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  • Question 1 - A 58-year-old woman presents to the emergency department with a 1-day history of...

    Correct

    • A 58-year-old woman presents to the emergency department with a 1-day history of facial paralysis. She also complains of some mild ear pain over the last 2 days. On examination, she has a fixed half-smile on the left side of her face. She is unable to raise her left eyelid and has increased sensitivity to sound in her left ear. She denies dizziness or vertigo. The remainder of her cranial nerve examination is normal. ENT examination shows an erythematous left ear canal and vesicles over her soft palate.
      What is the most appropriate treatment to initiate for the likely diagnosis?

      Your Answer: Oral aciclovir and prednisolone

      Explanation:

      When a patient presents with a facial nerve palsy and a vesicular rash, Ramsay Hunt syndrome should be considered. The vesicles may not be limited to the ear canal and can also appear on the tongue or soft palate. Treatment typically involves administering oral aciclovir and corticosteroids, unless the patient is severely ill. Ganciclovir is used to treat cytomegalovirus, while amoxicillin would be a more suitable option if bacterial otitis media was the underlying cause of the patient’s symptoms.

      Understanding Ramsay Hunt Syndrome

      Ramsay Hunt syndrome, also known as herpes zoster oticus, is a condition that occurs when the varicella zoster virus reactivates in the geniculate ganglion of the seventh cranial nerve. The first symptom of this condition is often auricular pain, followed by facial nerve palsy and a vesicular rash around the ear. Other symptoms may include vertigo and tinnitus.

      To manage Ramsay Hunt syndrome, doctors typically prescribe oral aciclovir and corticosteroids. These medications can help reduce the severity of symptoms and prevent complications.

    • This question is part of the following fields:

      • ENT
      40.2
      Seconds
  • Question 2 - A 45-year old woman became pregnant unexpectedly. She had given birth to five...

    Incorrect

    • A 45-year old woman became pregnant unexpectedly. She had given birth to five healthy children in her 20s and 30s with her now 47-year-old husband. Chorionic villus biopsy and karyotype analysis revealed that she was carrying a fetus with trisomy 21 (Down syndrome).
      What is the most likely cause of the condition?

      Your Answer: Spontaneous appearance of an autosomal dominant mutation in her fetus

      Correct Answer: The mother’s age

      Explanation:

      Down syndrome is a genetic condition that is caused by three mechanisms. The most common cause is Trisomy 21, which occurs when there is a non-separation of the homologous chromosomes during meiosis. This risk increases with advancing maternal age, with a likelihood of 1 in 1500 at age 20 and 1 in 50 at age 45 or older. Translocation, where part of chromosome 21 attaches to another chromosome, accounts for about 4% of cases. Mosaicism, where only some cells carry the extra copy of chromosome 21, is the rarest type. Paternal age is not a significant factor, but if either parent is a translocation carrier, there is a 1 in 2 chance of passing it on to their offspring. A spontaneous mutation in the fetus is not a cause of Down syndrome.

    • This question is part of the following fields:

      • Genetics
      32.3
      Seconds
  • Question 3 - A patient with small-cell lung cancer at the age of 60 has a...

    Correct

    • A patient with small-cell lung cancer at the age of 60 has a serum sodium concentration of 121 mmol/l. Which of the following is the most likely cause?

      Your Answer: SIADH

      Explanation:

      Understanding SIADH: The Syndrome of Inappropriate Antidiuretic Hormone Secretion

      SIADH, or the syndrome of inappropriate antidiuretic hormone secretion, is a condition where the body produces too much vasopressin (ADH), leading to overhydration in both the intracellular and extracellular compartments. This can result in dilutional hyponatraemia, where the sodium concentration falls to dangerous levels. Symptoms may include drowsiness, lethargy, irritability, mental confusion, and disorientation, with seizures and coma being the most severe features.

      SIADH can develop as a paraneoplastic syndrome, most commonly in patients with small-cell carcinoma of the lung. However, it can also be associated with various other neoplastic and non-neoplastic pathologies, as well as certain medications. Treatment for SIADH may involve restriction of fluids, demeclocycline, or other interventions, but caution must be taken to avoid complications such as cardiac failure, cerebral oedema, or central pontine myelinolysis.

      While a sodium-restricted diet or sodium-reduced water drinking may contribute to hyponatraemia, they are unlikely to cause such severe levels in the absence of other medical conditions. Liver metastases and bone metastases may also be associated with hyponatraemia, but in the context of a known diagnosis of small-cell lung cancer, SIADH is the most likely explanation.

      Overall, understanding SIADH and its potential causes and treatments is crucial for managing hyponatraemia and preventing serious complications.

    • This question is part of the following fields:

      • Respiratory Medicine
      12.8
      Seconds
  • Question 4 - A 28-year-old bartender presents to the Emergency Department after ingesting a mix of...

    Correct

    • A 28-year-old bartender presents to the Emergency Department after ingesting a mix of pills 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 fluctuating between extreme happiness and anxiety or anger. She has a history of self-harm and frequently drinks to excess. A psychiatric evaluation is requested to assess for a potential personality disorder. What is the most likely personality disorder diagnosis for this patient?

      Your Answer: Emotionally unstable personality disorder

      Explanation:

      Understanding Personality Disorders: Emotionally Unstable Personality Disorder

      Personality disorders are complex and severe disturbances in an individual’s character and behavior, often leading to 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, and anxieties about abandonment. Schizoid personality disorder, avoidant personality disorder, dependent personality disorder, and narcissistic personality disorder are other types of personality disorders, each with their own unique symptoms. However, the patient in this scenario is most consistent with borderline personality disorder. Understanding personality disorders is crucial in providing appropriate treatment and support for individuals struggling with these conditions.

    • This question is part of the following fields:

      • Psychiatry
      34.6
      Seconds
  • Question 5 - A 68-year-old woman with chronic osteoarthritis to multiple joints has been managed on...

    Correct

    • A 68-year-old woman with chronic osteoarthritis to multiple joints has been managed on morphine modified-release for several months. She currently takes 30 mg morphine modified-release twice daily. She has also been using Oramorph 10 mg four times daily for the past week because the twice-daily, 30-mg morphine modified-release has not been helping. You decide to increase the total dose of modified-release morphine.
      Which of the following is the most appropriate dose of morphine modified-release?
      Select the SINGLE most appropriate dose from the list below. Select ONE option only.

      Your Answer: Morphine modified-release 50 mg twice daily

      Explanation:

      Understanding Opioid Conversion and Dosage Adjustments

      When managing pain in patients with advanced and progressive disease, strong opioids such as morphine are often used. However, as the patient’s condition changes, adjustments to the dosage and type of opioid may be necessary.

      For example, if a patient is using a total of 100 mg of morphine in 24 hours and requires increased use of Oramorph PRN, it may be appropriate to increase the total daily dose of morphine modified-release. To calculate the new dose, simply add the total amount of morphine used in 24 hours and divide by 2, which gives a twice-daily dose for morphine modified-release.

