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  • Question 1 - A 3-year-old girl is brought to the paediatric emergency department by her father....

    Correct

    • A 3-year-old girl is brought to the paediatric emergency department by her father. She has been very fussy for the past 6 hours, crying out every 20 minutes, and her father suspects she is in pain. She has vomited twice during this time, and her father noticed a red jelly-like substance in her diaper 2 hours ago. The little girl is very uncooperative during examination and refuses to let anyone touch her abdomen. Her vital signs show a mild tachycardia, but no fever is present. What is the most appropriate diagnostic test to determine the cause of her symptoms?

      Your Answer: Abdominal ultrasound

      Explanation:

      Intussusception is best diagnosed through ultrasound. Given the boy’s symptoms, an urgent abdominal ultrasound is necessary to rule out this condition. While a complete blood count may provide some general information, it is not specific to any particular diagnosis. An abdominal X-ray can confirm the presence of intestinal obstruction, but it cannot identify the underlying cause, which is crucial in this case. CT scans should generally be avoided in young children due to the high levels of radiation they emit.

      Understanding Intussusception

      Intussusception is a medical condition that occurs when one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileo-caecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. The symptoms of intussusception include severe, crampy abdominal pain that comes and goes, inconsolable crying, vomiting, and blood stained stool, which is a late sign. During a paroxysm, the infant will typically draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.

      To diagnose intussusception, ultrasound is now the preferred method of investigation, as it can show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used as a first-line treatment instead of the traditional barium enema. If this method fails, or the child shows signs of peritonitis, surgery is performed.

      In summary, intussusception is a medical condition that affects infants and involves the folding of one part of the bowel into the lumen of the adjacent bowel. It is characterized by severe abdominal pain, vomiting, and blood stained stool, among other symptoms. Ultrasound is the preferred method of diagnosis, and treatment involves reducing the bowel by air insufflation or surgery if necessary.

    • This question is part of the following fields:

      • Paediatrics
      56.1
      Seconds
  • Question 2 - A 47-year-old woman visits her doctor with a complaint of experiencing cold hands...

    Incorrect

    • A 47-year-old woman visits her doctor with a complaint of experiencing cold hands and feet over the last two weeks. Her medications have been recently altered, with a new medication introduced to improve her blood pressure management. Which of the following medications is the probable cause of her symptoms?

      Your Answer: Losartan

      Correct Answer: Bisoprolol

      Explanation:

      Beta-blockers are frequently prescribed for hypertension treatment, but they can lead to cold extremities as a side effect. Thiazide diuretics like bendroflumethiazide commonly cause constipation, diarrhea, dizziness, and dry mouth. Angiotensin receptor blockers such as candesartan and losartan do not typically result in cold peripheries.

      Beta-blockers are a class of drugs that are primarily used to manage cardiovascular disorders. They have a wide range of indications, including angina, post-myocardial infarction, heart failure, arrhythmias, hypertension, thyrotoxicosis, migraine prophylaxis, and anxiety. Beta-blockers were previously avoided in heart failure, but recent evidence suggests that certain beta-blockers can improve both symptoms and mortality. They have also replaced digoxin as the rate-control drug of choice in atrial fibrillation. However, their role in reducing stroke and myocardial infarction has diminished in recent years due to a lack of evidence. Examples of beta-blockers include atenolol and propranolol, which was one of the first beta-blockers to be developed and is lipid soluble, allowing it to cross the blood-brain barrier.

      Like all drugs, beta-blockers have side-effects, including bronchospasm, cold peripheries, fatigue, sleep disturbances (including nightmares), and erectile dysfunction. They are contraindicated in uncontrolled heart failure, asthma, sick sinus syndrome, and concurrent use with verapamil, which may precipitate severe bradycardia.

    • This question is part of the following fields:

      • Medicine
      15.7
      Seconds
  • Question 3 - A 50-year-old woman visits the Menopause Clinic with complaints of severe vasomotor symptoms...

    Correct

    • A 50-year-old woman visits the Menopause Clinic with complaints of severe vasomotor symptoms such as hot flashes and night sweats. Despite experiencing light periods, she is worried about undergoing hormone replacement therapy (HRT) due to a past deep vein thrombosis (DVT) during pregnancy 18 years ago. Although she has not required any long-term treatment since then, she is anxious about the increased risk of clotting associated with HRT. without other risk factors, what is the most suitable form of HRT for her?

      Your Answer: Transdermal combined HRT patches

      Explanation:

      Hormone Replacement Therapy (HRT) Options for Women with a History of DVT

      Women with a history of deep vein thrombosis (DVT) need to be cautious when considering Hormone Replacement Therapy (HRT) options. Here are some options:

      1. Transdermal Combined HRT Patches: This option is the best as it bypasses the enterohepatic circulation, reducing the effect on the hepatic clotting system.

      2. Oral Continuous Combined HRT: This option is only suitable for postmenopausal women who have not had a period for over a year.

      3. Oral Sequential Combined HRT: This option is suitable for perimenopausal women who are still having periods. However, oral preparations increase the risk of clots, compared to transdermal preparations.

      4. Raloxifene: This is a selective oestrogen receptor modulator (SERM) that reduces osteoporosis in postmenopausal women. It has effects on lipids and bone but does not stimulate the endometrium or breast.

      5. Tibolone: This synthetic steroid has oestrogenic, progestational, and androgenic properties. It is only suitable for postmenopausal women who had their last period more than a year ago.

      In conclusion, women with a history of DVT should consult their healthcare provider before starting any HRT option. Transdermal combined HRT patches may be the safest option for these women.

    • This question is part of the following fields:

      • Gynaecology
      13.8
      Seconds
  • Question 4 - A 57-year-old woman presents with a 6-month history of deteriorating eyesight. She reports...

