-
Question 1
Correct
-
A 36-year-old woman is admitted to the hospital for delivery. She has had two previous vaginal deliveries. After three hours, she gives birth to a healthy baby girl with APGAR scores of 9 at 1 minute and 10 at 5 and 10 minutes. However, the newborn appears to be macrosomic, and during delivery, the mother suffers a perineal tear. The midwife calls the doctor to suture the tear and upon examination, they discover an injury to the superficial and deep transverse perineal muscles, involving the external and internal anal sphincters, with mucosal sparing. What degree of injury does she have?
Your Answer: Third-degree
Explanation:The perineal tear in this patient involves the anal sphincter complex, including both the external and internal anal sphincters, which is classified as a third-degree injury. This type of tear is typically caused by the intense pressure and stretching that occurs during childbirth, particularly in first-time mothers or those delivering larger babies, often due to undiagnosed gestational diabetes.
Perineal tears are a common occurrence during childbirth, and the Royal College of Obstetricians and Gynaecologists (RCOG) has developed guidelines to classify them based on their severity. First-degree tears are superficial and do not require any repair, while second-degree tears involve the perineal muscle and require suturing by a midwife or clinician. Third-degree tears involve the anal sphincter complex and require repair in theatre by a trained clinician, with subcategories based on the extent of the tear. Fourth-degree tears involve the anal sphincter complex and rectal mucosa and also require repair in theatre by a trained clinician.
There are several risk factors for perineal tears, including being a first-time mother, having a large baby, experiencing a precipitant labour, and having a shoulder dystocia or forceps delivery. It is important for healthcare providers to be aware of these risk factors and to provide appropriate care and management during childbirth to minimize the risk of perineal tears. By following the RCOG guidelines and providing timely and effective treatment, healthcare providers can help ensure the best possible outcomes for both mother and baby.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 2
Correct
-
A 20-year-old female comes to the clinic complaining of secondary amenorrhoea that has been going on for four months. She has also lost around 8 kg during this time and currently has a BMI of 17.4 kg/m2. What is the most probable diagnosis for her condition?
Your Answer: Anorexia nervosa
Explanation:Anorexia as a Cause of Secondary Amenorrhoea
This young woman is experiencing secondary amenorrhoea, which is the absence of menstrual periods for at least three months after previously having regular cycles. Her low BMI and weight loss suggest that anorexia is the most likely cause of her amenorrhoea. Anorexia is an eating disorder characterized by a distorted body image and an intense fear of gaining weight, leading to severe calorie restriction and weight loss.
In this case, the anorexia has likely caused a hypogonadotropic hypogonadism, which is a condition where the pituitary gland fails to produce enough hormones to stimulate the ovaries to produce estrogen. This hormonal imbalance can lead to a range of symptoms, including amenorrhoea, infertility, and osteoporosis.
It is important to address the underlying cause of secondary amenorrhoea, as it can have long-term health consequences. Treatment for anorexia may involve a combination of therapy, nutritional counseling, and medication. Once the underlying cause is addressed, menstrual cycles may resume, but it may take several months for regular cycles to return.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 3
Correct
-
A 50-year-old woman comes to see her GP for a follow-up on her Dupuytren's contracture. She has been experiencing more difficulty lately with her job, which involves a lot of typing. Despite taking Naproxen, she has not found much relief. During the examination, the GP observes that the metacarpophalangeal joints on her right hand's little finger and ring finger are bent forward by 30 degrees, and she is unable to place her hand flat on the table. What should be the GP's next appropriate step in managing her condition?
Your Answer: Make a routine referral to orthopaedics to be seen by a hand specialist
Explanation:When a patient with Dupuytren’s contracture is unable to straighten their metacarpophalangeal joints and place their hand flat on a table, surgical treatment should be considered. This condition occurs when the palmar fascia becomes stiff and fibroses, causing the affected fingers to contract, typically the ring and little finger of the right hand.
The severity of the condition will determine the appropriate management approach. In cases where the condition is severe and impacting the patient’s quality of life, referral to a hand specialist for secondary intervention is recommended. This may involve either surgical intervention or injectable enzyme therapy, which should only be initiated by a specialist.
For minor cases where the condition is not significantly affecting the patient’s quality of life, primary care management may be appropriate. This will involve reassurance that the condition may improve over time, regular reviews, and advice on when to return for referral if necessary.
It is important to note that corticosteroid injections are not effective in treating Dupuytren’s contracture. Additionally, as this is not an acute problem, patients should not be advised to attend the emergency department.
Understanding Dupuytren’s Contracture
Dupuytren’s contracture is a condition that affects about 5% of the population. It is more common in older men and those with a family history of the condition. The causes of Dupuytren’s contracture include manual labor, phenytoin treatment, alcoholic liver disease, diabetes mellitus, and trauma to the hand.
The condition typically affects the ring finger and little finger, causing them to become bent and difficult to straighten. In severe cases, the hand may not be able to be placed flat on a table.
Surgical treatment may be necessary when the metacarpophalangeal joints cannot be straightened.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 4
Incorrect
-
An 80-year-old man presents with complaints of stiffness and pain in both shoulders. He has experienced a weight loss of one stone over the past eight weeks and reports feeling lethargic with a decreased appetite. Upon investigation, a positive rheumatoid factor, normochromic normocytic anaemia, and a significantly elevated ESR (100 mm/hr) were found. What is the most probable diagnosis?
Your Answer: Polymyositis
Correct Answer: Polymyalgia rheumatica
Explanation:Polymyalgia rheumatica is an inflammatory disease that causes pain and stiffness in the shoulder and pelvic girdle muscles, along with systemic symptoms such as fever and weight loss. It is often associated with giant cell arthritis. Diagnosis can be difficult, but response to a moderate dose of steroids is a useful indicator. Non-steroidal anti-inflammatories are not recommended. Other inflammatory conditions should be excluded, such as rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and polyarteritis nodosa.
-
This question is part of the following fields:
- Rheumatology
-
-
Question 5
Incorrect
-
A 30-year-old man presents to the A&E with a painful shoulder injury he sustained while playing basketball. Upon examination, you discover an anterior dislocation of his right shoulder. What pre- and post-relocation test must you perform?
