00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 68-year-old man is being evaluated in the Cardiac Unit. He has developed...

    Incorrect

    • A 68-year-old man is being evaluated in the Cardiac Unit. He has developed a ventricular tachycardia of 160 bpm, appears ill, and has a blood pressure of 70/52 mmHg. What would be the most immediate treatment option?

      Your Answer: Intravenous lidocaine

      Correct Answer: DC cardioversion

      Explanation:

      Treatment Options for Ventricular Arrhythmia: Evaluating the Choices

      When faced with a patient experiencing ventricular arrhythmia, it is important to consider the appropriate treatment options. In the scenario of a broad complex tachycardia with low blood pressure, immediate DC cardioversion is the clear choice. Carotid sinus massage and IV adenosine are not appropriate options as they are used in the diagnosis and termination of SVT. Immediate heparinisation is not the immediate treatment for ventricular arrhythmia. Intravenous lidocaine may be considered if the VT is haemodynamically stable, but in this scenario, it cannot be the correct answer choice. It is important to carefully evaluate the available options and choose the most appropriate treatment for the patient’s specific condition.

    • This question is part of the following fields:

      • Cardiology
      17.9
      Seconds
  • Question 2 - A patient is rushed into the Emergency department after being attacked with a...

    Correct

    • A patient is rushed into the Emergency department after being attacked with a baseball bat by an unknown assailant. The patient is unconscious and in critical condition. An urgent CT scan is ordered and reveals the presence of a subdural hematoma. The scan also shows a fracture through the left pterion.

      Which blood vessel is likely responsible for the bleeding in this case?

      Your Answer: Anterior branch of the middle meningeal artery

      Explanation:

      The Pterion: A Clinically Significant Area of the Skull

      The pterion is a region of the skull where four bones – the frontal, parietal, temporal, and sphenoidal bones – meet. It is considered the weakest part of the skull and is of great clinical significance. This is because it is located above the anterior branch of the middle meningeal artery, which is a branch of the maxillary artery. Injuries to the maxillary artery can occur following facial bone or maxillary injuries, while injuries to the posterior auricular artery can occur following neck or ear trauma. The middle cerebral arteries are also often involved in stroke. the location and significance of the pterion is important for medical professionals in diagnosing and treating various head injuries.

    • This question is part of the following fields:

      • Clinical Sciences
      8.5
      Seconds
  • Question 3 - A 72-year-old male patient arrives in hospital with a hip fracture. His wife...

    Correct

    • A 72-year-old male patient arrives in hospital with a hip fracture. His wife mentions that he drinks around two bottles of wine per day. He is prescribed chlordiazepoxide, a benzodiazepine, for alcohol withdrawal.
      What is the reason for using this medication in this situation?

      Your Answer: Alcohol withdrawal leads to gamma-aminobutyric acid (GABA) deficiency; benzodiazepines facilitate GABA-A binding to its receptor

      Explanation:

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

    • This question is part of the following fields:

      • Pharmacology
      18.2
      Seconds
  • Question 4 - A 78-year-old man with atrial fibrillation was admitted to hospital with a fractured...

    Correct

    • A 78-year-old man with atrial fibrillation was admitted to hospital with a fractured neck of femur. He was maintained on digoxin 187.5 μg daily. On examination, his pulse was 70 bpm and his blood pressure was 124/76 mmHg. He was fully conscious.
      Investigation: plasma digoxin (taken at least 6 hours post-dose) 2.5 nmol/l (1.0–2.0)
      What is the most appropriate action regarding his digoxin dosage?

      Your Answer: Reduce digoxin to 125 μg and retest the serum level in a few days

      Explanation:

      Managing Digoxin Toxicity in Patients: Options and Considerations

      Digoxin therapy requires careful monitoring due to its narrow therapeutic window. Patients on digoxin should have their plasma levels tested regularly, with desired levels ranging from 0.8-2 ng/ml. Toxicity is defined as levels exceeding 2 nmol/l. The most common cause of digoxin toxicity is hypokalemia in patients with heart failure on diuretic therapy.