    Incorrect

    • A 57-year-old woman presents with a 6-month history of deteriorating eyesight. She reports difficulty distinguishing between colors, central vision impairment, 'floaters', and tension-like headaches. Upon examination, her visual acuity is 20/50 in the right eye and 20/70 in the left eye. Ophthalmoscopy reveals a red spot on the macula surrounded by a ring of retinal epithelial pigment loss resembling a 'bull's eye'. The patient has poorly controlled type 2 diabetes mellitus and rheumatoid arthritis, and is obese. She is currently taking metformin, methotrexate, and hydroxychloroquine. What is the most probable cause of her visual disturbance?

      Your Answer: Diabetic retinopathy

      Correct Answer: Hydroxychloroquine

      Explanation:

      Hydroxychloroquine can cause severe and permanent retinopathy, which is characterized by reduced color differentiation, reduced central visual acuity, and floaters. The typical appearance of bull’s eye maculopathy on ophthalmoscopy is also associated with hydroxychloroquine use. Therefore, hydroxychloroquine is the correct answer in this case.

      Diabetic retinopathy is an unlikely diagnosis as it is usually detected early through the diabetic eye screening program. It presents with similar symptoms to drug-induced retinopathy, such as floaters and blurred vision, and can cause reduced central vision if the macula is affected. However, the bull’s eye maculopathy described in this case is not typical of diabetic maculopathy.

      Central retinal artery occlusion is caused by a disruption of retinal blood supply and typically results in sudden vision loss. On ophthalmoscopy, a cherry-red fovea with retinal whitening is usually observed. Bilateral involvement is uncommon.

      Idiopathic intracranial hypertension (IIH) is also an unlikely diagnosis as it typically presents with headaches, vomiting, retro-orbital pain, pulsatile tinnitus, and visual disturbance, most commonly peripheral visual fields. Papilloedema is usually observed on ophthalmoscopy, which is not described in this case.

      Hydroxychloroquine: Uses and Adverse Effects

      Hydroxychloroquine is a medication commonly used in the treatment of rheumatoid arthritis and systemic/discoid lupus erythematosus. It is similar to chloroquine, which is used to treat certain types of malaria. However, hydroxychloroquine has been found to cause bull’s eye retinopathy, which can result in severe and permanent visual loss. Recent data suggests that this adverse effect is more common than previously thought, and the most recent guidelines recommend baseline ophthalmological examination and annual screening, including colour retinal photography and spectral domain optical coherence tomography scanning of the macula. Despite this risk, hydroxychloroquine may still be used in pregnant women if needed. Patients taking this medication should be asked about visual symptoms and have their visual acuity monitored annually using a standard reading chart.

    • This question is part of the following fields:

      • Musculoskeletal
      20.1
      Seconds
  • Question 5 - You are requested to assess a 76-year-old female patient who has been admitted...

    Correct

    • You are requested to assess a 76-year-old female patient who has been admitted with severe diarrhea. She had recently undergone a course of ciprofloxacin for a urinary tract infection and reports that the diarrhea started a few days after starting the antibiotics. Upon examination, she appears severely dehydrated and has a BP of 130/80 mmHg, with a 30 mmHg postural drop and an elevated pulse rate. You suspect that she may be suffering from Clostridium difficile infection. What measures can be taken to reduce its spread?

      Your Answer: Patients should be barrier nursed, and staff should use infectious precautions

      Explanation:

      The SIGHT Protocol for Dealing with Clostridium Difficile Infection

      The SIGHT protocol provides guidelines for proper barrier nursing, use of protective gear, and effective hand washing when dealing with patients suspected of having Clostridium difficile infection. Patients with suspected C. difficile should be isolated, and if the infection is confirmed, they should remain isolated until they are free of diarrhea for at least 48 hours. It is important to note that alcohol hand rub should never be used as a substitute for thorough hand washing. Additionally, it is crucial to list Clostridium difficile as the cause of death on the death certificate for monitoring purposes.

    • This question is part of the following fields:

      • Clinical Sciences
      24.5
      Seconds
  • Question 6 - What is the most frequent primary cancer that leads to bone metastases? ...

    Correct

    • What is the most frequent primary cancer that leads to bone metastases?

      Your Answer: Breast

      Explanation:

      Bone Metastases: Common Tumours, Symptoms, and Diagnosis

      Bone metastases are a common occurrence in patients with malignant disease, affecting approximately 30% of cases. The most frequent tumours that cause bone metastases are breast, prostate, bronchus, kidney, and thyroid, with breast and prostate cancers accounting for the majority. Symptoms of bone metastases typically include bone pain, the presence of a lump, pathological fractures, hypercalcaemia, or cord compression. Pathological fractures occur in about 10% of patients with bone metastases. Radiological changes usually occur late, and bone scintigraphy is the most sensitive diagnostic tool available to detect metastatic spread. Most metastases are osteolytic, but some tumours, such as prostate carcinoma, cause osteosclerotic lesions.

    • This question is part of the following fields:

      • Oncology
      2.8
      Seconds
  • Question 7 - What are the typical changes in the haematogenous system during infancy? ...

    Incorrect

    • What are the typical changes in the haematogenous system during infancy?

      Your Answer: Production of HbF increases up to 12 months

      Correct Answer: Extramedullary haematopoiesis stops

      Explanation:

      Haematopoiesis and Immunological Development in Infancy

      At birth, the liver is responsible for producing blood cells, but this process stops within the first year of life. Haematopoiesis, or the production of blood cells, can also occur outside of the bone marrow, known as Extramedullary haematopoiesis. During fetal development, the liver and spleen are responsible for haematopoiesis while the bone marrow develops. However, once the infant is born, the bone marrow takes over the production of blood cells, and haematopoiesis in the liver and spleen ceases. In some cases, such as beta-thalassaemia major, Extramedullary haematopoiesis can continue and expand to other areas of the body.

