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  • Question 1 - A teenager makes an uneventful recovery post-appendicectomy, and three months later is back...

    Incorrect

    • A teenager makes an uneventful recovery post-appendicectomy, and three months later is back at school when he gets a sharp pain in the right inguinal region and notices a bulge just above his groin on the right. His GP diagnoses an inguinal hernia.
      Which nerve is most likely to have been damaged during the teenager's appendicectomy?

      Your Answer: Genitofemoral

      Correct Answer: Ilioinguinal

      Explanation:

      Nerve Damage during Appendicectomy: Understanding the Ilioinguinal, T10, Femoral, Genitofemoral, and Obturator Nerves

      During an appendicectomy, it is possible for nerves to be damaged if the surgeon performs overzealous sharp dissection of the musculature within the incision. One of the nerves that can be affected is the ilioinguinal nerve, which is a branch from the first lumbar nerve. This nerve passes between the transversus abdominis and internal oblique muscles, supplying these muscles that form the roof of the inguinal canal in the groin region. Damage to the ilioinguinal nerve can lead to the development of an indirect inguinal hernia.

      It is important to note that the T10 nerve, which originates from below the thoracic vertebra 10, is too high to be damaged during an appendicectomy. The femoral nerve, which supplies the thigh and arises from the second, third, and fourth lumbar nerves, is also unlikely to be damaged during the procedure. The genitofemoral nerve and obturator nerve are also not typically affected during an appendicectomy.

      In summary, understanding the potential nerve damage that can occur during an appendicectomy is important for both patients and surgeons. By being aware of the nerves that are at risk, surgeons can take appropriate precautions to minimize the risk of complications and ensure the best possible outcome for their patients.

    • This question is part of the following fields:

      • Colorectal
      42
      Seconds
  • Question 2 - A 27-year-old woman who is 39+0 weeks pregnant undergoes an artificial rupture of...

    Incorrect

    • A 27-year-old woman who is 39+0 weeks pregnant undergoes an artificial rupture of membranes to speed up slow labour. However, soon after the procedure, the CTG shows foetal bradycardia and the umbilical cord is palpable at the vaginal opening. What is the first step in managing this patient?

      Your Answer: Perform an episiotomy

      Correct Answer: Ask the mother to 'go on all fours'

      Explanation:

      The appropriate action for a woman with a cord prolapse is to request that she assume an all-fours position on her knees and elbows. This condition occurs when the umbilical cord descends before the fetus’s presenting part, resulting in signs of fetal distress on a CTG after an artificial rupture of membranes. To prevent compression, the fetus’s presenting part may be pushed back into the uterus, and tocolytics may be used. If the cord is beyond the introitus, it should be kept warm and moist but not pushed back inside. The patient should be instructed to assume an all-fours position until an immediate caesarean section can be arranged. Applying external suprapubic pressure is not recommended, as it is part of the initial management of shoulder dystocia. Attempting to return the umbilical cord to the uterus is not recommended, as it may worsen fetal hypoxia and cause vasospasm. An episiotomy is not necessary for the initial management of cord prolapse and is typically used during instrumental vaginal deliveries or when the mother is at high risk of perineal trauma.

      Understanding Umbilical Cord Prolapse

      Umbilical cord prolapse is a rare but serious complication that can occur during delivery. It happens when the umbilical cord descends ahead of the presenting part of the fetus, which can lead to compression or spasm of the cord. This can cause fetal hypoxia and potentially irreversible damage or death. Certain factors increase the risk of cord prolapse, such as prematurity, multiparity, polyhydramnios, twin pregnancy, cephalopelvic disproportion, and abnormal presentations like breech or transverse lie.

      Around half of all cord prolapses occur when the membranes are artificially ruptured. Diagnosis is usually made when the fetal heart rate becomes abnormal and the cord is palpable vaginally or visible beyond the introitus. Cord prolapse is an obstetric emergency that requires immediate management. The presenting part of the fetus may be pushed back into the uterus to avoid compression, and the cord should be kept warm and moist to prevent vasospasm. The patient may be asked to go on all fours or assume the left lateral position until preparations for an immediate caesarian section have been carried out. Tocolytics may be used to reduce uterine contractions, and retrofilling the bladder with saline can help elevate the presenting part. Although caesarian section is the usual first-line method of delivery, an instrumental vaginal delivery may be possible if the cervix is fully dilated and the head is low.

      In conclusion, umbilical cord prolapse is a rare but serious complication that requires prompt recognition and management. Understanding the risk factors and appropriate interventions can help reduce the incidence of fetal mortality associated with this condition.

    • This question is part of the following fields:

      • Obstetrics
      66.6
      Seconds
  • Question 3 - A 60-year-old man has been admitted to the hospital after a fall resulting...

    Incorrect

    • A 60-year-old man has been admitted to the hospital after a fall resulting in a fractured intracapsular neck of femur. He has been consented for a hemiarthroplasty and is third on the list for the following morning. He is currently on warfarin, but vitamin K has been administered to normalise his international normalised ratio (INR) before surgery. He has several co-morbidities, including atrial fibrillation, previous transient ischaemic attacks (TIAs), and type 2 diabetes mellitus, and he takes a long list of medications. The senior house officer has been asked to review his medications before surgery tomorrow. He is currently haemodynamically stable, normocardic, and apyrexial.
      Which medication can he safely take on the day of surgery?

      Your Answer: Metformin

      Correct Answer: Digoxin

      Explanation:

      Medication Management in Perioperative Care

      During the perioperative period, it is important to carefully manage a patient’s medication regimen to ensure optimal outcomes. Here are some guidelines for managing specific medications:

      Digoxin: Antiarrhythmic drugs like digoxin should generally be continued on the day of surgery to prevent arrhythmias. It can be given intravenously if the patient cannot take it orally, but should be omitted if the patient is bradycardic.

      Gliclazide: This medication should be omitted on the morning of a procedure and restarted once the patient is eating again postoperatively.

      Ramipril: Patients on ACE inhibitors like ramipril have a higher risk of hypotension during anesthesia, especially if they are volume-depleted or undergoing epidural anesthesia.

      Metformin: Metformin should be stopped before the preoperative fast begins and used with caution in those who are dehydrated or at risk of renal impairment.

      Aspirin: Aspirin should be stopped when the risks of post-operative bleeding are high or when even minor bleeding could have significant consequences. Ideally, it should be stopped 5-7 days before elective surgery.

      Proper management of medications during the perioperative period can help minimize risks and improve outcomes for patients.

    • This question is part of the following fields:

      • Surgery
      67.3
      Seconds
  • Question 4 - A 35-year-old woman with two children visits the Gynaecology Clinic, referred by her...

    Correct

    • A 35-year-old woman with two children visits the Gynaecology Clinic, referred by her general practitioner. She has decided that she wants to undergo a tubal ligation procedure to prevent any future pregnancies after discussing it with her partner. During her consultation, she asks about the potential risks associated with the procedure.
      What is a commonly acknowledged potential outcome of tubal ligation?

