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  • Question 1 - A 30-year-old female visits her doctor with a complaint of oral ulcers that...

    Incorrect

    • A 30-year-old female visits her doctor with a complaint of oral ulcers that have been persistent for a month. She also reports experiencing swollen and painful hands for the past two weeks. During the examination, the doctor observes a malar rash on her face. To identify the underlying condition, the doctor orders some blood tests. What is the most sensitive antibody test for the underlying condition?

      Your Answer: Anti-Ro

      Correct Answer: ANA

      Explanation:

      Anti-Ro is less sensitive than ANA as it is only present in a smaller number of cases.

      Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive, making it useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%), but less sensitive (70%). Anti-Smith testing is also highly specific (>99%), but only 30% of SLE patients test positive. Other antibody tests include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).

      Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, but a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Proper monitoring of SLE is crucial for effective management of the disease.

    • This question is part of the following fields:

      • Musculoskeletal
      10.7
      Seconds
  • Question 2 - A 29-year-old female patient presents to the clinic with a complaint of missed...

    Correct

    • A 29-year-old female patient presents to the clinic with a complaint of missed periods for the past four months despite negative pregnancy tests. She is also distressed about the loss of her libido and has noticed milk leakage with minimal nipple stimulation during intercourse. On physical examination, her blood pressure is 122/70 mmHg, pulse is 70 and regular, and general physical examination is unremarkable. Which blood test is most likely to show elevated levels?

      Your Answer: Prolactin

      Explanation:

      Symptoms and Diagnosis of Hyperprolactinaemia

      Hyperprolactinaemia is a condition characterized by elevated levels of prolactin in the body. This condition is typically associated with symptoms such as milk production, decreased libido, and absence of menstruation. However, visual disturbances are not always present, as many cases of hyperprolactinaemia are related to a microprolactinoma.

      When diagnosing hyperprolactinaemia, it is important to assess thyroid status as this condition is often associated with hypothyroidism. Thyroxine levels are usually low in individuals with hyperprolactinaemia. Additionally, beta-HCG levels are elevated in pregnancy, so it is important to rule out pregnancy as a potential cause of elevated prolactin levels.

      In summary, hyperprolactinaemia is a condition that can present with a variety of symptoms, but is typically characterized by elevated prolactin levels. Diagnosis involves assessing thyroid status and ruling out pregnancy as a potential cause.

    • This question is part of the following fields:

      • Haematology
      5.9
      Seconds
  • Question 3 - A 67-year-old man presents to the emergency department with sudden onset epigastric pain...

    Correct

    • A 67-year-old man presents to the emergency department with sudden onset epigastric pain described as burning and radiating into his back. He reports vomiting and ongoing nausea. The patient has a history of recurrent gallstones and is awaiting a semi-elective cholecystectomy. He is not taking any regular medications. On examination, the patient has jaundiced sclera and diffuse abdominal tenderness with guarding. There is also periumbilical superficial oedema and bruising, and decreased bowel sounds on auscultation.

      What is a crucial aspect of the immediate management of this patient, given the likely diagnosis?

      Your Answer: Aggressive fluid resuscitation

      Explanation:

      The patient’s history of gallstones, epigastric pain radiating to the back, nausea, vomiting, jaundice, periumbilical bruising, abdominal tenderness with guarding, and decreased bowel sounds suggest a diagnosis of acute pancreatitis. Tachycardia, fever, tachypnea, hypotension, and potential oliguria are expected observations in this patient. Early and aggressive fluid resuscitation is crucial in the management of acute pancreatitis to correct third space losses and increase tissue perfusion, preventing severe inflammatory response syndrome and pancreatic necrosis. Antibiotic administration is not mandatory, as there is no consensus on its effectiveness in preventing pancreatic necrosis. Cautious fluid resuscitation is inappropriate, and large volumes of IV fluids should be administered, with input/output monitoring. The patient should not be made nil by mouth unless there is a clear reason, and total parenteral nutrition should only be offered to patients with severe or moderately severe disease if enteral feeding has failed or is contraindicated. This patient requires enteral nutrition within 72 hours of admission, but may not require parenteral nutrition.

      Managing Acute Pancreatitis in a Hospital Setting

      Acute pancreatitis is a serious condition that requires management in a hospital setting. The severity of the condition can be stratified based on the presence of organ failure and local complications. Key aspects of care include fluid resuscitation, aggressive early hydration with crystalloids, and adequate pain management with intravenous opioids. Patients should not be made ‘nil-by-mouth’ unless there is a clear reason, and enteral nutrition should be offered within 72 hours of presentation. Antibiotics should not be used prophylactically, but may be indicated in cases of infected pancreatic necrosis. Surgery may be necessary for patients with acute pancreatitis due to gallstones or obstructed biliary systems, and those with infected necrosis may require radiological drainage or surgical necrosectomy.

    • This question is part of the following fields:

      • Surgery
      13.5
      Seconds
  • Question 4 - A 30-year-old man is brought to his psychiatrist by his sister. His sister...

    Incorrect

    • A 30-year-old man is brought to his psychiatrist by his sister. His sister is worried that her brother firmly believes that he is a superhero, despite having no evidence or abilities to support this belief. Upon assessment, the man appears physically healthy. There are no signs of delusions, disorientation, or unusual speech patterns. However, he maintains an unyielding conviction that Beyonce is in live with him. What is the appropriate diagnosis for this condition?

      Your Answer: Capgras syndrome

      Correct Answer: De Clerambault's syndrome

      Explanation:

      The correct term for the delusion that a famous person is in love with someone, without any other psychotic symptoms, is De Clerambault’s syndrome. Capgras syndrome, on the other hand, refers to the delusion that a close relative has been replaced by an impostor, while De Frégoli syndrome is the delusion of seeing a familiar person in different individuals.

