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Question 1
Incorrect
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A 68-year-old man is experiencing insomnia and is prescribed temazepam. What is the mechanism of action of temazepam?
Your Answer: Inhibits the effect of acetylcholine
Correct Answer: Enhances the effect of gamma-aminobutyric acid
Explanation:The primary inhibitory neurotransmitter, GABA, is amplified by benzodiazepines.
Benzodiazepines are drugs that enhance the effect of the neurotransmitter GABA, which inhibits brain activity. They are used for various purposes, including sedation, anxiety relief, muscle relaxation, and seizure prevention. However, patients can develop a tolerance and dependence on these drugs, so they should only be prescribed for a short period of time. When withdrawing from benzodiazepines, it is important to do so gradually to avoid withdrawal symptoms, which can include insomnia, anxiety, and seizures. Barbiturates are another type of drug that affect GABA, but they work differently than benzodiazepines by increasing the duration of chloride channel opening.
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This question is part of the following fields:
- Psychiatry
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Question 2
Incorrect
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A 9-year-old girl comes to the clinic with a one-month history of unusual facial movements noticed by her father. Her father reports that he first noticed her having twitching of left eye and face as well as drooling of saliva. This happens about twice a week, always at night. Each episode lasts for 1-2 minutes and after each episode, the girl is unable to speak properly for around 5 minutes. The girl is aware of these occurrences but reports unable to control them. The father reports that his daughter is otherwise normal with normal development.
What is the diagnosis?Your Answer: Idiopathic childhood occipital epilepsy of Gastaut
Correct Answer: Benign rolandic epilepsy
Explanation:Benign rolandic epilepsy is identified by the occurrence of partial seizures during the night.
The child displays typical indications of benign rolandic epilepsy, which is distinguished by partial seizures that occur during the night. Reflex anoxic seizures are caused by anoxia and typically manifest as syncope and subsequent convulsions in very young children. Panayiotopoulos syndrome is characterised by seizures, often prolonged, with predominantly autonomic symptoms such as nausea and retching. Idiopathic childhood occipital epilepsy of Gastaut is mainly characterised by visual hallucinations. Night terrors are a sleep disorder that causes feelings of dread or terror, typically during REM sleep.
Benign rolandic epilepsy is a type of epilepsy that usually affects children between the ages of 4 and 12 years. This condition is characterized by seizures that typically occur at night and are often partial, causing sensations in the face. However, these seizures may also progress to involve the entire body. Despite these symptoms, children with benign rolandic epilepsy are otherwise healthy and normal.
Diagnosis of benign rolandic epilepsy is typically confirmed through an electroencephalogram (EEG), which shows characteristic centrotemporal spikes. Fortunately, the prognosis for this condition is excellent, with seizures typically ceasing by adolescence. While the symptoms of benign rolandic epilepsy can be concerning for parents and caregivers, it is important to remember that this condition is generally not associated with any long-term complications or developmental delays.
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This question is part of the following fields:
- Paediatrics
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Question 3
Incorrect
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An 80-year-old man visits a memory clinic accompanied by his daughter. He has a medical history of hypertension and is a former smoker. The daughter reports that he had been stable for several months before experiencing sudden declines on multiple occasions. The physical examination is normal, and his MoCA score is 18 out of 30. He denies experiencing any visual or auditory hallucinations. What is the probable underlying diagnosis?
Your Answer:
Correct Answer: Vascular dementia
Explanation:The gradual decline in cognitive function, along with hypertension and smoking as risk factors for cerebrovascular disease, suggest a diagnosis of vascular dementia. This type of dementia is caused by damage to the brain from reduced blood flow or bleeding due to cerebrovascular disease. In contrast, Alzheimer’s dementia progresses slowly over time, while frontotemporal dementia affects personality, behavior, language, and attention. Lewy body dementia is characterized by hallucinations and Parkinsonian symptoms, while Parkinson’s dementia occurs in patients with Parkinson’s disease and affects their mental function and memory, along with physical signs of PD.
Understanding Vascular Dementia: Causes, Symptoms, and Management
Vascular dementia is a type of cognitive impairment that is caused by different mechanisms resulting from cerebrovascular disease. It is the second most common form of dementia after Alzheimer’s disease. Vascular dementia is often recognized as the most severe form of the spectrum of deficits encompassed by the term vascular cognitive impairment. Early detection and an accurate diagnosis are crucial in preventing vascular dementia.
The prevalence of vascular dementia is estimated to be around 17% of dementia cases in the UK. The incidence of vascular dementia increases with age and is often associated with a history of stroke or transient ischemic attack, atrial fibrillation, hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, coronary heart disease, and a family history of stroke or cardiovascular disease. Rarely, vascular dementia can be inherited as in the case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
Patients with vascular dementia typically present with a sudden or stepwise deterioration of cognitive function, focal neurological abnormalities, difficulty with attention and concentration, seizures, memory disturbance, gait disturbance, speech disturbance, and emotional disturbance. Diagnosis is made based on a comprehensive history and physical examination, formal screening for cognitive impairment, medical review to exclude medication cause of cognitive decline, and MRI scan.
Treatment for vascular dementia is mainly symptomatic with the aim to address individual problems and provide support to the patient and carers. It is important to detect and address cardiovascular risk factors to slow down the progression of the disease. Non-pharmacological management is tailored to the individual and may include cognitive stimulation programs, multisensory stimulation, music and art therapy, and animal-assisted therapy. Pharmacological management is limited, and there is no specific pharmacological treatment approved for cognitive symptoms. Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies. There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia, and no randomized trials have evaluated statins for vascular dementia.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A 28-year-old female presents to the ENT specialists with a 1-month-history of severe otalgia, temporal headaches, and purulent otorrhoea. She has a medical history of type one diabetes mellitus and no allergies. On examination, the left external auditory canal and periauricular soft tissue are erythematous and tender. What is the most suitable antibiotic treatment for this patient?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:For patients with diabetes who present with otitis externa, it is important to consider the possibility of malignant otitis externa, which is a severe bacterial infection that can spread to the bony ear canal and cause osteomyelitis. Pseudomonas aeruginosa is the most common cause of this condition, so treatment should involve coverage for this bacteria. Intravenous ciprofloxacin is the preferred antibiotic for this purpose. It is also important to note that diabetic patients with non-malignant otitis externa should also be treated with ciprofloxacin due to their increased risk of developing malignant otitis externa. Clarithromycin and flucloxacillin are not appropriate choices for this condition, and leaving the infection untreated can lead to serious complications.
