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  • Question 1 - A 65-year-old woman comes in with a tremor. What distinguishing characteristic would indicate...

    Incorrect

    • A 65-year-old woman comes in with a tremor. What distinguishing characteristic would indicate a diagnosis of essential tremor instead of Parkinson's disease?

      Your Answer: Unilateral symptoms

      Correct Answer: Tremor is worse when the arms are outstretched

      Explanation:

      Typical symptoms of Parkinson’s include bradykinesia, postural instability, and initially unilateral symptoms. On the other hand, alcohol can alleviate essential tremor symptoms.

      Understanding Essential Tremor

      Essential tremor, also known as benign essential tremor, is a genetic condition that typically affects both upper limbs. The most common symptom is a postural tremor, which worsens when the arms are outstretched. However, the tremor can be improved by rest and alcohol consumption. Essential tremor is also the leading cause of head tremors, known as titubation.

      When it comes to managing essential tremor, the first-line treatment is propranolol. This medication can help reduce the severity of the tremors. In some cases, primidone may also be used to manage the condition. It’s important to note that essential tremor is a lifelong condition, but with proper management, individuals can lead a normal life. By understanding the symptoms and treatment options, those with essential tremor can take control of their condition and improve their quality of life.

    • This question is part of the following fields:

      • Neurology
      11.9
      Seconds
  • Question 2 - A 42-year-old man with known gallstones awaiting elective laparoscopic cholecystectomy attends his general...

    Correct

    • A 42-year-old man with known gallstones awaiting elective laparoscopic cholecystectomy attends his general practice surgery, complaining of a fever. He also has flu-like symptoms and pain in his abdomen.
      On examination, his temperature is 38.5 °C. His pulse is 120 bpm. He has yellow sclera and an abdomen which is soft but tender in the right upper quadrant.
      What is the most likely diagnosis?
      Select the SINGLE most likely diagnosis from the list below. Select ONE option only.

      Your Answer: Ascending cholangitis

      Explanation:

      Distinguishing Causes of Obstructive Jaundice: A Medical Overview

      Obstructive jaundice is a condition characterized by the yellowing of the skin and eyes due to the blockage of the bile ducts. Ascending cholangitis is a common cause of this condition, often associated with gallstone disease. Patients with this condition may experience fever, tachycardia, and abdominal pain. Influenza, on the other hand, rarely causes localized pain in the right upper quadrant and is unlikely to result in obstructive jaundice. Pancreatic cancer typically presents with painless jaundice, while acute hepatitis is often associated with a history of travel or high-risk behaviors. Biliary colic, which is caused by gallstones, can lead to colicky pain after eating. Understanding the different causes of obstructive jaundice is crucial in determining the appropriate treatment plan for patients.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      19.2
      Seconds
  • Question 3 - Legionnaires' disease has several statements associated with it, but which one is true?...

    Correct

    • Legionnaires' disease has several statements associated with it, but which one is true?

      Your Answer: Hyponatremia occurs significantly more often in Legionnaires’ disease than in other pneumonias

      Explanation:

      Understanding Legionnaires’ Disease: Causes, Symptoms, and Treatment

      Legionnaires’ disease is a type of pneumonia that is caused by the Legionella bacteria. This disease is often overlooked as a possible cause of community-acquired pneumonia, but it is consistently ranked among the top three or four most common causes. The bacteria are found in water sources, and most patients contract the disease through aspiration.

      One of the key symptoms of Legionnaires’ disease is hyponatremia, which is a low level of sodium in the blood. This symptom is more commonly associated with Legionnaires’ disease than with other types of pneumonia. The disease is also more likely to occur in patients who are immunocompromised, as cell-mediated immunity appears to be the primary host defense mechanism against Legionella infection.

      The urinary antigen test is the preferred initial test for Legionnaires’ disease, but it has low sensitivity and is not particularly specific. The test detects only L. pneumophila serogroup 1, which causes most cases of the disease. Specific therapy includes antibiotics that can achieve high intracellular concentrations, such as macrolides, quinolones, or ketolides.

      Predisposing factors for Legionnaires’ disease include age over 50, cigarette smoking, excessive alcohol intake, chronic lung disease, and immunosuppression. High fever and gastrointestinal symptoms are clinical clues to this disease. It is important for healthcare providers to consider Legionnaires’ disease as a possible cause of pneumonia, especially in patients with these risk factors.

