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Question 1
Correct
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A 55-year-old woman had a total thyroidectomy for follicular carcinoma of the thyroid gland. She experiences tingling sensations and neuromuscular irritability within 24 hours of surgery. What serum laboratory test should be ordered urgently to determine appropriate treatment for this patient?
Your Answer: Ionised calcium
Explanation:The Importance of Monitoring Ionised Calcium Levels Post-Thyroid Surgery
Thyroid surgery can result in inadvertent removal or trauma to the parathyroid glands, leading to hypocalcaemia and its associated symptoms such as tingling and neuromuscular irritability. To prevent complications, post-surgical monitoring of calcium levels is routinely performed, and temporary calcium supplementation may be required. While other hormones such as TSH, calcitonin, and total thyroxine may be affected by thyroid surgery, they do not explain the acute symptoms of decreased serum calcium. Therefore, measuring ionised calcium levels and promptly addressing any hypocalcaemia is crucial in post-thyroid surgery management.
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This question is part of the following fields:
- Surgery
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Question 2
Correct
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A 28-year-old primigravida woman presents at 38+5 weeks’ gestation to the Labour Ward with regular contractions that have started about three hours ago.
On examination, she has a short, soft cervix which is 2 cm dilated. Contractions are roughly every 4–5 minutes and are palpable, demonstrated on cardiotocography, but are not very strong or painful at present.
Which of the following statements applies to the first stage of labour?Your Answer: It occurs at a rate of about 1 cm per hour in a nulliparous woman
Explanation:Labour is the process of giving birth and is divided into three stages. The first stage begins with regular contractions and ends when the cervix is fully dilated at 10 cm. This stage is further divided into a latent phase, where the cervix dilates to 4 cm, and an active phase, where the cervix dilates from 4 cm to 10 cm. The rate of cervical dilation in a nulliparous woman is approximately 1 cm per hour, while in a multiparous woman, it is approximately 2 cm per hour. The second stage of labour begins when the cervix is fully dilated and ends with the delivery of the baby. During this stage, fetal heart rate monitoring should occur at least every five minutes and after each contraction. Cervical incompetence, which involves cervical shortening and dilation in the absence of contractions, can result in premature delivery or second trimester loss and is more common in women with a multiple pregnancy, previous cervical incompetence, or a history of cervical surgery. These women can be managed with monitoring of cervical length, cervical cerclage, or progesterone cervical pessaries. The third stage of labour involves the delivery of the placenta and membranes.
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This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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A 41-year-old man presents to the emergency department with sudden onset pain in his left leg. The pain has been constant for the past 2 hours. He has been experiencing calf pain when walking for the past few months, which improves with rest. He has no significant medical history and is asymptomatic otherwise.
Upon examination, his left leg appears pale and cool. The anterior tibialis pulse on the left cannot be palpated, but the popliteal pulse is normal. Both pulses on his right leg are normal.
What is the most appropriate course of action for managing this patient?Your Answer: Lower limb angiography
Correct Answer: Doppler examination of pulses
Explanation:When a patient presents with acute limb pain and a history of intermittent claudication, a handheld arterial Doppler examination should be performed to confirm suspected acute limb ischaemia. This is because manual palpation of pulses can be operator-dependent and the Doppler examination can quickly and easily quantify the extent of the loss. Other symptoms of acute limb ischaemia include pallor, loss of distal pulse, and feeling of coldness.
Compartment pressure monitoring can aid in the diagnosis of compartment syndrome, which presents with pain and possibly pallor in the lower leg, but not cold temperature. However, compartment syndrome is usually diagnosed clinically, and compartment pressure monitoring is only used in cases of diagnostic uncertainty.
Compression ultrasonography is useful when a deep vein thrombosis is suspected, which presents with swelling, redness, and a hot leg – the opposite of the symptoms described in acute limb ischaemia. It also does not affect the pulses or explain the intermittent claudication.
Immediate anticoagulation is not appropriate before further investigations and confirmation of diagnosis by a specialist. While anticoagulation is used in the treatment of acute limb ischaemia, it is important to have a more detailed assessment before initiating treatment.
Peripheral arterial disease can present in three main ways: intermittent claudication, critical limb ischaemia, and acute limb-threatening ischaemia. The latter is characterized by one or more of the 6 P’s: pale, pulseless, painful, paralysed, paraesthetic, and perishing with cold. Initial investigations include a handheld arterial Doppler examination and an ankle-brachial pressure index (ABI) if Doppler signals are present. It is important to determine whether the ischaemia is due to a thrombus or embolus, as this will guide management. Thrombus is suggested by pre-existing claudication with sudden deterioration, reduced or absent pulses in the contralateral limb, and evidence of widespread vascular disease. Embolus is suggested by a sudden onset of painful leg (<24 hours), no history of claudication, clinically obvious source of embolus, and no evidence of peripheral vascular disease. Initial management includes an ABC approach, analgesia, intravenous unfractionated heparin, and vascular review. Definitive management options include intra-arterial thrombolysis, surgical embolectomy, angioplasty, bypass surgery, or amputation for irreversible ischaemia.
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This question is part of the following fields:
- Surgery
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Question 4
Incorrect
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A 56-year-old retired man with a history of chronic hepatitis B infection presents with jaundice and significant abdominal distention. The patient does not drink, and smokes ten cigarettes a day.
On examination, the patient is found to have ascites and hepatomegaly. The patient is admitted for further investigations; the results of one tumour marker test is suggestive of a possible hepatocellular carcinoma (HCC).
Which of the following tumour markers is usually raised in primary HCC?Your Answer: Human chorionic gonadotropin (HCG)
Correct Answer: Alpha fetoprotein (AFP)
Explanation:Understanding Tumour Markers: Types and Associated Cancers
Tumour markers are compounds whose blood levels increase due to the presence of a particular malignant tumour. They are useful for diagnosis and detecting recurrence. However, they are not always specific, and different tumours may secrete the same marker. Here are some common tumour markers and the cancers they are associated with:
Alpha fetoprotein (AFP): Associated with liver and testicular cancers.
Prostate-specific antigen (PSA): Associated with prostate cancer.
