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  • Question 1 - A 5-year-old boy visited his doctor last week due to recurring nosebleeds and...

    Incorrect

    • A 5-year-old boy visited his doctor last week due to recurring nosebleeds and bruises on his sides. Upon examination, his clotting was found to be prolonged. The following are his test results, along with the normal ranges for a 5-year-old:
      - Hemoglobin: 80g/l (115-135)
      - Platelets: 100 * 109/l (150-450)
      - White blood cells: 10.0 * 109/l (5.0-17.0)
      - Neutrophils: 1.0 * 109/l (1.5-8.5)
      What is the most probable diagnosis?

      Your Answer: Aplastic anaemia

      Correct Answer: Acute lymphoblastic leukaemia

      Explanation:

      Leukaemia is the most probable diagnosis given the presence of epistaxis and bruising, along with anaemia and low platelets. The prolonged prothrombin time and low platelets suggest disseminated intravascular coagulation, which is consistent with acute lymphoblastic leukaemia. Acute myeloid leukaemia is unlikely due to the patient’s age. The normal white blood cell count rules out a chronic infection. Aplastic anaemia and myelodysplasia would not account for the symptoms of epistaxis and bruising.

      Acute lymphoblastic leukaemia (ALL) is a type of cancer that commonly affects children and accounts for 80% of childhood leukaemias. It is most prevalent in children between the ages of 2-5 years, with boys being slightly more affected than girls. Symptoms of ALL can be divided into those caused by bone marrow failure, such as anaemia, neutropaenia, and thrombocytopenia, and other features like bone pain, splenomegaly, and hepatomegaly. Fever is also present in up to 50% of new cases, which may indicate an infection or a constitutional symptom. Testicular swelling may also occur.

      There are three types of ALL: common ALL, T-cell ALL, and B-cell ALL. Common ALL is the most common type, accounting for 75% of cases, and is characterized by the presence of CD10 and a pre-B phenotype. Poor prognostic factors for ALL include age less than 2 years or greater than 10 years, a white blood cell count greater than 20 * 109/l at diagnosis, T or B cell surface markers, non-Caucasian ethnicity, and male sex.

    • This question is part of the following fields:

      • Paediatrics
      82.1
      Seconds
  • Question 2 - What is true about the inheritance pattern of achondroplasia? ...

    Incorrect

    • What is true about the inheritance pattern of achondroplasia?

      Your Answer: Autosomal recessive

      Correct Answer: Autosomal dominant

      Explanation:

      Achondroplasia: Inheritance and Genetic Testing

      Achondroplasia is a genetic condition that is inherited in an autosomal dominant manner. This means that if one parent has the condition, their child has a 50% chance of inheriting it as well. However, it is important to note that approximately 75% of individuals with achondroplasia are born to parents of average size, as the condition can also occur due to a new genetic mutation.

      The gene responsible for achondroplasia is called fibroblast growth factor receptor 3 (FGFR3). When two individuals with achondroplasia have children, there is a risk of the child inheriting two copies of the mutated gene, which is known as double homozygosity. Infants with this condition are either stillborn or die shortly after birth.

      Couples who are at risk of having a child with achondroplasia can undergo prenatal diagnosis through serial ultrasounds. Additionally, a DNA test is now available to detect double homozygosity. It is important for individuals and families affected by achondroplasia to understand the inheritance pattern and available testing options in order to make informed decisions about family planning.

    • This question is part of the following fields:

      • Clinical Sciences
      15
      Seconds
  • Question 3 - A 68-year-old male is brought to the emergency department by his son, who...

    Incorrect

    • A 68-year-old male is brought to the emergency department by his son, who is worried about his recent increase in confusion. The son also reports that his father has had multiple falls in the past few weeks. The patient has a history of chronic alcohol abuse, consuming approximately 70 units per week. Due to his confused state, obtaining a history from the patient is not possible. What is the underlying pathophysiological mechanism of the likely diagnosis?