      Your Answer: Ectopic pregnancy

      Explanation:

      Understanding the Potential Risks and Side Effects of Female Sterilisation

      Female sterilisation is a permanent contraceptive procedure that involves blocking the Fallopian tubes. While it is highly effective, it is important for women to understand the potential risks and side effects before undergoing the procedure.

      Risks and Side Effects of Female Sterilisation

      Explanation: Female sterilisation is a surgical procedure that permanently blocks the Fallopian tubes, preventing the passage of gametes. While it is a highly effective form of contraception, it is important for women to be aware of the potential risks and side effects before undergoing the procedure.

      One of the main risks of female sterilisation is the possibility of ectopic pregnancy, which occurs when a fertilized egg implants outside of the uterus. While the risk is low, it is important for women to be aware of this potential complication.

      Other risks and side effects of female sterilisation include complications during the procedure, such as the need for laparotomy under the same anesthesia, as well as the irreversibility of the procedure and the need to consider alternative contraceptive methods.

      It is also important to note that depression is a rare side effect of hormonal contraceptives, but is not seen with interventional approaches such as tubal ligation. Similarly, while unprotected intercourse can increase the risk of sexually transmitted infections (STIs), it would be unreasonable to label STIs after tubal ligation as a complication.

      Finally, weight gain is associated with hormonal contraceptives such as the combined oral contraceptive pill, but there is no evidence to suggest that tubal ligation causes weight gain. Women may also experience increased abdominal cramps during menstruation when using a non-hormonal intrauterine device (IUD) such as the copper IUD.

      Overall, it is important for women to have a thorough understanding of the potential risks and side effects of female sterilisation before making a decision about whether or not to undergo the procedure.

    • This question is part of the following fields:

      • Sexual Health
      93
      Seconds
  • Question 5 - A 28-year-old metal worker slips onto a furnace wall. He presents with a...

    Incorrect

    • A 28-year-old metal worker slips onto a furnace wall. He presents with a leathery lesion on his chest. It is dry and insensate with a waxy appearance. It does not blanch.
      How would you describe this burn?

      Your Answer: Partial-thickness burn (second-degree burn)

      Correct Answer: Full-thickness burn (third-degree burn)

      Explanation:

      Understanding Burn Classification: From Superficial to Full-Thickness Burns

      Burns can be classified based on their depth and severity. While the general public may be familiar with the ‘degree’ classification, plastic surgeons prefer to use the ‘thickness’ classification. Superficial burns, also known as first-degree burns, only affect the epidermis and are painful and red. Partial-thickness burns, or second-degree burns, penetrate deeper into the dermis layer and are more painful and prone to infection. Full-thickness burns, or third-degree burns, are painless and do not blanch due to damage to the nerves and microvasculature. The skin can be charred and leathery, with scarring likely in the long term. Fourth-degree burns involve damage to not only the skin but also the underlying muscles, tendons, or ligaments. Fifth-degree burns, which are rare and often only diagnosed at autopsy, penetrate down to the bone. It is important to understand the different classifications of burns to properly evaluate and treat them.

    • This question is part of the following fields:

      • Plastics
      40.5
      Seconds
  • Question 6 - A 4-year-old boy is brought to the General Practitioner (GP) by his parents...

    Correct

    • A 4-year-old boy is brought to the General Practitioner (GP) by his parents due to concerns raised by his nursery. Although he is meeting his developmental milestones, he seems to struggle with social interaction and play with other children.

      The parents report that he was born via normal vaginal delivery at term and has met all of his speech and motor milestones. However, they have noticed that he is different from his older siblings as he has never made any friends or engaged in any imaginative play. He prefers to play alone and becomes upset if anyone touches his toys. He insists on following the same routine every day, including eating the same meals and taking the same route to nursery. He struggles during weekends and holidays when his routine is disrupted.

      Which of the following diagnoses would be most consistent with the signs and symptoms observed in this child?

      Your Answer: Autism spectrum disorder

      Explanation:

      Understanding Different Developmental Disorders: A Comparison

      When observing a child’s behavior, it is important to consider various developmental disorders that may be present. In this case, the girl in question is displaying signs of autism spectrum disorder, which is characterized by persistent difficulties with social communication and interaction, as well as restrictive and repetitive patterns of behavior. This disorder must have been present since early childhood and cause significant impairment in important areas of functioning.

      It is important to differentiate autism spectrum disorder from other disorders, such as obsessive-compulsive disorder (OCD), which is characterized by the presence of obsessions and compulsions, and attention-deficit/hyperactivity disorder (ADHD), which is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

      Additionally, a learning disability may be considered if the child has a significantly reduced ability to understand new or complex information and learn new skills, with a reduced ability to cope independently. However, this is unlikely if the child is performing well academically.

      Finally, Rett syndrome is a progressive neurological condition that is usually only seen in girls and has features similar to autism spectrum disorder, such as the inability to show feelings. However, it also has other features such as microcephaly, abnormal gait, seizures, and hypotonia, and usually presents at a much younger age.

      Overall, understanding the differences between these developmental disorders is crucial in accurately identifying and addressing a child’s needs.

    • This question is part of the following fields:

      • Psychiatry
      61.1
      Seconds
  • Question 7 - A 76-year-old man presents to Accident and Emergency confused, dehydrated and constipated. He...

    Correct

    • A 76-year-old man presents to Accident and Emergency confused, dehydrated and constipated. He is complaining of significant pain down his left flank. He was diagnosed with multiple myeloma 6 months ago and is currently undergoing treatment. He is treated with aggressive fluid resuscitation and recovers promptly.
      Elevated levels of which biochemical parameter would has caused this presentation?

      Your Answer: Calcium

      Explanation:

      Electrolyte Imbalances and their Symptoms

      Calcium: Hypercalcaemia of malignancy is a common cause of lytic bone lesions in multiple myeloma patients. Symptoms include dehydration, which can be prevented with aggressive fluid resuscitation. Treatment involves intravenous bisphosphonate or denosumab and calcitonin to inhibit osteoclastic bone resorption.

      Vitamin D: Over-medication with vitamin D can lead to hypervitaminosis D, which presents similar symptoms to hypercalcaemia. However, hypercalcaemia of malignancy is more likely in patients with lytic bone lesions.

      Phosphate: Hyperphosphataemia can be caused by impaired renal excretion or massive extracellular phosphate loadings. Symptoms are similar to hypercalcaemia, but hypercalcaemia of malignancy is more likely in patients with multiple myeloma.

      Sodium: Hypernatraemia presents with symptoms of thirst, lethargy, weakness, and irritability.

      Potassium: Hyperkalaemia can present with symptoms of chest pain, palpitations, and weakness.

    • This question is part of the following fields:

      • Oncology
      27.5
      Seconds
  • Question 8 - Which one of the following statements regarding the reporting of medication related adverse...

    Incorrect

    • Which one of the following statements regarding the reporting of medication related adverse events using the Yellow Card scheme is accurate?