    • This question is part of the following fields:

      • Infectious Diseases
      16.8
      Seconds
  • Question 4 - A 48-year-old woman visits her GP complaining of back pain that has persisted...

    Correct

    • A 48-year-old woman visits her GP complaining of back pain that has persisted for 4 weeks despite taking various painkillers. She has a history of coeliac disease and mild vitamin D deficiency, and she smokes 10 cigarettes daily. During the examination, the GP notes tenderness in the T8 vertebrae without any visible deformity, and the patient's vital signs are normal. There are no abnormalities in her neurological examination. What is the concerning feature in this patient's presentation that requires further investigation?

      Your Answer: Thoracic back pain

      Explanation:

      When evaluating a patient with back pain, it is crucial to be aware of red flag symptoms such as thoracic back pain, unexplained weight loss, local spinal tenderness, focal neurology, and age over 50 or under 18. Thoracic back pain is particularly concerning for malignancy in patients over 50 years old. Additionally, if symptoms have a gradual onset and do not improve with pain relief, further investigation is necessary. Gender and smoking history are not considered red flag risk factors for back pain.

      Lower back pain is a common issue that is often caused by muscular strain. However, it is important to be aware of potential underlying causes that may require specific treatment. Certain red flags should be considered, such as age under 20 or over 50, a history of cancer, night pain, trauma, or systemic illness. There are also specific causes of lower back pain that should be kept in mind. Facet joint pain may be acute or chronic, worse in the morning and on standing, and typically worsens with back extension. Spinal stenosis may cause leg pain, numbness, and weakness that is worse on walking and relieved by sitting or leaning forward. Ankylosing spondylitis is more common in young men and causes stiffness that is worse in the morning and improves with activity. Peripheral arterial disease may cause pain on walking and weak foot pulses. It is important to consider these potential causes and seek appropriate diagnosis and treatment.

    • This question is part of the following fields:

      • Musculoskeletal
      25.9
      Seconds
  • Question 5 - A 25-year-old man with a history of bipolar disorder is scheduled for a...

    Correct

    • A 25-year-old man with a history of bipolar disorder is scheduled for a medication review. When inquiring about his current state, he starts discussing the vast array of emotions that exist and wonders if everyone has experienced all of them. Eventually, he spontaneously mentions that he is feeling quite good.
      What is the patient exhibiting in this scenario?

      Your Answer: Circumstantiality

      Explanation:

      The patient’s lengthy response to the question suggests circumstantiality, which can be a symptom of anxiety disorders or hypomania. However, the patient has remained on topic and has not derailed. Their response is coherent, and there is no evidence of pressured speech in this text-based interaction. Incoherence would be demonstrated by nonsensical statements, which is not the case here.

      Anxiety is a common disorder that can manifest in various ways. According to NICE, the primary feature is excessive worry about multiple events associated with heightened tension. It is crucial to consider potential physical causes when diagnosing anxiety disorders, such as hyperthyroidism, cardiac disease, and medication-induced anxiety. Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants, and caffeine.

      NICE recommends a step-wise approach for managing generalised anxiety disorder (GAD). This includes education about GAD and active monitoring, low-intensity psychological interventions, high-intensity psychological interventions or drug treatment, and highly specialist input. Sertraline is the first-line SSRI for drug treatment, and if it is ineffective, an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine may be offered. If the patient cannot tolerate SSRIs or SNRIs, pregabalin may be considered. For patients under 30 years old, NICE recommends warning them of the increased risk of suicidal thinking and self-harm and weekly follow-up for the first month.

      The management of panic disorder also follows a stepwise approach, including recognition and diagnosis, treatment in primary care, review and consideration of alternative treatments, review and referral to specialist mental health services, and care in specialist mental health services. NICE recommends either cognitive behavioural therapy or drug treatment in primary care. SSRIs are the first-line drug treatment, and if contraindicated or no response after 12 weeks, imipramine or clomipramine should be offered.

    • This question is part of the following fields:

      • Psychiatry
      29.8
      Seconds
  • Question 6 - A 55-year-old patient complains of a painful swollen left knee that has not...