Your Answer: Examine radial nerve function in the affected arm
Correct Answer: Examine axillary nerve function in the affected arm
Explanation:Assessing Vascular and Nerve Injury in Anterior Shoulder Dislocation: Important Tests to Consider
When examining a patient with anterior shoulder dislocation, it is crucial to assess for vascular and nerve injury in the affected arm. One way to test nerve function is by assessing sensation in the regimental patch area over the deltoid muscle. An X-ray before and after relocation is necessary to check for fractures and confirm successful reduction. If there is vascular injury, it will be evident from the examination of the limb, and urgent referral to surgeons is required. Checking the brachial pulse is acceptable to assess for vascular injury, and examining axillary nerve function before and after relocation is mandatory. Ultrasound of the affected limb may be helpful in identifying soft tissue injuries, but it is not as crucial as the other tests mentioned. Overall, a thorough assessment of vascular and nerve function is essential in managing anterior shoulder dislocation.
-
This question is part of the following fields:
- Orthopaedics
-
-
Question 6
Correct
-
You are interested in determining whether seatbelt use has an impact on the severity of injuries incurred following a motor vehicle accident among elderly individuals. You approach a doctor in the Geriatric Department, and he suggests you design a study.
Which of the following study designs would be most appropriate?Your Answer: Case-control study
Explanation:Choosing the Right Study Design for Assessing Seatbelt Use and Motor Vehicle Accidents
When it comes to studying the relationship between seatbelt use and the severity of injuries in motor vehicle accidents, choosing the right study design is crucial. While each design has its strengths and weaknesses, some are more appropriate than others for this particular research question.
Case-control studies are the most suitable for assessing factors associated with rare events, such as motor vehicle accidents. They can quickly and cost-effectively determine if seatbelt use affects injury severity.
Cross-sectional studies, on the other hand, are descriptive and cannot accurately determine associations. Cohort studies may be able to answer the question, but they require a significant amount of time and expense due to their prospective nature. Randomised controlled trials are not appropriate for this research question as it would be unethical to expose participants to something dangerous like a motor vehicle collision.
Finally, case series can provide a starting point for other study designs but are most useful for identifying possible relationships that must be explored in a more rigorous manner. In conclusion, a case-control study is the most appropriate study design for assessing the relationship between seatbelt use and the severity of injuries in motor vehicle accidents.
-
This question is part of the following fields:
- Statistics
-
-
Question 7
Incorrect
-
A 35-year-old female patient comes to the clinic for follow-up. She has been diagnosed with severe endometriosis and has not responded well to previous treatments. You decide to initiate therapy with an intranasal GnRH analogue. What is the correct representation of the long-term mechanism of action of GnRH analogues in the management of endometriosis?
Your Answer: Decreased production of male sex steroids
Correct Answer: Decreased production of female sex steroids
Explanation:How GnRH Analogues Work to Treat Endometriosis
GnRH analogues are a type of medication used to treat endometriosis. When given as a single dose, they stimulate the release of LH and FSH, which in turn increases the production of ovarian and testicular hormones. However, with repeated dosing, the body’s response to the medication gradually decreases. After three to four weeks of daily administration, the pituitary gland secretes fewer gonadotrophins or gonadotrophins with lower biological activity. This leads to a suppression of gonadal hormone production and a reduction in the symptoms of endometriosis. Overall, GnRH analogues work by suppressing the body’s natural hormone production, which can help alleviate the pain and discomfort associated with endometriosis.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 8
Correct
-
A 16-year-old Ethiopian girl has come to the emergency department complaining of recurring urinary tract infections. During the examination, you and a chaperone observe that the girl may have undergone clitoridectomy, indicating that she may have been a victim of female genital mutilation (FGM). The girl requests antibiotics and that no one else be informed. In addition to treating the infection, what actions should you take?
Your Answer: Inform the medical team and the police
Explanation:The UK Government implemented legal modifications in October 2015 regarding the response of doctors in England and Wales to instances of female genital mutilation (FGM). As per the guidelines of the General Medical Council (GMC), doctors are required to report all cases of FGM in individuals under the age of 18 to the police. This can be done by contacting 101 or using the established local channels. Reporting is compulsory to align with our responsibilities towards child protection and safeguarding.
Understanding Female Genital Mutilation
Female genital mutilation (FGM) is a term used to describe any procedure that involves the partial or complete removal of the external female genitalia or any other injury to the female genital organs for non-medical reasons. The World Health Organization (WHO) has classified FGM into four types. Type 1 involves the partial or total removal of the clitoris and/or the prepuce, while type 2 involves the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Type 3 involves the narrowing of the vaginal orifice with the creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris. Finally, type 4 includes all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, and cauterization. It is important to understand the different types of FGM to raise awareness and prevent this harmful practice.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 9
Incorrect
-
A 32-year-old man is brought to the Emergency Department by air ambulance after being involved in a road traffic accident. According to witnesses this was a high-impact car crash and the other passenger in the car has unfortunately already passed away. The man is unconscious when he arrives, and initial assessment reveals a Glasgow Coma Scale (GCS) score of 9. He has some minor facial injuries and is bleeding from his nose.
What is the appropriate initial management for traumatic brain injury in this case?Your Answer: Head-up tilt to 15 degrees
Correct Answer: Maintain pCO2 4.5 kPa
Explanation:Management of Traumatic Brain Injury: Key Considerations
Traumatic brain injury (TBI) is a serious condition that requires prompt and appropriate management to prevent secondary injury and improve outcomes. Here are some key considerations for managing TBI:
Maintain pCO2 4.5 kPa: Sedation and ventilation should be used to maintain a pCO2 of 4.5 kPa to protect the brain. Adequate oxygenation is also essential.
Permissive hypotension: Hypotension should be treated aggressively to prevent secondary ischaemic injury. Mean arterial pressure should be maintained >75 mmHg.
Intubation if GCS falls below 6: Patients with a GCS score below 8 should be intubated to maintain their airway. Spinal immobilisation is also essential.
Head-up tilt to 30 degrees: Head-up tilt to 30 degrees is an accepted measure to minimise rises in intracranial pressure in patients with TBI. Care should be taken if the patient has a cervical spine injury.
Fluid resuscitation with saline: Initial fluid resuscitation should be with a crystalloid, such as normal saline, and/or blood. Albumin should be avoided.
