00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 40-year-old male with a history of Ulcerative colitis (UC) presents with fatigue,...

    Correct

    • A 40-year-old male with a history of Ulcerative colitis (UC) presents with fatigue, abdominal pain, and generalized itching. During the examination, he is found to be jaundiced, and his blood tests reveal a significantly elevated bilirubin and alkaline phosphatase. An MRCP indicates the presence of multiple strictures in the biliary tree.

      What is the probable diagnosis?

      Your Answer: Primary sclerosing cholangitis

      Explanation:

      Differentiating between liver conditions: Primary Sclerosing Cholangitis, Wilson’s Disease, Cholangitis, Cholecystitis, and Primary Biliary Cholangitis

      Primary sclerosing cholangitis (PSC) is a condition characterized by inflammation, fibrosis, and strictures of the bile ducts. MRCP can show multiple strictures in the biliary tree and a characteristic beaded appearance. PSC is often associated with ulcerative colitis.

      Wilson’s disease is a rare inherited disorder that causes an accumulation of copper in various organs, particularly the liver and brain. Symptoms usually appear in teenage years and can include neuropsychiatric conditions or coagulopathy and hepatic encephalopathy. This does not fit with the case history given.

      Cholangitis is an ascending infection of the biliary tree, but the absence of signs of infection and the presence of strictures make this diagnosis unlikely.

      Cholecystitis is inflammation of the gallbladder, often caused by gallstones. If the gallstones become lodged in the common bile duct, obstructive signs may be seen, but the finding of strictures on MRCP is more suggestive of PSC.

      Primary biliary cholangitis (PBC) is an autoimmune disorder that causes destruction of the small interlobular bile ducts, leading to intrahepatic cholestasis, fibrosis, and ultimately cirrhosis of the liver. However, the patient’s history of ulcerative colitis makes PSC a more likely diagnosis. Additionally, strictures in the biliary tree would not be seen on MRCP in PBC.

      In summary, the presence of strictures on MRCP and a history of ulcerative colitis suggest a diagnosis of primary sclerosing cholangitis, while other liver conditions such as Wilson’s disease, cholangitis, cholecystitis, and primary biliary cholangitis can be ruled out based on the patient’s symptoms and diagnostic tests.

    • This question is part of the following fields:

      • Gastroenterology
      11.2
      Seconds
  • Question 2 - A 16-year-old previously healthy woman presents with a 10-month history of persistent non-bloody...

    Incorrect

    • A 16-year-old previously healthy woman presents with a 10-month history of persistent non-bloody diarrhoea and central abdominal pain. She also gives a history of unintentional weight loss. The patient is not yet menstruating. On examination, she has slight conjunctival pallor. Blood tests reveal a macrocytic anaemia.
      What is the likeliest diagnosis?

      Your Answer: Crohn’s disease

      Correct Answer: Coeliac disease

      Explanation:

      Coeliac disease is a condition where the lining of the small intestine is abnormal and improves when gluten is removed from the diet. It is caused by an immune response to a component of gluten called α-gliadin peptide. Symptoms can occur at any age but are most common in infancy and in adults in their 40s. Symptoms include abdominal pain, bloating, diarrhea, delayed puberty, and anemia. Blood tests are used to diagnose the disease, and a biopsy of the small intestine can confirm the diagnosis. Treatment involves avoiding gluten in the diet. Crohn’s disease and ulcerative colitis have different symptoms, while irritable bowel syndrome and carcinoid syndrome are unlikely in this case.

    • This question is part of the following fields:

      • Gastroenterology
      44.2
      Seconds
  • Question 3 - A 38-year-old woman presents with complaints of fever, malaise and pain in the...

    Incorrect

    • A 38-year-old woman presents with complaints of fever, malaise and pain in the neck, particularly when swallowing. She reports having had a viral respiratory infection a week ago. Upon examination, an enlarged thyroid, heart palpitations and excessive sweating are noted. Further tests reveal elevated ESR, leukocytosis, thyroid antibodies and low TSH levels. Additionally, a radionuclide thyroid uptake test shows decreased iodide uptake. What is the most probable diagnosis?

