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  • Question 1 - What are the components of Virchow's triad? ...

    Incorrect

    • What are the components of Virchow's triad?

      Your Answer: Venous thrombosis, injury to veins, blood hypercoagulability

      Correct Answer: Venous stasis, injury to veins, blood hypercoagulability

      Explanation:

      Virchow’s Triad and Its Three Categories of Thrombosis Factors

      Virchow’s triad is a concept that explains the three main categories of factors that contribute to thrombosis. These categories include stasis, injuries or trauma to the endothelium, and blood hypercoagulability. Stasis refers to abnormal blood flow, which can be caused by various factors such as turbulence, varicose veins, and stasis. Injuries or trauma to the endothelium can be caused by hypertension or shear stress, which can damage veins or arteries. Blood hypercoagulability is associated with several conditions such as hyperviscosity, deficiency of antithrombin III, nephrotic syndrome, disseminated malignancy, late pregnancy, and smoking.

      It is important to note that current thrombosis or past history of thrombosis and malignancy are not included in the triad. Malignancy is a specific procoagulant state, so it is covered under hypercoagulability. Virchow’s triad and its three categories of thrombosis factors can help healthcare professionals identify and manage patients who are at risk of developing thrombosis. By addressing these factors, healthcare professionals can help prevent thrombosis and its associated complications.

    • This question is part of the following fields:

      • Cardiology
      16.7
      Seconds
  • Question 2 - An infant, born to a 25-year-old woman immigrant who did not receive prenatal...

    Incorrect

    • An infant, born to a 25-year-old woman immigrant who did not receive prenatal care, is found to have a midline lesion on his lower back. Examination reveals a fluid-filled cystic mass that is continuous with the spinal canal.
      With which one of the following could this anomaly have been prevented by supplementation?

      Your Answer: A vitamin that prevents keratinised squamous metaplasia

      Correct Answer: A vitamin necessary in nucleic acid synthesis

      Explanation:

      The Importance of Vitamins in Various Biological Processes

      Vitamins play a crucial role in various biological processes, including nucleic acid synthesis, high-energy electron carrier synthesis, pyruvate dehydrogenase function, prevention of keratinised squamous metaplasia, and fatty acid synthesis.

      Insufficient maternal folate, a vitamin necessary in nucleic acid synthesis, can cause spina bifida, a neural tube defect. Supplementation with folate prior to conception can prevent such defects. Vitamin B3 is necessary for the synthesis of a high-energy electron carrier, while vitamin B1 is necessary for pyruvate dehydrogenase function. Vitamin A prevents keratinised squamous metaplasia and maintains specialised epithelium, but its supplementation is contraindicated during pregnancy. Finally, pantothenic acid or vitamin B5 is necessary for fatty acid synthesis, and its deficiency is rare.

      In conclusion, vitamins are essential for various biological processes, and their deficiency can lead to severe health issues. It is crucial to maintain a balanced diet and ensure adequate vitamin intake to prevent such deficiencies.

    • This question is part of the following fields:

      • Paediatrics
      20.7
      Seconds
  • Question 3 - A 35-year-old woman with bipolar disorder has been consistently taking her medication during...

    Correct

    • A 35-year-old woman with bipolar disorder has been consistently taking her medication during pregnancy. During her recent ultrasound, her baby was found to have characteristics linked to spina bifida. Which medication is the most probable cause of this?

      Your Answer: Sodium valproate

      Explanation:

      The Teratogenic Effects of Certain Medications During Pregnancy

      During pregnancy, certain medications can have teratogenic effects on the developing fetus. One such medication is sodium valproate, which is an anticonvulsant and bipolar disorder treatment. Its use during pregnancy is contraindicated due to its association with congenital malformations and neurodevelopmental disorders, such as spina bifida, congenital heart defects, cleft lip, and neonatal bleeding disorders. If sodium valproate must be used during pregnancy, the lowest effective dose should be administered and additional monitoring is required.

      Lithium therapy during pregnancy has also been linked to an increased risk of congenital heart disease, stillbirth, and early infant deaths, as well as increased risk of toxicity for both the mother and fetus. Olanzapine, on the other hand, has been found to have the same risk of congenital defects as the general population.

      Bupropion has been associated with an increased risk of congenital heart defects if used during pregnancy. However, studies suggest that carbamazepine has one of the lowest rates of teratogenicity when used during pregnancy. It is important for healthcare providers to carefully consider the risks and benefits of medication use during pregnancy and to explore alternative options whenever possible.

    • This question is part of the following fields:

      • Pharmacology
      8.3
      Seconds
  • Question 4 - A senior citizen has been prescribed an antidepressant by a hospital specialist. During...

    Incorrect

    • A senior citizen has been prescribed an antidepressant by a hospital specialist. During the consultation, she was cautioned against consuming cheese and game.
      Which of the following antidepressants is she most likely taking?

      Your Answer: Lofepramine

      Correct Answer: Phenelzine

      Explanation:

      Comparison of Antidepressants and their Interaction with Food: Phenelzine, Moclobemide, Lofepramine, Sertraline, and Trazodone

      Antidepressants are commonly used to treat depression and other mental health disorders. However, some antidepressants can interact with certain foods, leading to potentially dangerous side effects. Here, we compare the interaction of five different antidepressants with food.

      Phenelzine is an older type of monoamine oxidase inhibitor (MAOI) that can cause a hypertensive crisis if amine-containing foods, such as cheese and game, are ingested. Decongestant drugs can also produce the same effects.

      Moclobemide is a reversible inhibitor of monoamine oxidase (RIMA) that has a lower risk of hypertensive crisis if tyramine-rich foods are ingested, although this is still very rare.

      Lofepramine is a tricyclic antidepressant (TCA) that is not affected by cheese and game.

      Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is not affected by cheese and game.

      Trazodone is a TCA that is also not affected by cheese and game.

      It is important to be aware of the potential interactions between antidepressants and food to avoid any adverse effects. Patients should always consult with their healthcare provider before making any changes to their medication or diet.

    • This question is part of the following fields:

      • Pharmacology
      9.2
      Seconds
  • Question 5 - What vitamin is utilized to treat confusion in individuals with chronic alcoholism? ...

    Incorrect

    • What vitamin is utilized to treat confusion in individuals with chronic alcoholism?

      Your Answer: Niacin

      Correct Answer: Thiamine

      Explanation:

      Wernicke-Korsakoff Syndrome

      Wernicke-Korsakoff syndrome is a condition that arises due to insufficient intake of thiamine, as well as impaired absorption and storage. This condition is known to cause various symptoms, including dementia, nystagmus, paralysis of extra ocular muscles, ataxia, and retrograde amnesia, particularly in individuals who struggle with alcoholism.