By following these key considerations, healthcare professionals can effectively manage TBI and improve patient outcomes.
-
This question is part of the following fields:
- Neurology
-
-
Question 10
Correct
-
A 85-year-old woman with a history of dementia is discovered on the floor of her nursing home. She is taken to the Emergency Department and reports experiencing pain in her left hip and is unable to put weight on it. X-rays of the hip and pelvis show no abnormalities. Despite receiving sufficient pain relief, she continues to complain of severe hip pain and remains unable to bear weight. What is the most suitable course of action to take next?
Your Answer: MRI Hip
Explanation:When a patient presents with clinical symptoms of a hip fracture, it is necessary to conduct further imaging. Repeating plain films is unlikely to yield any new information. While radioisotope bone scans can detect areas of high bone turnover and osteoblastic activity, they are not very sensitive. Although CT scans are widely available, the recommended first line investigation for occult hip fractures is an MRI, as per NICE guidelines.
Hip fractures are a common occurrence, particularly in elderly women with osteoporosis. The femoral head’s blood supply runs up the neck, making avascular necrosis a potential risk in displaced fractures. Symptoms of a hip fracture include pain and a shortened and externally rotated leg. Patients with non-displaced or incomplete neck of femur fractures may still be able to bear weight. Hip fractures can be classified as intracapsular or extracapsular, with the Garden system being a commonly used classification system. Blood supply disruption is most common in Types III and IV fractures.
Intracapsular hip fractures can be treated with internal fixation or hemiarthroplasty if the patient is unfit. Displaced fractures are recommended for replacement arthroplasty, such as total hip replacement or hemiarthroplasty, according to NICE guidelines. Total hip replacement is preferred over hemiarthroplasty if the patient was able to walk independently outdoors with the use of a stick, is not cognitively impaired, and is medically fit for anesthesia and the procedure. Extracapsular hip fractures can be managed with a dynamic hip screw for stable intertrochanteric fractures or an intramedullary device for reverse oblique, transverse, or subtrochanteric fractures.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 11
Correct
-
A 35-year-old man comes to you seeking advice. He had a splenectomy ten years ago after a cycling accident and has been in good health since. However, a friend recently told him that he should be receiving treatment for his splenectomy. He is currently not taking any medication.
What would you recommend to him?Your Answer: Pneumococcal vaccination
Explanation:Asplenic Patients and the Importance of Vaccination
Asplenic patients are individuals who have had their spleen removed, leaving them at risk of overwhelming bacterial infections, particularly from pneumococcus and meningococcus. To prevent such infections, it is recommended that these patients receive the Pneumovax vaccine two weeks before surgery or immediately after emergency surgery. This vaccine should be repeated every five years. Additionally, influenzae vaccination is also recommended to prevent super added bacterial infections.
While oral penicillin is recommended for children, its long-term use in adults is a topic of debate. However, current guidance suggests that splenectomized patients should receive both antibiotic prophylaxis and appropriate immunization. It is crucial to take these preventative measures to protect asplenic patients from potentially life-threatening infections.
-
This question is part of the following fields:
- Haematology
-
-
Question 12
Correct
-
A 17-year-old girl presents with amenorrhoea for 6 months. She has a history of irregular periods with a cycle ranging from 25-39 days long and has missed a whole cycle before. She is concerned about the potential impact on her future fertility. The patient denies being sexually active and has no syndromic features on examination. There is no significant acne or excess body hair. She has a BMI of 20 kg/m² and is currently training for a half marathon. What is the probable cause of her condition?
Your Answer: Hypothalamic hypogonadism
Explanation:Secondary amenorrhoea is a common issue in highly athletic women, often caused by hypothalamic hypogonadism. This is the case for a young woman who is training for a marathon and has experienced oligomenorrhoea in the past. When a woman’s body has low levels of fat, the hypothalamus releases less gonadotrophin-releasing hormone, leading to hypogonadism. This is believed to occur because very low-fat levels are not conducive to successful pregnancy in females.
While an ultrasound may reveal many cysts on the ovaries, this woman does not meet the Rotterdam criteria for a diagnosis of polycystic ovary syndrome (PCOS). Although she experiences oligomenorrhoea, she does not exhibit signs of hyperandrogenism and has a lower-normal weight. It is also possible that she is pregnant, and a urine or serum pregnancy test should be conducted to rule out this possibility, even if she claims not to be sexually active.
While primary ovarian failure is a potential cause, it is not the most likely explanation in this case. However, it should still be investigated with gonadotrophins. If ovarian failure is present, gonadotrophin levels will be elevated, indicating that the hypothalamus and pituitary gland are not providing negative feedback on hormone release.
Understanding Amenorrhoea: Causes, Investigations, and Management
Amenorrhoea is a condition characterized by the absence of menstrual periods in women. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls without secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.
There are various causes of amenorrhoea, including gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, Sheehan’s syndrome, Asherman’s syndrome, and thyrotoxicosis. To determine the underlying cause of amenorrhoea, initial investigations such as full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels are necessary.
The management of amenorrhoea depends on the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause in women 40 years of age or older and treat the underlying cause accordingly. It is important to note that hypothyroidism may also cause amenorrhoea.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 13
Correct
-
John is an 80-year-old man who has come in with stiffness and pain in both shoulders. His doctor suspects PMR and orders some blood tests.
ESR - erythrocyte sedimentation rate
CRP - C-reactive protein
Anti-ccp - anti-cyclic citrullinated peptide
CK - creatine kinase
Which of the following results would be most indicative of PMR in John?Your Answer: ESR ↑ , CRP ↑, anti-CCP normal, CK normal
Explanation:Polymyalgia rheumatica typically presents with normal levels of creatine kinase, while patients are likely to have elevated ESR and CRP at the time of diagnosis. Unlike polymyositis, which is more commonly associated with muscle weakness, PMR does not cause an increase in CK levels. Additionally, a raised anti-CCP is typically indicative of rheumatoid arthritis.
Polymyalgia Rheumatica: A Condition of Muscle Stiffness in Older People
Polymyalgia rheumatica (PMR) is a common condition that affects older people. It is characterized by muscle stiffness and elevated inflammatory markers. Although it is closely related to temporal arthritis, the underlying cause is not fully understood, and it does not appear to be a vasculitic process. PMR typically affects patients over the age of 60 and has a rapid onset, usually within a month. Patients experience aching and morning stiffness in proximal limb muscles, along with mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, and night sweats.
