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  • Question 1 - A 27-year-old man is brought to the hospital by his sister after he...

    Incorrect

    • A 27-year-old man is brought to the hospital by his sister after he spent all of his savings on buying expensive gifts for strangers on the street, claiming that he is here to spread love and happiness. He insists that he is the chosen one to bring joy to the world and will do anything to achieve it. He is very restless, and the doctor cannot communicate with him to gather a medical history. His sister confirms that he has a known diagnosis of bipolar disorder and is currently on medication. For the past few days, the patient has not slept much and has been up all night planning his mission to spread love. There is no evidence of any overdose, but his sister says that he may have missed his medication while on a trip last week. The doctor decides to keep the patient in the hospital under a Section until tomorrow morning when an approved mental health professional can evaluate him.
      For how long can the patient be detained under the Section used?

      Your Answer: 28 days

      Correct Answer: 72 hours

      Explanation:

      Time Limits for Mental Health Detention in the UK

      In the UK, there are several time limits for mental health detention that healthcare professionals must adhere to. These time limits vary depending on the type of detention and the circumstances of the patient. Here are the time limits for mental health detention in the UK:

      Section 5(2): 72 hours
      A doctor can use Section 5(2) to keep a patient in hospital for a maximum of 72 hours. This cannot be extended, so an approved mental health professional should assess the patient as soon as possible to decide if the patient needs to be detained under Section 2 or 3.

      Section 5(4): 6 hours
      Mental health or learning disability nurses can use Section 5(4) to keep a patient in hospital for a maximum of six hours. This cannot be extended, so arrangements should be made for Section 2 or 3 if the patient is to be kept longer in hospital.

      Section 3: 6 months initially, renewable for one year at a time
      Section 3 can be used to keep a patient in hospital for treatment for six months. It can be extended for another six months, and then after that for one year for each renewal. During the first six months, patients can only be treated against their will in the first three months. For the next three months, the patient can only be treated after an ‘approved second-opinion doctor’ gives their approval for the treatment.

      Section 2: 28 days
      Approved mental health professionals can use Section 2 to keep a patient in hospital for assessment for a maximum of 28 days. It cannot be extended, so if a longer stay is required for treatment, Section 3 needs to be applied for.

      Section 3 Renewal: one year
      Section 3 can be renewed for a second time, after it has been renewed for a first time for six months after an initial six months upon application of the Section. The renewal is for one year at a time.

      Understanding Time Limits for Mental Health Detention in the UK

    • This question is part of the following fields:

      • Psychiatry
      1.1
      Seconds
  • Question 2 - A 67-year-old woman visits her GP complaining of left flank pain and haematuria...

    Correct

    • A 67-year-old woman visits her GP complaining of left flank pain and haematuria that has persisted for 3 weeks. She also reports a dry cough that has worsened over the past month. The patient has a history of smoking for 10 pack years. During the examination, a palpable mass is detected in the left flank. The patient is prescribed pembrolizumab and axitinib for treatment. What stage of cancer is likely to have been present at the time of diagnosis?

      Your Answer: Stage 4

      Explanation:

      The patient’s renal cell carcinoma had progressed to stage 4, which is metastatic and often presents with symptoms. This was supported by the fact that the patient was treated with pembrolizumab and axitinib, which are the first-line options for stage 4 disease. Stage 1 and 2 were ruled out as they are typically treated with surgical resection, surveillance, or local ablation. Stage 3 was also ruled out as it involves nearby structure invasion but no distant metastases, and is treated with radical nephrectomy.

      Understanding Renal Cell Cancer

      Renal cell cancer, also known as hypernephroma, is a primary renal neoplasm that accounts for 85% of cases. It typically arises from the proximal renal tubular epithelium, with the clear cell subtype being the most common. This type of cancer is more prevalent in middle-aged men and is associated with smoking, von Hippel-Lindau syndrome, and tuberous sclerosis. While renal cell cancer is only slightly increased in patients with autosomal dominant polycystic kidney disease, it can present with a classical triad of haematuria, loin pain, and abdominal mass. Other features include pyrexia of unknown origin, endocrine effects, and paraneoplastic hepatic dysfunction syndrome.

      The T category criteria for renal cell cancer are based on the size and extent of the tumour. For confined disease, a partial or total nephrectomy may be recommended depending on the tumour size. Patients with a T1 tumour are typically offered a partial nephrectomy, while those with larger tumours may require a total nephrectomy. Treatment options for renal cell cancer include alpha-interferon, interleukin-2, and receptor tyrosine kinase inhibitors such as sorafenib and sunitinib. These medications have been shown to reduce tumour size and treat patients with metastases. It is important to note that renal cell cancer can have paraneoplastic effects, such as Stauffer syndrome, which is associated with cholestasis and hepatosplenomegaly. Overall, early detection and prompt treatment are crucial for improving outcomes in patients with renal cell cancer.

