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  • Question 1 - A 25-year-old woman with epilepsy visits the well woman clinic complaining of weight...

    Incorrect

    • A 25-year-old woman with epilepsy visits the well woman clinic complaining of weight gain, acne, and hair loss. Her thyroid function is within normal limits. She is concerned that her epilepsy medication may be the culprit. Which of the following medications is the most probable cause?

      Your Answer: Lamotrigine

      Correct Answer: Valproate

      Explanation:

      Sodium Valproate and PCOS-Like Syndrome

      Sodium valproate is a medication that can cause a PCOS-like syndrome in some women who take it. This syndrome is characterized by weight gain, acne, and hirsutism. However, these symptoms gradually resolve once the medication is discontinued. For young female patients with epilepsy, lamotrigine is often the first choice agent as it does not cause a PCOS-like syndrome. Unlike carbamazepine or phenytoin, lamotrigine is not an enzyme inducer, which means it does not interfere with the effectiveness of oral contraceptives.

      Topiramate, on the other hand, has been studied as a potential weight loss agent. While it is not associated with a PCOS-like syndrome, it is important to note that all medications have potential side effects and should be discussed with a healthcare provider before use. Overall, it is important for women to be aware of the potential effects of medications on their reproductive and metabolic health.

    • This question is part of the following fields:

      • Pharmacology
      34.1
      Seconds
  • Question 2 - You are asked by nursing staff to review a pediatric patient in recovery...

    Correct

    • You are asked by nursing staff to review a pediatric patient in recovery overnight. As you arrive, the nurse looking after the patient informs you that she is just going to get a bag of fluid for him. On examination, the patient is unresponsive with an obstructed airway (snoring). You notice on the monitor that his heart rate is 33 bpm and blood pressure 89/60 mmHg. His saturation probe has fallen off.
      What is your first priority?

      Your Answer: Call for help and maintain the airway with a jaw thrust and deliver 15 l of high-flow oxygen

      Explanation:

      Managing a Patient with Bradycardia and Airway Obstruction: Priorities and Interventions

      When faced with a patient who is unresponsive and has both an obstructed airway and bradycardia, the first priority is to address the airway obstruction. After calling for help, the airway can be maintained with a jaw thrust and delivery of 15 l of high-flow oxygen via a non-rebreather mask. Monitoring the patient’s oxygen saturation is important to assess their response. If bradycardia persists despite maximal atropine treatment, second-line drugs such as an isoprenaline infusion or an adrenaline infusion can be considered. Atropine is the first-line medication for reversing the arrhythmia, given in 500-micrograms boluses iv and repeated every 3-5 minutes as needed. While a second iv access line may be beneficial, it is not a priority compared to maintaining the airway and controlling the bradycardia. Re-intubation may be necessary if simpler measures and non-definitive airway interventions have failed to ventilate the patient.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      32.2
      Seconds
  • Question 3 - A 59-year-old postmenopausal woman with a history of chronic hypertension and diabetes mellitus...

    Correct

    • A 59-year-old postmenopausal woman with a history of chronic hypertension and diabetes mellitus presents with mild vaginal bleeding. The bimanual pelvic examination reveals a relatively large mass on the right side of the pelvis. The patient undergoes an abdominal and pelvic computerised tomography scan with contrast injection. The scan shows multiple enlarged lymph nodes in the pelvis, along the iliac arteries. The para-aortic lymph nodes appear normal.
      What is the most likely diagnosis?

      Your Answer: Cervical squamous cell carcinoma

      Explanation:

      Differentiating Gynecologic Cancers: Understanding the Symptoms and Metastasis Patterns

      When a postmenopausal woman presents with vaginal bleeding, pelvic mass, and pelvic lymphadenopathy, it is important to consider the different types of gynecologic cancers that may be causing these symptoms.

      Cervical squamous cell carcinoma is the most likely diagnosis in this case, as it typically metastasizes to the pelvic lymph nodes along the iliac arteries. On the other hand, endometrial carcinoma first metastasizes to the para-aortic lymph nodes, while ovarian malignancies typically spread to the para-aortic lymph nodes and are not associated with vaginal bleeding.

      Uterine leiomyosarcoma, which is the most common type of sarcoma in the female pelvis, often extends beyond the uterine serosa and may metastasize to distant organs through blood vessels. However, vaginal bleeding and pelvic lymphadenopathy are not typical features of this cancer.

