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  • Question 1 - For a young adult who experiences occasional mild bronchoconstriction symptoms without any identified...

    Incorrect

    • For a young adult who experiences occasional mild bronchoconstriction symptoms without any identified trigger or night-time symptoms and is not currently taking any medication, which drug therapy combination is appropriate? Please choose ONE option from the list provided.

      Your Answer: Salbutamol and montelukast inhaler

      Correct Answer: Salbutamol and beclomethasone inhaler

      Explanation:

      Understanding Asthma Treatment: BTS/SIGN Guidelines

      Asthma is a chronic respiratory condition that affects millions of people worldwide. The British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) has developed a stepwise approach to managing asthma symptoms. The goal is to achieve complete control of symptoms while minimizing side effects from medication.

      Step 1 involves using a short-acting beta-2 agonist (SABA) on an as-needed basis and a low-dose inhaled corticosteroid (ICS) regularly. If symptoms persist, step 2 involves adding a long-acting beta-2 agonist (LABA) to the ICS. Step 3 involves increasing the ICS dose or adding a leukotriene receptor antagonist (LTRA) if the LABA is ineffective. Step 4 involves increasing the ICS dose or adding a fourth medication, such as a slow-release theophylline or a long-acting muscarinic receptor antagonist (LAMA). Step 5 involves using a daily steroid tablet in the lowest effective dose while maintaining high-dose ICS and considering other treatments to minimize the use of steroid tablets.

      It is important to note that the management of asthma in children under 5 years of age is different. Patients at step 4 or 5 should be referred for specialist care. Complete control of asthma symptoms is defined as no daytime or nighttime symptoms, no need for rescue medication, no asthma attacks, no limitations on activity, and normal lung function with minimal side effects from medication.

      In summary, the BTS/SIGN guidelines provide a comprehensive approach to managing asthma symptoms. By following these guidelines, patients can achieve complete control of their symptoms while minimizing the risk of side effects from medication.

    • This question is part of the following fields:

      • Respiratory Medicine
      34.7
      Seconds
  • Question 2 - Which one of the following clinical features would be least consistent with a...

    Incorrect

    • Which one of the following clinical features would be least consistent with a diagnosis of severe pre-eclampsia?

      Your Answer: Epigastric pain

      Correct Answer: Reflexes difficult to elicit

      Explanation:

      Hyperreflexia and clonus are commonly observed in patients with severe pre-eclampsia, while a decrease in platelet count may indicate the onset of HELLP syndrome.

      Pre-eclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure, proteinuria, and edema. It can lead to complications such as eclampsia, neurological issues, fetal growth problems, liver involvement, and cardiac failure. Severe pre-eclampsia is marked by hypertension, proteinuria, headache, visual disturbances, and other symptoms. Risk factors for pre-eclampsia include hypertension in a previous pregnancy, chronic kidney disease, autoimmune disease, diabetes, chronic hypertension, first pregnancy, and age over 40. Aspirin may be recommended for women with high or moderate risk factors. Treatment involves emergency assessment, admission for observation, and medication such as labetalol, nifedipine, or hydralazine. Delivery of the baby is the most important step in management, with timing depending on the individual case.

    • This question is part of the following fields:

      • Reproductive Medicine
      18.3
      Seconds
  • Question 3 - A 25-year-old man presents to the GP with a swelling in his scrotum....

    Correct

    • A 25-year-old man presents to the GP with a swelling in his scrotum. He is feeling well otherwise. Upon examination, there is a soft swelling on the right side of the scrotum that is painless and illuminates brightly with a pen torch. The swelling is localized to the scrotum, and the rest of the scrotum can be palpated above the mass. The testicle is palpable with no apparent mass. The patient is particularly concerned about the possibility of having testicular cancer.

      What is the most probable diagnosis?

      Your Answer: Hydrocele

      Explanation:

      Scrotal swelling caused by an accumulation of fluid in the tunica vaginalis is known as a hydrocele. This condition can be identified by its ability to transilluminate brightly with a pen torch and is confined to the scrotum. While epididymo-orchitis can also cause unilateral swelling, it is typically tender and accompanied by systemic symptoms. Testicular cancer may lead to a hydrocele, but if the testis is palpable and normal, it is less likely to be the cause of the swelling. In cases where the testis is not palpable, patients should be referred for a testicular ultrasound.

      Common Scrotal Problems and Their Features

      Epididymal cysts, hydroceles, and varicoceles are the most common scrotal problems seen in primary care. Epididymal cysts are usually found posterior to the testicle and are separate from the body of the testicle. They may be associated with conditions such as polycystic kidney disease, cystic fibrosis, and von Hippel-Lindau syndrome. Diagnosis is confirmed by ultrasound, and management is usually supportive, although surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts.