Malignant Otitis Externa: A Rare but Serious Infection
Malignant otitis externa is a type of ear infection that is uncommon but can be serious. It is typically found in individuals who are immunocompromised, with 90% of cases occurring in diabetics. The infection starts in the soft tissues of the external auditory meatus and can progress to involve the soft tissues and bony ear canal, eventually leading to temporal bone osteomyelitis.
When diagnosing malignant otitis externa, doctors will typically perform a CT scan. Key features in a patient’s medical history include diabetes or immunosuppression, severe and unrelenting ear pain, temporal headaches, and purulent otorrhea. In some cases, patients may also experience dysphagia, hoarseness, and/or facial nerve dysfunction.
If a patient presents with non-resolving otitis externa and worsening pain, they should be referred urgently to an ear, nose, and throat specialist. Treatment typically involves intravenous antibiotics that cover pseudomonal infections.
Overall, while malignant otitis externa is rare, it is important to be aware of its symptoms and risk factors, particularly in immunocompromised individuals. Early diagnosis and treatment can help prevent the infection from progressing and causing more serious complications.
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This question is part of the following fields:
- ENT
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Question 5
Incorrect
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A 35-year-old woman presents with a 7-day history of mucopurulent anal discharge, bloody stool and pain during defecation. She denies any recent travel and has not experienced any vomiting episodes.
Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Gonorrhoea
Explanation:Sexually Transmitted Infections: Differential Diagnosis
Sexually transmitted infections (STIs) are a common cause of morbidity worldwide. When evaluating a patient with symptoms suggestive of an STI, it is important to consider a broad differential diagnosis. Here are some common STIs and their clinical presentations:
Gonorrhoea: This is a purulent infection of the mucous membranes caused by Neisseria gonorrhoeae. In men, symptoms include urethritis, acute epididymitis, and rectal infection. A diagnosis can be made by identifying typical Gram-negative intracellular diplococci after a Gram stain.
Crohn’s disease: This is an inflammatory bowel disease that presents with prolonged diarrhea, abdominal pain, anorexia, and weight loss. It is not consistent with a typical STI presentation.
Candidiasis: This is a fungal infection caused by yeasts from the genus Candida. It is associated with balanitis, presenting with penile pruritus and whitish patches on the penis.
Salmonella infection: This is often transmitted orally via contaminated food or beverages. Symptoms include a severe non-specific febrile illness, which can be confused with typhoid fever. There is nothing in this clinical scenario to suggest Salmonella infection.
Chancroid: This is a bacterial STI caused by Haemophilus ducreyi. It is characterised by painful necrotising genital ulcers and inguinal lymphadenopathy.
In summary, a thorough differential diagnosis is important when evaluating patients with symptoms suggestive of an STI.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A 6-year-old girl presents to the Emergency Department with bloody diarrhoea, vomiting and fever. Her siblings and parents have also had similar symptoms after attending a birthday party at a local park. Her stool sample is positive for E. Coli and the Paediatric Team are concerned that she has haemolytic uraemic syndrome (HUS) secondary to this infection.
Which of the following results are most likely to be found if this patient is suffering from HUS?
Your Answer:
Correct Answer: Acute renal failure, low platelets, low haemoglobin
Explanation:Haemolytic uraemic syndrome (HUS) is a condition characterized by the simultaneous occurrence of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. This set of blood tests shows all three of these symptoms, indicating a possible diagnosis of HUS. HUS is most commonly found in children, with 90% of cases caused by Shiga toxin-producing E. coli. However, a patient with normal renal function and high platelet count is unlikely to have HUS, as low platelet count is a typical symptom. If a patient has ongoing diarrhoea or vomiting due to E. coli infection, they may require intravenous fluids to support their renal function. A raised haemoglobin level is not expected in HUS, as patients usually have reduced haemoglobin due to microangiopathic haemolytic anaemia. Additionally, HUS typically causes thrombocytopenia, not high platelet count. In some cases, children with HUS may require platelet transfusion.
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This question is part of the following fields:
- Renal Medicine/Urology
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Question 7
Incorrect
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A neonate is diagnosed with a cardiac congenital abnormality where the foetal aorta and pulmonary trunk are parallel with an absence of crossing. What medication should be initiated urgently before corrective surgery can be performed?
Your Answer:
Correct Answer: Prostaglandin E1
Explanation:The initial management for duct dependent congenital heart disease involves maintaining the ductus arteriosus with prostaglandins. In neonates with transposition of the great arteries (TGA), prostaglandin E1 is given intravenously to ensure the ductus arteriosus remains open, as its closure can lead to circulatory failure and profound cyanosis. Prostaglandins work by dilating vascular smooth muscle, which maintains the patency of the ductus arteriosus. Administering prostaglandins after delivery is necessary as the prostaglandin-rich placenta is no longer present to keep the ductus arteriosus open. Adenosine is not indicated in this case, as the newborn’s issue is circulatory rather than related to cardiac electrical activity. If heart failure occurs, angiotensin-converting enzyme (ACE) inhibitors may be used, but prostaglandins should be the first-line treatment to prevent heart failure. Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as they inhibit prostaglandin synthesis, leading to closure of the ductus arteriosus and likely death of the newborn. Prostaglandin E is the most potent type of prostaglandin responsible for maintaining ductus arteriosus patency, not prostaglandin F2.
Understanding Transposition of the Great Arteries
Transposition of the great arteries (TGA) is a type of congenital heart disease that results in a lack of oxygenated blood flow to the body. This condition occurs when the aorticopulmonary septum fails to spiral during septation, causing the aorta to leave the right ventricle and the pulmonary trunk to leave the left ventricle. Children born to diabetic mothers are at a higher risk of developing TGA.
