prevention and treatment of various conditions.

    • This question is part of the following fields:

      • Neurology
      10.5
      Seconds
  • Question 9 - Which one of the following clinical features would be least consistent with a...

    Incorrect

    • Which one of the following clinical features would be least consistent with a diagnosis of severe pre-eclampsia?

      Your Answer: Low platelet count

      Correct Answer: Reflexes difficult to elicit

      Explanation:

      Hyperreflexia and clonus are commonly observed in patients with severe pre-eclampsia, while a decrease in platelet count may indicate the onset of HELLP syndrome.

      Pre-eclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure, proteinuria, and edema. It can lead to complications such as eclampsia, neurological issues, fetal growth problems, liver involvement, and cardiac failure. Severe pre-eclampsia is marked by hypertension, proteinuria, headache, visual disturbances, and other symptoms. Risk factors for pre-eclampsia include hypertension in a previous pregnancy, chronic kidney disease, autoimmune disease, diabetes, chronic hypertension, first pregnancy, and age over 40. Aspirin may be recommended for women with high or moderate risk factors. Treatment involves emergency assessment, admission for observation, and medication such as labetalol, nifedipine, or hydralazine. Delivery of the baby is the most important step in management, with timing depending on the individual case.

    • This question is part of the following fields:

      • Reproductive Medicine
      28.8
      Seconds
  • Question 10 - A 67-year-old man with a 14 year history of type 2 diabetes mellitus...

    Correct

    • A 67-year-old man with a 14 year history of type 2 diabetes mellitus presents with complaints of blurred vision and poor eyesight. Upon examination using a Snellen chart, his visual acuity is found to be reduced to 6/12 in the left eye and 6/18 in the right eye. Fundoscopy reveals the presence of yellow deposits in the right eye, consistent with drusen formation, albeit to a lesser extent. Similar changes are observed in the left eye. What is the most probable diagnosis?

      Your Answer: Dry age-related macular degeneration

      Explanation:

      Dry macular degeneration is characterized by the presence of drusen.

      Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.

      To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with anti-oxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.

      In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and anti-oxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.

    • This question is part of the following fields:

      • Ophthalmology
      524.2
      Seconds
  • Question 11 - A 72-year-old patient with chronic lymphocytic leukaemia presents to the emergency department with...

    Incorrect

    • A 72-year-old patient with chronic lymphocytic leukaemia presents to the emergency department with haematemesis. Urgent blood tests are taken and blood products ordered from the laboratory.

      A full blood count shows:

      Hb 76 g/L Male: (135-180) Female: (115 - 160)

      Platelets 26 * 109/L (150 - 400)

      WBC 21.8 * 109/L (4.0 - 11.0)

      Which blood product carries the highest risk for this immunocompromised patient?

      Your Answer: Packed red cells

      Correct Answer: Platelets

      Explanation:

      Platelet transfusions have the highest risk of bacterial contamination due to their short shelf life and refrigeration. This patient requires both red blood cells and platelets, but caution should be taken with platelet transfusions due to the risk of contamination. Cryoprecipitate and plasma have lower contamination risks and can be stored for longer periods. Packed red cells can also be used and have a longer shelf life.

      Platelet Transfusion Guidelines for Active Bleeding and Pre-Invasive Procedures

      Platelet transfusions are recommended for patients with thrombocytopenia and clinically significant bleeding, such as haematemesis, melaena, or prolonged epistaxis, with a platelet count of less than 30 x 10 9. For severe bleeding or bleeding at critical sites, such as the CNS, platelet thresholds for transfusion are higher, with a maximum of less than 100 x 10 9. However, it should be noted that platelet transfusions have a higher risk of bacterial contamination compared to other types of blood products.

      For pre-invasive procedures, platelet transfusions are recommended to maintain platelet levels of greater than 50 x 10 9/L for most patients, 50-75 x 10 9/L for those at high risk of bleeding, and greater than 100 x 10 9/L for surgeries at critical sites. However, if there is no active bleeding or planned invasive procedure, a threshold of 10 x 10 9/L is recommended, unless platelet transfusion is contraindicated or there are alternative treatments available for the patient’s condition.