To diagnose PMR, doctors look for raised inflammatory markers, such as an ESR of over 40 mm/hr. Creatine kinase and EMG are normal. Treatment for PMR involves prednisolone, usually at a dose of 15 mg/od. Patients typically respond dramatically to steroids, and failure to do so should prompt consideration of an alternative diagnosis.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 14
Incorrect
-
A 50-year-old woman comes to the clinic complaining of heavy and prolonged menstrual bleeding that has been ongoing for six months, despite being treated with mefenamic and tranexamic acid. Upon conducting a transvaginal ultrasound, an endometrial thickness of 15mm is observed. What would be the next appropriate course of investigation?
Your Answer: Endometrial ablation
Correct Answer: Endometrial biopsy at hysteroscopy
Explanation:According to NICE guidelines, an endometrial biopsy should be performed if necessary to rule out endometrial cancer or atypical hyperplasia. The biopsy is recommended for women who experience persistent intermenstrual bleeding and for those aged 45 and above who have had unsuccessful or ineffective treatment. In the case of the patient mentioned above, her treatment has not been successful and she has a thickened endometrium. Although there is some debate about the thickness of the endometrium in premenopausal women, this patient qualifies for a biopsy based on her failed medical treatment alone, making it the most appropriate option.
Endometrial cancer is a type of cancer that is commonly found in women who have gone through menopause, but it can also occur in around 25% of cases before menopause. The prognosis for this type of cancer is usually good due to early detection. There are several risk factors associated with endometrial cancer, including obesity, nulliparity, early menarche, late menopause, unopposed estrogen, diabetes mellitus, tamoxifen, polycystic ovarian syndrome, and hereditary non-polyposis colorectal carcinoma. Postmenopausal bleeding is the most common symptom of endometrial cancer, which is usually slight and intermittent initially before becoming more heavy. Pain is not common and typically signifies extensive disease, while vaginal discharge is unusual.
When investigating endometrial cancer, women who are 55 years or older and present with postmenopausal bleeding should be referred using the suspected cancer pathway. The first-line investigation is trans-vaginal ultrasound, which has a high negative predictive value for a normal endometrial thickness (< 4 mm). Hysteroscopy with endometrial biopsy is also commonly used for investigation. The management of localized disease involves total abdominal hysterectomy with bilateral salpingo-oophorectomy, while patients with high-risk disease may have postoperative radiotherapy. progesterone therapy is sometimes used in frail elderly women who are not considered suitable for surgery. It is important to note that the combined oral contraceptive pill and smoking are protective against endometrial cancer.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 15
Correct
-
As a junior doctor in the emergency department, you are asked by a senior doctor to examine a child with a persistent cough. However, they caution you against examining the child's throat as it may lead to airway obstruction. What could be the possible diagnosis for this case?
Your Answer: Croup
Explanation:It is not recommended to conduct a throat examination on a patient with croup as it may lead to airway obstruction. This risk is higher in cases of acute epiglottitis, which is a less common condition. However, for the other conditions, throat examination is not contraindicated.
Understanding Croup: A Respiratory Infection in Infants and Toddlers
Croup is a type of upper respiratory tract infection that commonly affects infants and toddlers. It is characterized by a barking cough, fever, and coryzal symptoms, and is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses are the most common cause of croup. The condition typically peaks between 6 months and 3 years of age, and is more prevalent during the autumn season.
The severity of croup can be graded based on the presence of symptoms such as stridor, cough, and respiratory distress. Mild cases may only have occasional barking cough and no audible stridor at rest, while severe cases may have frequent barking cough, prominent inspiratory stridor at rest, and marked sternal wall retractions. Children with moderate or severe croup, those under 6 months of age, or those with known upper airway abnormalities should be admitted to the hospital.
Diagnosis of croup is usually made based on clinical presentation, but a chest x-ray may show subglottic narrowing, commonly referred to as the steeple sign. Treatment for croup typically involves a single dose of oral dexamethasone or prednisolone, regardless of severity. In emergency situations, high-flow oxygen and nebulized adrenaline may be necessary.
Understanding croup is important for parents and healthcare providers alike, as prompt recognition and treatment can help prevent complications and improve outcomes for affected children.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 16
Incorrect
-
Which statement accurately describes the null hypothesis in a randomized controlled trial comparing drug A to placebo for low back pain treatment?
Your Answer: If p>0.05 we reject the null hypothesis
Correct Answer: The null hypothesis is assumed to be correct until proven otherwise
Explanation:The Glasgow coma scale is a widely used tool to assess the severity of brain injuries. It is scored between 3 and 15, with 3 being the worst and 15 the best. The scale comprises three parameters: best eye response, best verbal response, and best motor response. The verbal response is scored from 1 to 5, with 1 indicating no response and 5 indicating orientation.
A score of 13 or higher on the Glasgow coma scale indicates a mild brain injury, while a score of 9 to 12 indicates a moderate injury. A score of 8 or less indicates a severe brain injury. Healthcare professionals rely on the Glasgow coma scale to assess the severity of brain injuries and determine appropriate treatment. The score is the sum of the scores as well as the individual elements. For example, a score of 10 might be expressed as GCS10 = E3V4M3.
Best eye response:
1- No eye opening
2- Eye opening to pain
3- Eye opening to sound
4- Eyes open spontaneouslyBest verbal response:
1- No verbal response
2- Incomprehensible sounds
3- Inappropriate words
4- Confused
5- OrientatedBest motor response:
1- No motor response.
2- Abnormal extension to pain
3- Abnormal flexion to pain
4- Withdrawal from pain
5- Localizing pain
6- Obeys commands -
This question is part of the following fields:
- Clinical Sciences
-
-
Question 17
Incorrect
-
A 27-year-old female patient complains of pain and swelling in her hand joints that have persisted for the past four months. She reports experiencing stiffness in her joints in the morning, which lasts for about an hour. The patient denies any pain or swelling in her elbows, ankles, or knees.
During the physical examination, the doctor observes swelling and tenderness in the second and third metacarpophalangeal (MCP) joints of both hands. Laboratory tests reveal an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.