      Your Answer: Ruptured cerebral aneurysm

      Correct Answer: Rupture of bridging veins

      Explanation:

      Based on the patient’s age, history of alcohol abuse, head injury, and insidious onset of symptoms, it is likely that they are suffering from a subdural hematoma. This condition is often caused by the rupture of bridging veins in the subdural space and can lead to confusion and decreased consciousness. While normal-pressure hydrocephalus can also cause confusion in elderly patients, it typically presents with additional symptoms such as urinary incontinence and gait disturbance. Diffuse axonal injury, on the other hand, is usually caused by rapid acceleration-deceleration and can result in coma. Extradural hematomas are more common in younger patients and are typically caused by trauma to the side of the head, while subarachnoid hemorrhages often present with a sudden, severe headache in the occipital area and are often caused by a ruptured cerebral aneurysm.

      Types of Traumatic Brain Injury

      Traumatic brain injury can result in primary and secondary brain injury. Primary brain injury can be focal or diffuse. Diffuse axonal injury occurs due to mechanical shearing, which causes disruption and tearing of axons. intracranial haematomas can be extradural, subdural, or intracerebral, while contusions may occur adjacent to or contralateral to the side of impact. Secondary brain injury occurs when cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation exacerbates the original injury. The normal cerebral auto regulatory processes are disrupted following trauma rendering the brain more susceptible to blood flow changes and hypoxia. The Cushings reflex often occurs late and is usually a pre-terminal event.

      Extradural haematoma is bleeding into the space between the dura mater and the skull. It often results from acceleration-deceleration trauma or a blow to the side of the head. The majority of epidural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery. Subdural haematoma is bleeding into the outermost meningeal layer. It most commonly occurs around the frontal and parietal lobes. Risk factors include old age, alcoholism, and anticoagulation. Subarachnoid haemorrhage classically causes a sudden occipital headache. It usually occurs spontaneously in the context of a ruptured cerebral aneurysm but may be seen in association with other injuries when a patient has sustained a traumatic brain injury. Intracerebral haematoma is a collection of blood within the substance of the brain. Causes/risk factors include hypertension, vascular lesion, cerebral amyloid angiopathy, trauma, brain tumour, or infarct. Patients will present similarly to an ischaemic stroke or with a decrease in consciousness. CT imaging will show a hyperdensity within the substance of the brain. Treatment is often conservative under the care of stroke physicians, but large clots in patients with impaired consciousness may warrant surgical evacuation.

    • This question is part of the following fields:

      • Surgery
      32
      Seconds
  • Question 4 - A 4-year-old boy, with a history of acute lymphoblastic leukaemia (ALL), is admitted...

    Incorrect

    • A 4-year-old boy, with a history of acute lymphoblastic leukaemia (ALL), is admitted to the Paediatric Ward due to a fever of 38.9 °C at home. He received his last treatment 1 week ago. His parents report that he has been feeling well, without cough, cold, rash, or vomiting.
      Upon examination, his vital signs are stable except for a temperature of 38.4 °C. Physical examination is unremarkable. Blood tests and blood culture are taken from the portacath, revealing a haemoglobin (Hb) level of 11.5, a white cell count (WCC) of 1.1, neutrophils of 0.2, and a C-reactive protein (CRP) level of 85.
      What is the most crucial next step in managing this patient?

      Your Answer: Start iv fluids

      Correct Answer: Start intravenous (iv) Tazocin®

      Explanation:

      Management of Febrile Neutropenia in a Child with ALL Receiving Chemotherapy

      Febrile neutropenia is a serious complication in cancer patients, particularly those receiving chemotherapy. It is defined as neutropenia with fever or symptoms of significant sepsis. In such cases, immediate initiation of broad-spectrum intravenous antibiotics is crucial to prevent mortality.

      In this scenario, a child with acute lymphoblastic leukemia (ALL) presents with febrile neutropenia. The first step is to start intravenous Tazocin® monotherapy, pending blood cultures and a thorough physical examination. A urine sample should also be obtained, particularly for children under the age of 5. Chest radiography is only necessary for symptomatic children.

      After 48 hours, if the child shows improvement and cultures are negative, empirical antibiotic treatment can be discontinued or switched to oral antibiotics such as Augmentin®. Intravenous fluids may be necessary if the child deteriorates or becomes haemodynamically unstable.

      It is also important to send urine and stool samples for microbial culture and sensitivity (MC&S) to investigate sepsis. However, initiating antibiotics should be the first priority.