    • This question is part of the following fields:

      • Surgery
      0.6
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  • Question 3 - A 29-year-old man is brought to the emergency department following a head-on collision...

    Correct

    • A 29-year-old man is brought to the emergency department following a head-on collision with his motorcycle. He is conscious and responsive, but he reports severe agony in his right leg. Upon examination, there is an exposed break in the right tibia with significant damage to the surrounding soft tissue and contamination. The medical team has administered intravenous antibiotics. What is the primary treatment for his fracture?

      Your Answer: Urgent intravenous antibiotics and debridement in theatre

      Explanation:

      Immediate administration of intravenous antibiotics and debridement is necessary for the management of open fractures, and definitive management should be delayed until soft tissues have recovered. A combined orthoplastic approach is recommended for achieving debridement, fixation, and soft tissue cover. If suitable, fixation and definitive soft tissue cover can be done immediately after debridement. However, if this is not possible, cover should be carried out within 72 hours to minimize the risk of infection. It is important to note that external fixation, fracture irrigation, and internal fixation should not be done before operative debridement, and free flap surgery should only be done after debridement.

      Fracture Management: Understanding Types and Treatment

      Fractures can occur due to trauma, stress, or pathological reasons. Diagnosis involves evaluating the site and type of injury, as well as associated injuries and neurovascular deficits. X-rays are important in assessing changes in bone length, distal bone angulation, rotational effects, and foreign material. Fracture types include oblique, comminuted, segmental, transverse, and spiral. It is also important to distinguish open from closed injuries, with the Gustilo and Anderson classification system being the most common for open fractures. Management involves immobilizing the fracture, monitoring neurovascular status, managing infection, and debriding open fractures within 6 hours of injury.

      To ensure proper fracture management, it is crucial to understand the different types of fractures and their causes. Diagnosis involves not only evaluating the fracture itself, but also any associated injuries and neurovascular deficits. X-rays are an important tool in assessing the extent of the injury. It is also important to distinguish between open and closed fractures, with open fractures requiring immediate attention and debridement. Proper management involves immobilizing the fracture, monitoring neurovascular status, and managing infection. By understanding the different types of fractures and their treatment, healthcare professionals can provide effective care for patients with fractures.

    • This question is part of the following fields:

      • Musculoskeletal
      0.5
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  • Question 4 - In the field of pharmacology, what is the term used to describe a...

    Incorrect

    • In the field of pharmacology, what is the term used to describe a ligand that binds to a receptor and induces a biological response by altering the receptor state, usually resulting in an increase in receptor activity?

      Your Answer: Functional antagonist

      Correct Answer: Agonist

      Explanation:

      An agonist is a drug that binds to a receptor and causes an increase in receptor activity. The effects of an agonist are determined by efficacy of agonism and degree of receptor occupancy. An antagonist is a ligand that binds to a receptor and reduces or inhibits receptor activity, causing no biological response. The effects of an antagonist are determined by degree of receptor occupancy, affinity to the receptor, and efficacy. A competitive antagonist has a similar structure to an agonist and will bind to the same site on the same receptor. A non-competitive antagonist has a different structure to the agonist and may cause an alteration in the receptor structure or the interaction of the receptor with downstream effects in the cell.

    • This question is part of the following fields:

      • Pharmacology
      0.9
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  • Question 5 - A 50-year-old woman comes to the clinic with creamy nipple discharge. She had...

    Incorrect

    • A 50-year-old woman comes to the clinic with creamy nipple discharge. She had a mammogram screening a year ago which was normal. She smokes 10 cigarettes per day. Upon examination, there were no alarming findings. A repeat mammogram was conducted and no abnormalities were detected. Although she is concerned about the possibility of a tumor, she is not bothered by the discharge itself. Her serum prolactin level is provided below.
      Prolactin 200 mIU/L (<600)
      What is the most probable diagnosis and what would be the best initial treatment?

      Your Answer: Mastectomy

      Correct Answer: Reassurance

      Explanation:

      Duct ectasia does not require any specific treatment. However, lumpectomy may be used to treat breast masses if they meet certain criteria such as being small-sized and peripheral, and taking into account the patient’s preference. Mastectomy may be necessary for malignant breast masses if lumpectomy is not suitable. In young women with duct ectasia, microdochectomy may be performed if the condition is causing discomfort. It is also used to treat intraductal papilloma.

      Understanding Duct Ectasia

      Duct ectasia is a condition that affects the terminal breast ducts located within 3 cm of the nipple. It is a common condition that becomes more prevalent as women age. The condition is characterized by the dilation and shortening of the ducts, which can cause nipple retraction and creamy nipple discharge. It is important to note that duct ectasia can be mistaken for periductal mastitis, which is more common in younger women who smoke. Periductal mastitis typically presents with infections around the periareolar or subareolar areas and may recur.

      When dealing with troublesome nipple discharge, treatment options may include microdochectomy for younger patients or total duct excision for older patients.

    • This question is part of the following fields:

      • Surgery
      1.8
      Seconds
  • Question 6 - A 40-year-old mid-level manager is referred by his company after a recent incident....