Which investigation has NICE recommended to be performed on all patients with similar symptoms?Your Answer: Anti-neutrophil cytoplasmic antibody (ANCA)
Correct Answer: X-ray of hands and feet
Explanation:The patient’s symptoms suggest rheumatoid arthritis, and according to NICE guidelines, x-rays of the hands and feet should be performed for all suspected cases. Additionally, tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) should be conducted. The presence of anti-neutrophil cytoplasmic antibody (ANCA) is more indicative of vasculitic syndromes, which this patient does not exhibit. Antinuclear antibody (ANA) testing is typically reserved for suspected cases of systemic lupus erythematosus (SLE) and should not be routinely performed for rheumatoid arthritis. Serum uric acid monitoring is more relevant for gout diagnosis.
Rheumatoid arthritis is a condition that can be diagnosed through initial investigations, including antibody tests and x-rays. One of the first tests recommended is the rheumatoid factor (RF) test, which detects a circulating antibody that reacts with the patient’s own IgG. This test can be done through the Rose-Waaler test or the latex agglutination test, with the former being more specific. A positive RF result is found in 70-80% of patients with rheumatoid arthritis, and high levels are associated with severe progressive disease. However, it is not a marker of disease activity. Other conditions that may have a positive RF result include Felty’s syndrome, Sjogren’s syndrome, infective endocarditis, SLE, systemic sclerosis, and the general population.
Another antibody test that can aid in the diagnosis of rheumatoid arthritis is the anti-cyclic citrullinated peptide antibody test. This test can detect the antibody up to 10 years before the development of rheumatoid arthritis and has a sensitivity similar to RF (around 70%) but a much higher specificity of 90-95%. NICE recommends that patients with suspected rheumatoid arthritis who are RF negative should be tested for anti-CCP antibodies.
In addition to antibody tests, x-rays of the hands and feet are also recommended for all patients with suspected rheumatoid arthritis. These x-rays can help detect joint damage and deformities, which are common in rheumatoid arthritis. Early detection and treatment of rheumatoid arthritis can help prevent further joint damage and improve overall quality of life for patients.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 18
Incorrect
-
A 49-year-old woman comes to the clinic complaining of irregular periods, hot flashes, and night sweats. She has had two uncomplicated pregnancies in the past and has been using a Mirena coil for the last five years. She is interested in exploring hormone replacement therapy (HRT) as a treatment option. Her mother had a history of DVT in her 40s. Based on her medical history, what would be the most suitable course of action?
Your Answer: Transdermal oestrogen
Correct Answer: Combined transdermal HRT
Explanation:For women who are at risk of venous thromboembolism, transdermal HRT is the recommended option. This is because it does not increase the risk of developing DVT, unlike oral preparations. In the case of a patient with a Mirena coil, a combined transdermal HRT would be offered, as she requires a progesterone component. However, the patient’s Mirena is not licensed for use in HRT as it has been in place for 5 years, exceeding the licensed duration of 4 years. Therefore, she needs to switch to an oestrogen-only transdermal preparation after the Mirena is replaced. Oral HRT or oral oestrogen would not be recommended as they carry a risk of causing DVT. HRT is not contraindicated in this case. While transdermal oestrogen has no increased risk of DVT, it cannot be used alone in this patient due to the need for combined oestrogen and progesterone.
Hormone replacement therapy (HRT) involves a small dose of oestrogen and progesterone to alleviate menopausal symptoms. The indications for HRT have changed due to the long-term risks, and it is primarily used for vasomotor symptoms and preventing osteoporosis in younger women. HRT consists of natural oestrogens and synthetic progestogens, and can be taken orally or transdermally. Transdermal is preferred for women at risk of venous thromboembolism.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 19
Correct
-
A 5-year-old girl is brought to the pediatrician by her father who reports a 'barking' cough that has occurred a few times daily for the past two days. The child's appetite and behavior remain unchanged. Upon examination, the pediatrician finds no abnormalities. What is the recommended first-line treatment for mild croup?
Your Answer: Oral dexamethasone
Explanation:Regardless of severity, a single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately for mild croup, which is characterized by a barking cough and the absence of stridor or systemic symptoms.
Understanding Croup: A Respiratory Infection in Infants and Toddlers
Croup is a type of upper respiratory tract infection that commonly affects infants and toddlers. It is characterized by a barking cough, fever, and coryzal symptoms, and is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses are the most common cause of croup. The condition typically peaks between 6 months and 3 years of age, and is more prevalent during the autumn season.
The severity of croup can be graded based on the presence of symptoms such as stridor, cough, and respiratory distress. Mild cases may only have occasional barking cough and no audible stridor at rest, while severe cases may have frequent barking cough, prominent inspiratory stridor at rest, and marked sternal wall retractions. Children with moderate or severe croup, those under 6 months of age, or those with known upper airway abnormalities should be admitted to the hospital.
Diagnosis of croup is usually made based on clinical presentation, but a chest x-ray may show subglottic narrowing, commonly referred to as the steeple sign. Treatment for croup typically involves a single dose of oral dexamethasone or prednisolone, regardless of severity. In emergency situations, high-flow oxygen and nebulized adrenaline may be necessary.
Understanding croup is important for parents and healthcare providers alike, as prompt recognition and treatment can help prevent complications and improve outcomes for affected children.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 20
Correct
-
A 56-year-old woman with a 28-year history of psoriasis presents to the Dermatologist. Despite treatment with ciclosporin, she has multiple patches on her arms, legs and scalp, which affect her sleep and work. The Dermatologist decides to initiate biological therapy with a TNF-alpha inhibitor. The patient has a past medical history of inactive tuberculosis.
Which TNF-alpha inhibitor is the Dermatologist likely to prescribe for the patient's severe psoriasis?Your Answer: Adalimumab
Explanation:Biological Agents for the Treatment of Psoriasis
Psoriasis is a chronic autoimmune disease that affects the skin and joints. Biological agents have revolutionized the treatment of psoriasis by targeting specific molecules involved in the immune response. Here are some commonly used biological agents for the treatment of psoriasis:
Adalimumab: This agent targets tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in systemic inflammation. Adalimumab is used when other systemic treatments have failed and the disease is severe.
Brodalumab: This agent targets the interleukin 17 receptor found on CD8+ cytotoxic T cells. It is used when methotrexate or ciclosporin have failed.