      Immunoglobulin production begins after six months, with maternal IgG providing most of the antibody coverage for the first three months of life. This means that infants are most vulnerable to encapsulated bacterial infections between three and nine months of age. Lymphatic tissue mass remains relatively unchanged during infancy but increases during early childhood, which may account for the increase in viral infections experienced by children. Neutrophil production does not increase unless there is a bacterial infection present, and the total white cell count decreases during infancy. Additionally, the production of fetal haemoglobin, or HbF, decreases steadily during the first year of life as it is replaced by HbA.

    • This question is part of the following fields:

      • Clinical Sciences
      14.8
      Seconds
  • Question 8 - A 47-year-old woman visits the renal clinic after six weeks of a triumphant...

    Correct

    • A 47-year-old woman visits the renal clinic after six weeks of a triumphant renal transplant. She has some inquiries about her immunosuppression for the consultant. The doctor clarifies that the typical regimen for renal transplant patients involves the initial utilization of an induction agent, followed by a combination of a calcineurin inhibitor, antimetabolite, and steroids. This combination is intended to prevent rejection of the transplanted kidney. What is the name of the anti-lymphocyte monoclonal antibody used as an induction agent?

      Your Answer: Alemtuzumab

      Explanation:

      Immunosuppressive Drugs and Their Mechanisms of Action

      Alemtuzumab is a monoclonal antibody that targets CD52 and depletes mature lymphocytes, but not stem cells. It has been found to be more effective than traditional therapy in preparing patients for renal transplantation.

      Tacrolimus is a calcineurin inhibitor that reduces the activation of NFAT, a transcription factor that promotes the production of IL-2, the primary cytokine that drives T cell proliferation.

      Both azathioprine and mycophenolate mofetil are antimetabolites that disrupt DNA synthesis. Mycophenolate indirectly inhibits inosine monophosphate dehydrogenase, which prevents purine synthesis. Azathioprine is a pro-drug that is metabolized into 6-mercaptopurine, which is inserted into the DNA sequence instead of a purine, triggering apoptosis.

      Sirolimus is an mTOR inhibitor that acts downstream of IL-2 signaling to promote T cell proliferation and survival.

    • This question is part of the following fields:

      • Nephrology
      19.1
      Seconds
  • Question 9 - A 35-year-old man presents to the Emergency Department with sudden-onset, severe chest pain,...

    Correct

    • A 35-year-old man presents to the Emergency Department with sudden-onset, severe chest pain, radiating to the intrascapular area, which he describes as a tearing-type pain.
      The patient is usually well, with the only other medical history of note being a diagnosis of Ehlers–Danlos syndrome. He is a non-smoker and rarely drinks.
      On examination, the patient appears to be in a significant amount of pain. He is apyrexial, with oxygen saturation of 98% on room air. Of note, the patient has a blood pressure of 175/100 mmHg in the right arm and 150/80 mmHg in the left. An early diastolic murmur is also heard in the aortic area.
      What is the most likely diagnosis?

      Your Answer: Aortic dissection

      Explanation:

      Differential Diagnosis: Aortic Dissection

      Aortic dissection is a medical emergency that occurs when there is a tear in the aortic intima, creating a false lumen between the intima and media. This condition is more likely to occur in men, older individuals, and those with hypertension or connective tissue disorders such as Marfan and Ehlers-Danlos syndromes.

      The classic presentation of aortic dissection includes abrupt chest pain that is often described as a shearing or tearing-type pain that may radiate to the back. Other symptoms may include differences in blood pressure between the right and left arm, aortic regurgitation, and signs of malperfusion.

      While a chest X-ray may show widening of the mediastinal shadow, imaging such as computed tomography (CT) or transoesophageal echocardiography is necessary to confirm the diagnosis. Treatment involves stabilizing the patient’s heart rate and blood pressure to prevent further damage, followed by surgical repair.

      Although myocardial infarction is a differential diagnosis, the classical history of presentation, age, and connective tissue disorder diagnosis make aortic dissection more likely in this scenario. Other differentials, such as ruptured abdominal aortic aneurysm, acute pancreatitis, and pulmonary embolism, can be ruled out based on the patient’s symptoms and examination findings.

      In conclusion, aortic dissection should be considered in any patient presenting with sudden-onset chest pain, especially those with risk factors for the condition. Early diagnosis and treatment are crucial in improving patient outcomes.

    • This question is part of the following fields:

      • Cardiothoracic
      15.9
      Seconds
  • Question 10 - A 30-year-old woman comes to the clinic with asymmetrical pupils. Upon shining light...

    Incorrect

    • A 30-year-old woman comes to the clinic with asymmetrical pupils. Upon shining light into her eyes, the right pupil is 3 mm larger than the left. In a darkened room, the right pupil remains larger, but by only 1mm. Both pupils are regular in shape. She reports no discomfort, her sclerae appear normal, and a slit-lamp examination reveals no abnormalities. Her eye movements are also unaffected. The patient's father died from a brain tumor, and she is concerned that she may have the same condition. What is the most probable underlying cause?

      Your Answer: Argyll-Robertson pupil

      Correct Answer: Adie's tonic pupil

      Explanation:

      The likely diagnosis for this patient’s anisocoria, which is worse in bright light, is Adie’s tonic pupil. This is because the pupil is unable to constrict properly, indicating dysfunction in the parasympathetic innervation. Adie’s tonic pupil is characterised by impaired pupil constriction due to ciliary ganglion dysfunction. Argyll-Robertson pupil, Horner syndrome, and oculomotor nerve palsy are not the correct diagnoses as they present with different symptoms and causes.

      Mydriasis, which is the enlargement of the pupil, can be caused by various factors. These include third nerve palsy, Holmes-Adie pupil, traumatic iridoplegia, pheochromocytoma, and congenital conditions. Additionally, certain drugs can also cause mydriasis, such as topical mydriatics like tropicamide and atropine, sympathomimetic drugs like amphetamines and cocaine, and anticholinergic drugs like tricyclic antidepressants. It’s important to note that anisocoria, which is when one pupil is larger than the other, can also result in the appearance of mydriasis.