    Incorrect

    • A 40-year-old mid-level manager is referred by his company after a recent incident. He had been working on a major project that would secure his promotion and position in the firm. After months of hard work, he was just about to finalize the project when his team member made a mistake that caused a setback. Frustrated by the setback, your patient began yelling, stomping on the floor and throwing objects until he broke a window.
      Which one of the following ego defences best describes his behaviour?

      Your Answer: Sublimation

      Correct Answer: Regression

      Explanation:

      Understanding Ego Defence Mechanisms: Types and Examples

      Regression, Sublimation, Identification, Dissociation, and Reaction Formation are all ego defence mechanisms that individuals use to cope with stress and anxiety.

      Regression is an immature defence mechanism where individuals revert to childish behaviour when faced with stress. For example, a frustrated person may throw a temper tantrum like a toddler.

      Sublimation, on the other hand, is a mature defence mechanism where individuals channel their unacceptable personality traits into respectable work that aligns with their values.

      Identification is when individuals model the behaviour of a more powerful person. For instance, a victim of child abuse may become a child abuser in adulthood.

      Dissociation is an immature defence mechanism where individuals temporarily modify their personal identity to avoid distress. An extreme form of dissociation is dissociative identity disorder.

      Finally, Reaction Formation is an immature defence mechanism where individuals repress unacceptable emotions and replace them with their exact opposite. For example, a man with homoerotic desires may champion anti-homosexual public policy.

      Understanding these ego defence mechanisms can help individuals recognize and cope with their own stress and anxiety in a healthy way.

    • This question is part of the following fields:

      • Psychiatry
      0.7
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  • Question 7 - A 9-month-old infant is experiencing feeding difficulties accompanied by a cough and wheeze,...

    Incorrect

    • A 9-month-old infant is experiencing feeding difficulties accompanied by a cough and wheeze, leading to a diagnosis of bronchiolitis. What is a triggering factor that can cause a more severe episode of bronchiolitis, rather than just an increased likelihood of developing the condition?

      Your Answer: Fragile X syndrome

      Correct Answer: Underlying congenital heart disease

      Explanation:

      Bronchiolitis can be more severe in individuals with congenital heart disease, particularly those with a ventricular septal defect. Fragile X is not associated with increased severity, but Down’s syndrome has been linked to worse episodes. Formula milk feeding is a risk factor for bronchiolitis, but does not affect the severity of the disease once contracted. While bronchiolitis is most common in infants aged 3-6 months, this age range is not indicative of a more severe episode. However, infants younger than 12 weeks are at higher risk. Being born at term is not a risk factor, but premature birth is associated with more severe episodes.

      Bronchiolitis is a condition where the bronchioles become inflamed, and it is most commonly caused by respiratory syncytial virus (RSV). This virus is responsible for 75-80% of cases, with other causes including mycoplasma and adenoviruses. Bronchiolitis is most prevalent in infants under one year old, with 90% of cases occurring in those aged 1-9 months. The condition is more serious in premature babies, those with congenital heart disease or cystic fibrosis. Symptoms include coryzal symptoms, dry cough, increasing breathlessness, and wheezing. Hospital admission is often necessary due to feeding difficulties associated with increasing dyspnoea.

      Immediate referral is recommended if the child has apnoea, looks seriously unwell, has severe respiratory distress, central cyanosis, or persistent oxygen saturation of less than 92% when breathing air. Clinicians should consider referral if the child has a respiratory rate of over 60 breaths/minute, difficulty with breastfeeding or inadequate oral fluid intake, or clinical dehydration. Immunofluorescence of nasopharyngeal secretions may show RSV, and management is largely supportive. Humidified oxygen is given via a head box if oxygen saturations are persistently low, and nasogastric feeding may be necessary if children cannot take enough fluid/feed by mouth. Suction may also be used for excessive upper airway secretions. NICE released guidelines on bronchiolitis in 2015 for more information.

    • This question is part of the following fields:

      • Paediatrics
      0.8
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  • Question 8 - A 28-year-old male was admitted to orthopaedics 3 days ago following a snowboarding...

    Incorrect

    • A 28-year-old male was admitted to orthopaedics 3 days ago following a snowboarding accident. X-rays revealed a closed right tibial shaft fracture with minimal displacement. Over the past 4 hours, he has been experiencing severe pain in the leg, despite receiving hourly oral morphine in addition to regular paracetamol and ibuprofen. His urine has turned dark and a dipstick test shows the presence of blood.

      On admission, his electrolyte and renal function tests were as follows:
      Na+ 138 mmol/L
      K+ 4.1 mmol/L
      Bicarbonate 23 mmol/L
      Urea 3.8 mmol/L
      Creatinine 72 µmol/L

      However, on day 3 of admission, his results have changed significantly:
      Na+ 142 mmol/L (135 - 145)
      K+ 5.6 mmol/L (3.5 - 5.0)
      Bicarbonate 18 mmol/L (22 - 29)
      Urea 11.9 mmol/L (2.0 - 7.0)
      Creatinine 189 µmol/L (55 - 120)

      What is the primary factor contributing to the development of acute kidney injury (AKI) in this patient?