      Signs of digoxin toxicity include central nervous system-related symptoms, cardiac-related symptoms, gastrointestinal-related symptoms, and vision changes. However, in cases where patients are rate-controlled and display no symptoms of toxicity, reducing the dose of digoxin and retesting levels in a few days may be adequate.

      In cases where it is difficult to maintain therapeutic levels, switching to atenolol or another β blocker for rate control may be an option. Giving a loading dose of digoxin or increasing the daily dose is not advised as it can exacerbate toxicity.

      In cases where patients exhibit symptoms of cardiac toxicity, treatment with digoxin Fab fragments may be necessary. However, emergency treatment with haemodialysis to lower digoxin levels is not required unless the patient is experiencing cardiac instability. Overall, careful monitoring and prompt intervention are crucial in managing digoxin toxicity in patients.

    • This question is part of the following fields:

      • Pharmacology
      24.4
      Seconds
  • Question 5 - A 32-year-old woman confides in you that she experienced childhood sexual abuse. Which...

    Correct

    • A 32-year-old woman confides in you that she experienced childhood sexual abuse. Which one of the following features is not a characteristic feature of post-traumatic stress disorder?

      Your Answer: Loss of inhibitions

      Explanation:

      Understanding Post-Traumatic Stress Disorder (PTSD)

      Post-traumatic stress disorder (PTSD) is a mental health condition that can develop in individuals of any age following a traumatic event. This can include experiences such as natural disasters, accidents, or even childhood abuse. PTSD is characterized by a range of symptoms, including re-experiencing the traumatic event through flashbacks or nightmares, avoidance of situations or people associated with the event, hyperarousal, emotional numbing, depression, and even substance abuse.

      Effective management of PTSD involves a range of interventions, depending on the severity of the symptoms. Single-session interventions are not recommended, and watchful waiting may be used for mild symptoms lasting less than four weeks. Military personnel have access to treatment provided by the armed forces, while trauma-focused cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR) therapy may be used in more severe cases.

      It is important to note that drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used, venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline, should be tried. In severe cases, NICE recommends that risperidone may be used. Overall, understanding the symptoms and effective management of PTSD is crucial in supporting individuals who have experienced traumatic events.

    • This question is part of the following fields:

      • Psychiatry
      12.5
      Seconds
  • Question 6 - A 16-year-old male undergoes an elective right hemicolectomy. During the 24-hour postoperative period,...

    Incorrect

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

      Your Answer: Hypochloraemic alkalosis

      Correct Answer: Hyperchloraemiac acidosis.

      Explanation:

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

      Guidelines for Post-Operative Fluid Management

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

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

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

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

    • This question is part of the following fields:

      • Surgery
      19
      Seconds
  • Question 7 - A 5-year-old girl, who has been wetting the bed at night attends surgery...

    Correct

    • A 5-year-old girl, who has been wetting the bed at night attends surgery today with her grandfather, as her mother is at work. Her grandfather is worried because it was also an issue for her older sister, who is 10-years-old and she is prescribed desmopressin. The girl in front of you is otherwise well and her bowels open regularly. An examination is unremarkable and she has a soft non-tender abdomen.
      What recommendations would you make?

      Your Answer: Reassurance and general advice

      Explanation:

      Reassurance and advice can be provided to manage nocturnal enuresis in children under the age of 5 years.

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

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

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

    • This question is part of the following fields:

      • Paediatrics
      23.7
      Seconds
  • Question 8 - A 15-year-old patient, with learning difficulties and poorly controlled epilepsy, is admitted following...

    Incorrect

    • A 15-year-old patient, with learning difficulties and poorly controlled epilepsy, is admitted following a tonic−clonic seizure which resolved after the administration of lorazepam by a Casualty officer. Twenty minutes later, a further seizure occurred that again ceased with lorazepam. A further 10 minutes later, another seizure takes place.
      What commonly would be the next step in the management of this patient?