      In summary, febrile neutropenia in cancer patients is a medical emergency that requires prompt initiation of broad-spectrum antibiotics. Close monitoring and appropriate investigations are necessary to ensure timely and effective management.

    • This question is part of the following fields:

      • Paediatrics
      116.2
      Seconds
  • Question 5 - A 34-year-old female who is 28 weeks pregnant presents to the emergency department...

    Correct

    • A 34-year-old female who is 28 weeks pregnant presents to the emergency department with severe lower abdominal pain. She is tachycardic but is otherwise stable. On examination, her uterus is tender and hard, but fetal lie is normal. Cardiotocography shows no signs of fetal distress.

      What is the most appropriate course of action for management?

      Your Answer: Admit her and administer steroids

      Explanation:

      When managing placental abruption in a case where the fetus is alive, less than 36 weeks old, and not displaying any signs of distress, the appropriate course of action is to admit the patient and administer steroids. Admitting the patient is necessary for monitoring and providing necessary care. Steroids are given to aid in the maturation of fetal lungs. It is recommended to deliver the baby at 37-38 weeks due to the increased risk of stillbirth. Tocolytics are not routinely given due to their controversial nature and potential for maternal cardiovascular side effects. Discharging the patient with safety netting is not appropriate as the patient is symptomatic. Activating the major haemorrhage protocol, calling 2222, and performing an emergency caesarean section are not the most suitable options as the patient is not hypotensive and there are no signs of fetal distress.

      Placental Abruption: Causes, Management, and Complications

      Placental abruption is a condition where the placenta separates from the uterine wall, leading to maternal haemorrhage. The severity of the condition depends on the extent of the separation and the gestational age of the fetus. Management of placental abruption is crucial to prevent maternal and fetal complications.

      If the fetus is alive and less than 36 weeks, immediate caesarean delivery is recommended if there is fetal distress. If there is no fetal distress, close observation, administration of steroids, and no tocolysis are recommended. The decision to deliver depends on the gestational age of the fetus. If the fetus is alive and more than 36 weeks, immediate caesarean delivery is recommended if there is fetal distress. If there is no fetal distress, vaginal delivery is recommended. If the fetus is dead, vaginal delivery should be induced.

      Placental abruption can lead to various maternal complications, including shock, disseminated intravascular coagulation (DIC), renal failure, and postpartum haemorrhage (PPH). Fetal complications include intrauterine growth restriction (IUGR), hypoxia, and death. The condition is associated with a high perinatal mortality rate and is responsible for 15% of perinatal deaths.

      In conclusion, placental abruption is a serious condition that requires prompt management to prevent maternal and fetal complications. Close monitoring and timely intervention can improve the prognosis for both the mother and the baby.

    • This question is part of the following fields:

      • Obstetrics
      43.4
      Seconds
  • Question 6 - A 26-year-old female patient arrives at the emergency department with worsening periorbital oedema,...

    Incorrect

    • A 26-year-old female patient arrives at the emergency department with worsening periorbital oedema, erythema, and drainage in her left eye. During examination, mild proptosis is observed. To further investigate her symptoms, a point of care ultrasound is conducted, revealing retro-orbital soft tissue prominence and oedema with echogenic fat. What is the appropriate treatment plan for this patient based on the underlying diagnosis?

      Your Answer: Topical corticosteroids

      Correct Answer: Intravenous antimicrobial

      Explanation:

      Hospital admission for IV antibiotics is necessary for patients with orbital cellulitis due to the potential for cavernous sinus thrombosis and intracranial spread. It is imperative that all patients with a clinical diagnosis of orbital cellulitis be admitted to the hospital and receive an ophthalmic evaluation as soon as possible. Oral antimicrobial treatment is inadequate in this situation, as intravenous antibiotic therapy is required to manage this medical emergency. Failure to treat orbital cellulitis promptly may result in blindness or even death. Therefore, no antimicrobial other than intravenous antibiotics is appropriate for this condition. Topical antimicrobial treatment is also insufficient for managing orbital cellulitis.