Infliximab: This agent is also a TNF-alpha inhibitor, but it has been shown to reactivate latent tuberculosis. Therefore, it should be used with caution in patients with a history of tuberculosis.
Guselkumab: This agent targets interleukin 23, which is involved in the activation of T17 lymphocytes. It is used in the treatment of moderate to severe psoriasis.
Secukinumab: This agent targets interleukin 17, which is found on CD8+ cytotoxic T cells. It is used in the treatment of moderate to severe psoriasis.
Before starting any of these agents, certain criteria must be met, such as failure of other treatments and severity of the disease. Additionally, some agents may be contraindicated in patients with certain medical histories, such as a history of tuberculosis.
-
This question is part of the following fields:
- Dermatology
-
-
Question 21
Incorrect
-
A 23-year-old man presents to his GP with complaints of redness and itching on his face and hands. He has been to another GP for similar issues in the past two years and has been on sick leave from his job as a builder. He is currently receiving benefits and is in the process of making an insurance claim for loss of earnings. He mentions that there was one ointment that worked for him, but he has not been able to find it again. On examination, there are no visible skin lesions or rash. The patient appears unconcerned and requests that his GP sign his insurance claim paperwork. What is the most likely diagnosis?
Your Answer: Munchausen syndrome
Correct Answer: Malingering
Explanation:Somatoform Disorders, Malingering, and Munchausen’s Syndrome
Somatoform disorders are characterized by the unconscious drive to produce illness and the motivation to seek medical attention. On the other hand, malingering involves a conscious effort to fake or claim a disorder for personal gain, such as financial compensation. Meanwhile, Munchausen’s syndrome is a chronic condition where patients have a history of multiple hospital admissions and are willing to undergo invasive procedures.
In somatoform disorders, patients are not intentionally faking their symptoms. Instead, their unconscious mind is producing physical symptoms as a way to cope with psychological distress. This can lead to a cycle of seeking medical attention and undergoing unnecessary tests and procedures. In contrast, malingering is a deliberate attempt to deceive medical professionals for personal gain. Patients may exaggerate or fabricate symptoms to receive compensation or avoid legal consequences.
Munchausen’s syndrome is a rare condition where patients repeatedly seek medical attention and undergo invasive procedures despite having no actual medical condition. This behavior is driven by a desire for attention and sympathy from medical professionals. Patients with Munchausen’s syndrome may go to great lengths to maintain their deception, including intentionally harming themselves to produce symptoms.
In summary, somatoform disorders, malingering, and Munchausen’s syndrome are all conditions that involve the production or faking of physical symptoms. However, the motivations behind these behaviors differ. these conditions can help medical professionals provide appropriate care and support for patients.
-
This question is part of the following fields:
- Dermatology
-
-
Question 22
Correct
-
A 55-year-old woman presents at the clinic for evaluation. She has not experienced menstrual periods for the past six months and has taken two pregnancy tests, both of which were negative. Upon clinical examination, no abnormalities were found. The patient desires a blood test to determine if she has entered menopause. What is the most sensitive hormone to test for this purpose?
Your Answer: FSH
Explanation:Hormone Levels and Menopausal Status
Follicle-stimulating hormone (FSH) levels that are greater than 30 IU/l, repeated over a period of four to eight weeks, are typically indicative of menopause. It is important to ensure that FSH is tested when the patient is not on contraception, although this is not relevant in the current scenario. While oestrogen and progesterone levels decrease after menopause, their assay is less reliable in determining menopausal status compared to FSH levels. Beta-HCG levels are elevated during pregnancy and trophoblastic disease, while prolactin levels increase in response to certain drug therapies and the presence of a pituitary tumour.
-
This question is part of the following fields:
- Haematology
-
-
Question 23
Incorrect
-
A 56-year-old man arrives at the emergency department after sustaining a head injury. He tripped over a rake in his backyard and hit his head on a tree trunk about an hour ago. He vomited once immediately after the incident and again on his way to the hospital. He has no other symptoms and is not taking any medication.
Upon examination, he is responsive and spontaneously opens his eyes. He has normal limb movement. His pupils are equal and react to light. There are no visible external injuries.
What is the most appropriate course of action for imaging?Your Answer: Contrast CT head within 8 hours
Correct Answer: Non-contrast CT head within 1 hour
Explanation:If a patient experiences more than one episode of vomiting following a head injury, a non-contrast CT head should be performed within 1 hour according to NICE guidelines. A contrast CT head within 1 hour or within 8 hours is not necessary, as non-contrast CT is typically preferred for head injuries. It is also incorrect to assume that no imaging is required, as two episodes of vomiting indicate the need for a CT head within 1 hour.
NICE Guidelines for Investigating Head Injuries in Adults
Head injuries can be serious and require prompt medical attention. The National Institute for Health and Care Excellence (NICE) has provided clear guidelines for healthcare professionals to determine which adult patients need further investigation with a CT head scan. Patients who require immediate CT head scans include those with a Glasgow Coma Scale (GCS) score of less than 13 on initial assessment, suspected open or depressed skull fractures, signs of basal skull fractures, post-traumatic seizures, focal neurological deficits, and more than one episode of vomiting.
For patients with any loss of consciousness or amnesia since the injury, a CT head scan within 8 hours is recommended for those who are 65 years or older, have a history of bleeding or clotting disorders, experienced a dangerous mechanism of injury, or have more than 30 minutes of retrograde amnesia of events immediately before the head injury. Additionally, patients on warfarin who have sustained a head injury without other indications for a CT head scan should also receive a scan within 8 hours of the injury.
It is important for healthcare professionals to follow these guidelines to ensure that patients receive appropriate and timely care for their head injuries. By identifying those who require further investigation, healthcare professionals can provide the necessary treatment and support to prevent further complications and improve patient outcomes.
-
This question is part of the following fields:
- Surgery
-
-
Question 24
Incorrect
-
A 28-year-old woman reports difficulty swallowing both solids and liquids, with occasional food getting stuck and needing to be washed down with a large drink. Achalasia of the oesophagus is suspected. Which nerve supplies the muscularis externa of the oesophagus?