      Your Answer: Admission to the intensive care unit (ICU)

      Correct Answer: Phenytoin

      Explanation:

      Managing Status Epilepticus: Medications and Treatment Options

      Epilepsy is a manageable condition for most patients, but in some cases, seizures may not self-resolve and require medical intervention. In such cases, benzodiazepines like rectal diazepam or intravenous lorazepam are commonly used. However, if seizures persist, other drugs like iv phenytoin may be administered. Paraldehyde is rarely used, and topiramate is more commonly used for seizure prevention. If a patient experiences status epilepticus, informing the intensive care unit may be appropriate, but the priority should be to stop the seizure with appropriate medication.

    • This question is part of the following fields:

      • Neurology
      18
      Seconds
  • Question 9 - A 25-year-old veterinary student is being evaluated for possible Addison's disease due to...

    Correct

    • A 25-year-old veterinary student is being evaluated for possible Addison's disease due to symptoms of weight loss, hypotension, and fatigue. As part of the diagnostic process, the patient undergoes testing to measure cortisol levels before and after receiving synthetic adrenocorticotropic hormone (ACTH) injection (short-synacthen test). What is a true statement regarding cortisol in this scenario?

      Your Answer: It has a peak hormonal concentration in the morning

      Explanation:

      Misconceptions about Cortisol: Clarifying the Facts

      Cortisol is a hormone that has been the subject of many misconceptions. Here are some clarifications to set the record straight:

      1. Peak Hormonal Concentration: Cortisol has a diurnal variation and peaks in the morning upon waking up. Its lowest level is around midnight.

      2. Protein or Steroid: Cortisol is a steroid hormone, not a protein.

      3. Blood Glucose: Cortisol increases blood glucose levels via various pathways, contrary to the belief that it lowers blood glucose.

      4. Anabolic or Catabolic: Cortisol is a catabolic hormone that causes a breakdown of larger molecules to smaller molecules.

      5. Stimulated by Renin or ACTH: Cortisol is stimulated by adrenocorticotropic hormone (ACTH) released from the anterior pituitary, not renin.

      By understanding the true nature of cortisol, we can better appreciate its role in our bodies and how it affects our health.

    • This question is part of the following fields:

      • Endocrinology
      11.6
      Seconds
  • Question 10 - A 75-year-old woman is admitted to a medical ward and the medical team...

    Incorrect

    • A 75-year-old woman is admitted to a medical ward and the medical team is concerned about her mental health in addition to her urgent medical needs. The patient is refusing treatment and insisting on leaving. The team suspects that she may be mentally incapacitated and unable to make an informed decision. Under which section of the Mental Health Act (MHA) can they legally detain her in England and Wales?

      Your Answer: Section 2

      Correct Answer: Section 5 (2)

      Explanation:

      Section 5 (2) of the MHA allows a doctor to detain a patient for up to 72 hours for assessment. This can be used for both informal patients in mental health hospitals and general hospitals. During this time, the patient is assessed by an approved mental health professional and a doctor with Section 12 approval. The patient can refuse treatment, but it can be given in their best interests or in an emergency. Section 2 and 3 can only be used if they are the least restrictive method for treatment and allow for detention for up to 28 days and 6 months, respectively. Section 135 allows police to remove a person from their home for assessment, while Section 136 allows for the removal of an apparently mentally disordered person from a public place to a place of safety for assessment. Since the patient in this scenario is already in hospital, neither Section 135 nor Section 136 would apply.

    • This question is part of the following fields:

      • Psychiatry
      15.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (0/1) 0%
Clinical Sciences (1/1) 100%
Pharmacology (2/2) 100%
Psychiatry (1/2) 50%
Surgery (0/1) 0%
Paediatrics (1/1) 100%
Neurology (0/1) 0%
Endocrinology (1/1) 100%
Passmed