      Your Answer: An allergic rash that develops in an elderly man secondary to co-amoxiclav should be reported

      Correct Answer: Diarrhoea occuring after starting a black triangle medicine should be reported

      Explanation:

      The Yellow Card Scheme for Reporting Adverse Reactions to Medications

      The Yellow Card scheme is a widely recognized method for reporting adverse reactions to medications. It is managed by the Medicines and Healthcare products Regulatory Agency (MHRA). The scheme is designed to encourage healthcare professionals and patients to report any suspected adverse drug reactions, including those related to new medicines, off-label use of medicines, and herbal remedies.

      The MHRA recommends that all suspected adverse drug reactions for new medicines, identified by the black triangle symbol, should be reported. Additionally, all suspected adverse drug reactions occurring in children, even if a medicine has been used off-label, should be reported. Serious suspected adverse drug reactions for established vaccines and medicines, including unlicensed medicines, should also be reported.

      Yellow Cards can be found at the back of the British National Formulary (BNF) or completed online through the Yellow Card website. It is important to note that any suspected reactions, not just confirmed ones, should be reported. Patients can also report adverse events through the scheme.

      Once Yellow Cards are submitted, the MHRA collates and assesses the information. The agency may consult with the Commission on Human Medicines (CHM), an independent scientific advisory body on medicines safety, to further evaluate the reported adverse reactions. Reactions that are fatal, life-threatening, disabling or incapacitating, result in or prolong hospitalization, or are medically significant are considered serious.

    • This question is part of the following fields:

      • Pharmacology
      49.3
      Seconds
  • Question 9 - You review a 56-year-old woman in the clinic who has a history of...

    Correct

    • You review a 56-year-old woman in the clinic who has a history of type 2 diabetes. She is currently treated with metformin 1g PO BD. On examination her BP is 150/80 mmHg, pulse is 78 and regular. Her chest is clear. Her abdomen is soft and non tender, her BMI is 31. Her bA1c is elevated at 9.1%, creatinine is 110 µmol/l. You decide to add dapagliflozin to her treatment plan. What is the correct mode of action of dapagliflozin?

      Your Answer: Reduces glucose reabsorption

      Explanation:

      How Dapagliflozin Reduces Blood Glucose Levels

      Dapagliflozin is a medication that inhibits the SGLT-2 (sodium glucose transporter) in the kidneys, which reduces the reabsorption of glucose. This means that around 30% of glucose present in the glomerular filtrate is not reabsorbed and is instead passed out into the urine. As a result, blood glucose levels are reduced without causing weight gain, and even with minor weight loss in clinical trials. However, increased loss of glucose into the urine has been associated with a higher risk of urinary tract infections.

      It is important to note that dapagliflozin’s effects on insulin sensitivity are indirect. On the other hand, SGLT-1 inhibitors block the absorption of glucose from the intestine. Overall, dapagliflozin’s ability to reduce glucose reabsorption in the kidneys is a key mechanism in its effectiveness as a medication for managing blood glucose levels.

    • This question is part of the following fields:

      • Pharmacology
      54.2
      Seconds
  • Question 10 - A 63-year-old man presents with persistent diarrhoea and abdominal pain. During the past...

    Correct

    • A 63-year-old man presents with persistent diarrhoea and abdominal pain. During the past week, he experienced several days of reduced bowel movements. Upon further questioning, he admits to occasional blood in his stools.

      On examination, his heart rate is 86 bpm and his temperature is 37.9ºC. There is tenderness in the lower left quadrant. He is admitted and treated. A CT chest, abdomen, and pelvis reveals mural thickening of the colon and pericolic fat stranding in the sigmoid colon.

      What lifestyle recommendations can aid in managing the probable diagnosis?

      Your Answer: Increase fruit and vegetables in his diet

      Explanation:

      Increasing dietary fibre intake, specifically through the addition of fruits and vegetables, is a helpful measure for managing diverticular disease. In the case of this man, his altered bowel habits and presence of blood in his stools, along with the CT scan findings of sigmoid colon inflammation and pericolic fat stranding, indicate acute diverticulitis. This diagnosis is supported by his low-grade fever. Diverticular disease is the most common cause of inflammation in the sigmoid colon, and constipation is a common cause of diverticulosis. Therefore, increasing dietary fibre intake can help prevent constipation and reduce the likelihood of worsening diverticular disease. Restricting fluid intake, reducing alcohol consumption, smoking cessation, and stress reduction are not directly helpful for managing diverticular disease in this patient.

      Understanding Diverticular Disease

      Diverticular disease is a common condition that involves the protrusion of colonic mucosa through the muscular wall of the colon. This typically occurs between the taenia coli, where vessels penetrate the muscle to supply the mucosa. Symptoms of diverticular disease include altered bowel habits, rectal bleeding, and abdominal pain. Complications can arise, such as diverticulitis, haemorrhage, fistula development, perforation and faecal peritonitis, abscess formation, and diverticular phlegmon.

      To diagnose diverticular disease, patients may undergo a colonoscopy, CT cologram, or barium enema. However, it can be challenging to rule out cancer, especially in diverticular strictures. For acutely unwell surgical patients, plain abdominal films and an erect chest x-ray can identify perforation, while an abdominal CT scan with oral and intravenous contrast can detect acute inflammation and local complications.

      Treatment for diverticular disease includes increasing dietary fibre intake and managing mild attacks with antibiotics. Peri colonic abscesses may require surgical or radiological drainage, while recurrent episodes of acute diverticulitis may necessitate a segmental resection. Hinchey IV perforations, which involve generalised faecal peritonitis, typically require a resection and stoma, with a high risk of postoperative complications and HDU admission. Less severe perforations may be managed with laparoscopic washout and drain insertion.

    • This question is part of the following fields:

      • Surgery
      68.5
      Seconds
  • Question 11 - Which nerve is most commonly injured in conjunction with shoulder dislocation? ...

    Incorrect

    • Which nerve is most commonly injured in conjunction with shoulder dislocation?

      Your Answer: Median

      Correct Answer: Axillary nerve

      Explanation:

      The Vulnerability of the Shoulder Joint

      The shoulder joint is the most mobile joint in the body, but this comes at a cost of vulnerability. It is prone to dislocation more than any other joint due to its unrestricted movement. The shoulder stability is maintained by the glenohumeral joint capsule, the cartilaginous glenoid labrum, and the muscles of the rotator cuff. Anterior dislocations are the most common, accounting for over 95% of dislocations, while posterior and inferior dislocations are less frequent. Superior and intrathoracic dislocations are extremely rare.

      Injuries to the axillary nerve occur in 5% to 18% of dislocations. The nerve may heal on its own or require surgical exploration and nerve grafting. The shoulder joint vulnerability highlights the importance of proper care and attention to prevent dislocations and other injuries.

    • This question is part of the following fields:

      • Neurology
      10.2
      Seconds
  • Question 12 - A 16-year-old arrives at the Emergency Department with sudden and severe pain in...

    Correct

    • A 16-year-old arrives at the Emergency Department with sudden and severe pain in his groin while playing basketball. He has no significant medical history and denies any trauma to the area. During the exam, he experiences persistent pain in his right testicle when it is raised. An ultrasound with Doppler reveals reduced blood flow in the right testicle. Which artery is most likely occluded in this patient?

