00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 35-year-old man is diagnosed with anterior uveitis.
    Which SINGLE statement regarding this condition...

    Correct

    • A 35-year-old man is diagnosed with anterior uveitis.
      Which SINGLE statement regarding this condition is FALSE?

      Your Answer: It most commonly involves the posterior chamber

      Explanation:

      Anterior uveitis refers to the inflammation of the iris and is characterized by a painful and red eye. It is often accompanied by symptoms such as sensitivity to light, excessive tearing, and a decrease in visual clarity. In less than 10% of cases, the inflammation may extend to the posterior chamber. The condition can also lead to the formation of adhesions between the iris and the lens or cornea, resulting in an irregularly shaped pupil known as synechia. In severe cases, pus may accumulate in the front part of the eye, specifically the anterior chamber, causing a condition called hypopyon.

      There are various factors that can cause anterior uveitis, including idiopathic cases where no specific cause can be identified. Other causes include trauma, chronic joint diseases like spondyloarthropathies and juvenile chronic arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriasis, sarcoidosis, and infections such as Lyme disease, tuberculosis, leptospirosis, herpes simplex virus (HSV), and varicella-zoster virus (VZV). It is worth noting that approximately 50% of patients with anterior uveitis have a strong association with the HLA-B27 genotype.

      Complications that can arise from uveitis include the development of cataracts, glaucoma, band keratopathy (a condition where calcium deposits form on the cornea), and even blindness.

    • This question is part of the following fields:

      • Ophthalmology
      20.5
      Seconds
  • Question 2 - A 7-year-old girl presents with a 4-day history of blurred vision in her...

    Incorrect

    • A 7-year-old girl presents with a 4-day history of blurred vision in her left eye. She is also experiencing eye pain and fatigue. On examination, her temperature is 38.0°C, but her other vital signs are normal. There is significant redness in the conjunctiva, and a collection of pus (hypopyon) is present in her left eye. Her visual acuity in that eye is reduced to counting fingers. She recently received a kitten as a pet from her parents.

      What is the SINGLE most likely causative organism?

      Your Answer: Pasteurella canis

      Correct Answer: Toxocara canis

      Explanation:

      Toxocariasis is a rare infection caused by the parasitic roundworm Toxocara canis. The main way it spreads to humans is through contact with dog feces. However, practicing good hand hygiene can help prevent transmission. While most people who come into contact with Toxocara canis don’t show any symptoms, a small number may experience a mild flu-like illness.

      The most common presentation of toxocariasis is in children, who may experience unilateral visual loss. This loss of vision is typically caused by conditions such as vitritis, macular edema, and tractional retinal detachment. It is believed that these lesions occur due to a toxic or immunoallergic reaction to the larval antigens.

    • This question is part of the following fields:

      • Ophthalmology
      38
      Seconds
  • Question 3 - You are caring for a pediatric patient in the resuscitation bay. Your attending...

    Correct

    • You are caring for a pediatric patient in the resuscitation bay. Your attending physician notices you selecting an oropharyngeal airway adjunct (OPA) and recommends using a laryngeal mask airway (LMA) instead. Which of the following statements about the advantages and disadvantages of using a laryngeal mask airway (LMA) is correct?

      Your Answer: Greater risk of inducing laryngospasm using LMA compared to endotracheal intubation

      Explanation:

      The use of a laryngeal mask airway (LMA) carries a higher risk of inducing laryngospasm compared to endotracheal intubation. However, LMAs are still considered excellent alternatives to bag masks as they reduce the risk of gastric inflation and aspiration. While they do decrease the risk of aspiration, they are not as protective as endotracheal tubes. Complications associated with LMA use include laryngospasm, nausea and vomiting, and a low risk of aspiration. LMAs have advantages over bag-mask ventilation, such as more effective ventilation, less gastric inflation, and a lower risk of aspiration. However, they also have disadvantages, including the risk of hypoventilation due to air leak around the cuff, greater gastric inflation compared to endotracheal intubation, and a very low risk of aspiration.