    • This question is part of the following fields:

      • Ophthalmology
      25.5
      Seconds
  • Question 11 - A 25-year-old professional who is working long hours develops intermittent periods of abdominal...

    Incorrect

    • A 25-year-old professional who is working long hours develops intermittent periods of abdominal pain and bloating. She also notices a change in bowel habit and finds that going to the restroom helps to relieve her abdominal pain.
      Which of the following drug treatments may help in the treatment of her colic and bloating symptoms?

      Your Answer: Fybogel

      Correct Answer: Mebeverine

      Explanation:

      Treatment Options for Irritable Bowel Syndrome (IBS)

      Irritable bowel syndrome (IBS) is a common functional bowel disorder that affects mostly young adults, with women being more commonly affected than men. The diagnosis of IBS can be established using the Rome IV criteria, which includes recurrent abdominal pain or discomfort for at least one day per week in the last three months, along with two or more of the following: improvement with defecation, onset associated with a change in frequency of stool, or onset associated with a change in form (appearance) of the stool.

      There are several treatment options available for IBS, depending on the predominant symptoms. Mebeverine, an antispasmodic, can be used to relieve colicky abdominal pain. Loperamide can be useful for patients with diarrhea-predominant IBS (IBS-D), while osmotic laxatives such as macrogols are preferred for constipation-predominant IBS (IBS-C). Cimetidine, a histamine H2 receptor antagonist, can help with acid reflux symptoms, but is unlikely to help with colic or bloating. Metoclopramide, a D2 dopamine receptor antagonist, is used as an antiemetic and prokinetic, but is not effective for colic and bloating symptoms.

      In summary, treatment options for IBS depend on the predominant symptoms and can include antispasmodics, laxatives, and acid reflux medications. It is important to consult with a healthcare provider to determine the best course of treatment for each individual patient.

    • This question is part of the following fields:

      • Gastroenterology
      13.6
      Seconds
  • Question 12 - 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
      60.1
      Seconds
  • Question 13 - A 55-year-old woman is scheduled for a routine blood pressure check. As she...

    Correct

    • A 55-year-old woman is scheduled for a routine blood pressure check. As she waits in the reception area, she suddenly experiences severe breathlessness with stridor. She had mentioned to someone else in the room that she was stung by an insect on her way to the clinic. Based on your assessment, you determine that she is having an anaphylactic reaction to the sting. What would be the appropriate dose and route of administration for adrenaline in this scenario?

      Your Answer: Intramuscular 1:1000 (500 micrograms)

      Explanation:

      Recommended Injection Route for Anaphylactic Reactions

      Anaphylactic reactions require immediate treatment, and one of the most effective ways to administer medication is through injection. The recommended route of injection is intramuscular, which involves injecting the medication into the muscle tissue. While the subcutaneous route can also be used, it is not as effective as the intramuscular route. In some cases, intravenous adrenaline 1:10000 may be used, but only under the supervision of a specialist. It is important to follow the guidelines provided by the Resuscitation Council (UK) for the emergency treatment of anaphylactic reactions. By administering medication through the recommended injection route, healthcare providers can effectively manage anaphylactic reactions and potentially save lives.

    • This question is part of the following fields:

      • Emergency Medicine
      14.9
      Seconds
  • Question 14 - You are called to the Emergency Department to help treat an intoxicated teenager...

    Incorrect

    • You are called to the Emergency Department to help treat an intoxicated teenager who has sustained a laceration on his cheek. It is decided that suturing is necessary.
      What diameter of suture material would be most suited to this task?

      Your Answer: 3/0

      Correct Answer: 5/0

      Explanation:

      Suture Sizes for Different Body Parts

      When it comes to suturing wounds, choosing the right size of suture is crucial for proper healing and minimizing scarring. Here are some common suture sizes and the body parts they are typically used on:

      – 5/0: This is the usual choice for suturing lesions on the face.
      – 6/0: This size is reserved for lesions around the eyes.
      – 4/0: Used for suturing wounds on the neck, hand, or fingers.
      – 3/0: Typically used for wounds on the lower limbs.
      – 2/0: Used for larger wounds on the lower limbs.

      By selecting the appropriate suture size for each body part, healthcare professionals can help ensure optimal healing and cosmetic outcomes for their patients.

    • This question is part of the following fields:

      • Plastics
      10.3
      Seconds
  • Question 15 - A 32-year-old office worker presents to the Emergency Department after taking a handful...

    Correct

    • A 32-year-old office worker presents to the Emergency Department after taking a handful of various tablets following an argument with her current partner. She has a history of tumultuous relationships and struggles to maintain friendships or romantic relationships due to this. She also admits to experiencing intense emotions, frequently oscillating between extreme happiness and anger or anxiety. In the past, she has engaged in self-harm and frequently drinks to excess. A psychiatry review is requested to evaluate the possibility of a personality disorder. What personality disorder is the most probable diagnosis for this patient?

      Your Answer: Borderline personality disorder

      Explanation:

      Understanding Personality Disorders: Borderline Personality Disorder and Other Types

      Personality disorders are complex and severe disturbances in an individual’s character and behavior, causing significant personal and social disruption. These disorders are challenging to treat, but psychological and pharmacological interventions can help manage symptoms. One of the most common types of personality disorder is borderline personality disorder, characterized by intense emotions, unstable relationships, impulsive behavior, self-harm, and abandonment anxieties. Other types of personality disorders include schizoid personality disorder, avoidant personality disorder, dependent personality disorder, and narcissistic personality disorder. Understanding these disorders can help individuals seek appropriate treatment and support.

    • This question is part of the following fields:

      • Psychiatry
      19.8
      Seconds
  • Question 16 - What is not a characteristic of Prader-Willi syndrome? ...

    Incorrect

    • What is not a characteristic of Prader-Willi syndrome?

