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Question 1
Incorrect
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A 13-year-old girl visits her GP with worries about not having started her periods yet, unlike her peers. During the examination, the GP notes that she is 143cm tall and has several melanocytic naevi on her arms. She also holds her arms at a wide carrying angle when at rest. There is no relevant family history and her cardiovascular examination is normal. What is the probable diagnosis?
Your Answer: Familial atypical multiple mole melanoma syndrome
Correct Answer: Turner's syndrome
Explanation:Understanding Turner’s Syndrome
Turner’s syndrome is a genetic disorder that affects approximately 1 in 2,500 females. It is caused by the absence of one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. This condition is denoted as 45,XO or 45,X.
The features of Turner’s syndrome include short stature, a shield chest with widely spaced nipples, a webbed neck, a bicuspid aortic valve (15%), coarctation of the aorta (5-10%), primary amenorrhea, cystic hygroma (often diagnosed prenatally), a high-arched palate, a short fourth metacarpal, multiple pigmented naevi, lymphoedema in neonates (especially feet), and elevated gonadotrophin levels. Hypothyroidism is much more common in Turner’s syndrome, and there is also an increased incidence of autoimmune disease (especially autoimmune thyroiditis) and Crohn’s disease.
In summary, Turner’s syndrome is a chromosomal disorder that affects females and can cause a range of physical features and health issues. Early diagnosis and management can help individuals with Turner’s syndrome lead healthy and fulfilling lives.
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This question is part of the following fields:
- Paediatrics
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Question 2
Correct
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A 26-year-old man with a 10-year history of type I diabetes presents with a 1-day history of vomiting and a 4-day history of myalgia and sore throat. He appears dehydrated, BP 120/74 mmHg, pulse 101 bpm, temperature 37.9 °C, oxygen saturation 97% on room air. There is mild erythema in his throat and nil else to find on clinical examination. The following are his laboratory investigations:
Investigation Result Normal value
pH 7.12 7.35–7.45
Ketones 5 mmol/l <0.6
Glucose 32 mmol/l 4–10 mmol/l
Potassium 4.2 mmol/l 3.5–5 mmol/l
Bicarbonate 10 mmol/l 24–30 mmol/l
Base excess -5 mEq/l −2 to +2 mEg/l
C-reactive protein (CRP) 22 mg/l 0–10 mg/l
White Cell Count (WCC) 12.7 × 109/l 4-11
Which of the following initial treatment plans should be commenced?Your Answer: IV insulin, IV fluids, potassium supplementation
Explanation:Management of Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious complication of diabetes that requires prompt management. The initial stages of DKA should involve the administration of IV insulin, IV fluids, and potassium supplementation. If the patient’s systolic blood pressure is below 90 mmHg, 500 ml of IV sodium chloride 0.9% should be given over 10-15 minutes, with repeat doses if necessary. Once blood pressure is over 90 mmHg, sodium chloride 0.9% should be given by intravenous infusion at a rate that replaces the deficit and provides maintenance. Potassium chloride should be included in the fluids, unless anuria is suspected or potassium levels are above 5.5 mmol/l. IV insulin should be infused at a fixed rate of 0.1 units/kg/hour, diluted with sodium chloride 0.9% to a concentration of 1 unit/ml.
If there are no signs of bacterial infection, antibiotics may not be necessary. In cases where there are symptoms of viral infection, such as a red sore throat and myalgia, IV antibiotics may not be required. Subcutaneous rapid-acting insulin should not be used, as IV insulin is more effective in rapidly treating hyperglycemia and can be titrated as needed on an hourly basis. Oral antibiotics may be considered if there are signs of bacterial infection.
In cases where the patient has established diabetes, long-acting insulin should be continued even if on IV insulin. Once blood glucose levels fall below 14 mmol/litre, glucose 10% should be given by intravenous infusion at a rate of 125 ml/hour, in addition to the sodium chloride 0.9% infusion. Glucose levels of 32 require the use of saline with potassium initially. Overall, prompt and appropriate management of DKA is crucial in preventing serious complications and improving patient outcomes.
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This question is part of the following fields:
- Endocrinology
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Question 3
Correct
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A 42-year-old teacher comes to the general practitioner (GP) worried about her risk of developing Alzheimer's disease. Her father has been diagnosed with an advanced form of the condition, and although she has no symptoms, the patient is anxious, as she has heard recently that the condition can be inherited.
Which one of the following statements regarding Alzheimer's disease is true?Your Answer: It is more common in women than men
Explanation:Myth Busting: Common Misconceptions About Alzheimer’s Disease
Alzheimer’s disease is a complex and often misunderstood condition. Here are some common misconceptions about the disease that need to be addressed:
1. It is more common in women than men: While it is true that women are more likely to develop Alzheimer’s disease, it is not entirely clear why. It is thought that this may be due to the fact that women generally live longer than men.
2. The familial variant is inherited as an autosomal recessive disorder: This is incorrect. The familial variant of Alzheimer’s disease is typically inherited as an autosomal dominant disorder.
3. It accounts for 30-40% of all cases of dementia: Alzheimer’s disease is actually responsible for approximately 60% of all cases of dementia.
4. The onset is rare after the age of 75: Onset of Alzheimer’s disease typically increases with age, and it is not uncommon for people to develop the disease after the age of 75.
5. It cannot be inherited: This is a myth. While not all cases of Alzheimer’s disease are inherited, there are certain genetic mutations that can increase a person’s risk of developing the disease.
It is important to dispel these myths and educate ourselves about the true nature of Alzheimer’s disease. By understanding the facts, we can better support those affected by the disease and work towards finding a cure.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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At what developmental stage would a child have the ability to briefly sit while leaning forward on their hands, grasp a cube and transfer it from hand to hand, babble, but not yet wave goodbye or use their finger and thumb to grasp objects?
Your Answer: 3 months
Correct Answer: 7 months
Explanation:Developmental Milestones at 7 Months
At 7 months, babies reach several developmental milestones. They are able to sit without support, which means they can sit up straight and maintain their balance without falling over. They also start to reach for objects with a sweeping motion, using their arms to grab things that catch their attention. Additionally, they begin to imitate speech sounds, such as babbling and making noises with their mouths.
Half of babies at this age can combine syllables into wordlike sounds, which is an important step towards language development. They may start to say simple words like mama or dada and understand the meaning behind them. Finally, many babies begin to crawl or lunge forward, which is a major milestone in their physical development. Overall, 7 months is an exciting time for babies as they continue to grow and develop new skills.
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This question is part of the following fields:
- Paediatrics
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Question 5
Correct
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A 42-year-old woman visits her General Practitioner (GP) on an emergency appointment due to her worsening anxiety state. She reveals to the GP that she has been experiencing this for several years and is now seeking treatment. What is the most effective approach for long-term management?