      The inadequate intake of thiamine is often associated with chronic alcoholism, as alcohol can interfere with the body’s ability to absorb and store thiamine. This can lead to a deficiency in the vitamin, which can cause damage to the brain and nervous system. The symptoms of Wernicke-Korsakoff syndrome can be severe and can significantly impact an individual’s quality of life.

      It is essential to understand the causes and symptoms of Wernicke-Korsakoff syndrome to ensure that individuals who are at risk receive the necessary treatment and support. With proper care and management, it is possible to manage the symptoms of this condition and improve an individual’s overall health and well-being.

    • This question is part of the following fields:

      • Emergency Medicine
      8.1
      Seconds
  • Question 6 - A 50-year-old farmer presents to the Emergency Department with a one day history...

    Incorrect

    • A 50-year-old farmer presents to the Emergency Department with a one day history of faecal and urinary incontinence. He is normally healthy, and only takes sertraline for depression. He is alert, but appears uneasy and sweaty.

      Upon examination, his chest is clear, and heart sounds are normal, while his pupils are 1mm in diameter, and reactive to light bilaterally. His abdomen is soft and non-tender, and peripheral neurological examination is normal, except for occasional lower limb fasciculations.

      His vital signs are as follows: respiratory rate 16/min; oxygen saturations 97% on air; temperature 36.2ºC; heart rate 50 beats per minute; blood pressure 99/60 mmHg.

      What is the most probable diagnosis?

      Your Answer: Opioid toxicity

      Correct Answer: Organophosphate poisoning

      Explanation:

      The patient’s symptoms suggest organophosphate poisoning, which occurs when acetylcholinesterase enzymes are inhibited by the insecticide. This leads to an increase in cholinergic transmission, resulting in over-activation of the parasympathetic nervous system. The patient’s excessive urination, defecation, borderline bradycardia, and miosis are all consistent with this diagnosis. Diaphoresis is also present due to the use of cholinergic transmission in postganglionic fibers of sweat glands. Opioid toxicity is unlikely as it would cause respiratory depression and constipation rather than faecal incontinence and urinary incontinence. Paraquat poisoning is a possible differential, but it would not explain the classic symptoms of excessive muscarinic cholinergic transmission. GHB toxicity is also unlikely as it causes respiratory depression and reduced alertness rather than cholinergic symptoms. Serotonin syndrome is a possibility, but it is more likely to be associated with flushing and tachycardia rather than miosis and excessive parasympathetic stimulation.

      Understanding Organophosphate Insecticide Poisoning

      Organophosphate insecticide poisoning is a condition that occurs when there is an accumulation of acetylcholine in the body, leading to the inhibition of acetylcholinesterase. This, in turn, causes an upregulation of nicotinic and muscarinic cholinergic neurotransmission. In warfare, sarin gas is a highly toxic synthetic organophosphorus compound that has similar effects. The symptoms of organophosphate poisoning can be remembered using the mnemonic SLUD, which stands for salivation, lacrimation, urination, and defecation/diarrhea. Other symptoms include hypotension, bradycardia, small pupils, and muscle fasciculation.

      The management of organophosphate poisoning involves the use of atropine, which helps to counteract the effects of acetylcholine. However, the role of pralidoxime in the treatment of this condition is still unclear. Meta-analyses conducted to date have failed to show any clear benefit of pralidoxime in the management of organophosphate poisoning.

    • This question is part of the following fields:

      • Pharmacology
      12.8
      Seconds
  • Question 7 - A mother brings her 4-year-old son to her General Practitioner. She has noticed...

    Correct

    • A mother brings her 4-year-old son to her General Practitioner. She has noticed that when her son gets tired, his left eye appears to deviate to the left. The child is referred to an ophthalmologist for further tests.
      Which of the following is the most appropriate initial test to assess strabismus?

      Your Answer: Cover test

      Explanation:

      Assessing Strabismus: Tests and Procedures

      Strabismus, commonly known as a squint, is a condition where the visual axis is misaligned, causing one eye to deviate from the object being viewed. The cover test is a useful tool in assessing strabismus, where one eye is covered while the other is observed for a shift in fixation. If this is positive, it is a manifest squint. Another test is the cover/uncover test, where one eye is covered and then uncovered to observe for movement of that eye, indicating a latent squint.

      The Ishihara test is used to assess colour vision and is not an initial test for evaluating strabismus. An MRI brain may be requested if an underlying neurological cause is suspected, but it is not an initial test. Retinal photography is not a first-line test for children presenting with possible strabismus, but the red reflex should be tested to exclude leukocoria, which may suggest a serious cause for the squint such as retinoblastoma. Tonometry is used to measure intraocular pressure and diagnose glaucoma, but it is not used in the assessment of strabismus.

    • This question is part of the following fields:

      • Ophthalmology
      3.6
      Seconds
  • Question 8 - A 26-year-old para 1+0 comes to the clinic at 36 weeks complaining of...

    Incorrect

    • A 26-year-old para 1+0 comes to the clinic at 36 weeks complaining of painless vaginal bleeding. She mentions having occasional spotting for the past 4 weeks, but it has become more frequent and heavier. Her blood pressure is 125/80 mmHg, and her heart rate is 85 bpm. During the examination, her abdomen is soft and non-tender, and the fetal head is not engaged and high. What further examination should you conduct to confirm your initial suspected diagnosis?

      Your Answer: Vaginal examination

      Correct Answer: Transvaginal ultrasound

      Explanation:

      The results are typical of placenta praevia, according to the findings.
      The RCOG suggests transvaginal ultrasound as it enhances the precision of placental positioning and is deemed to be safe.

      Understanding Placenta Praevia

      Placenta praevia is a condition where the placenta is located wholly or partially in the lower uterine segment. It is a relatively rare condition, with only 5% of women having a low-lying placenta when scanned at 16-20 weeks gestation. However, the incidence at delivery is only 0.5%, as most placentas tend to rise away from the cervix.

      There are several factors associated with placenta praevia, including multiparity, multiple pregnancy, and embryos implanting on a lower segment scar from a previous caesarean section. Clinical features of placenta praevia include shock in proportion to visible loss, no pain, a non-tender uterus, abnormal lie and presentation, and a usually normal fetal heart. Coagulation problems are rare, and small bleeds may occur before larger ones.

      Diagnosis of placenta praevia should not involve digital vaginal examination before an ultrasound, as this may provoke severe haemorrhage. The condition is often picked up on routine 20-week abdominal ultrasounds, but the Royal College of Obstetricians and Gynaecologists recommends the use of transvaginal ultrasound for improved accuracy and safety. Placenta praevia is classified into four grades, with grade IV being the most severe, where the placenta completely covers the internal os.