Chemical nature Name Associated tumour
Enzyme PSA
NSE
LDH Prostate
Small cell lung cancer
Non-specific, mainly haematological
Hormone HCG
Calcitonin
Parathormone Testes
Medullary thyroid carcinoma
Parathyroid carcinoma
Immunoglobulin IgG, IgA, etc. Multiple myeloma
Glycoprotein AFP
CA-125
CA-19-9
CA-15-3
CEA Liver, also testes
Ovary
Pancreas
Breast
Colon, stomachHowever, not all primary liver malignancies have AFP as a tumour marker. Certain types of liver malignancy, such as fibrolamellar carcinoma, hepatoblastoma, and hepatic angiosarcoma, do not secrete this protein. The first two usually occur in young persons. Hepatomas can occur de novo but are usually present because of an underlying disease such as hepatitis B infection (chronic) or cirrhosis of the liver. Alcoholism, aflatoxin, and obesity are also risk factors for hepatoma.
CA-125 is associated with ovarian cancer, CA-19-9 with pancreatic cancer, and HCG with testicular cancer. Understanding tumour markers and their associated cancers can aid in early detection and treatment.
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This question is part of the following fields:
- Oncology
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Question 5
Incorrect
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A 31-year-old woman who is 39 weeks pregnant reaches out to you seeking details about the newborn hearing screening program. She expresses concerns about potential harm to her baby's ears and is uncertain about giving consent for the screening. What specific test is provided to all newborns as part of this screening program?
Your Answer: Pure tone audiometry
Correct Answer: Automated otoacoustic emission test
Explanation:The automated otoacoustic emission test is the appropriate method for screening newborns for hearing problems. This test involves inserting a soft-tipped earpiece into the baby’s outer ear and emitting clicking sounds to detect a healthy cochlea. The auditory brainstem response test may be used if the baby does not pass the automated otoacoustic emission test. Play audiometry is only suitable for children between two and five years old, while pure tone audiometry is used for older children and adults and is not appropriate for newborns.
Hearing Tests for Children
Hearing tests are important for children to ensure that they are developing normally. There are several tests that may be performed on children of different ages. For newborns, an otoacoustic emission test is typically done as part of the Newborn Hearing Screening Programme. This test involves playing a computer-generated click through a small earpiece and checking for the presence of a soft echo, which indicates a healthy cochlea. If the results of this test are abnormal, an Auditory Brainstem Response test may be done.
For infants between 6-9 months, a Distraction test may be performed by a health visitor with the help of two trained staff members. For children between 18 months to 2.5 years, a Recognition of familiar objects test may be used, which involves using familiar objects like a teddy or cup and asking the child simple questions like where is the teddy? For children over 2.5 years, Performance testing and Speech discrimination tests may be used, such as the Kendall Toy test or McCormick Toy Test. Pure tone audiometry is typically done at school entry in most areas of the UK for children over 3 years old.
In addition to these tests, there is also a questionnaire for parents in the Personal Child Health Records called Can your baby hear you? It is important for parents to be aware of these tests and to have their child’s hearing checked regularly to ensure proper development.
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This question is part of the following fields:
- Paediatrics
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Question 6
Incorrect
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A 79-year-old man comes to you with a complaint of weight loss and fatigue that has been going on for 3 months. He reports upper abdominal discomfort that worsens after eating and lying down. He has also noticed that his stool has become pale in color and his son has observed that he appears very yellow. Additionally, he has had high blood glucose levels on two separate occasions. What tumour marker would you order next?
Your Answer: Alpha-feto protein (AFP)
Correct Answer: CA 19–9
Explanation:Tumour Markers and their Associated Cancers
Tumour markers are substances produced by cancer cells that can be detected in the blood. They are used to aid in the diagnosis and monitoring of cancer. Here are some common tumour markers and the cancers they are associated with:
– CA 19-9: This marker is associated with pancreatic cancer.
– CEA: This marker is associated with colorectal cancer.
– PSA: This marker is associated with prostate cancer.
– CA 125: This marker is associated with ovarian cancer.
– AFP: This marker is associated with hepatocellular carcinoma.It is important to note that tumour markers are not always specific to one type of cancer and can also be elevated in non-cancerous conditions. Therefore, they should always be used in conjunction with other diagnostic tests and clinical evaluations.
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This question is part of the following fields:
- Oncology
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Question 7
Incorrect
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A 35-year-old man visits his local clinic to inquire about screening programs for abdominal aortic aneurysm (AAA) after the recent death of a friend from the condition. What options are available for screening?
Your Answer: Abdominal ultrasound scan aged 65 and then every 5 years
Correct Answer: Single abdominal ultrasound aged 65
Explanation:Men in England are offered a one-time abdominal ultrasound screening for abdominal aortic aneurysm when they reach the age of 65. If the results show that the aneurysm is normal and measures less than 3 cm, no further scans will be required as the likelihood of developing an aneurysm after the age of 65 is low.
Abdominal aortic aneurysm (AAA) is a condition that often develops without any symptoms. However, a ruptured AAA can be fatal, which is why it is important to screen patients for this condition. Screening involves a single abdominal ultrasound for males aged 65. The results of the screening are interpreted based on the width of the aorta. If the width is less than 3 cm, no further action is needed. If it is between 3-4.4 cm, the patient should be rescanned every 12 months. For a width of 4.5-5.4 cm, the patient should be rescanned every 3 months. If the width is 5.5 cm or more, the patient should be referred to vascular surgery within 2 weeks for probable intervention.
For patients with a low risk of rupture, which includes those with a small or medium aneurysm (i.e. aortic diameter less than 5.5 cm) and no symptoms, abdominal US surveillance should be conducted on the time-scales outlined above. Additionally, cardiovascular risk factors should be optimized, such as quitting smoking. For patients with a high risk of rupture, which includes those with a large aneurysm (i.e. aortic diameter of 5.5 cm or more) or rapidly enlarging aneurysm (more than 1 cm/year) or those with symptoms, they should be referred to vascular surgery within 2 weeks for probable intervention. Treatment for these patients may involve elective endovascular repair (EVAR) or open repair if EVAR is not suitable. EVAR involves placing a stent into the abdominal aorta via the femoral artery to prevent blood from collecting in the aneurysm. However, a complication of EVAR is an endo-leak, which occurs when the stent fails to exclude blood from the aneurysm and usually presents without symptoms on routine follow-up.
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This question is part of the following fields:
- Surgery
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Question 8
Correct
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A 56-year-old man comes to the emergency department complaining of a painful swollen knee that started 1 day ago. Upon examination, his right knee is warm to the touch, diffusely swollen, and erythematosus. There is pain on both active and passive movement, and flexion and extension are limited due to pain.
Observations show a respiratory rate of 18 breaths per minute, oxygen saturations of 99%, blood pressure of 131/86 mmHg, heart rate of 68 beats per minute, and a temperature of 38.1ºC.
Blood tests have been sent off for cultures and the results are pending.