Your Answer: Sertraline
Explanation:Medications for Generalised Anxiety Disorder
Generalised anxiety disorder can severely impact a patient’s daily life. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is the recommended first-line treatment. However, caution must be taken when prescribing to young adults, those over 65, and patients on other medications due to potential side effects. Zopiclone, Haloperidol, and Diazepam are not appropriate treatments for this disorder and should be avoided. Amitriptyline, a tricyclic antidepressant, is not considered the best management for generalised anxiety disorder.
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This question is part of the following fields:
- Psychiatry
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Question 6
Correct
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You are requested by a nurse to assess a 66-year-old woman on the Surgical Assessment Unit who is 1-day postoperative, having undergone a laparoscopic cholecystectomy procedure for cholecystitis. She has a medical history of type II diabetes mellitus and chronic kidney disease. Blood tests taken earlier in the day revealed electrolyte imbalances with hyperkalaemia.
Which of the following ECG changes is linked to hyperkalaemia?Your Answer: Peaked T waves
Explanation:Electrocardiogram (ECG) Changes Associated with Hypo- and Hyperkalaemia
Hypo- and hyperkalaemia can cause significant changes in the ECG. Hypokalaemia is associated with increased amplitude and width of the P wave, T wave flattening and inversion, ST-segment depression, and prominent U-waves. As hypokalaemia worsens, it can lead to frequent supraventricular ectopics and tachyarrhythmias, eventually resulting in life-threatening ventricular arrhythmias. On the other hand, hyperkalaemia is associated with peaked T waves, widening of the QRS complex, decreased amplitude of the P wave, prolongation of the PR interval, and eventually ventricular tachycardia/ventricular fibrillation. Both hypo- and hyperkalaemia can cause prolongation of the PR interval, but only hyperkalaemia is associated with flattening of the P-wave. In hyperkalaemia, eventually ventricular tachycardia/ventricular fibrillation is seen, while AF can occur in hypokalaemia.
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This question is part of the following fields:
- Cardiology
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Question 7
Correct
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A 28-year-old man presents to his primary care physician with concerns about recurring thoughts. He has been experiencing thoughts of needing to repeatedly check that his car is locked when leaving it, even though he knows he locked it. Sometimes he feels the need to physically check the car, but other times it is just thoughts. He denies any symptoms of depression or psychosis and has no significant medical or family history. He is not taking any medications. What is the recommended first-line treatment for his likely diagnosis?
Your Answer: Exposure and response prevention
Explanation:The recommended treatment for a patient with OCD is exposure and response prevention, which involves exposing them to anxiety-inducing situations (such as having dirty hands) and preventing them from engaging in their usual compulsive behaviors. This therapy is effective in breaking the cycle of obsessive thoughts and compulsive actions.
Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions that can cause significant functional impairment and distress. Risk factors include family history, age, pregnancy/postnatal period, and history of abuse, bullying, or neglect. Treatment options include low-intensity psychological treatments, SSRIs, and more intensive CBT (including ERP). Severe cases should be referred to the secondary care mental health team for assessment and may require combined treatment with an SSRI and CBT or clomipramine as an alternative. ERP involves exposing the patient to an anxiety-provoking situation and stopping them from engaging in their usual safety behavior. Treatment with SSRIs should continue for at least 12 months to prevent relapse and allow time for improvement.
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This question is part of the following fields:
- Psychiatry
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Question 8
Correct
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A 25-year-old woman, presenting with a 4-month history of severe mood swings, breast tenderness and reduced cognitive ability to perform functions at work, comes for a review with her diary of symptoms corresponding to a period of three cycles. She attends work regularly during these episodes and goes out with friends, but does not enjoy it as much and is less productive.
Going through the diary, symptoms occur during the luteal phase and resolve 2–3 days into menstruation.
Blood tests, including thyroid function tests, are normal. She has tried the progesterone implant, which made her symptoms worse; therefore, she is not currently using any contraception.
A diagnosis of premenstrual syndrome (PMS) is made.
Which of the following is the next step in the management of this patient?Your Answer: Combined oral contraceptive pill (COCP)
Explanation:Management of Premenstrual Syndrome (PMS)
Premenstrual Syndrome (PMS) is a diagnosis of exclusion, characterized by cyclical psychological, behavioral, and physical symptoms during the luteal phase of the menstrual cycle. The exact causes are not yet identified, but studies suggest that the effects of hormones on serotonin and GABA signaling may have a significant role, in addition to psychological and environmental factors.
For moderate PMS, the National Institute for Health and Care Excellence (NICE) recommends the use of new-generation combined oral contraceptives, which prevent the natural cyclical change in hormones seen in the physiological menstrual cycle. Continuous use, rather than cyclical, showed better improvement. Response is unpredictable, and NICE suggests a trial of three months, and then to review.
Referral to a specialist clinic is reserved for women who have severe PMS, resistant to medication, that cannot be managed in the community. Fluoxetine, a selective serotonin reuptake inhibitor, has been used successfully in the treatment of women with severe PMS symptoms or in women with moderate PMS that fails to respond to other treatments.
Lifestyle modification advice is given to patients with mild PMS, including regular exercise, restriction in alcohol intake, smoking cessation, regular meals, regular sleep, and stress reduction. St John’s wort, an over-the-counter herbal remedy, has shown improvement of symptoms in some studies, but its safety profile is unknown, and it can interact with prescribed medication. Its use is at the discretion of the individual, but the patient needs to be warned of the potential risks.
Management Options for Premenstrual Syndrome (PMS)
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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An older man tries to lift a heavy shopping bag but experiences sudden pain in his shoulder. As a result, he feels soreness in the area of the greater tuberosity of the humerus. He notices that he cannot initiate abduction when he tries to move his shoulder, but can continue to abduct once the arm is lifted away from his side. The shoulder flexion and extension can be performed normally, and the humerus medial and lateral rotation is also unaffected. What is the most probable diagnosis for the tendon injury?
Your Answer: Deltoid
Correct Answer: Supraspinatus
Explanation:Muscles of the Shoulder: Functions and Roles
The shoulder joint is a complex structure that relies on several muscles to perform its various movements. Here are some of the key muscles involved in shoulder movement and their functions:
Supraspinatus: This muscle initiates the first 15-20 degrees of abduction of the arm. After this point, the middle fibers of the deltoid take over. The supraspinatus is also part of the rotator cuff.
Infraspinatus: Along with the teres minor, the infraspinatus is a lateral rotator of the humerus. It is also part of the rotator cuff.
Deltoid: The deltoid muscle assists with shoulder abduction after the first 15-20 degrees, which is initiated by the supraspinatus.
