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  • Question 1 - A 14-year-old girl (who has been recently diagnosed with anorexia nervosa) exercises regularly....

    Incorrect

    • A 14-year-old girl (who has been recently diagnosed with anorexia nervosa) exercises regularly. During one period of exercise, she becomes very light-headed. Several minutes later, she breaks into a sweat and develops palpitations. A friend takes her to an Emergency Department where a serum glucose of 2.2 mmol/l is demonstrated. The patient is given a soft drink to sip and feels better half an hour later.
      Which of the following hormones most likely triggered the sweating and palpitations the patient experienced?

      Your Answer: Insulin

      Correct Answer: Epinephrine

      Explanation:

      Hormones and their Role in Hypoglycaemia

      Hypoglycaemia, or low blood sugar, can be caused by various factors including exercise and minimal glycogen and lipid stores. Hormones play a crucial role in the body’s response to hypoglycaemia.

      Epinephrine is released in response to hypoglycaemia and promotes hepatic glucose production and release. Adrenocorticotropic hormone (ACTH) triggers cortisol release, which stimulates gluconeogenesis over several hours. Calcitonin modulates serum calcium levels but does not play a direct role in hypoglycaemia.

      Insulin secretion is associated with hypoglycaemia but does not cause symptoms such as sweating or palpitations. Similarly, thyroxine can cause similar symptoms but is not responsible for a specific role in the body’s response to hypoglycaemia. Understanding the role of hormones in hypoglycaemia can aid in its diagnosis and management.

    • This question is part of the following fields:

      • Endocrinology
      23
      Seconds
  • Question 2 - A 27-year-old woman comes to your clinic with a positive urine pregnancy test...

    Correct

    • A 27-year-old woman comes to your clinic with a positive urine pregnancy test result. She underwent a medical termination of pregnancy using mifepristone and misoprostol three weeks ago when she was eight weeks pregnant. She reports no ongoing pregnancy symptoms and only slight vaginal bleeding since the procedure. What advice would you give her?

      Your Answer: Reassure and repeat urine pregnancy test at 4 weeks post termination

      Explanation:

      It is common for HCG levels to remain positive for several weeks after a termination of pregnancy. HCG levels are typically measured every two days, and a positive result beyond four weeks may indicate a continuing pregnancy. However, in most cases, HCG levels will return to normal within four weeks.

      In this scenario, the appropriate course of action is to repeat the urine pregnancy test in one week, as the patient is currently only three weeks post-termination. There is no need for further referrals or imaging at this time, as a positive test result is unlikely to indicate a continuing pregnancy, and the patient does not exhibit any urgent symptoms such as infection or hemorrhage.

      Termination of Pregnancy in the UK

      The UK’s current abortion law is based on the 1967 Abortion Act, which was amended in 1990 to reduce the upper limit for termination from 28 weeks to 24 weeks gestation. To perform an abortion, two registered medical practitioners must sign a legal document, except in emergencies where only one is needed. The procedure must be carried out by a registered medical practitioner in an NHS hospital or licensed premise.

      The method used to terminate a pregnancy depends on the gestation period. For pregnancies less than nine weeks, mifepristone (an anti-progesterone) is administered, followed by prostaglandins 48 hours later to stimulate uterine contractions. For pregnancies less than 13 weeks, surgical dilation and suction of uterine contents is used. For pregnancies more than 15 weeks, surgical dilation and evacuation of uterine contents or late medical abortion (inducing ‘mini-labour’) is used.

      The 1967 Abortion Act outlines the circumstances under which a person shall not be guilty of an offence under the law relating to abortion. These include if two registered medical practitioners are of the opinion, formed in good faith, that the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family. The limits do not apply in cases where it is necessary to save the life of the woman, there is evidence of extreme fetal abnormality, or there is a risk of serious physical or mental injury to the woman.

    • This question is part of the following fields:

      • Gynaecology
      24.9
      Seconds
  • Question 3 - A 54-year-old woman has been diagnosed with ovarian cancer. She has had a...

    Correct

    • A 54-year-old woman has been diagnosed with ovarian cancer. She has had a positive CA125 blood test, ultrasound scan and CT abdomen and pelvis. She is found to have stage 2 ovarian cancer. What is the primary treatment?

      Your Answer: Surgical excision of the tumour

      Explanation:

      Surgical removal of the tumour is the primary treatment for ovarian cancers in stages 2-4, often accompanied by chemotherapy as well, according to NICE CG122.

      Ovarian cancer is a common malignancy in women, ranking fifth in frequency. It is most commonly diagnosed in women over the age of 60 and has a poor prognosis due to late detection. The majority of ovarian cancers, around 90%, are of epithelial origin, with serous carcinomas accounting for 70-80% of cases. Interestingly, recent research suggests that many ovarian cancers may actually originate in the distal end of the fallopian tube. Risk factors for ovarian cancer include a family history of BRCA1 or BRCA2 gene mutations, early menarche, late menopause, and nulliparity.

      Clinical features of ovarian cancer are often vague and can include abdominal distension and bloating, abdominal and pelvic pain, urinary symptoms such as urgency, early satiety, and diarrhea. The initial diagnostic test recommended by NICE is a CA125 blood test, although this can also be elevated in other conditions such as endometriosis and benign ovarian cysts. If the CA125 level is raised, an urgent ultrasound scan of the abdomen and pelvis should be ordered. However, a CA125 test should not be used for screening asymptomatic women. Diagnosis of ovarian cancer is difficult and usually requires a diagnostic laparotomy.

      Management of ovarian cancer typically involves a combination of surgery and platinum-based chemotherapy. Unfortunately, 80% of women have advanced disease at the time of diagnosis, leading to a 5-year survival rate of only 46%. It was previously thought that infertility treatment increased the risk of ovarian cancer due to increased ovulation, but recent evidence suggests that this is not a significant factor. In fact, the combined oral contraceptive pill and multiple pregnancies have been shown to reduce the risk of ovarian cancer by reducing the number of ovulations.

    • This question is part of the following fields:

      • Gynaecology
      17.3
      Seconds
  • Question 4 - A 26-year-old woman with type 1 diabetes becomes pregnant.
    Which of the following statements...

    Correct

    • A 26-year-old woman with type 1 diabetes becomes pregnant.
      Which of the following statements is correct?

      Your Answer: There is an increased risk of polyhydramnios

      Explanation:

      Misconceptions about Diabetes in Pregnancy

      During pregnancy, diabetic patients are at an increased risk of developing polyhydramnios, which is diagnosed when the amniotic fluid index is >25 cm or if the deepest vertical pool is >8 cm. Contrary to popular belief, fetal macrosomia is a risk of a diabetic pregnancy, rather than microsomia. All patients should be treated with insulin because this has no teratogenic effects, in contrast to oral hypoglycaemics. The mortality rate from DKA in pregnant patients approaches 50%, so very close monitoring and counselling about the importance of good diabetic control are essential. Hypertension in pregnancy may be treated with other anti-hypertensives, eg labetalol or methyldopa, as ACE inhibitors are contraindicated in pregnancy because they are associated with oligohydramnios.