    Incorrect

    • A 55-year-old patient complains of a painful swollen left knee that has not improved after a week of rest. The patient denies any history of injury. Upon examination, a moderate-sized effusion is observed. A plain radiograph reveals the following findings: some joint space loss and linear calcification of the articular cartilage. What is the probable diagnosis?

      Your Answer: Osteoarthritis

      Correct Answer: Pseudogout

      Explanation:

      Chondrocalcinosis is a useful indicator for differentiating between pseudogout and gout.

      The presence of chondrocalcinosis can be observed in an x-ray, which helps to distinguish between pseudogout and gout. In older individuals, joint space loss and osteoarthritic-like changes are common and may be caused by pseudogout.

      Pseudogout, also known as acute calcium pyrophosphate crystal deposition disease, is a type of microcrystal synovitis that occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovium. This condition is more common in older individuals, but those under 60 years of age may develop it if they have underlying risk factors such as haemochromatosis, hyperparathyroidism, low magnesium or phosphate levels, acromegaly, or Wilson’s disease. The knee, wrist, and shoulders are the most commonly affected joints, and joint aspiration may reveal weakly-positively birefringent rhomboid-shaped crystals. X-rays may show chondrocalcinosis, which appears as linear calcifications of the meniscus and articular cartilage in the knee. Treatment involves joint fluid aspiration to rule out septic arthritis, as well as the use of NSAIDs or steroids, as with gout.

    • This question is part of the following fields:

      • Musculoskeletal
      39.3
      Seconds
  • Question 7 - A 56-year-old man presents to the Emergency Department with nausea and vomiting, with...

    Correct

    • A 56-year-old man presents to the Emergency Department with nausea and vomiting, with associated lethargy. He has mild asthma which is well controlled with a steroid inhaler but has no other medical history of note. He does not smoke but drinks up to 30 units of alcohol a week, mostly on the weekends.
      Observations are as follows: Temperature is 37.2 oC, blood pressure is 108/68 mmHg, heart rate is 92 bpm and regular.
      On examination, the patient appears to be clinically dehydrated, but there are no other abnormalities noted.
      Investigations reveal the following:
      Investigation Result Normal Values
      Haemoglobin (Hb) 145 g/l 135–175 g/l
      White cell count (WCC) 8.2 × 109/l 4.0–11.0 × 109/l
      Urea 9.2 mmol/l 2.5–6.5 mmol/l
      Creatinine (Cr) 178 µmol/l
      (bloods carried out one year
      previously showed a creatinine
      of 76) 50–120 µmol/l
      Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
      Sodium (Na+) 131 mmol/l 135–145 mmol/l
      Which of the following is most suggestive of acute kidney injury rather than chronic renal failure?

      Your Answer: Oliguria

      Explanation:

      Understanding the Signs and Symptoms of Acute and Chronic Renal Failure

      Renal failure can be difficult to diagnose, especially when there are no previous urea and electrolyte levels available for comparison. However, there are certain signs and symptoms that can indicate whether the condition is acute or chronic.

      Acute renal failure may present with acute lethargy/fatigue, dehydration, shortness of breath, nausea and vomiting, oliguria, acute onset peripheral edema/edema of the face, confusion, seizures, and coma. On the other hand, chronic renal failure may manifest as anemia, pruritus, long-standing fatigue, weight loss, reduced appetite, and a history of underlying medical conditions such as diabetes or hypertension.

      Oliguria, or reduced urine output, is a hallmark of renal failure and can be an early sign of acute renal injury. Nocturia, or increased urination at night, is often found in patients with chronic kidney disease. Peripheral neuropathy is likely to be present in patients with chronic renal failure due to an underlying history of diabetes. Raised parathyroid hormone levels are more commonly found in chronic renal failure, secondary to low calcium levels associated with the condition. Small kidneys are also seen in chronic renal failure, as long-standing conditions affecting the kidney can cause atrophy and reduce function, leading to progressive renal failure. The kidneys are more likely to be of normal size in acute injury.

      In summary, understanding the signs and symptoms of acute and chronic renal failure can aid in the diagnosis and management of this condition.

    • This question is part of the following fields:

      • Renal Medicine/Urology
      45.8
      Seconds
  • Question 8 - A 50-year-old builder presents to the General Practitioner with pain in his right...