Subscapularis: This muscle inserts into the lesser tuberosity of the humerus and is a medial rotator of the humerus. It also helps stabilize the shoulder joint as part of the rotator cuff.
Biceps brachii: This muscle is responsible for flexion of the arm and forearm, as well as supination of the forearm. However, it does not play a role in abduction of the humerus.
Understanding the functions and roles of these muscles can help with injury prevention and rehabilitation, as well as improving overall shoulder strength and mobility.
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This question is part of the following fields:
- Orthopaedics
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Question 10
Incorrect
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A 28-year-old pregnant woman (38+2, G1 P0) presents to the labour ward with vaginal bleeding and severe abdominal pain. She reports a small amount of vaginal bleeding and has no significant medical history. However, she is a smoker and consumes 10 cigarettes per day. On examination, her abdomen is tender and tense, and cardiotocography reveals late decelerations. Her vital signs are as follows: respiratory rate 22 breaths/min, oxygen saturation 98%, heart rate 125 beats/min, blood pressure 89/56 mmHg, and temperature 35.9 ºC. What is the initial management for the probable diagnosis?
Your Answer: Category 2 caesarean section
Correct Answer: Category 1 caesarean section
Explanation:A category 1 caesarean section is necessary in cases of suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia, or persistent fetal bradycardia. In this scenario, the most likely diagnosis is a major placental abruption due to intense abdominal pain and haemodynamic shock. Guidelines recommend a category 1 caesarean section if the foetus is alive and >36 weeks with foetal distress, as indicated by late decelerations on cardiotocography. This is because the presentation of placental abruption, haemodynamic shock, and late decelerations poses an immediate threat to the lives of both the mother and baby. Administering corticosteroids and observation is not applicable in this scenario, as the foetus is >36 weeks and foetal distress is present. Category 2 and 4 caesarean sections are also inappropriate, as they are not immediately life-threatening and are elective, respectively.
Caesarean Section: Types, Indications, and Risks
Caesarean section, also known as C-section, is a surgical procedure that involves delivering a baby through an incision in the mother’s abdomen and uterus. In recent years, the rate of C-section has increased significantly due to an increased fear of litigation. There are two main types of C-section: lower segment C-section, which comprises 99% of cases, and classic C-section, which involves a longitudinal incision in the upper segment of the uterus.
C-section may be indicated for various reasons, including absolute cephalopelvic disproportion, placenta praevia grades 3/4, pre-eclampsia, post-maturity, IUGR, fetal distress in labor/prolapsed cord, failure of labor to progress, malpresentations, placental abruption, vaginal infection, and cervical cancer. The urgency of C-section may be categorized into four categories, with Category 1 being the most urgent and Category 4 being elective.
It is important for clinicians to inform women of the serious and frequent risks associated with C-section, including emergency hysterectomy, need for further surgery, admission to intensive care unit, thromboembolic disease, bladder injury, ureteric injury, and death. C-section may also increase the risk of uterine rupture, antepartum stillbirth, placenta praevia, and placenta accreta in subsequent pregnancies. Other complications may include persistent wound and abdominal discomfort, increased risk of repeat C-section, readmission to hospital, haemorrhage, infection, and fetal lacerations.
Vaginal birth after C-section (VBAC) may be an appropriate method of delivery for pregnant women with a single previous C-section delivery, except for those with previous uterine rupture or classical C-section scar. The success rate of VBAC is around 70-75%.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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A 55-year-old woman arrives at the Emergency Department complaining of intense abdominal pain. She is currently receiving peritoneal dialysis, and the physician suspects that she may be suffering from peritonitis.
What is the most indicative sign or symptom of peritonitis in this patient?Your Answer: Hyperactive tinkling bowel sounds
Correct Answer: Tachycardia
Explanation:Understanding Peritonitis: Symptoms and Treatment
Peritonitis is a condition characterized by inflammation of the serosa that lines the abdominal cavity and viscera. It is commonly caused by the introduction of an infective organism, perforation of an abdominal organ, trauma, or collection formation. Patients may also present with sterile peritonitis due to irritants such as bile or blood. Risk factors include existing ascites, liver disease, or peritoneal dialysis.
Symptoms of peritonitis include abdominal pain, tenderness, and guarding, with reduced or absent bowel sounds. Movement and coughing can worsen pain symptoms. Patients may have a fever and become tachycardic as the condition progresses due to intracapsular hypovolemia, release of inflammatory mediators, and third space losses. As the condition worsens, patients may become hypotensive, indicating signs of sepsis.
Treatment for peritonitis involves rapid identification and treatment of the source, aggressive fluid resuscitation, and targeted antibiotic therapy.
It is important to note that hyperactive tinkling bowel sounds are suggestive of obstruction, whereas patients with peritonitis typically present with a rigid abdomen and increased abdominal guarding. Pain tends to worsen with movement, as opposed to conditions such as renal colic where the patient may writhe around in pain.
In severe cases, patients with peritonitis may become hypothermic, but this is not a common presentation. Understanding the symptoms and treatment of peritonitis is crucial for prompt and effective management of this serious condition.
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This question is part of the following fields:
- Colorectal
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Question 12
Correct
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A 45-year-old woman is brought in by her daughter because ‘she is acting wild again’. She drinks moderately about once a week. She is not sleeping much, talks incessantly about plans to travel the world and has made many impulsive and irrational purchases. She reports hearing voices but refuses to discuss this issue when questioned by the admitting psychiatrist. She begins a task but does not complete it, all the while making lists of things to be done. She has been starting tasks and not finishing them. She had a similar episode 3 years ago. She also has depressive episodes several times over the last few years and recovered in between them.
What is the most likely underlying diagnosis?Your Answer: Bipolar, manic, with mood-congruent psychotic features
Explanation:Understanding Psychotic Disorders: Differential Diagnosis
Psychotic disorders are a group of mental illnesses characterized by the presence of psychotic symptoms such as hallucinations, delusions, and disorganized thinking. However, differentiating between these disorders can be challenging. Here are some possible diagnoses for a patient presenting with manic and psychotic symptoms:
Bipolar, manic, with mood-congruent psychotic features: This diagnosis is appropriate for a patient with both manic symptoms and mood-congruent psychotic features. The patient’s lack of insight is characteristic of either mania or psychosis. The need to get a history from a third party is typical. What distinguishes this from schizophrenia is that the patient appears to have a normal mood state.
Substance-induced psychosis: The use of substances in this scenario is far too little to account for the patient’s symptoms, ruling out psychosis secondary to substance abuse.
Schizophreniform disorder: This diagnosis is appropriate for a patient with symptoms of schizophrenia of <6 months' duration. Schizophrenia, paranoid type: This diagnosis is appropriate for a patient with symptoms for >6 months and multiple psychotic symptoms such as hallucinations, bizarre delusions, and social impairment.