      De Clerambault’s Syndrome: A Delusional Belief in Famous Love

      De Clerambault’s syndrome, also known as erotomania, is a type of paranoid delusion that has a romantic aspect. Typically, the patient is a single person who firmly believes that a well-known person is in love with them. This condition is characterized by a persistent and irrational belief that the famous person is sending secret messages or signals of love, even though there is no evidence to support this belief. The patient may engage in behaviors such as stalking, sending letters or gifts, or attempting to contact the object of their affection. Despite repeated rejections or lack of response, the patient remains convinced of the love affair. This syndrome can be distressing for both the patient and the object of their delusion, and it often requires psychiatric treatment.

    • This question is part of the following fields:

      • Psychiatry
      7.7
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  • Question 5 - A 35-year-old woman is 10 weeks pregnant. She plans to undergo a Down's...

    Correct

    • A 35-year-old woman is 10 weeks pregnant. She plans to undergo a Down's syndrome screening test around 15 weeks into her pregnancy.

      What is included in the measurement of a Down's screening blood test?

      Your Answer: Alpha-fetoprotein

      Explanation:

      AFP Measurement for Detecting Birth Defects and Chromosomal Abnormalities

      When a woman is 15 weeks pregnant, a blood test called AFP measurement can be performed to determine if there is an increased risk of certain birth defects and chromosomal abnormalities. This test can detect open neural tube or abdominal wall defects, as well as Down’s syndrome and trisomy 18. In the past, if the results of the AFP measurement were abnormal, an ultrasound scan would be performed. However, it is possible that in the future, mid-trimester anomaly scanning may replace the use of AFP measurement altogether.

    • This question is part of the following fields:

      • Haematology
      5.2
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  • Question 6 - A 20-year-old man was admitted to the Emergency Department after his roommate reported...

    Incorrect

    • A 20-year-old man was admitted to the Emergency Department after his roommate reported that he was afraid that the government had implanted a radio in his brain that was telling him to kill himself. Further evaluation revealed that he had many symptoms of schizophrenia and a decision was made to treat him with clozapine. Which statement about this drug is correct?

      Your Answer: It is a D2 agonist

      Correct Answer: It is a alpha1-adrenoceptor antagonist

      Explanation:

      Understanding the Mechanism of Action of Clozapine: A Multifaceted Antipsychotic Medication

      Clozapine is an atypical antipsychotic medication used in the treatment of schizophrenia for patients who have not responded to other medications. Its mechanism of action is complex and involves antagonistic effects on dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic receptors. Clozapine’s antipsychotic action is likely mediated through a combination of antagonistic effects at D2 receptors in the mesolimbic pathway and 5-HT2A receptors in the frontal cortex. D2 antagonism relieves positive symptoms while 5-HT2A antagonism alleviates negative symptoms. However, it is important to note that clozapine has a D1 antagonist action and is not a D1 agonist. Understanding the multifaceted mechanism of action of clozapine is crucial in its effective use in the treatment of schizophrenia.

    • This question is part of the following fields:

      • Pharmacology
      3.8
      Seconds
  • Question 7 - A 62-year-old female patient complains of breathlessness and weight loss over the past...

    Correct

    • A 62-year-old female patient complains of breathlessness and weight loss over the past three months. She is a smoker who consumes 10 cigarettes per day. During the examination, you observe clubbing of the fingers and a few crackles in the chest. What is the probable diagnosis?

      Your Answer: Pulmonary fibrosis

      Explanation:

      Respiratory Causes of Clubbing

      Clubbing is a condition where the fingertips and nails become enlarged and rounded. It is often associated with respiratory and cardiovascular diseases. One of the respiratory causes of clubbing is pulmonary fibrosis, which is characterized by weight loss and breathlessness. Other respiratory causes include bronchiectasis, empyema, bronchial carcinoma, and mesothelioma. These conditions can also lead to weight loss and breathlessness, making it important to seek medical attention if these symptoms are present. On the other hand, cardiovascular causes of clubbing include cyanotic congenital heart disease and infective endocarditis. It is important to identify the underlying cause of clubbing in order to provide appropriate treatment and management.

    • This question is part of the following fields:

      • Respiratory
      7.5
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  • Question 8 - A 25-year-old woman, a known type 1 diabetic, was asked to attend the...

    Correct

    • A 25-year-old woman, a known type 1 diabetic, was asked to attend the General Practice (GP) Surgery for her results in the diabetic retinopathy screening.
      You asked your GP supervisor if you can examine her eyes so that you can get signed off for using a direct ophthalmoscope. You found out that she had some dot-and-blot haemorrhages in her right eye with some venous looping and beading in the peripheral retina.
      What is the next step in management for this patient's eye condition?

      Your Answer: Routine referral to ophthalmology

      Explanation:

      Appropriate Management Plan for Pre-Proliferative Diabetic Retinopathy

      Pre-proliferative diabetic retinopathy requires routine referral to ophthalmology as the appropriate management plan. The waiting time for this referral is usually less than 13 weeks. Observation every 4-6 months is the usual management plan, and pan-retinal photocoagulation is only necessary in selected cases, such as in the only eye where the first eye was lost to proliferative diabetic retinopathy or prior to cataract surgery. Referring to an optometrist for a regular eye test is not appropriate for any type of diabetic retinopathy. Annual screening is only appropriate if there is none or background retinopathy. Fast-track referral to ophthalmology is only necessary if there are signs of proliferative retinopathy. Pan-retinal laser photocoagulation is not necessary in pre-proliferative retinopathy and is not the immediate next step in management.

    • This question is part of the following fields:

      • Ophthalmology
      11.4
      Seconds
  • Question 9 - A 5-year-old child, who was born in Germany, is brought to the General...

    Correct

    • A 5-year-old child, who was born in Germany, is brought to the General Practitioner (GP) by his mother because of recurrent sinus infections and failure to thrive. She is also concerned that the child has had diarrhoea for a few months, which is not resolving.
      During the examination, you notice several shiny, pink masses occupying the nasal canals.
      What is the most suitable initial step in treating this patient?

