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  • Question 1 - Which scenario results in a violation of an individual's autonomy? ...

    Correct

    • Which scenario results in a violation of an individual's autonomy?

      Your Answer: An older man whose physician and family coerce him into having foot surgery

      Explanation:

      The Importance of Autonomy in Medical Decision Making

      Autonomy is the principle that individuals have the right to make decisions for themselves and be self-governing. In the context of medical decision making, this means that patients have the right to refuse medical procedures even if it may be in their best interests. It is important for doctors and relatives to respect this right and not coerce the patient into undergoing the procedure.

      While it may be difficult for doctors and relatives to accept a patient’s refusal of a procedure, it is crucial to remember that autonomy is a fundamental principle in medical ethics. Patients have the right to make decisions about their own bodies and healthcare, and it is not up to others to make those decisions for them. It is the responsibility of healthcare providers to provide patients with all the necessary information to make informed decisions about their care.

      In conclusion, autonomy is a vital aspect of medical decision making. Patients have the right to make decisions for themselves, and it is important for healthcare providers to respect and uphold this right. By doing so, patients can feel empowered and in control of their own healthcare, leading to better outcomes and a more positive healthcare experience.

    • This question is part of the following fields:

      • Miscellaneous
      18.4
      Seconds
  • Question 2 - A 29-year-old woman had gone for her regular cervical smear test which was...

    Incorrect

    • A 29-year-old woman had gone for her regular cervical smear test which was carried out without any complications. The GP receives the result of the smear indicating that it was positive for high-risk HPV but there were no signs of cytological abnormalities.

      What would be the most suitable course of action to take next?

      Your Answer: Refer for colposcopy

      Correct Answer: Repeat cervical smear in 12 months

      Explanation:

      If a cervical cancer screening sample is positive for high-risk strains of human papillomavirus (hrHPV) but shows no cytological abnormalities, the recommended course of action is to repeat the smear after 12 months. This is in accordance with current guidance. Colposcopy is not necessary in this case. Repeating the smear after 3 months or waiting 3 years for routine recall are also not appropriate. A repeat smear after 6 months would only be necessary after treatment for cervical intraepithelial neoplasia.

      The cervical cancer screening program has evolved to include HPV testing, which allows for further risk stratification. A negative hrHPV result means a return to normal recall, while a positive result requires cytological examination. Abnormal cytology results lead to colposcopy, while normal cytology results require a repeat test at 12 months. Inadequate samples require a repeat within 3 months, and two consecutive inadequate samples lead to colposcopy. Treatment for CIN typically involves LLETZ or cryotherapy. Individuals who have been treated for CIN should be invited for a test of cure repeat cervical sample 6 months after treatment.

    • This question is part of the following fields:

      • Gynaecology
      42.9
      Seconds
  • Question 3 - A 4-year-old girl visits her GP complaining of a fever and a rash....

    Incorrect

    • A 4-year-old girl visits her GP complaining of a fever and a rash.

      What symptom might indicate the need for the GP to administer IM benzylpenicillin during the appointment?

      Your Answer: Strawberry tongue

      Correct Answer: Coalescent purpura over the arms

      Explanation:

      Common Paediatric Presentations and their Management

      Fever with rash is a common presentation in paediatric patients, with viral infections being the most common cause. However, it is important to rule out meningococcal septicaemia, which can present with purpuric lesions and requires immediate management with IM or IV benzylpenicillin and hospital transfer. The causative agent is Neisseria meningitidis, and the features can be divided into meningitis and septic. Meningitic features include vomiting, neck stiffness, photophobia, Kernig sign, Brudzinski sign, focal neurology, and opisthotonus. Septic features include systemic illness, pyrexia, anorexia, and reduced tone.

      Bilateral pustular eruptions on the fauces indicate bacterial tonsillitis, which is treated with amoxicillin. Measles can present with a maculopapular rash and white oral lesions known as Koplik spots. Varicella zoster virus infection causing chickenpox can present with pruritic vesicular eruptions over the trunk, which is treated symptomatically in immunocompetent children. A strawberry tongue is a sign of oral mucositis and can be found in scarlet fever or Kawasaki disease.

      In summary, fever with rash in paediatric patients can have a wide differential diagnosis, and it is important to consider serious conditions such as meningococcal septicaemia. Proper management and treatment depend on identifying the underlying cause of the presentation.

    • This question is part of the following fields:

      • Paediatrics
      50.8
      Seconds
  • Question 4 - A 30-year-old woman visits her doctor complaining of pharyngitis and is prescribed amoxicillin...