Schizoaffective disorder: This diagnosis is appropriate for a patient with both mood disorder and schizophrenic symptoms. However, the patient in this scenario is not expressing enough schizophrenic symptoms to establish a diagnosis of schizoaffective disorder.
In conclusion, accurate diagnosis of psychotic disorders requires careful evaluation of the patient’s symptoms, history, and social functioning. A thorough understanding of the differential diagnosis is essential for effective treatment and management of these complex conditions.
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This question is part of the following fields:
- Psychiatry
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Question 13
Incorrect
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A 27-year-old woman has been experiencing a pattern of tumultuous endings in all of her relationships. She confides in you that she seems to have a knack for choosing friends and romantic partners who ultimately reveal themselves to be awful people.
What defense mechanism is most likely at play in this patient?Your Answer: Reaction formation
Correct Answer: Splitting
Explanation:Defense Mechanisms: Understanding How We Cope
Defense mechanisms are psychological strategies that we use to protect ourselves from anxiety and emotional pain. These mechanisms are often unconscious and can be both adaptive and maladaptive. Here are some common defense mechanisms and their explanations:
Splitting: This is a common defense mechanism in borderline personality disorder. It involves seeing people as either all good or all bad, and the inability to reconcile both good and bad traits in a person.
Dissociation: This is an immature defense mechanism where one’s personal identity is temporarily modified to avoid distress. An extreme form is dissociative identity disorder.
Identification: This is when someone models the behavior of a more powerful example. An example would be a victim of child abuse becoming a child abuser in adulthood.
Sublimation: This is a mature defense mechanism where the person takes an unacceptable personality trait and uses it to drive a respectable work that does not conflict with their value system.
Reaction formation: This is an immature defense mechanism where unacceptable emotions are repressed and replaced by their exact opposite. A classic example is a man with homoerotic desires championing anti-homosexual public policy.
Understanding these defense mechanisms can help us recognize when we are using them and how they may be impacting our relationships and mental health.
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This question is part of the following fields:
- Psychiatry
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Question 14
Correct
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A 60-year-old active builder presents to the emergency department with left-sided scrotal pain and swelling accompanied by fever for the past two days. He had a urinary tract infection 10 days ago, which improved after taking antibiotics. He has a medical history of benign prostatic hyperplasia and is waiting for transurethral resection of the prostate. Despite his age, he is still sexually active with his wife and denies ever having a sexually transmitted disease. What is the probable pathogen responsible for his current condition?
Your Answer: Escherichia coli
Explanation:Epididymo-orchitis is probable in individuals with a low risk of sexually transmitted infections, such as a married man in his 50s who only has one sexual partner, and is most likely caused by enteric organisms like E. coli due to the presence of pain, swelling, and a history of urinary tract infections.
Epididymo-orchitis is a condition where the epididymis and/or testes become infected, leading to pain and swelling. It is commonly caused by infections spreading from the genital tract or bladder, with Chlamydia trachomatis and Neisseria gonorrhoeae being the usual culprits in sexually active younger adults, while E. coli is more commonly seen in older adults with a low-risk sexual history. Symptoms include unilateral testicular pain and swelling, with urethral discharge sometimes present. Testicular torsion, which can cause ischaemia of the testicle, is an important differential diagnosis and needs to be excluded urgently, especially in younger patients with severe pain and an acute onset.
Investigations are guided by the patient’s age, with sexually transmitted infections being assessed in younger adults and a mid-stream urine (MSU) being sent for microscopy and culture in older adults with a low-risk sexual history. Management guidelines from the British Association for Sexual Health and HIV (BASHH) recommend ceftriaxone 500 mg intramuscularly as a single dose, plus doxycycline 100 mg orally twice daily for 10-14 days if the organism causing the infection is unknown. Further investigations are recommended after treatment to rule out any underlying structural abnormalities.
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This question is part of the following fields:
- Surgery
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Question 15
Incorrect
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A 5-year-old child presents with the classic murmur of a patent ductus arteriosus. The child is underweight for their age but is otherwise in good health.
What course of action would you suggest for this patient?Your Answer: Review the child frequently, expecting spontaneous closure within the next five years
Correct Answer: Early operative closure
Explanation:Recommendations for Operative Closure and Antibiotic Use in Persistent Defects
Early operative closure is advised for patients with defects that have not resolved by 6 months of age. It is important to address these defects promptly to prevent complications and improve outcomes. However, prophylactic antibiotics are no longer recommended for dental and other invasive procedures in these patients. This change in practice is due to concerns about antibiotic resistance and the potential for adverse effects. Instead, careful monitoring and prompt treatment of any infections or complications that arise is recommended. By following these guidelines, healthcare providers can ensure the best possible outcomes for patients with persistent defects.
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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 72-year-old man is undergoing open surgery to repair a direct inguinal hernia. In theatre, the hernial sac is noted to lie medial to the inferior epigastric artery.
To weakness of which of the following structures can the hernia best be attributed?Your Answer: Superficial inguinal ring
Correct Answer: Conjoint tendon
Explanation:Types of Abdominal Hernias and Their Characteristics
Abdominal hernias occur when an organ or tissue protrudes through a weak point in the abdominal wall. There are different types of abdominal hernias, each with its own characteristics and symptoms.
Direct Inguinal Hernia
A direct inguinal hernia occurs medial to the inferior epigastric vessels. The bowel sac is pushed directly through a weak point in the conjoint tendon, which is formed by the aponeurosis of the internal oblique and transversus abdominis muscles. This type of hernia is more common in men and worsens with exercise, coughing, or straining.
Aponeurosis of External Oblique
In a direct inguinal hernia, the bowel sac does not push through the aponeurosis of the external oblique muscle.
Muscular Fibres of Internal Oblique
A ventral hernia occurs through the muscular fibres of the anterior abdominal muscles, such as the internal oblique. It can be incisional or occur at any site of muscle weakening. Epigastric hernias occur above the umbilicus, and hypogastric hernias occur below the umbilicus.
Muscular Fibres of Transversus Abdominis
Another type of ventral hernia occurs through the muscular fibres of the transversus abdominis. It becomes more prominent when the patient is sitting, leaning forward, or straining. Ventral hernias can be congenital, post-operative, or spontaneous.
Superficial Inguinal Ring
An indirect inguinal hernia is the most common type of abdominal hernia. It occurs in men and children and arises lateral to the inferior epigastric vessels. The bowel sac protrudes through the deep inguinal ring into the inguinal canal and then through the superficial inguinal ring, extending into the scrotum. It may be asymptomatic but can also undergo incarceration or strangulation or lead to bowel obstruction.