      Cervical adenocarcinomas, which are rare and account for about 25% of cervical cancers, are associated with human papillomavirus and prolonged exposure to exogenous estrogens, but not with smoking. Their presentation and management are similar to those of squamous cancer.

      Understanding the symptoms and metastasis patterns of different gynecologic cancers is crucial in making an accurate diagnosis and providing appropriate treatment.

    • This question is part of the following fields:

      • Gynaecology
      29.9
      Seconds
  • Question 4 - A 32-year-old dentist visits the GP with a complaint of severe pain during...

    Correct

    • A 32-year-old dentist visits the GP with a complaint of severe pain during bowel movements, accompanied by fresh red blood on the tissue and in the toilet pan. The patient also experiences anal pain that lasts for a few hours after defecation. He has been constipated for a few weeks, which he attributes to a recent change in diet. There have been no other symptoms such as abdominal pain, nausea, vomiting, or weight loss, and there is no family history of gastrointestinal conditions. The doctor attempts a rectal examination but has to abandon it due to pain. What is the most likely diagnosis for this patient?

      Your Answer: Anal fissure

      Explanation:

      Understanding Anal Fissures: Symptoms, Diagnosis, and Treatment Options

      Anal fissures are a common condition that can cause severe pain and discomfort when passing stool. This occurs when hard stool tears the anal mucosa, resulting in bleeding and pain during bowel movements. Patients may also experience continued pain hours after passing stool, leading to further constipation and exacerbation of symptoms.

      Diagnosis of anal fissures is based on a patient’s history, rectal examination, and visual inspection to confirm the fissure. Initial treatment includes prescribing stool softeners, encouraging fluid intake, and advising the use of sitz baths to help alleviate pain symptoms. Topical glyceryl trinitrate (GTN) creams may also be recommended to promote healing.

      Chronic or recurrent fissures may require surgical referral for management options, including local Botox injection and sphincterotomy. However, it is important to consider other conditions such as Crohn’s colitis, which may present with perianal symptoms like anal fissures.

      It is unlikely that this patient has colorectal malignancy, as they are young and have no family history of bowel disease. A perianal abscess would present with a painful swelling adjacent to the anus, while a thrombosed haemorrhoid would result in a tender dark blue swelling on rectal examination.

      Overall, understanding the symptoms, diagnosis, and treatment options for anal fissures can help patients manage their condition and prevent further complications.

    • This question is part of the following fields:

      • Colorectal
      48.6
      Seconds
  • Question 5 - Following the 2011 NICE guidelines for managing panic disorder, what is the most...

    Correct

    • Following the 2011 NICE guidelines for managing panic disorder, what is the most suitable initial drug therapy for treating the condition in younger patients?

      Your Answer: Selective serotonin reuptake inhibitor

      Explanation:

      Anxiety is a common disorder that can manifest in various ways. According to NICE, the primary feature is excessive worry about multiple events associated with heightened tension. It is crucial to consider potential physical causes when diagnosing anxiety disorders, such as hyperthyroidism, cardiac disease, and medication-induced anxiety. Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants, and caffeine.

      NICE recommends a step-wise approach for managing generalised anxiety disorder (GAD). This includes education about GAD and active monitoring, low-intensity psychological interventions, high-intensity psychological interventions or drug treatment, and highly specialist input. Sertraline is the first-line SSRI for drug treatment, and if it is ineffective, an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine may be offered. If the patient cannot tolerate SSRIs or SNRIs, pregabalin may be considered. For patients under 30 years old, NICE recommends warning them of the increased risk of suicidal thinking and self-harm and weekly follow-up for the first month.

      The management of panic disorder also follows a stepwise approach, including recognition and diagnosis, treatment in primary care, review and consideration of alternative treatments, review and referral to specialist mental health services, and care in specialist mental health services. NICE recommends either cognitive behavioural therapy or drug treatment in primary care. SSRIs are the first-line drug treatment, and if contraindicated or no response after 12 weeks, imipramine or clomipramine should be offered.

    • This question is part of the following fields:

      • Psychiatry
      11.9
      Seconds
  • Question 6 - A 30-year-old woman with a history of Crohn’s disease comes in for evaluation...