      Your Answer: Learning difficulties

      Correct Answer: Abnormality of maternally inherited chromosome 15q

      Explanation:

      Prader-Willi Syndrome

      Prader-Willi Syndrome is a genetic disorder that is associated with a deletion on the paternal 15q in 70% of cases. It is characterized by neonatal hypotonia and poor feeding, moderate mental handicap, small genitalia, hyperphagia, and obesity in later childhood.

      Individuals with Prader-Willi Syndrome often have difficulty controlling their appetite, which can lead to obesity and related health problems. They may also have developmental delays and intellectual disabilities. The condition is caused by a missing piece of genetic material on chromosome 15 that is inherited from the father.

      Early diagnosis and intervention can help manage the symptoms of Prader-Willi Syndrome and improve quality of life for affected individuals and their families. Treatment may include growth hormone therapy, behavioral therapy, and nutritional counseling. It is important for individuals with Prader-Willi Syndrome to receive ongoing medical care and support throughout their lives.

    • This question is part of the following fields:

      • Clinical Sciences
      5.5
      Seconds
  • Question 17 - A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for...

    Correct

    • A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for enteral feeding. What is the primary method to verify the NG tube's secure placement before starting feeding?

      Your Answer: Aspirate 10 ml and check the pH

      Explanation:

      Methods for Confirming Correct Placement of Nasogastric Tubes

      Nasogastric (NG) tubes are commonly used in medical settings to administer medication, nutrition, or to remove stomach contents. However, incorrect placement of an NG tube can lead to serious complications. Therefore, it is important to confirm correct placement before using the tube. Here are some methods for confirming correct placement:

      1. Aspirate and check pH: Aspirate 10 ml of fluid from the NG tube and test the pH. If the pH is less than 5.5, the tube is correctly placed in the stomach.

      2. Visual inspection: Do not rely on visual inspection of the aspirate to confirm correct placement, as bronchial secretions can be similar in appearance to stomach contents.

      3. Insert air and auscultate: Injecting 10-20 ml of air can help obtain a gastric aspirate, but auscultation to confirm placement is an outdated and unreliable technique.

      4. Chest X-ray: If no aspirate can be obtained or the pH level is higher than 5.5, a chest X-ray can be used to confirm correct placement. However, this should not be the first-line investigation.

      5. Abdominal X-ray: An abdominal X-ray is not helpful in determining correct placement of an NG tube, as it does not show the lungs.

      By using these methods, healthcare professionals can ensure that NG tubes are correctly placed and reduce the risk of complications.

    • This question is part of the following fields:

      • Gastroenterology
      7.2
      Seconds
  • Question 18 - A 76-year-old woman who has recently seen her GP for a change in...

    Correct

    • A 76-year-old woman who has recently seen her GP for a change in bowel habit towards constipation arrives in the Emergency Department with a tender, distended abdomen. She has also been suffering with a chest infection recently and has known chronic kidney disease (CKD) stage 4. Bowel sounds are absent. The rectum is empty on examination. Abdominal X-ray reveals distended loops of large bowel, consistent with large bowel obstruction.
      Which one of these investigations should be performed next?

      Your Answer: Computed tomography (CT) scan with Gastrografin®

      Explanation:

      Imaging and Diagnostic Procedures for Bowel Obstruction in CKD Patients

      Computed tomography (CT) scan with Gastrografin® is a safe and effective diagnostic tool for patients with chronic kidney disease (CKD) who present with bowel obstruction. This oral contrast medium provides crucial diagnostic information without posing a significant risk of renal injury. It is important to differentiate between large bowel obstruction and pseudo-obstruction, which can be achieved through imaging studies. Diagnostic peritoneal lavage is not indicated in the absence of trauma. Gastroscopy is not necessary as the issue is bowel obstruction, and an ultrasound would not provide the level of detail needed. While magnetic resonance imaging (MRI) can provide quality images, a CT scan is more readily available and can be organized faster.

    • This question is part of the following fields:

      • Colorectal
      30.7
      Seconds
  • Question 19 - An 80-year-old woman complains of deep pain in her leg bones that has...

    Incorrect

    • An 80-year-old woman complains of deep pain in her leg bones that has been gradually worsening over the past 4 months. She has no significant medical history. Upon conducting blood tests, the following results were obtained:
      - Calcium: 1.6 mmol/L (normal range: 2.1-2.6)
      - Phosphate: 0.5 mmol/L (normal range: 0.8-1.4)
      - ALP: 160 u/L (normal range: 30-100)
      - Parathyroid hormone (PTH): 100 pg/mL (normal range: 14-65)
      What is the most likely diagnosis?

      Your Answer: Osteitis fibrosa cystica

      Correct Answer: Osteomalacia

      Explanation:

      Osteomalacia is the likely diagnosis for an older woman experiencing bone pain, as indicated by low serum calcium, low serum phosphate, raised ALP, and raised PTH. This condition is caused by severe vitamin D deficiency, which impairs calcium and phosphate absorption from the gastrointestinal tract and kidneys. As a result, PTH secretion increases to compensate for low calcium, leading to increased bone resorption and elevated ALP levels. Osteitis fibrosis cystica, osteopetrosis, and osteoporosis are less likely diagnoses, as they present with different metabolic blood results.

      Lab Values for Bone Disorders

      When it comes to bone disorders, certain lab values can provide important information for diagnosis and treatment. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically within normal ranges. However, in osteomalacia, there is a decrease in calcium and phosphate levels, an increase in ALP levels, and an increase in PTH levels.

      Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels, but decreased phosphate levels. Chronic kidney disease can also lead to secondary hyperparathyroidism, with decreased calcium levels and increased phosphate and PTH levels.

      Paget’s disease, which causes abnormal bone growth, typically shows normal calcium and phosphate levels, but an increase in ALP levels. Osteopetrosis, a rare genetic disorder that causes bones to become dense and brittle, typically shows normal lab values for calcium, phosphate, ALP, and PTH.

      Overall, understanding these lab values can help healthcare professionals diagnose and treat various bone disorders.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 20 - A 28-year-old woman has been referred to the Infertility Clinic with her partner....