      Hydroceles, on the other hand, describe the accumulation of fluid within the tunica vaginalis. They may be communicating or non-communicating, and may develop secondary to conditions such as epididymo-orchitis, testicular torsion, or testicular tumors. Hydroceles are usually soft, non-tender swellings of the hemi-scrotum that transilluminate with a pen torch. Diagnosis may be clinical, but ultrasound is required if there is any doubt about the diagnosis or if the underlying testis cannot be palpated. Management depends on the severity of the presentation, with infantile hydroceles generally repaired if they do not resolve spontaneously by the age of 1-2 years.

      Varicoceles, on the other hand, are abnormal enlargements of the testicular veins that are usually asymptomatic but may be associated with subfertility. They are much more common on the left side and are classically described as a bag of worms. Diagnosis is confirmed by ultrasound with Doppler studies, and management is usually conservative, although surgery may be required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility.

    • This question is part of the following fields:

      • Renal Medicine/Urology
      34.5
      Seconds
  • Question 4 - A 28-year-old female comes to the clinic with a skin rash under her...

    Correct

    • A 28-year-old female comes to the clinic with a skin rash under her new bracelet. The possibility of a nickel allergy is being considered. What is the most appropriate test to confirm the diagnosis?

      Your Answer: Skin patch test

      Explanation:

      Understanding Nickel Dermatitis

      Nickel dermatitis is a type of allergic contact dermatitis that is commonly caused by exposure to nickel. This condition is an example of a type IV hypersensitivity reaction, which means that it is caused by an immune response to a specific substance. In the case of nickel dermatitis, the immune system reacts to nickel, which is often found in jewelry such as watches.

      To diagnose nickel dermatitis, a skin patch test is typically performed. This involves applying a small amount of nickel to the skin and monitoring the area for any signs of an allergic reaction. Symptoms of nickel dermatitis can include redness, itching, and swelling of the affected area.

    • This question is part of the following fields:

      • Dermatology
      20
      Seconds
  • Question 5 - A 35-year-old man with psoriatic arthritis presents with a severely painful red eye....

    Correct

    • A 35-year-old man with psoriatic arthritis presents with a severely painful red eye. The pain has been affecting his sleep for a few days. On examination, his visual acuity is normal but there is inflammation of the scleral, episcleral and conjunctival vessels. Both pupils are equal and react normally to light. There is no blanching of the episcleral vessels when 2.5% phenylephrine is applied to the eye.
      Which of the following is this patient most likely to be suffering from?

      Your Answer: Scleritis

      Explanation:

      Differentiating Ocular Inflammatory Conditions: Symptoms and Treatment

      Scleritis: A severe inflammation of the sclera, often associated with underlying inflammatory conditions such as rheumatoid arthritis. Symptoms include severe eye pain, watering, photophobia, and affected visual acuity. Treatment requires systemic medication such as non-steroidal anti-inflammatory drugs, corticosteroids, or immunosuppressants.

      Sjögren Syndrome: An association of dry eye and/or dry mouth with rheumatoid arthritis or other connective-tissue disorders. Pain is not a feature, but conjunctival hyperemia may be present.

      Anterior Uveitis: Inflammation of the iris with or without ciliary body involvement, often seen in patients with inflammatory bowel disease or ankylosing spondylitis. Symptoms include an acutely painful red eye with photophobia and a small, irregular, poorly reactive pupil.

      Conjunctivitis: Inflammation of the conjunctival vessels, causing sore red eyes with a sticky discharge. Pain is not a feature, and scleral and episcleral vessels are not affected. Often caused by bacterial or viral infections or irritants/allergens, it is usually self-limiting but may require topical antibiotics.

      Episcleritis: A mild inflammation of the episclera, often seen as an extra-articular manifestation of rheumatoid arthritis. Symptoms include mild eye irritation, redness, and sometimes photophobia. Application of 2.5% phenylephrine causes episcleral vessels to blanch, distinguishing it from scleritis. Visual acuity is unaffected, and it is usually self-limiting.

    • This question is part of the following fields:

      • Musculoskeletal
      40.5
      Seconds
  • Question 6 - A 39-year-old woman experiences lower back pain that travels down her left leg...

    Incorrect

    • A 39-year-old woman experiences lower back pain that travels down her left leg while doing DIY work. She reports a severe, sharp, stabbing pain that worsens with movement. During clinical examination, a positive straight leg raise test is observed on the left side. The patient is given appropriate pain relief. What is the most appropriate next step in management?