What is the most likely causative organism for this diagnosis?Your Answer: Staphylococcus aureus
Explanation:The most common organism causing septic arthritis is Staphylococcus aureus. It is important to consider septic arthritis as a possible diagnosis when a joint appears red, hot, and swollen. While Neisseria gonorrhoeae is the most common cause in sexually active young adults, it is less likely in a 54-year-old. Salmonella typhimurium is a rare cause, but individuals with sickle cell disease are at higher risk for Salmonella spp septic arthritis. Staphylococcus epidermidis is a common cause in patients with a new prosthetic joint.
Septic Arthritis in Adults: Causes, Symptoms, and Treatment
Septic arthritis is a condition that occurs when bacteria infect a joint, leading to inflammation and pain. The most common organism that causes septic arthritis in adults is Staphylococcus aureus, but in young adults who are sexually active, Neisseria gonorrhoeae is the most common organism. The infection usually spreads through the bloodstream from a distant bacterial infection, such as an abscess. The knee is the most common location for septic arthritis in adults. Symptoms include an acute, swollen joint, restricted movement, warmth to the touch, and fever.
To diagnose septic arthritis, synovial fluid sampling is necessary and should be done before administering antibiotics if necessary. Blood cultures may also be taken to identify the cause of the infection. Joint imaging may also be used to confirm the diagnosis.
Treatment for septic arthritis involves intravenous antibiotics that cover Gram-positive cocci. Flucloxacillin or clindamycin is recommended if the patient is allergic to penicillin. Antibiotic treatment is typically given for several weeks, and patients are usually switched to oral antibiotics after two weeks. Needle aspiration may be used to decompress the joint, and arthroscopic lavage may be required in some cases.
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This question is part of the following fields:
- Musculoskeletal
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Question 9
Correct
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A 75-year-old male presents with haematemesis and melaena.
His initial blood pressure is 80/46 mmHg, and his heart rate is 114 bpm. He has a history of idiopathic cirrhosis and mild encephalopathy.
You begin resuscitation with colloid, blood, FFP, and dextrose.
What is the most suitable next medical intervention while waiting for an OGD to be arranged?Your Answer: Terlipressin
Explanation:Treatment Options for Acute Gastrointestinal Bleed
Terlipressin is a medication that causes constriction of blood vessels in the splanchnic region, which can help to control bleeding from varices, a common cause of gastrointestinal bleeding. In cases of acute gastrointestinal bleeding, glypressin is the preferred treatment to help with cardiovascular resuscitation. Beta-blockers may be used later on to manage portal hypertension on a chronic basis. Lactulose is another medication that may be considered to prevent the progression of encephalopathy.
While an OGD (oesophagogastroduodenoscopy) may be necessary to diagnose the cause of the bleeding, it is important to first focus on resuscitation and medical management. In cases where ascites is present, ciprofloxacin may be used as a prophylactic measure against spontaneous bacterial peritonitis. However, this is considered a secondary concern in the context of acute gastrointestinal bleeding. By prioritizing the appropriate treatments and interventions, healthcare providers can help to manage this potentially life-threatening condition.
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This question is part of the following fields:
- Emergency Medicine
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Question 10
Correct
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A 35-year-old man has just returned from a trip to Kenya. He has been experiencing a productive cough with blood-stained sputum, fever, and general malaise for the past week. Upon testing his sputum, he is diagnosed with tuberculosis and is prescribed isoniazid, rifampicin, pyrazinamide, and ethambutol for the initial phase of treatment. What drugs will he take during the continuation phase, which will last for four months after the initial two-month phase?
Your Answer: Rifampicin + Isoniazid
Explanation:Treatment Options for Tuberculosis: Medications and Considerations
Tuberculosis (TB) is a serious infectious disease that requires prompt and effective treatment. The following are some of the medications used in the treatment of TB, along with important considerations to keep in mind:
Rifampicin + Isoniazid
This combination is used in the initial treatment of TB, which lasts for two months. Before starting treatment, it is important to check liver and kidney function, as these medications can be associated with liver toxicity. Ethambutol should be avoided in patients with renal impairment. If TB meningitis is diagnosed, the continuation phase of treatment should be extended to 10 months and a glucocorticoid should be used in the first two weeks of treatment. Side effects to watch for include visual disturbances with ethambutol and peripheral neuropathy with isoniazid.Rifampicin + Pyrazinamide
Pyrazinamide is used only in the initial two-month treatment, while rifampicin is used in both the initial and continuation phases.Pyrazinamide + Ethambutol
These medications are used only in the initial stage of TB treatment.Rifampicin alone
Rifampicin is used in combination with isoniazid for the continuation phase of TB treatment.Rifampicin + Ethambutol
Rifampicin is used in the continuation phase, while ethambutol is used only in the initial two-month treatment.It is important to work closely with a healthcare provider to determine the best treatment plan for TB, taking into account individual patient factors and potential medication side effects.
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This question is part of the following fields:
- Respiratory
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Question 11
Correct
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A 68-year-old woman with a history of stage III endometrial cancer and mucinous pancreatic cancer presents to the Emergency Department with severe abdominal pain. The pain has been ongoing for the last four weeks but has worsened in the last three days as she has run out of her analgesia. She denies nausea or vomiting and she has been opening her bowels regularly. She has not been able to get an appointment with the general practitioner so that the pain medication could be prescribed. She was admitted to a hospice last week for end-of-life care.
Examination reveals a distended abdomen. There is shifting dullness present. Bowel sounds are present. The abdomen is mildly tender to touch. Her legs are also oedematous.
Which of the following is the most appropriate step in management?Your Answer: Paracentesis
Explanation:Appropriate Procedures for a Hospice Patient
When a patient is admitted to hospice care, their medical treatment shifts towards end-of-life measures and comfort. In this context, certain procedures may not be appropriate or beneficial for the patient.
Paracentesis is a procedure that may be helpful for a hospice patient experiencing pain due to ascites. This condition is often caused by low albumin levels, which can be due to malabsorption or liver disease.
Colonoscopy and exploratory laparotomy are invasive procedures that require sedation and post-operative pain management. These procedures are unlikely to provide added benefit to a patient with a terminal diagnosis who is on comfort measures.
Flexible sigmoidoscopy is a simpler procedure that may be used to investigate for colon masses in patients with iron deficiency anemia.
Upper gastrointestinal endoscopy may be considered for symptom relief, but is not typically indicated for a hospice patient.
In summary, the appropriateness of a medical procedure for a hospice patient should be carefully considered in the context of their end-of-life care plan.