      In summary, placenta praevia is a rare condition that can have serious consequences if not diagnosed and managed appropriately. It is important for healthcare professionals to be aware of the associated factors and clinical features, and to use appropriate diagnostic methods for accurate grading and management.

    • This question is part of the following fields:

      • Obstetrics
      22.3
      Seconds
  • Question 9 - A 65-year-old woman presents to the Gynaecology clinic with complaints of vaginal bleeding....

    Correct

    • A 65-year-old woman presents to the Gynaecology clinic with complaints of vaginal bleeding. She reports that she underwent menopause at age 63 and has never engaged in sexual activity. Her height is 5 ft and she weighs 136 kg. Upon further investigation, malignancy is detected in the suspected organ. What is the typical histologic appearance of the epithelial lining of this organ?

      Your Answer: Simple columnar cells

      Explanation:

      Types of Epithelial Cells in the Female Reproductive System

      The female reproductive system is composed of various types of epithelial cells that serve different functions. Here are some of the most common types of epithelial cells found in the female reproductive system:

      1. Simple columnar cells – These cells are found in the endometrial lining and have a pseudostratified columnar appearance. They are often associated with endometrial carcinoma.

      2. Glycogen-containing stratified squamous cells – These cells are found in the vagina and are responsible for producing glycogen, which helps maintain a healthy vaginal pH.

      3. Cuboidal cells – These cells are found in the ovary and are responsible for producing and releasing eggs.

      4. Stratified squamous cells – These cells are found in the cervix and provide protection against infections.

      5. Columnar ciliated cells – These cells are located in the Fallopian tubes and are responsible for moving the egg from the ovary to the uterus.

      Understanding the different types of epithelial cells in the female reproductive system can help in the diagnosis and treatment of various reproductive disorders.

    • This question is part of the following fields:

      • Gynaecology
      12.6
      Seconds
  • Question 10 - A 70-year-old man contacts his primary care physician for guidance. He lost his...

    Incorrect

    • A 70-year-old man contacts his primary care physician for guidance. He lost his wife to cancer and has been a widower for 6 months. The patient has a supportive family and is not experiencing clinical depression, but he was very emotional after his wife's passing. He occasionally feels indifferent and disheartened, but this has improved significantly over time. However, he has heard his late wife speaking to him on several occasions over the last 2 weeks. He also believed he saw her once while shopping with a friend, but he acknowledges that this is impossible. What is the most appropriate course of action for management?

      Your Answer: Refer urgently to psychiatry

      Correct Answer: Reassure and safety-net

      Explanation:

      It is possible for pseudo hallucinations to be a normal part of the grieving process. People who are grieving may experience hearing, seeing, or smelling their deceased loved one, especially during acute grief. This can happen at any stage of bereavement. Therefore, the patient in question can be reassured that this is a common experience.

      Since there is no evidence of an organic cause for the patient’s symptoms, it would not be appropriate to arrange blood tests or urinalysis.

      While antidepressants may be used to treat severe or atypical cases of grief, the patient is not clinically depressed and is unlikely to benefit from them. In fact, they may cause harm due to their adverse effects.

      The patient is fully aware of the situation and has insight into their condition. Therefore, there is no need for urgent psychiatric involvement or sectioning under the Mental Health Act 1983.

      Understanding Pseudohallucinations

      Pseudohallucinations are false sensory perceptions that occur in the absence of external stimuli, but with the awareness that they are not real. While not officially recognized in the ICD 10 or DSM-5, there is a general consensus among specialists about their definition. Some argue that it is more helpful to view hallucinations on a spectrum, from mild sensory disturbances to full-blown hallucinations, to avoid misdiagnosis or mistreatment.

      One example of a pseudohallucination is a hypnagogic hallucination, which occurs during the transition from wakefulness to sleep. These vivid auditory or visual experiences are fleeting and can happen to anyone. It is important to reassure patients that these experiences are normal and do not necessarily indicate the development of a mental illness.

      Pseudohallucinations are particularly common in people who are grieving. Understanding the nature of these experiences can help healthcare professionals provide appropriate support and reassurance to those who may be struggling with them. By acknowledging the reality of pseudohallucinations and their potential impact on mental health, we can better equip ourselves to provide compassionate care to those who need it.

    • This question is part of the following fields:

      • Psychiatry
      13.7
      Seconds
  • Question 11 - A healthy toddler is playing outside but suddenly stops breathing. The toddler's heart...

    Incorrect

    • A healthy toddler is playing outside but suddenly stops breathing. The toddler's heart rate is over 100 bpm, but the skin colour is blue and the toddler is not moving. After calling for help and checking for a pulse, what is the most appropriate action to take?

      Your Answer: Suction to airways

      Correct Answer: Give five breaths of air via a face mask

      Explanation:

      Steps for Neonatal Resuscitation

      Neonatal resuscitation is a crucial process that can save a newborn’s life. Here are the steps to follow:

      1. Dry the baby and assess its tone, breathing, and heart rate. If the baby is not breathing or gasping, open the airway by placing the baby on its back with the head in a neutral position. Give five inflation breaths of air via a face mask.

      2. If the heart rate increases but the baby still cannot breathe, give breaths at a rate of 30-40 per minute until the baby can breathe independently.

      3. Cardiac massage should only be done if the chest is not moving or the heart rate drops below 60 bpm. In this case, commence cardiac massage at a rate of three compressions to one breath.

      4. Suction of the airways should only be done if there is an obvious airway obstruction that cannot be corrected by airway repositioning manoeuvres.

      5. While it is important to keep the baby warm, avoid wrapping it tightly in a towel as it can obstruct the resuscitation process.

      6. Intubation is not the first step in the resuscitation process. It is an option when resuscitation is failing and is the decision of a senior paediatrician.

      By following these steps, you can increase the chances of a successful neonatal resuscitation.

    • This question is part of the following fields:

      • Paediatrics
      26.3
      Seconds
  • Question 12 - A man with mild dementia has just been admitted to the Emergency Department...

    Incorrect

    • A man with mild dementia has just been admitted to the Emergency Department unit in Scotland following a fall. He has total external rotation of his left leg, indicating that he has a fractured neck of femur. He refused to be taken into the ambulance at home, and the GP successfully applied to a Justice of the Peace for a warrant to remove him to hospital. He still does not want any treatment, and will not allow examination of his hip.
      What is the best legal option to take?

      Your Answer: Common law principle of necessity

      Correct Answer: A section 47 certificate under Adults with Incapacity (Scotland) Act 2000

      Explanation:

      Appropriate Legal Options for Treatment Refusal in Scotland

      When a patient refuses treatment in Scotland, it is important to consider the appropriate legal options available. Depending on the circumstances, different legislation may apply.