      Your Answer: Lumbar spine x-ray

      Correct Answer: Arrange physiotherapy

      Explanation:

      A prolapsed disc is suspected based on the patient’s symptoms. However, even if an MRI scan confirms this diagnosis, the initial management would remain the same as most patients respond well to conservative treatment like physiotherapy.

      Understanding Prolapsed Disc and its Features

      A prolapsed lumbar disc is a common cause of lower back pain that can lead to neurological deficits. It is characterized by clear dermatomal leg pain, which is usually worse than the back pain. The pain is often aggravated when sitting. The features of the prolapsed disc depend on the site of compression. For instance, L3 nerve root compression can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, L4 nerve root compression can lead to sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain. It involves analgesia, physiotherapy, and exercises. According to NICE, the first-line treatment for back pain without sciatica symptoms is NSAIDs +/- proton pump inhibitors, rather than neuropathic analgesia. If the symptoms persist after 4-6 weeks, referral for consideration of MRI is appropriate. Understanding the features of prolapsed disc can help in the diagnosis and management of this condition.

    • This question is part of the following fields:

      • Musculoskeletal
      27.4
      Seconds
  • Question 7 - A 63-year-old woman with a history of scleroderma presents with recurrent bouts of...

    Incorrect

    • A 63-year-old woman with a history of scleroderma presents with recurrent bouts of diarrhoea for the past few months. Her stools are pale, bulky, and offensive during these episodes. She consumes 12 units of alcohol per week. Laboratory tests reveal the following results:
      - Hemoglobin: 10.8 g/dL
      - Platelets: 231 * 10^9/L
      - White blood cells: 5.4 * 10^9/L
      - Ferritin: 14 ng/mL
      - Vitamin B12: 170 ng/L
      - Folate: 2.2 nmol/L
      - Sodium: 142 mmol/L
      - Potassium: 3.4 mmol/L
      - Urea: 4.5 mmol/L
      - Creatinine: 77 µmol/L
      - Bilirubin: 21 µmol/L
      - Alkaline phosphatase: 88 U/L
      - Alanine transaminase: 21 U/L
      - Gamma-glutamyl transferase: 55 U/L
      - Albumin: 36 g/L

      What is the most likely complication that has occurred in this patient?

      Your Answer: Chronic pancreatitis

      Correct Answer: Malabsorption syndrome

      Explanation:

      Scleroderma (systemic sclerosis) frequently leads to malabsorption syndrome, which is characterized by reduced absorption of certain vitamins (B12, folate), nutrients (iron), and protein (low albumin) as indicated by blood tests.

      Understanding Malabsorption: Causes and Symptoms

      Malabsorption is a condition that is characterized by diarrhea, steatorrhea, and weight loss. It occurs when the body is unable to absorb nutrients from the food that is consumed. The causes of malabsorption can be broadly divided into three categories: intestinal, pancreatic, and biliary. Intestinal causes include conditions such as coeliac disease, Crohn’s disease, tropical sprue, Whipple’s disease, Giardiasis, and brush border enzyme deficiencies. Pancreatic causes include chronic pancreatitis, cystic fibrosis, and pancreatic cancer. Biliary causes include biliary obstruction and primary biliary cirrhosis. Other causes of malabsorption include bacterial overgrowth, short bowel syndrome, and lymphoma.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      81.2
      Seconds
  • Question 8 - A 14-year-old girl is referred to haematology due to heavy and prolonged periods...

    Incorrect

    • A 14-year-old girl is referred to haematology due to heavy and prolonged periods that have not responded well to tranexamic acid and the combined oral contraceptive pill. Her blood tests reveal Hb of 10.3 g/dl, Plt of 239 * 109/l, WBC of 6.5 * 109/l, PT of 12.9 secs, and APTT of 37 secs. What is the probable diagnosis?

      Your Answer: Idiopathic thrombocytopenic purpura

      Correct Answer: Von Willebrand's disease

      Explanation:

      Understanding Von Willebrand’s Disease

      Von Willebrand’s disease is a common inherited bleeding disorder that is usually passed down in an autosomal dominant manner. It behaves like a platelet disorder, with symptoms such as nosebleeds and heavy menstrual bleeding being common, while joint and muscle bleeding are rare. The disease is caused by a deficiency or abnormality in von Willebrand factor, a large glycoprotein that promotes platelet adhesion to damaged endothelium and acts as a carrier molecule for factor VIII.

      There are three types of Von Willebrand’s disease. Type 1 is the most common and is characterized by a partial reduction in von Willebrand factor. Type 2 is further divided into four subtypes, each with a different abnormality in the von Willebrand factor. Type 3 is the most severe form and is caused by a total lack of von Willebrand factor, inherited in an autosomal recessive manner.