    Correct

    • A 50-year-old builder presents to the General Practitioner with pain in his right elbow. He reports that the pain has been worsening over the past few months and is affecting his ability to work. He has not attempted any treatment yet.

      Upon examination, there is no swelling at the right elbow joint. The elbow can be flexed and extended without pain, and there is a good range of motion. The pain is reproduced on resisted supination.

      What is the most appropriate first line diagnosis-management pairing for this patient? Choose the SINGLE most suitable option from the list below.

      Your Answer: Lateral epicondylitis – rest, non-steroidal anti-inflammatory drugs (NSAIDs)

      Explanation:

      Lateral epicondylitis is a condition that typically affects people in their fourth decade or older, and is caused by repetitive activity or minor trauma to the elbow. It is usually seen in the dominant arm and causes pain in the front of the lateral epicondyle, which can radiate down the forearm and lead to weakness of grip strength and difficulty in carrying objects. On examination, there is tenderness in the lateral epicondyle over the extensor mass, but no swelling or pain when flexing and extending the elbow. Treatment for lateral epicondylitis involves rest and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, with physiotherapy recommended if there is no response after six weeks. Corticosteroid injections may be considered, but are unlikely to affect long-term outcomes. In contrast, medial epicondylitis affects the flexor-pronator muscles at their origin on the medial epicondyle, causing pain in that area. Treatment for both conditions is similar, involving rest and NSAIDs initially, with physiotherapy if necessary. Osteoarthritis, on the other hand, presents with joint stiffness and reduced range of motion, and is not evident in this patient.

    • This question is part of the following fields:

      • Musculoskeletal
      49.6
      Seconds
  • Question 9 - A 42-year-old man experiences a sudden onset of migraine and is administered a...

    Incorrect

    • A 42-year-old man experiences a sudden onset of migraine and is administered a subcutaneous injection of sumatriptan, resulting in the alleviation of his symptoms.
      What is the mechanism of action of the drug?

      Your Answer: Acting on opioid receptors in the central nervous system

      Correct Answer: Causing vasoconstriction of cranial arteries

      Explanation:

      Understanding the Mechanisms of Sumatriptan: A Migraine and Cluster Headache Treatment

      Sumatriptan is a medication commonly used to treat migraine and cluster headaches. It works by activating specific serotonin receptors (5-HT1D and 5-HT1B) found on cranial and basilar arteries, causing vasoconstriction of these blood vessels. This medication can be administered orally, by subcutaneous injection, or intranasally.

      It is important to note that sumatriptan has no effect on adrenergic receptors or acetylcholinesterase receptors. It is also not a cyclooxygenase (COX) inhibitor or an opioid receptor agonist or antagonist.

      In addition to its effects on blood vessels, sumatriptan has been shown to decrease the activity of the trigeminal nerve, which is responsible for its effectiveness in treating cluster headaches.

      Overall, understanding the mechanisms of sumatriptan can help healthcare professionals and patients better understand how this medication works to alleviate the symptoms of migraine and cluster headaches.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      23
      Seconds
  • Question 10 - A 65 year old man presents to the emergency department with a productive...

    Incorrect

    • A 65 year old man presents to the emergency department with a productive cough that has been ongoing for three days. He has been experiencing increasing shortness of breath, weakness, and lethargy over the past two days. He also reports fevers and rigors. His wife brought him in as she is concerned about his rapid deterioration. On examination, his heart rate is 125 beats per minute, respiratory rate is 32 breaths per minute, Sa02 is 90% on room air, temperature is 38.9º, and blood pressure is 130/84 mmHg. He appears distressed but is not confused. Initial investigations show a Hb of 134 g/l, platelets of 550 * 109/l, WBC of 18 * 109/l, Na+ of 141 mmol/l, K+ of 3.7 mmol/l, urea of 9.2 mmol/l, and creatinine of 130 µmol/l. A CXR shows left lower zone consolidation. What is his CURB-65 score based on this information?

      Your Answer: 5

      Correct Answer: 3

      Explanation:

      The patient is currently in a room with normal air temperature of 38.9º and has a blood pressure reading of 130/84 mmHg. Although he appears distressed, he is not experiencing confusion. Initial tests reveal that his hemoglobin level is at 134 g/l and his platelet count is yet to be determined.

