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  • Question 1 - A middle-aged woman presents with symptoms that can be associated with sexually transmitted...

    Incorrect

    • A middle-aged woman presents with symptoms that can be associated with sexually transmitted infection. Following her investigations, she is diagnosed with gonorrhoea.

      Which of the following is the most common presenting clinical feature of gonorrhoea in women?

      Your Answer: Dysuria

      Correct Answer: Vaginal discharge

      Explanation:

      Neisseria gonorrhoeae is a type of bacteria that is shaped like two spheres and stains pink when tested. It is responsible for causing the sexually transmitted infection known as gonorrhoea. This infection is most commonly seen in individuals between the ages of 15 and 35, and it is primarily transmitted through sexual contact. One important thing to note is that the gonococcal pili, which are hair-like structures on the bacteria, can change their appearance. This means that even if someone has recovered from a previous infection, they can still be reinfected due to the bacteria’s ability to alter its antigens.

      In men, the most common symptoms of gonorrhoea include inflammation of the urethra, which is the tube that carries urine out of the body. This is seen in approximately 80% of cases. Other symptoms may include painful urination, as well as the presence of a discharge that is a combination of mucus and pus. In some cases, the infection can also affect the rectum, leading to anal discharge. It is worth noting that pharyngitis, which is inflammation of the throat, is usually asymptomatic in men.

      On the other hand, women with gonorrhoea often experience a vaginal discharge as the main symptom, which is seen in about 50% of cases. Lower abdominal pain is another common symptom, occurring in approximately 25% of cases. Dysuria, or painful urination, is seen in about 10-15% of women with the infection. Some women may also experience tenderness in the pelvic or lower abdominal area. Additionally, there may be a discharge or bleeding from the endocervix, which is the opening of the cervix. Similar to men, rectal infection is usually asymptomatic in women, but it can cause anal discharge. Pharyngitis, or inflammation of the throat, is typically not accompanied by any noticeable symptoms in women.

      Overall, it is important to be aware of the various clinical features of gonorrhoea in both men and women in order to recognize and seek appropriate treatment for this sexually transmitted infection.

    • This question is part of the following fields:

      • Sexual Health
      11.5
      Seconds
  • Question 2 - You evaluate a 35-year-old combat veteran named Mark, who was recently discharged from...

    Correct

    • You evaluate a 35-year-old combat veteran named Mark, who was recently discharged from service after being discovered to be under the influence of drugs and alcohol during a training exercise. He completed three tours of duty in Iraq and witnessed the death of a close comrade during his final deployment. Mark acknowledges experiencing frequent flashbacks and nightmares and often feels on edge. His spouse has accused him of being emotionally distant and lacking feelings, resulting in their separation. Lately, he has been heavily relying on alcohol as a coping mechanism.
      What is the SINGLE MOST probable diagnosis?

      Your Answer: Post-traumatic stress disorder

      Explanation:

      Post-traumatic stress disorder (PTSD) develops after experiencing an extremely threatening or catastrophic event that would cause distress in almost anyone. It is important to note that PTSD does not develop from everyday upsetting situations like divorce, job loss, or failing an exam.

      The most common symptom of PTSD is re-experiencing the traumatic event involuntarily and vividly. This can manifest as flashbacks, nightmares, repetitive distressing images or sensations, and physical symptoms such as pain, sweating, nausea, or trembling. Other notable features of PTSD include avoidance, rumination, hyperarousal, emotional numbing, irritability, and insomnia.

      It is common for individuals with PTSD to also experience other mental health problems such as depression, anxiety, phobias, self-harming behaviors, and substance abuse.

      The recommended treatments for PTSD are Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-focused Cognitive Behavioral Therapy (CBT). These treatments should be offered to individuals of all ages, regardless of the time that has passed since the traumatic event. Typically, 8-12 sessions are recommended, but more may be necessary in cases involving multiple traumas, chronic disability, comorbidities, or social problems.

    • This question is part of the following fields:

      • Mental Health
      23.4
      Seconds
  • Question 3 - A 62-year-old woman presents, confused and trembling. She has a strong smell of...