      Your Answer: Testing in which pilocarpine is administered

      Explanation:

      Diagnostic Testing for Nasal Polyps in Children: The Role of Pilocarpine Sweat Test

      Nasal polyps in children should raise suspicion of cystic fibrosis (CF), especially when accompanied by other symptoms. The gold standard test for CF diagnosis is the sweat test, which involves administering the direct-acting muscarinic agonist pilocarpine and measuring the chloride content of sweat. Loratadine, a second-generation antihistamine, is not the first step in managing nasal polyps. Genetic testing is more expensive and time-consuming than the sweat test and is not the initial diagnostic choice. Biopsy is not necessary for benign nasal polyps. Bacterial culture is not relevant to the pathology underlying nasal polyps in children.

    • This question is part of the following fields:

      • ENT
      62.1
      Seconds
  • Question 10 - A 56-year-old man visits his doctor with complaints of difficulty maintaining an erection,...

    Incorrect

    • A 56-year-old man visits his doctor with complaints of difficulty maintaining an erection, which has been ongoing for some time and is causing problems in his relationship. He is generally healthy, except for high blood pressure that is managed with amlodipine. He reports still experiencing morning erections and has not noticed any changes in his sex drive. During the examination, his blood pressure is measured at 145/78 mmHg, and his BMI is 30 kg/m2. His abdominal, genital, and prostate exams are all normal. What is the most crucial test to rule out any organic causes for his difficulty maintaining an erection?

      Your Answer: Testosterone levels

      Correct Answer: HbA1c

      Explanation:

      Investigations for Erectile Dysfunction: Assessing Cardiovascular Risk Factors

      Erectile dysfunction can have both psychological and organic causes. In this case, the patient still experiences morning erections, suggesting a functional overlay. However, it is important to screen for cardiovascular risk factors, as they are the most common cause of erectile dysfunction. This includes assessing HbA1c or fasting blood glucose and lipid profile, especially since the patient has a high BMI and is at increased risk of diabetes and high cholesterol. Ambulatory blood pressure monitoring may also be necessary, given the patient’s history of hypertension. While repeat blood pressure checks are important, they would not rule out other organic causes for the patient’s symptoms. It is crucial to investigate for both organic and psychological causes of erectile dysfunction, even if the cause is believed to be functional. Prostate-specific antigen testing is not necessary in this case, as the genital and prostate examination were normal. Testosterone levels may also be assessed, but since the patient reports good libido and morning erections, low testosterone is unlikely to be the cause.

    • This question is part of the following fields:

      • Urology
      20.2
      Seconds
  • Question 11 - A 68-year-old man presents to the Cardiology Clinic with worsening central crushing chest...

    Incorrect

    • A 68-year-old man presents to the Cardiology Clinic with worsening central crushing chest pain that only occurs during physical activity and never at rest. He is currently taking bisoprolol 20 mg per day, ramipril, omeprazole, glyceryl trinitrate (GTN), and atorvastatin. What is the most suitable course of action?

      Your Answer: Immediate angiogram

      Correct Answer: Commence isosorbide mononitrate and arrange an outpatient angiogram

      Explanation:

      Management of Stable Angina: Adding Isosorbide Mononitrate and Arranging Outpatient Angiogram

      For a patient with stable angina who is already taking appropriate first-line medications such as bisoprolol and GTN, the next step in management would be to add a long-acting nitrate like isosorbide mononitrate. This medication provides longer-term vasodilation compared to GTN, which is only used when required. This can potentially reduce the frequency of angina symptoms.

      An outpatient angiogram should also be arranged for the patient. While stable angina does not require an urgent angiogram, performing one on a non-urgent basis can provide more definitive management options like stenting if necessary.

      Increasing the dose of ramipril or statin is not necessary unless there is evidence of worsening hypertension or high cholesterol levels, respectively. Overall, the management of stable angina should be tailored to the individual patient’s needs and risk factors.

    • This question is part of the following fields:

      • Cardiology
      21.4
      Seconds
  • Question 12 - What is the most prevalent form of colorectal cancer that is inherited?

    Familial...

    Correct

    • What is the most prevalent form of colorectal cancer that is inherited?

      Familial adenomatous polyposis, Li-Fraumeni syndrome, Hereditary non-polyposis colorectal carcinoma, Fanconi syndrome, and Peutz-Jeghers syndrome are all types of inherited colorectal cancer. However, which one is the most common?

      Your Answer: Hereditary non-polyposis colorectal carcinoma

      Explanation:

      Genetics and Types of Colorectal Cancer

      Colorectal cancer is a type of cancer that affects the colon and rectum. There are three main types of colorectal cancer: sporadic, hereditary non-polyposis colorectal carcinoma (HNPCC), and familial adenomatous polyposis (FAP). Sporadic colon cancer is the most common type, accounting for 95% of cases. It is believed to be caused by a series of genetic mutations, including allelic loss of the APC gene, activation of the K-ras oncogene, and deletion of p53 and DCC tumour suppressor genes.

      HNPCC, also known as Lynch syndrome, is an autosomal dominant condition that accounts for 5% of cases. It is the most common form of inherited colon cancer and is caused by mutations in genes involved in DNA mismatch repair, leading to microsatellite instability. The most commonly affected genes are MSH2 and MLH1. Patients with HNPCC are also at a higher risk of developing other cancers, such as endometrial cancer.

      FAP is a rare autosomal dominant condition that accounts for less than 1% of cases. It is caused by a mutation in the adenomatous polyposis coli gene (APC), which leads to the formation of hundreds of polyps by the age of 30-40 years. Patients with FAP inevitably develop carcinoma and are also at risk of duodenal tumors. A variant of FAP called Gardner’s syndrome can also feature osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma, and epidermoid cysts on the skin.

      In conclusion, understanding the genetics behind colorectal cancer is important for diagnosis and treatment. While sporadic colon cancer is the most common type, HNPCC and FAP are inherited conditions that require genetic testing and surveillance for early detection and prevention.