      It is important to note that platelet transfusions should not be performed for chronic bone marrow failure, autoimmune thrombocytopenia, heparin-induced thrombocytopenia, or thrombotic thrombocytopenic purpura. These guidelines aim to provide appropriate and safe platelet transfusion practices for patients with thrombocytopenia.

    • This question is part of the following fields:

      • Haematology/Oncology
      312.7
      Seconds
  • Question 12 - A 6-year-old boy presents to his General Practitioner with his mother three weeks...

    Correct

    • A 6-year-old boy presents to his General Practitioner with his mother three weeks following his recent admission to the Paediatric Ward where he was treated for Kawasaki disease. He responded well to his treatment in the hospital.
      His mother asks if her son still needs to be taking the treatment prescribed by the Paediatric Team.
      Which of the following treatments is the patient likely to still be taking?

      Your Answer: Oral aspirin daily

      Explanation:

      Treatment Options for Kawasaki Disease: Understanding the Use of Aspirin

      Kawasaki disease is a condition that affects children and causes inflammation in the blood vessels throughout the body. When diagnosed, treatment typically involves intravenous immunoglobulin and aspirin. In this article, we will discuss the use of aspirin in the treatment of Kawasaki disease and why it is important.

      Oral aspirin is given to patients with Kawasaki disease due to its anti-inflammatory and antiplatelet properties. It helps to reduce the chances of blood clots if there are developing problems in the heart, such as coronary artery aneurysms that can occur in Kawasaki disease. The dosage of aspirin is usually higher (30 mg/kg per day) for up to two weeks and then continued at lower doses (3-5 mg/kg per day) until a review of echocardiogram, which is usually 6-8 weeks after the onset of illness.

      If the review echocardiogram at 6-8 weeks shows no evidence of any coronary artery aneurysms, then aspirin is usually stopped. However, until that time, patients with Kawasaki disease will continue to take oral aspirin daily.

      It is important to note that other non-steroidal anti-inflammatory medications such as ibuprofen should be avoided while taking aspirin. Additionally, oral steroids are a second-line treatment that are considered when there is failure to respond to initial intravenous immunoglobulin therapy.

      In conclusion, aspirin is an important part of the treatment for Kawasaki disease due to its anti-inflammatory and antiplatelet properties. Patients with Kawasaki disease will continue to take oral aspirin daily until a review echocardiogram shows no evidence of any coronary artery aneurysms. It is important to follow the treatment plan prescribed by a specialist to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Musculoskeletal
      33.9
      Seconds
  • Question 13 - In the differential diagnosis of cognitive decline, which of the following is the...

    Incorrect

    • In the differential diagnosis of cognitive decline, which of the following is the single most appropriate statement?

      Your Answer: Visual hallucinations are typical of Alzheimer's disease

      Correct Answer: In Creutzfeldt-Jakob disease an EEG may be characteristic

      Explanation:

      Misconceptions about Dementia: Debunking Common Myths

      Dementia is a complex and often misunderstood condition. Here are some common misconceptions about dementia that need to be debunked:

      1. In Creutzfeldt-Jakob disease an EEG may be characteristic: An EEG is abnormal in approximately 90% of cases of Creutzfeldt-Jakob disease, showing characteristic changes (i.e. periodic sharp wave complexes).

      2. A multi-infarct aetiology is more common than the Alzheimer disease type: Multi-infarct dementia is the second most common type of dementia in people aged over 65 years.

      3. A CT scan will reliably distinguish between Alzheimer disease and multi-infarct dementia: The diagnosis of both AD and multi-infarct dementia remains essentially a clinical one (and can only be definitively confirmed at autopsy).

      4. In Alzheimer disease a gait disorder is seen at an early stage: Gait disturbances are usually a late sign of AD.

      5. Visual hallucinations are typical of Alzheimer’s disease: Visual hallucinations, often very vivid and colourful, are typical of dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), not of AD.