The clinical features of TGA include cyanosis, tachypnea, a loud single S2 heart sound, and a prominent right ventricular impulse. Chest x-rays may show an egg-on-side appearance.
To manage TGA, it is important to maintain the ductus arteriosus with prostaglandins. Surgical correction is the definitive treatment for this condition. Understanding the basic anatomical changes and clinical features of TGA can help with early diagnosis and appropriate management.
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This question is part of the following fields:
- Paediatrics
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Question 8
Incorrect
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A 15-year-old student presents to his General Practitioner with symptoms of tingling and irritation in his mouth and throat on two or three occasions in the past year. Most recently, he suffered from swelling of his throat and difficulty breathing after receiving a local anaesthetic for tooth extraction at the dentist. He reports that his father died of a suspected allergic reaction when he was 42 years old.
Investigations reveal the following:
Investigation Result Normal value
Haemoglobin (Hb) 129 g/l 135–175 g/l
White cell count (WCC) 6.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 341 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate (ESR) 5 mm/hour 1–20 mm/hour
Patch testing Mild reaction to grass pollens
C4 Low
C3 Normal
Which of the following is the most likely diagnosis in this case?Your Answer:
Correct Answer: Hereditary angio-oedema
Explanation:The correct diagnosis for this patient is hereditary angio-oedema, also known as hereditary angioneurotic oedema. This is an autosomal dominant disorder caused by a congenital deficiency of the C1 inhibitor protein, which is mapped to chromosome 11. In some cases, C1 inhibitor levels are normal but have reduced function. Symptoms typically appear during adolescence and include recurrent attacks of pain, tingling, or itching, particularly around the mouth and pharynx, which may be triggered by increased circulating sex steroids or dental anaesthesia using lidocaine. Diagnosis is made by measuring complement levels, with C4 always low during attacks and often low in between, while C3 and C1q are always normal. Treatment involves using C1 inhibitor concentrate during acute attacks and danazol to increase C4 levels and reduce the frequency and severity of attacks. ACE inhibitors are contraindicated due to the risk of bradykinin accumulation. Acquired angio-oedema, which is caused by an acquired C1 inhibitor deficiency and is associated with lymphoproliferative disorders, is a different condition. Protein C deficiency is a genetic prothrombotic condition that does not explain this patient’s symptoms, and somatisation disorder is unlikely given the clear test abnormalities related to the patient’s symptoms.
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This question is part of the following fields:
- Immunology/Allergy
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Question 9
Incorrect
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A 28-year-old female patient presents to her GP complaining of a foul-smelling vaginal discharge that has persisted for 5 days after having unprotected sex. She reports feeling generally well and denies any fever or urinary symptoms. The patient also confirms that she is not pregnant. During the examination, the doctor observes multiple punctate lesions on her cervix and a green discharge with a strong odor. What is the probable diagnosis?
Your Answer:
Correct Answer: Trichomoniasis
Explanation:The patient is likely suffering from trichomoniasis caused by Trichomonas vaginalis, a sexually transmitted disease that results in a yellow/green discharge with a foul odor, vulval itching, and dysuria. During a speculum examination, the cervix may appear as a strawberry cervix due to multiple punctate haemorrhages. Bacterial vaginosis, which is not a sexually transmitted disease and can be caused by various factors, is less likely to be the diagnosis due to the recent unprotected sexual intercourse and the presence of an offensive discharge. Chlamydia and gonorrhoea, both sexually transmitted diseases, can also cause dysuria and vaginal discharge, but the punctate cervical haemorrhages and malodorous green discharge make them less likely diagnoses. Syphilis, which presents in three stages, is unlikely due to the acute onset of symptoms and the absence of genital lesions.
Understanding Trichomonas vaginalis and its Comparison to Bacterial Vaginosis
Trichomonas vaginalis is a type of protozoan parasite that is highly motile and flagellated. It is known to cause trichomoniasis, which is a sexually transmitted infection. The infection is characterized by symptoms such as offensive, yellow/green, frothy vaginal discharge, vulvovaginitis, and strawberry cervix. The pH level is usually above 4.5, and in men, it may cause urethritis.
To diagnose trichomoniasis, a wet mount microscopy is conducted to observe the motile trophozoites. The treatment for trichomoniasis involves oral metronidazole for 5-7 days, although a one-off dose of 2g metronidazole may also be used.
When compared to bacterial vaginosis, trichomoniasis has distinct differences. Bacterial vaginosis is caused by an overgrowth of bacteria in the vagina, while trichomoniasis is caused by a protozoan parasite. The symptoms of bacterial vaginosis include a thin, grayish-white vaginal discharge with a fishy odor, and a pH level above 4.5. Unlike trichomoniasis, bacterial vaginosis is not considered a sexually transmitted infection.
In conclusion, understanding the differences between trichomoniasis and bacterial vaginosis is crucial in diagnosing and treating these conditions effectively. Proper diagnosis and treatment can help prevent complications and improve overall health and well-being.
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This question is part of the following fields:
- Reproductive Medicine
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Question 10
Incorrect
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Which one of the following clinical features would be least consistent with a diagnosis of severe pre-eclampsia?
Your Answer:
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.
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This question is part of the following fields:
- Reproductive Medicine
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Question 11
Incorrect
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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 ÂşC. 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:
Correct 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.
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This question is part of the following fields:
- Gastroenterology/Nutrition
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Question 12
Incorrect
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A 75-year-old man came to the clinic with painless, blurry vision in his right eye. He reported no other ocular symptoms and had a history of bilateral cataract surgery five years ago. What is the most probable reason for his vision impairment?
Your Answer:
Correct Answer: Posterior capsule opacification
Explanation:Blurred vision years after cataract surgery may be caused by posterior capsule opacification, which can occur even after the cataract has been removed and an artificial lens has been implanted.
Understanding Cataracts: Causes, Symptoms, and Management
A cataract is a common eye condition that affects the lens of the eye, causing it to become cloudy and reducing the amount of light that reaches the retina. This can lead to blurred or reduced vision, making it difficult to see clearly. Cataracts are more common in women and tend to increase in incidence with age. While the normal ageing process is the most common cause, other factors such as smoking, alcohol consumption, trauma, diabetes, and long-term corticosteroid use can also contribute to the development of cataracts.