      Your Answer: Directly from the aorta

      Explanation:

      Understanding the Arteries Involved in Testicular Torsion

      Testicular torsion is a condition that causes extreme pain in the groin due to the rotation of the testicle within the scrotum, which occludes flow through the testicular artery. This condition is common in male teenagers during exercise and requires immediate medical attention. In this article, we will discuss the arteries involved in testicular torsion and their functions.

      The testicular artery (both left and right) arises from the aorta at the level of L2. Torsion can be diagnosed through colour Doppler ultrasound of the testicle, which shows decreased blood flow. Surgery is required within 6 hours of onset of symptoms to re-establish blood flow and prevent recurrent torsion (orchidopexy). If >6 hours elapse, there is an increased risk for permanent ischaemic damage.

      The right and left renal arteries provide branches to the adrenal gland, not the testicles. Both the left and right renal arteries arise from the aorta at the level of L1/2. The internal iliac artery gives off branches to the perineum, but not the testicles. The internal iliac artery branches from the common iliac artery at the level of L5/S1. The external iliac artery gives off the inferior epigastric artery and becomes the femoral artery when it crosses deep to the inguinal ligament. The external iliac artery bifurcates from the common iliac artery at the level of L5/S1.

      In conclusion, understanding the arteries involved in testicular torsion is crucial for timely diagnosis and treatment. The testicular artery arising from the aorta at the level of L2 is the primary artery involved in this condition, and surgery within 6 hours of onset of symptoms is necessary to prevent permanent damage.

    • This question is part of the following fields:

      • Urology
      38
      Seconds
  • Question 13 - An older woman presents to the Emergency Department with severe headache, nausea, vomiting...

    Incorrect

    • An older woman presents to the Emergency Department with severe headache, nausea, vomiting and a painful, red right eye. She has reduced visual acuity in the right eye and normal visual acuity in the left eye. On examination, she had a stony hard eye with marked pericorneal reddening and a hazy corneal reflex. Tonometry revealed raised intraocular pressure.
      Which of the following is the most appropriate management plan?

      Your Answer: Single dose of oral acetazolamide (500 mg) and then emergency referral to an ophthalmologist

      Correct Answer: Admit for immediate review by on call ophthalmologist. Topical pilocarpine, followed by a single dose of oral acetazolamide (500 mg) if there is a significant delay prior to specialist review

      Explanation:

      Emergency Management of Acute Closed Angle Glaucoma

      Acute closed angle glaucoma is a medical emergency that requires urgent ophthalmological review. The condition causes sudden loss of vision, severe eye pain, and marked pericorneal injection. The patient may also experience nausea and vomiting. On examination, the eye is stony hard with a semi-dilated, non-reactive pupil, and tonometry reveals a high intraocular pressure (40–80 mmHg).

      The primary treatment for acute closed angle glaucoma is urgent referral to an ophthalmologist. However, if there is a significant delay in specialist review, a single dose of oral acetazolamide (500 mg) can be given to reduce aqueous secretion, and topical pilocarpine can be used to cause pupillary constriction.

      It is important to note that topical steroids are not effective in resolving the underlying problems of acute closed angle glaucoma. Urgent referral to a neurologist is also not appropriate for managing this condition. Additionally, topical tropicamide should not be used as it has the opposite effect to pilocarpine and can worsen attacks of glaucoma.

      In summary, acute closed angle glaucoma is a medical emergency that requires urgent ophthalmological review. If there is a delay in specialist review, a single dose of oral acetazolamide and topical pilocarpine can be given to manage the condition.

    • This question is part of the following fields:

      • Ophthalmology
      80.1
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  • Question 14 - A 58-year-old woman visited her doctor after fracturing her humerus in a minor...

    Incorrect

    • A 58-year-old woman visited her doctor after fracturing her humerus in a minor accident. She reported feeling fatigued, weak, and depressed. The doctor conducted the following tests:
      Total Ca2+ 3.22 mmol/l (2.12–2.65 mmol/l)
      Albumin 40 g/l (35–50 g/l)
      PO43− 0.45 mmol/l (0.8–1.5 mmol/l)
      Alkaline phosphatase 165 iu/l (30–150 iu/l)
      Based on these results, what is the likely diagnosis?

      Your Answer: Secondary hyperparathyroidism

      Correct Answer: Primary hyperparathyroidism

      Explanation:

      Understanding Primary Hyperparathyroidism: Causes, Symptoms, and Diagnosis

      Primary hyperparathyroidism is a medical condition that is usually caused by a parathyroid adenoma or, in rare cases, by multiple endocrine neoplasia (MEN) syndromes. This condition is characterized by an increase in parathyroid hormone (PTH) levels, which leads to increased calcium reabsorption and decreased phosphate reabsorption in the kidneys, as well as increased calcium absorption from the bones. As a result, patients with primary hyperparathyroidism typically exhibit hypercalcemia and hypophosphatemia, with normal or low albumin levels. Additionally, alkaline phosphatase levels are usually elevated due to increased bone turnover.

      The most common symptoms of primary hyperparathyroidism are related to high calcium levels, including weakness, fatigue, and depression. Diagnosis is typically made through blood tests that measure PTH, calcium, phosphate, and alkaline phosphatase levels, as well as imaging studies such as ultrasound or sestamibi scans.

      Other conditions that can cause hypercalcemia include excess vitamin D, bone metastases, secondary hyperparathyroidism, and myeloma. However, each of these conditions has distinct diagnostic features that differentiate them from primary hyperparathyroidism. For example, excess vitamin D causes hypercalcemia and hyperphosphatemia, with normal alkaline phosphatase levels, while bone metastases typically present with elevated alkaline phosphatase levels and normal or elevated phosphate levels.

      Overall, understanding the causes, symptoms, and diagnostic features of primary hyperparathyroidism is essential for accurate diagnosis and effective treatment of this condition.

    • This question is part of the following fields:

      • Endocrinology
      123.3
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  • Question 15 - An epileptic teenager is seeking advice regarding their ability to drive following a...

    Correct

    • An epileptic teenager is seeking advice regarding their ability to drive following a seizure six months ago. On further enquiry, you discover that the seizure was in response to a medication change, which also took place six months ago and since being put back on their original medication, they have been seizure-free.
      What advice is appropriate for this patient?

      Your Answer: She can apply to the DVLA to reinstate her licence now

      Explanation:

      Clarifying Misconceptions about Driving Eligibility for Patients with Epilepsy

      There are several misconceptions about driving eligibility for patients with epilepsy. One common misconception is that a patient must wait another six months before being eligible to drive after a medication-induced seizure. However, according to DVLA guidance, if the patient has been seizure-free for six months on their working medication, they can apply to reinstate their licence.

      Another misconception is that the patient must trial the new medication again to determine if they can drive. This is not true, as reverting back to the previous medication that did not work would not be helpful.

      Additionally, some believe that the patient must wait another 12 months due to the medication change resulting in the seizure. However, the time a patient must be seizure-free is not increased because the seizure was medication-induced.