      Pneumonia is a serious respiratory infection that requires prompt assessment and management. In the primary care setting, the CRB65 criteria are used to stratify patients based on their risk of mortality. Patients with a score of 0 are considered low risk and may be treated at home, while those with a score of 3 or 4 are high risk and require urgent admission to hospital. The use of a point-of-care CRP test can help guide antibiotic therapy. In the secondary care setting, the CURB65 criteria are used, which includes an additional criterion of urea > 7 mmol/L. Chest x-rays and blood and sputum cultures are recommended for intermediate or high-risk patients. Treatment for low-severity community acquired pneumonia typically involves a 5-day course of amoxicillin, while moderate and high-severity cases may require dual antibiotic therapy for 7-10 days. Discharge criteria and advice post-discharge are also provided, including information on expected symptom resolution timeframes and the need for a repeat chest x-ray at 6 weeks.

    • This question is part of the following fields:

      • Respiratory Medicine
      74.4
      Seconds
  • Question 11 - A 68-year-old man came to your GP clinic complaining of stiffness and pain...

    Incorrect

    • A 68-year-old man came to your GP clinic complaining of stiffness and pain in his knee joints, painful urination, and a red eye with circumcorneal redness, hypopyon, and photophobia. What is the most probable reason for his red eye?

      Your Answer: Scleritis

      Correct Answer: Iritis

      Explanation:

      When dealing with reactive arthritis, it is important to keep in mind that anterior uveitis may also be present in addition to conjunctivitis.

      Since reactive arthritis is linked to HLA-B27, it is important to consider the possibility of iritis or anterior uveitis, even though conjunctivitis is more commonly seen as part of the triad of symptoms. The specific description of a red eye with circumcorneal redness and hypopyon suggests iritis rather than conjunctivitis. Conjunctivitis typically causes a more generalized redness of the eye and hypopyon is not commonly observed. Corneal ulceration is unlikely in this case as there is no mention of increased fluorescein uptake on the cornea or a visible ulcer. Scleritis can be ruled out as it does not present with circumcorneal redness or hypopyon. While scleritis is associated with systemic conditions such as rheumatoid arthritis and other collagen/vascular disorders like Wegener’s granulomatosis, polyarteritis nodosa, and systemic lupus erythematosus, it is not associated with reactive arthritis. Blepharitis is also an incorrect diagnosis as there were no eyelid symptoms and blepharitis does not typically cause a red eye with photophobic symptoms.

      Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.

    • This question is part of the following fields:

      • Ophthalmology
      35.3
      Seconds
  • Question 12 - A 65-year-old male with a history of COPD and hypertension complains of pain...

    Correct

    • A 65-year-old male with a history of COPD and hypertension complains of pain while swallowing. The patient is currently taking a salbutamol and beclomethasone inhaler, bendroflumethiazide, and amlodipine. What could be the possible reason for this symptom?

      Your Answer: Oesophageal candidiasis

      Explanation:

      Oesophageal candidiasis, a known complication of inhaled steroid therapy, often presents with pain while swallowing (odynophagia).

      Understanding Dysphagia and its Causes

      Dysphagia, or difficulty in swallowing, can be caused by various conditions affecting the esophagus, such as oesophageal cancer, oesophagitis, oesophageal candidiasis, achalasia, pharyngeal pouch, systemic sclerosis, and myasthenia gravis. Each condition has its own characteristic features, which can help in identifying the underlying cause of dysphagia. For instance, dysphagia associated with weight loss, anorexia, or vomiting during eating may indicate oesophageal cancer, while dysphagia of both liquids and solids from the start may suggest achalasia.

      To determine the cause of dysphagia, patients usually undergo an upper GI endoscopy, which allows doctors to examine the esophagus and detect any abnormalities. Fluoroscopic swallowing studies may also be done to evaluate motility disorders. Additionally, a full blood count and ambulatory oesophageal pH and manometry studies may be required for certain conditions.

      It’s important to note that new-onset dysphagia is a red flag symptom that requires urgent endoscopy, regardless of age or other symptoms. Therefore, understanding the different causes of dysphagia and their characteristic features can aid in prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      12.8
      Seconds
  • Question 13 - A 67-year-old woman presents with blistering lesions on her leg and is suspected...

    Correct

    • A 67-year-old woman presents with blistering lesions on her leg and is suspected to have bullous pemphigoid. What would be the most suitable course of action for management?