      Further Reading:

      Techniques to keep the airway open:

      1. Suction: Used to remove obstructing material such as blood, vomit, secretions, and food debris from the oral cavity.

      2. Chin lift manoeuvres: Involves lifting the head off the floor and lifting the chin to extend the head in relation to the neck. Improves alignment of the pharyngeal, laryngeal, and oral axes.

      3. Jaw thrust: Used in trauma patients with cervical spine injury concerns. Fingers are placed under the mandible and gently pushed upward.

      Airway adjuncts:

      1. Oropharyngeal airway (OPA): Prevents the tongue from occluding the airway. Sized according to the patient by measuring from the incisor teeth to the angle of the mandible. Inserted with the tip facing backwards and rotated 180 degrees once it touches the back of the palate or oropharynx.

      2. Nasopharyngeal airway (NPA): Useful when it is difficult to open the mouth or in semi-conscious patients. Sized by length (distance between nostril and tragus of the ear) and diameter (roughly that of the patient’s little finger). Contraindicated in basal skull and midface fractures.

      Laryngeal mask airway (LMA):

      – Supraglottic airway device used as a first line or rescue airway.
      – Easy to insert, sized according to patient’s bodyweight.
      – Advantages: Easy insertion, effective ventilation, some protection from aspiration.
      – Disadvantages: Risk of hypoventilation, greater gastric inflation than endotracheal tube (ETT), risk of aspiration and laryngospasm.

      Note: Proper training and assessment of the patient’s condition are essential for airway management.

    • This question is part of the following fields:

      • Basic Anaesthetics
      6.1
      Seconds
  • Question 4 - A 45-year-old woman presents with painless haematuria and undergoes a flexible cystoscopy. A...

    Correct

    • A 45-year-old woman presents with painless haematuria and undergoes a flexible cystoscopy. A diagnosis of bladder cancer is made following the investigation.

      Which of the following is the most significant risk factor for developing bladder cancer in the United Kingdom?

      Your Answer: Smoking

      Explanation:

      Bladder cancer ranks as the seventh most prevalent form of cancer in the United Kingdom, with men outnumbering women by a ratio of 3 to 1. The primary factors that increase the risk of bladder cancer are advancing age and smoking. It is estimated that around 50% of bladder cancer cases are caused by smoking, which is believed to be influenced by the presence of aromatic amines and polycyclic aromatic hydrocarbons that are eliminated through the kidneys. Smokers face a 2 to 6 times higher risk of developing bladder cancer compared to non-smokers.

      Additional risk factors for bladder cancer include occupational exposure to aromatic amines found in dyes, paints, solvents, leather dust, combustion products, rubber, and textiles. Radiation therapy to the pelvic region is also considered a risk factor.

      In developing nations, particularly in the Middle East, schistosomiasis is responsible for approximately 80% of bladder cancer cases.

    • This question is part of the following fields:

      • Urology
      15
      Seconds
  • Question 5 - You evaluate the pupillary light reflex in a patient with a cranial nerve...

    Correct

    • You evaluate the pupillary light reflex in a patient with a cranial nerve impairment. Upon shining the light into the left eye, there is no alteration in pupil size in either the left or right eye. However, when the light is directed into the right eye, both the left and right pupils constrict.

      What is the location of the lesion in this scenario?

      Your Answer: Left optic nerve

      Explanation:

      The pupillary light reflex is a reflex that regulates the size of the pupil in response to the intensity of light that reaches the retina. It consists of two separate pathways, the afferent pathway and the efferent pathway.

      The afferent pathway begins with light entering the pupil and stimulating the retinal ganglion cells in the retina. These cells then transmit the light signal to the optic nerve. At the optic chiasm, the nasal retinal fibers cross to the opposite optic tract, while the temporal retinal fibers remain in the same optic tract. The fibers from the optic tracts then project and synapse in the pretectal nuclei in the dorsal midbrain. From there, the pretectal nuclei send fibers to the ipsilateral Edinger-Westphal nucleus via the posterior commissure.