Symptoms of cataracts include reduced vision, faded colour vision, glare, and halos around lights. A defect in the red reflex is also a sign of cataracts. Diagnosis is typically made through ophthalmoscopy and slit-lamp examination, which can reveal the presence of a visible cataract.
In the early stages, age-related cataracts can be managed conservatively with stronger glasses or contact lenses and brighter lighting. However, surgery is the only effective treatment for cataracts and involves removing the cloudy lens and replacing it with an artificial one. Referral for surgery should be based on the presence of visual impairment, impact on quality of life, and patient choice. Complications following surgery can include posterior capsule opacification, retinal detachment, posterior capsule rupture, and endophthalmitis.
Overall, cataracts are a common and treatable eye condition that can significantly impact a person’s vision. Understanding the causes, symptoms, and management options can help individuals make informed decisions about their eye health.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Incorrect
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A 72-year-old man has been admitted to the orthopaedic ward following a left hemiarthroplasty. He has a history of hypertension, type 2 diabetes and chronic myeloid leukaemia (CML).
The nurse has requested an urgent review of the patient as he is displaying signs of confusion. His blood pressure is 96/54 mmHg and his heart rate is 135 bpm. The patient has been passing 10 ml of urine an hour through his catheter and the nurse has observed that the urine in the catheter bag is bright red.
Upon examination, the patient has petechial bruising over his arms and blood is slowly oozing from his peripheral cannula. What blood test results would you anticipate?Your Answer:
Correct Answer: Low platelets, low fibrinogen, raised APTT and PT and raised D-dimer
Explanation:The typical blood picture for DIC includes a decrease in platelets and fibrinogen levels, as well as an increase in PT and APTT, and fibrinogen degradation products. DIC can be triggered by trauma, malignancies, and other factors. The patient’s symptoms, such as oliguria, hypotension, and tachycardia, suggest circulatory collapse due to DIC. Bleeding at multiple sites, including haematuria, petechial bruising, and bleeding from a peripheral cannula, is also common in DIC. The release of procoagulants in DIC leads to widespread clotting activation, which consumes platelets and clotting factors, resulting in a low platelet count and prolonged bleeding times. Fibrinolysis is also activated, leading to low fibrinogen levels and high D-dimer levels. Additionally, haemoglobin levels may be low due to bleeding and lysis caused by fibrin strands in small blood vessels.
Understanding Disseminated Intravascular Coagulation (DIC) Diagnosis
Under normal conditions, coagulation and fibrinolysis work together to maintain homeostasis. However, in DIC, these processes become dysregulated, leading to widespread clotting and bleeding. One key factor in the development of DIC is the release of tissue factor (TF), a glycoprotein found on the surface of various cell types. Normally, TF is not in contact with the general circulation, but it is exposed after vascular damage or in response to certain cytokines. Once activated, TF triggers the extrinsic pathway of coagulation, which then triggers the intrinsic pathway. DIC can be caused by various factors, including sepsis, trauma, obstetric complications, and malignancy.
To diagnose DIC, a typical blood picture will show decreased platelets and fibrinogen, increased fibrinogen degradation products, and the presence of schistocytes due to microangiopathic hemolytic anemia. Additionally, both the prothrombin time and activated partial thromboplastin time are prolonged, while bleeding time and platelet count are often low. Understanding the diagnosis of DIC is crucial for prompt and effective treatment.
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This question is part of the following fields:
- Haematology/Oncology
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Question 14
Incorrect
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A 20-year-old man is brought to the emergency department after experiencing a possible allergic reaction to seafood he ate at a restaurant. He administered his adrenaline autoinjector and received an additional dose of intramuscular adrenaline from the paramedics.
Upon examination, his temperature is 37.8ÂşC, heart rate is 130 beats/min, and blood pressure is 88/50 mmHg. He has a respiratory rate of 30 breaths/min and oxygen saturation of 93% on room air.
What is the next course of action in managing this patient?Your Answer:
Correct Answer: Intravenous adrenaline infusion
Explanation:For patients with refractory anaphylaxis, which is characterized by persistent respiratory and/or cardiovascular problems despite receiving 2 doses of intramuscular adrenaline, the recommended next step is to start an intravenous adrenaline infusion. Administering further intramuscular adrenaline is not recommended. Intravenous chlorphenamine and hydrocortisone are also no longer recommended in the updated guidelines for anaphylaxis management.
Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically occur suddenly and progress rapidly, affecting the airway, breathing, and circulation. Common signs include swelling of the throat and tongue, hoarse voice, respiratory wheeze, dyspnea, hypotension, and tachycardia. In addition, around 80-90% of patients experience skin and mucosal changes, such as generalized pruritus, erythematous rash, or urticaria.
The management of anaphylaxis requires prompt and decisive action, as it is a medical emergency. The Resuscitation Council guidelines recommend intramuscular adrenaline as the most important drug for treating anaphylaxis. The recommended doses of adrenaline vary depending on the patient’s age, ranging from 100-150 micrograms for infants under 6 months to 500 micrograms for adults and children over 12 years. Adrenaline can be repeated every 5 minutes if necessary, and the best site for injection is the anterolateral aspect of the middle third of the thigh. In cases of refractory anaphylaxis, IV fluids and expert help should be sought.
Following stabilisation, patients may be given non-sedating oral antihistamines to manage persisting skin symptoms. It is important to refer all patients with a new diagnosis of anaphylaxis to a specialist allergy clinic and provide them with an adrenaline injector as an interim measure before the specialist assessment. Patients should also be prescribed two adrenaline auto-injectors and trained on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and complete resolution of symptoms, while those who require two doses of IM adrenaline or have a history of biphasic reaction should be observed for at least 12 hours following symptom resolution.
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This question is part of the following fields:
- Immunology/Allergy
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Question 15
Incorrect
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The phlebotomist in a pediatric clinic sustains a needlestick injury while drawing blood from a child who is known to have Hepatitis B. After thoroughly washing the wound, what is the most suitable course of action?