      Your Answer: Refer to secondary care

      Explanation:

      Understanding Bullous Pemphigoid

      Bullous pemphigoid is an autoimmune disease that causes blistering of the skin due to the development of antibodies against hemidesmosomal proteins BP180 and BP230. This condition is more common in elderly patients and is characterized by itchy, tense blisters that typically appear around flexures. However, the blisters usually heal without scarring, and there is usually no mucosal involvement.

      To diagnose bullous pemphigoid, a skin biopsy is necessary, and immunofluorescence shows IgG and C3 at the dermoepidermal junction. Treatment for this condition involves referral to a dermatologist for biopsy and confirmation of diagnosis, as well as the use of oral corticosteroids as the mainstay of treatment. Topical corticosteroids, immunosuppressants, and antibiotics may also be used.

      It is worth noting that while mucosal involvement is seen in some patients, it is not a classic feature of bullous pemphigoid and is therefore not always mentioned in exam questions. Overall, understanding the symptoms, diagnosis, and treatment of bullous pemphigoid is crucial for healthcare professionals to provide appropriate care for patients with this condition.

    • This question is part of the following fields:

      • Dermatology
      65.6
      Seconds
  • Question 14 - A 35-year-old woman came to your GP clinic with a cold sore and...

    Correct

    • A 35-year-old woman came to your GP clinic with a cold sore and left eye discomfort. She reported experiencing a red, painful eye with watering and sensitivity to light for the past 3 days. During fluorescein examination, you observed a dendritic ulcer on the cornea that was stained with fluorescein.

      What is the primary treatment for this condition?

      Your Answer: Topical aciclovir drops

      Explanation:

      The appropriate treatment for herpes simplex keratitis is the use of topical aciclovir. Antibiotics are ineffective against viral infections and should not be used. The use of steroids can worsen the condition and should be avoided. If the patient is already using topical steroids for another eye condition, the dosage should be decreased.

      Understanding Herpes Simplex Keratitis

      Herpes simplex keratitis is a condition that affects the cornea of the eye and is caused by the herpes simplex virus. The most common symptom of this condition is a dendritic corneal ulcer, which can cause a red, painful eye, photophobia, and epiphora. In some cases, visual acuity may also be decreased. Fluorescein staining may show an epithelial ulcer, which can help with diagnosis. One common treatment for this condition is topical aciclovir, which can help to reduce the severity of symptoms and prevent further damage to the cornea.

    • This question is part of the following fields:

      • Ophthalmology
      21.1
      Seconds
  • Question 15 - A 67-year-old male with metastatic prostate cancer is seen in clinic. His wife...

    Incorrect

    • A 67-year-old male with metastatic prostate cancer is seen in clinic. His wife reports that he has been experiencing confusion and occasionally talks to people who are not present. Despite investigations for reversible causes, no underlying issues are found. If conservative measures prove ineffective and he continues to exhibit confusion and agitation, what is the most suitable course of action?

      Your Answer: Oral diazepam

      Correct Answer: Oral haloperidol

      Explanation:

      Palliative Care Prescribing for Agitation and Confusion

      When dealing with agitation and confusion in palliative care patients, it is important to identify and treat any underlying causes such as hypercalcaemia, infection, urinary retention, or medication. If these specific treatments fail, medication can be used to manage symptoms. Haloperidol is the first choice for treating agitation and confusion, with chlorpromazine and levomepromazine as alternative options. In the terminal phase of the illness, midazolam is the preferred medication for managing agitation or restlessness. Proper management of these symptoms can greatly improve the quality of life for palliative care patients.

    • This question is part of the following fields:

      • Psychiatry
      17.5
      Seconds
  • Question 16 - A 72-year-old man presents to the Haematology Clinic with symptoms of bone pain...

    Incorrect

    • A 72-year-old man presents to the Haematology Clinic with symptoms of bone pain and anaemia. The medical team suspects multiple myeloma (MM) and orders a set of blood tests, including a full blood count, urea, serum creatinine and electrolytes, serum calcium, albumin, serum protein electrophoresis, serum-free light-chain assay, and serum beta-2 microglobulin. The team also plans to perform an imaging investigation to look for osteolytic lesions. What initial scan should be ordered?