      If the patient’s refusal does not fall under mental health legislation and their condition is not immediately life-threatening, the Adults with Incapacity (Scotland) Act 2000 may be the operating legislation. In this case, a section 47 certificate can be used to proceed with treatment.

      However, if there is an underlying mental health disorder, the Mental Health (Care and Welfare) (Scotland) Act 2003 may be applicable. An Emergency Treatment Certificate can be used in cases where there is an immediate risk to life, while a short-term detention certificate and compulsory treatment order can be used in other situations.

      It is also important to consider the common law principle of necessity, which may apply in cases where there is an immediate risk to life.

      Overall, it is crucial to carefully consider the circumstances and applicable legislation when determining the appropriate legal options for treatment refusal in Scotland.

    • This question is part of the following fields:

      • Ethics And Legal
      33.4
      Seconds
  • Question 13 - A 35-year-old woman complains that she is unable to leave the house and...

    Correct

    • A 35-year-old woman complains that she is unable to leave the house and as a result, her children are missing out and she is a bad mother. She reports feeling anxious most of the time, but when she is in public, she experiences a rapid heartbeat, fast breathing, and believes that everyone is staring at her. These symptoms began approximately three weeks after she lost her job when the company she worked for shut down. Since then, she has been unable to find enjoyment in anything and feels constantly fatigued. What is her diagnosis?

      Your Answer: Depression with secondary anxiety

      Explanation:

      Understanding the Relationship Between Depression and Anxiety: A Clinical Perspective

      Depression and anxiety are two common mental health conditions that often co-occur. However, it is important to distinguish between the two and determine which is the primary diagnosis, as this will guide treatment. In cases where depression is the underlying main diagnosis, patients may develop secondary symptoms such as anxiety and panic attacks. On the other hand, in cases where anxiety is the primary diagnosis, patients may also experience secondary depressive symptoms.

      One key factor in determining the primary diagnosis is the temporal development of symptoms. In cases where depressive symptoms clearly started first, a correct diagnosis of depression is important, as treating the underlying disorder can also improve secondary anxiety symptoms. Symptoms of depression include low mood, anhedonia, and anergia.

      Generalized anxiety disorder is characterized by uncontrollable and irrational worry or anxiety about a wide range of issues and situations, while agoraphobia is an excessive fear of being in a situation where a person cannot freely escape or where help may not be available. Panic disorder is diagnosed when a person has recurrent, severe panic attacks without an obvious precipitant.

      In cases where anxiety is secondary to depression, it is important to address the underlying depressive symptoms in order to improve the abnormal anxiety. Symptoms of abnormal anxiety and depression frequently present co-morbidly, and careful history-taking is necessary to determine which is the primary diagnosis. By understanding the relationship between depression and anxiety, clinicians can provide more effective treatment for their patients.

    • This question is part of the following fields:

      • Psychiatry
      6.2
      Seconds
  • Question 14 - A 36-year-old woman has experienced a stillbirth and wants to stop lactation. What...

    Incorrect

    • A 36-year-old woman has experienced a stillbirth and wants to stop lactation. What medication should be used for this purpose?

      Your Answer: L-dopa

      Correct Answer: Bromocriptine

      Explanation:

      Medications for Lactation Suppression

      Lactation is stimulated by the release of prolactin, and drugs that decrease prolactin levels are effective in suppressing lactation. Dopamine agonists like bromocriptine are the most commonly used drugs for this purpose. On the other hand, drugs like domperidone and amitriptyline that increase serum prolactin levels are not effective in suppressing lactation.

      Ondansetron is an antiemetic drug that works by blocking the 5-HT system. It is not used for lactation suppression as it does not affect prolactin levels. L-dopa, another drug that can reduce prolactin levels, is not commonly used due to its side effects. It often causes nausea in patients, making dopamine agonists a preferred choice for lactation suppression.

    • This question is part of the following fields:

      • Pharmacology
      6.8
      Seconds
  • Question 15 - You receive a call from the husband of a 50-year-old patient who is...

    Correct

    • You receive a call from the husband of a 50-year-old patient who is registered at your practice. The patient has a history of type 2 diabetes mellitus treated with metformin. According to her husband, for the past three days, she has been talking nonsensically and experiencing hallucinations. An Approved Mental Health Professional is contacted and heads to the patient's residence. Upon arrival, you encounter a disheveled and emaciated woman sitting on the pavement outside her home, threatening to physically harm you. What is the most appropriate course of action?

      Your Answer: Call the police

      Explanation:

      If the patient is exhibiting violent behavior in a public place, it is advisable to contact the police and have her taken to a secure location for a proper evaluation. It is important to note that Metformin does not lead to hypoglycemia.

      Sectioning under the Mental Health Act is a legal process used for individuals who refuse voluntary admission. This process excludes patients who are under the influence of drugs or alcohol. There are several sections under the Mental Health Act that allow for different types of admission and treatment.

      Section 2 allows for admission for assessment for up to 28 days, which is not renewable. An Approved Mental Health Professional (AMHP) or the nearest relative (NR) can make the application on the recommendation of two doctors, one of whom should be an approved consultant psychiatrist. Treatment can be given against the patient’s wishes.

      Section 3 allows for admission for treatment for up to 6 months, which can be renewed. An AMHP and two doctors, both of whom must have seen the patient within the past 24 hours, can make the application. Treatment can also be given against the patient’s wishes.

      Section 4 is used as an emergency 72-hour assessment order when a section 2 would involve an unacceptable delay. A GP and an AMHP or NR can make the application, which is often changed to a section 2 upon arrival at the hospital.

      Section 5(2) allows a doctor to legally detain a voluntary patient in hospital for 72 hours, while section 5(4) allows a nurse to detain a voluntary patient for 6 hours.

      Section 17a allows for Supervised Community Treatment (Community Treatment Order) and can be used to recall a patient to the hospital for treatment if they do not comply with the conditions of the order in the community, such as taking medication.

      Section 135 allows for a court order to be obtained to allow the police to break into a property to remove a person to a Place of Safety. Section 136 allows for someone found in a public place who appears to have a mental disorder to be taken by the police to a Place of Safety. This section can only be used for up to 24 hours while a Mental Health Act assessment is arranged.

    • This question is part of the following fields:

      • Psychiatry
      34.3
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  • Question 16 - A 72-year-old male is recovering from carotid endarterectomy for an 80% stenosis of...

    Correct

    • A 72-year-old male is recovering from carotid endarterectomy for an 80% stenosis of the carotid artery. After a smooth recovery period, the registrar examined the patient's cranial nerves. Upon requesting the patient to protrude his tongue, it was observed that the tongue deviated towards the right side of the patient. Which nerve has been impacted?