Your Answer:
Correct Answer: Refer to Emergency Department + oral antiretroviral therapy for 4 weeks
Explanation:Oral antiretroviral therapy for 4 weeks is used as post-exposure prophylaxis for HIV.
Post-Exposure Prophylaxis for Infectious Diseases
Post-exposure prophylaxis (PEP) is a preventive treatment given to individuals who have been exposed to an infectious disease. The type of PEP given depends on the specific disease and the circumstances of the exposure. For hepatitis A, either human normal immunoglobulin (HNIG) or the hepatitis A vaccine may be used. For hepatitis B, if the source is HBsAg positive, a booster dose of the HBV vaccine should be given to known responders. Non-responders require hepatitis B immune globulin (HBIG) and a booster vaccine. If the source is unknown, known responders may receive a booster dose of the HBV vaccine, while known non-responders require HBIG and a vaccine. Those in the process of being vaccinated should have an accelerated course of the HBV vaccine. For hepatitis C, monthly PCR is recommended, and if seroconversion occurs, interferon +/- ribavirin may be given. For HIV, the risk of transmission depends on the incident and the current viral load of the patient. Low-risk incidents such as human bites generally do not require PEP. However, for high-risk incidents, a combination of oral antiretrovirals should be given as soon as possible for four weeks. For varicella zoster, VZIG is recommended for IgG negative pregnant women or immunosuppressed individuals. It is important to note that the risk of transmission varies depending on the virus, with hepatitis B having a higher risk than hepatitis C and HIV.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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A 16-month-old child has been referred to the haematology team due to painful bone swellings in the hands and feet, along with a positive family history of sickle cell disease. What is the mode of inheritance for this condition?
Your Answer:
Correct Answer: Autosomal recessive
Explanation:Sickle cell anaemia is a genetic disorder that follows an autosomal recessive pattern of inheritance. This means that an individual must inherit two copies of the mutated gene, one from each parent who are carriers of the condition. Huntington’s Disease is an example of an autosomal dominant condition, while Fragile X syndrome is an example of an X-linked dominant condition. Haemophilia is an example of an X-linked recessive condition, and alpha-1 antitrypsin deficiency is an example of a co-dominant condition.
Sickle-cell anaemia is a genetic disorder that occurs when abnormal haemoglobin, known as HbS, is produced due to an autosomal recessive condition. This condition is more common in individuals of African descent, as the heterozygous condition provides some protection against malaria. About 10% of UK Afro-Caribbean’s are carriers of HbS, and they only experience symptoms if they are severely hypoxic. Homozygotes tend to develop symptoms between 4-6 months when the abnormal HbSS molecules replace fetal haemoglobin.
The pathophysiology of sickle-cell anaemia involves the substitution of the polar amino acid glutamate with the non-polar valine in each of the two beta chains (codon 6) of haemoglobin. This substitution decreases the water solubility of deoxy-Hb, causing HbS molecules to polymerise and sickle RBCs in the deoxygenated state. HbAS patients sickle at p02 2.5 – 4 kPa, while HbSS patients sickle at p02 5 – 6 kPa. Sickle cells are fragile and haemolyse, blocking small blood vessels and causing infarction.
The definitive diagnosis of sickle-cell anaemia is through haemoglobin electrophoresis.
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This question is part of the following fields:
- Genetics
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Question 17
Incorrect
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A newly qualified nurse in her 50s at the local hospital undergoes vaccination against hepatitis B. The following results are obtained three months after completion of the primary course:
Result Anti-HBs: 10 - 100 mIU/ml
Reference An antibody level of >100 mIU/ml indicates a good immune response with protective immunity
What should be done next?Your Answer:
Correct Answer: Give one further dose of hepatitis B vaccine
Explanation:Understanding Hepatitis B: Causes, Symptoms, Complications, and Management
Hepatitis B is a type of virus that contains double-stranded DNA and is transmitted through exposure to infected blood or body fluids. It can also be passed from mother to child during childbirth. The incubation period for this virus is between 6 to 20 weeks. Symptoms of hepatitis B include fever, jaundice, and elevated liver transaminases. Complications of this infection include chronic hepatitis, fulminant liver failure, hepatocellular carcinoma, glomerulonephritis, polyarteritis nodosa, and cryoglobulinemia.
To prevent hepatitis B, children born in the UK are now vaccinated as part of the routine immunization schedule. At-risk groups who should also be vaccinated include healthcare workers, intravenous drug users, sex workers, close family contacts of an individual with hepatitis B, individuals receiving regular blood transfusions, chronic kidney disease patients, prisoners, and chronic liver disease patients. However, around 10-15% of adults may fail to respond or respond poorly to the vaccine.
Testing for anti-HBs is only recommended for those at risk of occupational exposure and patients with chronic kidney disease. The interpretation of anti-HBs levels is as follows: an anti-HBs level of >100 indicates an adequate response, 10-100 indicates a suboptimal response, and <10 indicates a non-responder. Management of hepatitis B includes the use of pegylated interferon-alpha, which reduces viral replication in up to 30% of chronic carriers. Other antiviral medications such as tenofovir, entecavir, and telbivudine are also used to suppress viral replication.
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This question is part of the following fields:
- Immunology/Allergy
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Question 18
Incorrect
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A 30-year-old medical student noticed that he had a murmur when he tested his new stethoscope. On assessment in the Cardiology Clinic, he was found to have a harsh systolic murmur over his precordium, which did not change with inspiration. His electrocardiogram (ECG) showed features of biventricular hypertrophy.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Ventricular septal defect (VSD)
Explanation:Common Heart Murmurs and their Characteristics
Heart murmurs are abnormal sounds heard during a heartbeat and can indicate underlying heart conditions. Here are some common heart murmurs and their characteristics:
1. Ventricular Septal Defect (VSD): This has a pansystolic murmur, heard loudest at the lower left sternal edge and causing biventricular hypertrophy due to increased strain on both the right and left ventricles.
2. Mitral Regurgitation: This has a pansystolic murmur which is heard loudest at the apex and radiates to the axilla; it is louder on expiration. The ECG can show left ventricular and left atrial enlargement.