Appropriate Procedures for a Hospice Patient
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This question is part of the following fields:
- Oncology
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Question 12
Incorrect
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A 65-year-old man with chronic obstructive pulmonary disease (COPD) continues to be breathless at rest despite maximal inhaler therapy, pulmonary rehabilitation and home oxygen therapy. He has been reviewed for lung volume reduction surgery but was deemed unsuitable. He is referred for consideration of lung transplantation.
His FEV1 is 30% predicted, he has not smoked for 12 years, and his past medical history includes bowel cancer, for which he underwent partial colectomy and adjunctive chemotherapy six years previously without evidence of recurrence on surveillance, and pulmonary tuberculosis age 37, which was fully sensitive and treated with six months of anti-tuberculous therapy. The patient’s body mass index (BMI) is 29 kg/m2.
What feature in this patient’s history would make him ineligible for listing for lung transplantation at this time?Your Answer: Previous malignancy
Correct Answer: FEV1 30% predicted
Explanation:Contraindications for Lung Transplantation in a Patient with COPD
Lung transplantation is a potential treatment option for patients with end-stage chronic obstructive pulmonary disease (COPD). However, certain factors may make a patient ineligible for the procedure.
One important factor is the patient’s forced expiratory volume in one second (FEV1) percentage predicted. The International Society for Heart and Lung Transplantation recommends a minimum FEV1 of less than 25% predicted for lung transplantation. In addition, patients must have a Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE) index of 5 to 6, a PaCO2 > 6.6 kPa and/or a PaO2 < 8 kPa. A previous history of pulmonary tuberculosis is also a contraindication to lung transplantation, as active infection with Mycobacterium tuberculosis can complicate the procedure. The patient’s body mass index (BMI) is another important consideration. A BMI greater than 35 kg/m2 is an absolute contraindication to transplant, while a BMI between 30 and 35 kg/m2 is a relative contraindication. Age is also a factor, with patients over 65 years old being considered a relative contraindication to lung transplantation. However, there is no absolute age limit for the procedure. Finally, a previous history of malignancy may also impact a patient’s eligibility for lung transplantation. If the malignancy has a low risk of recurrence, such as basal cell carcinoma, patients may be considered for transplant after two years. For most other cancers, a five-year period without recurrence is required. In this case, the patient’s previous malignancy occurred six years ago and would not be an absolute contraindication to transplantation.
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This question is part of the following fields:
- Respiratory
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Question 13
Correct
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A 50-year-old woman underwent a mammogram which showed a 2-cm lump in the upper outer quadrant of her right breast. Assuming the primary tumor has spread to a nearby lymph node, where would the metastatic cells most likely be located?
Your Answer: Axillary
Explanation:Lymph Nodes and Their Drainage Areas
Lymph nodes are small, bean-shaped structures that play a crucial role in the immune system. They filter lymphatic fluid and trap foreign substances, such as bacteria and cancer cells. Here are some of the major lymph nodes in the body and their drainage areas:
Axillary lymph nodes: These nodes receive lymphatic drainage from the mammary glands and upper limb. They are important in breast cancer staging.
Cervical lymph nodes: These nodes drain structures in the head and neck and can be enlarged in various cancers.
Hilar lymph nodes: These nodes drain the lungs and can become enlarged in lung cancer and other conditions.
Mediastinal lymph nodes: These nodes drain the trachea and oesophagus.
Coeliac lymph nodes: These nodes drain the spleen and foregut, including the stomach, duodenum, liver, and pancreas.
Understanding the drainage areas of lymph nodes is important in diagnosing and treating various diseases.
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This question is part of the following fields:
- Breast
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Question 14
Correct
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A 67-year-old woman was admitted to the hospital after collapsing while shopping. During her inpatient investigations, she underwent cardiac catheterisation. The results of the procedure are listed below, including oxygen saturation levels, pressure measurements, and end systolic/end diastolic readings at various anatomical sites.
- Superior vena cava: 75% oxygen saturation, no pressure measurement available
- Right atrium: 73% oxygen saturation, 6 mmHg pressure
- Right ventricle: 74% oxygen saturation, 30/8 mmHg pressure (end systolic/end diastolic)
- Pulmonary artery: 74% oxygen saturation, 30/12 mmHg pressure (end systolic/end diastolic)
- Pulmonary capillary wedge pressure: 18 mmHg
- Left ventricle: 98% oxygen saturation, 219/18 mmHg pressure (end systolic/end diastolic)
- Aorta: 99% oxygen saturation, 138/80 mmHg pressure
Based on these results, what is the most likely diagnosis?Your Answer: Aortic stenosis
Explanation:Diagnosis of Aortic Stenosis
There is a significant difference in pressure (81 mmHg) between the left ventricle and the aortic valve, indicating a critical case of aortic stenosis. Although hypertrophic obstructive cardiomyopathy (HOCM) can also cause similar pressure differences, the patient’s age and clinical information suggest that aortic stenosis is more likely.
To determine the severity of aortic stenosis, the valve area and mean gradient are measured. A valve area greater than 1.5 cm2 and a mean gradient less than 25 mmHg indicate mild aortic stenosis. A valve area between 1.0-1.5 cm2 and a mean gradient between 25-50 mmHg indicate moderate aortic stenosis. A valve area less than 1.0 cm2 and a mean gradient greater than 50 mmHg indicate severe aortic stenosis. A valve area less than 0.7 cm2 and a mean gradient greater than 80 mmHg indicate critical aortic stenosis.
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This question is part of the following fields:
- Cardiology
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Question 15
Correct
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A 2-day-old baby has her heel prick test done, and it comes back that she has a raised level of immunoreactive trypsinogen (IRT).
What is the most suitable subsequent test for this infant?Your Answer: Sweat test
Explanation:At day 5 of life, newborns undergo a heel prick test to check for various metabolic diseases including cystic fibrosis (CF), sickle cell disease, and congenital hypothyroidism. A positive result for CF is indicated by elevated levels of immunoreactive trypsinogen (IRT) and requires a sweat test to confirm the diagnosis. If the sweat test is also positive, the baby is diagnosed with CF.
Diagnosis of Cystic Fibrosis through Sweat Test
Cystic fibrosis (CF) is a genetic disorder that affects the respiratory, digestive, and reproductive systems. One of the most reliable ways to diagnose CF is through a sweat test. This test measures the amount of chloride in a patient’s sweat, which is abnormally high in those with CF. A normal value is less than 40 mEq/l, while a value greater than 60 mEq/l indicates CF.
However, there are some causes of false positive results, such as malnutrition, adrenal insufficiency, glycogen storage diseases, nephrogenic diabetes insipidus, hypothyroidism, hypoparathyroidism, G6PD, and ectodermal dysplasia. On the other hand, false negative results can occur due to skin edema, which is often caused by hypoalbuminemia or hypoproteinemia resulting from pancreatic exocrine insufficiency.