      It is important to note that transdermal patch formulations should not be routinely offered to patients for whom oral opioids are suitable. If a patient requires additional pain relief, other options such as adding a fentanyl patch may be considered.

      When converting between different opioids, it is important to consult the BNF or local guidance for equi-analgesic potencies. For example, 10 mg of oral morphine is equivalent to 100 mg of codeine phosphate or dihydrocodeine, 1.3 mg of hydromorphone, 5 mg of oxycodone, 25 mg of tapentadol, or 67 mg of tramadol.

      Dosage adjustments should always be undertaken with specialist advice, especially when converting to or from methadone. Transdermal opioids also require careful consideration, with buprenorphine and fentanyl patches available in various strengths and corresponding oral morphine equivalents.

      In summary, understanding opioid conversion and dosage adjustments is crucial for effective pain management in patients with advanced and progressive disease.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      42.8
      Seconds
  • Question 6 - A 25-year-old woman receives a Nexplanon implant. What is the duration of its...

    Correct

    • A 25-year-old woman receives a Nexplanon implant. What is the duration of its contraceptive effectiveness?

      Your Answer: 3 years

      Explanation:

      Implanon and Nexplanon are subdermal contraceptive implants that slowly release the progestogen hormone etonogestrel to prevent ovulation and thicken cervical mucus. Nexplanon is the newer version and has a redesigned applicator to prevent deep insertions and is radiopaque for easier location. It is highly effective with a failure rate of 0.07/100 women-years and lasts for 3 years. It does not contain estrogen, making it suitable for women with a past history of thromboembolism or migraine. It can be inserted immediately after a termination of pregnancy. However, a trained professional is needed for insertion and removal, and additional contraceptive methods are required for the first 7 days if not inserted on days 1 to 5 of a woman’s menstrual cycle.

      The main disadvantage of these implants is irregular and heavy bleeding, which can be managed with a co-prescription of the combined oral contraceptive pill. Other adverse effects include headache, nausea, and breast pain. Enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon, and women should switch to a method unaffected by enzyme-inducing drugs or use additional contraception until 28 days after stopping the treatment.

      There are also contraindications for using these implants, such as ischaemic heart disease/stroke, unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, and liver cancer. Current breast cancer is a UKMEC 4 condition, which represents an unacceptable risk if the contraceptive method is used. Overall, these implants are a highly effective and long-acting form of contraception, but they require careful consideration of the potential risks and contraindications.

    • This question is part of the following fields:

      • Reproductive Medicine
      6.8
      Seconds
  • Question 7 - A 25-year-old woman with a history of type 1 diabetes mellitus presents at...

    Correct

    • A 25-year-old woman with a history of type 1 diabetes mellitus presents at the emergency department complaining of vomiting and abdominal pain. Upon examination, she appears dehydrated. The following are some of her blood test results:
      pH 7.23 (7.35-7.45)
      pCO2 2.1 kPa (4.5-6.0)
      pO2 11.2 kPa (10-14)
      Na+ 135 mmol/L (135-145)
      K+ 3.1 mmol/L (3.5-5.0)
      Bicarbonate 13 mmol/L (22-28)
      Glucose 22.4 mmol/L (<11.1)
      Ketones 3.6 mmol/L (<0.6)

      Question: What should be done with her regular insulin during her treatment?

      Your Answer: Continue long-acting insulin and stop short-acting insulin

      Explanation:

      In the management of DKA, it is important to continue the patient’s regular long-acting insulin while stopping their short-acting insulin. Fixed-rate insulin and fluids should also be administered. Continuing short-acting insulin may lead to hypoglycaemia, so it should be stopped until the patient is stable. Increasing the dose of both long-acting and short-acting insulin is not recommended.

      Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus, accounting for around 6% of cases. It can also occur in rare cases of extreme stress in patients with type 2 diabetes mellitus. However, mortality rates have decreased from 8% to under 1% in the past 20 years. DKA is caused by uncontrolled lipolysis, resulting in an excess of free fatty acids that are ultimately converted to ketone bodies. The most common precipitating factors of DKA are infection, missed insulin doses, and myocardial infarction. Symptoms include abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and acetone-smelling breath. Diagnostic criteria include glucose levels above 13.8 mmol/l, pH below 7.30, serum bicarbonate below 18 mmol/l, anion gap above 10, and ketonaemia.

      Management of DKA involves fluid replacement, insulin, and correction of electrolyte disturbance. Most patients with DKA are depleted around 5-8 litres, and isotonic saline is used initially, even if the patient is severely acidotic. Insulin is administered through an intravenous infusion, and correction of electrolyte disturbance is necessary. Long-acting insulin should be continued, while short-acting insulin should be stopped. DKA resolution is defined as pH above 7.3, blood ketones below 0.6 mmol/L, and bicarbonate above 15.0mmol/L. Complications may occur from DKA itself or the treatment, such as gastric stasis, thromboembolism, arrhythmias, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Children and young adults are particularly vulnerable to cerebral oedema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      47.2
      Seconds
  • Question 8 - As a junior doctor in psychiatry, you are evaluating a young man in...

    Correct

    • As a junior doctor in psychiatry, you are evaluating a young man in the Emergency Department who was brought in by the police for carrying a knife. Your conversation with him goes as follows:

      Doctor: I see that the police have brought you in from the town centre today. Can you tell me why, as a young man, you felt the need to carry a knife?

      Your Answer: Tangentiality

      Explanation:

      Tangentiality is when someone goes off on a tangent and does not return to the original topic. It is a type of formal thought disorder that is often seen in people with schizophrenia. The person may provide excessive and unnecessary details that are somewhat relevant to the question but never answer the central point. Circumstantiality is similar, but the person ultimately provides an answer. Clang associations involve using words that sound similar but have no logical connection, while perseveration is when someone continues to respond to a previous question even after a new one has been asked.

      Thought disorders can manifest in various ways, including circumstantiality, tangentiality, neologisms, clang associations, word salad, Knight’s move thinking, flight of ideas, perseveration, and echolalia. Circumstantiality involves providing excessive and unnecessary detail when answering a question, but eventually returning to the original point. Tangentiality, on the other hand, refers to wandering from a topic without returning to it. Neologisms are newly formed words, often created by combining two existing words. Clang associations occur when ideas are related only by their similar sounds or rhymes. Word salad is a type of speech that is completely incoherent, with real words strung together into nonsensical sentences. Knight’s move thinking is a severe form of loosening of associations, characterized by unexpected and illogical leaps from one idea to another. Flight of ideas is a thought disorder that involves jumping from one topic to another, but with discernible links between them. Perseveration is the repetition of ideas or words despite attempts to change the topic. Finally, echolalia is the repetition of someone else’s speech, including the question that was asked.

    • This question is part of the following fields:

      • Psychiatry
      51.1
      Seconds
  • Question 9 - A 6-year-old boy presents to his General Practitioner with his mother three weeks...