      Your Answer: Deposition of anti-glomerular basement membrane antibodies in the glomeruli

      Correct Answer: Accumulation of myoglobin in the renal tubules

      Explanation:

      Compartment syndrome is commonly linked to fractures of the tibial shaft and supracondylar region. The presence of rapidly-progressing pain that is unresponsive to high doses of pain medication is indicative of compartment syndrome. This condition can cause an increase in pressure within the fascial compartment, leading to muscle breakdown and the release of myoglobin into the bloodstream, resulting in rhabdomyolysis. This can cause acute kidney injury, with myoglobinuria causing urine to appear dark brown and test positive for blood. Dehydration and pre-renal AKI may also occur, but urinalysis would not show blood in this case. Goodpasture’s syndrome, which involves the deposition of anti-glomerular basement membrane antibodies, typically presents with AKI, proteinuria, and pulmonary symptoms such as haemoptysis and shortness of breath. Obstructive stones usually cause right loin pain, and a single ureter obstruction is unlikely to cause significant renal impairment. While NSAIDs can worsen renal function by inhibiting prostaglandins and causing vasoconstriction of the glomerular afferent arteriole, compartment syndrome and rhabdomyolysis are likely the primary causes of AKI in this case.

      Compartment syndrome is a complication that can occur after fractures or vascular injuries. It is characterized by increased pressure within a closed anatomical space, which can lead to tissue death. Supracondylar fractures and tibial shaft injuries are the most common fractures associated with compartment syndrome. Symptoms include pain, numbness, paleness, and possible paralysis of the affected muscle group. Diagnosis is made by measuring intracompartmental pressure, with pressures over 20 mmHg being abnormal and over 40 mmHg being diagnostic. X-rays typically do not show any pathology. Treatment involves prompt and extensive fasciotomies, with careful attention to decompressing deep muscles in the lower limb. Patients may develop myoglobinuria and require aggressive IV fluids. In severe cases, debridement and amputation may be necessary, as muscle death can occur within 4-6 hours.

    • This question is part of the following fields:

      • Musculoskeletal
      2
      Seconds
  • Question 9 - A 67-year-old man comes to the clinic with a lump in his left...

    Incorrect

    • A 67-year-old man comes to the clinic with a lump in his left groin. He is uncertain when it first appeared and reports no pain, abdominal discomfort, or alterations in bowel movements. During the examination, a mass is visible above and towards the middle of the pubic tubercle, and it vanishes when he lies down. It does not transilluminate. He has a medical history of type 2 diabetes mellitus and is taking metformin.

      What is the best course of action for managing his condition?

      Your Answer: Refer for fitting of a truss

      Correct Answer: Routine surgical referral

      Explanation:

      It is recommended to refer patients with inguinal hernias for repair, even if they are not experiencing any symptoms. This is because many patients eventually become asymptomatic and require surgery anyway. Urgent surgical referral is not necessary unless there are signs of incarceration or strangulation. Watching and waiting for the hernia to resolve is not recommended as it does not spontaneously resolve. Fitting a truss is an option for patients who are not fit for surgery, but in this case, routine surgical referral is the most appropriate course of action.

      Understanding Inguinal Hernias

      Inguinal hernias are the most common type of abdominal wall hernias, with 75% of cases falling under this category. They are more prevalent in men, with a 25% lifetime risk of developing one. The main feature of an inguinal hernia is a lump in the groin area, which is located superior and medial to the pubic tubercle. This lump disappears when pressure is applied or when the patient lies down. Discomfort and aching are common symptoms, which can worsen with activity, but severe pain is rare. Strangulation, a serious complication, is uncommon.

      The clinical management of inguinal hernias involves treating medically fit patients, even if they are asymptomatic. A hernia truss may be an option for patients who are not fit for surgery, but it has little role in other patients. Mesh repair is the preferred method of treatment, as it is associated with the lowest recurrence rate. Unilateral hernias are generally repaired with an open approach, while bilateral and recurrent hernias are repaired laparoscopically. Patients can return to non-manual work after 2-3 weeks following an open repair and after 1-2 weeks following laparoscopic repair, according to the Department for Work and Pensions.

      Complications of inguinal hernias include early bruising and wound infection, as well as late chronic pain and recurrence. While traditional textbooks describe the anatomical differences between indirect and direct hernias, this is not relevant to clinical management. Overall, understanding the features, management, and complications of inguinal hernias is crucial for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Surgery
      0.9
      Seconds
  • Question 10 - A 55-year-old patient presents with complaints of dyspnea upon exertion. A chest X-ray...