3. Aortic Stenosis: This causes a crescendo-decrescendo murmur, heard loudest in the aortic area and radiating to the carotids. It (and all other left-sided murmurs) is louder on expiration.
4. Hypertrophic Cardiomyopathy (HCM): HCM has an early peaking systolic murmur which is worse on Valsalva and reduced on squatting. It is also associated with a jerky pulse. The ECG would show left ventricular hypertrophy.
5. Tricuspid Regurgitation: This has a pansystolic murmur and a brief rumbling diastolic murmur; these are louder on inspiration. The ECG may show right ventricular enlargement.
It is important to note that right-sided murmurs increase with inspiration (e.g. tricuspid regurgitation or TR), whereas left-sided murmurs show no change. The clue to diagnosis is in the ECG finding. Aortic stenosis and mitral regurgitation produce left ventricular hypertrophy; TR produces right ventricular hypertrophy and a VSD produces biventricular hypertrophy.
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This question is part of the following fields:
- Cardiovascular
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Question 19
Incorrect
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A 32-week pregnant woman presents to the early pregnancy unit with a concern that her uterus is small for this stage of pregnancy. Upon ultrasound, she is diagnosed with oligohydramnios. What could be a potential cause of oligohydramnios?
Your Answer:
Correct Answer: Renal agenesis
Explanation:Oligohydramnios is a condition that occurs during pregnancy when there is a shortage of amniotic fluid. This can result in a smaller symphysiofundal height.
Oligohydramnios is a condition characterized by a decrease in the amount of amniotic fluid present in the womb. The definition of oligohydramnios varies, but it is generally considered to be present when there is less than 500ml of amniotic fluid at 32-36 weeks of gestation or an amniotic fluid index (AFI) that falls below the 5th percentile.
There are several potential causes of oligohydramnios, including premature rupture of membranes, Potter sequence, bilateral renal agenesis with pulmonary hypoplasia, intrauterine growth restriction, post-term gestation, and pre-eclampsia. These conditions can all contribute to a reduction in the amount of amniotic fluid present in the womb, which can have significant implications for fetal development and health. It is important for healthcare providers to monitor amniotic fluid levels and identify any potential causes of oligohydramnios in order to provide appropriate care and support for both the mother and the developing fetus.
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This question is part of the following fields:
- Reproductive Medicine
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Question 20
Incorrect
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A 30-year-old male with a history of ankylosing spondylitis presents to his GP with complaints of eye pain and sensitivity to light. He wears glasses for nearsightedness and this is his first occurrence, affecting only his right eye. Upon examination, his right eye has a visual acuity of 6/6 while his left eye is corrected to 6/18. The left pupil is misshapen and the eye is red, but the cornea appears clear. What is the most likely diagnosis for this patient?
Your Answer:
Correct Answer: Anterior uveitis
Explanation:Ankylosing spondylitis is commonly associated with anterior uveitis, which presents with symptoms such as a misshapen pupil, red eye, and reduced vision. This condition involves both eyes and is more likely than other eye conditions. Retinal detachment does not cause eye pain.
Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.
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This question is part of the following fields:
- Ophthalmology
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Question 21
Incorrect
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A 30-year-old man visits his doctor's office with complaints of difficulty sleeping. Upon further inquiry, he reveals that he avoids social situations due to a fear of being judged, and experienced a panic attack with rapid heart rate and shortness of breath while at a movie theater a few weeks ago.
What is the most probable diagnosis?Your Answer:
Correct Answer: Social phobia
Explanation:Differentiating Social Phobia from Other Anxiety Disorders
Social phobia, also known as social anxiety disorder, is a type of anxiety disorder characterized by intense fear and anxiety in social situations, particularly when being scrutinized. It typically starts in adolescence and affects both men and women equally. Some individuals may have a specific fear of certain situations, while others may experience anxiety in most social situations outside of close family and friends. Low self-esteem is often associated with social phobia, and avoidance of feared situations is common. Treatment typically involves psychological interventions such as cognitive-behavioral therapy.
It is important to differentiate social phobia from other anxiety disorders. Panic disorder is characterized by recurrent episodes of severe anxiety that occur unpredictably and without an objective danger. Agoraphobia involves a fear of situations where escape to a safe place is difficult or impossible. Generalized anxiety disorder is characterized by non-specific and persistent anxiety, often accompanied by autonomic and motor overactivity. Depression may also be associated with anxiety, but typically involves early morning waking rather than difficulty falling asleep.
By understanding the specific features of social phobia and how it differs from other anxiety disorders, healthcare professionals can provide appropriate diagnosis and treatment for their patients.
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This question is part of the following fields:
- Psychiatry
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Question 22
Incorrect
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A 60-year-old white man, who is a chronic smoker, presents with low back and hip pain. His serum alkaline phosphatase level is 1000 iu/l (39–117 iu/l), calcium 2.25 mmol/l (2.2–2.67 mmol/l) and phosphate 1.2 mmol/l (0.8–1.5 mmol/l). Other liver function tests (LFTs) are normal. He also complains of difficulty in hearing.
Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Paget’s disease of bone
Explanation:Bone Disorders and Blood Biochemistry: Understanding the Differences
Bone disorders can be difficult to diagnose, as many of them share similar symptoms. However, blood biochemistry can often provide clues to help differentiate between them. Here, we will discuss several common bone disorders and their associated blood biochemistry.
Paget’s Disease of Bone
Paget’s disease of bone is a disorder of bone remodeling that typically affects patients over the age of 40. Symptoms include bone and joint pain, deformities, nerve compression, and pathological fractures. Blood biochemistry typically shows raised serum alkaline phosphatase, with normal calcium and phosphate levels. Bisphosphonates are the mainstay of treatment.
Squamous Cell Carcinoma of the Lung
Squamous cell carcinoma of the lung is the second most common form of lung cancer and is strongly linked to smoking. Symptoms include cough, wheeze, and haemoptysis. Squamous cell carcinomas can cause hypercalcaemia as part of the paraneoplastic syndrome, but normal calcium levels and lack of respiratory symptoms may rule out this diagnosis.
Multiple Myeloma
Multiple myeloma is a malignant disease of plasma cells of the bone marrow. Normal calcium levels and the mention of hearing loss may rule out this diagnosis.