    • This question is part of the following fields:

      • Neurology
      50.8
      Seconds
  • Question 14 - Which X-ray alteration is not linked to osteoarthritis? ...

    Correct

    • Which X-ray alteration is not linked to osteoarthritis?

      Your Answer: Periarticular erosions

      Explanation:

      X-Ray Changes in Osteoarthritis

      Osteoarthritis is a degenerative joint disease that affects millions of people worldwide. One of the most common diagnostic tools used to identify osteoarthritis is an X-ray. X-ray changes in osteoarthritis are characterized by the acronym LOSS, which stands for loss of joint space, osteophytes forming at joint margins, subchondral sclerosis, and subchondral cysts.

      Loss of joint space refers to the narrowing of the space between the bones in a joint. This occurs as the cartilage that cushions the joint wears away, causing the bones to rub against each other. Osteophytes are bony growths that form at the edges of the joint. These growths can cause pain and limit joint movement. Subchondral sclerosis is a hardening of the bone beneath the cartilage. This occurs as the bone tries to compensate for the loss of cartilage. Subchondral cysts are fluid-filled sacs that form in the bone beneath the cartilage. These cysts can cause pain and further damage to the joint.

      In summary, X-ray changes in osteoarthritis are characterized by LOSS: loss of joint space, osteophytes forming at joint margins, subchondral sclerosis, and subchondral cysts. These changes can help doctors diagnose and monitor the progression of osteoarthritis.

    • This question is part of the following fields:

      • Musculoskeletal
      57.8
      Seconds
  • Question 15 - A 55-year-old woman is brought into the Emergency Department with a sudden onset...

    Correct

    • A 55-year-old woman is brought into the Emergency Department with a sudden onset of severe back pain lasting 30 minutes. The pain is constant and not exacerbated by coughing or sneezing.
      On examination, the patient is in shock, with a palpable 7 cm mass deep in the epigastrium above the umbilicus. Her past medical history includes a 5 cm abdominal aortic aneurysm diagnosed three years ago at the time of appendectomy. The patient is a non-smoker and drinks one glass of wine a week.
      What is the most likely diagnosis?

      Your Answer: Rupturing abdominal aortic aneurysm

      Explanation:

      Possible Causes of Sudden-Onset Severe Back Pain: A Differential Diagnosis

      Sudden-onset severe back pain can be a sign of various medical conditions. In the case of a male patient with increasing age and a known history of abdominal aortic aneurysm, a rupturing aortic aneurysm should be suspected until proven otherwise. This suspicion is supported by the presence of shock, a large palpable mass deep in the epigastrium, and severe back pain that may radiate to the abdomen. The risk of rupture increases with the size of the aneurysm, and blood initially leaks into the retroperitoneal space before spilling into the peritoneal cavity.

      Other possible causes of sudden-onset severe back pain include acute cholecystitis, which is unlikely in a patient who had a previous cholecystectomy. Acute pancreatitis may also cause epigastric pain that radiates to the back, but this condition is usually accompanied by vomiting and diarrhea, and the patient does not have significant risk factors for it. Renal colic, which is characterized by acute severe pain that radiates from the loin to the groin, may cause tachycardia but is less likely in a patient who is haemodynamically unstable and has a known large AAA. Herniated lumbar disc, which may cause back pain that worsens with coughing or sneezing and radiates down the leg, is also less likely in this case.

      Therefore, a rupturing abdominal aortic aneurysm is the most probable cause of the patient’s sudden-onset severe back pain, and urgent management is necessary to prevent further complications.

    • This question is part of the following fields:

      • Cardiovascular
      61.5
      Seconds
  • Question 16 - A 35-year-old woman presents to your clinic with a history of recurrent episodes...

    Correct

    • A 35-year-old woman presents to your clinic with a history of recurrent episodes of dizziness characterized by a sensation of the entire room spinning around her. She reports feeling nauseous during these episodes but denies any hearing disturbance or tinnitus. The dizziness is not exacerbated by head movement and lasts for approximately 4-5 hours, with complete resolution in between episodes. She recalls having a viral illness the week prior to the onset of her symptoms. What is the most probable diagnosis?