    Incorrect

    • A 6-year-old boy presents to his General Practitioner with his mother three weeks following his recent admission to the Paediatric Ward where he was treated for Kawasaki disease. He responded well to his treatment in the hospital.
      His mother asks if her son still needs to be taking the treatment prescribed by the Paediatric Team.
      Which of the following treatments is the patient likely to still be taking?

      Your Answer: Oral steroids daily

      Correct Answer: Oral aspirin daily

      Explanation:

      Treatment Options for Kawasaki Disease: Understanding the Use of Aspirin

      Kawasaki disease is a condition that affects children and causes inflammation in the blood vessels throughout the body. When diagnosed, treatment typically involves intravenous immunoglobulin and aspirin. In this article, we will discuss the use of aspirin in the treatment of Kawasaki disease and why it is important.

      Oral aspirin is given to patients with Kawasaki disease due to its anti-inflammatory and antiplatelet properties. It helps to reduce the chances of blood clots if there are developing problems in the heart, such as coronary artery aneurysms that can occur in Kawasaki disease. The dosage of aspirin is usually higher (30 mg/kg per day) for up to two weeks and then continued at lower doses (3-5 mg/kg per day) until a review of echocardiogram, which is usually 6-8 weeks after the onset of illness.

      If the review echocardiogram at 6-8 weeks shows no evidence of any coronary artery aneurysms, then aspirin is usually stopped. However, until that time, patients with Kawasaki disease will continue to take oral aspirin daily.

      It is important to note that other non-steroidal anti-inflammatory medications such as ibuprofen should be avoided while taking aspirin. Additionally, oral steroids are a second-line treatment that are considered when there is failure to respond to initial intravenous immunoglobulin therapy.

      In conclusion, aspirin is an important part of the treatment for Kawasaki disease due to its anti-inflammatory and antiplatelet properties. Patients with Kawasaki disease will continue to take oral aspirin daily until a review echocardiogram shows no evidence of any coronary artery aneurysms. It is important to follow the treatment plan prescribed by a specialist to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Musculoskeletal
      18.4
      Seconds
  • Question 10 - A 32-year-old woman presents to her General Practitioner with generalised fatigue and polyuria....

    Correct

    • A 32-year-old woman presents to her General Practitioner with generalised fatigue and polyuria. These symptoms started three months ago but became much more pronounced in the preceding hour.
      At the clinic, she also starts complaining of extreme thirst and mild lower back pain. She is noted to be breathing heavily, with her breath smelling of acetone.
      Which of the following is the likely diagnosis?

      Your Answer: Diabetic ketoacidosis (DKA)

      Explanation:

      The patient’s symptoms of general fatigue and polyuria suggest the possibility of type I diabetes, which can lead to diabetic ketoacidosis (DKA). DKA can occur as a complication of existing type I diabetes or as the first presentation of the disease. In rare cases, extreme stress can also cause DKA in patients with type II diabetes. DKA is caused by uncontrolled lipolysis, resulting in excess free fatty acids that are converted to ketone bodies. Common triggers include infection, missed insulin doses, and myocardial infarction.

      Anxiety attacks can cause heavy breathing and abdominal pain, but they do not explain the polyuria, polydipsia, and pear-drops-smelling breath. Symptoms of anxiety attacks include chest pain, palpitations, nausea and vomiting, sweating, insomnia, flushing, tremor, and urinary frequency.

      Acute pancreatitis should be ruled out in cases of central abdominal pain. Symptoms of acute pancreatitis include severe epigastric pain radiating to the back, vomiting, epigastric tenderness, ileus, and low-grade fever. Cullen’s sign and Grey-Turner’s sign are rare.

      Addison’s disease, the most common cause of primary hypoadrenalism in the UK, can present similarly to this case with general fatigue and abdominal pain. Other symptoms of Addison’s disease include anorexia, nausea and vomiting, weight loss, salt-craving, hyperpigmentation, vitiligo, loss of pubic hair in women, hypotension, hypoglycaemia, hyponatraemia, and hyperkalaemia.

      Hyperparathyroidism can also cause polyuria, polydipsia, and abdominal pain, but the Kussmaul respiration and pear-drops-smelling breath suggest a likely diagnosis of DKA. Symptoms of hyperparathyroidism include bone pain, osteopenia and osteoporosis, increased risk of kidney stones, constipation, nausea, vomiting and abdominal pain, and fatigue, depression, and memory impairment, all of which are symptoms of underlying hypercalcaemia.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      14.1
      Seconds
  • Question 11 - A 32-year-old woman presents to the Emergency Department with a three-day history of...

    Incorrect

    • A 32-year-old woman presents to the Emergency Department with a three-day history of an increasingly painful and swollen left eye. She complains of blurring of vision and pain, especially with eye movements, which are quite restricted.
      On examination, the visual acuity is 6/12 in the left eye and 6/6 in the right. The periorbital area of the left eye is very swollen and erythematous. The eye itself is red and proptosed. The conjunctiva was chemosed. Eye movements in the left eye are quite restricted in all directions. There is relative afferent pupillary defect on the left.
      Her temperature is 38.2 °C. Her blood pressure is 130/80 mmHg, and her pulse is 80 beats per minute. Her respiratory rate is 20 breaths per minute. Her oxygen saturations are 97% on air.
      What is the most important step in your management plan to determine the cause of this patient’s eye problem?

      Your Answer: Intravenous (IV) cefuroxime

      Correct Answer: Computed tomography (CT) scan of the orbit, sinuses, and brain

      Explanation:

      Diagnostic Steps for Orbital Cellulitis: CT Scan of the Orbit, Sinuses, and Brain

      Orbital cellulitis is a serious infection that can lead to vision loss and even death if left untreated. The most common cause of orbital cellulitis is ethmoidal sinusitis. To diagnose and manage this condition, a series of diagnostic steps must be taken.

      The first and most important step is a CT scan of the orbit, sinuses, and brain. This imaging test can show diffuse orbital infiltrate, proptosis, sinus opacity, or even orbital abscesses. It is essential in determining the extent of the infection and guiding treatment decisions.

      While blood tests such as a full blood count, urea and electrolytes, and clotting profile can be helpful, they do not determine the cause of the orbital cellulitis. Blood culture can be useful but is very low yield according to recent studies. It is not the most important step in determining the cause.

      Intravenous (IV) cefuroxime as well as metronidazole are necessary to control the infection but do not help to determine the cause.

      Performing fundoscopy is not necessary in this case as the patient is suffering from orbital cellulitis, which is primarily a clinical diagnosis. The main purpose of fundoscopy in clinical examination is to examine the back of the eye and the optic disc. Since the back of the eye is not involved in the pathology of orbital cellulitis, performing fundoscopy would not add anything here.

      In summary, a CT scan of the orbit, sinuses, and brain is the most important diagnostic step in determining the extent of orbital cellulitis and guiding treatment decisions.