Understanding the Different Types of Abdominal Hernias
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This question is part of the following fields:
- Colorectal
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Question 17
Incorrect
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A 26-year-old man has arrived at the Emergency Department with sudden-onset, deteriorating right lower quadrant abdominal pain. He has a significantly decreased appetite and has vomited multiple times in the past few days. During the examination, there is notable tenderness upon palpation in the right iliac fossa. A CT scan of the abdomen confirms the diagnosis of acute appendicitis. After consulting with a surgeon, it is decided that an emergency open appendectomy is necessary. What is the most suitable preoperative management for this patient?
Your Answer: iv flucloxacillin
Correct Answer: A single dose of intravenous (iv) Tazocin® 30 minutes before the procedure
Explanation:Preoperative Management for Gastrointestinal Surgery
Surgical site infections are a common complication of gastrointestinal surgery, with up to 60% of emergency procedures resulting in infections. To prevent this, a single dose of broad-spectrum antibiotics, such as Tazocin®, should be given intravenously 30 minutes before the procedure. Patients should also be hydrated with iv fluids and be nil by mouth for at least six hours before surgery. In cases of potential post-operative intestinal obstruction or ileus, a nasogastric tube may be necessary. However, narrow-spectrum antibiotics like iv flucloxacillin are not appropriate for prophylaxis in this case. Finally, VTE prophylaxis with LMWH should be given preoperatively but stopped 12 hours before the procedure.
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This question is part of the following fields:
- Surgery
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Question 18
Incorrect
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A 50-year-old man with a long-standing history of hypertension visits his primary care physician for a routine check-up. He mentions experiencing a painful, burning sensation in his legs when he walks long distances and feeling cold in his lower extremities. He has no history of dyslipidaemia. During the examination, his temperature is recorded as 37.1 °C, and his blood pressure in the left arm is 174/96 mmHg, with a heart rate of 78 bpm, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. Bilateral 1+ dorsalis pedis pulses are noted, and his lower extremities feel cool to the touch. Cardiac auscultation does not reveal any murmurs, rubs, or gallops. His abdominal examination is unremarkable, and no bruits are heard on auscultation. His renal function tests show a creatinine level of 71 μmol/l (50–120 μmol/l), which is his baseline. What is the most likely defect present in this patient?
Your Answer: Renal artery stenosis
Correct Answer: Coarctation of the aorta
Explanation:The patient’s symptoms suggest coarctation of the aorta, a condition where the aortic lumen narrows just after the branches of the aortic arch. This causes hypertension in the upper extremities and hypotension in the lower extremities, leading to lower extremity claudication. Chest X-rays may show notching of the ribs. Treatment involves surgical resection of the narrowed lumen. Bilateral lower extremity deep vein thrombosis, patent ductus arteriosus, renal artery stenosis, and atrial septal defects are other conditions that can cause different symptoms and require different treatments.
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This question is part of the following fields:
- Cardiology
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Question 19
Correct
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A patient attends the neurology clinic following a referral from the GP due to difficulty with eating and chewing food. A neurologist performs a cranial nerve assessment and suspects a lesion of the right trigeminal nerve.
Which of the following is a clinical feature of a trigeminal nerve palsy in an elderly patient?Your Answer: Bite weakness on the right
Explanation:Common Symptoms of Cranial Nerve Lesions
Cranial nerves are responsible for various functions in the head and neck region. Damage to these nerves can result in specific symptoms that can help identify the location and extent of the lesion. Here are some common symptoms of cranial nerve lesions:
1. Bite weakness on the right: The masticatory muscles are served by the motor branch of the mandibular division of the trigeminal nerve. Therefore, weakness in biting on the right side can indicate damage to this nerve.
2. Loss of taste in anterior two-thirds of the tongue: The facial nerve carries taste fibers from the anterior two-thirds of the tongue. Damage to this nerve can result in a loss of taste sensation in this region.
3. Paralysis of the right buccinator muscle: The muscles of facial expression, including the buccinator, are supplied by the motor fibers carried in the facial nerve. Paralysis of this muscle on the right side can indicate damage to the facial nerve.
4. Hyperacusis: The stapedius muscle, which is innervated by the facial nerve, helps dampen down loud noise by attenuating transmission of the acoustic signal in the middle ear. Damage to the facial nerve can result in hyperacusis, a condition where sounds are perceived as too loud.
5. Loss of taste in posterior third of the tongue: The glossopharyngeal nerve supplies the posterior third of the tongue. Damage to this nerve can result in a loss of taste sensation in this region.
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This question is part of the following fields:
- Neurology
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Question 20
Incorrect
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A 55-year-old man presents to the Emergency Department after vomiting bright red blood multiple times over the past four hours. He has a history of alcohol abuse and has been diagnosed with spontaneous bacterial peritonitis in the past. He currently consumes 4-5 pints of beer daily and has a poor compliance with his medication regimen, resulting in missed appointments and discharge from outpatient follow-up. On examination, he has dry mucous membranes, palmar erythema, and hepatomegaly. His vital signs are as follows: temperature 36.6°C, blood pressure 113/67 mmHg, respiratory rate 21 breaths per minute, heart rate 100 beats per minute, and SpO2 99% on room air. The patient is resuscitated with aggressive intravenous fluids, and the gastroenterology team is consulted. They suspect bleeding oesophageal varices and perform an upper gastrointestinal endoscopy, which confirms the diagnosis. The varices are banded, and bleeding is significantly reduced.
Which medication is most likely to prevent further episodes of oesophageal varices in this 55-year-old patient?Your Answer: Omeprazole
Correct Answer: Propranolol
Explanation:Medications for Secondary Prevention of Variceal Hemorrhage
Variceal hemorrhage is a serious complication of portal hypertension, which can be prevented by using certain medications. Non-selective beta-blockers like nadolol or propranolol are commonly used for secondary prevention of variceal hemorrhage. They work by blocking dilatory tone of the mesenteric arterioles, resulting in unopposed vasoconstriction and therefore a decrease in portal inflow. Selective beta-blockers are not effective in reducing portal hypertension. The dose of the non-selective beta-blocker should be titrated to achieve a resting heart rate of between 55 and 60 beats per minute. Ciprofloxacin is another medication used in prophylaxis of spontaneous bacterial peritonitis in high-risk patients. However, it is not effective in preventing variceal bleeding. Proton-pump inhibitors (PPIs) like omeprazole are used in the treatment of gastric reflux and peptic ulcer disease, but they have little impact on portal hypertension and are not indicated in the prophylaxis of variceal bleeding. Similarly, ranitidine, a histamine-2 receptor antagonist, is not likely to help prevent further episodes of variceal bleeding.