      Debunking Common Myths about Diabetes in Pregnancy

    • This question is part of the following fields:

      • Obstetrics
      19.5
      Seconds
  • Question 5 - A 29-year-old soccer player hits the side of his head on a goal...

    Incorrect

    • A 29-year-old soccer player hits the side of his head on a goal post while attempting to make a save. Initially, he seems disoriented but quickly recovers and walks off the field without assistance. However, after the game ends, approximately 60 minutes later, he experiences confusion and complains of a severe headache. He stumbles and falls before becoming drowsy and starting to lose consciousness. Emergency services are contacted.
      Which artery is most likely to have been affected by the impact to this individual's head?

      Your Answer: Supraorbital artery

      Correct Answer: Middle meningeal artery

      Explanation:

      Arteries of the Head: Middle Meningeal, Temporal, Occipital, Supraorbital, and Posterior Auricular Arteries

      The head is supplied by various arteries, each with its own unique course and function. One of these arteries is the middle meningeal artery, which arises from the maxillary artery and enters the middle cranial fossa via the foramen spinosum. It supplies the dura and calvaria and can be injured by a direct blow to the side of the head, resulting in an extradural hematoma.

      Another important artery is the temporal artery, which originates from the external carotid artery and supplies various parts of the scalp and face. It is commonly biopsied to aid in the diagnosis of temporal arthritis.

      The occipital artery, on the other hand, arises from the external carotid artery at the level of the digastric muscle and supplies the neck and auricular structures. It is not involved in blunt trauma to the side of the head.

      The supraorbital artery, a branch of the ophthalmic artery, supplies the extraocular muscles and exits the orbit via the supraorbital notch. It is not damaged in blunt injuries to the side of the head as it runs in the frontal area.

      Lastly, the posterior auricular artery, a branch of the external carotid artery, supplies the auricle and the scalp posterior to it. It ascends posteriorly to the parotid gland, between the auricular cartilage and mastoid process of the temporal bone.

      Understanding the different arteries of the head is crucial in diagnosing and treating injuries and conditions that affect these structures.

    • This question is part of the following fields:

      • Neurosurgery
      25.2
      Seconds
  • Question 6 - As a healthcare professional, you are requested to address a family who have...

    Incorrect

    • As a healthcare professional, you are requested to address a family who have recently been informed of a diagnosis of pulmonary hypoplasia on fetal MRI. What is the most frequent cause of pulmonary hypoplasia?

      Your Answer: Tetralogy of Fallot

      Correct Answer: Congenital diaphragmatic hernia

      Explanation:

      Pulmonary hypoplasia in CDH is not a direct result of hernial development but rather occurs alongside it as part of a sequence. It is caused by oligohydramnios, which reduces the size of the intrathoracic cavity and prevents foetal lung growth. Other less common causes of pulmonary hypoplasia include diaphragm agenesis, tetralogy of Fallot, and osteogenesis imperfecta.

      Understanding Pulmonary Hypoplasia in Newborns

      Pulmonary hypoplasia is a condition that affects newborn infants, where their lungs are underdeveloped. This means that the lungs are smaller than they should be, and they may not function properly. There are several causes of pulmonary hypoplasia, including oligohydramnios and congenital diaphragmatic hernia.

      Oligohydramnios is a condition where there is a low level of amniotic fluid in the womb. This can happen for a variety of reasons, such as a problem with the placenta or a leak in the amniotic sac. When there is not enough amniotic fluid, the baby may not have enough room to move around and develop properly. This can lead to pulmonary hypoplasia, as the lungs do not have enough space to grow.

      Congenital diaphragmatic hernia is a condition where there is a hole in the diaphragm, which is the muscle that separates the chest cavity from the abdominal cavity. This can allow the organs in the abdomen to move up into the chest cavity, which can put pressure on the lungs and prevent them from developing properly. This can also lead to pulmonary hypoplasia.

      In summary, pulmonary hypoplasia is a condition where newborn infants have underdeveloped lungs. It can be caused by a variety of factors, including oligohydramnios and congenital diaphragmatic hernia. It is important to diagnose and treat this condition as soon as possible, as it can lead to serious health problems for the baby.

    • This question is part of the following fields:

      • Paediatrics
      16.3
      Seconds
  • Question 7 - A 75-year-old man is taking warfarin for paroxysmal atrial fibrillation. He has been...

    Correct

    • A 75-year-old man is taking warfarin for paroxysmal atrial fibrillation. He has been referred to the Medical Admissions Unit from the Community Warfarin Clinic with an INR of 9.0. He has recently finished a course of antibiotics prescribed by his GP.
      Which antibiotic is the most probable cause of the elevated INR?

      Your Answer: Clarithromycin

      Explanation:

      Impact of Antibiotics on Warfarin Metabolism

      Antibiotics can have varying effects on the metabolism of warfarin, a commonly prescribed blood thinner. Clarithromycin, a macrolide antibiotic, inhibits the cytochrome P450 system and can lead to an accumulation of warfarin, resulting in a raised INR. On the other hand, broad-spectrum antibiotics like amoxicillin may alter warfarin metabolism through their impact on gut flora, but the effect is likely to be less significant. Trimethoprim and nitrofurantoin are not known to affect warfarin metabolism. Rifampicin, however, induces the cytochrome P450 system and may increase the first-pass metabolism of warfarin, leading to a reduction in INR levels. It is important for healthcare providers to be aware of these potential interactions when prescribing antibiotics to patients taking warfarin.

    • This question is part of the following fields:

      • Pharmacology
      11.7
      Seconds
  • Question 8 - A 65-year-old man presents to the GP with a 3-week history of generalised...

    Correct

    • A 65-year-old man presents to the GP with a 3-week history of generalised fatigue and weakness. He reports difficulty walking or standing for extended periods and struggles to get up from chairs. During examination, a violaceous non-oedematous rash is observed around his eyes, and his hands are extremely dry. Additionally, rough red papules are present over the extensor surfaces of his fingers. He has smoked 20 cigarettes a day for the last 45 years.
      What is the most crucial next step in managing his likely diagnosis?

      Your Answer: Malignancy screening

      Explanation:

      Dermatomyositis is often associated with an underlying malignancy, therefore malignancy screening is necessary. The patient’s symptoms, including proximal muscle weakness, heliotrope rash, dry hands, and Gottron’s papules, suggest a diagnosis of dermatomyositis. While an electromyogram may aid in diagnosis, it is not essential. Fundoscopy and referral to ophthalmology are not necessary as there are no eye-related symptoms. Instead, screening for malignancy through chest x-rays, CT scans, and blood tests is crucial.

      Dermatomyositis is a condition that causes inflammation and muscle weakness, as well as distinct skin lesions. It can occur on its own or be associated with other connective tissue disorders or underlying cancers, particularly ovarian, breast, and lung cancer. Screening for cancer is often done after a diagnosis of dermatomyositis. Polymyositis is a variant of the disease that does not have prominent skin manifestations.