      Your Answer: Vestibular neuronitis

      Explanation:

      Patients with vestibular neuronitis experience recurrent episodes of vertigo lasting for hours to days, often accompanied by nausea. Unlike other causes of vertigo, there is no hearing loss, tinnitus, or neurological symptoms. Meniere’s disease, on the other hand, presents with vertigo, hearing loss, and tinnitus. Benign paroxysmal positional vertigo is characterized by brief episodes of vertigo triggered by head movement, while acoustic neuromas typically present with hearing loss, tinnitus, and facial nerve palsy. Vertebrobasilar insufficiency, which occurs in elderly patients, is associated with neck pain and symptoms triggered by head movement.

      Understanding Vestibular Neuronitis

      Vestibular neuronitis is a type of vertigo that typically occurs after a viral infection. It is characterized by recurrent episodes of vertigo that can last for hours or days, accompanied by nausea and vomiting. Horizontal nystagmus, or involuntary eye movements, is a common symptom, but there is usually no hearing loss or tinnitus.

      It is important to distinguish vestibular neuronitis from other conditions that can cause similar symptoms, such as viral labyrinthitis or posterior circulation stroke. The HiNTs exam can be used to differentiate between vestibular neuronitis and stroke.

      Treatment for vestibular neuronitis may involve medications such as prochlorperazine or antihistamines to alleviate symptoms. However, vestibular rehabilitation exercises are often the preferred treatment for patients with chronic symptoms. These exercises can help to retrain the brain and improve balance and coordination. With proper management, most people with vestibular neuronitis can recover fully and resume their normal activities.

    • This question is part of the following fields:

      • ENT
      66.1
      Seconds
  • Question 17 - As the medical doctor on call, a 23-year-old woman presents to the emergency...

    Correct

    • As the medical doctor on call, a 23-year-old woman presents to the emergency department with a 4-day history of loose stools, abdominal pain, and fatigue. She reports having bowel movements an average of 8 times a day, and in the last 24 hours, she has noticed blood mixed in with the stools. The patient has a medical history of ulcerative colitis, which is typically well controlled with rectal mesalazine. She has no allergies or other medical conditions.

      Upon examination, the patient's blood pressure is 100/60 mmHg, heart rate is 95 beats per minute, respiratory rate is 16/min, oxygen saturation is 96%, and temperature is 37.9 ºC. Heart sounds are normal, chest is clear, and the abdomen is soft with localized tenderness in the left iliac fossa. There is no guarding or peritonism, and bowel sounds are audible.

      The patient's Hb is 102 g/L (normal range for females: 115-160), platelets are 398 * 109/L (normal range: 150-400), WBC is 13.2 * 109/L (normal range: 4.0-11.0), Na is 140 mmol/L (normal range: 135-145), K is 3.8 mmol/L (normal range: 3.5-5.0), urea is 4.6 mmol/L (normal range: 2.0-7.0), creatinine is 95 µmol/L (normal range: 55-120), and CRP is 35 mg/L (normal range: <5). Based on these findings, a flare of ulcerative colitis is suspected.

      What is the appropriate management plan for this patient?

      Your Answer: Admit + IV hydrocortisone

      Explanation:

      Ulcerative colitis can be managed through inducing and maintaining remission. The severity of the condition is classified as mild, moderate, or severe based on the number of stools and presence of systemic upset. Treatment for mild-to-moderate cases of proctitis involves using topical aminosalicylate, while proctosigmoiditis and left-sided ulcerative colitis may require a combination of oral and topical medications. Extensive disease may require a high-dose oral aminosalicylate and topical treatment. Severe colitis should be treated in a hospital with intravenous steroids or ciclosporin. Maintaining remission can involve using a low maintenance dose of an oral aminosalicylate or oral azathioprine/mercaptopurine. Methotrexate is not recommended, but probiotics may prevent relapse in mild to moderate cases.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      174.6
      Seconds
  • Question 18 - A 4-year-old boy is brought to see his General Practitioner by his mother...