    • This question is part of the following fields:

      • Medicine
      14.1
      Seconds
  • Question 13 - A 21-year-old student presents to his GP a few days after returning from...

    Incorrect

    • 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: Impetigo

      Correct 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
      51.4
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  • Question 14 - A 14-month old toddler is brought to the pediatrician by his father, who...

    Incorrect

    • A 14-month old toddler is brought to the pediatrician by his father, who is worried about his child's decreased appetite and mouth ulcers for the past three days. During the examination, a few blisters are observed on the soles of his feet. Vital signs indicate a temperature of 37.8ºC, heart rate of 125/min, respiratory rate of 28/min, and oxygen saturation of 98% in room air.

      The father reports that his child was born at full term through a normal delivery, is following the growth chart appropriately, and has received all the recommended vaccinations. What is the most probable cause of the child's symptoms?

      Your Answer: Kawasaki disease

      Correct Answer: Coxsackie A16

      Explanation:

      The child’s symptoms are indicative of hand, foot and mouth disease, which is caused by Coxsackie A16. The condition is characterized by mild systemic discomfort, oral ulcers, and vesicles on the palms and soles. It typically resolves on its own within 7 to 10 days, and the child may find relief from any pain by taking over-the-counter analgesics. Over-the-counter oral numbing sprays may also help alleviate sore throat symptoms. Kawasaki disease, on the other hand, is associated with a higher fever than what this child is experiencing, as well as some distinct features that can be recalled using the mnemonic ‘CRASH and burn’. These include conjunctivitis (bilateral), non-vesicular rash, cervical adenopathy, swollen strawberry tongue, and hand or foot swelling, along with a fever that lasts for more than 5 days and is very high.

      Hand, Foot and Mouth Disease: A Contagious Condition in Children

      Hand, foot and mouth disease is a viral infection that commonly affects children. It is caused by intestinal viruses from the Picornaviridae family, particularly coxsackie A16 and enterovirus 71. This condition is highly contagious and often occurs in outbreaks in nurseries. The symptoms of hand, foot and mouth disease include mild systemic upset such as sore throat and fever, as well as oral ulcers and vesicles on the palms and soles of the feet.

      Symptomatic treatment is the only management option for hand, foot and mouth disease. This includes general advice about hydration and analgesia, as well as reassurance that there is no link to disease in cattle. Children do not need to be excluded from school, but the Health Protection Agency recommends that children who are unwell should be kept off school until they feel better. If there is a suspected large outbreak, it is advised to contact the Health Protection Agency for further guidance.

    • This question is part of the following fields:

      • Paediatrics
      23.9
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  • Question 15 - A 79-year-old woman presents with recent-onset confusion. She had been in her usual...

    Correct

    • A 79-year-old woman presents with recent-onset confusion. She had been in her usual state of health until she was observed to be confused and agitated during dinner yesterday. This morning, she was alert and oriented, but later in the evening, she became completely confused, agitated, and hostile. She was subsequently transported to the Emergency Department by ambulance. Additional history reveals no prior instances of confusion, but she has experienced increased frequency of urination over the past few days.
      What is the probable reason for her confusion?

      Your Answer: Urinary tract infection (UTI)

      Explanation:

      Diagnosing Delirium in an Elderly Patient: UTI vs. Dementia vs. Pyelonephritis

      When an 89-year-old woman presents with waxing and waning consciousness, punctuated by ‘sun-downing’, it is important to consider the possible causes of delirium. In this case, the patient has normal cognitive function but is experiencing acute global cerebral dysfunction. One possible cause of delirium in the elderly is a urinary tract infection (UTI), which can present with symptoms such as frequency and confusion.

      However, it is important to rule out other potential causes of delirium, such as vascular dementia or Alzheimer’s dementia. In these conditions, cognitive decline is typically steady and progressive, whereas the patient in this case is experiencing waxing and waning consciousness. Additionally, neither of these conditions would account for the patient’s new urinary symptoms.

      Another possible cause of delirium is pyelonephritis, which can present with similar symptoms to a UTI but may also include pyrexia, renal angle tenderness, and casts on urinalysis. However, in this case, the patient does not exhibit these additional symptoms.

      Finally, pseudodementia is unlikely in this scenario as the patient does not exhibit any affective signs. Overall, it is important to consider all possible causes of delirium in an elderly patient and conduct a thorough evaluation to determine the underlying condition.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      15.2
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  • Question 16 - This is the full blood count result of a 72-year-old male who presents...

    Incorrect

    • This is the full blood count result of a 72-year-old male who presents with fatigue following his retirement 6 months ago:

      Hb 130 g/L (120-160)
      RBC 4.5 ×1012/L -
      Haematocrit 0.39 (0.36-0.46)
      MCV 86.5 fL (80-100)
      MCH 28.1 pg (27-32)
      Platelets 180 ×109/L (150-400)
      WBC 6.5 ×109/L (4-11)
      Neutrophils 3.8 ×109/L (2-7)
      Lymphocytes 1.9 ×109/L (1-4)
      Monocytes 0.5 ×109/L (0.2-1)
      Eosinophils 0.2 ×109/L (0-0.5)
      Basophils 0.1 ×109/L (0-0.1)

      He is brought into the clinic by his wife who is concerned that her husband is constantly tired, has lost interest in his hobbies and has trouble sleeping.

      Examination is pretty much normal except that he appears fatigued. There are no abnormalities on chest, abdominal or respiratory examination. Neurological examination is normal.

      What is the most likely cause of this blood picture?