      Understanding Orbital Cellulitis: Causes, Symptoms, and Management

      Orbital cellulitis is a serious infection that affects the fat and muscles behind the orbital septum within the orbit, but not the globe. It is commonly caused by upper respiratory tract infections that spread from the sinuses and can lead to a high mortality rate. On the other hand, periorbital cellulitis is a less severe infection that occurs in the superficial tissues anterior to the orbital septum. However, it can progress to orbital cellulitis if left untreated.

      Risk factors for orbital cellulitis include childhood, previous sinus infections, lack of Haemophilus influenzae type b (Hib) vaccination, recent eyelid infections or insect bites, and ear or facial infections. Symptoms of orbital cellulitis include redness and swelling around the eye, severe ocular pain, visual disturbance, proptosis, ophthalmoplegia, eyelid edema, and ptosis. In rare cases, meningeal involvement can cause drowsiness, nausea, and vomiting.

      To differentiate between orbital and preseptal cellulitis, doctors look for reduced visual acuity, proptosis, and ophthalmoplegia, which are not consistent with preseptal cellulitis. Full blood count and clinical examination involving complete ophthalmological assessment are necessary to determine the severity of the infection. CT with contrast can also help identify inflammation of the orbital tissues deep to the septum and sinusitis. Blood culture and microbiological swab are also necessary to determine the organism causing the infection.

      Management of orbital cellulitis requires hospital admission for IV antibiotics. It is a medical emergency that requires urgent senior review. Early diagnosis and treatment are crucial to prevent complications and reduce the risk of mortality.

    • This question is part of the following fields:

      • Ophthalmology
      51.8
      Seconds
  • Question 7 - You are working as a Foundation Year 2 in a GP surgery. A...

    Correct

    • You are working as a Foundation Year 2 in a GP surgery. A mother brings her 4-year-old girl to see you with a cough. You notice an alert on her notes that states she is on a child protection plan.
      Which of the following is true regarding a child protection plan?

      Your Answer: They are devised for children at risk of significant harm

      Explanation:

      Understanding Child Protection Plans and Child in Need Plans

      Child protection plans and child in need plans are two different interventions designed to support children who may be at risk of harm or in need of extra support. It is important to understand the differences between these plans and how they are implemented.

      Child protection plans are devised for children who are at risk of significant harm. The aim of these plans is to ensure the child’s safety, promote their health and development, and support the family in safeguarding and promoting the child’s welfare. Child protection plans are not voluntary and involve a team of professionals working together to ensure the child’s safety.

      On the other hand, child in need plans are voluntary and are designed to support children who may need extra help with their health, safety, or development. These plans identify a lead professional and outline the resources and services needed to achieve the planned outcomes within a specific timeframe.

      It is important to note that both plans involve consultation with parents, wider family members, and relevant agencies. Additionally, child protection plans are regularly reviewed to ensure that the child’s safety and well-being are being maintained.

      In summary, child protection plans and child in need plans are interventions designed to support children in different ways. Understanding the differences between these plans can help ensure that children receive the appropriate support and interventions they need to thrive.

    • This question is part of the following fields:

      • Paediatrics
      21.5
      Seconds
  • Question 8 - A 28-year-old woman presents with complaints of intermittent abdominal distension and bloating. She...

    Correct

    • A 28-year-old woman presents with complaints of intermittent abdominal distension and bloating. She experiences bouts of loose motions that provide relief from the symptoms. There is no history of rectal bleeding or weight loss. The patient works as a manager in a busy office and finds work to be stressful. She has previously taken a course of fluoxetine for depression/anxiety. Abdominal examination is unremarkable.
      What is the probable diagnosis?

      Your Answer: Irritable bowel syndrome (IBS)

      Explanation:

      IBS is a chronic condition that affects bowel function, but its cause is unknown. To diagnose IBS, patients must have experienced abdominal pain or discomfort for at least 3 months, along with two or more of the following symptoms: relief after defecation, changes in stool frequency or appearance, and abdominal bloating. Other symptoms may include altered stool passage, mucorrhoea, and headaches. Blood tests are recommended to rule out other conditions, and further investigation is not necessary unless symptoms of organic disease are present. Diverticulitis, anxiety disorder, Crohn’s disease, and ulcerative colitis are all conditions that can be ruled out based on the absence of certain symptoms.