      On the other hand, the efferent pathway starts with the Edinger-Westphal nucleus projecting preganglionic parasympathetic fibers. These fibers exit the midbrain and travel along the oculomotor nerve. They then synapse on post-ganglionic parasympathetic fibers in the ciliary ganglion. The post-ganglionic fibers, known as the short ciliary nerves, innervate the sphincter muscle of the pupils, causing them to constrict.

      The result of these pathways is that when light is shone in one eye, both the direct pupillary light reflex (ipsilateral eye) and the consensual pupillary light reflex (contralateral eye) occur.

      Lesions affecting the pupillary light reflex can be identified by comparing the direct and consensual reactions to light in both eyes. If the optic nerve of the first eye is damaged, both the direct and consensual reflexes in the second eye will be lost. However, when light is shone into the second eye, the pupil of the first eye will still constrict. If the optic nerve of the second eye is damaged, the second eye will constrict consensually when light is shone into the unaffected first eye. If the oculomotor nerve of the first eye is damaged, the first eye will have no direct light reflex, but the second eye will still constrict consensually. Finally, if the oculomotor nerve of the second eye is damaged, there will be no consensual constriction of the second eye when light is shone into the unaffected first eye.

    • This question is part of the following fields:

      • Ophthalmology
      21.4
      Seconds
  • Question 6 - A 65-year-old woman comes in with a history of frequent falls, difficulty with...

    Incorrect

    • A 65-year-old woman comes in with a history of frequent falls, difficulty with walking, and urinary incontinence. After a thorough evaluation and tests, she is diagnosed with normal-pressure hydrocephalus.
      Which of the following medical interventions is most likely to be beneficial?

      Your Answer: Mannitol

      Correct Answer: Acetazolamide

      Explanation:

      This patient is displaying symptoms that are characteristic of normal-pressure hydrocephalus (NPH). NPH is a type of communicating hydrocephalus where the pressure inside the skull, as measured through lumbar puncture, is either normal or occasionally elevated. It primarily affects elderly individuals, and the likelihood of developing NPH increases with age.

      Around 50% of NPH cases are idiopathic, meaning that no clear cause can be identified. The remaining cases are secondary to various conditions such as head injury, meningitis, subarachnoid hemorrhage, central nervous system tumors, and radiotherapy.

      The typical presentation of NPH includes a classic triad of symptoms: gait disturbance (often characterized by a broad-based and shuffling gait), sphincter disturbance leading to incontinence (usually urinary incontinence), and progressive dementia with memory loss, inattention, inertia, and bradyphrenia.

      Diagnosing NPH primarily relies on identifying the classic clinical triad mentioned above. Additional investigations can provide supportive evidence and may involve CT and MRI scans, which reveal enlarged ventricles and periventricular lucency. Lumbar puncture can also be performed to assess cerebrospinal fluid (CSF) levels, which are typically normal or intermittently elevated. Intraventricular monitoring may show beta waves present for more than 5% of a 24-hour period.

      NPH is one of the few reversible causes of dementia, making early recognition and treatment crucial. Medical treatment options include the use of carbonic anhydrase inhibitors (such as acetazolamide) and repeated lumbar punctures as temporary measures. However, the definitive treatment for NPH involves surgically inserting a cerebrospinal fluid (CSF) shunt. This procedure provides lasting clinical benefits for 70% to 90% of patients compared to their pre-operative state.

    • This question is part of the following fields:

      • Elderly Care / Frailty
      23.1
      Seconds
  • Question 7 - A 3-year-old child is brought in by his father complaining of itchy skin...

    Incorrect

    • A 3-year-old child is brought in by his father complaining of itchy skin on his arms. He has a history of allergies, and over the past few days, both of his arms have become covered in small red bumps. His father also reports that he has had a low-grade fever of 37.8°C. During the examination, you observe significant swelling of the lymph nodes in his neck. While speaking with his father, you notice a scabbing sore on the right side of his mouth.

      What is the SINGLE most likely diagnosis?