In conclusion, the sweat test is a reliable method for diagnosing CF, but it is important to consider the potential causes of false positive and false negative results. Proper interpretation of the test results can help ensure accurate diagnosis and appropriate treatment for patients with CF.
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This question is part of the following fields:
- Paediatrics
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Question 16
Incorrect
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A 32-year-old woman gives birth to a 37-week gestational age male neonate. Within 6 hours after delivery, the neonate shows signs of excessive respiratory efforts and tachypnoea. There is grunting and intercostal retraction. A chest X-ray reveals bilateral pulmonary oedema with a ground-glass appearance. What antenatal examination findings are most likely to have been observed in the mother?
Your Answer: Elevated titres of anti-nuclear and anti-SSA antibodies
Correct Answer: Fasting blood sugar of 14.0 mmol/l
Explanation:The neonate in question has a fasting blood sugar level of 14.0 mmol/l and is suffering from neonatal respiratory distress syndrome (NRDS). This is a common condition in premature infants, and those born to diabetic mothers are at an increased risk due to delayed lung maturation. An elevated total thyroxine concentration is a normal response to pregnancy and is not related to NRDS. Maternal hypocalcaemia also has no relation to NRDS. A positive indirect Coombs’ test indicates a risk of Rh isoimmunisation in the fetus, which can lead to complications such as erythroblastosis fetalis and jaundice, but is not directly related to NRDS. Elevated titres of anti-nuclear and anti-SSA antibodies are associated with maternal systemic lupus erythematosus and fetal conduction heart block, but again, this is not directly related to NRDS unless it leads to preterm birth. Overall, prematurity and maternal diabetes are the major risk factors for NRDS.
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This question is part of the following fields:
- Paediatrics
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Question 17
Incorrect
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A 12-year-old boy is brought into the emergency department by the paramedics, accompanied by three friends of the same age who called for help. According to the boy's friends, he admitted to taking 30 paracetamol tablets the previous night and coughing up blood while they were playing in a nearby park. As the attending healthcare provider, you attempt to assess the child, but he refuses to speak with you. Despite appearing alert and talkative with his friends, he insists that his parents not be contacted, that it was all a joke, and that he does not require medical attention.
What is the appropriate course of action in this scenario?Your Answer: Try to establish a full history from the child, and perform necessary investigations and treatment without the knowledge of the child's parents
Correct Answer: Speak with the child to assess her capacity and to advise her of the serious nature of a paracetamol overdose and the witnessed blood, and the importance of contacting her parents to attend
Explanation:Treatment of Minors: Competency and Best Interests
When treating minors, it is important to consider their competency and best interests. In the case of an 11-year-old child refusing treatment, it would be unusual for them to be considered Gillick competent. Even if they were, their refusal could be overridden by someone with parental responsibility. It is crucial for practitioners to act in the best interests of their patients and provide sufficient information to the child, explaining the importance of contacting their parents.
If the child is deemed incompetent, treatment must be provided in their best interests under the common law doctrine of necessity. This is consistent with ethical guidance from the GMC, which allows for treatment without consent in emergency situations where it is necessary to save the patient’s life or prevent serious deterioration of their condition. However, if the child is competent and refusing vital treatment, urgent efforts should be made to obtain authority from someone with parental responsibility or through the courts.
In cases where there is a concern for the child’s safety or risk of abuse, it may be appropriate to contact social services. Practitioners should review local child protection guidance and be familiar with the Department for Education’s guidance on what to do if a child is being abused. Overall, the treatment of minors requires careful consideration of their competency and best interests, as well as adherence to legal and ethical guidelines.
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This question is part of the following fields:
- Miscellaneous
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Question 18
Correct
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A 70-year-old man is prescribed amiodarone for atrial fibrillation. What set of tests should the GP conduct on this patient as a baseline?
Your Answer: Liver function tests (LFTs), urea and electrolytes (U&Es), thyroid function tests (TFTs) and chest X-ray
Explanation:Amiodarone is a medication used to treat heart conditions, but it can have significant side effects. Before starting treatment, it is important to establish a baseline thyroid profile, as amiodarone contains iodine that can cause hyper- or hypothyroidism. A baseline chest X-ray is also required and should be repeated annually, as amiodarone can cause toxicity in the lungs. Liver toxicity is common in those on long-term amiodarone therapy, so liver function tests should be done regularly. Respiratory complications such as pneumonitis and pulmonary fibrosis can occur, so further investigation may be needed if patients develop respiratory symptoms. Other tests such as nerve conduction studies and visual field studies are not necessary before starting amiodarone, but LFTs, U&Es, and TFTs should be done due to the potential for liver and thyroid toxicity.
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This question is part of the following fields:
- Pharmacology
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Question 19
Incorrect
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A 27-year-old male presents with lower back pain and painful feet that feel like walking on pebbles. He has been generally healthy, but he recently returned from a trip to Corfu where he had a diarrheal illness. He admits to infrequently taking ecstasy but takes no other medication. On examination, he has limited movement and pain in the sacroiliac joints and soreness in the soles of his feet upon deep palpation. What is the most probable diagnosis?
Your Answer: Drug-induced arthropathy
Correct Answer: Reactive arthritis
Explanation:After a diarrhoeal illness, the patient may be at risk of developing reactive arthritis, which is a possible diagnosis for both sacroiliitis and plantar fasciitis. However, it is less likely to be related to inflammatory bowel disease (IBD) if there is only one acute episode of diarrhoea.
Sacroiliitis is a condition that affects the sacroiliac joint, which is located at the base of the spine where it connects to the pelvis. It causes inflammation and pain in the lower back, buttocks, and legs. Plantar fasciitis, on the other hand, is a condition that affects the plantar fascia, a thick band of tissue that runs along the bottom of the foot. It causes pain and stiffness in the heel and arch of the foot.
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This question is part of the following fields:
- Rheumatology
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Question 20
Incorrect
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A 35-year-old woman visits her GP complaining of menstrual irregularity, ‘hot flashes’, nausea, palpitations and sweating, especially at night. The GP suspects that the patient may be experiencing premature menopause.
What is a known factor that can cause premature menopause?Your Answer: Hyperthyroidism
Correct Answer: Addison’s disease
Explanation:Premature Menopause: Risk Factors and Associations
Premature menopause, also known as premature ovarian failure, is a condition where a woman’s ovaries stop functioning before the age of 40. While the exact cause is unknown, there are certain risk factors and associations that have been identified.