    Correct

    • A 30-year-old woman with a history of Crohn’s disease comes in for evaluation due to left flank pain indicative of renal colic. During the physical examination, a significant midline abdominal scar is observed, which is consistent with a previous small bowel resection. An abdominal X-ray without contrast shows several kidney stones.
      What kind of kidney stones are most likely present in this scenario?

      Your Answer: Calcium oxalate stones

      Explanation:

      Types of Kidney Stones and Their Causes

      Kidney stones are hard deposits that form in the kidneys and can cause severe pain when they pass through the urinary tract. There are different types of kidney stones, each with their own causes and treatment options.

      Calcium Oxalate Stones
      Increased urinary oxalate can be genetic, idiopathic, or enteric. Calcium citrate supplementation is the preferred therapy to reduce stone formation. Pain relief and infection prevention are important during the acute period of renal colic. Lithotripsy can be used to break up larger stones.

      Uric Acid Stones
      Uric acid stones are not visible on X-rays.

      Cystine Stones
      Cystine stones are also not visible on X-rays.

      Calcium Carbonate Stones
      These stones are linked to high levels of calcium in the body, either from diet or conditions like hyperparathyroidism.

      Magnesium Carbonate Stones
      Also known as struvite stones, these are made from magnesium, ammonia, and phosphate and are associated with urinary tract infections.

      Understanding the different types of kidney stones and their causes can help with prevention and treatment.

    • This question is part of the following fields:

      • Urology
      32.3
      Seconds
  • Question 7 - A 21-year-old student presents to his GP a few days after returning from...

    Correct

    • A 21-year-old student presents to his GP a few days after returning from a regeneration project working with a fishing community in South America. His main complaint is of an itchy, erythematosus rash predominantly affecting both feet. He has no past medical history of note. On examination he has erythematosus, edematous papules and vesicles affecting both feet. There are serpiginous erythematosus trails which track 2-3 cm from each lesion. Investigations:
      Investigation Result Normal value
      Haemoglobin 138 g/l 135–175 g/l
      White cell count (WCC) 8.0 × 109/l
      (slight peripheral blood eosinophilia) 4–11 × 109/l
      Platelets 245 × 109/l 150–400 × 109/l
      Sodium (Na+) 140 mmol/l 135–145 mmol/l
      Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
      Creatinine 79 μmol/l 50–120 µmol/l
      Chest X-ray Normal lung fields
      Which of the following diagnoses fits best with this clinical scenario?

      Your Answer: Cutaneous larva migrans

      Explanation:

      Cutaneous Larva Migrans and Other Skin Conditions: A Differential Diagnosis

      Cutaneous larva migrans is a common skin condition caused by the migration of nematode larvae through the skin. It is typically found in warm sandy soils and can be diagnosed based on the history and appearance of serpiginous lesions. Treatment involves the use of thiobendazole. Other skin conditions, such as impetigo, tinea pedis, and photoallergic dermatitis, have different causes and presentations and are less likely to be the correct diagnosis. Larva currens, caused by Strongyloides stercoralis, is another condition that can cause itching and skin eruptions, but it is typically associated with an intestinal infection and recurrent episodes. A differential diagnosis is important to ensure proper treatment and management of these skin conditions.

    • This question is part of the following fields:

      • Dermatology
      57
      Seconds
  • Question 8 - A 65-year-old woman presents to the Emergency Department feeling generally unwell, with fever...

    Correct

    • A 65-year-old woman presents to the Emergency Department feeling generally unwell, with fever and a cough. She had chemotherapy for her breast cancer 4 days ago. There are no known drug allergies. On examination:
      Investigation Result Normal value
      Blood pressure (BP) 108/70 < 120/80 mmHg
      Heart rate (HR) 101 60–100 beats/min
      Respiratory rate (RR) 26 12–18 breaths/min
      Sats 96% on air 94–98%
      Temperature 38.7ºC 36.1–37.2°C
      There is some scattered crepitations at the right lung base. You check on the system and see that bloods were done 2 days ago, and showed:
      Investigation Result Normal value
      Haemoglobin 120 g/l 115–155 g/l
      White cell count (WCC) 3.1 × 109/l 4–11 × 109/l
      Neutrophils 0.8 × 109/l 1.7–7.5 × 109/l
      Lymphocytes 1.5 × 109/l 1.0–4.5 × 109/l
      Eosinophils 0.6 × 109/l 0.0–0.4 × 109/l
      Which of the following is the most appropriate next-step management?