    Correct

    • A 62-year-old woman presents, confused and trembling. She has a strong smell of alcohol and her appearance is unkempt. She informs you that she typically consumes large amounts of alcohol (>1 L vodka per day) but has not had any since yesterday. Upon examination, you observe that she has jaundice and abdominal distension. There are numerous spider naevi on her abdomen. Her initial blood results are as follows:

      AST: 492 IU/L (5-40)
      ALT: 398 IU/L (5-40)
      ALP: 320 IU/L (20-140)
      Gamma GT: 712 IU/L (5-40)
      Bilirubin: 104 mmol (3-20)

      What is the SINGLE most likely diagnosis?

      Your Answer: Alcohol-induced hepatitis

      Explanation:

      This patient presents with elevated transaminases and gamma GT, along with mildly elevated ALP and hyperbilirubinemia. These findings strongly indicate a diagnosis of alcohol-induced hepatitis. Additionally, the patient’s history and examination features strongly suggest a history of chronic alcohol abuse and withdrawal, further supporting this diagnosis.

    • This question is part of the following fields:

      • Gastroenterology & Hepatology
      58.1
      Seconds
  • Question 4 - A 6-month-old infant is referred by the community pediatrician following a well-child visit...

    Incorrect

    • A 6-month-old infant is referred by the community pediatrician following a well-child visit with a rash. After an assessment by the dermatology team and subsequent investigations, the infant is discovered to have a localized skin infection. The underlying cause is thought to be bacterial in nature.

      Which of the following is the SINGLE most likely diagnosis?

      Your Answer: Breastmilk jaundice

      Correct Answer: Alpha 1-antitrypsin deficiency

      Explanation:

      Neonatal jaundice is a complex subject, and it is crucial for candidates to have knowledge about the different causes, presentations, and management of conditions that lead to jaundice in newborns. Neonatal jaundice can be divided into two groups: unconjugated hyperbilirubinemia, which can be either physiological or pathological, and conjugated hyperbilirubinemia, which is always pathological.

      The causes of neonatal jaundice can be categorized as follows:

      Haemolytic unconjugated hyperbilirubinemia:
      – Intrinsic causes of haemolysis include hereditary spherocytosis, G6PD deficiency, sickle-cell disease, and pyruvate kinase deficiency.
      – Extrinsic causes of haemolysis include haemolytic disease of the newborn and Rhesus disease.

      Non-haemolytic unconjugated hyperbilirubinemia:
      – Breastmilk jaundice, cephalhaematoma, polycythemia, infection (particularly urinary tract infections), Gilbert syndrome.

      Hepatic conjugated hyperbilirubinemia:
      – Hepatitis A and B, TORCH infections, galactosaemia, alpha 1-antitrypsin deficiency, drugs.

      Post-hepatic conjugated hyperbilirubinemia:
      – Biliary atresia, bile duct obstruction, choledochal cysts.

      By understanding these different categories and their respective examples, candidates will be better equipped to handle neonatal jaundice cases.

    • This question is part of the following fields:

      • Neonatal Emergencies
      35.4
      Seconds
  • Question 5 - A 45-year-old woman presents with a 4-week history of persistent hoarseness of her...

    Correct

    • A 45-year-old woman presents with a 4-week history of persistent hoarseness of her voice. She has also been bothered by a sore throat on and off but describes this as mild, and she has no other symptoms. On examination, she is afebrile, her chest is clear, and examination of her throat is unremarkable.

      What is the SINGLE most appropriate next management step for this patient?

      Your Answer: Urgent referral to an ENT specialist (for an appointment within 2 weeks)

      Explanation:

      Laryngeal cancer should be suspected in individuals who experience prolonged and unexplained hoarseness. The majority of laryngeal cancers, about 60%, occur in the glottis, and the most common symptom is dysphonia. If the cancer is detected early, the chances of a cure are excellent, with a success rate of approximately 90%.

      Other clinical signs of laryngeal cancer include difficulty swallowing (dysphagia), the presence of a lump in the neck, a persistent sore throat, ear pain, and a chronic cough.

      According to the current guidelines from the National Institute for Health and Care Excellence (NICE) regarding the recognition and referral of suspected cancer, individuals who are over the age of 45 and present with persistent unexplained hoarseness or an unexplained lump in the neck should be considered for a suspected cancer referral pathway. This pathway aims to ensure that these individuals are seen by a specialist within two weeks for further evaluation.

      For more information, please refer to the NICE guidelines on the recognition and referral of suspected cancer.

    • This question is part of the following fields:

      • Ear, Nose & Throat
      96.6
      Seconds
  • Question 6 - You assess a patient with a previous diagnosis of bipolar disorder. His family...