      Your Answer: Right hypoglossal

      Explanation:

      During a carotid endarterectomy, there is a significant chance of damaging the hypoglossal nerve on the same side as the procedure. This nerve is responsible for providing motor function to the tongue and muscles that depress the hyoid bone. Additionally, the accessory nerve is responsible for supplying the sternocleidomastoid and trapezius muscles.

      Nerve Lesions in Surgery: Risks and Procedures

      During surgical procedures, there is a risk of iatrogenic nerve injury, which can have significant consequences for patients and lead to legal issues. Several operations are associated with specific nerve lesions, including posterior triangle lymph node biopsy and accessory nerve lesion, Lloyd Davies stirrups and common peroneal nerve, thyroidectomy and laryngeal nerve, anterior resection of rectum and hypogastric autonomic nerves, axillary node clearance and long thoracic nerve, thoracodorsal nerve, and intercostobrachial nerve, inguinal hernia surgery and ilioinguinal nerve, varicose vein surgery and sural and saphenous nerves, posterior approach to the hip and sciatic nerve, and carotid endarterectomy and hypoglossal nerve.

      To minimize the incidence of nerve lesions, surgeons must have a sound anatomical understanding of the tissue planes involved in commonly performed procedures. Nerve injuries often occur when surgeons operate in unfamiliar tissue planes or use haemostats blindly, which is not recommended. By being aware of the risks and taking appropriate precautions, surgeons can reduce the likelihood of nerve injuries during surgery.

    • This question is part of the following fields:

      • Surgery
      6.5
      Seconds
  • Question 17 - A 10-year-old boy comes to you with a midline cyst that rises upwards...

    Incorrect

    • A 10-year-old boy comes to you with a midline cyst that rises upwards when he sticks out his tongue. You suspect it to be a thyroglossal cyst. Where does the thyroid gland originate from?

      Your Answer: Third branchial pouch

      Correct Answer: Foramen caecum

      Explanation:

      Development of the Thyroid Gland and its Relationship to Other Structures

      The thyroid gland develops from the foramen caecum on the tongue, which is a diverticulum between the first and second branchial arches. It descends to its final position in the neck, passing anteriorly to the hyoid bone. During this descent, a thyroglossal duct traces its path, which usually obliterates but can cause formation of a thyroglossal cyst if persistent. The third branchial pouch forms the inferior parathyroid glands and some cells of the thymus, while the fourth branchial pouch forms the superior parathyroid glands. It is important to note that the foramen caecum of the frontal bone shares its name with the structure on the tongue where the thyroid gland begins development, but the thyroid gland does not start development from the base of the skull. Understanding the relationship between these structures is crucial in the study of embryology and endocrinology.

    • This question is part of the following fields:

      • Endocrinology
      16.2
      Seconds
  • Question 18 - A 27-year-old woman presents to the Emergency department with a suspected intentional overdose....

    Incorrect

    • A 27-year-old woman presents to the Emergency department with a suspected intentional overdose. She is unsure of the medication she has taken. Her medical history includes severe asthma, anxiety, and depression. Additionally, she is a regular cannabis smoker.

      During the assessment, the patient appears agitated and confused, unable to remain still on the bed. There is significant global hypertonia and clonus, particularly in the legs. Her vital signs reveal a sinus tachycardia on ECG with a pulse of 135 bpm. Her blood pressure is 156/96 mmHg, SpO2 97% on air, respiratory rate of 32, and temperature of 40.6°C. The patient's pupils are dilated, and she is sweating.

      Which medication is the patient likely to have overdosed on?

      Your Answer: Cannabis

      Correct Answer: Fluoxetine

      Explanation:

      Serotonergic Toxidrome

      Serotonergic toxidrome, also known as serotonin syndrome, is a condition of drug toxicity that is characterized by extreme temperature, mental agitation and confusion, hypertonia, hyperreflexia, and clonus. This condition is caused by a flooding of the central nervous system with excess serotonin, which can be triggered by various drugs, including antidepressants, opioid analgesics, and certain herbal remedies. Recreational drugs such as cocaine, ecstasy, and amphetamines can also augment serotonin pharmacodynamics and increase the risk of serotonergic toxidrome.

      Deliberate overdosage is a common cause of serotonergic toxidrome, but it can also occur inadvertently, especially in patients taking multiple drugs that affect the metabolism and usage of serotonin. Life-threatening serotonergic toxidrome is a medical emergency that requires admission to the intensive care unit for haemofiltration, intubation, paralysis, and artificial cooling to control the temperature and manage the rhabdomyolysis. Serotonin antagonists such as cyproheptadine may be given, and tachycardia and hypertension can be controlled with intravenous short-acting beta-blockade.

      While other drugs may display some similar features, the serotonergic toxidrome is a relatively specific presentation, typically of rapid onset. Aminophylline, cannabis, diazepam, and paracetamol overdose are unlikely to cause this picture. It is important to screen blood for paracetamol levels in any patient in whom any overdose is suspected, as it is easily treated and can be lethal if missed.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 19 - A 23-year-old man comes to your clinic complaining of chronic back pain. He...

    Incorrect

    • A 23-year-old man comes to your clinic complaining of chronic back pain. He denies any history of trauma but reports experiencing anterior uveitis within the past year. You suspect that he may have ankylosing spondylitis (AS) and decide to perform Schober's test, which yields a positive result. What is a commonly utilized diagnostic test that could provide further evidence to support this diagnosis?

      Your Answer: CT chest, abdomen and pelvis

      Correct Answer: Pelvic radiograph

      Explanation:

      The most supportive diagnostic tool for ankylosing spondylitis is a pelvic X-ray that can reveal sacroiliitis. While a chest X-ray may show bamboo spine, it is a late sign and not likely to be present in the patient at this stage. A full-blood count is not useful for diagnosis. Although a CT scan can provide detailed imaging, it is not commonly used due to the high radiation exposure. HLA-B27 testing is not typically performed in clinical practice as it only indicates a predisposition to AS and is not specific to the condition, often being positive in healthy individuals.

      Investigating and Managing Ankylosing Spondylitis

      Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in males aged 20-30 years old. Inflammatory markers such as ESR and CRP are usually elevated, but normal levels do not necessarily rule out ankylosing spondylitis. HLA-B27 is not a reliable diagnostic tool as it can also be positive in normal individuals. The most effective way to diagnose ankylosing spondylitis is through a plain x-ray of the sacroiliac joints. However, if the x-ray is negative but suspicion for AS remains high, an MRI can be obtained to confirm the diagnosis.

