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  • Question 1 - A 35-year-old woman visits her GP after her 38-year-old sister was diagnosed with...

    Correct

    • A 35-year-old woman visits her GP after her 38-year-old sister was diagnosed with breast cancer. She is worried about her own risk of developing the disease, especially since their mother passed away from breast cancer at age 41. The patient requests a referral for genetic testing to determine if she carries mutations commonly associated with inherited breast cancer.

      In which genes are these mutations most frequently found?

      Your Answer: BRCA2

      Explanation:

      Genetic Mutations and Their Associated Risks

      Inherited genetic mutations can increase the risk of developing certain diseases, including cancer. The BRCA1 and BRCA2 genes are associated with an increased incidence of breast and ovarian cancers, with a 50% chance of inheritance from a parent. Mutations in these genes significantly increase the lifetime risk of developing these malignancies, with women with the BRCA1 mutation having a 72% risk of developing breast cancer and a 44% risk of developing ovarian cancer. The APC gene is associated with familial polyposis and an increased risk of colorectal cancer, while mutations in the PKD1 gene are associated with polycystic kidney disease. The delta F508 gene mutation causes cystic fibrosis, and mutations in the RAS gene are implicated in a wide range of malignancies. Understanding these genetic mutations and their associated risks can aid in early detection and prevention efforts.

    • This question is part of the following fields:

      • Oncology
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  • Question 2 - An 80-year-old woman visits your clinic after experiencing a fall in her kitchen...

    Incorrect

    • An 80-year-old woman visits your clinic after experiencing a fall in her kitchen last week. She was evaluated in the emergency department and was found to have some bruising, but no fractures. She expresses concern about the possibility of falling again and the risk of future fractures. You recommend an evaluation of her fracture risk. What would be the most suitable method for assessing her fracture risk?

      Your Answer: DEXA scan

      Correct Answer: FRAX tool

      Explanation:

      The Fracture Risk Assessment tool (FRAX) was created by the World Health Organisation (WHO) to evaluate the risk of fractures in patients aged 40 to 90 years old, regardless of whether they have a bone mineral density (BMD) value. NICE recommends using FRAX or QFRACTURE to assess the risk of fragility fractures, with FRAX being the only option available in this case. While DEXA is used to measure BMD, FRAX should be used initially to determine the patient’s risk, and further investigation with a DEXA scan may be necessary based on the results. X-rays of the carpal bones or head of the humerus would not be appropriate, and a bone scan (bone scintigraphy) would not provide information on the patient’s risk of fracture. The source for this information is NICE 2012 guidelines on assessing the risk of fragility fracture in patients with osteoporosis.

      Assessing the Risk of Osteoporosis

      Osteoporosis is a concern due to the increased risk of fragility fractures. To determine which patients require further investigation, NICE produced guidelines in 2012 for assessing the risk of fragility fracture. Women aged 65 years and older and men aged 75 years and older should be assessed, while younger patients should be assessed in the presence of risk factors such as previous fragility fracture, history of falls, and low body mass index.

      NICE recommends using a clinical prediction tool such as FRAX or QFracture to assess a patient’s 10-year risk of developing a fracture. FRAX estimates the 10-year risk of fragility fracture and is valid for patients aged 40-90 years. QFracture estimates the 10-year risk of fragility fracture and includes a larger group of risk factors.

      If the FRAX assessment was done without a bone mineral density (BMD) measurement, the results will be categorised into low, intermediate, or high risk. If the FRAX assessment was done with a BMD measurement, the results will be categorised into reassurance, consider treatment, or strongly recommend treatment. Patients assessed using QFracture are not automatically categorised into low, intermediate, or high risk.

      NICE recommends reassessing a patient’s risk if the original calculated risk was in the region of the intervention threshold for a proposed treatment and only after a minimum of 2 years or when there has been a change in the person’s risk factors.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 3 - A 36-year-old woman comes to her General Practitioner (GP) complaining of mood changes...

    Correct

    • A 36-year-old woman comes to her General Practitioner (GP) complaining of mood changes eight days after giving birth. She expresses that she does not want the baby and believes that it is dying. She feels like crying constantly. She experiences auditory and visual hallucinations that tell her to harm herself. Apart from this, she has no significant medical history.
      What is the diagnosis for this patient?