    Incorrect

    • A 28-year-old woman has been referred to the Infertility Clinic with her partner. They have been trying to conceive for almost one year now, having regular unprotected intercourse.
      Initial investigations, including thyroid function tests and mid-luteal phase progesterone and prolactin, are normal. Semen analysis is also normal. No sexually transmitted infections were detected on testing. The patient reports regular periods and a history of endometriosis.
      Which of the following is the next most appropriate investigation?

      Your Answer: Hysterosalpingography

      Correct Answer: Laparoscopy and dye

      Explanation:

      Investigating Infertility: Recommended Tests and Procedures

      When a patient presents with infertility, there are several tests and procedures that can be performed to identify the underlying cause. In the case of a patient with known co-morbidities such as previous ectopic pregnancy, pelvic inflammatory disease, or endometriosis, laparoscopy and dye is the most appropriate next step of investigation. This procedure involves Exploratory laparoscopy, allowing direct visualisation of the pelvis, and injection of dye into the uterus to assess tubal patency.

      Luteinising hormone (LH) and follicle-stimulating hormone (FSH) testing is typically performed when a patient has irregular menses, but may not be necessary for those with regular cycles and normal mid-luteal progesterone levels indicating ovulation. Basal body temperature charts are not recommended by NICE guidelines, as a mid-luteal phase progesterone blood test is a more accurate measure of ovulation.

      Cervical smears may be indicated if the patient is due for screening, but do not form part of infertility investigations. Hysterosalpingography is recommended by NICE guidelines for women without co-morbidities, but is not appropriate for those with a history of endometriosis. Understanding the appropriate tests and procedures for investigating infertility can help healthcare providers identify the underlying cause and develop an effective treatment plan.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 21 - A 27-year-old female office assistant comes to you with complaints of palpitations, restlessness,...

    Incorrect

    • A 27-year-old female office assistant comes to you with complaints of palpitations, restlessness, fatigue, and excessive sweating. She also mentions that she has been experiencing irregular periods and has lost some weight recently. Upon examination, you notice that she has tachycardia and tremors, and her reflexes are hyperactive. Blood tests reveal that she has hyperthyroidism. Further examination of her neck shows multiple small nodules in an enlarged thyroid gland.

      What would be the best initial approach to manage this patient?

      Your Answer: Fine needle aspiration of the nodules

      Correct Answer: Propranolol

      Explanation:

      Treatment for Thyrotoxic Patient

      This patient is experiencing symptoms of thyrotoxicosis and requires treatment to alleviate the effects of adrenergic stimulation. The first step in treatment would be to administer propranolol, a beta-blocker that can help relieve symptoms such as palpitations, tremors, and anxiety.

      Once the patient’s symptoms have been managed, the next step would be to address the underlying cause of the thyrotoxicosis. This would involve treatment to restore the patient to a euthyroid state, which can be achieved through the use of radioiodine therapy. However, it is important to note that propranolol would still be necessary during this initial phase of treatment to manage symptoms and prevent complications.

      In summary, the treatment plan for this patient with thyrotoxicosis involves a two-step approach: first, managing symptoms with propranolol, and second, restoring the patient to a euthyroid state with radioiodine therapy.

    • This question is part of the following fields:

      • Endocrinology
      17.2
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  • Question 22 - A 35-year-old man presents with complaints of numbness in his lower extremities. He...

    Correct

    • A 35-year-old man presents with complaints of numbness in his lower extremities. He has no significant medical history. Upon physical examination, there is a loss of proprioception on his left side below the umbilical line, and complete loss of sensation at the umbilical line. Furthermore, there is a loss of thermal and pain sensation in the groin area and below, on the right side. Radiological imaging reveals a mass on the spine. What is the most likely location of the mass?

      Your Answer: Thoracic level 10 on the right side

      Explanation:

      Understanding Sensory Loss in Spinal Lesions at Different Levels

      Spinal lesions can cause a range of sensory deficits depending on the level of the injury. For example, a lesion at the right tenth thoracic level can result in Brown-Séquard syndrome, with loss of tactile discrimination and vibratory and proprioceptive sensations on the ipsilateral side below the lesion, and loss of pain and temperature sensation on the contralateral side 2-3 levels below the lesion. However, a lesion at lumbar level 1 on the left side would cause sensory loss on the opposite side, around the level of the anterior superior iliac spines. It’s important to note that the umbilical line is innervated by T10, so a lesion at T11 on either side would spare sensation at this level. Understanding these patterns of sensory loss can aid in diagnosing and treating spinal lesions.

    • This question is part of the following fields:

      • Neurosurgery
      28.5
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  • Question 23 - A 26-year-old male comes in with a painless lump in his testicle. During...

    Incorrect

    • A 26-year-old male comes in with a painless lump in his testicle. During the examination, the lump is found to be hard and irregular. What is the most suitable test to order?

      Your Answer: Surgical biopsy

      Correct Answer: Testicular ultrasound scan

      Explanation:

      The initial investigation for a testicular mass is an ultrasound, which is also the recommended first-line test for suspected testicular cancer. While beta-hCG levels may be elevated in certain types of testicular cancer, it is not a sensitive enough test to be used as the primary investigation. A surgical biopsy is not necessary at this stage, and a CT scan would subject the patient to unnecessary radiation. A bone scan is typically used for staging certain cancers after diagnosis, but it is not a first-line investigation for cancer.

      Understanding Testicular Cancer

      Testicular cancer is a type of cancer that commonly affects men between the ages of 20 and 30. Germ-cell tumors are the most common type of testicular cancer, accounting for around 95% of cases. These tumors can be divided into seminomas and non-seminomas, which include embryonal, yolk sac, teratoma, and choriocarcinoma. Other types of testicular cancer include Leydig cell tumors and sarcomas. Risk factors for testicular cancer include infertility, cryptorchidism, family history, Klinefelter’s syndrome, and mumps orchitis.