      Management of ankylosing spondylitis involves regular exercise, such as swimming, and the use of NSAIDs as the first-line treatment. Physiotherapy can also be helpful. Disease-modifying drugs used for rheumatoid arthritis, such as sulphasalazine, are only useful if there is peripheral joint involvement. Anti-TNF therapy, such as etanercept and adalimumab, should be given to patients with persistently high disease activity despite conventional treatments, according to the 2010 EULAR guidelines. Ongoing research is being conducted to determine whether anti-TNF therapies should be used earlier in the course of the disease. Spirometry may show a restrictive defect due to a combination of pulmonary fibrosis, kyphosis, and ankylosis of the costovertebral joints.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 20 - A 55-year-old carpet layer presented with acute pain and swelling affecting his left...

    Incorrect

    • A 55-year-old carpet layer presented with acute pain and swelling affecting his left knee. There is no history of trauma. Past medical history includes haemochromatosis for which he receives regular venesection.
      Examination reveals a hot, tender, swollen left knee.
      Investigations:
      Investigation Result Normal value
      Haemoglobin 135 g/l 135–175 g/l
      White cell count (WCC) 4.0 × 109/l 4–11 × 109/l
      Platelets 200 × 109/l 150–400 × 109/l
      Erythrocyte sedimentation rate (ESR) 12 mm/h 0–10mm in the 1st hour
      Sodium (Na+) 139 mmol/l 135–145 mmol/l
      Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
      Creatinine 120 μmol/l 50–120 µmol/l
      Knee aspirate: 12 000 white blood cells/ml (majority neutrophils); rhomboid-shaped, weakly positively birefringent crystals. No growth on culture.
      Which of the following is the most likely diagnosis in this case?

      Your Answer: Pre–patellar bursitis

      Correct Answer: Pseudogout

      Explanation:

      Differential Diagnosis for Knee Aspirate: Pseudogout, Gout, prepatellar Bursitis, Septic Arthritis, Osteoarthritis

      A knee aspirate was performed on a patient who presented with knee pain. The aspirate revealed positively birefringent calcium pyrophosphate crystals, indicating pseudogout. This condition is associated with haemochromatosis and can be treated with non-steroidal anti-inflammatory agents, corticosteroid injections, or short courses of oral corticosteroids. Colchicine may also be an option for some patients. Familial pyrophosphate arthropathy, a rare form of the condition, may be linked to mutations in genes related to inorganic phosphate transport.

      Gout is a differential diagnosis for this case, but the knee aspirate would reveal negatively birefringent crystals. prepatellar bursitis, a sterile condition not associated with crystals or raised white cell counts, can be ruled out. Septic arthritis would present with a systemic inflammatory response and rhomboid-shaped birefringent crystals would not be present. Osteoarthritis is a chronic condition and would not present acutely, and joint aspirate would not show rhomboid-shaped birefringent crystals.

    • This question is part of the following fields:

      • Rheumatology
      6.4
      Seconds
  • Question 21 - A 35-year-old woman in her second pregnancy has been diagnosed with pre-eclampsia and...

    Correct

    • A 35-year-old woman in her second pregnancy has been diagnosed with pre-eclampsia and is taking labetalol twice daily. She presents to the Antenatal Assessment Unit with abdominal pain that began earlier this morning, followed by a brown discharge. The pain is constant and radiates to the back. During the examination, the uterus is hard and tender, and there is a small amount of dark red blood on the pad she presents to you. Which investigation is more likely to diagnose the cause of this patient's antepartum bleeding?

      Your Answer: Transabdominal ultrasound scan

      Explanation:

      When a patient presents with symptoms that suggest placental abruption, a transabdominal ultrasound scan is the most appropriate first-line investigation. This is especially true if the patient has risk factors such as pre-eclampsia and age over 35. The ultrasound scan can serve a dual purpose by assessing the position of the placenta and excluding placenta praevia, as well as assessing the integrity of the placenta and detecting any blood collection or haematoma that may indicate placental abruption. However, in some cases, the ultrasound scan may be normal even in the presence of placental abruption. In such cases, a magnetic resonance imaging (MRI) scan may be necessary for a more accurate diagnosis.

      Before performing a bimanual pelvic examination, it is essential to rule out placenta praevia, as this can lead to significant haemorrhage and fetal and maternal compromise. A full blood count is also necessary to assess the extent of bleeding and anaemia, but it is not diagnostic of placental abruption.

      An abdominal CT scan is not used as a first-line investigation for all women with antepartum haemorrhage, as it exposes the fetus to a significant radiation dose. It is only used in the assessment of pregnant women who have suffered traumatic injuries. Urinalysis is important in the assessment of women with antepartum haemorrhage, as it can detect genitourinary infections, but it does not aid in the diagnosis of placental abruption.

    • This question is part of the following fields:

      • Obstetrics
      13.6
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  • Question 22 - You are asked to assess a middle-aged woman in the maternity ward who...

    Incorrect

    • You are asked to assess a middle-aged woman in the maternity ward who is 5 days post-partum and reporting persistent vaginal bleeding with clots. You reassure her that lochia is a normal part of the post-partum period, but advise her that further investigation with ultrasound may be necessary if the bleeding continues beyond what time frame?

      Your Answer: 4 weeks

      Correct Answer: 6 weeks

      Explanation:

      If lochia continues for more than 6 weeks, an ultrasound should be performed.

      During the puerperium, which is the period of around 6 weeks after childbirth when the woman’s reproductive organs return to their normal state, lochia is the discharge of blood, mucous, and uterine tissue that occurs. It is expected to stop after 4-6 weeks. However, if it persists beyond this time, an ultrasound is necessary to investigate the possibility of retained products of conception.

      Lochia refers to the discharge that is released from the vagina after childbirth. This discharge is composed of blood, mucous, and uterine tissue. It is a normal occurrence that can last for up to six weeks following delivery. During this time, the body is working to heal and recover from the physical changes that occurred during pregnancy and childbirth. It is important for new mothers to monitor their lochia and report any unusual changes or symptoms to their healthcare provider.

    • This question is part of the following fields:

      • Obstetrics
      9.5
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  • Question 23 - A 56-year-old homeless man is discovered unresponsive on the pavement. Upon arrival at...

    Incorrect

    • A 56-year-old homeless man is discovered unresponsive on the pavement. Upon arrival at the emergency department, blood tests are conducted, revealing an abnormality - Amylase 1100 U/l. An ultrasound is performed, indicating no biliary tree dilatation. What is the probable reason for this man's condition?

      Your Answer: Gallstones

      Correct Answer: Hypothermia

      Explanation:

      Acute pancreatitis is a condition that is mainly caused by gallstones and alcohol in the UK. A popular mnemonic to remember the causes is GET SMASHED, which stands for gallstones, ethanol, trauma, steroids, mumps, autoimmune diseases, scorpion venom, hypertriglyceridaemia, hyperchylomicronaemia, hypercalcaemia, hypothermia, ERCP, and certain drugs. CT scans of patients with acute pancreatitis show diffuse parenchymal enlargement with oedema and indistinct margins. It is important to note that pancreatitis is seven times more common in patients taking mesalazine than sulfasalazine.