      The skin features of dermatomyositis include a photosensitive macular rash on the back and shoulders, a heliotrope rash around the eyes, roughened red papules on the fingers’ extensor surfaces (known as Gottron’s papules), extremely dry and scaly hands with linear cracks on the fingers’ palmar and lateral aspects (known as mechanic’s hands), and nail fold capillary dilation. Other symptoms may include proximal muscle weakness with tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease (such as fibrosing alveolitis or organizing pneumonia), dysphagia, and dysphonia.

      Investigations for dermatomyositis typically involve testing for ANA antibodies, which are positive in around 80% of patients. Approximately 30% of patients have antibodies to aminoacyl-tRNA synthetases, including antibodies against histidine-tRNA ligase (also called Jo-1), antibodies to signal recognition particle (SRP), and anti-Mi-2 antibodies.

    • This question is part of the following fields:

      • Musculoskeletal
      26.3
      Seconds
  • Question 9 - A 32-year-old woman is 24 weeks pregnant and she receives a letter about...

    Correct

    • A 32-year-old woman is 24 weeks pregnant and she receives a letter about her routine cervical smear. She asks her obstetrician if she should make an appointment for her smear. All her smears in the past have been negative. What should the obstetrician advise?

      Your Answer: Reschedule the smear to occur at least 12 weeks post-delivery

      Explanation:

      According to NICE guidelines, women who are due for routine cervical screening should wait until 12 weeks after giving birth. If a woman has had an abnormal smear in the past and becomes pregnant, she should seek specialist advice. If there are no contraindications, such as a low-lying placenta, a cervical smear can be performed during the middle trimester of pregnancy. It is crucial to encourage women to participate in regular cervical screening.

      Cervical Cancer Screening in the UK

      Cervical cancer screening is a well-established program in the UK that aims to detect pre-malignant changes in the cervix. This program is estimated to prevent 1,000-4,000 deaths per year. However, it should be noted that around 15% of cervical adenocarcinomas are frequently undetected by screening.

      The screening program has evolved significantly in recent years. Initially, smears were examined for signs of dyskaryosis, which may indicate cervical intraepithelial neoplasia. However, the introduction of HPV testing allowed for further risk stratification, and the NHS has now moved to an HPV first system. This means that a sample is tested for high-risk strains of human papillomavirus (hrHPV) first, and cytological examination is only performed if this is positive.

      All women between the ages of 25-64 years are offered a smear test. Women aged 25-49 years are screened every three years, while those aged 50-64 years are screened every five years. However, cervical screening cannot be offered to women over 64. In Scotland, screening is offered from 25-64 every five years.

      In special situations, cervical screening in pregnancy is usually delayed until three months post-partum, unless there are missed screenings or previous abnormal smears. Women who have never been sexually active have a very low risk of developing cervical cancer and may wish to opt-out of screening.

      It is recommended to take a cervical smear around mid-cycle, although there is limited evidence to support this advice. Overall, the UK’s cervical cancer screening program is an essential tool in preventing cervical cancer and promoting women’s health.

    • This question is part of the following fields:

      • Obstetrics
      19.2
      Seconds
  • Question 10 - Which ONE of the following women has gestational hypertension?

    Rewritten: Which ONE of the...

    Incorrect

    • Which ONE of the following women has gestational hypertension?

      Rewritten: Which ONE of the following women, who are all 35 years old, has gestational hypertension?

      Your Answer: 32 weeks gestation and BP 170/100 and proteinuria ++

      Correct Answer: 22 weeks gestation and BP 150/100 and no proteinuria

      Explanation:

      If high blood pressure occurs after 20 weeks gestation and there is no proteinuria, it is considered gestational hypertension. However, if high blood pressure is present before 20 weeks, it is likely pre-existing hypertension.

      Hypertension during pregnancy is a common occurrence that requires careful management. In normal pregnancies, blood pressure tends to decrease in the first trimester and then gradually increase to pre-pregnancy levels by term. However, in cases of hypertension during pregnancy, the systolic blood pressure is usually above 140 mmHg or the diastolic blood pressure is above 90 mmHg. Additionally, an increase of more than 30 mmHg systolic or 15 mmHg diastolic from the initial readings may also indicate hypertension.

      There are three categories of hypertension during pregnancy: pre-existing hypertension, pregnancy-induced hypertension (PIH), and pre-eclampsia. Pre-existing hypertension refers to a history of hypertension before pregnancy or elevated blood pressure before 20 weeks gestation. PIH occurs in the second half of pregnancy and resolves after birth. Pre-eclampsia is characterized by hypertension and proteinuria, and may also involve edema.

      The management of hypertension during pregnancy involves the use of antihypertensive medications such as labetalol, nifedipine, and hydralazine. In cases of pre-existing hypertension, ACE inhibitors and angiotensin II receptor blockers should be stopped immediately and alternative medications should be prescribed. Women who are at high risk of developing pre-eclampsia should take aspirin from 12 weeks until the birth of the baby. It is important to carefully monitor blood pressure and proteinuria levels during pregnancy to ensure the health of both the mother and the baby.

    • This question is part of the following fields:

      • Obstetrics
      35
      Seconds
  • Question 11 - A 85-year-old, previously healthy woman comes to the Emergency department after collapsing at...

    Correct

    • A 85-year-old, previously healthy woman comes to the Emergency department after collapsing at home. She looks pale and breathless, with a respiratory rate of 28, oxygen saturation of 98% on room air, a heart rate of 64 bpm sinus, and a blood pressure of 164/88 mmHg. Her haemoglobin level is 70 g/L (115-165), and tests are being conducted to determine the cause.

      What is the best approach to enhance her oxygenation?

      Your Answer: Transfuse two units of blood

      Explanation:

      Interpreting Oxygen Saturation in Anemic Patients

      Interpreting oxygen saturation levels in anemic patients can be misleading. While a patient may have a saturation level of 98%, it does not necessarily mean that they have enough oxygen in their blood. This is because the patient may not have enough hemoglobin to carry the oxygen. To calculate the amount of oxygen per liter of blood, the equation (13.9 × Hb × sats/100) + (PaO2 × 0.03) ml O2/litre blood can be used. The latter part of the equation refers to the amount of dissolved oxygen in the blood and can be ignored for now.

      Advising an anemic patient to breathe more rapidly may slightly increase their oxygen saturation levels, but it will cause them to blow off all their CO2 and experience tingling in their fingers and around their mouth. Increasing their saturation levels from 98% to 100% will not make a significant difference. Similarly, advising the patient to breathe more slowly is unlikely to have any significant effect. Giving the patient maximum oxygen through a facemask or artificial ventilation will also not be helpful since the limiting factor is the amount of hemoglobin.