      Your Answer: Postpartum psychosis

      Explanation:

      Differentiating Postpartum Psychosis from Other Psychiatric Disorders

      Postpartum psychosis is a severe form of postpartum depression that presents with psychotic features, including auditory hallucinations instructing the patient to harm herself and rejection of the child. Antipsychotic medication is required for intervention in severe cases, while cognitive behavioural therapy and selective serotonin reuptake inhibitors may be used for milder cases. On the other hand, postnatal blues is a mild, transient disturbance in mood occurring between the third and sixth day after delivery, while adjustment disorder is diagnosed in the absence of another psychiatric diagnosis and does not involve auditory or visual hallucinations. Anxiety disorder, specifically generalised anxiety disorder, is characterised by excessive worry disproportionate to the situation, restlessness, fatigue, impaired concentration, muscle tenderness, and poor sleep, but does not occur specifically post-delivery. Schizoid personality disorder, which involves a lack of interest in social relationships, solitary lifestyle, secretiveness, emotional coldness, and apathy, is not an acute presentation like postpartum psychosis.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 4 - A 50-year-old woman presents with swelling and pain in several joints of her...

    Incorrect

    • A 50-year-old woman presents with swelling and pain in several joints of her right hand and left wrist. The affected joints are also stiff, erythematosus, and warm to touch. She denies any recent injury to the joints and is otherwise healthy. Upon joint aspirate, the sample appears turbid and yellow with a WBC count of 25,000/mm³ and 70% neutrophils. Viscosity is reduced and polarised light microscopy is unremarkable. What is the most probable diagnosis?

      Your Answer: Pseudogout

      Correct Answer: Rheumatoid arthritis

      Explanation:

      The joint aspirate in rheumatoid arthritis typically displays a high count of white blood cells, with a majority being neutrophils. The appearance is usually cloudy and yellow, and there are no crystals present.

      In contrast, gout would reveal needle-shaped urate crystals that are negatively birefringent under polarised light microscopy. Osteoarthritis would show fewer white blood cells and a lower proportion of neutrophils, with a clear appearance. It is more commonly found in larger weight-bearing joints. Pseudogout would display rhomboid-shaped crystals that are positively birefringent.

      Therefore, the correct answer is rheumatoid arthritis, which is characterised by an elevated white cell count, predominantly neutrophils, and a cloudy appearance.

      Rheumatoid Arthritis: Symptoms and Presentations

      Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints, causing pain, swelling, and stiffness. The typical features of rheumatoid arthritis include swollen and painful joints in the hands and feet, with stiffness being worse in the morning. The condition gradually worsens over time, with larger joints becoming involved. The presentation of rheumatoid arthritis usually develops insidiously over a few months, and a positive ‘squeeze test’ may be observed, which causes discomfort on squeezing across the metacarpal or metatarsal joints.

      Late features of rheumatoid arthritis include Swan neck and boutonnière deformities, which are unlikely to be present in a recently diagnosed patient. However, other presentations of rheumatoid arthritis may include an acute onset with marked systemic disturbance or relapsing/remitting monoarthritis of different large joints, known as palindromic rheumatism. It is important to recognize the symptoms and presentations of rheumatoid arthritis to ensure prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Musculoskeletal
      68.2
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  • Question 5 - A 68-year-old male comes to the clinic after tripping while walking his dog....

    Incorrect

    • A 68-year-old male comes to the clinic after tripping while walking his dog. He stumbled forward but managed to catch himself with his hands. He did not experience any head trauma or loss of consciousness.
      Upon examination, he reports persistent discomfort in his left hand, and the pain intensifies when pressure is applied through the metacarpal of his thumb.
      An X-ray shows an unsteady fracture in the proximal pole of a carpal bone.
      What would be the most suitable course of action for managing this condition?

      Your Answer:

      Correct Answer: Refer to orthopaedic surgery

      Explanation:

      Surgical fixation is necessary for all proximal scaphoid pole fractures, including this patient’s unstable fracture. The positive scaphoid compression test indicates instability, and the retrograde blood supply increases the risk of avascular necrosis. Rest, ice, compression, and elevation are not sufficient treatments in this case. While a long-arm thumb spica cast may be helpful for waist scaphoid fractures, it is less effective for unstable scaphoid pole fractures. Repeating a wrist x-ray after 10 days is appropriate when radiological signs are absent but clinical suspicion remains high. Attempting manual reduction is not recommended for scaphoid fractures, which require surgical fixation for optimal healing.

      Understanding Scaphoid Fractures

      A scaphoid fracture is a type of wrist fracture that typically occurs when a person falls onto an outstretched hand or during contact sports. It is important to recognize this type of fracture due to the unusual blood supply of the scaphoid bone. Interruption of the blood supply can lead to avascular necrosis, which is a serious complication. Patients with scaphoid fractures typically present with pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination is highly sensitive and specific when certain signs are present, such as tenderness over the anatomical snuffbox and pain on telescoping of the thumb.