      Your Answer: Hypothyroidism

      Correct Answer: Alcohol excess

      Explanation:

      Delayed Grief Reaction and Elevated MCV in a Patient

      Explanation:
      The patient in question is displaying a delayed grief reaction following the recent death of her husband. Her FBC shows a normal picture except for an elevated MCV, which suggests alcohol excess. If the cause of macrocytosis were folate or B12 deficiency, it would be expected to cause anemia in association with the macrocytosis. Hypothyroidism may also cause macrocytosis, but the patient’s weight loss argues against this diagnosis. For further information on macrocytosis, refer to the BMJ Practice article Macrocytosis: pitfalls in testing and summary of guidance, the BMJ Endgames case report A woman with macrocytic anemia and confusion, and the BMJ Best Practice article Assessment of anemia.

    • This question is part of the following fields:

      • Haematology
      151.6
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  • Question 17 - A 72-year-old man is undergoing open surgery to repair a direct inguinal hernia....

    Incorrect

    • 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

    • This question is part of the following fields:

      • Colorectal
      2418.4
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  • Question 18 - You are requested to evaluate a 15-year-old Caucasian girl who has been feeling...

    Correct

    • You are requested to evaluate a 15-year-old Caucasian girl who has been feeling unwell for a few days. She has been experiencing intermittent fevers and chills and complains of extreme fatigue. Suddenly, half an hour before her admission to the hospital, she lost all vision in her left eye.

      During the examination, the patient appears pale and unwell. Her vital signs are as follows: temperature 38.5°C, pulse 120/minute, regular, blood pressure 100/55 mmHg, and respiratory rate 22/minute. A pansystolic murmur is audible at the apex and lower left sternal border. Both lungs are clear.

      The right pupil reacts normally to light, but there is no reaction from the left pupil, which remains fixed and dilated. The patient has complete loss of vision in the left eye, and the left fundus appears paler than the right, without papilloedema. The only additional finding on examination was a paronychia on her right thumb, and light pressure on the nail bed was very uncomfortable.

      Investigations reveal the following results: Hb 109 g/L (115-165), WBC 14.1 ×109/L (4-11), Neutrophils 9.0 ×109/L (1.5-7), Lymphocytes 4.8 ×109/L (1.5-4), Monocytes 0.29 ×109/L (0-0.8), Eosinophils 0.01 ×109/L (0.04-0.4), and Platelets 550 ×109/L (150-400).

      What is the most crucial investigation to determine the cause of her illness?

      Your Answer: Blood cultures

      Explanation:

      Complications of Chronic Paronychia

      Chronic paronychia can lead to serious complications such as osteomyelitis and endocarditis. The most common causative organism for these complications is Staphylococcus aureus. Endocarditis can cause emboli, which are fragments of vegetation that can block or damage blood vessels in any part of the body. This can result in severe consequences such as blindness, stroke, or paralysis.

      To properly assess and manage a patient with chronic paronychia and its complications, several investigations may be necessary. However, the most crucial immediate investigations are blood cultures and echocardiography. These tests can help identify the causative organism and determine the extent of damage to the heart valves. Early diagnosis and treatment are essential to prevent further complications and improve the patient’s prognosis.

    • This question is part of the following fields:

      • Neurology
      76.7
      Seconds
  • Question 19 - A 35-year-old female comes to the clinic complaining of difficulty swallowing solids. She...

    Incorrect

    • A 35-year-old female comes to the clinic complaining of difficulty swallowing solids. She has observed a gradual decrease in her mouth opening and tightening of the skin over her distal forearms over the past year. During the examination, her fingers seem to be blanched and cold, and her skin has a 'salt and pepper' appearance. You suspect that she has a connective tissue disorder. What test will aid in establishing a conclusive diagnosis?

      Your Answer: Anti-ds-DNA antibodies

      Correct Answer: Anti-centromere antibodies

      Explanation:

      Understanding Systemic Sclerosis

      Systemic sclerosis is a condition that affects the skin and other connective tissues, but its cause is unknown. It is more common in females, with three patterns of the disease. Limited cutaneous systemic sclerosis is characterised by Raynaud’s as the first sign, affecting the face and distal limbs, and associated with anti-centromere antibodies. CREST syndrome is a subtype of limited systemic sclerosis that includes Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, and Telangiectasia. Diffuse cutaneous systemic sclerosis affects the trunk and proximal limbs, associated with scl-70 antibodies, and has a poor prognosis. Respiratory involvement is the most common cause of death, with interstitial lung disease and pulmonary arterial hypertension being the primary complications. Renal disease and hypertension are also possible complications, and patients with renal disease should be started on an ACE inhibitor. Scleroderma without internal organ involvement is characterised by tightening and fibrosis of the skin, manifesting as plaques or linear. Antibodies such as ANA, RF, anti-scl-70, and anti-centromere are associated with different types of systemic sclerosis.

    • This question is part of the following fields:

      • Musculoskeletal
      8
      Seconds
  • Question 20 - A 29-year-old woman presents with dry, eczematous hands. She reports being a very...

    Correct

    • A 29-year-old woman presents with dry, eczematous hands. She reports being a very hygienic person, but since the onset of the COVID-19 pandemic, she has been washing her hands excessively - up to 60 times a day. She is aware that this is causing her skin to become dry and irritated, but her anxiety about contracting the virus is too great to stop. She works in a hospital and is worried about her colleagues noticing her frequent hand washing. You suspect she may have obsessive-compulsive disorder and decide to refer her to the community mental health team. What treatment options are likely to be offered to her?

      Your Answer: Cognitive behavioural therapy

      Explanation:

      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.

    • This question is part of the following fields:

      • Psychiatry
      11.7
      Seconds
  • Question 21 - A cohort study of 5,000 elderly patients aimed to determine whether the consumption...

    Incorrect

    • A cohort study of 5,000 elderly patients aimed to determine whether the consumption of green tea has an effect on cognitive decline. Roughly half of the patients drank green tea regularly and half did not.
      What is a drawback of conducting a cohort study?