      Your Answer: Hashimoto's thyroiditis

      Correct Answer: de Quervain's thyroiditis

      Explanation:

      Differentiating Thyroid Disorders: A Comparison of De Quervain’s, Graves’, Hashimoto’s, Subacute Lymphocytic, and Riedel’s Thyroiditis

      Thyroid disorders can present with similar symptoms, making it challenging to differentiate between them. De Quervain’s thyroiditis, also known as subacute granulomatous thyroiditis, typically affects women after a viral respiratory infection. Symptoms of thyrotoxicosis may occur initially, but the disease can progress to hypothyroidism with thyroid gland destruction. In contrast, Graves’ disease is characterized by a markedly increased uptake of iodine on a radionuclide thyroid test. Hashimoto’s thyroiditis is an autoimmune disease that can present with a hyperthyroid phase, but the patient is unlikely to experience fever and neck pain. Subacute lymphocytic thyroiditis occurs only after pregnancy, while Riedel’s thyroiditis is a rare disorder characterized by extensive fibrosis of the thyroid gland, mimicking a carcinoma. Understanding the unique features of each thyroid disorder is crucial for accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Endocrinology
      40.1
      Seconds
  • Question 4 - A 9-month-old baby is presented to the emergency department due to vomiting and...

    Correct

    • A 9-month-old baby is presented to the emergency department due to vomiting and diarrhoea that has been going on for 2 days. The vomit and stools are unremarkable, but the father reports that the baby has been lethargic and unsettled for the past 3 days. Additionally, the baby has had 6 episodes of uncontrollable crying where he draws his legs up to his chest for a few minutes at a time. The baby has no fever. During the examination, the baby appears pale and lethargic, and a small mass is palpated in the right upper quadrant. To investigate further, a plain abdominal x-ray is performed, which shows no signs of obstruction, and an ultrasound scan reveals a target sign. What is the most probable diagnosis?

      Your Answer: Intussusception

      Explanation:

      This question pertains to gastrointestinal disorders in children, specifically focusing on the symptoms of vomiting and diarrhea. While there can be various reasons for these symptoms, the child in this scenario displays indications of Intussusception. One of the classic signs is the child crying intermittently and pulling their legs towards their chest. Additionally, the presence of a small mass in the right upper quadrant and a target sign on ultrasound further support this diagnosis, along with the vomiting, diarrhea, and pain.

      The vomit and stool do not show any significant abnormalities, and the absence of a fever suggests that it is not an infectious episode. Pyloric stenosis is unlikely to present in this manner. However, before an abdominal ultrasound x-ray is conducted, it is not possible to rule out a small bowel obstruction. Nevertheless, there are no indications of obstruction on the x-ray.

      Understanding Intussusception

      Intussusception is a medical condition that occurs when one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileo-caecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. The symptoms of intussusception include severe, crampy abdominal pain that comes and goes, inconsolable crying, vomiting, and blood stained stool, which is a late sign. During a paroxysm, the infant will typically draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.

      To diagnose intussusception, ultrasound is now the preferred method of investigation, as it can show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used as a first-line treatment instead of the traditional barium enema. If this method fails, or the child shows signs of peritonitis, surgery is performed.

      In summary, intussusception is a medical condition that affects infants and involves the folding of one part of the bowel into the lumen of the adjacent bowel. It is characterized by severe abdominal pain, vomiting, and blood stained stool, among other symptoms. Ultrasound is the preferred method of diagnosis, and treatment involves reducing the bowel by air insufflation or surgery if necessary.

    • This question is part of the following fields:

      • Paediatrics
      39
      Seconds
  • Question 5 - This 70-year-old man is in atrial fibrillation, which was confirmed on a 24-hour...

    Correct

    • This 70-year-old man is in atrial fibrillation, which was confirmed on a 24-hour tape during a pre-operative assessment clinic. He reports no prior heart issues but has experienced temporary loss of vision in his right eye over the past two months. He has type II diabetes and COPD but takes no other medications. His blood pressure is normal, and an echocardiogram shows an ejection fraction greater than 65%. What is his CHA2DS2-VASC score?

      Your Answer: 4

      Explanation:

      Understanding the CHA2DS2-VASc Score for Stroke Risk Assessment in Atrial Fibrillation Patients

      The CHA2DS2-VASc score is a tool used by clinicians to assess the risk of stroke in patients with atrial fibrillation. It takes into account various risk factors, including congestive cardiac failure, hypertension, age, diabetes, previous stroke or TIA, vascular disease, age, and sex.

      Based on the score, clinicians can determine whether anti-coagulation is necessary to prevent stroke. Men with a score greater than 0 and women with a score greater than 1 should be considered for anticoagulation, while anyone with a score greater than 2 is recommended for anticoagulation.

      For example, a 70-year-old man with type II diabetes and visual symptoms suggestive of a TIA would score 4 on the CHA2DS2-VASc scale and should be anticoagulated after assessing his bleeding risk.

      It’s important to note that a score of 6 indicates a high risk of stroke and warrants anti-coagulation if there are no contraindications. Understanding the CHA2DS2-VASc score can help clinicians make informed decisions about stroke prevention in atrial fibrillation patients.