Addison’s Disease: Women with Addison’s disease, an autoimmune disorder that affects the adrenal glands, may have steroid cell autoantibodies that cross-react with the ovarian follicles. This can lead to premature ovarian failure and early menopause.
Multiparity: Having multiple pregnancies does not increase the risk of premature menopause.
Polycystic Ovarian Syndrome: While PCOS can cause menstrual irregularities, it is not associated with premature menopause.
Recurrent Miscarriage: Women who experience recurrent miscarriages are not at an increased risk for premature menopause.
Hyperthyroidism: Hyperthyroidism can cause menstrual disturbances, but once it is treated and the patient is euthyroid, their menstrual cycle returns to normal. It is not associated with premature menopause.
In conclusion, while the cause of premature menopause is still unknown, it is important to understand the risk factors and associations in order to identify and manage the condition.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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A patient in their 60s was diagnosed with disease of a heart valve located between the left ventricle and the ascending aorta. Which of the following is most likely to describe the cusps that comprise this heart valve?
Your Answer: Anterior, posterior and septal cusps
Correct Answer: Right, left and posterior cusps
Explanation:Different Cusps of Heart Valves
The heart has four valves that regulate blood flow through the chambers. Each valve is composed of cusps, which are flaps that open and close to allow blood to pass through. Here are the different cusps of each heart valve:
Aortic Valve: The aortic valve is made up of a right, left, and posterior cusp. It is located at the junction between the left ventricle and the ascending aorta.
Mitral Valve: The mitral valve is usually the only bicuspid valve and is composed of anterior and posterior cusps. It is located between the left atrium and the left ventricle.
Tricuspid Valve: The tricuspid valve has three cusps – anterior, posterior, and septal. It is located between the right atrium and the right ventricle.
Pulmonary Valve: The pulmonary valve is made up of right, left, and anterior cusps. It is located at the junction between the right ventricle and the pulmonary artery.
Understanding the different cusps of heart valves is important in diagnosing and treating heart conditions.
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This question is part of the following fields:
- Cardiology
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Question 22
Incorrect
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A 25-year-old backpacker had embarked on a climbing expedition to Mount Everest. He had flown from the United Kingdom the previous day. To avoid the predicted bad weather, he and his team left the base camp the following day. They reached an altitude of 6000 m on day four. He complained of occasional dull headaches and feeling light-headed, which he attributed to his dehydration. The next day, he set off alone, but was discovered by the search party ten hours later. He was found to be confused, unable to walk in a straight line, irritable, and extremely fatigued. His symptoms significantly improved after receiving dexamethasone and resting in a portable hyperbaric chamber.
What is the most probable diagnosis?Your Answer: Acute mountain sickness (AMS)
Correct Answer: High-altitude cerebral oedema (HACE)
Explanation:Differential Diagnosis for High-Altitude Illness in a Patient with AMS Symptoms
High-altitude cerebral oedema (HACE) is a serious complication of acute mountain sickness (AMS) that can lead to ataxia, confusion, and even coma. In this patient, the symptoms progressed from mild AMS to HACE, as evidenced by the alleviation of symptoms following dexamethasone and hyperbaric treatment. Hypoglycaemia can mimic HACE symptoms, but the rapid ascent to high altitude and progression of symptoms point to a diagnosis of HACE. Alcohol intoxication can also mimic AMS and HAPE symptoms, but the patient’s response to treatment excludes this differential diagnosis. High-altitude pulmonary oedema (HAPE) is another potential complication, but the absence of respiratory symptoms rules it out in this case. Overall, a careful differential diagnosis is necessary to accurately diagnose and treat high-altitude illness in patients with AMS symptoms.
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This question is part of the following fields:
- Acute Medicine And Intensive Care
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Question 23
Incorrect
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A 32-year-old woman gives birth to her second child. The baby is born via normal vaginal delivery and weighs 3.8 kg. The baby has a normal Newborn and Infant Physical Examination (NIPE) after birth and the mother recovers well following the delivery. The mother wishes to breastfeed her baby and is supported to do so by the midwives on the ward.
They are visited at home by the health visitor two weeks later. The health visitor asks how they have been getting on and the mother explains that she has been experiencing problems with breastfeeding and that her baby often struggles to latch on to her breast. She explains that this has made her very anxious that she is doing something wrong and has made her feel like she is failing as a mother. When her baby does manage to latch on to feed he occasionally gets reflux and vomits afterward. The health visitor weighs the baby who is now 3.4kg.
What is the next most appropriate step?Your Answer: Provide reassurance to the mother that all babies lose weight after birth and that is is normal to struggle with breastfeeding
Correct Answer: Refer her to a midwife-led breastfeeding clinic
Explanation:If a baby loses more than 10% of its birth weight, it is necessary to refer the mother and baby to a midwife for assistance in increasing the baby’s weight.
Breastfeeding Problems and Their Management
Breastfeeding is a natural process, but it can come with its own set of challenges. Some of the minor problems that breastfeeding mothers may encounter include frequent feeding, nipple pain, blocked ducts, and nipple candidiasis. These issues can be managed by seeking advice on proper positioning, trying breast massage, and using appropriate medication.
Mastitis is a more serious problem that affects around 1 in 10 breastfeeding women. It is characterized by symptoms such as fever, nipple fissure, and persistent pain. Treatment involves the use of antibiotics, such as flucloxacillin, for 10-14 days. Breastfeeding or expressing milk should continue during treatment to prevent complications such as breast abscess.
Breast engorgement is another common problem that causes breast pain in breastfeeding women. It occurs in the first few days after birth and affects both breasts. Hand expression of milk can help relieve the discomfort of engorgement. Raynaud’s disease of the nipple is a less common problem that causes nipple pain and blanching. Treatment involves minimizing exposure to cold, using heat packs, and avoiding caffeine and smoking.
If a breastfed baby loses more than 10% of their birth weight in the first week of life, it may be a sign of poor weight gain. This should prompt consideration of the above breastfeeding problems and an expert review of feeding. Monitoring of weight should continue until weight gain is satisfactory.
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This question is part of the following fields:
- Obstetrics
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Question 24
Correct
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A 50-year-old diabetic male patient arrives at the clinic with worries about his erectile dysfunction. Can you explain the mechanism of action of sildenafil?
Your Answer: Phosphodiesterase type V inhibitor
Explanation:A phosphodiesterase type V inhibitor is what sildenafil is.
Understanding Phosphodiesterase Type V Inhibitors
Phosphodiesterase type V (PDE5) inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. These drugs work by increasing the levels of cGMP, which leads to the relaxation of smooth muscles in the blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which was the first drug of its kind. It is a short-acting medication that is usually taken one hour before sexual activity.