    • This question is part of the following fields:

      • Ophthalmology
      57.7
      Seconds
  • Question 12 - A 54-year-old diabetic patient visits your clinic with a complaint of painless difficulty...

    Correct

    • A 54-year-old diabetic patient visits your clinic with a complaint of painless difficulty in swallowing that has been ongoing for the past two months. The patient reports that the difficulty has been getting worse, but is unsure if there has been any weight loss. On examination, there are no notable findings.

      What would be your next course of action considering the possible diagnoses?

      Your Answer: Referral for gastroscopy

      Explanation:

      If a patient experiences new-onset dysphagia, urgent endoscopy is necessary regardless of age or other symptoms. In the case of progressive dysphagia, it is crucial to rule out oesophageal or stomach cancer with a two week wait referral for gastroscopy. Gastroparesis, a delay in gastric emptying associated with diabetes, can be treated with metoclopramide. Plummer-vinson syndrome, which is characterized by iron deficiency anaemia and oesophageal webs, can also cause dysphagia along with glossitis and stomatitis. Gaviscon is not a suitable treatment for dysphagia as it only helps with dyspepsia. While a stroke can cause difficulties in initiating swallowing, it is typically sudden onset rather than progressive.

      Understanding Dysphagia and its Causes

      Dysphagia, or difficulty in swallowing, can be caused by various conditions affecting the esophagus, such as oesophageal cancer, oesophagitis, oesophageal candidiasis, achalasia, pharyngeal pouch, systemic sclerosis, and myasthenia gravis. Each condition has its own characteristic features, which can help in identifying the underlying cause of dysphagia. For instance, dysphagia associated with weight loss, anorexia, or vomiting during eating may indicate oesophageal cancer, while dysphagia of both liquids and solids from the start may suggest achalasia.

      To determine the cause of dysphagia, patients usually undergo an upper GI endoscopy, which allows doctors to examine the esophagus and detect any abnormalities. Fluoroscopic swallowing studies may also be done to evaluate motility disorders. Additionally, a full blood count and ambulatory oesophageal pH and manometry studies may be required for certain conditions.

      It’s important to note that new-onset dysphagia is a red flag symptom that requires urgent endoscopy, regardless of age or other symptoms. Therefore, understanding the different causes of dysphagia and their characteristic features can aid in prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      25
      Seconds
  • Question 13 - A 32-year-old woman presents to the Eye Hospital Emergency Department with a 4-day...

    Incorrect

    • A 32-year-old woman presents to the Eye Hospital Emergency Department with a 4-day history of blurred vision and left-eye pain worse on movement. On examination, there is decreased visual acuity and impaired colour vision in the left eye and a left relative afferent pupillary defect. Fundoscopy reveals a mildly swollen left optic disc. Intraocular pressure is 20 mmHg in the left eye. Her past medical history includes type II diabetes mellitus and hyperlipidemia. What is the most likely diagnosis?

      Your Answer: Acute glaucoma

      Correct Answer: Optic neuritis

      Explanation:

      Understanding Optic Neuritis: Symptoms and Differential Diagnosis

      Optic neuritis is a condition that can be either idiopathic or secondary to multiple sclerosis. Patients with optic neuritis typically experience periocular pain associated with eye movement, as well as a loss of color vision. Visual field defects, such as a central scotoma, can also occur. If the other eye is uninvolved, there is typically a relative afferent pupillary defect.

      It is important to differentiate optic neuritis from other conditions that can cause similar symptoms. A stroke, for example, would not typically cause eye pain or affect color vision. Acute-angle-closure glaucoma can also be ruled out if intraocular pressure is within the normal range. Cerebral venous thrombosis would usually cause sudden painless loss of vision with severe retinal hemorrhages on fundoscopy. In cases of raised intracranial pressure, papilledema would be seen in both optic discs.

      Overall, understanding the symptoms and differential diagnosis of optic neuritis is crucial for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Neurology
      20.7
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  • Question 14 - A 45-year-old overweight woman comes to the clinic worried about a lump in...

    Incorrect

    • A 45-year-old overweight woman comes to the clinic worried about a lump in her right breast. She was in a car accident as a passenger two weeks ago and suffered a minor neck injury while wearing her seat belt. During the examination, a sizable, hard lump with some skin discoloration is discovered.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Fat necrosis

      Explanation:

      Fat necrosis is a condition where local fat undergoes saponification, resulting in a benign inflammatory process. It is becoming more common due to breast-conserving surgery and mammoplasty procedures. Trauma or nodular panniculitis are common causes, with trauma being the most frequent. It is more prevalent in women with large breasts and tends to occur in the subareolar and periareolar regions. The breast mass is usually firm, round, and painless, but there may be a single or multiple masses. It may be tender or painful in some cases, and the skin around the lump may be red, bruised, or dimpled. A biopsy may be necessary to differentiate it from breast cancer.

    • This question is part of the following fields:

      • Reproductive Medicine
      0
      Seconds
  • Question 15 - An 80-year-old man presents with leg swelling and nocturnal dyspnea. His BNP levels...

    Incorrect

    • An 80-year-old man presents with leg swelling and nocturnal dyspnea. His BNP levels are elevated and an echocardiogram confirms heart failure with reduced ejection fraction. He has a history of diabetes and is currently on metformin. Besides furosemide, what other medication should be initiated for his heart failure management?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      When treating heart failure patients, it is recommended to initiate therapy with either an angiotensin-converting enzyme (ACE) inhibitor or a beta-blocker licensed for heart failure treatment, but not both simultaneously. If the patient exhibits signs of fluid overload or has diabetes mellitus, an ACE inhibitor like ramipril is preferred. On the other hand, if the patient has angina, a beta-blocker such as bisoprolol, carvedilol, or nebivolol is preferred.

      Drug Management for Chronic Heart Failure: NICE Guidelines

      Chronic heart failure is a serious condition that requires proper management to improve patient outcomes. In 2018, the National Institute for Health and Care Excellence (NICE) updated their guidelines on drug management for chronic heart failure. The guidelines recommend first-line therapy with both an ACE-inhibitor and a beta-blocker, with clinical judgement used to determine which one to start first. Second-line therapy involves the use of aldosterone antagonists, which should be monitored for hyperkalaemia. SGLT-2 inhibitors are also increasingly being used to manage heart failure with a reduced ejection fraction. Third-line therapy should be initiated by a specialist and may include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin, or cardiac resynchronisation therapy. Other treatments such as annual influenza and one-off pneumococcal vaccines are also recommended.

      Overall, the NICE guidelines provide a comprehensive approach to drug management for chronic heart failure. It is important to note that loop diuretics have not been shown to reduce mortality in the long-term, and that ACE-inhibitors and beta-blockers have no effect on mortality in heart failure with preserved ejection fraction. Healthcare professionals should carefully consider the patient’s individual needs and circumstances when determining the appropriate drug therapy for chronic heart failure.