    Correct

    • You assess a patient with a previous diagnosis of bipolar disorder. His family members are worried about his conduct.
      What is ONE characteristic symptom of mania?

      Your Answer: Thought disorder

      Explanation:

      The flight of ideas observed in mania is considered a type of thought disorder. The primary clinical characteristics of mania include changes in mood, behavior, speech, and thought.

      In terms of mood, individuals experiencing mania often exhibit an elated mood and a sense of euphoria. They may also display irritability and hostility instead of their usual amiability. Additionally, there is an increase in enthusiasm.

      Regarding behavior, individuals in a manic state tend to be overactive and have heightened energy levels. They may lose their normal social inhibitions and engage in more risk-taking behaviors. This can also manifest as increased sexual promiscuity and libido, as well as an increased appetite.

      In terms of speech, individuals with mania often speak in a pressured and rapid manner. Their conversations may be cheerful, and they may engage in rhyming or punning.

      Lastly, in terms of thought, the flight of ideas is a prominent feature of mania and is classified as a thought disorder. Individuals may experience grandiose delusions and have an inflated sense of self-esteem. They may also struggle with poor attention and concentration.

      Overall, mania is characterized by a range of symptoms that affect mood, behavior, speech, and thought.

    • This question is part of the following fields:

      • Mental Health
      12.2
      Seconds
  • Question 7 - A 72 year old female who is a known heavy smoker visits the...

    Correct

    • A 72 year old female who is a known heavy smoker visits the emergency department. She has experienced a worsening productive cough for the past week and feels breathless. An arterial blood gas is obtained and the results are as follows:

      Parameter Result
      pH 7.31
      pO2 9.1 kPa
      pCO2 6.5 kPa
      Bicarbonate 32 mmol/l
      Base Excess +4

      Which of the following options most accurately characterizes this blood gas result?

      Your Answer: Respiratory acidosis with metabolic compensation

      Explanation:

      The typical pH range for blood is 7.35-7.45. The blood gases indicate a condition called respiratory acidosis, which is partially corrected by metabolic processes. This condition may also be referred to as type 2 respiratory failure, characterized by low oxygen levels and high carbon dioxide levels in the blood.

      Further Reading:

      Arterial blood gases (ABG) are an important diagnostic tool used to assess a patient’s acid-base status and respiratory function. When obtaining an ABG sample, it is crucial to prioritize safety measures to minimize the risk of infection and harm to the patient. This includes performing hand hygiene before and after the procedure, wearing gloves and protective equipment, disinfecting the puncture site with alcohol, using safety needles when available, and properly disposing of equipment in sharps bins and contaminated waste bins.

      To reduce the risk of harm to the patient, it is important to test for collateral circulation using the modified Allen test for radial artery puncture. Additionally, it is essential to inquire about any occlusive vascular conditions or anticoagulation therapy that may affect the procedure. The puncture site should be checked for signs of infection, injury, or previous surgery. After the test, pressure should be applied to the puncture site or the patient should be advised to apply pressure for at least 5 minutes to prevent bleeding.

      Interpreting ABG results requires a systematic approach. The core set of results obtained from a blood gas analyser includes the partial pressures of oxygen and carbon dioxide, pH, bicarbonate concentration, and base excess. These values are used to assess the patient’s acid-base status.

      The pH value indicates whether the patient is in acidosis, alkalosis, or within the normal range. A pH less than 7.35 indicates acidosis, while a pH greater than 7.45 indicates alkalosis.

      The respiratory system is assessed by looking at the partial pressure of carbon dioxide (pCO2). An elevated pCO2 contributes to acidosis, while a low pCO2 contributes to alkalosis.

      The metabolic aspect is assessed by looking at the bicarbonate (HCO3-) level and the base excess. A high bicarbonate concentration and base excess indicate alkalosis, while a low bicarbonate concentration and base excess indicate acidosis.

      Analyzing the pCO2 and base excess values can help determine the primary disturbance and whether compensation is occurring. For example, a respiratory acidosis (elevated pCO2) may be accompanied by metabolic alkalosis (elevated base excess) as a compensatory response.

      The anion gap is another important parameter that can help determine the cause of acidosis. It is calculated by subtracting the sum of chloride and bicarbonate from the sum of sodium and potassium.

    • This question is part of the following fields:

      • Respiratory
      27.7
      Seconds
  • Question 8 - A 45-year-old individual is preparing to board a flight for a business conference...