      It is important to note that if a patient with epilepsy has been seizure-free for a certain period of time, depending on certain circumstances, they will be eligible to drive again in most cases. It is crucial for patients and healthcare professionals to have accurate information about driving eligibility for patients with epilepsy.

    • This question is part of the following fields:

      • Neurology
      43.7
      Seconds
  • Question 16 - A 52-year-old woman comes to the postmenopausal bleeding clinic complaining of continuous vaginal...

    Correct

    • A 52-year-old woman comes to the postmenopausal bleeding clinic complaining of continuous vaginal bleeding for the past 2 weeks. What would be your initial investigation in the clinic?

      Your Answer: Trans-vaginal ultrasound

      Explanation:

      TVUS is the recommended initial investigation for PMB, unless there are contraindications. This is because it provides the most accurate measurement of endometrial thickness, which is crucial in determining if the bleeding is due to endometrial cancer.

      Understanding Postmenopausal Bleeding

      Postmenopausal bleeding refers to vaginal bleeding that occurs after a woman has gone 12 months without a menstrual period. While most cases do not involve cancer, it is important to rule out this possibility in all women. The most common cause of postmenopausal bleeding is vaginal atrophy, which occurs due to a reduction in estrogen following menopause. Other causes include hormone replacement therapy, endometrial hyperplasia, endometrial cancer, cervical cancer, ovarian cancer, and vaginal cancer.

      To investigate postmenopausal bleeding, women over the age of 55 should undergo an ultrasound within two weeks to check for endometrial cancer. If referred on a cancer pathway, a transvaginal ultrasound is the preferred method of investigation. Treatment options depend on the underlying cause of the bleeding. For vaginal atrophy, topical estrogen and lifestyle changes can help alleviate symptoms, while HRT may also be used. If the bleeding is due to a specific type of HRT, switching to a different preparation may be helpful. In cases of endometrial hyperplasia, dilation and curettage may be necessary to remove excess tissue.

      Overall, it is important for women experiencing postmenopausal bleeding to seek medical attention and undergo appropriate testing to rule out any serious underlying conditions.

    • This question is part of the following fields:

      • Gynaecology
      58.8
      Seconds
  • Question 17 - A 45-year-old man is admitted to the Surgical Unit with colicky central abdominal...

    Incorrect

    • A 45-year-old man is admitted to the Surgical Unit with colicky central abdominal pain. He has been vomiting for 6 hours and has not passed any stools for over 24 hours. On examination, he is in obvious discomfort; his abdomen is distended, and his pulse is 90 bpm, respiratory rate 18 breaths per minute and blood pressure 90/55 mmHg. A supine radiograph film confirms small bowel obstruction.
      What is the most common cause of small bowel obstruction in the United Kingdom (UK)?

      Your Answer: Malignancy

      Correct Answer: Adhesions

      Explanation:

      Causes and Management of Small Bowel Obstruction

      Small bowel obstruction is a common surgical condition that can be caused by various factors. The most common cause in the UK is adhesions, accounting for 50-70% of cases. Other causes include volvulus, hernia, malignancy, and foreign bodies. The obstruction can be classified based on its location, whether it is intraluminal, intramural, or extramural.

      The typical presentation of small bowel obstruction includes pain, vomiting, and failure to pass stool or gas. Abdominal distension and tinkling bowel sounds may also be observed, along with tachycardia and hypotension. Diagnosis is made through plain abdominal X-ray, which may show distended bowel loops in the center.

      Management of small bowel obstruction involves fluid resuscitation and prompt correction of the underlying cause. Conservative treatment, such as intravenous fluids and regular aspiration through a nasogastric tube, may be used initially. However, operative intervention is necessary for suspected strangulation, irreducible hernias, and cases that do not resolve with conservative management.

      In summary, small bowel obstruction can have various causes and presentations, but early diagnosis and appropriate management are crucial for successful outcomes.

    • This question is part of the following fields:

      • Colorectal
      51.4
      Seconds
  • Question 18 - What is a true statement about coronary artery grafting for ischaemic heart disease?...

    Correct

    • What is a true statement about coronary artery grafting for ischaemic heart disease?

      Your Answer: It requires a preceding coronary angiography

      Explanation:

      Myocardial Revascularization: Debunking Common Misconceptions

      Myocardial revascularization, commonly known as coronary artery surgery, is a surgical procedure that aims to improve blood flow to the heart muscle. However, there are several misconceptions surrounding this procedure that need to be addressed.

      Contrary to popular belief, coronary angiography is a necessary pre-surgery investigation. This is because it helps the surgeon identify the location and severity of the blockages in the coronary arteries.

      Another misconception is that the success of the surgery is limited to patients with less than two major coronary artery blockages. In fact, patients with three or four-vessel disease can benefit greatly from the procedure, as it provides relief from symptoms and reduces morbidity.

      It is also not true that the surgery always requires cardiopulmonary bypass. Depending on the patient’s condition, the surgery may be performed on or off bypass.

      Lastly, while it is true that the surgery does not necessarily prolong life, it does provide significant relief from symptoms and reduces mortality.

      In terms of the grafts used during the surgery, the left internal mammary artery or the saphenous vein are typically used, rather than intercostal arteries.

      In conclusion, it is important to dispel these misconceptions surrounding myocardial revascularization in order to provide patients with accurate information and improve their understanding of the procedure.

    • This question is part of the following fields:

      • Cardiothoracic
      78.6
      Seconds
  • Question 19 - A 35-year-old teacher presents in a routine GP appointment feeling like everything is...

    Correct

    • A 35-year-old teacher presents in a routine GP appointment feeling like everything is falling apart. Despite this, she has never taken a day off work and has no history of mental illness. Her partner has noticed her cleaning the house more than usual and becoming irritated by the apparent lack of cleanliness at home. The patient is also becoming increasingly irritated with others' inability to perform tasks to her personal standards. She has a long-standing history of perfectionism and never spends her money on frivolous items. What is the probable diagnosis?

      Your Answer: Obsessive-compulsive personality

      Explanation:

      Individuals who exhibit obsessive-compulsive personality traits tend to be inflexible when it comes to their principles, beliefs, and standards, and frequently exhibit hesitancy in delegating tasks to others.

      Personality disorders are a set of personality traits that are maladaptive and interfere with normal functioning in life. It is estimated that around 1 in 20 people have a personality disorder, which are typically categorized into three clusters: Cluster A, which includes Odd or Eccentric disorders such as Paranoid, Schizoid, and Schizotypal; Cluster B, which includes Dramatic, Emotional, or Erratic disorders such as Antisocial, Borderline (Emotionally Unstable), Histrionic, and Narcissistic; and Cluster C, which includes Anxious and Fearful disorders such as Obsessive-Compulsive, Avoidant, and Dependent.