      Your Answer: They are susceptible to recall bias; there is a differential ability of patients to remember exposure to a risk factor

      Correct Answer: When the outcome of interest is rare a very large sample size is needed

      Explanation:

      Cohort Studies: Advantages and Disadvantages

      A cohort study is a research method that involves following a group of individuals over a period of time to determine whether exposure to a particular factor has an effect on the incidence of disease. Although they are time-consuming and expensive, cohort studies have several advantages. For instance, they can be used to study rare exposure factors and are less prone to recall bias than case-control studies. Additionally, they can measure the incidence or risk of a disease, which is useful in determining the effectiveness of interventions.

      One of the main advantages of cohort studies is that they allow researchers to study exposure factors that are rare. This is because they involve following a group of individuals over a period of time, which means that even if the exposure factor is rare, it may still be possible to observe its effects. Another advantage is that cohort studies are less susceptible to recall bias than case-control studies. This is because the exposure factor is measured before the disease occurs, which reduces the likelihood of participants misremembering their exposure.

      However, cohort studies also have some disadvantages. One of the main disadvantages is that they are time-consuming and expensive to perform. This is because they involve following a group of individuals over a period of time, which requires a significant amount of resources. Additionally, cohort studies may not be suitable for studying diseases that have a long latency period, as it may take many years for the disease to develop. Finally, cohort studies may be affected by loss to follow-up, which can reduce the validity of the results.

    • This question is part of the following fields:

      • Clinical Sciences
      21.3
      Seconds
  • Question 22 - A 72-year-old woman has been diagnosed with stress incontinence. Her BMI is 30...

    Incorrect

    • A 72-year-old woman has been diagnosed with stress incontinence. Her BMI is 30 kg/m2 and she has a history of hypertension and osteoporosis. She presents to you today with worsening symptoms despite reducing her caffeine intake and starting a regular exercise routine. She has had a normal pelvic exam and has completed three months of pelvic floor exercises with only mild improvement. She is hesitant to undergo surgery due to a previous severe reaction to general anesthesia. What is the next step in managing this patient?

      Your Answer: Continue pelvic floor exercises for up to another three months and then reassess symptoms

      Correct Answer: Duloxetine

      Explanation:

      Management Options for Stress Incontinence: A Case-Based Discussion

      Stress incontinence is a common condition that can significantly impact a patient’s quality of life. In this scenario, a female patient has attempted lifestyle changes and pelvic floor exercises for three months with little effect. What are the next steps in management?

      Duloxetine is a second-line management option for stress incontinence when conservative measures fail. It works by inhibiting the reuptake of serotonin and noradrenaline, leading to continuous stimulation of the nerves in Onuf’s nucleus and preventing involuntary urine loss. However, caution should be exercised in patients with certain medical conditions.

      Continuing pelvic floor exercises for another three months is unlikely to yield significant improvements, and referral is indicated at this stage.

      Intramural urethral-bulking agents can be used when conservative management has failed, but they are not as effective as other surgical options and symptoms can recur.

      The use of a ring pessary is not recommended as a first-line treatment option for stress incontinence.

      A retropubic mid-urethral tape procedure is a successful surgical option, but it may not be appropriate for high-risk patients who wish to avoid surgery.

      In conclusion, the management of stress incontinence requires a tailored approach based on the patient’s individual circumstances and preferences.

    • This question is part of the following fields:

      • Gynaecology
      14.2
      Seconds
  • Question 23 - A 50-year-old man has been diagnosed with colorectal cancer. Upon imaging, it has...

    Incorrect

    • A 50-year-old man has been diagnosed with colorectal cancer. Upon imaging, it has been found that the tumour is located in the mid-rectum and does not extend beyond it. What would be the most suitable surgical approach for a mid-rectal tumour?

      Your Answer: Abdominoperineal excision of rectum

      Correct Answer: Anterior resection

      Explanation:

      Anterior resection is the preferred surgical procedure for rectal tumours, except for those located in the lower rectum. For mid to high rectal tumours, anterior resection is the usual approach. Hartmann’s procedure is typically reserved for sigmoid tumours, while abdominoperineal excision of the rectum is commonly used for anal or low rectal tumours.

      Colorectal cancer is typically diagnosed through CT scans and colonoscopies or CT colonography. Patients with tumors below the peritoneal reflection should also undergo MRI to evaluate their mesorectum. Once staging is complete, a treatment plan is formulated by a dedicated colorectal MDT meeting.

      For colon cancer, surgery is the primary treatment option, with resectional surgery being the only cure. The procedure is tailored to the patient and tumor location, with lymphatic chains being resected based on arterial supply. Anastomosis is the preferred method of restoring continuity, but in some cases, an end stoma may be necessary. Chemotherapy is often offered to patients with risk factors for disease recurrence.

      Rectal cancer management differs from colon cancer due to the rectum’s anatomical location. Tumors can be surgically resected with either an anterior resection or an abdominoperineal excision of rectum (APER). A meticulous dissection of the mesorectal fat and lymph nodes is integral to the procedure. Neoadjuvant radiotherapy is often offered to patients prior to resectional surgery, and those with obstructing rectal cancer should have a defunctioning loop colostomy.

      Segmental resections based on blood supply and lymphatic drainage are the primary operations for cancer. The type of resection and anastomosis depend on the site of cancer. In emergency situations where the bowel has perforated, an end colostomy is often safer. Left-sided resections are more risky, but ileocolic anastomoses are relatively safe even in the emergency setting and do not need to be defunctioned.

    • This question is part of the following fields:

      • Surgery
      18.8
      Seconds
  • Question 24 - A 32-year-old woman complains of numbness and ‘pins and needles’ in her left...

    Correct

    • A 32-year-old woman complains of numbness and ‘pins and needles’ in her left leg that has been present for 48 h after a long flight. On examination, there is reduced sensation to light touch at the lateral aspect of her left thigh, extending from the iliac crest to the knee. There is no distal sensory loss. There is preserved motor function through all muscle groups of the affected limb. There is no weakness or sensory change in the opposite limb.
      What is the most likely anatomical source for this woman’s presentation?