      In cases where anemic patients require oxygen therapy, it is important to consider their hemoglobin levels. One unit of blood transfusion can raise Hb by approximately 10 grams/L, which can make a significant difference in the amount of oxygen carried by the blood. Therefore, in such cases, administering two units of blood transfusion may be the most effective solution.

    • This question is part of the following fields:

      • Basic Sciences
      42.6
      Seconds
  • Question 12 - A 28-year-old woman has recently delivered a baby in the labour ward. Following...

    Incorrect

    • A 28-year-old woman has recently delivered a baby in the labour ward. Following the delivery, an evaluation is conducted to determine the amount of blood loss for recording purposes. The medical records indicate that she experienced a primary postpartum haemorrhage. Can you provide the accurate definition of primary postpartum haemorrhage (PPH)?

      Your Answer: The loss of 1000 ml or more of blood from the genital tract within 24 hours of the birth of a baby

      Correct Answer: The loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby

      Explanation:

      Maternal mortality rates are still high globally due to obstetric haemorrhage. Postpartum haemorrhage is characterized by blood loss of 500 ml after vaginal delivery, not including the placenta. If blood loss exceeds 1000mls, it is classified as major postpartum haemorrhage. It is crucial to evaluate the severity of the bleeding and seek appropriate management (as outlined below).

      Understanding Postpartum Haemorrhage

      Postpartum haemorrhage (PPH) is a condition where a woman experiences blood loss of more than 500 ml after giving birth vaginally. It can be classified as primary or secondary. Primary PPH occurs within 24 hours after delivery and is caused by the 4 Ts: tone, trauma, tissue, and thrombin. The most common cause is uterine atony. Risk factors for primary PPH include previous PPH, prolonged labour, pre-eclampsia, increased maternal age, emergency Caesarean section, and placenta praevia.

      In managing PPH, it is important to involve senior staff immediately and follow the ABC approach. This includes two peripheral cannulae, lying the woman flat, blood tests, and commencing a warmed crystalloid infusion. Mechanical interventions such as rubbing up the fundus and catheterisation are also done. Medical interventions include IV oxytocin, ergometrine, carboprost, and misoprostol. Surgical options such as intrauterine balloon tamponade, B-Lynch suture, ligation of uterine arteries, and hysterectomy may be considered if medical options fail to control the bleeding.

      Secondary PPH occurs between 24 hours to 6 weeks after delivery and is typically due to retained placental tissue or endometritis. It is important to understand the causes and risk factors of PPH to prevent and manage this life-threatening emergency effectively.

    • This question is part of the following fields:

      • Obstetrics
      37.3
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  • Question 13 - A 26-year-old male patient arrives at the Emergency department complaining of mild left...

    Correct

    • A 26-year-old male patient arrives at the Emergency department complaining of mild left testicular pain and dysuria that has been going on for six days. During the examination, the patient's scrotum is inflamed, and the epididymis is the most tender area. The patient has a temperature of 37.9°C, and the urine dipstick test came back negative. The cremasteric reflex is present.

      What is the most appropriate management plan for the underlying cause of this patient's symptoms?

      Your Answer: Doxycycline 100 mg bd for 10 days (or single dose 1g azithromycin) plus IM ceftriaxone

      Explanation:

      Acute Epididymitis and its Treatment

      Acute epididymitis is a condition characterized by the inflammation of the epididymis, which causes pain and swelling in the testicles over several days. It is most commonly caused by sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae in patients under 35 years old. In contrast, urinary coliforms are the most common cause in children and men over 35 years old.

      To treat acute epididymitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae, a combination of antibiotics is required. A course of doxycycline or a single dose of azithromycin can cover chlamydia, while ceftriaxone can cover Neisseria, which can be resistant to other antibiotics. It is important to note that single agents do not cover both infections.

      Symptomatic relief can be achieved through the use of anti-inflammatory drugs and scrotal support, but they do not treat the underlying cause. It is crucial to seek medical attention promptly to prevent complications and ensure proper treatment.

      In summary, acute epididymitis is a painful condition that requires a combination of antibiotics to treat the underlying infection. Prompt medical attention and proper treatment are essential to prevent complications and achieve symptomatic relief.

    • This question is part of the following fields:

      • Surgery
      21.5
      Seconds
  • Question 14 - A 50-year-old man visits the Respiratory Outpatients Department complaining of a dry cough...

    Incorrect

    • A 50-year-old man visits the Respiratory Outpatients Department complaining of a dry cough and increasing breathlessness. During the examination, the doctor observes finger clubbing, central cyanosis, and fine end-inspiratory crackles upon auscultation. The chest X-ray shows reticular shadows and peripheral honeycombing, while respiratory function tests indicate a restrictive pattern with reduced lung volumes but a normal forced expiratory volume in 1 second (FEV1): forced vital capacity (FVC) ratio. The patient's pulmonary fibrosis is attributed to which of the following medications?

      Your Answer: Spironolactone

      Correct Answer: Bleomycin

      Explanation:

      Drug-Induced Pulmonary Fibrosis: Causes and Investigations

      Pulmonary fibrosis is a condition characterized by scarring of the lungs, which can be caused by various diseases and drugs. One drug that has been linked to pulmonary fibrosis is bleomycin, while other causes include pneumoconiosis, occupational lung diseases, and certain medications. To aid in diagnosis, chest X-rays, high-resolution computed tomography (CT), and lung function tests may be performed. Treatment involves addressing the underlying cause. However, drugs such as aspirin, ramipril, spironolactone, and simvastatin have not been associated with pulmonary fibrosis. It is important to be aware of the potential risks of certain medications and to monitor for any adverse effects.

    • This question is part of the following fields:

      • Respiratory
      31.1
      Seconds
  • Question 15 - A 32-year-old G3P2 woman at 16 weeks gestation visits her doctor with concerns...

    Correct

    • A 32-year-old G3P2 woman at 16 weeks gestation visits her doctor with concerns about a new rash on her 6-year-old daughter's arm that appeared 2 days ago. The rash looks vesicular, and the mother reports that there is a chickenpox outbreak at school. The patient is unsure if she had chickenpox in her childhood.

      What should be the next step in managing this situation?

      Your Answer: Check the patient's varicella-zoster antibodies

      Explanation:

      The first step in managing chickenpox exposure during pregnancy is to confirm the patient’s immunity by checking her varicella-zoster antibodies. If the woman is unsure about her past exposure to chickenpox, this test will determine if she has antibodies to the virus. If the test confirms her immunity, no further action is necessary. Administering the varicella-zoster vaccine or IV immunoglobulin is not appropriate in this situation. Neglecting to check the patient’s immunity status can put her and her unborn child at risk.

      Chickenpox exposure in pregnancy can pose risks to both the mother and fetus, including fetal varicella syndrome. Post-exposure prophylaxis (PEP) with varicella-zoster immunoglobulin (VZIG) or antivirals should be given to non-immune pregnant women, with timing dependent on gestational age. If a pregnant woman develops chickenpox, specialist advice should be sought and oral acyclovir may be given if she is ≥ 20 weeks and presents within 24 hours of onset of the rash.