      Diagnosis of Von Willebrand’s disease involves tests such as a prolonged bleeding time, APTT, factor VIII levels, and platelet aggregation with ristocetin. Management options include tranexamic acid for mild bleeding, desmopressin to raise levels of von Willebrand factor, and factor VIII concentrate. While there is no clear correlation between symptomatic presentation and type of Von Willebrand’s disease, common themes among patients include excessive mucocutaneous bleeding, bruising in the absence of trauma, and menorrhagia in females.

    • This question is part of the following fields:

      • Haematology/Oncology
      30.6
      Seconds
  • Question 9 - A 21-year-old young woman attends surgery concerned about painful periods. She reports normal...

    Correct

    • A 21-year-old young woman attends surgery concerned about painful periods. She reports normal blood loss and a regular cycle; she is not sexually active. Pelvic examination is normal.
      Which of the following is the most appropriate treatment choice?

      Your Answer: Mefenamic acid

      Explanation:

      According to NICE guidelines, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or mefenamic acid should be the first-line treatment for primary dysmenorrhoea, unless contraindicated. Combined oral contraceptives (COCs) containing ethinylestradiol and norethisterone, norgestimate, or levonorgestrel are also recommended for women who do not wish to conceive. However, for a non-sexually active woman, a non-hormonal drug would be more appropriate. Paracetamol can be prescribed if NSAIDs are not tolerated or contraindicated. Tranexamic acid is useful for menorrhagia, not dysmenorrhoea. The diagnosis of primary dysmenorrhoea is likely if menstrual pain starts 6-12 months after menarche, before menstruation, and lasts up to 72 hours, with non-gynaecological symptoms present, and a normal pelvic examination.

    • This question is part of the following fields:

      • Reproductive Medicine
      20.8
      Seconds
  • Question 10 - A 42-year-old female is admitted to the psychiatric ward and experiences an acute...

    Correct

    • A 42-year-old female is admitted to the psychiatric ward and experiences an acute episode of psychosis. The on-call doctor is consulted and prescribes medication, but the patient subsequently develops severe acute agitation and torticollis.
      What is the most suitable course of treatment?

      Your Answer: Procyclidine

      Explanation:

      Common Drugs and Their Roles in Treating Extra-Pyramidal Side Effects

      Extra-pyramidal side effects (EPSE) are a common occurrence in patients taking antipsychotic medications. Procyclidine is an antimuscarinic drug that is the first line treatment for EPSE, including torticollis. It can be administered orally or parenterally and is usually very effective.

      Naloxone, on the other hand, is an opioid antagonist used in the emergency treatment of opioid overdose. It has no role in the treatment of EPSE, including torticollis. Flumazenil, a benzodiazepine antagonist, is used to reverse central sedative effects of benzodiazepines during anaesthesia or diagnostic, surgical or dental procedures. It has no role in the treatment of torticollis or other EPSE.

      N-acetylcysteine (NAC) is mainly used in the treatment of paracetamol overdose and has no role in the treatment of EPSE, including torticollis. Sodium thiosulphate, used as an antidote to cyanide poisoning, also has no role in the treatment of EPSE, including torticollis. Understanding the roles of these common drugs can help healthcare professionals provide appropriate treatment for patients experiencing EPSE.

    • This question is part of the following fields:

      • Psychiatry
      91
      Seconds
  • Question 11 - As a young medical practitioner in the emergency department, you encounter a patient...

    Correct

    • As a young medical practitioner in the emergency department, you encounter a patient who has been in a severe road accident. The patient has suffered significant head injuries and is now reliant on mechanical ventilation, with no signs of responsiveness. You and your senior colleagues suspect that the patient may have experienced brain death. What is the process for confirming this diagnosis?

      Your Answer: By a minimum of two doctors on separate occasions

      Explanation:

      To minimize the risk of errors, brain death testing must be conducted by two experienced doctors on different occasions. The testing involves evaluating the patient’s history, pupil reactions, reflexes, pain response, and respiratory effort. Once brain death is confirmed, life support can be discontinued, and the patient may be considered for organ donation, which can take place before the withdrawal of life support.

      Criteria and Testing for Brain Stem Death

      Brain death occurs when the brain and brain stem cease to function, resulting in irreversible loss of consciousness and vital functions. To determine brain stem death, certain criteria must be met and specific tests must be performed. The patient must be in a deep coma of known cause, with reversible causes excluded and no sedation. Electrolyte levels must be normal.