    Incorrect

    • A 55-year-old patient presents with complaints of dyspnea upon exertion. A chest X-ray reveals fibrosis, and the patient reports increasing fatigue and malaise with a pale appearance. Further testing shows an elevated thyroid-stimulating hormone (TSH) level. What medication is this patient currently taking?

      Your Answer: Procainamide

      Correct Answer: Amiodarone

      Explanation:

      Anti-Arrhythmic Medications: Mechanisms and Side-Effects

      Amiodarone, Flecainide, Lidocaine, Procainamide, and Quinidine are all anti-arrhythmic medications used in the treatment of various types of arrhythmias. Each medication has a unique mechanism of action and associated side-effects.

      Amiodarone is a class III anti-arrhythmic agent that prolongs the repolarisation phase by blocking potassium efflux. It can cause thyroid dysfunction, pulmonary fibrosis, bradycardia, and other side-effects.

      Flecainide is a class Ic sodium channel blocker that slows conduction of the electrical impulse in the heart. It can cause oedema, dyspnoea, visual disturbances, and other side-effects.

      Lidocaine is a class Ib anti-arrhythmic agent that shortens the repolarisation phase by blocking Na channels. It can cause drowsiness, respiratory failure, and other side-effects.

      Procainamide is a class Ia anti-arrhythmic medication that prolongs the repolarisation phase. It can cause bradycardia, hypotension, and shock. Prolonged use has been associated with the development of systemic lupus erythematosus.

      Quinidine is a class Ia anti-arrhythmic medication that prolongs the repolarisation phase and can cause torsades de pointe. It can also lead to thrombocytopenia, myasthenia gravis, and other side-effects.

      In conclusion, each anti-arrhythmic medication has its own unique mechanism of action and associated side-effects. It is important to carefully consider the risks and benefits of each medication before prescribing it to a patient.

    • This question is part of the following fields:

      • Pharmacology
      0.9
      Seconds
  • Question 11 - A 32-year-old businessman came to the hospital with a low-grade fever, blood-streaked sputum...

    Incorrect

    • A 32-year-old businessman came to the hospital with a low-grade fever, blood-streaked sputum and a dry cough that had been persisting for 7 weeks. He had been travelling extensively in India, staying in cheap and unsanitary accommodations. Upon further testing, he was diagnosed with tuberculosis and started on appropriate antibiotics. However, when he visited your outpatient clinic two weeks later, he complained of joint pain, fatigue, and a new rash that was limited to his face and had a butterfly shape. You suspect that one of the drugs he is taking is causing drug-induced lupus. Which drug is responsible for his condition?

      Your Answer: Streptomycin

      Correct Answer: Isoniazid

      Explanation:

      Understanding Drug-Induced Lupus

      Drug-induced lupus is a condition that shares some similarities with systemic lupus erythematosus, but not all of its typical features are present. Unlike SLE, renal and nervous system involvement is rare in drug-induced lupus. The good news is that this condition usually resolves once the drug causing it is discontinued.

      The most common symptoms of drug-induced lupus include joint pain, muscle pain, skin rashes (such as the malar rash), and pulmonary issues like pleurisy. In terms of laboratory findings, patients with drug-induced lupus typically test positive for ANA (antinuclear antibodies) but negative for dsDNA (double-stranded DNA) antibodies. Anti-histone antibodies are found in 80-90% of cases, while anti-Ro and anti-Smith antibodies are only present in around 5% of cases.

      The most common drugs that can cause drug-induced lupus are procainamide and hydralazine. Other less common culprits include isoniazid, minocycline, and phenytoin.

    • This question is part of the following fields:

      • Musculoskeletal
      1.2
      Seconds
  • Question 12 - A 36-year-old woman with a history of chronic pelvic pain has been diagnosed...

    Incorrect

    • A 36-year-old woman with a history of chronic pelvic pain has been diagnosed with endometriosis. Which of the following is not a recognized treatment for this condition?

      Your Answer: Gonadotrophin-releasing hormone analogues

      Correct Answer: Dilation and curettage

      Explanation:

      Understanding Endometriosis

      Endometriosis is a common condition where endometrial tissue grows outside of the uterus. It affects around 10% of women of reproductive age and can cause chronic pelvic pain, painful periods, painful intercourse, and subfertility. Other symptoms may include urinary problems and painful bowel movements. Diagnosis is typically made through laparoscopy, and treatment options depend on the severity of symptoms.

      First-line treatments for symptomatic relief include NSAIDs and/or paracetamol. If these do not help, hormonal treatments such as the combined oral contraceptive pill or progestogens may be tried. If symptoms persist or fertility is a priority, referral to secondary care may be necessary. Secondary treatments may include GnRH analogues or surgery. For women trying to conceive, laparoscopic excision or ablation of endometriosis plus adhesiolysis is recommended, as well as ovarian cystectomy for endometriomas.

      It is important to note that there is poor correlation between laparoscopic findings and severity of symptoms, and that there is little role for investigation in primary care. If symptoms are significant, referral for a definitive diagnosis is recommended.