Osteomalacia
Osteomalacia is a disease of inadequate bone mineralization, most commonly caused by vitamin D deficiency. Symptoms include bony pain, muscle tenderness and weakness, pathological fractures, and proximal myopathy. Blood biochemistry may reveal hypocalcaemia and raised alkaline phosphatase.
Osteoporosis
Osteoporosis is caused by decreased bone density and tends to present initially with a fragility fracture. Blood biochemistry would be normal in a patient with osteoporosis.
In summary, understanding the differences in blood biochemistry can help differentiate between common bone disorders. This knowledge can aid in accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Musculoskeletal
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Question 23
Incorrect
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A 35-year-old man with ulcerative colitis is seen for his follow-up appointment. He had a moderate flare-up of his condition two months ago, which was treated with oral steroids and resolved. He has not had any other flare-ups in the past year and his most recent colonoscopy showed left-sided disease. He is currently asymptomatic, with normal observations and bowel movements of 2-3 times per day. What is the best medical treatment to maintain remission for this patient?
Your Answer:
Correct Answer: Oral mesalazine
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.
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This question is part of the following fields:
- Gastroenterology/Nutrition
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Question 24
Incorrect
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A 72-year-old man with atrial fibrillation (AF) experiences colicky abdominal pain after eating a large meal; this has been happening consistently for the past 3 weeks, causing him to develop a fear of eating.
What is the most probable diagnosis?
Your Answer:
Correct Answer: Chronic mesenteric ischaemia (CMI)
Explanation:Differential Diagnosis for Abdominal Pain: Chronic Mesenteric Ischaemia, Chronic Pancreatitis, Diverticulitis, Gastric Cancer, and Acute Mesenteric Ischaemic Embolism
Abdominal pain is a common presenting symptom in clinical practice, and it can be caused by a variety of conditions. In this article, we will discuss the differential diagnosis for abdominal pain, including chronic mesenteric ischaemia (CMI), chronic pancreatitis, diverticulitis, gastric cancer, and acute mesenteric ischaemic embolism.
CMI usually results from atherosclerotic disease of two or more mesenteric vessels, while chronic pancreatitis is characterised by a continuing, chronic, inflammatory process of the pancreas. Diverticulitis is an inflammation of one or more diverticula, while gastric cancer is the third most common cause of cancer-related death in the world. Acute mesenteric ischaemic embolism is characterised by pain that is disproportionate to physical examination findings.
Each condition has its own unique set of symptoms and clinical presentation. By understanding the differential diagnosis for abdominal pain, clinicians can make an accurate diagnosis and provide appropriate treatment for their patients.
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This question is part of the following fields:
- Gastroenterology/Nutrition
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Question 25
Incorrect
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An 80-year-old woman arrives at the emergency department complaining of chest pain and shortness of breath. Her oxygen saturation is 90%. After receiving oxygen, she experiences ventricular fibrillation and has a GCS of 3. ALS is initiated. The patient has a medical history of type 2 diabetes and multiple pulmonary emboli. What additional medication should be considered for her management during ALS?
Your Answer:
Correct Answer: Alteplase
Explanation:During CPR, thrombolytic drugs should be considered if a pulmonary embolism (PE) is suspected. Alteplase is a suitable option for advanced life support (ALS) in such cases. This is particularly relevant for patients who present with symptoms suggestive of a PE and have a medical history of previous pulmonary emboli. Thrombolysis can be a life-saving intervention for these patients.
Adenosine is not appropriate for this situation as it is a class 5 antiarrhythmic used mainly for supraventricular tachycardia. Apixaban is an anticoagulant that is useful for long-term treatment and prevention of pulmonary emboli, but it is not suitable for immediate use in a hemodynamically unstable patient requiring advanced life support. Clopidogrel is an antiplatelet medication that is used in peripheral arterial disease and acute coronary syndrome, but it has no role in the acute treatment of a life-threatening pulmonary embolism.
The 2015 Resus Council guidelines for adult advanced life support outline the steps to be taken when dealing with patients with shockable and non-shockable rhythms. For both types of patients, chest compressions are a crucial part of the process, with a ratio of 30 compressions to 2 ventilations. Defibrillation is recommended for shockable rhythms, with a single shock for VF/pulseless VT followed by 2 minutes of CPR. Adrenaline and amiodarone are the drugs of choice for non-shockable rhythms, with adrenaline given as soon as possible and amiodarone administered after 3 shocks for VF/pulseless VT. Thrombolytic drugs should be considered if a pulmonary embolus is suspected. Atropine is no longer recommended for routine use in asystole or PEA. Oxygen should be titrated to achieve saturations of 94-98% following successful resuscitation. The Hs and Ts should be considered as potential reversible causes of cardiac arrest.
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This question is part of the following fields:
- Cardiovascular
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Question 26
Incorrect
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A 60-year-old woman presents to her General Practitioner with mild central abdominal discomfort. She also reports unintentional weight loss over the past four months. However, she denies any rectal bleeding or fatigue and has no significant family history.
What is the most appropriate course of action for management?Your Answer:
Correct Answer: 2-week wait referral to the colorectal services
Explanation:Referral for Investigation of Colorectal Cancer with a 2-Week Wait
According to the National Institute for Health and Care Excellence (NICE) guidelines, patients aged 40 or over who present with unexplained weight loss and abdominal pain should be referred for investigation of colorectal cancer with a 2-week wait. Other criteria for a 2-week wait referral include patients with unexplained rectal bleeding, iron-deficiency anaemia, change in bowel habit, positive faecal occult blood tests, rectal or abdominal mass, unexplained anal mass or anal ulceration, and patients under 50 years with rectal bleeding and any of the following unexplained symptoms or findings: abdominal pain, change in bowel habit, weight loss or iron-deficiency anaemia.
Doing nothing and just following up with the patient, prescribing analgesia and following up in one month, referring the patient routinely, or taking urgent bloods and following up in two weeks would not be appropriate in the presence of red-flag symptoms and can create a serious delay in diagnosis and treatment. Therefore, referral for investigation of colorectal cancer with a 2-week wait is the recommended course of action. However, taking urgent bloods and following up the patient in two weeks can still be done while the patient is waiting for the referral appointment.