      The testing for brain stem death involves several assessments. The pupils must be fixed and unresponsive to changes in light intensity. The corneal reflex must be absent, and there should be no response to supraorbital pressure. The oculo-vestibular reflexes must be absent, which is tested by injecting ice-cold water into each ear. There should be no cough reflex to bronchial stimulation or gagging response to pharyngeal stimulation. Finally, there should be no observed respiratory effort in response to disconnection from the ventilator for at least five minutes, with adequate oxygenation ensured.

      It is important that the testing is performed by two experienced doctors on two separate occasions, with at least one being a consultant. Neither doctor can be a member of the transplant team if organ donation is being considered. These criteria and tests are crucial in determining brain stem death and ensuring that the patient is beyond recovery.

    • This question is part of the following fields:

      • Neurology
      12.9
      Seconds
  • Question 12 - A woman with a history of asthma who is 25 weeks pregnant is...

    Correct

    • A woman with a history of asthma who is 25 weeks pregnant is found to have consistent blood pressure readings >170/95 mmHg. She is admitted under Gynaecology.
      Which of the following antihypertensives would you initiate for this patient?

      Your Answer: Nifedipine

      Explanation:

      Safe and Effective Treatment Options for Gestational Hypertension

      Gestational hypertension is a serious condition that requires prompt medical attention. According to NICE guidelines, labetalol is the first-line treatment for gestational hypertension. However, if the patient has asthma, labetalol is contraindicated. In such cases, nifedipine is listed as the second-line treatment, followed by methyldopa if necessary.

      Diltiazem is not usually used in gestational hypertension, and the role of this medication in pregnancy is unclear. Bendroflumethiazide is relatively contraindicated in pregnancy, while ACE inhibitors and ARBs are absolutely contraindicated due to their potential adverse effects on fetal blood pressure and renal function.

      In cases of gestational hypertension, it is crucial to rule out pre-eclampsia. If the patient’s blood pressure is above 160/110, NICE guidelines recommend admission until the blood pressure is below this level.

      Calcium channel blockers, such as nifedipine, are safe and effective in pregnancy, while the role of diltiazem is uncertain. Bendroflumethiazide is relatively contraindicated, while ACE inhibitors and ARBs are absolutely contraindicated. It is essential to choose the appropriate medication based on the patient’s medical history and individual circumstances.

    • This question is part of the following fields:

      • Cardiovascular
      16.9
      Seconds
  • Question 13 - A 19-year-old man with a history of anxiety and depression is being managed...

    Incorrect

    • A 19-year-old man with a history of anxiety and depression is being managed by the Child and Adolescent Mental Health Service. They have suggested prescribing an SSRI. What is the most suitable medication to prescribe?

      Your Answer: Sertraline

      Correct Answer: Fluoxetine

      Explanation:

      Fluoxetine is the preferred SSRI for children and adolescents.

      Selective serotonin reuptake inhibitors (SSRIs) are commonly used as the first-line treatment for depression. Citalopram and fluoxetine are the preferred SSRIs, while sertraline is recommended for patients who have had a myocardial infarction. However, caution should be exercised when prescribing SSRIs to children and adolescents. Gastrointestinal symptoms are the most common side-effect, and patients taking SSRIs are at an increased risk of gastrointestinal bleeding. Patients should also be aware of the possibility of increased anxiety and agitation after starting a SSRI. Fluoxetine and paroxetine have a higher propensity for drug interactions.

      The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning regarding the use of citalopram due to its association with dose-dependent QT interval prolongation. As a result, citalopram and escitalopram should not be used in patients with congenital long QT syndrome, known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval. The maximum daily dose of citalopram is now 40 mg for adults, 20 mg for patients older than 65 years, and 20 mg for those with hepatic impairment.

      When initiating antidepressant therapy, patients should be reviewed by a doctor after 2 weeks. Patients under the age of 25 years or at an increased risk of suicide should be reviewed after 1 week. If a patient responds well to antidepressant therapy, they should continue treatment for at least 6 months after remission to reduce the risk of relapse. When stopping a SSRI, the dose should be gradually reduced over a 4 week period, except for fluoxetine. Paroxetine has a higher incidence of discontinuation symptoms, including mood changes, restlessness, difficulty sleeping, unsteadiness, sweating, gastrointestinal symptoms, and paraesthesia.

      When considering the use of SSRIs during pregnancy, the benefits and risks should be weighed. Use during the first trimester may increase the risk of congenital heart defects, while use during the third trimester can result in persistent pulmonary hypertension of the newborn. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester.

    • This question is part of the following fields:

      • Psychiatry
      24.5
      Seconds
  • Question 14 - A 56-year-old man presents to his GP complaining of numbness and tingling in...