      Your Answer: Lateral femoral cutaneous nerve

      Explanation:

      Common Nerve Injuries and Their Symptoms

      Nerve injuries can cause a variety of symptoms depending on the affected nerve. Here are some common nerve injuries and their associated symptoms:

      Lateral Femoral Cutaneous Nerve: A mononeuropathy of this nerve causes numbness in a narrow strip of the lateral thigh. It is often associated with rapid weight gain, such as in pregnancy.

      Sciatic Nerve: A sciatic neuropathy can cause weakness in hip extension, knee flexion, ankle plantar flexion/dorsiflexion, and toe plantar flexion/dorsiflexion, as well as inversion and eversion of the foot. It is commonly caused by pelvic trauma, neoplasia, or surgery.

      Femoral Nerve: A femoral neuropathy can cause numbness in the medial thigh, medial leg, and medial aspect of the ankle, as well as weakness in hip flexion and knee extension. It is often caused by motor compression, such as in femoral fracture or childbirth.

      Obturator Nerve: An obturator neuropathy can cause weakness in internal rotation and adduction at the hip, as well as sensory disturbance over the medial thigh.

      L5 Nerve Root: Involvement of the L5 nerve root can cause weakness in ankle and toe dorsiflexion (causing a foot drop) and weakness in ankle inversion. There is also sensory disturbance along the lateral aspect of the leg (below the knee). It can be similar to an anterior tibial neuropathy, but can be distinguished by the weakness in ankle eversion instead of inversion.

    • This question is part of the following fields:

      • Neurology
      21.2
      Seconds
  • Question 25 - A breast cancer screening programme involved 1000 patients who underwent mammograms. Out of...

    Incorrect

    • A breast cancer screening programme involved 1000 patients who underwent mammograms. Out of these, 120 patients were recalled for further investigations due to being a high-risk group. Among the recalled patients, 18 were found to have breast cancer. Meanwhile, 880 patients were not recalled, and 45 of them were diagnosed with breast cancer. What is the percentage of positive predictive value for the patients who were recalled in this screening programme?

      Your Answer: 28.50%

      Correct Answer: 15%

      Explanation:

      Understanding the Statistics of a Medical Screening Test

      Medical screening tests are an important tool in detecting diseases early on. However, it is important to understand the statistics behind these tests to accurately interpret the results. Here are some key terms to know:

      Positive Predictive Value: The percentage of people with a positive test result who actually have the disease. Calculated as true positives/(true positives + false positives) x 100%.

      Disease Prevalence: The percentage of cases of the disease within one population.

      Negative Predictive Value: The percentage of patients who test negative for the screening test that are true negatives, ie do not have the disease. Calculated as true negatives/(true negatives + false negatives) x 100%.

      Sensitivity: The ability of the test to correctly identify the patients who have a disease. Calculated as true positives/(true positives + false negatives) x 100%.

      Specificity: The ability of the test to identify true negatives, specifically people without the disease in question. Calculated as true negatives/(true negatives + false positives) x 100%.

      Understanding these statistics can help healthcare professionals and patients make informed decisions about further testing and treatment.

    • This question is part of the following fields:

      • Statistics
      2.8
      Seconds
  • Question 26 - A 28-year-old woman with clinical signs of hyperandrogenism (hirsutism, severe acne and pigmented...

    Incorrect

    • A 28-year-old woman with clinical signs of hyperandrogenism (hirsutism, severe acne and pigmented areas of skin in the axillae) and multiple ovarian cysts, demonstrated on ultrasound scan of both ovaries, has been trying to conceive for six months, but her periods are irregular. She has lost 2 stones in weight and attends clinic for further advice on management.
      What is the most appropriate step in the management of this 28-year-old patient with clinical signs of hyperandrogenism, multiple ovarian cysts, irregular periods, and a desire to conceive, who has lost 2 stones in weight?

      Your Answer: Gonadotrophins

      Correct Answer: Clomiphene citrate

      Explanation:

      Treatment Options for Infertility in Women with PCOS

      Polycystic ovary syndrome (PCOS) is a common cause of infertility in women. Clomiphene citrate is the first-line medication used to induce ovulation in women with PCOS who wish to conceive. It works by binding to hypothalamic estrogen receptors, inhibiting the negative feedback on follicle-stimulating hormone (FSH) and triggering ovulation. However, it is important to counsel women about the increased risk of multiple pregnancy when treated with Clomiphene. Metformin, once considered a viable option for PCOS-related infertility, is now considered inferior to Clomiphene. However, it can be used in combination with Clomiphene to increase the success of ovulation induction. Gonadotrophins are recommended as second-line treatment for women who do not respond to Clomiphene. Laparoscopic ovarian drilling is a surgical option reserved for cases where Clomiphene has failed. It involves destroying ovarian stroma to reduce androgen-secreting tissue and induce ovulation. The choice of treatment depends on individual patient factors and should be discussed with a healthcare provider.

    • This question is part of the following fields:

      • Gynaecology
      14.8
      Seconds
  • Question 27 - A 65-year-old retired librarian presents to her General Practitioner complaining of a feeling...

    Correct

    • A 65-year-old retired librarian presents to her General Practitioner complaining of a feeling of fullness in her vagina. She states that this feeling is present at all times. On further questioning she also has a 1-year history of urinary frequency and has been treated for urinary tract infections in two instances in the past year. She has never smoked and is teetotal.
      What is the most likely diagnosis?

      Your Answer: Cystocele

      Explanation:

      Common Vaginal Conditions: Symptoms and Management

      Cystocele: A weakening of pelvic muscles can cause the bladder to prolapse into the vagina, resulting in stress incontinence, frequent urinary tract infections, and a dragging sensation or lump in the vagina. Management ranges from conservative with pelvic floor exercises to surgery.

      Rectocele: Women with a rectocele experience pressure and a lump in the vagina, as well as difficulty with bowel movements. Treatment may involve pelvic floor exercises or surgery.

      Bartholin cyst: A blocked Bartholin gland can lead to a cyst that presents as a tender mass in the vaginal wall. Treatment involves incision and drainage, as well as antibiotics.