    • This question is part of the following fields:

      • Obstetrics
      16.6
      Seconds
  • Question 16 - A 65-year-old man with a history of diabetes mellitus complains of a swollen...

    Incorrect

    • A 65-year-old man with a history of diabetes mellitus complains of a swollen right ankle joint that is not painful. Upon examination, radiographs reveal a joint that has been destroyed and contains a significant number of loose bodies. What is the most likely diagnosis?

      Your Answer: Perthes Disease

      Correct Answer: Charcot's joint

      Explanation:

      Charcot’s Joint: A Destructive Process Affecting Weight-Bearing Joints

      Charcot’s joint is a condition that primarily affects the weight-bearing joints in the extremities, including the feet, ankles, knees, and hips. It is a destructive process that can often be mistaken for an infection in these areas. The condition is characterized by a decreased sensation in the affected area and peripheral neuropathy. It is most commonly associated with diabetes mellitus, leprosy, and tabes dorsalis.

      Charcot’s joint is a serious condition that can lead to significant disability if left untreated. It is important to recognize the symptoms and seek medical attention promptly. Treatment typically involves immobilization of the affected joint and management of the underlying condition. With proper care, it is possible to prevent further damage and preserve joint function.

    • This question is part of the following fields:

      • Endocrinology
      16.1
      Seconds
  • Question 17 - A mother brings her 10-year-old daughter who was recently diagnosed with attention-deficit/hyperactivity disorder...

    Correct

    • A mother brings her 10-year-old daughter who was recently diagnosed with attention-deficit/hyperactivity disorder (ADHD).
      She is visiting the clinic as she is still having difficulty managing her daughter's disruptive and challenging behavior, despite receiving group-based support and environmental modifications.
      What is the primary treatment option for managing ADHD?

      Your Answer: Methylphenidate

      Explanation:

      Management of ADHD: First-Line Treatment and Other Options

      Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects young people. While group-based support and environmental modifications can be helpful, medication and therapy are often necessary for ongoing, persistent impairment. Here are some options for managing ADHD:

      First-Line Treatment: Methylphenidate
      Methylphenidate is a central nervous system stimulant that is considered first-line treatment for young people with ADHD who still have significant symptoms despite other interventions. However, it is not approved for use in children under six years and requires monitoring of height, weight, heart rate, blood pressure, and ECG.

      Therapy: Cognitive Behavioural Therapy (CBT)
      CBT can be helpful for patients who have already tried medication but continue to have significant symptoms. It can cover topics such as social skills, active listening, self-control, and expression of feelings.

      Alternative Medication: Dexamphetamine
      Dexamphetamine is an option for patients who cannot tolerate or do not respond to methylphenidate. However, it is not first-line treatment.

      Not Recommended: Diazepam and Melatonin
      Diazepam is not recommended for sedation in patients with ADHD. Melatonin can be used for regulating sleep in patients with learning difficulties, but it is not routinely used for ADHD management.

      In summary, ADHD management requires a tailored approach that may involve medication, therapy, or both. Methylphenidate is the first-line treatment, but other options are available for patients who do not respond or cannot tolerate it.

    • This question is part of the following fields:

      • Psychiatry
      18.6
      Seconds
  • Question 18 - A 35-year-old man has been diagnosed with ankylosing spondylitis and his condition is...

    Incorrect

    • A 35-year-old man has been diagnosed with ankylosing spondylitis and his condition is not well controlled. His rheumatologist suggests starting him on a new medication. In cases of predominantly axial disease, how many non-steroidal anti-inflammatory drugs must be ineffective before anti-TNF alpha inhibitors can be considered?

      Your Answer: 3

      Correct Answer: 2

      Explanation:

      In cases of axial ankylosing spondylitis that have not responded to two different NSAIDs and meet the criteria for active disease on two separate occasions 12 weeks apart, the use of anti-TNF alpha inhibitors is recommended. Additionally, physiotherapy should be incorporated throughout the treatment process.

      Investigating and Managing Ankylosing Spondylitis

      Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in males aged 20-30 years old. Inflammatory markers such as ESR and CRP are usually elevated, but normal levels do not necessarily rule out ankylosing spondylitis. HLA-B27 is not a reliable diagnostic tool as it can also be positive in normal individuals. The most effective way to diagnose ankylosing spondylitis is through a plain x-ray of the sacroiliac joints. However, if the x-ray is negative but suspicion for AS remains high, an MRI can be obtained to confirm the diagnosis.

      Management of ankylosing spondylitis involves regular exercise, such as swimming, and the use of NSAIDs as the first-line treatment. Physiotherapy can also be helpful. Disease-modifying drugs used for rheumatoid arthritis, such as sulphasalazine, are only useful if there is peripheral joint involvement. Anti-TNF therapy, such as etanercept and adalimumab, should be given to patients with persistently high disease activity despite conventional treatments, according to the 2010 EULAR guidelines. Ongoing research is being conducted to determine whether anti-TNF therapies should be used earlier in the course of the disease. Spirometry may show a restrictive defect due to a combination of pulmonary fibrosis, kyphosis, and ankylosis of the costovertebral joints.

    • This question is part of the following fields:

      • Musculoskeletal
      14.2
      Seconds
  • Question 19 - A 2-year-old presents with a 5-day history of high fever and coryza. His...

    Incorrect

    • A 2-year-old presents with a 5-day history of high fever and coryza. His parents bring him to clinic with a rash that started today on his chest and has now spread to his arms. He has been off his food for the last 48 hours, but his fever has settled. On examination, he is apyrexial. Other vital signs are normal. He is alert and responsive. He has cervical lymphadenopathy, with enlarged red tonsils but no pus. Both tympanic membranes are slightly pink. His chest is clear. He has a pink blanching maculopapular rash to his torso and arms.
      What is the diagnosis?

      Your Answer: Scarlet fever

      Correct Answer: Roseola infantum

      Explanation:

      Common Childhood Infections and Their Symptoms

      Roseola Infantum, Glandular Fever, Parvovirus Infection, Scarlet Fever, and Meningococcal Septicaemia are some of the common childhood infections that parents should be aware of.

      Roseola Infantum is caused by herpesvirus 6 and is characterized by high fever lasting for 3-5 days, followed by a rash on the body. Glandular Fever, caused by Epstein-Barr virus, presents with general malaise, sore throat, fever, and abdominal pain. Parvovirus Infection causes erythema infectiosum, with a rash starting on the cheeks and spreading to the limbs. Scarlet Fever, associated with Streptococcus pyogenes, presents with a sandpaper-like rash on the neck, chest, and trunk, and a red, strawberry-like tongue. Meningococcal Septicaemia is characterized by a haemorrhagic, non-blanching rash or purpura found all over the body.

      It is important for parents to be aware of the symptoms of these infections and seek medical attention if necessary.