    Incorrect

    • A 56-year-old man presents to his GP complaining of numbness and tingling in his thumb, middle, and index fingers for the past 8 months. This is beginning to interfere with his work as a financial analyst. He has a history of hypothyroidism for which he takes 75 micrograms of thyroxine daily. Other than that, his medical history is unremarkable. Which nerves are likely affected in this condition?

      Your Answer: Radial nerve

      Correct Answer: Median nerve

      Explanation:

      To identify the affected nerve, it is crucial to accurately diagnose the underlying condition. The patient’s symptoms, such as numbness and tingling in the thumb and middle finger (and possibly the radial half of the ring finger), suggest carpal tunnel syndrome. Additionally, the patient’s occupation involving computer use and hypothyroidism are risk factors for this condition. Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist within the carpal tunnel.

      Understanding Carpal Tunnel Syndrome

      Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. Patients with this condition typically experience pain or pins and needles in their thumb, index, and middle fingers. In some cases, the symptoms may even ascend proximally. Patients often shake their hand to obtain relief, especially at night.

      During an examination, doctors may observe weakness of thumb abduction and wasting of the thenar eminence (not the hypothenar). Tapping on the affected area may cause paraesthesia, which is known as Tinel’s sign. Flexion of the wrist may also cause symptoms, which is known as Phalen’s sign.

      Carpal tunnel syndrome can be caused by a variety of factors, including idiopathic reasons, pregnancy, oedema (such as heart failure), lunate fracture, and rheumatoid arthritis. Electrophysiology tests may show prolongation of the action potential in both motor and sensory nerves.

      Treatment for carpal tunnel syndrome may include a 6-week trial of conservative treatments, such as corticosteroid injections and wrist splints at night. If symptoms persist or are severe, surgical decompression (flexor retinaculum division) may be necessary.

    • This question is part of the following fields:

      • Musculoskeletal
      64.9
      Seconds
  • Question 15 - A 3 day old infant who was delivered via ventouse presents with a...

    Incorrect

    • A 3 day old infant who was delivered via ventouse presents with a swelling on the left parietal region of the head. The swelling was not present immediately after birth and the baby is otherwise healthy. Upon examination, the swelling does not cross suture lines and the fontanelles and sutures appear normal. What is the probable diagnosis?

      Your Answer: Caput succedeneum

      Correct Answer: Cephalohaematoma

      Explanation:

      A cephalohaematoma is a swelling caused by bleeding between the skull and periosteum, typically seen in the parietal region of newborns delivered with instruments. It usually appears 2-3 days after birth and does not cross suture lines, resolving over several weeks.

      Caput succadeneum is a common condition in newborns immediately after birth, caused by generalised scalp oedema that crosses suture lines. It is associated with prolonged labour and resolves quickly within a few days.

      Subaponeurotic haematoma is a rare and potentially life-threatening condition where bleeding occurs outside the periosteum, causing a fluctuant scalp swelling that is not limited by suture lines.

      Craniosynostosis is a rare condition where cranial sutures close prematurely, leading to skull deformities that may be evident at birth and associated with genetic syndromes. The shape of the skull depends on which sutures are involved, and other clinical features include early closure of the anterior fontanelle and a raised ridge along the fused suture.

      A cephalohaematoma is a swelling that appears on a newborn’s head, usually a few hours after delivery. It is caused by bleeding between the skull and periosteum, with the parietal region being the most commonly affected site. This condition may lead to jaundice as a complication and can take up to three months to resolve.

      In comparison to caput succedaneum, which is another type of swelling that can occur on a newborn’s head, cephalohaematoma is more localized and does not cross suture lines. Caput succedaneum, on the other hand, is a diffuse swelling that can cross suture lines and is caused by fluid accumulation in the scalp tissue. Both conditions are usually harmless and resolve on their own, but medical attention may be necessary in severe cases.

    • This question is part of the following fields:

      • Paediatrics
      17.1
      Seconds
  • Question 16 - A 25-year-old woman is brought into the emergency department by the police after...

    Correct

    • A 25-year-old woman is brought into the emergency department by the police after being arrested in a local bar for odd and aggressive behaviour. Whilst taking a history she tells you that she can't understand why she has been arrested as she was just celebrating the fact that she has recently figured out how to solve world hunger and she wants to share this with everyone. You struggle to keep up with her pace of speech and throughout the consultation, she is aggressive and at times sexually inappropriate. An initial drug screen is clear and her bloods are unremarkable.
      What is the most likely cause of her behaviour?