      Your Answer: Dermatitis herpetiformis

      Correct Answer: Eczema herpeticum

      Explanation:

      Eczema herpeticum occurs when an individual with atopic eczema comes into contact with the herpes simplex virus. While some patients may only experience typical cold sores, others may develop a more extensive infection. This condition is often accompanied by systemic disturbance and can be quite painful. Administering antiviral treatment can help reduce the duration of the illness. In cases where the rash is widespread or there are concerns about eye complications, hospital admission may be necessary for intravenous antiviral therapy.

    • This question is part of the following fields:

      • Dermatology
      93.6
      Seconds
  • Question 8 - A 40-year-old man is prescribed a medication for a neurological condition in the...

    Incorrect

    • A 40-year-old man is prescribed a medication for a neurological condition in the 2nd-trimester of his wife's pregnancy. The baby is born with restlessness, muscle contractions, shaking, and exhibits unsteady, abrupt movements.

      Which of the following medications is the most probable reason for these abnormalities?

      Your Answer: Lithium

      Correct Answer: Haloperidol

      Explanation:

      Haloperidol, when administered during the third trimester of pregnancy, can lead to extrapyramidal symptoms in the newborn. These symptoms may include agitation, poor feeding, excessive sleepiness, and difficulty breathing. The severity of these side effects can vary, with some infants requiring intensive care and extended hospital stays. It is important to closely monitor exposed neonates for signs of extrapyramidal syndrome or withdrawal. Haloperidol should only be used during pregnancy if the benefits clearly outweigh the risks to the fetus.

      Below is a list outlining commonly encountered drugs that have adverse effects during pregnancy:

      ACE inhibitors (e.g. ramipril): If given during the second and third trimesters, these drugs can cause hypoperfusion, renal failure, and the oligohydramnios sequence.

      Aminoglycosides (e.g. gentamicin): These drugs can cause ototoxicity and deafness in the fetus.

      Aspirin: High doses of aspirin can lead to first-trimester abortions, delayed onset of labor, premature closure of the fetal ductus arteriosus, and fetal kernicterus. However, low doses (e.g. 75 mg) do not pose significant risks.

      Benzodiazepines (e.g. diazepam): When administered late in pregnancy, these drugs can cause respiratory depression and a neonatal withdrawal syndrome.

      Calcium-channel blockers: If given during the first trimester, these drugs can cause phalangeal abnormalities. If given during the second and third trimesters, they can result in fetal growth retardation.

      Carbamazepine: This drug can lead to hemorrhagic disease of the newborn and neural tube defects.

      Chloramphenicol: Administration of chloramphenicol can cause gray baby syndrome in newborns.

      Corticosteroids: If given during the first trimester, corticosteroids may cause orofacial clefts in the fetus.

      Danazol: When administered during the first trimester, danazol can cause masculinization of the female fetuses genitals.

      Finasteride: Pregnant women should avoid handling finasteride as crushed or broken tablets can be absorbed through the skin and affect male sex organ development.

      Haloperidol: If given during the first trimester, haloperidol may cause limb malformations. If given during the third trimester, there is an increased risk of extrapyramidal symptoms in the neonate.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      31.4
      Seconds
  • Question 9 - A 32 year old male is brought into the emergency department following a...

    Correct

    • A 32 year old male is brought into the emergency department following a car accident. You evaluate the patient's risk of cervical spine injury using the Canadian C-spine rule. What is included in the assessment for the Canadian C-spine rule?

      Your Answer: Ask patient to rotate their neck 45 degrees to the left and right

      Explanation:

      The Canadian C-spine assessment includes evaluating for tenderness along the midline of the spine, checking for any abnormal sensations in the limbs, and assessing the ability to rotate the neck 45 degrees to the left and right. While a significant portion of the assessment relies on gathering information from the patient’s history, there are also physical examination components involved. These include testing for tenderness along the midline of the cervical spine, asking the patient to perform neck rotations, ensuring they are comfortable in a sitting position, and assessing for any sensory deficits in the limbs. It is important to note that any reported paraesthesia in the upper or lower limbs can also be taken into consideration during the assessment.