    • This question is part of the following fields:

      • Surgery
      5.5
      Seconds
  • Question 24 - A 28-year-old woman with a history of depression comes in 2 months postpartum...

    Incorrect

    • A 28-year-old woman with a history of depression comes in 2 months postpartum with symptoms of low mood, lack of energy, and loss of pleasure for the past 3 weeks. She is currently breastfeeding. She has previously taken fluoxetine and found it effective but stopped during pregnancy. After a conversation, she has decided to resume her medication.
      Which antidepressant would be the best choice to initiate treatment?

      Your Answer: Duloxetine

      Correct Answer: Sertraline

      Explanation:

      Understanding Postpartum Mental Health Problems

      Postpartum mental health problems can range from mild ‘baby-blues’ to severe puerperal psychosis. To screen for depression, healthcare professionals may use the Edinburgh Postnatal Depression Scale, which is a 10-item questionnaire that indicates how the mother has felt over the previous week. A score of more than 13 indicates a ‘depressive illness of varying severity’, with sensitivity and specificity of more than 90%. The questionnaire also includes a question about self-harm.

      ‘Baby-blues’ is seen in around 60-70% of women and typically occurs 3-7 days following birth. It is more common in primips, and mothers are characteristically anxious, tearful, and irritable. Reassurance and support from healthcare professionals, particularly health visitors, play a key role in managing this condition. Most women with the baby blues will not require specific treatment other than reassurance.

      Postnatal depression affects around 10% of women, with most cases starting within a month and typically peaking at 3 months. The features are similar to depression seen in other circumstances, and cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine may be used if symptoms are severe. Although these medications are secreted in breast milk, they are not thought to be harmful to the infant.

      Puerperal psychosis affects approximately 0.2% of women and requires admission to hospital, ideally in a Mother & Baby Unit. Onset usually occurs within the first 2-3 weeks following birth, and features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations). There is around a 25-50% risk of recurrence following future pregnancies. Paroxetine is recommended by SIGN because of the low milk/plasma ratio, while fluoxetine is best avoided due to a long half-life.

    • This question is part of the following fields:

      • Psychiatry
      6
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  • Question 25 - A 56-year-old woman without significant medical history presents to the emergency department complaining...

    Incorrect

    • A 56-year-old woman without significant medical history presents to the emergency department complaining of right-sided hip pain that has been bothering her for the past 2 weeks. Despite the pain, she is still able to walk, although with a slight limp. The pain is particularly worse at night when she rolls onto her right side, causing her to have difficulty sleeping.
      Upon examination, there is tenderness over the lateral aspect of the right hip, and she experiences pain on internal and external rotation of the hip. Blood tests reveal the following results: Hb 142 g/L (Female: 115-160), WBC 9.8 * 109/L (4.0 - 11.0), and CRP 23 mg/L (< 5).
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Trochanteric bursitis

      Explanation:

      Understanding Greater Trochanteric Pain Syndrome

      Greater trochanteric pain syndrome, also known as trochanteric bursitis, is a condition that results from the repetitive movement of the fibroelastic iliotibial band. This condition is most commonly observed in women aged between 50 and 70 years. The primary symptom of this condition is pain experienced over the lateral side of the hip and thigh. Additionally, tenderness is observed upon palpation of the greater trochanter.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 26 - A 78-year-old man is admitted with new-onset confusion. He is usually independent and...

    Incorrect

    • A 78-year-old man is admitted with new-onset confusion. He is usually independent and enjoys gardening in his spare time. When he didn't show up for his weekly gardening club meeting, a friend went to his house. The friend noticed that the patient appeared disoriented and was speaking nonsensically, prompting them to call for medical assistance.
      What distinguishes delirium from dementia?

      Your Answer:

      Correct Answer: Fluctuating level of consciousness

      Explanation:

      Dementia vs Delirium: Understanding the Differences

      Dementia and delirium are two conditions that can affect cognitive abilities and behavior. While they share some similarities, there are also important differences between them.

      Dementia is a group of neurodegenerative disorders that cause a progressive decline in cognition and/or behavior from previous levels of functioning. It is characterized by a slow, insidious progression and is rarely reversible. Memory loss, executive functioning problems, speech and language difficulties, social interaction loss, personality changes, and visuospatial problems are some of the areas of loss associated with dementia. Mobility and gait disturbances are also common.

      Delirium, on the other hand, is an acute confusional state characterized by a relatively rapid onset and variable, fluctuating progression. It may cause a global reduction in cognitive abilities but is usually reversible if the underlying cause is promptly identified. Common causes include sepsis, medications, metabolic derangement, and causes of raised intracranial pressure.

      While there are some similarities between dementia and delirium, there are also some differences. For example, dementia is never associated with a persistent fluctuating level of consciousness, which is a feature of delirium. Visual hallucinations are present in both delirium and dementia, particularly Lewy body dementia. Impaired memory and dysarthria are also present in both conditions, as is urinary incontinence.

      In summary, understanding the differences between dementia and delirium is important for proper diagnosis and treatment. While both conditions can affect cognitive abilities and behavior, they have distinct features that can help differentiate them.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 27 - A fifty-six-year-old, known alcoholic, presents to his general practitioner (GP) with complaints of...

    Incorrect

    • A fifty-six-year-old, known alcoholic, presents to his general practitioner (GP) with complaints of swelling in his right foot. The patient is unsure when the swelling started, but it has been gradually worsening for the past four months. The swelling is constant and not painful, and he is still able to bear weight on both limbs. He sleeps with two pillows at night but denies being short of breath or experiencing paroxysmal nocturnal dyspnoea. The patient has been smoking 10 cigarettes a day for 30 years and consuming 15 units of alcohol per day for 20 years.

      During examination, the patient's heart rate is 84/minute, respiratory rate is 12/minute, blood pressure is 135/74 mmHg, oxygen saturations are 98%, and temperature is 36.5ºC. The right foot is visibly swollen and erythematosus, and it is hot to the touch. There is no tenderness on palpation, but there is reduced range of movement due to stiffness from swelling. Pulses are present, but there is reduced sensation in all dermatomes below the knee. The left foot is mildly swollen, but not hot or erythematosus. There is no tenderness on palpation of the joint or tarsal bones, and there is a normal range of movement. Pulses are present, but there is reduced sensation in all dermatomes below the knee.