    • This question is part of the following fields:

      • Gynaecology
      1.7
      Seconds
  • Question 13 - A 28-year-old female patient named Emily, who is a G2P1, visits you, a...

    Incorrect

    • A 28-year-old female patient named Emily, who is a G2P1, visits you, a locum general practitioner, to inform you about her pregnancy. Upon reviewing her medical history, you discover that Emily has asthma, gastro-oesophageal reflux, constipation, and a recent deep vein thrombosis. She is currently taking senna, over the counter ranitidine, budesonide and salbutamol inhalers, and rivaroxaban. However, none of her medications have been altered due to her pregnancy status. Can you identify which medication needs to be changed?

      Your Answer: Budesonide

      Correct Answer: Rivaroxaban

      Explanation:

      Pregnant women should not use novel oral anticoagulants, so those who are currently taking them should switch to low molecular weight heparin.

      Venous Thromboembolism in Pregnancy: Risk Assessment and Prophylactic Measures

      Pregnancy increases the risk of developing venous thromboembolism (VTE), a condition that can be life-threatening for both the mother and the fetus. To prevent VTE, it is important to assess a woman’s individual risk during pregnancy and initiate appropriate prophylactic measures. This risk assessment should be done at the first antenatal booking and on any subsequent hospital admission.

      Women with a previous history of VTE are automatically considered high risk and require low molecular weight heparin throughout the antenatal period, as well as input from experts. Women at intermediate risk due to hospitalization, surgery, co-morbidities, or thrombophilia should also be considered for antenatal prophylactic low molecular weight heparin.

      The risk assessment at booking should include factors that increase the likelihood of developing VTE, such as age over 35, body mass index over 30, parity over 3, smoking, gross varicose veins, current pre-eclampsia, immobility, family history of unprovoked VTE, low-risk thrombophilia, multiple pregnancy, and IVF pregnancy.

      If a woman has four or more risk factors, immediate treatment with low molecular weight heparin should be initiated and continued until six weeks postnatal. If a woman has three risk factors, low molecular weight heparin should be initiated from 28 weeks and continued until six weeks postnatal.

      If a diagnosis of deep vein thrombosis (DVT) is made shortly before delivery, anticoagulation treatment should be continued for at least three months, as in other patients with provoked DVTs. Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy, while direct oral anticoagulants (DOACs) and warfarin should be avoided.

      In summary, a thorough risk assessment and appropriate prophylactic measures can help prevent VTE in pregnancy, which is crucial for the health and safety of both the mother and the fetus.

    • This question is part of the following fields:

      • Obstetrics
      1.3
      Seconds
  • Question 14 - What vitamin is utilized to treat confusion in individuals with chronic alcoholism? ...

    Incorrect

    • What vitamin is utilized to treat confusion in individuals with chronic alcoholism?

      Your Answer: Riboflavin

      Correct Answer: Thiamine

      Explanation:

      Wernicke-Korsakoff Syndrome

      Wernicke-Korsakoff syndrome is a condition that arises due to insufficient intake of thiamine, as well as impaired absorption and storage. This condition is known to cause various symptoms, including dementia, nystagmus, paralysis of extra ocular muscles, ataxia, and retrograde amnesia, particularly in individuals who struggle with alcoholism.

      The inadequate intake of thiamine is often associated with chronic alcoholism, as alcohol can interfere with the body’s ability to absorb and store thiamine. This can lead to a deficiency in the vitamin, which can cause damage to the brain and nervous system. The symptoms of Wernicke-Korsakoff syndrome can be severe and can significantly impact an individual’s quality of life.

      It is essential to understand the causes and symptoms of Wernicke-Korsakoff syndrome to ensure that individuals who are at risk receive the necessary treatment and support. With proper care and management, it is possible to manage the symptoms of this condition and improve an individual’s overall health and well-being.

    • This question is part of the following fields:

      • Emergency Medicine
      1.2
      Seconds
  • Question 15 - A 27-year-old woman presents to the Emergency department with a suspected intentional overdose....

    Incorrect

    • A 27-year-old woman presents to the Emergency department with a suspected intentional overdose. She is unsure of the medication she has taken. Her medical history includes severe asthma, anxiety, and depression. Additionally, she is a regular cannabis smoker.

      During the assessment, the patient appears agitated and confused, unable to remain still on the bed. There is significant global hypertonia and clonus, particularly in the legs. Her vital signs reveal a sinus tachycardia on ECG with a pulse of 135 bpm. Her blood pressure is 156/96 mmHg, SpO2 97% on air, respiratory rate of 32, and temperature of 40.6°C. The patient's pupils are dilated, and she is sweating.

      Which medication is the patient likely to have overdosed on?