      Your Answer: Manic episode

      Explanation:

      The woman is exhibiting clear indications of a manic episode, including rapid speech, uninhibited behavior, and grandiose delusions. Tests for drugs and alcohol have ruled out intoxication or drug-induced psychosis. Schizophrenia is unlikely as a first-time diagnosis, and the symptoms suggest mania or bipolar disorder. However, a diagnosis of bipolar disorder cannot be made without evidence of depressive symptoms. Therefore, the correct diagnosis in this case is an isolated manic episode of unknown origin.

      Understanding the Difference between Hypomania and Mania

      Hypomania and mania are two terms that are often used interchangeably, but they actually refer to two different conditions. While both conditions share some common symptoms, there are some key differences that set them apart.

      Mania is a more severe form of hypomania that lasts for at least seven days and can cause significant impairment in social and work settings. It may require hospitalization due to the risk of harm to oneself or others and may present with psychotic symptoms such as delusions of grandeur or auditory hallucinations.

      On the other hand, hypomania is a lesser version of mania that lasts for less than seven days, typically 3-4 days. It does not impair functional capacity in social or work settings and is unlikely to require hospitalization. It also does not exhibit any psychotic symptoms.

      Both hypomania and mania share common symptoms such as elevated or irritable mood, pressured speech, flight of ideas, poor attention, insomnia, loss of inhibitions, increased appetite, and risk-taking behavior. However, the length of symptoms, severity, and presence of psychotic symptoms help differentiate mania from hypomania.

    • This question is part of the following fields:

      • Psychiatry
      36.7
      Seconds
  • Question 17 - A mother brings her 10-month-old baby to her pediatrician with concerns about her...

    Correct

    • A mother brings her 10-month-old baby to her pediatrician with concerns about her development. The baby was born at 37 weeks with a low birth weight of 2,100 grams. The mother reports that the baby is able to sit unsupported but tends to use her right hand only to grasp toys, even when they are on her left side. When a task requires both hands, the baby uses her left hand to assist the right, but it appears uncoordinated. What is the best course of action for management?

      Your Answer: Refer urgently to a child development service for multidisciplinary assessment

      Explanation:

      If a child shows a preference for one hand before the age of 12 months, it may be a sign of cerebral palsy and should be addressed promptly. The appropriate course of action is to refer the child to a child development service for a comprehensive evaluation by a multidisciplinary team. Children with cerebral palsy typically receive specialized care from birth, but in some cases, the condition may be suspected in a primary care setting. According to NICE guidelines, delayed motor milestones such as not sitting by 8 months (adjusted for gestational age), not walking by 18 months (adjusted for gestational age), early asymmetry of hand function, and persistent toe-walking may indicate cerebral palsy. In this case, as the child is exhibiting hand preference before the age of 1 year and has a risk factor for cerebral palsy (low birth weight), an urgent referral is necessary. Other options are not appropriate and may delay diagnosis and treatment.

      Common Developmental Problems and Possible Causes

      Developmental problems can manifest in various ways, including referral points such as not smiling at 10 weeks, inability to sit unsupported at 12 months, and failure to walk at 18 months. Fine motor skill problems may also arise, such as abnormal hand preference before 12 months, which could indicate cerebral palsy. Gross motor problems are often caused by a variant of normal, cerebral palsy, or neuromuscular disorders like Duchenne muscular dystrophy. Speech and language problems should always be checked for hearing issues, as they can also be caused by environmental deprivation or general development delay.

      It is important to recognize these developmental problems early on and seek appropriate interventions to address them. By doing so, children can receive the necessary support to reach their full potential and overcome any challenges they may face. With proper care and attention, many children with developmental problems can go on to lead happy and fulfilling lives.

    • This question is part of the following fields:

      • Paediatrics
      23
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  • Question 18 - A 50-year-old man with Down's syndrome presents to you with a recent diagnosis...

    Correct

    • A 50-year-old man with Down's syndrome presents to you with a recent diagnosis of essential hypertension. He is accompanied by his caregiver and expresses his fear of needles, requesting medication that does not require regular blood tests. Which of the following medications would be appropriate for him?

      Your Answer: Amlodipine

      Explanation:

      Regular monitoring of renal function and electrolytes is necessary for both Ramipril, an ACE inhibitor, and Candesartan, an angiotensin 2 receptor blocker.

      Understanding Calcium Channel Blockers

      Calcium channel blockers are medications primarily used to manage cardiovascular diseases. These blockers target voltage-gated calcium channels present in myocardial cells, cells of the conduction system, and vascular smooth muscle cells. The different types of calcium channel blockers have varying effects on these three areas, making it crucial to differentiate their uses and actions.

      Verapamil is an example of a calcium channel blocker used to manage angina, hypertension, and arrhythmias. However, it is highly negatively inotropic and should not be given with beta-blockers as it may cause heart block. Verapamil may also cause side effects such as heart failure, constipation, hypotension, bradycardia, and flushing.