      The GP sends the patient for X-rays of both feet. The X-ray of the right foot shows evidence of osteolysis of the distal metatarsals and widespread joint dislocation in the forefoot. The X-ray of the left foot is normal. What is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Charcot joint

      Explanation:

      The patient is suffering from alcoholic neuropathy, which increases the risk of developing a Charcot joint (also known as neuropathic arthropathy). This condition gradually damages weight-bearing joints due to loss of sensation, leading to continued damage without pain awareness. While diabetic neuropathy is the most common cause, other conditions such as alcoholic neuropathy, syphilis, and cerebral palsy can also lead to it. The X-ray results of osteolysis and joint dislocation, along with the clinical symptoms of a non-tender, swollen, red, and warm foot, are characteristic of an acute Charcot joint. Osteoarthritis (OA) may cause a swollen and red foot, but it would not produce the X-ray changes described in this case. The history of alcoholism and peripheral neuropathy makes OA less likely. Although alcoholism can increase the risk of heart failure, the patient has no other symptoms of heart failure, making it an unlikely cause. Rheumatoid arthritis (RA) is an inflammatory arthropathy that can affect any joint in the body, but the combination of alcoholism and radiological findings makes RA less likely than a Charcot joint.

      A Charcot joint, also known as a neuropathic joint, is a joint that has been severely damaged due to a loss of sensation. In the past, they were commonly caused by syphilis, but now they are most often seen in diabetics. These joints are typically less painful than expected, but some degree of pain is still reported by 75% of patients. The joint is usually swollen, red, and warm. The condition involves extensive bone remodeling and fragmentation, particularly in the midfoot, as seen in patients with poorly controlled diabetes. Charcot joints are a serious condition that require prompt medical attention.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 28 - A 72-year-old woman is prescribed amiodarone for her atrial fibrillation. Her physician orders...

    Incorrect

    • A 72-year-old woman is prescribed amiodarone for her atrial fibrillation. Her physician orders baseline liver and renal function tests as well as a chest x-ray. What other important test should be done before starting amiodarone therapy?

      Your Answer:

      Correct Answer: Thyroid function

      Explanation:

      The Side Effects of Amiodarone

      Amiodarone is a medication used to treat various cardiac dysrhythmias, but its use is limited due to its significant side effect profile. The drug can cause hepatic dysfunction and drug-associated hepatitis, so regular liver function assessments are necessary. Respiratory complications, such as pneumonitis and pulmonary fibrosis, can also occur, and a baseline chest x-ray should be carried out before treatment. If respiratory symptoms occur, prompt investigation is necessary, and discontinuation of the drug is advisable to prevent further deterioration in function.

      Amiodarone can also cause eye-related side effects, such as corneal microdeposits that can impair visual acuity and cause night-time glare. Visual discolouration, optic atrophy, non-ischaemic neuritis, papilloedema, and various visual field defects have also been reported. Peripheral neuropathy with decreased peripheral sensation and tremor can also occur.

      It is important to establish a baseline thyroid profile before starting treatment, as amiodarone can cause both hyperthyroidism and hypothyroidism. Both free thyroxine (T4) and tri-iodothyronine (T3) are monitored, as well as thyroid stimulating hormone (TSH).

      In summary, amiodarone can cause significant side effects, and regular monitoring is necessary to detect and manage them promptly.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 29 - A 25-year-old patient presented with red rashes on their feet. Upon examination, they...

    Incorrect

    • A 25-year-old patient presented with red rashes on their feet. Upon examination, they were found to be pale with purpuric spots on their lower legs. Their temperature was 38.3 °C and they also complained of nausea. On the second day of admission, their fever increased and they became disoriented. New bleeding spots started appearing on their face. Blood reports revealed low hemoglobin, high white cell count, low platelets, and high creatinine levels. A peripheral blood smear showed helmet cells and anisocytosis. The CSF study was normal. What test should be done next for this patient?

      Your Answer:

      Correct Answer: Urinary β-human chorionic gonadotrophin (hCG)

      Explanation:

      The patient is presenting with thrombotic thrombocytopenic purpura (TTP), which is characterized by low platelet count due to clotting and platelet sequestration in small vessels. TTP is associated with haemolytic anaemia, thrombocytopenic purpura, fever, and neurological and renal abnormalities. The patient’s risk factors for TTP include being female, obese, pregnant, and of Afro-Caribbean origin. To determine the appropriate management, a urinary β-hCG test should be performed to establish pregnancy status. The first-line treatment for TTP is plasma exchange with fresh frozen plasma. Blood cultures should also be performed to check for underlying septicaemia. Antiplatelet antibody titres can be raised in idiopathic thrombocytopenic purpura (ITP), but ITP does not cause renal failure. A bone marrow study is appropriate to rule out leukaemia. Illicit drug use should also be considered as a cause of disseminated intravascular coagulation (DIC).

    • This question is part of the following fields:

      • Haematology
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  • Question 30 - A 30-year-old man is referred to a Rapid Access Neurology Service due to...

    Incorrect

    • A 30-year-old man is referred to a Rapid Access Neurology Service due to severe headache. He gives a history of recurrent rapid-onset severe right-sided headache and eye pain. It sometimes wakes him up at night. He claims the eye itself becomes watery and red during the periods of pain. He also claims that side of his face feels hot and painful during episodes. They normally last 60 minutes. However, he says they can be shorter or longer. There is no significant medical history. He is a smoker. He is pain-free during the consultation and examination is non-contributory.
      Which of the following is most likely to be of value in relieving pain?

      Your Answer:

      Correct Answer: Oxygen

      Explanation:

      Understanding Cluster Headaches and Treatment Options

      Cluster headaches are a rare and severe form of headache with an unknown cause, although it is believed to be related to serotonin hyperreactivity in the superficial temporal artery smooth muscle and an autosomal dominant gene. They are more common in young male smokers but can affect any age group. Symptoms include sudden onset of severe unilateral headache, pain around one eye, watery and bloodshot eye, lid swelling, facial flushing, and more. Attacks can occur 1-2 times a day and last 15 minutes to 2 hours. Treatment options include high-flow 100% oxygen, subcutaneous sumatriptan, and verapamil or topiramate for prevention. Other treatments, such as amitriptyline for trigeminal neuralgia or high-dose prednisolone for giant cell arthritis, are not appropriate for cluster headaches.

    • This question is part of the following fields:

      • Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (0/1) 0%
Paediatrics (0/2) 0%
Pharmacology (1/5) 20%
Emergency Medicine (0/1) 0%
Ophthalmology (1/1) 100%
Obstetrics (1/3) 33%
Gynaecology (1/1) 100%
Psychiatry (2/4) 50%
Ethics And Legal (0/1) 0%
Surgery (1/2) 50%
Endocrinology (0/1) 0%
Musculoskeletal (0/1) 0%
Rheumatology (0/1) 0%
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