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This question is part of the following fields:
- Gastroenterology
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Question 21
Incorrect
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A 50-year-old office worker visits the doctor complaining of a painful right elbow. He indicates the medial epicondyle of the humerus as the source of pain. Although he cannot recall any previous injury, he reports that the pain worsens when he uses his arm, and it can extend to his forearm. As a result, he has stopped playing tennis. Apart from this, he is healthy and not taking any medications.
Based on the patient's history, the doctor suspects a specific diagnosis. What finding during the examination would be most indicative of this suspected diagnosis?Your Answer: Worsening symptoms with the wrist flexed and supinated
Correct Answer: Worsening symptoms with the wrist flexed and pronated
Explanation:Medial epicondylitis, also known as golfers’ elbow, is a condition where the tendons of the wrist flexors become damaged due to repetitive use of these muscles. A patient presenting with pain at the medial epicondyle, such as a golf player, is likely to have this condition. Examination of the patient would reveal worsening symptoms when the wrist is flexed and pronated, as this aggravates the wrist flexor muscles at their common attachment point on the medial epicondyle of the humerus.
If a patient has a fluctuant swelling over the olecranon process, it suggests olecranon bursitis, which is caused by inflammation of the fluid-filled bursa overlying the olecranon process. This condition would present with swelling, pain, and tenderness over the olecranon process, rather than the medial epicondyle.
It is incorrect to assume that worsening symptoms would occur with the wrist extended and pronated or extended and supinated in a patient with medial epicondylitis. Lateral epicondylitis, also known as tennis elbow, would cause worsening symptoms when the wrist is extended and supinated, as this aggravates the wrist extensors at their insertion point on the lateral epicondyle of the humerus.
Understanding Medial Epicondylitis
Medial epicondylitis, commonly referred to as golfer’s elbow, is a condition characterized by pain and tenderness in the medial epicondyle. This area is located on the inner side of the elbow and is responsible for attaching the forearm muscles to the elbow. The pain is often aggravated by wrist flexion and pronation, which are movements commonly used in golf swings and other activities that involve repetitive gripping and twisting motions.
In addition to pain and tenderness, individuals with medial epicondylitis may also experience numbness or tingling in the fourth and fifth fingers due to ulnar nerve involvement. This nerve runs along the inner side of the elbow and can become compressed or irritated in cases of medial epicondylitis.
Overall, understanding the symptoms and causes of medial epicondylitis can help individuals take steps to prevent and manage this condition. This may include modifying activities that place strain on the elbow, using proper equipment and technique, and seeking medical treatment if symptoms persist.
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This question is part of the following fields:
- Musculoskeletal
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Question 22
Incorrect
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An 80-year-old woman is recovering on the surgical ward two days after undergoing hemicolectomy for colorectal carcinoma. She has been instructed to fast. Her epidural fell out about twelve hours after the surgery, causing her significant pain. Despite the on-call anaesthetist being unavailable for several hours, the epidural was eventually replaced. The next morning, you examine her and find that she is now pain-free but complaining of shortness of breath. Additionally, she has developed a fever of 38.2º. What is the most probable reason for her fever?
Your Answer: Basal atelectasis
Correct Answer: Respiratory tract infection
Explanation:Poor post-operative pain management can lead to pneumonia as a complication. Junior doctors on surgical wards often face the challenge of identifying and managing post-operative fever. A general timeline can be used to determine the probable cause of fever, with wind (pneumonia, aspiration, pulmonary embolism) being the likely cause on days 1-2, water (urinary tract infection) on days 3-5, wound (infection at surgical site or abscess formation) on days 5-7, and walking (deep vein thrombosis or pulmonary embolism) on day 5 and beyond. Drug reactions, transfusion reactions, sepsis, and line contamination can occur at any time. In this case, the patient’s inadequate pain relief may have caused her to breathe shallowly, increasing her risk of respiratory tract infections and atelectasis. While atelectasis is a common post-operative finding, there is no evidence that it causes fever. Therefore, the patient’s new symptoms are more likely due to a respiratory tract infection. Anastomotic leak is unlikely as the patient is still not eating or drinking. Surgical site infections are more common after day 5, and urinary tract infections would not explain the patient’s shortness of breath.
Complications can occur in all types of surgery and require vigilance in their detection. Anticipating likely complications and appropriate avoidance can minimize their occurrence. Understanding the anatomy of a surgical field will allow appreciation of local and systemic complications that may occur. Physiological and biochemical derangements may also occur, and appropriate diagnostic modalities should be utilized. Safe and timely intervention is the guiding principle for managing complications.
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This question is part of the following fields:
- Surgery
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Question 23
Incorrect
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A 50-year-old G3P2 presents to the emergency department after experiencing a generalized tonic-clonic seizure. Upon arrival, her blood pressure is measured at 190/125 mmHg. The paramedics administered intramuscular magnesium sulfate to treat her seizures and she is currently receiving an IV infusion of the same medication. However, her respiratory rate is only 10 breaths per minute, indicating possible respiratory depression caused by the magnesium sulfate. What is the preferred drug for reversing this respiratory depression?
Your Answer: Naloxone
Correct Answer: Calcium gluconate
Explanation:Magnesium sulphate induced respiratory depression can be treated with calcium gluconate as the first-line option. Bicarbonates are administered to prevent cardiovascular complications resulting from tricyclic antidepressant overdose. Flumazenil is used to counter benzodiazepine overdose, while naloxone is the drug of choice for reversing respiratory depression caused by opioid overdose.
Understanding Eclampsia and its Treatment
Eclampsia is a condition that occurs when seizures develop in association with pre-eclampsia, a pregnancy-induced hypertension that is characterized by proteinuria and occurs after 20 weeks of gestation. To prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop, magnesium sulphate is commonly used. However, it is important to note that this medication should only be given once a decision to deliver has been made. In cases of eclampsia, an IV bolus of 4g over 5-10 minutes should be given, followed by an infusion of 1g/hour. During treatment, it is crucial to monitor urine output, reflexes, respiratory rate, and oxygen saturations. Respiratory depression can occur, and calcium gluconate is the first-line treatment for magnesium sulphate-induced respiratory depression. Treatment should continue for 24 hours after the last seizure or delivery, as around 40% of seizures occur post-partum. Additionally, fluid restriction is necessary to avoid the potentially serious consequences of fluid overload.
In summary, understanding the development of eclampsia and its treatment is crucial in managing this potentially life-threatening condition. Magnesium sulphate is the primary medication used to prevent and treat seizures, but it should only be given once a decision to deliver has been made. Monitoring vital signs and urine output is essential during treatment, and calcium gluconate should be readily available in case of respiratory depression. Finally, fluid restriction is necessary to avoid complications associated with fluid overload.