      The most common symptom of testicular cancer is a painless lump, although some men may experience pain. Other symptoms may include hydrocele and gynaecomastia, which occurs due to an increased oestrogen:androgen ratio. Tumor markers such as hCG, AFP, and beta-hCG may be elevated in germ cell tumors. Ultrasound is the first-line diagnostic tool for testicular cancer.

      Treatment for testicular cancer depends on the type and stage of the tumor. Orchidectomy, chemotherapy, and radiotherapy may be used. Prognosis for testicular cancer is generally excellent, with a 5-year survival rate of around 95% for seminomas and 85% for teratomas if caught at Stage I. It is important for men to perform regular self-examinations and seek medical attention if they notice any changes or abnormalities in their testicles.

    • This question is part of the following fields:

      • Surgery
      15.7
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  • Question 24 - An 8-year-old boy comes to you with a history of easy bleeding and...

    Incorrect

    • An 8-year-old boy comes to you with a history of easy bleeding and bruising, even with minor injuries. His parents are healthy, but his mother reports that her brother also has a bleeding disorder and suspects that other male relatives may be affected. Based on this information, what is the most probable mode of inheritance for this condition?

      Your Answer: X-linked dominant

      Correct Answer: X-linked recessive

      Explanation:

      Inherited Genetic Disorders: Understanding X-Linked Recessive Inheritance

      X-linked recessive inheritance is a type of genetic inheritance that affects significantly more males than females. This type of inheritance is commonly associated with bleeding disorders such as haemophilia A and B, which are caused by deficiencies in clotting factors VIII and IX respectively. In X-linked recessive inheritance, female carriers are unaffected, but all male offspring that inherit the mutated allele on the X chromosome will be affected.

      A family history of the disease can help identify the mode of inheritance. For example, if a mother is a carrier and her brother has the disease, it is likely that their grandmother was also a carrier. The mother and her brother both inherited the abnormal X chromosome, but the mother is a carrier while the uncle is affected. Similarly, if a male inherits the abnormal X chromosome from his mother, he will be affected by the disease.

      Other types of genetic inheritance include Y-linked, autosomal dominant, autosomal recessive, and X-linked dominant. Examples of Y-linked inherited conditions include male infertility, retinitis pigmentosa, and hypertrichosis pinnae. Autosomal dominant conditions include Marfan syndrome, achondroplasia, and osteogenesis imperfecta. Autosomal recessive conditions include CF, Wilson’s disease, and haemochromatosis. Examples of X-linked dominant conditions include Rett syndrome, fragile X syndrome, and vitamin D-resistant rickets.

      Understanding the mode of inheritance can help individuals and families make informed decisions about genetic testing and family planning.

    • This question is part of the following fields:

      • Genetics
      27.4
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  • Question 25 - A 55-year-old man complains of lower back pain, painful urination, and low-grade fevers...

    Incorrect

    • A 55-year-old man complains of lower back pain, painful urination, and low-grade fevers for the past 3 days. During the examination, the physician noted a tender, boggy prostate and diffuse pain in the lower abdomen. A urine dip test revealed 2+ blood in the urine. What is the recommended treatment for the suspected diagnosis?

      Your Answer: Refer to secondary care for urgent hospital admission

      Correct Answer: A 14 day course of ciprofloxacin

      Explanation:

      If a patient is diagnosed with prostatitis, a urine sample should be taken for culture. If the patient is stable enough to be treated outside of a hospital setting, they should be prescribed a 14-day course of a quinolone such as ciprofloxacin or ofloxacin. However, if the patient is experiencing severe symptoms, is septic, unable to take oral antibiotics, or is in urinary retention, they should be referred to secondary care urgently.

      Acute bacterial prostatitis is a condition that occurs when gram-negative bacteria enter the prostate gland through the urethra. The most common pathogen responsible for this condition is Escherichia coli. Risk factors for acute bacterial prostatitis include recent urinary tract infection, urogenital instrumentation, intermittent bladder catheterisation, and recent prostate biopsy. Symptoms of this condition include pain in various areas such as the perineum, penis, rectum, or back, obstructive voiding symptoms, fever, and rigors. A tender and boggy prostate gland can be detected during a digital rectal examination.

      The recommended treatment for acute bacterial prostatitis is a 14-day course of a quinolone. It is also advisable to consider screening for sexually transmitted infections.

    • This question is part of the following fields:

      • Surgery
      30.9
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  • Question 26 - A 25-year-old woman is admitted to the Emergency Department with vomiting. She has...

    Correct

    • A 25-year-old woman is admitted to the Emergency Department with vomiting. She has vague abdominal pain, and a particularly keen junior surgeon takes her to theatre for an appendectomy; the appendix is removed and is normal. In recovery, she becomes hypotensive and tachycardic and does not respond as expected to fluid replacement. On examination, she is very well tanned and slim; her blood pressure is 90/65 mmHg, with a pulse rate of 100 bpm.
      Investigations:
      Investigation Result Normal value
      Potassium (K+) 6.2 mmol/l 3.5–5.0 mmol/l
      Sodium (Na+) 127 mmol/l 135–145 mmol/l
      Urea 9.1 mmol/l 2.5–6.5 mmol/l
      Creatinine 165 μmol/l 50–120 µmol/l
      Haemoglobin 98 g/l (normochromic normocytic) 115–155 g/l
      Free T4 6.2 pmol/l (low) 11–22 pmol/l
      Which of the following fits best with this clinical scenario?