      Paranoid individuals exhibit hypersensitivity and an unforgiving attitude when insulted, a reluctance to confide in others, and a preoccupation with conspiratorial beliefs and hidden meanings. Schizoid individuals show indifference to praise and criticism, a preference for solitary activities, and emotional coldness. Schizotypal individuals exhibit odd beliefs and magical thinking, unusual perceptual disturbances, and inappropriate affect. Antisocial individuals fail to conform to social norms, deceive others, and exhibit impulsiveness, irritability, and aggressiveness. Borderline individuals exhibit unstable interpersonal relationships, impulsivity, and affective instability. Histrionic individuals exhibit inappropriate sexual seductiveness, a need to be the center of attention, and self-dramatization. Narcissistic individuals exhibit a grandiose sense of self-importance, lack of empathy, and excessive need for admiration. Obsessive-compulsive individuals are occupied with details, rules, and organization to the point of hampering completion of tasks. Avoidant individuals avoid interpersonal contact due to fears of criticism or rejection, while dependent individuals have difficulty making decisions without excessive reassurance from others.

      Personality disorders are difficult to treat, but a number of approaches have been shown to help patients, including psychological therapies such as dialectical behavior therapy and treatment of any coexisting psychiatric conditions.

    • This question is part of the following fields:

      • Psychiatry
      48.8
      Seconds
  • Question 20 - A 10-year-old boy comes to the GP with his father, complaining of right-sided...

    Incorrect

    • A 10-year-old boy comes to the GP with his father, complaining of right-sided hip pain that has been present for the past 3 weeks. The pain has gradually worsened over time. When asked to point to the location of the pain, he indicates his right hip and groin area. Upon examination, his heart rate is 71 bpm and temperature is 37.3ºC. He is able to walk, but with moderate discomfort and an antalgic gait that causes him to out-toe. Passive movement of the hip reveals a loss of internal rotation of the right leg in flexion. What is the most likely diagnosis?

      Your Answer: Septic arthritis

      Correct Answer: Slipped capital femoral epiphysis

      Explanation:

      Slipped capital femoral epiphysis is a possible diagnosis for a boy aged 10-15 years old presenting with hip pain and a key examination finding of limited internal rotation of the leg in flexion. Other diagnoses such as septic arthritis, juvenile idiopathic arthritis, and Perthe’s disease are less likely based on the absence of certain symptoms and age range. Further investigation and imaging should be done to confirm the diagnosis.

      Slipped Capital Femoral Epiphysis: A Rare Hip Condition in Children

      Slipped capital femoral epiphysis, also known as slipped upper femoral epiphysis, is a rare hip condition that primarily affects children between the ages of 10 and 15. It is more commonly seen in obese boys. This condition is characterized by the displacement of the femoral head epiphysis postero-inferiorly, which may present acutely following trauma or with chronic, persistent symptoms.

      The most common symptoms of slipped capital femoral epiphysis include hip, groin, medial thigh, or knee pain and loss of internal rotation of the leg in flexion. In some cases, a bilateral slip may occur. Diagnostic imaging, such as AP and lateral (typically frog-leg) views, can confirm the diagnosis.

      The management of slipped capital femoral epiphysis typically involves internal fixation, which involves placing a single cannulated screw in the center of the epiphysis. However, if left untreated, this condition can lead to complications such as osteoarthritis, avascular necrosis of the femoral head, chondrolysis, and leg length discrepancy.

      In summary, slipped capital femoral epiphysis is a rare hip condition that primarily affects children, especially obese boys. It is characterized by the displacement of the femoral head epiphysis postero-inferiorly and can present with various symptoms. Early diagnosis and management are crucial to prevent complications.

    • This question is part of the following fields:

      • Paediatrics
      81.8
      Seconds
  • Question 21 - A 28-year-old man, diagnosed with ulcerative colitis (UC) 18 months ago, presents with...

    Incorrect

    • A 28-year-old man, diagnosed with ulcerative colitis (UC) 18 months ago, presents with 2-day history of progressively worsening abdominal pain and bloody diarrhoea. He is currently passing motion 11 times per day.
      On examination, there is generalised abdominal tenderness and distension. He is pyrexial, with a temperature of 39 °C; his pulse is 124 bpm.
      Investigations:
      Investigation Result Normal value
      Haemoglobin (Hb) 90 g/l 135–175 g/l
      White cell count (WCC) 15 × 109/l 4–11 × 109/l
      Erect chest X-ray Normal
      Plain abdominal X-ray 12-cm dilation of the transverse colon
      He also has a raised C-reactive protein (CRP).
      What would be the most appropriate initial management of this patient?

      Your Answer: IV vedolizumab infusion

      Correct Answer: Intravenous (IV) hydrocortisone, low-molecular-weight heparin (LMWH), IV fluids, reassess response after 72 hours

      Explanation:

      Management of Toxic Megacolon in Ulcerative Colitis: Medical and Surgical Options

      Toxic megacolon (TM) is a rare but life-threatening complication of ulcerative colitis (UC) characterized by severe colon dilation and systemic toxicity. The initial management of TM involves aggressive medical therapy with intravenous (IV) hydrocortisone, low-molecular-weight heparin (LMWH), and IV fluids to restore hemodynamic stability. Oral mesalazine is indicated for mild to moderate UC or for maintenance of remission. If the patient fails to respond to medical management after 72 hours, urgent surgery, usually subtotal colectomy with end ileostomy, should be considered.

      Infliximab and vedolizumab are second-line management options for severe active UC in patients who fail to respond to intensive IV steroid treatment. However, their role in the setting of TM is unclear. LMWH is required for UC patients due to their high risk of venous thromboembolism.

      Prompt recognition and management of TM is crucial to prevent mortality. A multidisciplinary approach involving gastroenterologists, surgeons, and critical care specialists is recommended for optimal patient outcomes.

    • This question is part of the following fields:

      • Gastroenterology
      155.2
      Seconds
  • Question 22 - Which structure, containing both white and red pulp, is responsible for trapping foreign...

    Correct

    • Which structure, containing both white and red pulp, is responsible for trapping foreign substances present in the blood?

      Your Answer: Spleen

      Explanation:

      Comparison of Lymphoid Organs and Non-Lymphoid Organs

      The human body contains various organs that serve different functions. Among these are the lymphoid organs, which play a crucial role in the immune system. In this article, we will compare the characteristics of three lymphoid organs (spleen, lymph node, and thymus) with two non-lymphoid organs (heart and thyroid gland).

      Spleen
      The spleen is the largest secondary lymphoid organ. It is located in the left upper quadrant of the abdomen and contains both white pulp (lymphatic tissue and macrophages) and red pulp (sinusoids and red blood cells). One of its functions is to filter foreign substances from the blood.

      Lymph Node
      Lymph nodes are secondary lymphoid organs that contain structures where mature lymphocytes are stimulated by antigens to undergo further division and differentiation. They do not contain white and red pulp.

      Thymus
      The thymus is a primary lymphoid organ where T lymphocytes mature, differentiate, and proliferate. It does not contain white and red pulp.

      Heart
      The heart is the main organ of the circulatory system and does not contain white and red pulp.

      Thyroid Gland
      The thyroid gland is located in the anterior neck and is part of the endocrine system. It does not contain white and red pulp.

      In summary, lymphoid organs play a crucial role in the immune system, while non-lymphoid organs serve other functions. Understanding the characteristics of these organs can help us appreciate the complexity and diversity of the human body.