      Vaginal cancer: Symptoms include vaginal or postcoital bleeding, vaginal discharge, and persistent pelvic pain.

      Bladder cancer: Painless hematuria is a common symptom, with risk factors including smoking, working in the aniline dye industry, or previous infection with Schistosoma haematobium.

    • This question is part of the following fields:

      • Gynaecology
      30.3
      Seconds
  • Question 28 - Which nerve root is associated with the ankle reflex test performed during a...

    Correct

    • Which nerve root is associated with the ankle reflex test performed during a neurological examination of the lower limbs where the foot is held in external rotation, the knee is flexed, and the Achilles tendon is struck with a tendon hammer while observing the calf?

      Your Answer: Tibial nerve S1, S2

      Explanation:

      The Tibial Nerve and Ankle Reflex

      The ankle reflex is controlled by the tibial nerve, which originates from the S1 and S2 nerve roots. This nerve is a branch of the sciatic nerve and is responsible for supplying the posterior muscles of the leg and knee joint. The tibial nerve forms in the popliteal fossa and runs downwards on the tibialis posterior.

      As it travels, the tibial nerve provides sensation and motor function to the muscles in the leg and knee joint. It terminates by dividing into the medial and lateral plantar nerves. These nerves are responsible for providing sensation to the sole of the foot and controlling the muscles that move the foot and toes.

      Overall, the tibial nerve plays a crucial role in the ankle reflex and the overall function of the leg and foot. Its proper functioning is essential for maintaining balance and mobility.

    • This question is part of the following fields:

      • Clinical Sciences
      20.2
      Seconds
  • Question 29 - A loud systolic murmur, which extends into diastole and is ‘machinery-like’ in quality,...

    Incorrect

    • A loud systolic murmur, which extends into diastole and is ‘machinery-like’ in quality, is found in a toddler at his 18-month check-up. The murmur radiates to the back between the scapulae. His first heart sound is normal; the second sound is obscured by the murmur. He has bounding pulses. His mother reports that he is asymptomatic.
      Which of the following is correct of this condition?

      Your Answer: This condition is due to failure of closure of a fetal vessel derived from the fourth aortic arch

      Correct Answer: This condition is likely to occur with increased frequency in those with hyaline membrane disease of the lungs

      Explanation:

      Misconceptions about a Pediatric Cardiac Condition

      Clearing Up Misconceptions About a Pediatric Cardiac Condition

      There are several misconceptions about a pediatric cardiac condition that need to be addressed. Firstly, the condition is likely to be patent ductus arteriosus (PDA), which can occur more frequently in children with hyaline membrane disease and cyanotic congenital heart conditions. However, it is treatable, with surgical repair required for larger defects.

      Secondly, the right recurrent laryngeal nerve hooks around the right subclavian artery, which is not affected by PDA. Thirdly, the condition is not due to failure of closure of a fetal vessel derived from the fourth aortic arch.

      Lastly, the underlying diagnosis is not Tetralogy of Fallot, which is a separate condition consisting of pulmonary stenosis, a ventricular septal defect, right ventricular hypertrophy, and an overriding aorta. It is important to clear up these misconceptions to ensure accurate understanding and treatment of this pediatric cardiac condition.

    • This question is part of the following fields:

      • Paediatrics
      25.1
      Seconds
  • Question 30 - Which of the following statements about the use of aspirin in patients with...

    Correct

    • Which of the following statements about the use of aspirin in patients with ischemic heart disease is accurate?

      Your Answer: All patients should take aspirin if there is no contraindication

      Explanation:

      Aspirin is recommended for all patients with ischaemic heart disease, unless there is a contraindication. However, the guidelines have been updated to suggest that patients with other types of cardiovascular disease, such as stroke and peripheral arterial disease, should be given clopidogrel as the first-line treatment.

      The Mechanism and Guidelines for Aspirin Use in Cardiovascular Disease

      Aspirin is a medication that works by blocking the action of cyclooxygenase-1 and 2, which are responsible for the synthesis of prostaglandin, prostacyclin, and thromboxane. By inhibiting the formation of thromboxane A2 in platelets, aspirin reduces their ability to aggregate, making it a widely used medication in cardiovascular disease. However, recent trials have cast doubt on the use of aspirin in primary prevention of cardiovascular disease, leading to changes in guidelines. Aspirin is now recommended as a first-line treatment for patients with ischaemic heart disease, but it should not be used in children under 16 due to the risk of Reye’s syndrome. The medication can also potentiate the effects of oral hypoglycaemics, warfarin, and steroids.

      The Medicines and Healthcare products Regulatory Agency (MHRA) issued a drug safety update in January 2010, reminding prescribers that aspirin is not licensed for primary prevention. NICE now recommends clopidogrel as a first-line treatment following an ischaemic stroke and for peripheral arterial disease. However, the situation is more complex for TIAs, with recent Royal College of Physician (RCP) guidelines supporting the use of clopidogrel, while older NICE guidelines still recommend aspirin + dipyridamole – a position the RCP state is ‘illogical’. Despite these changes, aspirin remains an important medication in the treatment of cardiovascular disease, and its use should be carefully considered based on individual patient needs and risk factors.

    • This question is part of the following fields:

      • Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal (0/2) 0%
Haematology (2/3) 67%
Surgery (1/2) 50%
Psychiatry (1/2) 50%
Pharmacology (1/2) 50%
Respiratory (1/1) 100%
Ophthalmology (1/1) 100%
ENT (1/1) 100%
Urology (0/1) 0%
Cardiology (0/1) 0%
Medicine (1/1) 100%
Dermatology (0/1) 0%
Paediatrics (0/2) 0%
Acute Medicine And Intensive Care (1/1) 100%
Colorectal (0/1) 0%
Neurology (2/2) 100%
Clinical Sciences (1/2) 50%
Gynaecology (1/3) 33%
Statistics (0/1) 0%
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