    • This question is part of the following fields:

      • Surgery
      102.9
      Seconds
  • Question 6 - You are a junior doctor working at an inpatient psychiatry unit. You have...

    Incorrect

    • You are a junior doctor working at an inpatient psychiatry unit. You have been asked to assess a patient by the nursing staff as they are currently occupied by a distressed patient and relative. The patient you've been asked to review has known schizophrenia and wishes to leave the unit. However, following consultation with the patient, you are concerned they are exhibiting features of an acute psychotic episode.
      Which section of the Mental Health Act (2007) could be used to detain the patient?

      Your Answer: Section 5(4)

      Correct Answer: Section 5(2)

      Explanation:

      Understanding the Different Sections of the Mental Health Act (2007)

      The Mental Health Act (2007) provides a legal framework for patients with confirmed or suspected mental disorders that pose a risk to themselves or the public. The Act outlines specific guidelines for detention, treatment, and the individuals authorized to use its powers. Here are some of the key sections of the Mental Health Act:

      Section 5(2): This section allows for the temporary detention of a patient already in the hospital for up to 72 hours, after which a full Mental Health Act assessment must be conducted. A doctor who is fully registered (FY2 or above) can use this section to detain a patient.

      Section 3: This section is used for admission for treatment for up to 6 months, with the exact mental disorder being treated stated on the application. It can be renewed for a further six months if required, and the patient has the right to appeal.

      Section 2: This section allows for compulsory admission for assessment of presumed mental disorder. The section lasts for 28 days and must be signed by two doctors, one of whom is approved under Section 12(2), usually a consultant psychiatrist, and another doctor who knows the patient in a professional capacity, usually their GP.

      Section 5(4): This section can be used by psychiatric nursing staff to detain a patient for up to 6 hours while arranging review by appropriate medical personnel for further assessment and either conversion to a Section 5(2). If this time elapses, there is no legal right for the nursing staff to detain the patient. In this scenario, the nursing staff are unavailable to assess the patient.

      Section 7: This section is an application for guardianship. It is used for patients in the community where an approved mental health practitioner (AMHP), usually a social worker, requests compulsory treatment requiring the patient to live in a specified location, attend specific locations for treatment, and allow access for authorized persons.

    • This question is part of the following fields:

      • Psychiatry
      42.6
      Seconds
  • Question 7 - What feature is typical of the early stages of Alzheimer's disease? ...

    Correct

    • What feature is typical of the early stages of Alzheimer's disease?

      Your Answer: Impaired short term memory

      Explanation:

      Identifying Dementia: Symptoms and Differential Diagnosis

      Dementia is a progressive neurological disorder that affects cognitive function, including memory, language, and decision-making abilities. Alzheimer’s disease is the most common form of dementia, and it is characterised by short-term memory loss in the early stages. However, other symptoms may suggest an alternative diagnosis.

      For instance, gait ataxia and urinary incontinence may indicate normal pressure hydrocephalus, while myoclonic jerks may suggest Creutzfeldt-Jakob disease. Visual hallucinations and delirium are common in Lewy body dementia.

      It is important to differentiate between different types of dementia to provide appropriate treatment and care. Early diagnosis and intervention can help slow down the progression of the disease and improve the quality of life for patients and their families. Healthcare professionals should be aware of the various symptoms and differential diagnosis of dementia to provide accurate diagnosis and management.

    • This question is part of the following fields:

      • Miscellaneous
      13.6
      Seconds
  • Question 8 - A 16-year-old boy with learning difficulties was brought in by ambulance with his...

    Incorrect

    • A 16-year-old boy with learning difficulties was brought in by ambulance with his carer, he was found lying on the floor at home. He was suspected of having taken some pills at home as the carer found an empty bottle next to him. On arrival, he is very agitated with his jaw clenched, there is also involuntary upward deviation of his eyes.
      Which of the following drugs is most likely the causative agent?

      Your Answer: Amitriptyline

      Correct Answer: Metoclopramide

      Explanation:

      Medication Side-Effects: A Comparison

      When it comes to medication, it’s important to be aware of potential side-effects. Here’s a comparison of some commonly used medications and their associated side-effects:

      Metoclopramide: This medication can induce oculogyric crisis, a dystonic reaction in young women. The management for it is to give an intravenous antimuscarinic.

      Phenytoin: The acute side-effects of Phenytoin include dizziness, diplopia, nystagmus, slurred speech or ataxia.

      Amitriptyline: This medication is not known to cause oculogyric crisis.

      Carbamazepine: The side-effects profile of carbamazepine may cause dizziness and ataxia.