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This question is part of the following fields:
- Pharmacology
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Question 24
Correct
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An 80-year-old man comes to the clinic with his son. The son reports that his father's memory has been declining for the past 8 months and he has been experiencing fluctuations in attention and consciousness. The patient has also reported seeing dogs and children running around in his living room. The patient has a medical history of resting tremors, rigidity, and shuffling gait for the past 10 years. However, there is no history of mood swings or urinary or bowel incontinence. On examination, there are no postural changes in his blood pressure. What is the most likely diagnosis?
Your Answer: Parkinson's disease dementia
Explanation:Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) share similar features such as tremors, rigidity, postural instability, fluctuating cognition, and hallucinations. However, they can be differentiated based on the time of onset of dementia compared to motor symptoms. PDD is diagnosed if a patient had a Parkinson’s disease diagnosis for at least 1 year before the emergence of dementia. In contrast, DLB would have dementia occurring first followed by motor symptoms. This patient has had 8 years of preceding motor symptoms before the onset of dementia, making PDD more likely. It is important to distinguish between the two as their management varies significantly. Levodopa is the mainstay of treatment in PDD, whereas rivastigmine is the drug of choice in DLB. Treating this patient as DLB may miss out on important elements of treatment needed in patients with PDD. Frontotemporal dementia (FTD) and multiple system atrophy are not likely diagnoses in this case as they have different clinical features.
Understanding Lewy Body Dementia
Lewy body dementia is a type of dementia that is becoming more recognized as a cause of cognitive impairment, accounting for up to 20% of cases. It is characterized by the presence of alpha-synuclein cytoplasmic inclusions, known as Lewy bodies, in certain areas of the brain. While there is a complicated relationship between Parkinson’s disease and Lewy body dementia, with dementia often seen in Parkinson’s disease, the two conditions are distinct. Additionally, up to 40% of patients with Alzheimer’s disease have Lewy bodies.
The features of Lewy body dementia include progressive cognitive impairment, which typically occurs before parkinsonism, but both features usually occur within a year of each other. Unlike other forms of dementia, cognition may fluctuate, and early impairments in attention and executive function are more common than memory loss. Other features include parkinsonism, visual hallucinations, and sometimes delusions and non-visual hallucinations.
Diagnosis of Lewy body dementia is usually clinical, but single-photon emission computed tomography (SPECT) can be used to confirm the diagnosis. Management of Lewy body dementia involves the use of acetylcholinesterase inhibitors and memantine, similar to Alzheimer’s disease. However, neuroleptics should be avoided as patients with Lewy body dementia are extremely sensitive and may develop irreversible parkinsonism. It is important to carefully consider the use of medication in these patients to avoid worsening their condition.
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This question is part of the following fields:
- Medicine
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Question 25
Incorrect
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During your work in general practice, you come across a 16-year-old female patient who complains of nipple discharge. Her 85-year-old grandmother passed away 7 months ago due to breast cancer. The discharge is pale in colour and present in both nipples. The volume is minimal, and there are no palpable masses upon examination. The patient is worried about having breast cancer. What is the probable diagnosis?
Your Answer: Prolactinoma
Correct Answer: Hormonal changes
Explanation:It is highly unlikely that bilateral nipple discharge is linked to breast cancer. In fact, in someone of this age, small amounts of pale or colorless discharge are more likely to be associated with hormonal changes during puberty. Breast cancer rarely presents with bilateral nipple discharge, and if it does, it is usually accompanied by a breast lump and bloody discharge. Additionally, given the patient’s age, breast cancer is an unlikely diagnosis. Other possible causes of bilateral nipple discharge include a benign pituitary tumor called a prolactinoma, which can cause cream-colored lactation, or fat necrosis of the breast, which may result from blunt trauma to the breast and can cause a hard lump but no nipple discharge. A breast abscess, on the other hand, is characterized by pus discharge from the nipple and red, swollen, warm breast skin.
Understanding Nipple Discharge: Causes and Assessment
Nipple discharge is a common concern among women, and it can be caused by various factors. Physiological discharge occurs during breastfeeding, while galactorrhea may be triggered by emotional events or certain medications. Hyperprolactinemia, which is often associated with pituitary tumors, can also cause nipple discharge. Mammary duct ectasia, which is characterized by the dilation of breast ducts, is common among menopausal women and smokers. On the other hand, nipple discharge may also be a sign of more serious conditions such as carcinoma or intraductal papilloma.
To assess patients with nipple discharge, a breast examination is necessary to determine the presence of a mass lesion. If a mass lesion is suspected, triple assessment is recommended. Reporting of investigations follows a system that uses a prefix denoting the type of investigation and a numerical code indicating the abnormality found. For non-malignant nipple discharge, endocrine disease should be excluded, and smoking cessation advice may be given for duct ectasia. In severe cases of duct ectasia, total duct excision may be necessary.
Understanding the causes and assessment of nipple discharge is crucial in providing appropriate management and treatment. It is important to seek medical attention if nipple discharge persists or is accompanied by other symptoms such as pain or a lump in the breast.
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This question is part of the following fields:
- Surgery
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Question 26
Incorrect
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A 55-year-old diabetic man is scheduled for an elective incision and drainage of a groin abscess in the day surgery unit. He is typically well-managed on metformin. How should his diabetic control be managed during this procedure?
Your Answer: Commence variable rate insulin infusion on the day of surgery
Correct Answer: Continue her normal regimen
Explanation:It is unlikely that this patient, who is a diabetic taking oral medication, will require a sliding scale regimen for an incision and drainage procedure, unless it is a major surgery. In the case of significant surgery, the patient would typically be admitted the night before and put on a variable rate infusion. It is generally not recommended to postpone surgery unless there are significant reasons to do so. As this is likely to be a day case surgery, the patient can continue taking their regular metformin medication.
Metformin is a medication commonly used to treat type 2 diabetes mellitus. It belongs to a class of drugs called biguanides and works by activating the AMP-activated protein kinase (AMPK), which increases insulin sensitivity and reduces hepatic gluconeogenesis. Additionally, it may decrease the absorption of carbohydrates in the gastrointestinal tract. Unlike other diabetes medications, such as sulphonylureas, metformin does not cause hypoglycemia or weight gain, making it a first-line treatment option, especially for overweight patients. It is also used to treat polycystic ovarian syndrome and non-alcoholic fatty liver disease.
While metformin is generally well-tolerated, gastrointestinal side effects such as nausea, anorexia, and diarrhea are common and can be intolerable for some patients. Reduced absorption of vitamin B12 is also a potential side effect, although it rarely causes clinical problems. In rare cases, metformin can cause lactic acidosis, particularly in patients with severe liver disease or renal failure. However, it is important to note that lactic acidosis is now recognized as a rare side effect of metformin.