      Plain film radiographs should be requested, including scaphoid views, but the sensitivity in the first week of injury is only 80%. A CT scan may be requested in the context of ongoing clinical suspicion or planning operative management, while MRI is considered the definite investigation to confirm or exclude a diagnosis. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the patient and type of fracture, with undisplaced fractures of the scaphoid waist typically treated with a cast for 6-8 weeks. Displaced scaphoid waist fractures require surgical fixation, as do proximal scaphoid pole fractures. Complications of scaphoid fractures include non-union, which can lead to pain and early osteoarthritis, and avascular necrosis.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 6 - A 38-year-old female patient visits her doctor's office for a follow-up appointment. She...

    Incorrect

    • A 38-year-old female patient visits her doctor's office for a follow-up appointment. She was recently diagnosed with hypothyroidism and is currently taking a daily dose of 100 micrograms of thyroxine. The doctor has access to the patient's thyroid function and other test results from the previous week.

      Which test would be most effective in monitoring the patient's progress and treatment?

      Your Answer:

      Correct Answer: Thyroid stimulating hormone (TSH) levels

      Explanation:

      Thyroxine and TSH Levels in Hypothyroidism

      Thyroxine is a medication that can help reduce the high levels of thyroid-stimulating hormone (TSH) that are often seen in individuals with hypothyroidism. When TSH levels are high, it indicates that the thyroid gland is not producing enough thyroid hormones, which can lead to a range of symptoms such as fatigue, weight gain, and depression. By taking thyroxine, individuals with hypothyroidism can help regulate their TSH levels and improve their overall health.

      To monitor the effectiveness of thyroxine treatment, doctors often use TSH as a key monitoring test. The goal is to get TSH levels into the normal range, which indicates that the thyroid gland is producing enough hormones. Other tests that may be used in the initial investigation and diagnosis of hypothyroidism include triiodothyronine, free thyroxine (T4), thyroid peroxidase antibody, and protein-bound iodine levels. By using a combination of these tests, doctors can get a better of a patient’s thyroid function and develop an appropriate treatment plan.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A 30-year-old female patient visits the neurology clinic due to recurring headaches that...

    Incorrect

    • A 30-year-old female patient visits the neurology clinic due to recurring headaches that happen once a month. She also reports experiencing peculiar flashes before the onset of pain. During an attack, she feels exhausted and finds relief by resting in a dark room. What is the most probable diagnosis, and what medication should be prescribed for symptom prevention?

      Your Answer:

      Correct Answer: Propranolol

      Explanation:

      Propranolol is the preferred medication for migraine prevention in women of childbearing age, as it is safer than topiramate which is teratogenic. Both medications are equally effective, but propranolol has a better side effects profile. Amitriptyline can also be used for migraine prophylaxis, but it is usually reserved for cases where propranolol and topiramate are ineffective. Paracetamol is only recommended for acute management of migraine, while sumatriptan is only recommended for acute management and should not be taken more than twice a week to avoid medication overuse headaches.

      Managing Migraines: Guidelines and Treatment Options

      Migraines can be debilitating and affect a significant portion of the population. To manage migraines, it is important to understand the different treatment options available. According to the National Institute for Health and Care Excellence (NICE) guidelines, acute treatment for migraines involves a combination of an oral triptan and an NSAID or paracetamol. For young people aged 12-17 years, a nasal triptan may be preferred. If these measures are not effective, non-oral preparations of metoclopramide or prochlorperazine may be considered, along with a non-oral NSAID or triptan.

      Prophylaxis should be given if patients are experiencing two or more attacks per month. NICE recommends topiramate or propranolol, depending on the patient’s preference, comorbidities, and risk of adverse events. Propranolol is preferred in women of childbearing age as topiramate may be teratogenic and reduce the effectiveness of hormonal contraceptives. Acupuncture and riboflavin may also be effective in reducing migraine frequency and intensity for some people. For women with predictable menstrual migraines, frovatriptan or zolmitriptan may be recommended as a type of mini-prophylaxis.

      Specialists may consider other treatment options, such as candesartan or monoclonal antibodies directed against the calcitonin gene-related peptide (CGRP) receptor, like erenumab. However, pizotifen is no longer recommended due to common adverse effects like weight gain and drowsiness. It is important to exercise caution with young patients as acute dystonic reactions may develop. By following these guidelines and considering various treatment options, migraines can be effectively managed.

    • This question is part of the following fields:

      • Medicine
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  • Question 8 - A 68-year-old woman has undergone a radical hysterectomy and bilateral salpingo-oophorectomy for endometrial...