Your Answer: Greater splanchnic nerves
Correct Answer: Vagus nerves
Explanation:The vagus nerves are part of the tenth pair of cranial nerves and work with sympathetic nerves to form the oesophageal plexus. They have a parasympathetic function, stimulating peristalsis and supplying smooth muscle. The lower oesophageal sphincter, which relaxes to allow food into the stomach, is influenced by the vagus nerve. Oesophageal achalasia can occur when there is increased tone of the lower oesophageal sphincter, incomplete relaxation, and lack of peristalsis, leading to dysphagia and regurgitation.
The glossopharyngeal nerves are mixed cranial nerves that supply motor fibres to the stylopharyngeus muscle and parasympathetic fibres to the parotid gland. They also form the pharyngeal plexus with the vagus nerve, supplying the palate, larynx, and pharynx.
The greater splanchnic nerves contribute to the coeliac plexus, which supplies the enteric nervous system and the adrenals. The intercostal nerves arise from the anterior rami of the first 11 thoracic spinal nerves and supply various structures in their intercostal space. The phrenic nerves supply the diaphragm.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 25
Incorrect
-
A 28-year-old woman is diagnosed with hypertension during her first prenatal visit at 12 weeks with a blood pressure reading of 150/100 mmHg. Her urine test reveals +++ protein. What is the best course of action to manage her hypertension?
Your Answer: Administer lisinopril with target blood pressure < 135/85 mmHg
Correct Answer:
Explanation:Hypertension during pregnancy is a common occurrence that requires careful management. In normal pregnancies, blood pressure tends to decrease in the first trimester and then gradually increase to pre-pregnancy levels by term. However, in cases of hypertension during pregnancy, the systolic blood pressure is usually above 140 mmHg or the diastolic blood pressure is above 90 mmHg. Additionally, an increase of more than 30 mmHg systolic or 15 mmHg diastolic from the initial readings may also indicate hypertension.
There are three categories of hypertension during pregnancy: pre-existing hypertension, pregnancy-induced hypertension (PIH), and pre-eclampsia. Pre-existing hypertension refers to a history of hypertension before pregnancy or elevated blood pressure before 20 weeks gestation. PIH occurs in the second half of pregnancy and resolves after birth. Pre-eclampsia is characterized by hypertension and proteinuria, and may also involve edema.
The management of hypertension during pregnancy involves the use of antihypertensive medications such as labetalol, nifedipine, and hydralazine. In cases of pre-existing hypertension, ACE inhibitors and angiotensin II receptor blockers should be stopped immediately and alternative medications should be prescribed. Women who are at high risk of developing pre-eclampsia should take aspirin from 12 weeks until the birth of the baby. It is important to carefully monitor blood pressure and proteinuria levels during pregnancy to ensure the health of both the mother and the baby.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 26
Correct
-
A 70-year-old man presents to the clinic with a four-month history of abdominal swelling and discomfort along with breathlessness. Upon examination, he appears unwell and pale. The liver is palpable 12 cm below the right costal margin, and the spleen is palpable 15 cm below the left costal margin. No lymphadenopathy is detected. The following investigations were conducted:
Hb 59 g/L (130-180)
RBC 2.1 ×1012/L -
PCV 0.17 l/l -
MCH 30 pg (28-32)
MCV 82 fL (80-96)
Reticulocytes 1.4% (0.5-2.4)
Total WBC 23 ×109/L (4-11)
Normoblasts 8% -
Platelets 280 ×109/L (150-400)
Neutrophils 9.0 ×109/L (1.5-7)
Lymphocytes 5.2 ×109/L (1.5-4)
Monocytes 1.3 ×109/L (0-0.8)
Eosinophils 0.2 ×109/L (0.04-0.4)
Basophils 0.2 ×109/L (0-0.1)
Metamyelocytes 5.1 ×109/L -
Myelocytes 1.6 ×109/L -
Blast cells 0.4 ×109/L -
The blood film shows anisocytosis, poikilocytosis, and occasional erythrocyte tear drop cells. What is the correct term for this blood picture?Your Answer: Leukoerythroblastic anaemia
Explanation:Leukoerythroblastic Reactions and Myelofibrosis
Leukoerythroblastic reactions refer to a condition where the peripheral blood contains immature white cells and nucleated red cells, regardless of the total white cell count. This means that even if the overall white cell count is normal, the presence of immature white cells and nucleated red cells can indicate a leukoerythroblastic reaction. Additionally, circulating blasts may also be seen in this condition.
On the other hand, myelofibrosis is characterized by the presence of tear drop cells. These cells are not typically seen in other conditions and are therefore considered a hallmark of myelofibrosis. Tear drop cells are red blood cells that have been distorted due to the presence of fibrous tissue in the bone marrow. This condition can lead to anemia, fatigue, and other symptoms.
Overall, both leukoerythroblastic reactions and myelofibrosis are conditions that can be identified through specific characteristics in the peripheral blood. It is important for healthcare professionals to be aware of these findings in order to properly diagnose and treat patients.
-
This question is part of the following fields:
- Haematology
-
-
Question 27
Correct
-
A 24-year-old pregnant woman arrives at 16 weeks gestation with painless vaginal bleeding, excessive morning sickness, and shortness of breath. During a routine examination, her abdomen shows a uterus that extends up to the umbilicus. An ultrasound reveals a solid collection of echoes with several small anechoic spaces. What is the probable diagnosis?
Your Answer: Hydatidiform mole
Explanation:A Hydatidiform mole, also known as a molar pregnancy, is a type of gestational trophoblastic disease that is precancerous. It occurs due to an imbalance in chromosomes during pregnancy, resulting in non-viable pregnancies. The main symptoms include painless vaginal bleeding in early pregnancy and a uterus that is larger than expected. The abnormal trophoblastic tissue can produce excessive amounts of human chorionic gonadotropin (hCG), leading to hyperemesis gravidarum and thyrotoxicosis. Ultrasound is a useful tool for diagnosis, with the mole appearing as a solid collection of echoes with numerous small anechoic spaces, resembling a bunch of grapes. It is important to note that a large uterus extending up to the umbilicus is indicative of a pregnancy that is large for dates, ruling out fibroids as a possible cause. Miscarriage and ectopic pregnancy are unlikely due to the absence of pain.