Other PDE5 inhibitors include tadalafil (Cialis) and vardenafil (Levitra). Tadalafil is longer-acting than sildenafil and can be taken on a regular basis, while vardenafil has a similar duration of action to sildenafil. However, these drugs are not suitable for everyone. Patients taking nitrates or related drugs, those with hypotension, and those who have had a recent stroke or myocardial infarction should not take PDE5 inhibitors.
Like all medications, PDE5 inhibitors can cause side effects. These may include visual disturbances, blue discolouration, non-arteritic anterior ischaemic neuropathy, nasal congestion, flushing, gastrointestinal side-effects, headache, and priapism. It is important to speak to a healthcare professional before taking any medication to ensure that it is safe and appropriate for you.
Overall, PDE5 inhibitors are an effective treatment for erectile dysfunction and pulmonary hypertension. However, they should only be used under the guidance of a healthcare professional and with careful consideration of the potential risks and benefits.
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This question is part of the following fields:
- Pharmacology
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Question 25
Correct
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As an F1 in the emergency department, you receive a 15-year-old girl who has been brought in from her high school due to complaints of abdominal pain and nausea. Upon examination, you discover that she is septic and can only provide a brief medical history before becoming drowsy. The surgical team suspects that she may have a perforated appendicitis and requires immediate surgery. Unfortunately, the patient's parents cannot be reached with the contact numbers provided by the school, and the patient is not in a state to provide consent for the operation. What would be the most appropriate course of action in this situation?
Your Answer: Take the patient to surgery immediately
Explanation:According to GMC, it is permissible to administer emergency treatment to a child or young person without their consent in order to save their life or prevent their health from seriously deteriorating. This means that obtaining consent from their parents, seeking permission from others, or obtaining a court order is not required.
Understanding Consent in Children
The issue of consent in children can be complex and confusing. However, there are some general guidelines to follow. If a patient is under 16 years old, they may be able to consent to treatment if they are deemed competent. This is determined by the Fraser guidelines, which were previously known as Gillick competence. However, even if a child is competent, they cannot refuse treatment that is deemed to be in their best interest.
For patients between the ages of 16 and 18, it is generally assumed that they are competent to give consent to treatment. Patients who are 18 years or older can consent to or refuse treatment.
When it comes to providing contraceptives to patients under 16 years old, the Fraser Guidelines outline specific requirements that must be met. These include ensuring that the young person understands the advice given by the healthcare professional, cannot be persuaded to inform their parents, is likely to engage in sexual activity with or without treatment, and will suffer physical or mental health consequences without treatment. Ultimately, the young person’s best interests must be taken into account when deciding whether to provide contraceptive advice or treatment, with or without parental consent.
In summary, understanding consent in children requires careful consideration of age, competence, and best interests. The Fraser Guidelines provide a useful framework for healthcare professionals to follow when providing treatment and advice to young patients.
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This question is part of the following fields:
- Paediatrics
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Question 26
Incorrect
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A 52-year-old man is shot in the abdomen and suffers a significant intra-abdominal injury. He undergoes a laparotomy, bowel resection, and end colostomy, and requires a 6-unit blood transfusion due to an associated vascular injury. After a prolonged recovery, he is paralyzed and ventilated for 2 weeks in the intensive care unit. He is given total parenteral nutrition and eventually weaned off the ventilator and transferred to the ward. During a routine blood test, the following results are observed:
Full blood count
Hb 11.3 g/dl
Platelets 267 x 109/l
WBC 10.1 x109/l
Urea and electrolytes
Na+ 131 mmol/l
K+ 4.6 mmol/l
Urea 2.3 mmol/l
Creatinine 78 µmol/l
Liver function tests
Bilirubin 25 µmol/l
ALP 445 u/l
ALT 89 u/l
γGT 103 u/l
What is the most probable underlying cause for the noted abnormalities?Your Answer: Delayed type blood transfusion reaction
Correct Answer: Total parenteral nutrition
Explanation:Liver function tests are often affected by TPN, which can cause cholestasis but it is unlikely to lead to the formation of gallstones as seen in the image. While blood transfusion reactions may cause hepatitis, they usually present earlier and with changes in haemoglobin, which is rare in modern times.
Understanding Total Parenteral Nutrition
Total parenteral nutrition is a commonly used method of providing nutrition to surgical patients who are nutritionally compromised. The bags used in this method contain a combination of glucose, lipids, and essential electrolytes, with the exact composition being determined by the patient’s nutritional requirements. While it is possible to infuse this nutrition peripherally, doing so may result in thrombophlebitis. As such, longer-term infusions should be administered into a central vein, preferably via a PICC line.
Complications associated with total parenteral nutrition are related to sepsis, refeeding syndromes, and hepatic dysfunction. It is important to monitor patients closely for any signs of these complications and adjust the nutrition accordingly. By understanding the basics of total parenteral nutrition, healthcare professionals can provide optimal care to their patients and ensure their nutritional needs are being met.
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This question is part of the following fields:
- Surgery
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Question 27
Correct
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A 30-year-old woman has been discharged from hospital with a diagnosis of systemic lupus erythematosus (SLE) with antiphospholipid antibodies. Her antibodies remained positive at 12 weeks and she is now on hydroxychloroquine monotherapy. She has a healthy BMI and blood pressure, does not smoke, and has no personal or family history of venous or arterial thrombosis or breast cancer. She is requesting to restart the combined pill. How would you advise her on this?
Your Answer: There is an unacceptably high clinical risk and she cannot use the pill anymore
Explanation:The appropriate answer is that the woman cannot use the pill anymore due to an unacceptably high clinical risk. She has developed systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies, which is classified as UK Medical Eligibility Criteria for Contraceptive Use UKMEC 4, meaning it is an absolute contraindication. The risks of arterial and venous thrombosis would be too high if she were to restart the combined pill, and alternative contraceptive options should be considered. It is important to note that both SLE with positive antiphospholipid antibodies and isolated presence of antiphospholipid antibodies are classified as UKMEC 4 conditions, but not the diagnosis of antiphospholipid syndrome. The advantages of using the pill generally outweigh the risks is an incorrect answer, as it is equivalent to UKMEC 2. The correct answer would be applicable if the woman did not test positive for any of the three antiphospholipid antibodies or if she did not test positive again after 12 weeks. The risks usually outweigh the advantages of using the combined pill is also incorrect, as it is equivalent to UKMEC 3. Lastly, there is no risk or contraindication to her restarting the combined pill is an incorrect answer, as it is equivalent to UKMEC 1.