      Diltiazem is another calcium channel blocker used to manage angina and hypertension. It is less negatively inotropic than verapamil, but caution should still be exercised when patients have heart failure or are taking beta-blockers. Diltiazem may cause side effects such as hypotension, bradycardia, heart failure, and ankle swelling.

      On the other hand, dihydropyridines such as nifedipine, amlodipine, and felodipine are calcium channel blockers used to manage hypertension, angina, and Raynaud’s. These blockers affect the peripheral vascular smooth muscle more than the myocardium, resulting in no worsening of heart failure but may cause ankle swelling. Shorter-acting dihydropyridines such as nifedipine may cause peripheral vasodilation, resulting in reflex tachycardia and side effects such as flushing, headache, and ankle swelling.

      In summary, understanding the different types of calcium channel blockers and their effects on the body is crucial in managing cardiovascular diseases. It is also important to note the potential side effects and cautions when prescribing these medications.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      17.9
      Seconds
  • Question 19 - A 45-year-old woman develops significantly increasing pain in her leg one day postoperatively...

    Incorrect

    • A 45-year-old woman develops significantly increasing pain in her leg one day postoperatively following surgery for a tibial shaft fracture. The plaster cast is removed and examination reveals tender swelling of her lower leg. All distal pulses are present and the foot and leg are warm. Pain is significantly worse with passive extension of the toes.
      Which of the following is the most likely diagnosis?

      Your Answer: Deep vein thrombosis (DVT)

      Correct Answer: Acute compartment syndrome

      Explanation:

      Differential Diagnosis for a Swollen Calf: Understanding Acute Compartment Syndrome and Other Potential Causes

      A swollen calf can be a concerning symptom, especially following trauma or surgery on the lower limb. One potential cause is acute compartment syndrome, which is a surgical emergency that can lead to limb-threatening complications. This condition occurs when pressure within a closed fascial compartment increases and compromises the neurovascular supply to the muscles within that compartment. Other potential causes of a swollen calf include a ruptured Baker’s cyst, acute limb ischaemia, cellulitis, and deep vein thrombosis (DVT). Understanding the clinical features and differential diagnosis of these conditions is crucial for prompt and appropriate management.

    • This question is part of the following fields:

      • Musculoskeletal
      51.3
      Seconds
  • Question 20 - A 40-year-old inpatient experienced an episode of acute psychosis. He was given a...

    Correct

    • A 40-year-old inpatient experienced an episode of acute psychosis. He was given a medication on the ward and later developed severe torticollis.
      What is the most probable drug that was administered to the patient?

      Your Answer: Haloperidol

      Explanation:

      Common Psychiatric Medications and Their Side-Effects

      Haloperidol: A typical antipsychotic drug that can cause extrapyramidal side-effects (EPSEs), including acute dystonic reactions. Treatment is with anticholinergic drugs or benzodiazepines.

      Clozapine: An atypical antipsychotic mainly used in treatment-resistant schizophrenia. Common side-effects include sedation, constipation, hypersalivation, weight gain, and metabolic syndrome. Rare but important side-effects include agranulocytosis, arrhythmias, and myocarditis. EPSEs are possible but rare.

      Diazepam: A benzodiazepine used in anxiety, insomnia, seizures, and muscle spasms. Side-effects include sedation, muscle weakness, drowsiness, and confusion. EPSEs are not a recognised side-effect and may improve with the use of benzodiazepines.

      Lithium: A mood stabiliser used in the treatment of mania, depression, and bipolar disorder. Side-effects include gastrointestinal disturbances, tremor, polydipsia, polyuria, and electrolyte disturbances. Lithium-induced hypothyroidism is common. EPSEs are not a side-effect of lithium.

      Olanzapine: An atypical antipsychotic used in the treatment of schizophrenia and acute mania. Common side-effects include sedation, weight gain, and metabolic symptoms. EPSEs can occur but are not a typical side-effect of olanzapine.

    • This question is part of the following fields:

      • Psychiatry
      15.8
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SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory Medicine (0/1) 0%
Reproductive Medicine (1/2) 50%
Renal Medicine/Urology (1/1) 100%
Dermatology (1/1) 100%
Musculoskeletal (1/4) 25%
Gastroenterology/Nutrition (0/1) 0%
Haematology/Oncology (0/1) 0%
Psychiatry (3/4) 75%
Neurology (1/1) 100%
Cardiovascular (1/1) 100%
Paediatrics (1/2) 50%
Pharmacology/Therapeutics (1/1) 100%
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