    • This question is part of the following fields:

      • Cardiovascular
      0
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  • Question 16 - A 70-year-old man is seen on a home visit by his General Practitioner...

    Incorrect

    • A 70-year-old man is seen on a home visit by his General Practitioner as his wife is concerned about an ulcer on his lower leg, which has been present for a couple of weeks. It is starting to leak clear fluid. He has a history of chronic congestive cardiac failure and chronic obstructive pulmonary disease. A diagnosis of a venous ulcer is suspected.
      Which of the following examination findings would best support this diagnosis?

      Your Answer:

      Correct Answer: Atrophie blanche

      Explanation:

      Signs and Symptoms of Leg Ulcers: Differentiating Arterial, Venous, and Inflammatory Causes

      Leg ulcers can have various causes, including arterial, venous, and inflammatory conditions. Here are some signs and symptoms that can help differentiate between these causes:

      Atrophie Blanche: This is a white atrophic scar surrounded by areas of hyperpigmentation, which is a sign of severe venous insufficiency.

      Ankle Brachial Pressure Index (ABPI) of 0.4: ABPI is the ratio of systolic blood pressure in the ankle compared with the arm. An ABPI < 0.5 indicates severe arterial disease, suggesting that the ulcer is most likely arterial, rather than venous, in nature. Hairless and Pale Skin on the Lower Legs: Pallor of the skin and a lack of hair growth on the lower legs is a sign of arterial disease, pointing towards a diagnosis of an arterial ulcer rather than a venous ulcer. Necrobiosis Lipoidica: This is a rare granulomatous condition that usually affects people with insulin-dependent diabetes. Plaques are present on the shins, often with telangiectasia in the center and may ulcerate. The cause for the leg ulcer is, therefore, inflammatory rather than venous in origin. Reduced Light-Touch Sensation in Both Feet: Reduced sensation in the feet could be neuropathic in nature (diabetes, multiple sclerosis) or the result of severe arterial disease. Venous insufficiency does not usually affect sensation, so this finding on examination would support a diagnosis of arterial or neuropathic ulcer. By recognizing these signs and symptoms, healthcare professionals can better diagnose and treat leg ulcers based on their underlying causes.

    • This question is part of the following fields:

      • Dermatology
      0
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  • Question 17 - A 28-year-old law student visits his primary care physician complaining of ear pain....

    Incorrect

    • A 28-year-old law student visits his primary care physician complaining of ear pain. He suspects that this is related to the same issue causing dryness in his scalp and beard, as well as eczema-like patches in his nasolabial folds. He has been using non-prescription topical treatments to manage these symptoms but seeks guidance for his earache. What is the probable diagnosis that connects all of this patient's symptoms?

      Your Answer:

      Correct Answer: Seborrhoeic dermatitis

      Explanation:

      Seborrhoeic dermatitis can lead to common complications such as otitis externa and blepharitis. The patient is experiencing eczema-like plaques and dry skin in areas rich in sebum, which he has been treating with over-the-counter antifungal shampoos. However, his complaint of earache may be due to otitis externa, which is associated with seborrhoeic dermatitis. A full ear examination should be performed to rule out other diagnoses. Contact dermatitis is unlikely to present in this distribution and would not cause otalgia. Eczema herpeticum is a severe primary infection by herpes-simplex-virus 1 or 2, commonly seen in children with atopic eczema. Guttate psoriasis commonly affects children after Streptococcal upper respiratory tract infection and will clear over the course of ,3 months without treatment. Irritant dermatitis is unlikely to cause such focal areas of irritation.

      Understanding Seborrhoeic Dermatitis in Adults

      Seborrhoeic dermatitis is a chronic skin condition that affects around 2% of the general population. It is caused by an inflammatory reaction related to the overgrowth of a fungus called Malassezia furfur, which is a normal inhabitant of the skin. The condition is characterized by eczematous lesions that appear on the sebum-rich areas of the body, such as the scalp, periorbital, auricular, and nasolabial folds. It can also lead to the development of otitis externa and blepharitis.

      Seborrhoeic dermatitis is often associated with other medical conditions, such as HIV and Parkinson’s disease. The management of the condition depends on the affected area. For scalp disease, over-the-counter preparations containing zinc pyrithione and tar are usually the first-line treatment. If these are not effective, ketoconazole is the preferred second-line agent. Selenium sulphide and topical corticosteroids may also be useful.

      For the face and body, topical antifungals such as ketoconazole and topical steroids are often used. However, it is important to use steroids for short periods only to avoid side effects. Seborrhoeic dermatitis can be difficult to treat, and recurrences are common. Therefore, it is important to work closely with a healthcare provider to manage the condition effectively.

    • This question is part of the following fields:

      • Dermatology
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  • Question 18 - A 42-year-old woman with epilepsy complains of hair loss and tremors. Her husband...

    Incorrect

    • A 42-year-old woman with epilepsy complains of hair loss and tremors. Her husband reports that she has become more irritable since starting her medication.
      Which medication is the most likely culprit?

      Your Answer:

      Correct Answer: Sodium valproate (Epilim®)

      Explanation:

      Common Side Effects of Anticonvulsants and Analysis of Symptoms Associated with Different Medications

      Anticonvulsants are commonly used to treat seizures, but they can also have side effects. One of the most common side effects of sodium valproate is hair loss, along with aggression and tremors. Levetiracetam is commonly associated with aggression and tremors, but rarely with alopecia. Carbamazepine is rarely associated with aggression or alopecia, and lamotrigine is commonly associated with aggression and tremors but not hair loss. Phenytoin is commonly associated with tremors but not the other symptoms mentioned. This analysis can help identify which medication may be causing certain symptoms. Other common side effects of anticonvulsants include fatigue, skin rashes, and gastrointestinal issues. It is important to consult with a healthcare provider about any concerns regarding medication side effects.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
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  • Question 19 - A 30-year-old woman presents to surgery with a complaint of not having a...

    Incorrect

    • A 30-year-old woman presents to surgery with a complaint of not having a regular menstrual cycle for the past year, despite a negative pregnancy test. You order initial tests to establish a baseline. Which of the following is not included in your list of possible diagnoses?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      Primary amenorrhoea is caused by Turner’s syndrome instead of secondary amenorrhoea.

      Understanding Amenorrhoea: Causes, Investigations, and Management

      Amenorrhoea is a condition characterized by the absence of menstrual periods in women. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls with no secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.

      There are various causes of amenorrhoea, including gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, Sheehan’s syndrome, Asherman’s syndrome, and thyrotoxicosis. To determine the underlying cause of amenorrhoea, initial investigations such as full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels are necessary.

      The management of amenorrhoea depends on the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause in women 40 years of age or older and treat the underlying cause accordingly. It is important to note that hypothyroidism may also cause amenorrhoea.