    • This question is part of the following fields:

      • Paediatrics
      38.3
      Seconds
  • Question 20 - What is the dermatological condition that is linked to neurofibromatosis type 1? ...

    Incorrect

    • What is the dermatological condition that is linked to neurofibromatosis type 1?

      Your Answer: Vitiligo

      Correct Answer: Café au lait spots

      Explanation:

      Neurofibromatosis Type 1 and Type 2

      Neurofibromatosis is a genetic disorder that affects the 17th chromosome and is inherited in an autosomal dominant manner. There are two types of neurofibromatosis: type 1 and type 2. Type 1 is also known as von Recklinghausen’s disease and is characterized by flat, light-brown skin lesions called café au lait spots, axillary freckling, small purple-colored lesions called dermal neurofibromas, nodular neurofibromas that can cause paraesthesia when compressed, and Lisch nodules on the iris. Complications of type 1 neurofibromatosis include nerve compression, phaeochromocytoma, mild learning disability, and epilepsy.

      Type 2 neurofibromatosis is much rarer than type 1 and also demonstrates autosomal dominant inheritance. In addition to café au lait spots, individuals with type 2 may also develop vestibular schwannomas (acoustic neuromas) and premature cataracts. It is important to note that while both types of neurofibromatosis share some similarities, they also have distinct differences in their clinical presentation and associated complications. these differences can aid in accurate diagnosis and management of these conditions.

    • This question is part of the following fields:

      • Dermatology
      4.8
      Seconds
  • Question 21 - A 65-year-old woman, whose children called for an ambulance due to concerns about...

    Correct

    • A 65-year-old woman, whose children called for an ambulance due to concerns about her breathing, has an arterial blood gas (ABG) test done. She is a frequent visitor to the Accident and Emergency department and has been experiencing a cough and producing green sputum for the past 6 days. She is currently receiving long-term oxygen therapy (LTOT) at home. While on controlled oxygen therapy through a Venturi system, her ABG results are as follows:
      Investigation Result Normal value
      pH 7.232 7.35–7.45
      CO2 8.9 kPa 3.5–4.5 kPa
      O2 9.4 kPa 8.0–10.0 kPa
      HCO3– 33 mmol/l 22.0–28.0 mmol/l
      SaO2 89%
      Lactate 2.1 0.1–2.2
      Which of the following statements best describes this ABG?

      Your Answer: Respiratory acidosis with partial metabolic compensation

      Explanation:

      Interpreting ABGs: Examples of Acid-Base Imbalances

      Acid-base imbalances can be identified through arterial blood gas (ABG) analysis. Here are some examples of ABGs and their corresponding acid-base imbalances:

      Respiratory acidosis with partial metabolic compensation
      This ABG indicates a patient with long-term chronic obstructive pulmonary disease (COPD) who has chronic carbon dioxide (CO2) retention and partial metabolic compensation (elevated bicarbonate (HCO3)). However, during an infective exacerbation of COPD, the patient’s hypoxia and hypercapnia worsened, resulting in a more severe acidaemia. The metabolic compensation is therefore only partial.

      Respiratory acidosis with complete metabolic compensation
      This ABG shows respiratory acidosis with a low pH due to CO2 retention. Despite some metabolic compensation, this is an acute-on-chronic change that has led to a worsening of the acidaemia.

      Metabolic acidosis with partial respiratory compensation
      In this ABG, a patient with chronic COPD who has presented with an infective exacerbation shows respiratory acidosis with partial metabolic compensation.

      Metabolic alkalosis with respiratory compensation
      This ABG indicates acidaemia due to a chronic respiratory disease.

      Respiratory acidosis without compensation
      Although this ABG shows respiratory acidosis, there is an element of metabolic compensation, as evidenced by the rise in HCO3.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      50.5
      Seconds
  • Question 22 - A 3-month-old boy is brought to the emergency department by his mother. She...

    Incorrect

    • A 3-month-old boy is brought to the emergency department by his mother. She reports a 3 hour history of a non-blanching rash all over his body. She also mentions that he has been more fussy than usual and has been refusing to eat.
      Upon examination, the baby has a temperature of 38.9ºC and a non-blanching petechial rash with overall hypotonia. The anterior fontanelle is also bulging.
      Based on the likely diagnosis and appropriate investigation, what would be the most suitable initial management option?

      Your Answer: IV amoxicillin and IV dexamethasone

      Correct Answer: IV cefotaxime and IV amoxicillin

      Explanation:

      When dealing with suspected or confirmed bacterial meningitis in children under 3 months old, it is not recommended to use corticosteroids. Instead, the most appropriate treatment option would be a combination of IV cefotaxime and IV amoxicillin. IV cefotaxime is effective in covering for pneumococcal and haemophilus influenzae, but since children under 3 months are at risk of listeria monocytogenes as a cause of bacterial meningitis, amoxicillin is necessary to provide adequate coverage. It is important to note that IV dexamethasone is typically given to patients with bacterial meningitis to reduce the risk of neurological complications, but this is not recommended for children under 3 months old.

      Investigation and Management of Meningitis in Children

      Meningitis is a serious condition that can affect children. When investigating meningitis, it is important to note any contraindications to lumbar puncture, such as signs of raised intracranial pressure, focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, or signs of cerebral herniation. For patients with meningococcal septicaemia, a lumbar puncture is contraindicated, and blood cultures and PCR for meningococcus should be obtained instead.

      The management of meningitis in children involves administering antibiotics, such as IV amoxicillin (or ampicillin) and IV cefotaxime for children under three months, and IV cefotaxime (or ceftriaxone) for children over three months. Steroids should be considered if the lumbar puncture reveals certain findings, such as purulent cerebrospinal fluid, a high white blood cell count, or bacteria on Gram stain. Fluids should be administered to treat shock, and cerebral monitoring should be conducted, including mechanical ventilation if necessary.

      It is also important to notify public health authorities and administer antibiotic prophylaxis to contacts. Ciprofloxacin is now preferred over rifampicin for this purpose. Overall, prompt and appropriate management of meningitis in children is crucial for ensuring the best possible outcomes.

    • This question is part of the following fields:

      • Paediatrics
      26.5
      Seconds
  • Question 23 - A 47-year-old patient arrives at the dialysis center for their thrice-weekly haemodialysis. They...

    Correct

    • A 47-year-old patient arrives at the dialysis center for their thrice-weekly haemodialysis. They have end stage renal failure caused by membranous glomerulonephritis and no other health issues. The patient reports feeling fatigued but is otherwise in good health. During routine blood work, their haemoglobin level is found to be 89 g/L (115-165). If the anaemia is a result of their renal disease, what is the appropriate treatment for this patient?

      Your Answer: Intravenous iron plus or minus parenteral erythropoietin

      Explanation:

      Patients with end stage kidney disease have poor iron absorption and lack endogenous erythropoietin, making parenteral iron replacement and erythropoietin the best management. Anaemia is common in these patients due to poor oral iron absorption and GI blood loss. Acute packed red cell transfusion is extreme and renal transplant may be an option, but the patient’s haemoglobin can be modified with increased IV iron and epo doses. Oral iron tablets are poorly absorbed and tolerated.