      Your Answer:

      Correct Answer: Whole-body low-dose CT (WBLD-CT)

      Explanation:

      When investigating suspected multiple myeloma (MM), it is crucial to use whole-body low-dose CT (WBLD-CT) imaging. This method is more effective than traditional radiology in detecting lytic lesions and should be the first option if available. Lesions with a diameter of 5mm or more are considered positive. If WBLD-CT and MRI fail to show lesions with a strong clinical indication, an FDG-PET or FDG-PET-CT can be used to detect bone lesions. During treatment follow-up, an FDG-PET-CT can detect active lesions and provide prognostic information. While a skeletal survey (X-ray) is less sensitive than WBLD-CT, it can still be useful. If suspicion remains high for MM despite negative WBLD-CT or skeletal survey results, a whole-body MRI should be performed. This method can detect focal lesions and bone marrow infiltration and may also be of prognostic value in asymptomatic patients. The presence of focal lesions is a strong predictor of progression to symptomatic MM.

    • This question is part of the following fields:

      • Haematology/Oncology
      0
      Seconds
  • Question 17 - A newborn is delivered at term via vaginal delivery with no complications, however...

    Incorrect

    • A newborn is delivered at term via vaginal delivery with no complications, however she is not showing signs of breathing at one minute. Her heart rate is >110bpm, but she is floppy and has a blue colouration. What is the most appropriate next step?

      Your Answer:

      Correct Answer: 5 breaths of air via face mask

      Explanation:

      Performing airway suction should be avoided unless there is clear evidence of thick meconium causing obstruction, as it may lead to reflex bradycardia in infants. Chest compressions are not necessary if the heart rate (HR) is above 100 beats per minute (bpm). CPR should only be initiated if the HR drops below 60 bpm. If there are no signs of breathing due to fluid in the lungs, administering five breaths through a 250ml ambu bag is a more effective and hygienic approach than using mouth-to-mouth resuscitation in a hospital setting.

      The Apgar score is a tool used to evaluate the health of a newborn baby. It is recommended by NICE to be assessed at 1 and 5 minutes after birth, and again at 10 minutes if the initial score is low. The score is based on five factors: pulse, respiratory effort, color, muscle tone, and reflex irritability. A score of 0-3 is considered very low, 4-6 is moderate low, and 7-10 indicates that the baby is in good health. The score helps healthcare professionals quickly identify any potential issues and provide appropriate care.

    • This question is part of the following fields:

      • Paediatrics
      0
      Seconds
  • Question 18 - A 43-year-old Nigerian woman comes to the clinic with complaints of heavy menstrual...

    Incorrect

    • A 43-year-old Nigerian woman comes to the clinic with complaints of heavy menstrual bleeding and pelvic discomfort for the past 3 months. During the physical examination, a solid, non-painful abdominal mass is detected, which originates from the pelvis. The pelvic ultrasound confirms the presence of a sizable uterine fibroid. The medical team decides to perform a hysterectomy. What medication should be administered to prepare her for the surgery?

      Your Answer:

      Correct Answer: GnRH agonist e.g. Leuprolide

      Explanation:

      GnRH agonists can be effective in reducing the size of uterine fibroids, but their use is typically limited to short-term treatment. It is important to note that these agonists are primarily used to decrease the size of the uterus prior to surgery, as the risk of post-operative blood loss is directly related to the size of the uterus. Progesterone receptor inhibitors, on the other hand, do not have an impact on overall uterine size and are therefore not useful in preparing for surgery. However, they can be helpful in reducing the severity of fibroid-related bleeding. It is also important to avoid taking COCP 4-6 weeks prior to major surgery due to an increased risk of venous thromboembolism, and to avoid antiplatelet drugs such as Ibuprofen before surgery. While antifibrinolytics like tranexamic acid can be useful in reducing the severity of uterine bleeding, they are not helpful in preparing for surgery.

      Understanding Uterine Fibroids

      Uterine fibroids are non-cancerous growths that develop in the uterus. They are more common in black women and are thought to occur in around 20% of white women in their later reproductive years. Fibroids are usually asymptomatic, but they can cause menorrhagia, which can lead to iron-deficiency anaemia. Other symptoms include lower abdominal pain, bloating, and urinary symptoms. Fibroids may also cause subfertility.