    • This question is part of the following fields:

      • ENT
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  • Question 20 - A 30-year-old female patient visits the GP clinic complaining of excessive pain during...

    Incorrect

    • A 30-year-old female patient visits the GP clinic complaining of excessive pain during her menstrual cycle for the past 6 months. She experiences pain 1-2 days before the onset of menstruation, which lasts throughout the cycle. Additionally, she reports pain during sexual intercourse, particularly during deep penetration. Her last menstrual period occurred 2 days ago. She has been in a monogamous relationship with her partner for 8 years, and she has never been pregnant. She does not use any form of contraception except for condoms. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Refer to gynaecology

      Explanation:

      Patients with secondary dysmenorrhoea require referral to gynaecology for investigation, including this patient who exhibits such symptoms. While tranexamic acid is effective for menorrhagia, it is not useful for dysmenorrhoea. While a transvaginal ultrasound scan may be part of the investigation, a specialist review is more crucial, particularly for this patient who displays symptoms indicative of endometriosis, which may not be visible on an ultrasound scan. Before using the intrauterine system or combined oral contraceptive pill to treat endometriosis, a diagnosis is necessary.

      Dysmenorrhoea is a condition where women experience excessive pain during their menstrual period. There are two types of dysmenorrhoea: primary and secondary. Primary dysmenorrhoea affects up to 50% of menstruating women and is not caused by any underlying pelvic pathology. It usually appears within 1-2 years of the menarche and is thought to be partially caused by excessive endometrial prostaglandin production. Symptoms include suprapubic cramping pains that may radiate to the back or down the thigh, and pain typically starts just before or within a few hours of the period starting. NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women, and combined oral contraceptive pills are used second line for management.

      Secondary dysmenorrhoea, on the other hand, typically develops many years after the menarche and is caused by an underlying pathology. The pain usually starts 3-4 days before the onset of the period. Causes of secondary dysmenorrhoea include endometriosis, adenomyosis, pelvic inflammatory disease, intrauterine devices, and fibroids. Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation. It is important to note that the intrauterine system (Mirena) may help dysmenorrhoea, but this only applies to normal copper coils.

    • This question is part of the following fields:

      • Reproductive Medicine
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  • Question 21 - A 50-year-old woman with a history of multiple sclerosis for a few years...

    Incorrect

    • A 50-year-old woman with a history of multiple sclerosis for a few years has been struggling with increased muscle stiffness and trouble with fluid movements. Despite taking baclofen for a year, there has been no improvement. What medication should be considered next to alleviate these symptoms?

      Your Answer:

      Correct Answer: Gabapentin

      Explanation:

      Spasticity in multiple sclerosis is caused by demyelination along the nerves that control movement, resulting in stiffness that can sometimes be helpful but can also become painful. Physiotherapy exercises are the simplest and most effective treatment, but first-line medications such as baclofen and gabapentin are also recommended. Gabapentin is an anticonvulsant that can be effective against muscle spasms, while diazepam is a muscle relaxant that may be more useful at night due to side effects at higher doses. Botulinum toxin and dantrolene sodium can be considered if conventional treatments prove ineffective, but are not used as first-line for spasticity. The NICE multiple sclerosis guideline recommends gabapentin as one of the first drugs to try in the treatment of spasms and spasticity.

      Multiple sclerosis is a condition that cannot be cured, but its treatment aims to reduce the frequency and duration of relapses. In the case of an acute relapse, high-dose steroids may be administered for five days to shorten its length. However, it is important to note that steroids do not affect the degree of recovery. Disease-modifying drugs are used to reduce the risk of relapse in patients with MS. These drugs are typically indicated for patients with relapsing-remitting disease or secondary progressive disease who have had two relapses in the past two years and are able to walk a certain distance unaided. Natalizumab, ocrelizumab, fingolimod, beta-interferon, and glatiramer acetate are some of the drugs used to reduce the risk of relapse in MS.

      Fatigue is a common problem in MS patients, and amantadine is recommended by NICE after excluding other potential causes such as anaemia, thyroid problems, or depression. Mindfulness training and CBT are other options for managing fatigue. Spasticity is another issue that can be addressed with first-line drugs such as baclofen and gabapentin, as well as physiotherapy. Cannabis and botox are currently being evaluated for their effectiveness in managing spasticity. Bladder dysfunction is also a common problem in MS patients, and anticholinergics may worsen symptoms in some patients. Ultrasound is recommended to assess bladder emptying, and intermittent self-catheterisation may be necessary if there is significant residual volume. Gabapentin is the first-line treatment for oscillopsia, which is a condition where visual fields appear to oscillate.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - Treatment of an acute attack of gout with allopurinol may result in which...

    Incorrect

    • Treatment of an acute attack of gout with allopurinol may result in which of the following?

      Select the SINGLE result from the list below.

      Your Answer:

      Correct Answer: Exacerbation and prolongation of the attack

      Explanation:

      To effectively treat gout, it is important to understand the proper use of allopurinol. Starting prophylactic treatment with allopurinol should be delayed until 1-2 weeks after the inflammation has settled to avoid exacerbating and prolonging the attack. It may take several weeks to reduce uric acid levels to normal, and the dose should be titrated every few weeks until sUA levels are below 300 mmol/l. It is not recommended to start allopurinol during an acute attack, as it is unlikely to lead to complete remission of symptoms. Allopurinol use is not associated with an increased risk of acute pyelonephritis, but renal impairment may occur if the starting dose is too high. In mild cases, self-care may be considered, but if drug treatment is necessary, NSAIDs or colchicine can be prescribed. It is important to measure the baseline sUA level and consider prophylaxis in high-risk patients. When starting allopurinol, a low dose of NSAID or colchicine should be co-prescribed for at least 1 month to prevent acute attacks of gout.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 23 - A 43-year-old man visits his GP complaining of a painful right shoulder. Despite...

    Incorrect

    • A 43-year-old man visits his GP complaining of a painful right shoulder. Despite being generally healthy and playing tennis regularly, he has been limited by the pain. Upon examination, his shoulders appear symmetrical with no skin changes, but he experiences mild tenderness over the right acromion. He can fully abduct his arm, but experiences pain approximately halfway through the motion, with the start and end of abduction being pain-free. There are no other symptoms or abnormalities in his upper limbs. What is the probable underlying pathology for this man's presentation?

      Your Answer:

      Correct Answer: Subacromial impingement

      Explanation:

      Subacromial impingement is often characterized by a painful arc of abduction. This is likely the cause of the patient’s shoulder pain, which is accompanied by tenderness at the acromion and pain around the midpoint of abduction (typically between 60 to 120 degrees). These symptoms are not indicative of inflammatory arthritis affecting the acromioclavicular joint, which is rare. Osteoarthritis affecting the ACJ may cause tenderness and swelling, but not acromial tenderness or a painful arc in abduction. Cervical radiculopathy would cause neuropathic pain in the distribution of a cervical root, which is not consistent with the patient’s symptoms. Rheumatoid arthritis and other inflammatory arthropathies typically cause acute joint inflammation and effusion, which is not present in this case. A supraspinatus tear is a possible differential diagnosis, but the pain would be limited to the initial 60 degrees of abduction rather than the midpoint, indicating impingement as the more likely cause. Depending on the extent of the tear, abduction may also be limited due to difficulty initiating the movement.