    Incorrect

    • A 30-year-old woman visits her doctor complaining of pharyngitis and is prescribed amoxicillin for a week. She also requests a refill of her oral contraceptive pill, bendroflumethiazide, lansoprazole, and naproxen, which she has been taking for the past nine months due to a skiing injury.

      After three weeks, she returns to the doctor with joint pains and a mild rash. Blood tests reveal a creatinine level of 356 µmol/L and an eosinophilia of 1.7 ×109/L (NR 0-0.4). The doctor refers her to renal services with a suspected diagnosis of tubulointerstitial nephritis.

      Which medication is the most likely cause of her symptoms?

      Your Answer: Naproxen

      Correct Answer: Amoxicillin

      Explanation:

      The most likely cause of tubulointerstitial nephritis in this case is amoxicillin, which can cause acute inflammation of the tubules and interstitium of the kidney. TIN can also be caused by other drugs, infections, and autoimmune disorders. Treatment involves removing the causative agent and using oral steroids to dampen inflammation. Chronic TIN can lead to end stage renal failure. Drug-induced TIN is usually due to hypersensitivity reactions and is characterized by raised IgE levels and eosinophilia.

    • This question is part of the following fields:

      • Nephrology
      68.2
      Seconds
  • Question 5 - Which patient has abnormal blood results that suggest they may have myeloma?

    Patient...

    Correct

    • Which patient has abnormal blood results that suggest they may have myeloma?

      Patient A:
      Adjusted calcium - 2.3 mmol/L
      Phosphate - 0.9 mmol/L
      PTH - 8.09 pmol/L
      Urea - 7.8 mmol/L
      Creatinine - 132 μmol/L
      Albumin - 36 g/L
      Total protein - 77 g/L

      Patient B:
      Adjusted calcium - 2.9 mmol/L
      Phosphate - 0.5 mmol/L
      PTH - 7.2 pmol/L
      Urea - 5 mmol/L
      Creatinine - 140 μmol/L
      Albumin - 38 g/L
      Total protein - 68 g/L

      Patient C:
      Adjusted calcium - 2.8 mmol/L
      Phosphate - 1.2 mmol/L
      PTH - 0.45 pmol/L
      Urea - 7.2 mmol/L
      Creatinine - 150 μmol/L
      Albumin - 28 g/L
      Total protein - 88 g/L

      Patient D:
      Adjusted calcium - 2.5 mmol/L
      Phosphate - 1.6 mmol/L
      PTH - 2.05 pmol/L
      Urea - 32.8 mmol/L
      Creatinine - 190 μmol/L
      Albumin - 40 g/L
      Total protein - 82 g/L

      Patient E:
      Adjusted calcium - 2.2 mmol/L
      Phosphate - 0.7 mmol/L
      PTH - 5.88 pmol/L
      Urea - 4.6 mmol/L
      Creatinine - 81 μmol/L
      Albumin - 18 g/L
      Total protein - 55 g/L

      Your Answer: Patient C

      Explanation:

      Myeloma Diagnosis in Patient C

      Patient C has been diagnosed with myeloma, a type of cancer that affects the plasma cells in the bone marrow. This diagnosis is supported by several indicators, including elevated total protein levels with low albumin and abnormally high globulins. Additionally, the patient has high serum calcium levels and suppressed parathyroid hormone, which are consistent with hypercalcaemia of malignancy. High phosphate levels are also present, which is a common occurrence in haematological malignancies where there is a large amount of cell turnover.

      Furthermore, the patient is experiencing renal impairment, which is typically caused by chronic kidney deterioration due to the deposition of myeloma casts in the nephrons. However, the hypercalcaemia can also cause dehydration, exacerbating the renal impairment. Overall, these indicators point towards a diagnosis of myeloma in Patient C.

    • This question is part of the following fields:

      • Nephrology
      55.3
      Seconds
  • Question 6 - A 70-year-old man is admitted to an acute psychiatric unit with sudden onset...

    Incorrect

    • A 70-year-old man is admitted to an acute psychiatric unit with sudden onset of agitation and psychosis. He has a history of schizophrenia with a fluctuating course. To alleviate his symptoms, he is given a one-time intramuscular injection of 50 mg chlorpromazine. What is the primary pharmacological effect of chlorpromazine in managing psychosis?