    Correct

    • A 4-year-old boy is brought to see his General Practitioner by his mother who is concerned that he has had diarrhoea for three days. He has been experiencing 2–3 loose, watery stools every day. He has also vomited twice at the onset of the illness but not since.
      On examination, he is afebrile and well hydrated. His abdomen is soft and nontender. The family recently returned from a trip to Australia. While away, the patient was admitted to hospital for two days with a lower respiratory tract infection.
      Which of the patient’s features is most likely to indicate the need for a stool sample for culture and sensitivity?
      Select the SINGLE factor from the list below.

      Your Answer: The recent hospital admission

      Explanation:

      Assessing the Need for Stool Culture in a Child with Gastroenteritis

      Gastroenteritis is a common illness characterized by diarrhea, abdominal pain, and nausea. In most cases, it is caused by a viral, bacterial, or parasitic infection and is self-limiting. However, recent hospital admission or antibiotic treatment can increase the risk of Clostridium difficile toxin as the cause, making stool culture necessary. Additionally, patients who have recently traveled to certain countries or are under the age of five and attend nursery, pre-school, or school may require stool culture. If symptoms persist beyond seven days or if there is blood or mucus in the stool, stool samples should be taken. Vomiting is not a red-flag feature unless it leads to dehydration. Parents should be given safety-net advice on when to seek further medical attention if their child’s condition worsens.

    • This question is part of the following fields:

      • Infectious Diseases
      56.4
      Seconds
  • Question 19 - A 68-year-old man has been taking medication for psoriasis with arthropathy for a...

    Correct

    • A 68-year-old man has been taking medication for psoriasis with arthropathy for a prolonged period. He has recently experienced a dry cough and worsening shortness of breath with minimal activity.
      Which of the following medications is the most probable cause of his symptoms?
      Choose ONE option from the list provided.

      Your Answer: Methotrexate

      Explanation:

      Identifying the Probable Cause of Pulmonary Fibrosis

      Methotrexate is the correct answer as it is a well-known drug-related cause of pulmonary fibrosis, which is the probable cause of the patient’s symptoms. Hydroxychloroquine, azathioprine, ciclosporin, and penicillamine are not known to cause pulmonary fibrosis, although some of them have the potential to cause pneumonitis. Ciclosporin has been studied as a treatment for the disease, but it is not recommended by NICE. Therefore, it is important to identify the probable cause of pulmonary fibrosis to provide appropriate treatment and prevent further complications.

    • This question is part of the following fields:

      • Respiratory Medicine
      45.1
      Seconds
  • Question 20 - In the UK, which malignancy is most frequently diagnosed in women? ...

    Correct

    • In the UK, which malignancy is most frequently diagnosed in women?

      Your Answer: Breast cancer

      Explanation:

      Most Common Cancers in Women in the UK

      Breast cancer is the most frequently diagnosed cancer in women in the UK, with approximately 54,800 cases in 2014. Lung cancer follows as the second most common cancer in women, with around 21,600 cases diagnosed in the same year. Bowel cancer ranks third, with approximately 18,400 cases diagnosed in 2014. Uterine cancer is the fourth most common cancer in women, with around 9,300 cases diagnosed. Leukaemia is the eleventh most common cancer in women, with approximately 3,800 cases diagnosed in 2014. These statistics are according to Cancer Research UK.

    • This question is part of the following fields:

      • Haematology/Oncology
      11
      Seconds

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Psychiatry (1/1) 100%
Paediatrics (1/2) 50%
Cardiovascular (2/2) 100%
Ophthalmology (1/2) 50%
Neurology (2/3) 67%
Endocrinology/Metabolic Disease (0/1) 0%
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Musculoskeletal (2/2) 100%
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Gastroenterology/Nutrition (1/1) 100%
Infectious Diseases (1/1) 100%
Respiratory Medicine (1/1) 100%
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