      Further Reading:

      When assessing for cervical spine injury, it is recommended to use the Canadian C-spine rules. These rules help determine the risk level for a potential injury. High-risk factors include being over the age of 65, experiencing a dangerous mechanism of injury (such as a fall from a height or a high-speed motor vehicle collision), or having paraesthesia in the upper or lower limbs. Low-risk factors include being involved in a minor rear-end motor vehicle collision, being comfortable in a sitting position, being ambulatory since the injury, having no midline cervical spine tenderness, or experiencing a delayed onset of neck pain. If a person is unable to actively rotate their neck 45 degrees to the left and right, their risk level is considered low. If they have one of the low-risk factors and can actively rotate their neck, their risk level remains low.

      If a high-risk factor is identified or if a low-risk factor is identified and the person is unable to actively rotate their neck, full in-line spinal immobilization should be maintained and imaging should be requested. Additionally, if a patient has risk factors for thoracic or lumbar spine injury, imaging should be requested. However, if a patient has low-risk factors for cervical spine injury, is pain-free, and can actively rotate their neck, full in-line spinal immobilization and imaging are not necessary.

      NICE recommends CT as the primary imaging modality for cervical spine injury in adults aged 16 and older, while MRI is recommended as the primary imaging modality for children under 16.

      Different mechanisms of spinal trauma can cause injury to the spine in predictable ways. The majority of cervical spine injuries are caused by flexion combined with rotation. Hyperflexion can result in compression of the anterior aspects of the vertebral bodies, stretching and tearing of the posterior ligament complex, chance fractures (also known as seatbelt fractures), flexion teardrop fractures, and odontoid peg fractures. Flexion and rotation can lead to disruption of the posterior ligament complex and posterior column, fractures of facet joints, lamina, transverse processes, and vertebral bodies, and avulsion of spinous processes. Hyperextension can cause injury to the anterior column, anterior fractures of the vertebral body, and potential retropulsion of bony fragments or discs into the spinal canal. Rotation can result in injury to the posterior ligament complex and facet joint dislocation.

    • This question is part of the following fields:

      • Trauma
      12
      Seconds
  • Question 10 - A 40-year-old man presents very unwell with an acute exacerbation of his asthma.
    Which...

    Correct

    • A 40-year-old man presents very unwell with an acute exacerbation of his asthma.
      Which of the following drug doses used in the treatment of acute adult asthma is incorrect?

      Your Answer: Terbutaline 5mg via oxygen-driven nebuliser

      Explanation:

      The recommended drug doses for adult acute asthma are as follows:

      – Salbutamol: Administer 5 mg using an oxygen-driven nebulizer.
      – Ipratropium bromide: Deliver 500 mcg via an oxygen-driven nebulizer.
      – Prednisolone: Take orally at a dose of 40-50 mg.
      – Hydrocortisone: Administer 100 mg intravenously.
      – Magnesium sulphate: Infuse 1.2-2 g intravenously over a period of 20 minutes.

      Terbutaline can be used as an alternative to salbutamol, with a dose of 10 mg via an oxygen-driven nebulizer. Intravenous salbutamol may be considered (250 mcg IV slowly) only when inhaled therapy is not possible, such as when a patient is receiving bag-mask ventilation.

      According to the current ALS guidelines, IV aminophylline may be considered in severe or life-threatening asthma, following senior advice. If used, a loading dose of 5 mg/kg should be given over 20 minutes, followed by an infusion of 500-700 mcg/kg/hour. It is important to maintain serum theophylline levels below 20 mcg/ml to prevent toxicity.

      For more information, please refer to the BTS/SIGN Guideline on the Management of Asthma.

    • This question is part of the following fields:

      • Respiratory
      18
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Ophthalmology (2/3) 67%
Basic Anaesthetics (1/1) 100%
Urology (1/1) 100%
Elderly Care / Frailty (0/1) 0%
Dermatology (0/1) 0%
Pharmacology & Poisoning (0/1) 0%
Trauma (1/1) 100%
Respiratory (1/1) 100%
Passmed