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This question is part of the following fields:
- Gastroenterology/Nutrition
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Question 27
Incorrect
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A 27 year old woman with a confirmed diagnosis of premenstrual syndrome (PMS) visits her GP seeking medical intervention. Despite implementing recommended lifestyle changes, she has seen minimal relief in her symptoms. She has no immediate plans of starting a family. What treatment option would be appropriate to suggest, provided there are no contraindications?
Your Answer:
Correct Answer: Combined oral contraceptive pill
Explanation:Understanding Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and does not occur before puberty, during pregnancy, or after menopause.
Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.
Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.
Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this common condition.
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This question is part of the following fields:
- Reproductive Medicine
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Question 28
Incorrect
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A 30-year-old woman presents with a productive cough, weight loss, and night sweats, four months after returning from India. She is diagnosed with pulmonary tuberculosis and started on appropriate antibiotics. However, six weeks into her treatment, she experiences numbness and tingling in her distal extremities, a known side effect of isoniazid. What medication should have been prescribed alongside her antibiotic regimen to minimize this side effect?
Your Answer:
Correct Answer: Pyridoxine
Explanation:To treat active tuberculosis, isoniazid is often prescribed alongside other antibiotics such as rifampicin, ethambutol, or pyrazinamide. However, it is important to note that isoniazid alone does not protect against peripheral neuropathy, a potential side effect of tuberculosis treatment.
Rifampicin is an antibiotic that can increase the rate of B6 excretion, which may lead to a deficiency in some individuals.
Ethambutol is another antibiotic used to treat tuberculosis, but it can cause a loss of visual acuity and color blindness.
Prednisolone is typically only prescribed for meningeal or pericardial tuberculosis and can cause side effects such as mood changes, weight gain, and immunosuppression.
Pyrazinamide is another antibiotic used to treat tuberculosis, but it can cause liver toxicity.
Side-Effects and Mechanism of Action of Tuberculosis Drugs
Rifampicin is a drug that inhibits bacterial DNA dependent RNA polymerase, which prevents the transcription of DNA into mRNA. However, it is a potent liver enzyme inducer and can cause hepatitis, orange secretions, and flu-like symptoms.
Isoniazid, on the other hand, inhibits mycolic acid synthesis. It can cause peripheral neuropathy, which can be prevented with pyridoxine (Vitamin B6). It can also cause hepatitis and agranulocytosis. Additionally, it is a liver enzyme inhibitor.
Pyrazinamide is converted by pyrazinamidase into pyrazinoic acid, which in turn inhibits fatty acid synthase (FAS) I. However, it can cause hyperuricaemia, leading to gout, as well as arthralgia, myalgia, and hepatitis.
Lastly, Ethambutol inhibits the enzyme arabinosyl transferase, which polymerizes arabinose into arabinan. It can cause optic neuritis, so it is important to check visual acuity before and during treatment. Additionally, the dose needs adjusting in patients with renal impairment.
In summary, these tuberculosis drugs have different mechanisms of action and can cause various side-effects. It is important to monitor patients closely and adjust treatment accordingly to ensure the best possible outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 29
Incorrect
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A 72-year-old man presents to your clinic complaining of left nostril blockage and frequent nosebleeds for the past 4 weeks. He has a medical history of well-controlled diabetes and hypertension and has a smoking history of 20 cigarettes per day since he was 18. He used to work in construction. During the examination, you observe a nasal polyp on the left side. What would be the most suitable course of action?
Your Answer:
Correct Answer: 2 week-wait referral
Explanation:Unilateral nasal polyps are a cause for concern and should be promptly referred to an ENT specialist as they may indicate nasal cancer. However, they can also be caused by other factors such as nose picking, foreign bodies, misapplication of nasal spray or cystic fibrosis. Treatment with antibiotics, oral steroids, nasal drops or cautery is unlikely to be effective and may delay the diagnosis of a serious condition.
Understanding Nasal Polyps
Nasal polyps are a relatively uncommon condition affecting around 1% of adults in the UK. They are more commonly seen in men and are not typically found in children or the elderly. There are several associations with nasal polyps, including asthma (particularly late-onset asthma), aspirin sensitivity, infective sinusitis, cystic fibrosis, Kartagener’s syndrome, and Churg-Strauss syndrome. When asthma, aspirin sensitivity, and nasal polyposis occur together, it is known as Samter’s triad.
The symptoms of nasal polyps include nasal obstruction, rhinorrhoea, sneezing, and a poor sense of taste and smell. It is important to note that any unusual symptoms, such as unilateral symptoms or bleeding, require further investigation. If nasal polyps are suspected, patients should be referred to an ear, nose, and throat (ENT) specialist for a full examination.
The management of nasal polyps typically involves the use of topical corticosteroids, which can shrink polyp size in around 80% of patients. Overall, understanding nasal polyps and their associations can help with early detection and appropriate management.
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This question is part of the following fields:
- ENT
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Question 30
Incorrect
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A 55-year-old man presents with a chronic cough and is diagnosed with lung cancer. He asks if his occupation could be a contributing factor. What is the most probable occupational risk factor for developing lung cancer?
Your Answer:
Correct Answer: Passive smoking
Explanation:Risk Factors for Lung Cancer
Lung cancer is a deadly disease that can be caused by various factors. The most significant risk factor for lung cancer is smoking, which increases the risk by a factor of 10. However, other factors such as exposure to asbestos, arsenic, radon, nickel, chromate, and aromatic hydrocarbon can also increase the risk of developing lung cancer. Additionally, cryptogenic fibrosing alveolitis has been linked to an increased risk of lung cancer.
It is important to note that not all factors are related to lung cancer. For example, coal dust exposure has not been found to increase the risk of lung cancer. However, smoking and asbestos exposure are synergistic, meaning that a smoker who is also exposed to asbestos has a 50 times increased risk of developing lung cancer (10 x 5). Understanding these risk factors can help individuals make informed decisions about their health and take steps to reduce their risk of developing lung cancer.
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This question is part of the following fields:
- Respiratory Medicine
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