      Your Answer: Cannabis

      Correct Answer: Fluoxetine

      Explanation:

      Serotonergic Toxidrome

      Serotonergic toxidrome, also known as serotonin syndrome, is a condition of drug toxicity that is characterized by extreme temperature, mental agitation and confusion, hypertonia, hyperreflexia, and clonus. This condition is caused by a flooding of the central nervous system with excess serotonin, which can be triggered by various drugs, including antidepressants, opioid analgesics, and certain herbal remedies. Recreational drugs such as cocaine, ecstasy, and amphetamines can also augment serotonin pharmacodynamics and increase the risk of serotonergic toxidrome.

      Deliberate overdosage is a common cause of serotonergic toxidrome, but it can also occur inadvertently, especially in patients taking multiple drugs that affect the metabolism and usage of serotonin. Life-threatening serotonergic toxidrome is a medical emergency that requires admission to the intensive care unit for haemofiltration, intubation, paralysis, and artificial cooling to control the temperature and manage the rhabdomyolysis. Serotonin antagonists such as cyproheptadine may be given, and tachycardia and hypertension can be controlled with intravenous short-acting beta-blockade.

      While other drugs may display some similar features, the serotonergic toxidrome is a relatively specific presentation, typically of rapid onset. Aminophylline, cannabis, diazepam, and paracetamol overdose are unlikely to cause this picture. It is important to screen blood for paracetamol levels in any patient in whom any overdose is suspected, as it is easily treated and can be lethal if missed.

    • This question is part of the following fields:

      • Pharmacology
      0.8
      Seconds
  • Question 16 - A middle-aged homeless alcoholic who frequently attends the Emergency Department is brought by...

    Correct

    • A middle-aged homeless alcoholic who frequently attends the Emergency Department is brought by ambulance, having been found unconscious on the street. He had been examined the previous day with head and facial injuries following a fist fight. Examination on admission reveals an unconscious patient smelling strongly of alcohol. He is rousable with painful stimuli, but confused and unco-operative. His pupils are unequal, with the left pupil measuring approximately 8 mm and the right 4 mm. The left pupil is unreactive to both direct and consensual light stimulus, whereas the right pupil constricts normally to direct and consensual light stimulus.
      Which cranial nerve(s) is this lesion affecting?

      Your Answer: The left oculomotor nerve

      Explanation:

      Assessing the Pupillary Light Reflex and Nerve Lesions

      The pupillary light reflex involves two cranial nerves, the second and third, and their respective pathways. The optic nerve carries visual stimuli to the brain, while the oculomotor nerve controls the constriction of the pupil. Second-order neurons from the optic tract bypass the thalamus and primary visual cortex to reach the midbrain’s pretectal area. From there, neurons pass to the Edinger-Westphal nuclei, which send preganglionic parasympathetic fibers to both oculomotor nerves en route to the ciliary ganglion and sphincter pupillae.

      If a lesion occurs in the left oculomotor nerve, the left pupil will not constrict to light. This can happen due to raised intracranial pressure with a left-sided subdural hematoma, which can impinge on the nerve. However, if the right pupil constricts normally, the right oculomotor nerve and optic nerve must be intact.

      If a lesion occurs in the left optic nerve, the left pupil will not constrict to light, and the right pupil will not constrict to consensual light. This is because the optic nerve relays visual stimuli from the retina to the brain, and both eyes must be intact for the reflex to occur.

      If a combined lesion occurs in the left oculomotor and optic nerves, the left pupil will not constrict to light, and the right pupil will not constrict to consensual light. However, the right pupil will still constrict to direct light, indicating that the optic nerve is intact bilaterally.

    • This question is part of the following fields:

      • Neurology
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  • Question 17 - A 3-year-old child is brought to the paediatric emergency department with symptoms of...

    Incorrect

    • A 3-year-old child is brought to the paediatric emergency department with symptoms of malaise, rash, vomiting and fever. The mother reports that the child has not been eating well for the past day and has been running a low-grade temperature. Additionally, the mother points out a partial thickness burn on the child's arm that has been treated with dressings by their GP. What is the probable diagnosis?

      Your Answer: Meningococcal septicaemia

      Correct Answer: Toxic shock syndrome

      Explanation:

      Differential diagnosis for an unwell child with an unhealed burn

      When a child with an unhealed burn appears acutely unwell, several life-threatening conditions must be considered and ruled out promptly. Among them, toxic shock syndrome and meningococcal septicaemia are particularly concerning and require urgent management in the intensive care unit. Anaphylaxis, although a rare possibility, should also be considered and treated promptly with intramuscular adrenaline. Haemophilus influenzae and Salmonella are less likely causes, as they typically present with respiratory or gastrointestinal symptoms, respectively, which are not evident in this case. A thorough assessment and appropriate interventions are crucial to ensure the best possible outcome for the child.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 18 - Each one of the following statements regarding ADHD is correct, except: ...