    • This question is part of the following fields:

      • Nephrology
      24.7
      Seconds
  • Question 24 - A 26-year-old man has been brought to the Psychiatric Ward by his family...

    Incorrect

    • A 26-year-old man has been brought to the Psychiatric Ward by his family members who are concerned about his mental health. They believe he needs to be admitted to the hospital to be formally assessed by Psychiatry. He has been detained under the Mental Health Act (MHA), as he would not agree to be admitted voluntarily. The situation is not an emergency.
      What is the appropriate duration for the Section to be valid when admitting this patient under the MHA for assessment?

      Your Answer: 72 hours

      Correct Answer: 28 days

      Explanation:

      Time Limits for Detention under the Mental Health Act

      The Mental Health Act (MHA) provides legal frameworks for the detention and treatment of individuals with mental health disorders. Different sections of the MHA allow for varying periods of detention. Here are the time limits for detention under the MHA:

      Section 2: 28 days
      This section allows for admission for assessment in a non-emergency situation. An approved mental health professional can recommend this based on the advice of two doctors.

      Section 5(4): 6 hours
      This section permits a nurse to detain a patient who is already in the hospital for a further six hours.

      Section 136: 24 hours
      This section allows the police to take a patient to a place of safety if found in a public place. The detention period is up to 24 hours.

      Section 4: 72 hours
      This section is used in an emergency where Section 2 would cause delay. It allows for detention for up to 72 hours.

      Section 5(2): 72 hours
      This section permits a doctor to detain a patient who is already in the hospital for a further 72 hours.

      Section 3: 6 months
      This section allows for admission for treatment for up to six months. It can be renewed to allow for continued treatment.

      In conclusion, the MHA provides different time limits for detention depending on the circumstances. It is important to follow the appropriate section to ensure the rights of the patient are protected.

    • This question is part of the following fields:

      • Ethics And Legal
      22.4
      Seconds
  • Question 25 - A 72-year-old man is prescribed tamsulosin for benign prostatic hyperplasia. What are the...

    Correct

    • A 72-year-old man is prescribed tamsulosin for benign prostatic hyperplasia. What are the potential side-effects he may encounter?

      Your Answer: Dizziness + postural hypotension

      Explanation:

      Benign prostatic hyperplasia (BPH) is a common condition that affects older men, with around 50% of 50-year-old men showing evidence of BPH and 30% experiencing symptoms. The risk of BPH increases with age, with around 80% of 80-year-old men having evidence of the condition. BPH typically presents with lower urinary tract symptoms (LUTS), which can be categorised into voiding symptoms (obstructive) and storage symptoms (irritative). Complications of BPH can include urinary tract infections, retention, and obstructive uropathy.

      Assessment of BPH may involve dipstick urine tests, U&Es, and PSA tests. A urinary frequency-volume chart and the International Prostate Symptom Score (IPSS) can also be used to assess the severity of LUTS and their impact on quality of life. Management options for BPH include watchful waiting, alpha-1 antagonists, 5 alpha-reductase inhibitors, combination therapy, and surgery. Alpha-1 antagonists are considered first-line treatment for moderate-to-severe voiding symptoms, while 5 alpha-reductase inhibitors may be indicated for patients with significantly enlarged prostates and a high risk of progression. Combination therapy and antimuscarinic drugs may also be used in certain cases. Surgery, such as transurethral resection of the prostate (TURP), may be necessary in severe cases.

    • This question is part of the following fields:

      • Surgery
      7.4
      Seconds
  • Question 26 - A 35-year-old female patient reports a constant 'funny-bone' feeling in her left elbow,...

    Incorrect

    • A 35-year-old female patient reports a constant 'funny-bone' feeling in her left elbow, along with tingling in the pinky and ring fingers. The symptoms intensify when the elbow is flexed for extended periods. What is the probable diagnosis?

      Your Answer: Lateral epicondylitis

      Correct Answer: Cubital tunnel syndrome

      Explanation:

      Common Causes of Elbow Pain

      Elbow pain can be caused by a variety of conditions, each with their own characteristic features. Lateral epicondylitis, also known as tennis elbow, is characterized by pain and tenderness localized to the lateral epicondyle. Pain is worsened by resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended. Episodes typically last between 6 months and 2 years, with acute pain lasting for 6-12 weeks.

      Medial epicondylitis, or golfer’s elbow, is characterized by pain and tenderness localized to the medial epicondyle. Pain is aggravated by wrist flexion and pronation, and symptoms may be accompanied by numbness or tingling in the 4th and 5th finger due to ulnar nerve involvement.

      Radial tunnel syndrome is most commonly due to compression of the posterior interosseous branch of the radial nerve, and is thought to be a result of overuse. Symptoms are similar to lateral epicondylitis, but the pain tends to be around 4-5 cm distal to the lateral epicondyle. Symptoms may be worsened by extending the elbow and pronating the forearm.

      Cubital tunnel syndrome is due to the compression of the ulnar nerve. Initially, patients may experience intermittent tingling in the 4th and 5th finger, which may be worse when the elbow is resting on a firm surface or flexed for extended periods. Later, numbness in the 4th and 5th finger with associated weakness may occur.

      Olecranon bursitis is characterized by swelling over the posterior aspect of the elbow, with associated pain, warmth, and erythema. It typically affects middle-aged male patients. Understanding the characteristic features of these conditions can aid in their diagnosis and treatment.

    • This question is part of the following fields:

      • Musculoskeletal
      15.1
      Seconds
  • Question 27 - A 68-year-old retired ship dockland worker presents to the Medical Outpatient Department with...

    Incorrect

    • A 68-year-old retired ship dockland worker presents to the Medical Outpatient Department with a history of difficulty breathing, hoarse voice, weight loss and occasional night sweats. He also complains of difficulty in swallowing, although this happens very infrequently. He has also noticed that, in the past month, he has become easily tired when performing his daily activities.
      On examination, there is unilateral dullness to percussion at the right lung base, decreased breath sounds on the right side, asymmetrical chest wall expansion and scoliosis are observed. A chest X-ray demonstrates diffuse pleural thickening on the right side and decreased right lung volume. A positron emission tomography (PET) scan and video-assisted thoracoscopy (VAT) are performed to obtain the pleural biopsy, and a histopathological diagnosis is made.
      Which of the treatments could achieve the best possible outcome in this patient?

      Your Answer: Cisplatin plus pemetrexed

      Correct Answer: Combination therapy

      Explanation:

      Treatment Options for Malignant Pleural Mesothelioma

      Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the mesothelial cells of the pleural cavity, pericardium, mediastinum, and tunica vaginalis. Treatment options for MPM include non-surgical (chemotherapy, radiotherapy), surgical (macroscopic complete resection or MCR), and combined therapies.