      Your Answer: M1 and M2 muscarinic acetylcholine receptor blockade

      Correct Answer: Dopaminergic blockade in the mesolimbic system

      Explanation:

      Chlorpromazine is a typical antipsychotic drug that acts on many neurotransmitter systems, but it’s antipsychotic properties come from its action on dopaminergic neurotransmission in the mesolimbic system. However, blocking dopamine transmission can also cause extrapyramidal side effects of movement and hyperprolactinemia. The drug’s anticholinergic actions cause dry mouth, urinary retention, palpitations, tachycardia, abnormal dreams, and hypotension. Inhibition of serotonergic neurotransmission can attenuate the anticholinergic side effects and inhibit aggressive tendencies and anxiety.

    • This question is part of the following fields:

      • Pharmacology
      32.4
      Seconds
  • Question 7 - A 44-year-old gardener comes to her General Practitioner complaining of pain when kneeling...

    Correct

    • A 44-year-old gardener comes to her General Practitioner complaining of pain when kneeling on her right knee for the past month. She denies any fevers and is generally in good health. During the examination of her right knee, the doctor notices a slightly tender swelling in front of the patella that feels fluctuant. Although the knee is not red, it is warm to the touch, and the patient experiences some discomfort when flexing it. What are the probable results of joint aspiration?

      Your Answer: Clear/milky joint aspirate with normal microscopy and culture

      Explanation:

      Diagnosing Prepatellar Bursitis: Understanding Joint Aspirate Results

      Prepatellar bursitis, also known as housemaid’s knee, is a common condition caused by inflammation of the prepatellar bursa. This can result from repetitive microtrauma, such as prolonged kneeling. Patients typically present with localised, mildly tender swelling over the patella, which can be warm but not hot. Aspiration of the aseptic bursa will reveal a clear and/or milky aspirate that has negative Gram staining and normal microscopy.

      When examining joint aspirate results, it is important to consider other potential diagnoses. Gram-positive cocci, for example, would be grown in the case of Staphylococcus aureus infection, a common cause of septic bursitis. However, in the absence of fever, erythema, and reduced range of motion, septic arthritis is unlikely. Similarly, needle-shaped crystals with strong negative birefringence on polarised light microscopy are seen in gout, but this condition typically presents with acute pain, redness, and inflammation.

      Rhomboid-shaped crystals with weak positive birefringence on polarised light microscopy are seen in pseudogout, which can affect the knee. However, this condition typically affects the entire knee joint and is more common in the elderly.

      In summary, a clear or milky joint aspirate with normal microscopy and culture is consistent with prepatellar bursitis. Other potential diagnoses should be considered based on the patient’s history and examination findings.

    • This question is part of the following fields:

      • Rheumatology
      35.8
      Seconds
  • Question 8 - A 13-year-old girl presented with cystic hygroma and significant oedema. At the age...

    Incorrect

    • A 13-year-old girl presented with cystic hygroma and significant oedema. At the age of 27, she had a short stature, a webbed neck and a broad, shield-like chest. She did not develop secondary sexual characteristics at the appropriate age. What is the most probable diagnosis?

      Your Answer: Klinefelter’s syndrome

      Correct Answer: Turner syndrome

      Explanation:

      Genetic Disorders Affecting Sexual Development

      Turner Syndrome, Congenital Adrenal Hyperplasia, Klinefelter’s Syndrome, Androgen Insensitivity Syndrome, and 5-α Reductase Deficiency are genetic disorders that affect sexual development.

      Turner Syndrome is a condition where a woman is missing a whole or part of an X chromosome. This can cause delayed puberty, failure to develop normal secondary sexual characteristics, and cardiovascular abnormalities.

      Congenital Adrenal Hyperplasia is a group of conditions associated with abnormal enzymes involved in the production of hormones from the adrenals. This can cause ambiguous genitalia at birth and symptoms of polycystic ovary syndrome in women, and hyperpigmentation in men.

      Klinefelter’s Syndrome is a chromosomal aneuploidy where men carry an extra X chromosome. This can cause tall stature, hypogonadism, gynaecomastia, and delayed motor and language development.

      Androgen Insensitivity Syndrome is a condition where patients with a male karyotype fail to respond to androgen hormones and thus develop female external genitalia and characteristics. Treatment involves careful gender assignment and hormone replacement therapy.

      5-α Reductase Deficiency is a condition associated with an inability to convert testosterone to dihydrotestosterone, leading to abnormal sexual development and infertility.

    • This question is part of the following fields:

      • Paediatrics
      40
      Seconds
  • Question 9 - An obese 60-year-old man presents to his General Practitioner (GP) with ongoing vague...