    Incorrect

    • Each one of the following statements regarding ADHD is correct, except:

      Your Answer: 75% of children are male

      Correct Answer: The majority of children have normal or increased intelligence

      Explanation:

      Understanding Autism Spectrum Disorder

      Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects social interaction, communication, and behaviour. It is usually diagnosed during early childhood, but symptoms may manifest later. ASD can occur in individuals with any level of intellectual ability, and its manifestations range from subtle problems to severe disabilities. The prevalence of ASD has increased over time due to changes in definitions and increased awareness, with recent estimates suggesting a prevalence of 1-2%. Boys are three to four times more likely to be diagnosed with ASD than girls, and around 50% of children with ASD have an intellectual disability.

      Individuals with ASD may exhibit a broad range of clinical manifestations, including impaired social communication and interaction, repetitive behaviours, interests, and activities, and associated conditions such as attention deficit hyperactivity disorder and epilepsy. Although there is no cure for ASD, early diagnosis and intensive educational and behavioural management can improve outcomes. Treatment involves a comprehensive approach that includes non-pharmacological therapies such as early educational and behavioural interventions, pharmacological interventions for associated conditions, and family support and counselling. The goal of treatment is to increase functional independence and quality of life for individuals with ASD.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 19 - A 60-year-old man has been resuscitated after a cardiac arrest and is now...

    Correct

    • A 60-year-old man has been resuscitated after a cardiac arrest and is now being treated for hypoxic brain injury in the Neuro-Intensive Care Unit. His family is concerned about his prognosis. What is the most reliable source of information regarding his potential outcome?

      Your Answer: Bilaterally absent somatosensory evoked responses (SSEPs) at 24–72 hours

      Explanation:

      Prognostic Indicators for Hypoxic Brain Injury Patients

      Hypoxic brain injury patients require ancillary tests to aid in determining their prognosis. Bilaterally absent somatosensory evoked responses (SSEPs) at 24–72 hours and complete generalised suppression of electroencephalographic (EEG) waves on day three are reliable indicators of poor prognosis. Absent pupillary or corneal reflexes at three days after cardiac arrest, along with the absence of motor response, is also a better prognostic marker. However, in the absence of either one of these factors, the prognosis should be evaluated using results from ancillary tests (SSEP/EEG). Extensor motor response on day three, despite the absence of motor response, is a reliable indicator for poor prognosis. Myoclonic status epilepticus (MSE) – bilateral and synchronous myoclonus of the face, limbs and axial skeleton – has been studied as a reliable marker for poor prognosis in these patients, even in the presence of brainstem and motor responses. However, it should not be considered in isolation as a prognostic indicator. It is important to note that the reliability of these indicators may be affected by factors such as noise interferences, hypothermia, and drugs given during resuscitation.

    • This question is part of the following fields:

      • Anaesthetics & ITU
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  • Question 20 - A 36-year-old man with a known history of severe depression has been in...

    Incorrect

    • A 36-year-old man with a known history of severe depression has been in hospital for the past year. He was diagnosed with depression at the age of 23 and has been on antidepressants since. He has had multiple self-harm and suicide attempts in the past. For the past year, he has been receiving treatment in hospital and has been making some progress with regard to his mental health. He is not happy to be in hospital, but the doctors thought that it was in his best interests to keep him in hospital for treatment. He has been under a Section which allowed him to be kept in hospital for six months. At the end of the first six months, the doctors applied for a second time for him to be kept for another six months, as they feel he is not yet fit for discharge.
      For how long can the relevant Section be renewed for this patient for the third time?

      Your Answer: Three months

      Correct Answer: One year

      Explanation:

      Understanding the Time Limits of Mental Health Detention in the UK

      In the UK, mental health detention is governed by specific time limits depending on the type of detention and the purpose of the detention. Here are some of the key time limits to be aware of:

      – Section 2: This is the Section used for assessment, and a patient can be kept in hospital for a maximum of 28 days under this Section. It cannot be extended.
      – Section 3: This is the Section used for treatment, and a patient can be detained for up to six months initially. The Section can be renewed for another six months, and then for one year at a time. Treatment without consent can be given for the first three months, and then only with the approval of an ‘approved second-opinion doctor’ for the next three months.
      – Two years: While a patient can be kept in hospital for up to two years for treatment, Section 3 cannot be renewed for two years at a time. The patient can also be discharged earlier if the doctor thinks the patient is well enough.
      – Six months: This is the time for which an initial Section 3 can be applied for and the time for which it can be renewed for a second time. For a third time and onwards, Section 3 can be renewed for one year each time, but the patient can be discharged earlier if doctors think it is not necessary for the patient to be under Section anymore.

      Understanding these time limits is important for both patients and healthcare professionals involved in mental health detention in the UK.

    • This question is part of the following fields:

      • Psychiatry
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SESSION STATS - PERFORMANCE PER SPECIALTY

Psychiatry (0/3) 0%
Surgery (1/3) 33%
Musculoskeletal (1/3) 33%
Pharmacology (0/3) 0%
Paediatrics (0/3) 0%
Gynaecology (0/1) 0%
Obstetrics (0/1) 0%
Emergency Medicine (0/1) 0%
Neurology (1/1) 100%
Anaesthetics & ITU (1/1) 100%
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