      Aspirin: Aspirin is not known to associate with any dystonia.

      It’s important to always consult with a healthcare provider about any potential side-effects of medication.

    • This question is part of the following fields:

      • Pharmacology
      138.4
      Seconds
  • Question 9 - A 68-year-old man presents with sudden-onset abdominal pain, rectal bleeding and diarrhoea. On...

    Correct

    • A 68-year-old man presents with sudden-onset abdominal pain, rectal bleeding and diarrhoea. On examination, he appears uncomfortable, with a heart rate of 105 bpm, blood pressure 124/68 mmHg, oxygen saturations on room air of 95%, respiratory rate of 20 breaths per minute and a temperature of 37.4 °C. His cardiovascular and respiratory examinations are unremarkable, except for a previous median sternotomy scar. Abdominal examination reveals tenderness throughout the abdomen, which is significantly worse on the left with guarding. Urgent blood tests are taken, and chest and abdominal X-rays are performed. The chest X-ray is normal, except for an increased cardiothoracic ratio, but the abdominal X-ray shows thumbprinting in the left colon but an otherwise normal gas pattern.
      What is the most probable diagnosis?

      Your Answer: Ischaemic colitis

      Explanation:

      Differentiating Causes of Acute Abdominal Pain: A Guide

      When a patient presents with sudden-onset abdominal pain, it is important to consider the underlying cause in order to provide prompt and appropriate treatment. Here are some key points to consider when differentiating between potential causes:

      Ischaemic colitis: This can occur as a result of atherosclerosis in the mesenteric arteries, leading to tissue death and subsequent inflammation. It is a surgical emergency that requires urgent investigation and treatment.

      Angiodysplasia: This is a small vascular malformation that typically presents with melaena, unexplained PR bleeding, or anaemia. It is unlikely to cause an acute abdomen.

      Infectious colitis: While infectious colitis can cause abdominal pain and diarrhoea, it typically does not come on as rapidly as other causes. Clostridium difficile colitis is a subtype that can be particularly severe and difficult to manage.

      Ulcerative colitis: This is a form of inflammatory bowel disease that usually presents with abdominal pain, bloody diarrhoea, and other symptoms. It is unlikely to be a first presentation in a 69-year-old patient.

      Diverticulitis: This is a common cause of left-sided abdominal pain, especially in older patients. It occurs when diverticula become infected or inflamed, but can be treated with antibiotics. Complications such as perforation or PR bleeding may require urgent intervention.

      By considering these potential causes and their associated symptoms, healthcare providers can more effectively diagnose and treat patients with acute abdominal pain.

    • This question is part of the following fields:

      • Colorectal
      68
      Seconds
  • Question 10 - A 35-year-old male with a history of agoraphobia for the past 3 months...

    Correct

    • A 35-year-old male with a history of agoraphobia for the past 3 months presents for a telemedicine consultation to discuss his current issues. He reports feeling unable to leave his home due to a fear of contamination and illness. He explains that he feels the outside world is too dirty and that he will become sick and die if he leaves his house. He also reports washing his hands six times with soap and water after touching anything, which has resulted in his hands becoming dry, cracked, and erythematosus. He has lost his job as a result of missing deadlines and not being able to complete his work due to his compulsive hand washing behavior. Despite his awareness of the negative impact of his behavior, he feels unable to stop himself from washing his hands exactly six times every time.

      During the telemedicine consultation, his mental state examination is unremarkable. However, upon requesting to see his hands over the video conversation, it is noted that they appear dry, cracked, and erythematosus.

      What is the most appropriate management strategy for this patient?

      Your Answer: SSRI and CBT (including ERP)

      Explanation:

      Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions that can cause significant functional impairment and distress. Risk factors include family history, age, pregnancy/postnatal period, and history of abuse, bullying, or neglect. Treatment options include low-intensity psychological treatments, SSRIs, and more intensive CBT (including ERP). Severe cases should be referred to the secondary care mental health team for assessment and may require combined treatment with an SSRI and CBT or clomipramine as an alternative. ERP involves exposing the patient to an anxiety-provoking situation and stopping them from engaging in their usual safety behavior. Treatment with SSRIs should continue for at least 12 months to prevent relapse and allow time for improvement.

    • This question is part of the following fields:

      • Psychiatry
      67.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (1/2) 50%
Endocrinology (0/1) 0%
Paediatrics (1/1) 100%
Surgery (1/1) 100%
Psychiatry (1/2) 50%
Miscellaneous (1/1) 100%
Pharmacology (0/1) 0%
Colorectal (1/1) 100%
Passmed