      Your Answer: iv hydrocortisone is the initial treatment of choice

      Explanation:

      The recommended initial treatment for patients experiencing an adrenal crisis is intravenous hydrocortisone. This is because the adrenal glands are not producing enough cortisol, which can lead to severe adrenal insufficiency. The most common causes of an adrenal crisis include undiagnosed adrenal insufficiency with associated major stress, abrupt cessation of glucocorticoid therapy, and bilateral infarction of the adrenal glands. Symptoms of an adrenal crisis can include hyperkalemia, hyponatremia, renal impairment, and normochromic normocytic anemia, as well as non-specific symptoms such as vomiting, abdominal pain, weakness, fever, and lethargy. The patient’s tan may be due to increased melanocyte activity caused by raised levels of adrenocorticotrophic hormone. Intravenous T3 replacement may be effective in treating the patient’s low free T4 levels, which are likely a result of adrenal insufficiency. Fluid replacement alone will not be sufficient to treat the patient’s shock, which is the main manifestation of an adrenal crisis. Normochromic normocytic anemia can be treated with corticosteroid replacement, and the patient’s deranged renal function is likely a result of sepsis.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      93.8
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  • Question 27 - A 28-year-old amateur football player arrives at the emergency department complaining of knee...

    Incorrect

    • A 28-year-old amateur football player arrives at the emergency department complaining of knee pain. During the game, she experienced a popping sensation in her left knee. Upon examination, her knee is swollen, and she cannot fully extend it. Which diagnostic test is most likely to reveal the underlying cause?

      Your Answer: Ultrasound scan (US)

      Correct Answer: Magnetic resonance imaging (MRI)

      Explanation:

      When it comes to detecting lateral and medial meniscal tears, an MRI is the most sensitive option available. It surpasses the other choices in terms of sensitivity and should be requested for all patients who are suspected of having a meniscal injury. Ultrasound may be challenging to perform due to the patient’s probable swelling and pain. An X-ray may be necessary for patients with arthritis or a history of repeated meniscal tears.

      Understanding Meniscal Tear and its Symptoms

      Meniscal tear is a common knee injury that usually occurs due to twisting injuries. Its symptoms include pain that worsens when the knee is straightened, a feeling that the knee may give way, tenderness along the joint line, and knee locking in cases where the tear is displaced. To diagnose a meniscal tear, doctors may perform Thessaly’s test, which involves weight-bearing at 20 degrees of knee flexion while the patient is supported by the doctor. If the patient experiences pain on twisting the knee, the test is considered positive.

    • This question is part of the following fields:

      • Musculoskeletal
      31.9
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  • Question 28 - Sophie is a 25-year-old woman who was diagnosed with generalised anxiety disorder 8...

    Incorrect

    • Sophie is a 25-year-old woman who was diagnosed with generalised anxiety disorder 8 months ago. She has been taking sertraline for 5 months but feels that her symptoms have not improved much. Sophie wants to switch to a different medication. What is the most suitable drug to start?

      Your Answer: Mirtazapine

      Correct Answer: Venlafaxine

      Explanation:

      If sertraline, a first-line SSRI, is ineffective or not well-tolerated for treating GAD, alternative options include trying a different SSRI like paroxetine or escitalopram, or an SNRI like duloxetine or venlafaxine. In Maxine’s case, since sertraline did not work, venlafaxine, an SNRI, would be a suitable option. Bupropion is primarily used for smoking cessation but may be considered off-label for depression treatment if other options fail. Mirtazapine is a NaSSA used for depression, not GAD. Pregabalin can be used if SSRIs or SNRIs are not suitable, and propranolol can help with acute anxiety symptoms but is not a specific treatment for GAD.

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

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

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

    • This question is part of the following fields:

      • Psychiatry
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  • Question 29 - A 79-year-old woman complains of difficulty urinating, weak stream, feeling of incomplete bladder...

    Correct

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

      Your Answer: Overflow incontinence

      Explanation:

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

      Understanding Urinary Incontinence: Causes, Classification, and Management

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

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

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

    • This question is part of the following fields:

      • Urology
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  • Question 30 - A 28-year-old female presents with a two-day history of right loin and supra-pubic...

    Correct

    • A 28-year-old female presents with a two-day history of right loin and supra-pubic pain, dysuria, and swinging fevers. She has a past medical history of urinary tract infections. Upon examination, she is febrile with a temperature of 39.2°C, her blood pressure is 100/60 mmHg, and her pulse is 94 bpm and regular. She appears unwell, and right renal angle and supra-pubic pain are confirmed. Laboratory tests show an elevated white blood cell count and a creatinine level of 125 µmol/L. What is the most appropriate imaging test for this patient?

      Your Answer: CT of the urinary tract without contrast

      Explanation:

      Importance of CT Scan in Evaluating Ureteric Obstruction

      A CT scan is necessary to rule out ureteric obstruction, such as a stone or abscess formation, even in cases where there is a significant elevation in creatinine. Although contrast nephropathy is a risk, the likelihood is low with a creatinine level of 125 µmol/L. It is important to note that iodinated contrast is the nephrotoxic component of a CT scan, and a non-contrast CT is both effective and poses minimal risk to the patient.

      A plain radiograph may not detect stones that are not radio-opaque, and a micturating cystourethrogram is typically used to identify anatomical or functional abnormalities affecting the lower renal tract. If a CT scan is not feasible in the acute situation, an ultrasound may be a reasonable alternative. Overall, a CT scan is crucial in evaluating ureteric obstruction and should be considered even in cases where there is a slight risk of contrast nephropathy.

    • This question is part of the following fields:

      • Medicine
      55.3
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SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (1/1) 100%
Medicine (1/2) 50%
Gynaecology (1/2) 50%
Musculoskeletal (0/3) 0%
Clinical Sciences (1/3) 33%
Oncology (1/1) 100%
Nephrology (1/1) 100%
Cardiothoracic (1/1) 100%
Ophthalmology (0/1) 0%
Gastroenterology (1/2) 50%
Neurology (1/1) 100%
Emergency Medicine (1/1) 100%
Plastics (0/1) 0%
Psychiatry (1/2) 50%
Colorectal (1/1) 100%
Endocrinology (0/1) 0%
Neurosurgery (1/1) 100%
Surgery (0/2) 0%
Genetics (0/1) 0%
Acute Medicine And Intensive Care (1/1) 100%
Urology (1/1) 100%
Passmed