    • This question is part of the following fields:

      • Haematology
      8.2
      Seconds
  • Question 23 - A 35-year-old male is being seen on the surgical ward round, four days...

    Correct

    • A 35-year-old male is being seen on the surgical ward round, four days after his abdominal surgery. He complains of a peculiar sensation over the wound while shifting in bed. Upon removing the dressings, it is discovered that the wound is gaping open, with visible internal organs. Despite this, his vital signs are all normal, and he does not seem to be bothered by the situation. The wound is covered with gauze impregnated with saline. While waiting for additional surgical assistance, what other urgent treatment should be provided?

      Your Answer: IV ceftriaxone and metronidazole

      Explanation:

      The initial management for abdominal wound dehiscence involves covering the wound with saline impregnated gauze and administering broad-spectrum antibiotics intravenously. In this case, a combination of ceftriaxone and metronidazole would be appropriate. Flucloxacillin is not broad enough to cover the range of organisms that may be present. While fluids are important, a 1 L stat bolus is excessive at this stage. Analgesia should be provided, but it is less urgent than antibiotics. Oxygen is not indicated based on the patient’s current condition.

      Abdominal wound dehiscence is a serious issue that surgeons who perform abdominal surgery frequently encounter. It occurs when all layers of an abdominal mass closure fail, resulting in the protrusion of the viscera externally. This condition is associated with a 30% mortality rate and can be classified as either superficial or complete, depending on the extent of the wound failure.

      Several factors increase the risk of abdominal wound dehiscence, including malnutrition, vitamin deficiencies, jaundice, steroid use, major wound contamination (such as faecal peritonitis), and poor surgical technique. To prevent this condition, the preferred method is the mass closure technique, also known as the Jenkins Rule.

      When sudden full dehiscence occurs, the wound should be covered with saline impregnated gauze, and the patient should receive IV broad-spectrum antibiotics, analgesia, and IV fluids. Arrangements should also be made for a return to the operating theatre.

    • This question is part of the following fields:

      • Surgery
      67
      Seconds
  • Question 24 - A 28-year-old woman presents to the Emergency Department with sharp, left lower abdominal...

    Incorrect

    • A 28-year-old woman presents to the Emergency Department with sharp, left lower abdominal pain, which has been intermittently present for several days. It does not radiate anywhere. It is not associated with any gastrointestinal upset. Her last menstrual period was 10 weeks ago. She is sexually active although admits to not using contraception all the time. Her past medical history includes multiple chlamydial infections. On examination, the abdomen is tender. An internal examination is also performed; adnexal tenderness is demonstrated. A urine pregnancy test is positive.
      What investigation is recommended as the first choice for the likely diagnosis?

      Your Answer: Diagnostic laparoscopy

      Correct Answer: Transvaginal ultrasound

      Explanation:

      The most appropriate investigation for a suspected ectopic pregnancy is a transvaginal ultrasound. In this case, the patient’s symptoms and examination findings suggest an ectopic pregnancy, making transvaginal ultrasound the investigation of choice. Transabdominal ultrasound is less sensitive and therefore not ideal. NAAT, which is used to detect chlamydia, is not relevant in this case as the patient’s history suggests a higher likelihood of ectopic pregnancy rather than infection. Laparoscopy, which is used to diagnose endometriosis, is not indicated based on the clinical presentation.

      Ectopic pregnancy is a serious condition that requires prompt investigation and management. Women who are stable are typically investigated and managed in an early pregnancy assessment unit, while those who are unstable should be referred to the emergency department. The investigation of choice for ectopic pregnancy is a transvaginal ultrasound, which will confirm the presence of a positive pregnancy test.

      There are three ways to manage ectopic pregnancies: expectant management, medical management, and surgical management. The choice of management will depend on various criteria, such as the size of the ectopic pregnancy, whether it is ruptured or not, and the patient’s symptoms and hCG levels. Expectant management involves closely monitoring the patient over 48 hours, while medical management involves giving the patient methotrexate and requires follow-up. Surgical management can involve salpingectomy or salpingostomy, depending on the patient’s risk factors for infertility.

      Salpingectomy is the first-line treatment for women without other risk factors for infertility, while salpingostomy should be considered for women with contralateral tube damage. However, around 1 in 5 women who undergo a salpingostomy require further treatment, such as methotrexate and/or a salpingectomy. It is important to carefully consider the patient’s individual circumstances and make a decision that will provide the best possible outcome.

    • This question is part of the following fields:

      • Gynaecology
      72.9
      Seconds
  • Question 25 - What do muscarinic receptors refer to? ...

    Correct

    • What do muscarinic receptors refer to?

      Your Answer: Cholinergic receptors

      Explanation:

      Muscarinic Receptors: A Subclass of Cholinergic Receptors

      Muscarinic receptors are a type of cholinergic receptors that are responsible for a variety of functions in the body. They are divided into five subclasses based on their location, namely M1-5. M1, M4, and M5 are found in the central nervous system and are involved in complex functions such as memory, analgesia, and arousal. M2 is located on cardiac muscle and helps reduce conduction velocity at the sinoatrial and atrioventricular nodes, thereby lowering heart rate. M3, on the other hand, is found on smooth muscle, including bronchial tissue, bladder, and exocrine glands, and is responsible for a variety of responses.

      It is important to note that muscarinic receptors are a subclass of cholinergic receptors, with the other subclass being nicotinic receptors. Adrenergic receptors, on the other hand, bind to adrenaline, while dopaminergic receptors bind to dopamine. Glutamatergic receptors bind to glutamate, and histamine receptors bind to histamine. the different types of receptors and their functions is crucial in the development of drugs and treatments for various medical conditions.

    • This question is part of the following fields:

      • Neurology
      20.5
      Seconds
  • Question 26 - A 32-year-old female (P0 G1) is 28 weeks pregnant and has just been...

    Correct

    • A 32-year-old female (P0 G1) is 28 weeks pregnant and has just been informed that her baby is in the breech position. She is considering the external cephalic version (ECV) and wants to know when she can be offered this procedure?

      Your Answer: 36 weeks

      Explanation:

      It is recommended to wait until the lady reaches 36 weeks of pregnancy to check if the baby has changed position, as she is currently only 30 weeks pregnant. For nulliparous women, such as the lady in this case, ECV should be provided at 36 weeks if the baby remains in the breech position. However, if the lady had previous pregnancies, ECV would be offered at 37 weeks.

      Breech presentation occurs when the caudal end of the fetus is in the lower segment, and it is more common at 28 weeks than near term. Risk factors include uterine malformations, placenta praevia, and fetal abnormalities. Management options include spontaneous turning, external cephalic version (ECV), planned caesarean section, or vaginal delivery. The RCOG recommends informing women that planned caesarean section reduces perinatal mortality and early neonatal morbidity, but there is no evidence that the long-term health of babies is influenced by how they are born. ECV is contraindicated in certain cases, such as where caesarean delivery is required or there is an abnormal cardiotocography.