    Correct

    • An obese 60-year-old man presents to his General Practitioner (GP) with ongoing vague abdominal pain and fatigue for the last three months. His past medical history is significant for type 2 diabetes mellitus and hypertension.
      Physical examination suggests hepatomegaly. Laboratory studies reveal a negative hepatitis panel and normal iron studies. Antibodies for autoimmune liver disease are also normal.
      A diagnosis of non-alcoholic fatty liver disease (NAFLD) is likely.
      Which of the following is the most appropriate treatment for this patient?

      Your Answer: Weight loss

      Explanation:

      Management of Hepatomegaly and Non-Alcoholic Fatty Liver Disease (NAFLD)

      Hepatomegaly and non-alcoholic fatty liver disease (NAFLD) are common conditions that require appropriate management to prevent progression to liver cirrhosis and other complications. The following are important considerations in the management of these conditions:

      Diagnosis: Diagnosis of NAFLD involves ruling out other causes of hepatomegaly and demonstrating hepatic steatosis through liver biopsy or radiology.

      Conservative management: Most patients with NAFLD can be managed conservatively with maximized control of cardiovascular risk factors, weight loss, immunizations to hepatitis A and B viruses, and alcohol abstinence. Weight loss in a controlled manner is recommended, with a 10% reduction in body weight over a 6-month period being an appropriate recommendation to patients. Rapid weight loss should be avoided, as it can worsen liver inflammation and fibrosis. Unfortunately, no medications are currently licensed for the management of NAFLD.

      Liver transplant: Patients with NAFLD do not require a liver transplant at this stage. Conservative management with weight loss and controlling cardiovascular risk factors is the recommended approach.

      Oral steroids: Oral steroids are indicated in patients with autoimmune hepatitis. Patients with autoimmune hepatitis typically present with other immune-mediated conditions like pernicious anemia and ulcerative colitis.

      Penicillamine: Penicillamine is the treatment for patients with Wilson’s disease, a rare disorder of copper excretion that leads to excess copper deposition in the liver and brain. Patients typically present with neurological signs like tremor, ataxia, clumsiness, or abdominal signs like fulminant liver failure.

      Ursodeoxycholic acid: Ursodeoxycholic acid is used in the management of primary biliary cholangitis (PBC), a condition more common in women. Given this patient’s normal autoimmune screen, PBC is an unlikely diagnosis.

    • This question is part of the following fields:

      • Gastroenterology
      47
      Seconds
  • Question 10 - A 25-year-old woman with a diagnosis of obsessive-compulsive disorder has been undergoing cognitive...

    Incorrect

    • A 25-year-old woman with a diagnosis of obsessive-compulsive disorder has been undergoing cognitive behavioural therapy and taking fluoxetine, but her symptoms persist. Her doctor decides to prescribe clomipramine, but warns her of potential side effects. What is the most likely side effect she may experience as a result of taking clomipramine?

      Your Answer: Neuroleptic malignant syndrome

      Correct Answer: Dry mouth and weight gain

      Explanation:

      Clomipramine, a TCA, can cause dry mouth due to its anticholinergic effects and weight gain due to its antihistaminic effects. While rare, extrapyramidal side effects and neuroleptic malignant syndrome are also possible but more commonly associated with antipsychotic drugs. Increased urinary frequency and thirst are side effects of lithium, not TCAs. Additionally, mydriasis, not miosis, is a side effect of TCAs.

      Tricyclic Antidepressants for Neuropathic Pain

      Tricyclic antidepressants (TCAs) were once commonly used for depression, but their side-effects and toxicity in overdose have led to a decrease in their use. However, they are still widely used in the treatment of neuropathic pain, where smaller doses are typically required. TCAs such as low-dose amitriptyline are commonly used for the management of neuropathic pain and the prophylaxis of headache, while lofepramine has a lower incidence of toxicity in overdose. It is important to note that some TCAs, such as amitriptyline and dosulepin, are considered more dangerous in overdose than others.

      Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of the QT interval. When choosing a TCA for neuropathic pain, the level of sedation may also be a consideration. Amitriptyline, clomipramine, dosulepin, and trazodone are more sedative, while imipramine, lofepramine, and nortriptyline are less sedative. It is important to work with a healthcare provider to determine the appropriate TCA and dosage for the individual’s specific needs.

    • This question is part of the following fields:

      • Psychiatry
      14.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Miscellaneous (1/1) 100%
Gynaecology (0/1) 0%
Paediatrics (0/2) 0%
Nephrology (1/2) 50%
Pharmacology (0/1) 0%
Rheumatology (1/1) 100%
Gastroenterology (1/1) 100%
Psychiatry (0/1) 0%
Passmed