      Understanding Rotator Cuff Injuries

      Rotator cuff injuries are a common cause of shoulder problems that can be classified into four types of disease: subacromial impingement, calcific tendonitis, rotator cuff tears, and rotator cuff arthropathy. The symptoms of a rotator cuff injury include shoulder pain that worsens during abduction.

      The signs of a rotator cuff injury include a painful arc of abduction, which typically occurs between 60 and 120 degrees in cases of subacromial impingement. In cases of rotator cuff tears, the pain may be felt in the first 60 degrees of abduction. Additionally, tenderness over the anterior acromion may be present.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 24 - A 28-year-old woman comes to the Endocrine Clinic with a history of hyperthyroidism....

    Incorrect

    • A 28-year-old woman comes to the Endocrine Clinic with a history of hyperthyroidism. Her blood tests confirm that she is currently experiencing thyrotoxicosis. She is hoping to conceive and wants to discuss her treatment options.
      What is the most suitable treatment for her condition in this scenario?

      Your Answer:

      Correct Answer: Thyroidectomy

      Explanation:

      Treatment Options for Hyperthyroidism in Women Planning a Pregnancy

      When it comes to treating hyperthyroidism in women who are planning a pregnancy, there are several options to consider. Definitive treatment, such as thyroidectomy, is the preferred option as it eliminates the risk of thyrotoxicosis during pregnancy and the need for medication that could harm the fetus. However, following thyroidectomy, the patient will need thyroxine replacement and should wait until she is euthyroid before trying to conceive.

      Propylthiouracil and thyroxine are not recommended for use during pregnancy due to the risk of fetal goitre or hypothyroidism. Carbimazole is teratogenic and should not be started in women planning a pregnancy. Propylthiouracil can be used in low doses if there is no other suitable alternative.

      Radioactive iodine is highly effective but is contraindicated in women planning a pregnancy within six months. This option can be considered if the patient is willing to continue contraception until six months after treatment. Ultimately, the best course of action will depend on the individual patient’s needs and preferences, and should be discussed with a healthcare provider.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
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  • Question 25 - Prolonged use of which drug can result in tachyphylaxis, which is an acute...

    Incorrect

    • Prolonged use of which drug can result in tachyphylaxis, which is an acute and sudden decrease in response to a drug after its administration, leading to a rapid and short-term onset of drug tolerance?

      Your Answer:

      Correct Answer: Xylometazoline (eg Sudafed® nasal spray)

      Explanation:

      Common Drugs and Tachyphylaxis: Understanding the Risk

      Nasal decongestants, such as xylometazoline, are often used to relieve nasal congestion. However, prolonged use can lead to rebound congestion, known as rhinitis medicamentosa. Amiodarone, an antiarrhythmic drug, has a long half-life and potential for drug interactions even after treatment has stopped. Metronidazole, an antimicrobial drug, can be absorbed systemically and may interact with other medications. Naproxen, a non-steroidal anti-inflammatory drug, has no evidence of tachyphylaxis. Phenoxymethylpenicillin, an antibiotic, is not associated with tachyphylaxis. Understanding the risk of tachyphylaxis with common drugs is important for safe and effective use.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
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  • Question 26 - A 35-year-old male is admitted to hospital after an overdose of paracetamol. He...

    Incorrect

    • A 35-year-old male is admitted to hospital after an overdose of paracetamol. He waited until his children had gone to school and his wife had left for work before taking 100 tablets. He did not drink any alcohol and rarely has any. He had taken annual leave from the steady job in a factory and had left a note. His wife had forgotten something so returned from work earlier than usual and found him semi-conscious.

      After treatment for his physical health he tells you that he does not regret the attempt but feels bad that he has put his children through enough seeing him in hospital. He is not religious. His wife is not very supportive of him and thinks he is 'attention-seeking'. He has no other family or friends locally. He has struggled with symptoms of depression for a number of months and has never sought help, but otherwise is physically well.

      During your assessment, you want to ascertain any protective factors.

      Which of the following is a protective factor in this case?

      Your Answer:

      Correct Answer: She has children at home

      Explanation:

      Completed suicide can be prevented by certain protective factors such as having social support, religious beliefs, having children at home, and regretting a previous attempt. It is important to note that the duration of mental illness is not a determining factor, but having a mental illness, especially depression, increases the risk. Alcohol misuse is also a risk factor, but in this scenario, the fact that the person does not drink much alcohol is not particularly protective. The individual in the scenario lacks social support and is not religious, making those options incorrect. However, having children present at home is a protective factor.

      Suicide Risk Factors and Protective Factors

      Suicide risk assessment is a common practice in psychiatric care, with patients being stratified into high, medium, or low risk categories. However, there is a lack of evidence on the positive predictive value of individual risk factors. A review in the BMJ concluded that such assessments may not be useful in guiding decision-making, as 50% of suicides occur in patients deemed low risk. Nevertheless, certain factors have been associated with an increased risk of suicide, including male sex, history of deliberate self-harm, alcohol or drug misuse, mental illness, depression, schizophrenia, chronic disease, advancing age, unemployment or social isolation, and being unmarried, divorced, or widowed.

      If a patient has attempted suicide, there are additional risk factors to consider, such as efforts to avoid discovery, planning, leaving a written note, final acts such as sorting out finances, and using a violent method. On the other hand, there are protective factors that can reduce the risk of suicide, such as family support, having children at home, and religious belief. It is important to consider both risk and protective factors when assessing suicide risk and developing a treatment plan.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 27 - You are a foundation year 2 Doctor on your GP placement. Your first...

    Incorrect

    • You are a foundation year 2 Doctor on your GP placement. Your first appointment is 6-year-old Jack. His mother has brought him to see you as he has had a cold over the past 6 days and now has developed a productive cough with green sputum. On examination you hear bilateral crackles at the base of his lungs and there is dullness to percussion at the left base. All basic observations are within normal limits. You diagnose a lower respiratory tract infection and decide to prescribe some antibiotics. Jack has no allergies.
      What is the first line antibiotic you would prescribe for Jack?

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      For children without a penicillin allergy, amoxicillin is the primary treatment for pneumonia according to the 2011 guidelines from the British Thoracic Society. If the initial treatment is ineffective, macrolides may be added. Macrolides are recommended if Mycoplasma or Chlamydia is suspected. Co-amoxiclav is suggested for pneumonia associated with influenza.