      Combination therapy, which includes systemic chemotherapy, MCR, and radiotherapy, has been shown to prolong the relative survival time of MPM patients compared to chemotherapy alone. The choice of MCR procedure depends on the tumor characteristics, surgeon’s expertise, and local institutional protocols. Cisplatin plus pemetrexed is used in systemic chemotherapy for patients with unresectable tumors or those who do not qualify for curative surgery.

      Immunotherapeutic drugs, such as anti-programmed cell death protein 1 (PD-1) antibodies like pembrolizumab and nivolumab, have shown promising results in a few randomized controlled trials. However, the first line of treatment for unresectable MPM is pemetrexed and platinum-based compounds.

      Radiotherapy poses technical challenges due to the limited ipsilateral side involvement of MPM and the potential for radiation toxicity. Prophylactic doses of radiation are used before systemic chemotherapy and surgery, and three-dimensional techniques like intensity-modulated radiation therapy (IMRT) can deliver effective radiation doses while sparing healthy tissues. However, exposure of the contralateral lung to radiation can lead to pneumonitis.

      In conclusion, a combination of therapies, including systemic chemotherapy, MCR, and radiotherapy, can prolong the survival time of MPM patients. The choice of treatment depends on the tumor characteristics, patient selection, and institutional protocols. Immunotherapy and radiotherapy are also potential treatment options, but their use depends on the patient’s individual circumstances.

    • This question is part of the following fields:

      • Cardiothoracic
      41.8
      Seconds
  • Question 28 - A 14-year-old girl presents with a 3-day history of fever and polyarthralgia. She...

    Incorrect

    • A 14-year-old girl presents with a 3-day history of fever and polyarthralgia. She has widespread aches in multiple joints, including the hips, wrists and knees. She is normally fit and well, and the only medical history to note was eczema as a child, which she has now grown out of. The patient’s mother mentions that she did have a sore throat around two weeks ago, which was self-limiting. From the history and examination findings, the examining doctor feels that the patient is likely to have rheumatic fever.
      Which of the following is most likely to be the cause of rheumatic fever?

      Your Answer: Group B Streptococcus

      Correct Answer: Group A Streptococcus

      Explanation:

      Different Types of Streptococcus Bacteria and Their Associated Infections

      Streptococcus bacteria are a group of Gram-positive bacteria that can cause a variety of infections in humans. Here are some of the different types of Streptococcus bacteria and the infections they are associated with:

      1. Group A Streptococcus: This type of bacteria can cause rheumatic fever, tonsillitis, erysipelas, scarlet fever, cellulitis, septic arthritis, Henoch–Schönlein purpura, post-streptococcal autoimmunity, and erythema multiforme.

      2. Group B Streptococcus: This type of bacteria can cause septic abortion and bacterial meningitis.

      3. Gamma-haemolytic Streptococcus: This type of bacteria is classified as gamma-haemolytic because it does not break down red blood cells on blood agar plates.

      4. Streptococcus pneumoniae: This type of bacteria is a common cause of community-acquired pneumonia.

      5. Streptococcus viridans: This type of bacteria is an important cause of bacterial endocarditis.

      Overall, it is important to be aware of the different types of Streptococcus bacteria and the infections they can cause in order to properly diagnose and treat these infections.

    • This question is part of the following fields:

      • Microbiology
      28.1
      Seconds
  • Question 29 - A 50-year-old woman presents with fatigue, weight gain and constipation. On examination, she...

    Correct

    • A 50-year-old woman presents with fatigue, weight gain and constipation. On examination, she has cool and dry hands, bradycardia and slow-relaxing reflexes. When asked about medication, she reports taking a tablet for her mental health disorder for a prolonged period. Which medication is most likely responsible for her current symptoms?

      Your Answer: Lithium

      Explanation:

      Lithium and Hypothyroidism

      Lithium is a commonly used medication for bipolar disorder, but it has a narrow therapeutic window and can easily cause toxicity. One of the long-term side effects of lithium is hypothyroidism, which can present with symptoms such as cool hands, bradycardia, and slow reflexes. Treatment for hypothyroidism caused by lithium typically involves thyroxine. Other psychiatric medications, such as olanzapine, amitriptyline, clonazepam, and clozapine, are less likely to cause hypothyroidism and would not present with the same clinical picture.

    • This question is part of the following fields:

      • Pharmacology
      14.1
      Seconds
  • Question 30 - A 55-year-old man with a history of hypertension and type 2 diabetes presents...

    Incorrect

    • A 55-year-old man with a history of hypertension and type 2 diabetes presents to the Emergency department with complaints of central chest pain that radiates down his left arm. He is currently taking ramipril, metformin, atorvastatin, and gliclazide. On examination, his blood pressure is 129/72 mmHg, and his pulse is 81. Bibasal crackles are heard on auscultation of his chest.

      The following investigations were conducted:
      - Haemoglobin: 138 g/L (130-180)
      - White cell count: 8.9 ×109/L (4-11)
      - Platelet: 197 ×109/L (150-400)
      - Sodium: 141 mmol/L (135-146)
      - Potassium: 4.1 mmol/L (3.5-5)
      - Creatinine: 123 µmol/L (79-118)
      - Glucose: 12.3 mmol/L (<7.0)
      - ECG: Anterolateral ST depression

      The patient is given sublingual GTN. What is the next most appropriate therapy?

      Your Answer: Aspirin 300 mg and low molecular weight heparin

      Correct Answer: Aspirin 300 mg, clopidogrel 300 mg and unfractionated heparin

      Explanation:

      Treatment Plan for High-Risk Patient with Type 2 Diabetes Mellitus

      This patient, who has a history of type 2 diabetes mellitus, is considered high risk and requires immediate treatment. The recommended treatment plan includes loading the patient with both aspirin and clopidogrel to reduce the risk of further complications. If the patient experiences further chest pain or if ECG signs do not improve, additional interventions such as angiography may be necessary.

      In addition to aspirin and clopidogrel, unfractionated heparin is also recommended as an alternative to fondaparinux for patients who are likely to undergo coronary angiography within 24 hours of admission. If the patient does not progress to angiogram, screening for ischaemia should be considered prior to discharge.

      Overall, it is important to closely monitor this high-risk patient and adjust the treatment plan as necessary to ensure the best possible outcome.

    • This question is part of the following fields:

      • Endocrinology
      36.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/3) 0%
Gynaecology (2/2) 100%
Obstetrics (3/5) 60%
Neurosurgery (0/1) 0%
Paediatrics (0/3) 0%
Pharmacology (2/2) 100%
Musculoskeletal (1/3) 33%
Basic Sciences (1/1) 100%
Surgery (2/2) 100%
Respiratory (0/1) 0%
Psychiatry (1/1) 100%
Dermatology (0/1) 0%
Acute Medicine And Intensive Care (1/1) 100%
Nephrology (1/1) 100%
Ethics And Legal (0/1) 0%
Cardiothoracic (0/1) 0%
Microbiology (0/1) 0%
Passmed