      Your Answer: Start IV piperacillin with tazobactam (Tazocin)

      Explanation:

      Management of Neutropenic Sepsis in a Post-Chemotherapy Patient

      When a patient presents with neutropenic sepsis post-chemotherapy, it is crucial to start a broad-spectrum antibiotic immediately, without waiting for blood results or investigations. Tazocin is the first-line antibiotic recommended by NICE, but local hospital guidelines should be consulted if there is a known penicillin allergy. The Sepsis 6 protocol should be initiated promptly, and antibiotics should be administered within an hour of presentation. Once the patient is stabilized, an urgent chest X-ray can be performed. While granulocyte-colony stimulating factor (G-CSF) administration may have a role in selected patients, it is not routinely used in neutropenic sepsis. Consultation with the haematology team is also recommended.

    • This question is part of the following fields:

      • Oncology
      54.4
      Seconds
  • Question 9 - A 67-year-old man presents to the emergency department with unilateral limb weakness and...

    Incorrect

    • A 67-year-old man presents to the emergency department with unilateral limb weakness and slurred speech. A CT scan of the head reveals a haemorrhagic stroke, but the medical team has no access to his records as he was found on the street. However, a warfarin card is discovered in his wallet. Upon conducting blood tests, his International Normalised Ratio is found to be 8.5. Which medication from his history is most likely to have caused this?

      Your Answer: Rifampicin

      Correct Answer: Isoniazid

      Explanation:

      The only medication from the given list that inhibits the P450 system is isoniazid. This is relevant in the case of a patient who has suffered a haemorrhagic stroke and has a high INR due to warfarin not being cleared away by the P450 system, which is being inhibited. Carbamazepine, on the other hand, is a P450 inducer and would be expected to lower INR levels. Paracetamol does not significantly affect the P450 system, but is itself affected by it, leading to liver failure. Rifampicin, like isoniazid, is an antibiotic used in the treatment of tuberculosis, but it is a P450 inducer, not an inhibitor.

      P450 Enzyme System and its Inducers and Inhibitors

      The P450 enzyme system is responsible for metabolizing drugs in the body. Induction of this system usually requires prolonged exposure to the inducing drug, unlike P450 inhibitors, which have rapid effects. Some drugs that induce the P450 system include antiepileptics like phenytoin and carbamazepine, barbiturates such as phenobarbitone, rifampicin, St John’s Wort, chronic alcohol intake, griseofulvin, and smoking, which affects CYP1A2 and is the reason why smokers require more aminophylline.

      On the other hand, some drugs inhibit the P450 system, including antibiotics like ciprofloxacin and erythromycin, isoniazid, cimetidine, omeprazole, amiodarone, allopurinol, imidazoles such as ketoconazole and fluconazole, SSRIs like fluoxetine and sertraline, ritonavir, sodium valproate, and acute alcohol intake. It is important to be aware of these inducers and inhibitors as they can affect the metabolism and efficacy of drugs in the body. Proper dosing and monitoring can help ensure safe and effective treatment.

    • This question is part of the following fields:

      • Pharmacology
      44.9
      Seconds
  • Question 10 - A 79-year-old woman complains of difficulty urinating, weak stream, feeling of incomplete bladder...

    Incorrect

    • A 79-year-old woman complains of difficulty urinating, weak stream, feeling of incomplete bladder emptying, and urinary leakage. Urodynamic testing reveals a detrusor pressure of 90 cm H2O during voiding (normal range < 70 cm H2O) and a peak flow rate of 5 mL/second (normal range > 15 mL/second). What is the probable diagnosis?

      Your Answer:

      Correct Answer: Overflow incontinence

      Explanation:

      Bladder outlet obstruction can be indicated by a high voiding detrusor pressure and low peak flow rate, leading to overflow incontinence. Voiding symptoms such as poor flow and incomplete emptying may also suggest this condition.

      Understanding Urinary Incontinence: Causes, Classification, and Management

      Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.

      Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.

      In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.

    • This question is part of the following fields:

      • Urology
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology (0/2) 0%
Acute Medicine And Intensive Care (1/1) 100%
Gynaecology (1/1) 100%
Colorectal (1/1) 100%
Psychiatry (1/1) 100%
Urology (2/2) 100%
Dermatology (1/1) 100%
Passmed