    Incorrect

    • A 68-year-old woman has undergone a radical hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. She is attending her follow-up clinic to receive her results, and the consultant reports that the tumour was found to involve the right fallopian tube and ovary, but the vagina and parametrial tissue were free of tumour. All nodes submitted were negative for carcinoma. No distant metastases were present. According to the above description, how would you stage the tumour using the TNM 8 classification?

      Your Answer:

      Correct Answer: T3a N0 M0

      Explanation:

      Stages of Endometrial Carcinoma: TNM Classification Explained

      Endometrial carcinoma is a type of cancer that affects the lining of the uterus. The TNM classification system is used to describe the extent of the cancer and guide treatment decisions. Here are some common stages of endometrial carcinoma:

      T3a N0 M0: This stage describes endometrial carcinoma that involves the uterine serosa or adnexae, but has not spread to lymph nodes or other organs.

      T3b N0 M0: This stage describes endometrial carcinoma that involves the vagina or parametrial tissues, but has not spread to lymph nodes or other organs.

      T1a N0 M0: This stage describes endometrial carcinoma that is confined to the endometrium or has invaded less than half of the myometrium, without lymph node or distal metastases.

      T1b N0 M0: This stage describes endometrial carcinoma that is confined to the uterus but has invaded more than half of the myometrium, without lymph node or distal metastases.

      T2 N0 M0: This stage describes endometrial carcinoma that involves the cervix but has not spread beyond the uterus, without lymph node or distal metastases.

      Understanding the stage of endometrial carcinoma is important for determining the best treatment options and predicting outcomes.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 9 - A 65-year-old woman presents to the Emergency Department with shortness of breath after...

    Incorrect

    • A 65-year-old woman presents to the Emergency Department with shortness of breath after being sat at home.
      An arterial blood gas (ABG) is performed and shows the following results:
      Investigation Result Normal value
      pH 7.48 7.35–7.45
      pO2 7.3 kPa 10.5–13.5 kPa
      pCO2 3.9 kPa 4.6–6 kPa
      HCO3 24 mmol/l 24–30 mmol/l
      Which one of the following conditions is most likely to account for these investigation results?

      Your Answer:

      Correct Answer: Pulmonary embolism

      Explanation:

      Understanding Respiratory Failure: Causes and ABG Interpretation

      Respiratory failure is a condition where the lungs fail to adequately oxygenate the blood or remove carbon dioxide. There are two types of respiratory failure: type I and type II. Type I respiratory failure is characterized by low levels of oxygen and normal or low levels of carbon dioxide, resulting in respiratory alkalosis. Type II respiratory failure, on the other hand, is characterized by low levels of oxygen and high levels of carbon dioxide, resulting in respiratory acidosis.

      Pulmonary embolism is the only cause of type I respiratory failure. This condition results in reduced oxygenation of the blood due to a blockage in the pulmonary artery. The ABG of a patient with pulmonary embolism would show low levels of oxygen and carbon dioxide, as well as respiratory alkalosis.

      Hypothyroidism, Guillain–Barré syndrome, and myasthenia gravis are all causes of type II respiratory failure. Hypothyroidism can result in decreased ventilatory drive, while Guillain–Barré syndrome and myasthenia gravis can cause respiratory muscle weakness, leading to hypoventilation and respiratory acidosis.

      Opiate overdose is another cause of type II respiratory failure. Opiates act on the respiratory centers in the brain, reducing ventilation and causing respiratory acidosis.

      In summary, understanding the causes and ABG interpretation of respiratory failure is crucial in identifying and managing this potentially life-threatening condition.

    • This question is part of the following fields:

      • Respiratory
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  • Question 10 - What is the correct information regarding the storage requirements and lifespan of blood...

    Incorrect

    • What is the correct information regarding the storage requirements and lifespan of blood products?

      Your Answer:

      Correct Answer: Fresh frozen plasma is stored at −25°C for up to 36 months

      Explanation:

      Storage Guidelines for Blood Products

      Blood products such as fresh frozen plasma, red cells, and platelets have specific storage guidelines to ensure their safety and efficacy. Fresh frozen plasma can be stored for up to 36 months at a temperature of −25°C. On the other hand, red cells are stored at a temperature of 4°C for a maximum of 35 days, while platelets are stored at a temperature of 22°C for up to 5 days on a platelet shaker/agitator.

      These guidelines are important to follow to maintain the quality of blood products and prevent any adverse reactions in patients who receive them. It is crucial to store blood products at the appropriate temperature and for the recommended duration to ensure their effectiveness when used in transfusions. Healthcare professionals should be aware of these guidelines and ensure that they are followed to provide safe and effective blood transfusions to patients.

    • This question is part of the following fields:

      • Haematology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Oncology (1/1) 100%
Musculoskeletal (0/2) 0%
Psychiatry (1/1) 100%
Passmed