There are several contraindications to using metformin, including chronic kidney disease, recent myocardial infarction, sepsis, acute kidney injury, severe dehydration, and alcohol abuse. Additionally, metformin should be discontinued before and after procedures involving iodine-containing x-ray contrast media to reduce the risk of contrast nephropathy.
When starting metformin, it is important to titrate the dose slowly to reduce the incidence of gastrointestinal side effects. If patients experience intolerable side effects, modified-release metformin may be considered as an alternative.
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This question is part of the following fields:
- Pharmacology
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Question 27
Incorrect
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A 72-year-old retired farmer has switched his General Practitioner (GP) and comes in for a check-up. During the appointment, he asks for a review of several lesions on his forehead.
Upon examination, he is bald and has multiple scaly, crusted lesions on his mid-frontal scalp, along with a keratinous horn with a smooth base on the helix of his right ear. He mentions that he had similar lesions on his scalp before. These were treated with a cream that made the lesions worse for four weeks before completely resolving when the treatment was finished.
What is the most probable diagnosis?Your Answer: Seborrhoeic keratosis
Correct Answer: Actinic keratosis
Explanation:Differentiating Skin Lesions: Actinic Keratosis, Chondrodermatitis Nodularis Helicis, Basal Cell Carcinoma, Lentigo Maligna, and Seborrhoeic Keratosis
Skin lesions can be difficult to differentiate, but understanding their characteristics can aid in diagnosis and treatment. Actinic keratosis is a pre-malignant condition that is more common in sun-exposed patients, often presenting as scaly lesions on bald areas. Treatment with Efudix may initially worsen the lesions before improving. Chondrodermatitis nodularis helicis is a benign condition characterized by a tender, firm lesion on the ear due to pressure from sleeping on that side. It is treated with strong topical steroids and is not associated with a keratinous horn. Basal cell carcinoma is a common skin cancer associated with sun exposure, presenting with telangiectasia and a rolled edge. Lentigo maligna is a malignant lesion associated with sun exposure, typically pigmented and occurring on the face. Seborrhoeic keratosis is a common benign lesion that can mimic other lesions, but is not associated with sun exposure and is often found on the back, appearing stuck-on rather than scaly. Understanding the characteristics of these skin lesions can aid in accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Dermatology
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Question 28
Incorrect
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A 28-year-old accountant is referred to Dermatology after developing some patches of hypopigmentation. The patient reports a 2-month history of patchy areas of discolouration over her chest and back. She is feeling extremely distressed and self-conscious about these areas. The patient has stopped going to the beach due to the lesions, which she previously enjoyed.
During examination, the patient has multiple patches of flaky, discoloured hypopigmented lesions distributed over the chest and back.
What is the most likely cause of hypopigmented skin in this case?Your Answer: Urticaria pigmentosa
Correct Answer: Pityriasis versicolor
Explanation:Skin Conditions and Pigmentation Changes
Pigmentation changes in the skin can be caused by various factors, including skin conditions and hormonal imbalances. Here are some examples:
Pityriasis versicolor: This common skin complaint is characterized by flaky, discoloured, hypopigmented patches that mainly appear on the chest and back. It is caused by the overgrowth of a yeast called Malassezia furfur.
Whipple’s disease: This rare bacterial infection can cause hyperpigmentation in some cases.
High oestriol: Elevated levels of this hormone, which can occur during pregnancy, are associated with hyperpigmentation.
Neurofibromatosis type I: This genetic disorder causes numerous café-au-lait patches, which are hyperpigmented patches.
Urticaria pigmentosa: This condition, which typically develops in childhood, causes hyperpigmented patches that usually fade by the teenage years.
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This question is part of the following fields:
- Dermatology
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Question 29
Incorrect
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A 52-year-old woman visits her GP with a complaint of cough that began a week ago. She reports no production of sputum or blood. The patient has a medical history of type II diabetes mellitus, essential hypertension, and psoriasis.
She has not traveled recently and has not been in contact with anyone with similar symptoms. She notes that she was recently given a new prescription medication.
Which of the following medications is the most probable one prescribed?Your Answer: Ciclosporins
Correct Answer: ACE inhibitors
Explanation:Common Medications and Their Side Effects
There are several common medications used to treat various conditions, each with their own set of side effects. Here are some examples:
ACE inhibitors: These are often the first-line antihypertensives for individuals under 55 years old. They can help reduce blood pressure and have renal protective effects for patients with diabetes. However, a common side effect is a dry cough, which occurs because ACE inhibitors inhibit bradykinin breakdown. Patients may need to switch to an ARB.
Ciclosporins: This immunosuppressant medication is used to treat inflammatory and autoimmune conditions, as well as prevent organ rejection after transplantation. Side effects may include headache, flushing, nausea, vomiting, and abdominal discomfort.
Angiotensin-receptor blockers (ARBs): These are an alternative to ACE inhibitors for patients who develop a dry cough. ARBs work on the same system but do not produce the cough.
Corticosteroids: These are used for asthma, inflammatory, and autoimmune conditions. They have a large side-effect profile, including hyperglycemia, osteoporosis, easy bruising, and striae, but not dry cough.
Hydralazine: This antihypertensive medication is also used in pregnancy and heart failure management. Side effects may include nausea, vomiting, abdominal discomfort, and headache, but not dry cough.
Understanding Common Medications and Their Side Effects
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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An 80-year-old man complains of stiffness and pain in his right shoulder. During the examination, it is observed that he cannot internally or externally rotate or abduct the shoulder. The patient has a history of diabetes. What is the most probable diagnosis?
Your Answer: Rotator cuff tendonitis
Correct Answer: Adhesive capsulitis
Explanation:Common Shoulder Conditions and Their Symptoms
The shoulder joint is a complex structure that allows for a wide range of movements. However, it is also prone to various conditions that can cause pain and limit mobility. Here are some common shoulder conditions and their symptoms:
1. Adhesive capsulitis (Frozen Shoulder): This condition is characterized by stiffness and limited range of motion in the shoulder joint. It can last up to 18-24 months and is more common in diabetics.
2. Rotator cuff tendonitis: This condition causes pain and tenderness in the shoulder, especially when lifting the arm. However, some degree of abduction (up to 120 degrees) is still possible.
3. Subacromial impingement: This condition causes pain and discomfort when lifting the arm, especially during abduction. However, some degree of movement is still possible.
4. Medial epicondylitis (Golfer’s Elbow): This condition affects the elbow and causes pain and tenderness on the inner side of the elbow.
5. Shoulder dislocation: This is an acute condition that causes severe pain and requires emergency medical attention.
Treatment for these conditions may include painkillers, anti-inflammatory drugs, corticosteroid injections, physiotherapy, and gentle exercise. It is important to seek medical advice if you experience any shoulder pain or discomfort.
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This question is part of the following fields:
- Orthopaedics
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