    • This question is part of the following fields:

      • Gastroenterology
      26.2
      Seconds
  • Question 9 - A 67-year-old male patient arrives at the Emergency Department with a rash. He...

    Incorrect

    • A 67-year-old male patient arrives at the Emergency Department with a rash. He has been experiencing fever and fatigue for three days, but within the last 12 hours, a rash has developed. He is extremely anxious and in severe pain. The rash is primarily on his face and torso, consisting of a combination of target lesions and blisters. His tongue and lips show significant mucosal desquamation. You identify this as a severe and uncommon side effect of one of his medications.
      What medication is the most probable cause?

      Your Answer: Fluoxetine

      Correct Answer: Amoxicillin

      Explanation:

      Adverse Reactions of Common Medications

      Stevens-Johnson Syndrome and Common Drug Triggers
      Stevens-Johnson Syndrome (SJS) is a rare but severe condition that affects 1-2 million people each year. It is more common in patients with HIV and can be triggered by antibiotics, antifungals, antivirals, non-steroidal anti-inflammatory drugs, anticonvulsants, and allopurinol. Symptoms include a painful rash on the trunk, face, and limbs, with lesions that can be macules, targets, or blisters. Mucosal involvement is severe, affecting the eyes, lips, mouth, oesophagus, and genital area. Mortality rates range from 10-50%, making it crucial to stop the causative drug immediately and provide supportive treatment.

      Candesartan, Diltiazem, Fluoxetine, and Prednisolone: Common Side Effects
      Candesartan can rarely cause a rash, but more common side effects include hypotension, hyperkalaemia, and angioedema. Diltiazem can cause bradycardia, palpitations, and dizziness, and may rarely cause rashes such as erythema multiforme and exfoliative dermatitis. Fluoxetine can rarely cause toxic epidermal necrolysis, but more common side effects are gastrointestinal and hypersensitivity reactions, including rash, urticarial, and angioedema. High doses of prednisolone can cause Cushing syndrome, with moon face, striae, and acne, as well as skin effects such as urticaria, hyperhidrosis, skin atrophy, bruising, and telangiectasia.

    • This question is part of the following fields:

      • Pharmacology
      38.3
      Seconds
  • Question 10 - The arterial blood gas results are as follows: pH of 7.6 (normal range:...

    Incorrect

    • The arterial blood gas results are as follows: pH of 7.6 (normal range: 7.35-7.45), pO2 of 13.3 kPa (normal range: 10.5-13.5 kPa), pCO2 of 5.6 kPa (normal range: 4.6-6.0 kPa), HCO3 of 32 mmol/l (normal range: 24-30 mmol/l), and SaO2 of 97% on room air. Based on these results, which clinical scenario is the most likely explanation for these findings?

      Your Answer: Hyperventilation

      Correct Answer: Pyloric stenosis

      Explanation:

      Understanding Acid-Base Imbalances in Various Medical Conditions

      Pyloric Stenosis:
      Pyloric stenosis causes projectile vomiting due to the inability of stomach contents to pass into the duodenum, resulting in metabolic alkalosis. Respiratory compensation may occur, leading to a raised pCO2.

      Septic Shock:
      Septic shock leads to metabolic acidosis due to poor tissue perfusion and increased anaerobic respiration. Respiratory compensation may occur, leading to an increased respiratory rate.

      Pneumothorax:
      A pneumothorax typically causes respiratory alkalosis, but if associated with fractured ribs, respiratory acidosis may occur. In the acute setting, there is unlikely to be any metabolic compensation.

      Hyperventilation:
      Hyperventilation leads to respiratory alkalosis as the patient exhales excess CO2. There is unlikely to be metabolic compensation in the acute setting.

      Bowel Ischaemia:
      Bowel ischaemia leads to metabolic acidosis due to anaerobic respiration in the affected tissue. Respiratory compensation may occur, leading to an increased respiratory rate.

    • This question is part of the following fields:

      • Clinical Biochemistry
      37.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (1/3) 33%
Clinical Sciences (0/1) 0%
Surgery (0/1) 0%
Obstetrics (1/1) 100%
Ophthalmology (0/1) 0%
Gastroenterology (1/1) 100%
Pharmacology (0/1) 0%
Clinical Biochemistry (0/1) 0%
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