Gestational trophoblastic disorders refer to a range of conditions that originate from the placental trophoblast. These disorders include complete hydatidiform mole, partial hydatidiform mole, and choriocarcinoma. Complete hydatidiform mole is a benign tumor of trophoblastic material that occurs when an empty egg is fertilized by a single sperm that duplicates its own DNA, resulting in all 46 chromosomes being of paternal origin. Symptoms of this disorder include bleeding in the first or early second trimester, exaggerated pregnancy symptoms, a uterus that is large for dates, and very high levels of human chorionic gonadotropin (hCG) in the serum. Hypertension and hyperthyroidism may also be present. Urgent referral to a specialist center is necessary, and evacuation of the uterus is performed. Effective contraception is recommended to avoid pregnancy in the next 12 months, as around 2-3% of cases may develop choriocarcinoma.
Partial hydatidiform mole, on the other hand, occurs when a normal haploid egg is fertilized by two sperms or by one sperm with duplication of the paternal chromosomes. As a result, the DNA is both maternal and paternal in origin, and the fetus may have triploid chromosomes, such as 69 XXX or 69 XXY. Fetal parts may also be visible. It is important to note that hCG can mimic thyroid-stimulating hormone (TSH), which may lead to hyperthyroidism.
In summary, gestational trophoblastic disorders are a group of conditions that arise from the placental trophoblast. Complete hydatidiform mole and partial hydatidiform mole are two types of these disorders. While complete hydatidiform mole is a benign tumor of trophoblastic material that occurs when an empty egg is fertilized by a single sperm that duplicates its own DNA, partial hydatidiform mole occurs when a normal haploid egg is fertilized by two sperms or by one sperm with duplication of the paternal chromosomes. It is important to seek urgent medical attention and effective contraception to avoid pregnancy in the next 12 months.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 28
Incorrect
-
A 35-year-old woman visits the GP clinic complaining of nausea and vomiting. She is currently 8 weeks pregnant and it is her first pregnancy. She desires an antiemetic to use during the first trimester so she can continue working. She is not experiencing dehydration, has no ketonuria, and can retain fluids. She has no previous medical conditions. What is the best course of action for her management?
Your Answer: Prescribe metoclopramide
Correct Answer: Prescribe promethazine
Explanation:Promethazine is the appropriate medication to prescribe for nausea and vomiting in pregnancy, as it is a first-line antiemetic. Metoclopramide should be avoided due to the risk of extrapyramidal effects if used for more than 5 days. While alternative methods such as ginger and acupressure bands may be discussed, as the patient has requested medication, it is appropriate to prescribe promethazine. It is also important to support the patient’s decision to continue working if that is her preference.
Hyperemesis gravidarum is an extreme form of nausea and vomiting of pregnancy that occurs in around 1% of pregnancies and is most common between 8 and 12 weeks. It is associated with raised beta hCG levels and can be caused by multiple pregnancies, trophoblastic disease, hyperthyroidism, nulliparity, and obesity. Referral criteria for nausea and vomiting in pregnancy include continued symptoms with ketonuria and/or weight loss, a confirmed or suspected comorbidity, and inability to keep down liquids or oral antiemetics. The diagnosis of hyperemesis gravidarum requires the presence of 5% pre-pregnancy weight loss, dehydration, and electrolyte imbalance. Management includes first-line use of antihistamines and oral cyclizine or promethazine, with second-line options of ondansetron and metoclopramide. Admission may be needed for IV hydration. Complications can include Wernicke’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, acute tubular necrosis, and fetal growth issues.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 29
Correct
-
A 35-year-old woman with Crohn's disease presents with severe abdominal pain. Upon investigation, a small intestinal obstruction is discovered, and during surgery, a large stricture is found in the terminal ileum. As a result, approximately 90 cm of the terminal ileum had to be resected. What is the most common complication in this scenario?
Your Answer: Vitamin B12 deficiency
Explanation:Complications of Terminal Ileum Resection
When the terminal ileum is lost due to resection, there can be various complications depending on the length of the resection. One such complication is D-lactic acidosis, which occurs after the intake of refined carbohydrates. Gallstones may also form due to interruption in the enterohepatic circulation of bile acids. Patients with a short bowel are encouraged to eat more to replenish the different vitamins and minerals. They may also be at risk of developing calcium oxalate kidney stones. However, they are not at increased risk of uric acid stones unless they have coexisting conditions such as gout. It is important to note that iron deficiency may not be affected by ileal pathology, while vitamin K and D deficiencies are not common complications of terminal ileum resection.
-
This question is part of the following fields:
- Colorectal
-
-
Question 30
Incorrect
-
A 14-year-old girl presents to her GP with concerns about not having started her periods. She has also not developed any other secondary sexual characteristics. Upon examination, she is found to be proportionate but notably short in stature. Additionally, she has wide-spaced nipples, low-set ears, and subtle neck webbing. What is the most likely diagnosis for this patient?
Your Answer: Atrial septal defect
Correct Answer: Aortic coarctation
Explanation:Individuals with Turner’s syndrome (XO) often exhibit physical characteristics such as a webbed neck, low set ears, and widely spaced nipples. Short stature and primary amenorrhea are common, along with a degree of puberty failure. Other physical features to look for include a wide carrying angle, down-sloping eyes with partial ptosis, and a low posterior hairline. Turner’s syndrome is frequently linked to aortic coarctation and bicuspid aortic valve, while other cardiac abnormalities may be associated with different genetic conditions.
Understanding Turner’s Syndrome
Turner’s syndrome is a genetic disorder that affects approximately 1 in 2,500 females. It is caused by the absence of one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. This condition is denoted as 45,XO or 45,X.
The features of Turner’s syndrome include short stature, a shield chest with widely spaced nipples, a webbed neck, a bicuspid aortic valve (15%), coarctation of the aorta (5-10%), primary amenorrhea, cystic hygroma (often diagnosed prenatally), a high-arched palate, a short fourth metacarpal, multiple pigmented naevi, lymphoedema in neonates (especially feet), and elevated gonadotrophin levels. Hypothyroidism is much more common in Turner’s syndrome, and there is also an increased incidence of autoimmune disease (especially autoimmune thyroiditis) and Crohn’s disease.
In summary, Turner’s syndrome is a chromosomal disorder that affects females and can cause a range of physical features and health issues. Early diagnosis and management can help individuals with Turner’s syndrome lead healthy and fulfilling lives.
-
This question is part of the following fields:
- Paediatrics
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Mins)