      Pneumonia is a common illness in children, with S. pneumoniae being the most likely cause of bacterial pneumonia. The British Thoracic Society has published guidelines for the management of community acquired pneumonia in children. According to these guidelines, amoxicillin is the first-line treatment for all children with pneumonia. Macrolides may be added if there is no response to first-line therapy, or if mycoplasma or chlamydia is suspected. In cases of pneumonia associated with influenza, co-amoxiclav is recommended. It is important to follow these guidelines to ensure effective treatment and management of pneumonia in children.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 28 - A 54-year-old man is seen in the Cardiology clinic after experiencing a heart...

    Incorrect

    • A 54-year-old man is seen in the Cardiology clinic after experiencing a heart attack a year ago. He was diagnosed with hypertension and diabetes during his hospitalization. The patient reports gaining 5kg in the last 6 months and wonders if any of his medications could be causing this weight gain. Which of his prescribed drugs may be contributing to his recent weight gain?

      Your Answer:

      Correct Answer: Gliclazide

      Explanation:

      Weight gain is a common side effect of sulfonylureas.

      Sulfonylureas are a type of medication used to treat type 2 diabetes mellitus. They work by increasing the amount of insulin produced by the pancreas, but they are only effective if the pancreas is functioning properly. Sulfonylureas bind to a specific channel on the cell membrane of pancreatic beta cells, which helps to increase insulin secretion. However, there are some potential side effects associated with these drugs.

      One of the most common side effects of sulfonylureas is hypoglycaemia, which can be more likely to occur with long-acting preparations like chlorpropamide. Weight gain is another possible side effect. In rare cases, sulfonylureas can cause hyponatraemia, which is a condition where the body retains too much water and sodium levels become too low. Other rare side effects include bone marrow suppression, hepatotoxicity (liver damage), and peripheral neuropathy. It is important to note that sulfonylureas should not be used during pregnancy or while breastfeeding.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
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  • Question 29 - A 7-year-old girl presents to you with her father. She complains of bilateral...

    Incorrect

    • A 7-year-old girl presents to you with her father. She complains of bilateral knee and calf pain at night for the past 6 months. The pain worsens after playing soccer during the day and can cause her to wake up 1-2 times per month. Knee examination is normal, and she is otherwise healthy. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Growing pains

      Explanation:

      Children between the ages of 3 and 12 often experience growing pains, which typically involve leg pain. However, it is crucial to check for any potential warning signs when examining these children. One such warning sign is osteosarcoma, a rare but significant diagnosis that should be ruled out. Symptoms of osteosarcoma include an inexplicable lump, bone pain, or swelling. Another condition to consider is juvenile rheumatoid arthritis, which typically presents with fever, rash, and symmetrical joint pain and swelling.

      Understanding Growing Pains in Children

      Growing pains are a common complaint among children aged 3-12 years. These pains are often attributed to ‘benign idiopathic nocturnal limb pains of childhood’ in rheumatology, as they are not necessarily related to growth. Boys and girls are equally affected by growing pains, which are characterized by intermittent pain in the legs with no obvious cause.

      One of the key features of growing pains is that they are never present at the start of the day after the child has woken up. Additionally, there is no limp or limitation of physical activity, and the child is systemically well with normal physical examination and motor milestones. Symptoms may worsen after a day of vigorous activity.

      Overall, growing pains are a benign condition that can be managed with reassurance and simple measures such as massage or heat application. However, it is important to rule out other potential causes of leg pain in children, especially if there are any worrying features present.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 30 - A 23-year-old woman visits the GP clinic to receive the results of her...

    Incorrect

    • A 23-year-old woman visits the GP clinic to receive the results of her recent blood tests. She has been experiencing fatigue, bloating, and flatulence. The blood test results are as follows:

      - Hb: 110 g/L (normal range for females: 115-160 g/L)
      - Platelets: 201 * 10^9/L (normal range: 150-400 * 10^9/L)
      - WBC: 10.2 * 10^9/L (normal range: 4.0-11.0 * 10^9/L)
      - Ferritin: 25 ug/L (normal range: 15-200 ug/L)
      - Deaminated gliadin IgG: 14 U/mL (normal range: <7 U/mL)
      - Tissue transglutaminase IgA: 21 U/mL (normal range: <7 U/mL)

      What additional tests or criteria would be necessary to make a definitive diagnosis of her condition?

      Your Answer:

      Correct Answer: Endoscopic intestinal biopsy without dietary modification

      Explanation:

      In order to diagnose coeliac disease, endoscopic intestinal biopsy is considered the most reliable method and should be performed on all patients who show signs of the condition based on serology. A young patient with non-specific symptoms that suggest coeliac disease has been found to have mild anaemia and elevated coeliac serology. While these results are suggestive, they are not conclusive, and putting the patient on a gluten-free diet without further testing could be detrimental to their quality of life. Therefore, an intestinal biopsy without dietary modification is necessary to confirm the diagnosis. If the patient excludes gluten prior to the biopsy, the results may not be significant, so it is important to continue or reintroduce gluten for at least 6 weeks before the procedure. The expected results of a biopsy for coeliac disease include villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, and lymphocyte infiltration in the lamina propria. It is incorrect to assume that the patient does not require further testing, as the antibody results are not conclusive. Repeating antibody tests without dietary modification or advising the patient to exclude gluten and repeat the tests are also unnecessary. However, repeating antibody tests after a confirmed diagnosis may be useful in assessing patient adherence to a gluten-free diet. The patient should be referred to a gastroenterologist for an intestinal biopsy to confirm the diagnosis.

      Investigating Coeliac Disease

      Coeliac disease is a condition caused by sensitivity to gluten, which can lead to villous atrophy and malabsorption. It is often associated with other conditions such as dermatitis herpetiformis and autoimmune disorders. Diagnosis of coeliac disease is made through a combination of serology and endoscopic intestinal biopsy. The gold standard for diagnosis is the biopsy, which should be performed in all patients with suspected coeliac disease to confirm or exclude the diagnosis. The biopsy traditionally takes place in the duodenum, but jejunal biopsies are also sometimes performed. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, an increase in intraepithelial lymphocytes, and lamina propria infiltration with lymphocytes. Serology tests for coeliac disease include tissue transglutaminase antibodies and endomyseal antibodies, while anti-gliadin antibodies are not recommended. Patients who are already on a gluten-free diet should reintroduce gluten for at least six weeks prior to testing. Rectal gluten challenge is not widely used. A gluten-free diet can reverse villous atrophy and immunology in patients with coeliac disease.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
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SESSION STATS - PERFORMANCE PER SPECIALTY

ENT (1/1) 100%
Genetics (0/1) 0%
Respiratory Medicine (1/1) 100%
Psychiatry (2/2) 100%
Pharmacology/Therapeutics (1/1) 100%
Reproductive Medicine (1/1) 100%
Endocrinology/Metabolic Disease (2/2) 100%
Musculoskeletal (0/1) 0%
Ophthalmology (0/1) 0%
Gastroenterology/Nutrition (1/1) 100%
Neurology (0/1) 0%
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