    • This question is part of the following fields:

      • Obstetrics
      29.9
      Seconds
  • Question 27 - What is the definition of Nissl bodies? ...

    Incorrect

    • What is the definition of Nissl bodies?

      Your Answer: Neuronal nucleoli

      Correct Answer: Granules of rough endoplasmic reticulum

      Explanation:

      Nissl Bodies: Stacks of Rough Endoplasmic Reticulum

      Nissl bodies are named after the German neurologist Franz Nissl and are found in neurones following a selective staining method known as Nissl staining. These bodies are composed of stacks of rough endoplasmic reticulum and are a major site of neurotransmitter synthesis, particularly acetylcholine, in the neurone. Therefore, the correct answer is that Nissl bodies are granules of rough endoplasmic reticulum. It is important to note that the other answer options are incorrect as they refer to entirely different organelles.

    • This question is part of the following fields:

      • Neurology
      23.5
      Seconds
  • Question 28 - A 28-year-old woman has been diagnosed with HIV and started on antiretroviral medication....

    Incorrect

    • A 28-year-old woman has been diagnosed with HIV and started on antiretroviral medication. She initially responded well to treatment, but now presents with fatigue and abdominal discomfort after 8 months. Upon conducting blood tests, the following results were obtained:
      - Haemoglobin: 92 g/L (115-165)
      - Urea: 6 mmol/L (2.5-7.5)
      - Bilirubin: 3 mg/dL; direct: 0.2 mg/dL (0.3-1.9)
      - AST: 39 IU/L (<35)
      - ALP: 150 IU/L (44-140)

      Which specific antiretroviral drug is this patient currently taking?

      Your Answer: Stavudine

      Correct Answer: Atazanavir

      Explanation:

      Drug Reaction with Atazanavir and Indinavir

      The use of protease inhibitors such as atazanavir and indinavir can lead to unconjugated hyperbilirubinemia, which is characterized by elevated levels of bilirubin in the blood. This condition was observed in a patient who had normal renal function and mildly raised liver enzymes. The reaction is usually benign and reversible upon discontinuation of the drug. The mechanism of this drug reaction is competitive inhibition of the UGT1A1 enzyme. Individuals with Gilbert’s syndrome are more susceptible to this reaction.

      Other drugs used in the treatment of HIV/AIDS have different side effect profiles. Nevirapine can cause hepatitis, which is characterized by elevated liver enzymes. Stavudine can cause peripheral neuropathy and pancreatitis, but it is being phased out of treatment regimens. Tenofovir can lead to renal dysfunction, which was not observed in this patient. Zidovudine can cause anemia, hepatitis, and myopathy, among other side effects.

      In conclusion, the patient’s presentation of unconjugated hyperbilirubinemia is most likely due to the use of atazanavir or indinavir. Discontinuation of the drug is usually sufficient to reverse the condition. Other drugs used in the treatment of HIV/AIDS have different side effect profiles and should be considered when evaluating patients for drug reactions.

    • This question is part of the following fields:

      • Infectious Diseases
      67.5
      Seconds
  • Question 29 - What is a metabolic effect of exenatide? ...

    Correct

    • What is a metabolic effect of exenatide?

      Your Answer: Suppresses appetite

      Explanation:

      The Metabolic Effects of Exenatide

      Exenatide is a medication that imitates the actions of GLP-1, a hormone produced in the gut. It has been found to have beneficial effects on the metabolism of individuals with diabetes mellitus. One of the main effects of exenatide is its ability to suppress appetite, which can help individuals with diabetes to manage their weight. Additionally, exenatide inhibits glucose production in the liver, which can help to regulate blood sugar levels. It also slows gastric emptying, which can help to prevent spikes in blood sugar after meals. Finally, exenatide stimulates insulin release, which can help to lower blood sugar levels. It is important to note that exenatide does not increase insulin sensitivity, which is achieved by other medications such as metformin and the glitazones. Overall, exenatide has a range of metabolic effects that can be beneficial for individuals with diabetes mellitus.

    • This question is part of the following fields:

      • Endocrinology
      20.7
      Seconds
  • Question 30 - A 48-year-old man presents to the emergency department after a bicycle accident. He...

    Correct

    • A 48-year-old man presents to the emergency department after a bicycle accident. He reports feeling fine and denies any symptoms such as vomiting, seizures, or loss of consciousness. The patient has a medical history of tricuspid valve replacement and takes warfarin. On examination, a small 1 cm laceration is found on his left temple, which has stopped bleeding. The patient has a GCS score of 15/15 and a normal neurological exam. What is the best course of action?

      Your Answer: Perform a CT scan within 8 hours

      Explanation:

      If a person is taking anticoagulants and has suffered a head injury, it is crucial to conduct a CT scan within 8 hours. This is because such patients are at a higher risk of developing intracranial bleeds, which may have a delayed onset of symptoms. While neurological observations are necessary, they cannot replace the need for a CT scan in this case. Discharging the patient with safety netting advice would also be inappropriate as they may have developed a serious intracranial bleed due to their anticoagulant therapy. However, performing a CT scan within 1 hour is not necessary if the patient does not exhibit key symptoms such as post-traumatic seizures or vomiting. It is also not appropriate to perform an MRI scan within 8 hours as CT scan is the preferred imaging modality for head injuries.

      NICE Guidelines for Investigating Head Injuries in Adults

      Head injuries can be serious and require prompt medical attention. The National Institute for Health and Care Excellence (NICE) has provided clear guidelines for healthcare professionals to determine which adult patients need further investigation with a CT head scan. Patients who require immediate CT head scans include those with a Glasgow Coma Scale (GCS) score of less than 13 on initial assessment, suspected open or depressed skull fractures, signs of basal skull fractures, post-traumatic seizures, focal neurological deficits, and more than one episode of vomiting.

      For patients with any loss of consciousness or amnesia since the injury, a CT head scan within 8 hours is recommended for those who are 65 years or older, have a history of bleeding or clotting disorders, experienced a dangerous mechanism of injury, or have more than 30 minutes of retrograde amnesia of events immediately before the head injury. Additionally, patients on warfarin who have sustained a head injury without other indications for a CT head scan should also receive a scan within 8 hours of the injury.

      It is important for healthcare professionals to follow these guidelines to ensure that patients receive appropriate and timely care for their head injuries. By identifying those who require further investigation, healthcare professionals can provide the necessary treatment and support to prevent further complications and improve patient outcomes.

    • This question is part of the following fields:

      • Surgery
      52.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Colorectal (0/2) 0%
Obstetrics (1/2) 50%
Surgery (3/4) 75%
Sexual Health (1/1) 100%
Plastics (0/1) 0%
Psychiatry (2/2) 100%
Oncology (1/1) 100%
Pharmacology (1/2) 50%
Neurology (2/4) 50%
Urology (1/1) 100%
Ophthalmology (0/1) 0%
Endocrinology (1/2) 50%
Gynaecology (1/2) 50%
Cardiothoracic (1/1) 100%
Paediatrics (0/1) 0%
Gastroenterology (0/1) 0%
Haematology (1/1) 100%
Infectious Diseases (0/1) 0%
Passmed