    Correct

    • A 45-year-old individual is preparing to board a flight for a business conference and has concerns regarding the potential risk of developing DVT. They would like to inquire about the minimum duration of travel that is considered to pose an elevated risk of DVT during air travel.

      Your Answer: 4 hours

      Explanation:

      The World Health Organisation Research into Global Hazards of Travel (Wright) Project found that the main factor contributing to deep venous thrombosis is being immobile, and the risk of developing a blood clot is higher when traveling for more than 4 hours. According to the Wright Study, the absolute risk of experiencing deep venous thrombosis during flights lasting over 4 hours was found to be one in 4656. For more information on this topic, you can refer to the guidance provided by the Civil Aviation Authority for medical professionals.

    • This question is part of the following fields:

      • Vascular
      15.5
      Seconds
  • Question 9 - You are treating a 32-year-old woman with septic shock in resus. She is...

    Correct

    • You are treating a 32-year-old woman with septic shock in resus. She is reviewed by the on-call intensive care team, and a decision is made to place a central venous catheter.
      Which of the surface anatomy landmarks will be most useful in placing the central venous catheter?

      Your Answer: The two lower heads of the sternocleidomastoid muscle

      Explanation:

      The internal jugular vein is a significant vein located close to the surface of the body. It is often chosen for the insertion of central venous catheters due to its accessibility. To locate the vein, a needle is inserted into the middle of a triangular area formed by the lower heads of the sternocleidomastoid muscle and the clavicle. It is important to palpate the carotid artery to ensure that the needle is inserted to the side of the artery.

    • This question is part of the following fields:

      • Resus
      21.6
      Seconds
  • Question 10 - A 32-year-old woman with a known history of asthma presents with a headache,...

    Correct

    • A 32-year-old woman with a known history of asthma presents with a headache, nausea, and abdominal pain. Her heart rate is elevated at 117 bpm. She currently takes a salbutamol inhaler and theophylline for her asthma. She had visited the Emergency Department a few days earlier and was prescribed an antibiotic.
      Which antibiotic was most likely prescribed to this patient?

      Your Answer: Ciprofloxacin

      Explanation:

      Theophylline is a medication used to treat severe asthma. It is a bronchodilator that comes in modified-release forms, which can maintain therapeutic levels in the blood for 12 hours. Theophylline works by inhibiting phosphodiesterase and blocking the breakdown of cyclic AMP. It also competes with adenosine on A1 and A2 receptors.

      Achieving the right dose of theophylline can be challenging because there is a narrow range between therapeutic and toxic levels. The half-life of theophylline can be influenced by various factors, further complicating dosage adjustments. It is recommended to aim for serum levels of 10-20 mg/l six to eight hours after the last dose.

      Unlike many other medications, the specific brand of theophylline can significantly impact its effects. Therefore, it is important to prescribe theophylline by both its brand name and generic name.

      Several factors can increase the half-life of theophylline, including heart failure, cirrhosis, viral infections, and certain drugs. Conversely, smoking, heavy drinking, and certain medications can decrease the half-life of theophylline.

      There are several drugs that can either increase or decrease the plasma concentration of theophylline. Calcium channel blockers, cimetidine, fluconazole, macrolides, methotrexate, and quinolones can increase the concentration. On the other hand, carbamazepine, phenobarbitol, phenytoin, rifampicin, and St. John’s wort can decrease the concentration.

      The clinical symptoms of theophylline toxicity are more closely associated with acute overdose rather than chronic overexposure. Common symptoms include headache, dizziness, nausea, vomiting, abdominal pain, rapid heartbeat, dysrhythmias, seizures, mild metabolic acidosis, low potassium, low magnesium, low phosphates, abnormal calcium levels, and high blood sugar.

      Seizures are more prevalent in acute overdose cases, while chronic overdose typically presents with minimal gastrointestinal symptoms. Cardiac dysrhythmias are more common in chronic overdose situations compared to acute overdose.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      29.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Sexual Health (0/1) 0%
Mental Health (2/2) 100%
Gastroenterology & Hepatology (1/1) 100%
Neonatal Emergencies (0/1) 0%
Ear, Nose & Throat (1/1) 100%
Respiratory (1/1) 100%
Vascular (1/1) 100%
Resus (1/1) 100%
Pharmacology & Poisoning (1/1) 100%
Passmed