The decision to prescribe the combined oral contraceptive pill is now based on the UK Medical Eligibility Criteria (UKMEC), which categorizes potential contraindications and cautions on a four-point scale. UKMEC 1 indicates no restrictions for use, while UKMEC 2 suggests that the benefits outweigh the risks. UKMEC 3 indicates that the disadvantages may outweigh the advantages, and UKMEC 4 represents an unacceptable health risk. Examples of UKMEC 3 conditions include controlled hypertension, a family history of thromboembolic disease in first-degree relatives under 45 years old, and current gallbladder disease. Examples of UKMEC 4 conditions include a history of thromboembolic disease or thrombogenic mutation, breast cancer, and uncontrolled hypertension. Diabetes mellitus diagnosed over 20 years ago is classified as UKMEC 3 or 4 depending on severity. In 2016, Breastfeeding between 6 weeks and 6 months postpartum was changed from UKMEC 3 to UKMEC 2.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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A 45-year-old man is referred to the Cardiology Clinic for a check-up. On cardiac auscultation, an early systolic ejection click is found. A blowing diastolic murmur is also present and best heard over the third left intercostal space, close to the sternum. S1 and S2 heart sounds are normal. There are no S3 or S4 sounds. He denies any shortness of breath, chest pain, dizziness or episodes of fainting.
What is the most likely diagnosis?Your Answer: Mixed aortic stenosis and regurgitation
Correct Answer: Bicuspid aortic valve without calcification
Explanation:Differentiating between cardiac conditions based on murmurs and clicks
Bicuspid aortic valve without calcification is a common congenital heart malformation in adults. It is characterized by an early systolic ejection click and can also present with aortic regurgitation and/or stenosis, resulting in a blowing early diastolic murmur and/or systolic ejection murmur. However, if there is no systolic ejection murmur, it can be assumed that there is no valvular stenosis or calcification. Bicuspid aortic valves are not essentially associated with stenosis and only become symptomatic later in life when significant calcification is present.
On the other hand, a bicuspid aortic valve with significant calcification will result in aortic stenosis and an audible systolic ejection murmur. This can cause chest pain, shortness of breath, dizziness, or syncope. The absence of a systolic murmur in this case excludes aortic stenosis.
Mixed aortic stenosis and regurgitation can also be ruled out if there is no systolic ejection murmur. An early systolic ejection click without an ejection murmur or with a short ejection murmur is suggestive of a bicuspid aortic valve.
Aortic regurgitation alone will not cause an early systolic ejection click. This is often associated with aortic or pulmonary stenosis or a bicuspid aortic valve.
Lastly, aortic stenosis causes a systolic ejection murmur, while flow murmurs are always systolic in nature and not diastolic.
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This question is part of the following fields:
- Cardiology
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Question 29
Incorrect
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A 29-year-old Romanian immigrant presents to his general practitioner, complaining of firm and tender reddish-blue raised nodules on the front of both shins. These have been present for a number of months. He has also lost weight and suffered from a chronic cough since the beginning of the year. On examination, there are multiple red/purple, firm, painful lesions affecting both shins. Investigations:
Investigation Result Normal value
Haemoglobin 105 g/l 135–175 g/l
White cell count (WCC) 9.2 × 109/l 4–11 × 109/l
Platelets 220 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 110 μmol/l 50–120 µmol/l
Chest X-ray Calcified hilar lymph nodes,
area of upper lobe fibrosis in the right lung
Induced sputum Acid- and alcohol-fast bacilli seen
Which of the following is the most likely diagnosis for his rash?Your Answer: Insect bites
Correct Answer: Erythema nodosum
Explanation:Understanding Erythema Nodosum and Differential Diagnosis
Erythema nodosum is a painful, raised rash that typically occurs on the anterior aspect of the lower legs. It is a type of panniculitis and is often associated with tuberculosis and sarcoidosis. To rule out these serious conditions, a chest radiograph is usually performed at diagnosis. Diagnosis is made on clinical grounds, and patients are screened for associated medical conditions. Treatment involves managing the underlying condition, such as tuberculosis chemotherapy, and using non-steroidals for the skin rash.
Other conditions that may present with similar symptoms include erythema infectiosum, which is caused by Parvovirus B19 and presents as a rash on the cheeks. Erythema multiforme causes target lesions that appear on the hands and feet before spreading to other areas of the body. Superficial thrombophlebitis, on the other hand, is inflammation of a superficial vein and is not associated with tuberculosis. Insect bites may cause swollen red lumps, but they are unlikely to cause the nodules seen in erythema nodosum.
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This question is part of the following fields:
- Dermatology
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Question 30
Correct
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A 68-year-old man with extensive peripheral vascular disease has sudden-onset severe abdominal pain with cramping and bloody stools. An arterial blood gas shows a pH of 6.9.
Which one of the following would you most likely find in this patient?Your Answer: pCO2: decreased; HCO3−: decreased; urine pH: decreased
Explanation:Interpreting Acid-Base Disorders: Understanding the Relationship between pCO2, HCO3−, and Urine pH
When analyzing acid-base disorders, it is important to understand the relationship between pCO2, HCO3−, and urine pH. Here are some examples:
1. Metabolic acidosis: pCO2 decreased, HCO3− decreased, urine pH decreased. This is due to excess H+ ions, which causes HCO3− to decrease and respiratory compensation to increase. The kidneys also work to excrete excess acid, lowering the pH of the urine.
2. Respiratory acidosis: pCO2 increased, HCO3− increased, urine pH decreased. A pH of 6.9 suggests acidosis, so CO2 would be reduced and HCO3− would be increased to try and normalize the pH. The urinary pH would be decreased.
3. Metabolic alkalosis: pCO2 increased, HCO3− increased, urine pH increased. HCO3− is increased as they are metabolically alkalotic, CO2 increased to try and offset the alkalosis, and the urinary pH increased as the kidneys try to excrete the excess HCO3−.
4. Renal metabolic acidosis: pCO2 decreased, HCO3− decreased, urine pH increased. In this case, the urine pH will be increased as the metabolic acidosis is due to renal dysfunction, and the kidneys are excreting the excess acid.
5. Mixed acidosis/alkalosis: pCO2 decreased, HCO3− increased, urine pH decreased. This is not seen in any straightforward acid-base disorder but could be seen in states of mixed acidosis/alkalosis.
Understanding these relationships can help healthcare professionals diagnose and treat acid-base disorders effectively.
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This question is part of the following fields:
- Clinical Biochemistry
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