      Diagnosis is usually made through transvaginal ultrasound. Asymptomatic fibroids do not require treatment, but periodic monitoring is recommended. Menorrhagia secondary to fibroids can be managed with various treatments, including the levonorgestrel intrauterine system, NSAIDs, tranexamic acid, and hormonal therapies.

      Medical treatment to shrink or remove fibroids may include GnRH agonists or ulipristal acetate, although the latter is not currently recommended due to concerns about liver toxicity. Surgical options include myomectomy, hysteroscopic endometrial ablation, hysterectomy, and uterine artery embolization.

      Fibroids generally regress after menopause, but complications such as subfertility and iron-deficiency anaemia can occur. Red degeneration, which is haemorrhage into the tumour, is a common complication during pregnancy.

    • This question is part of the following fields:

      • Reproductive Medicine
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  • Question 19 - As a junior doctor in the Emergency Department, you encounter a 40-year-old woman...

    Incorrect

    • As a junior doctor in the Emergency Department, you encounter a 40-year-old woman who has been brought in by the police under a section 135. The police had to obtain a warrant as part of the process. The patient is currently agitated and speaking incoherently about religious phrases. She has a documented history of severe depression.

      What powers does section 135 grant to the police in this situation?

      Your Answer:

      Correct Answer: To bring a person with suspected mental health issues in from their property

      Explanation:

      If the police believe that someone requires a mental health assessment or treatment, they can request a section 135 to remove the individual from their property. The procedure involves an Approved Mental Health Practitioner (AMHP) presenting evidence at a Magistrate’s Court to obtain a warrant. This warrant permits the Police, an AMHP, and a registered medical practitioner to enter the premises and conduct an assessment or take the person to a safe location for evaluation.

      Sectioning under the Mental Health Act is a legal process used for individuals who refuse voluntary admission. This process excludes patients who are under the influence of drugs or alcohol. There are several sections under the Mental Health Act that allow for different types of admission and treatment.

      Section 2 allows for admission for assessment for up to 28 days, which is not renewable. An Approved Mental Health Professional (AMHP) or the nearest relative (NR) can make the application on the recommendation of two doctors, one of whom should be an approved consultant psychiatrist. Treatment can be given against the patient’s wishes.

      Section 3 allows for admission for treatment for up to 6 months, which can be renewed. An AMHP and two doctors, both of whom must have seen the patient within the past 24 hours, can make the application. Treatment can also be given against the patient’s wishes.

      Section 4 is used as an emergency 72-hour assessment order when a section 2 would involve an unacceptable delay. A GP and an AMHP or NR can make the application, which is often changed to a section 2 upon arrival at the hospital.

      Section 5(2) allows a doctor to legally detain a voluntary patient in hospital for 72 hours, while section 5(4) allows a nurse to detain a voluntary patient for 6 hours.

      Section 17a allows for Supervised Community Treatment (Community Treatment Order) and can be used to recall a patient to the hospital for treatment if they do not comply with the conditions of the order in the community, such as taking medication.

      Section 135 allows for a court order to be obtained to allow the police to break into a property to remove a person to a Place of Safety. Section 136 allows for someone found in a public place who appears to have a mental disorder to be taken by the police to a Place of Safety. This section can only be used for up to 24 hours while a Mental Health Act assessment is arranged.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 20 - A 75-year-old patient presents to you with a query about discontinuing her alendronic...

    Incorrect

    • A 75-year-old patient presents to you with a query about discontinuing her alendronic acid medication. She has been taking it for six years since she suffered a distal radial fracture after tripping over an uneven kerb. She has not experienced any other fractures before or after this incident. Her DEXA scan six years ago revealed a T-score of -2.4. The patient has no significant medical history and has not had any recent falls. She is a non-smoker. What would be the appropriate course of action to discuss with the patient?

      Your Answer:

      Correct Answer: Repeat DEXA scan and FRAX score now and stop the bisphosphonate if low risk, T score is now >-2.5, and review in two years

      Explanation:

      The topic of bisphosphonate holidays has gained attention due to recent evidence from the National Osteoporosis Guideline Group (NOGG) in January 2016. The guidance recommends that after a five-year period of taking oral bisphosphonates (or three years for IV zoledronate), patients should undergo a re-assessment of their treatment. This includes an updated FRAX score and DEXA scan to determine if ongoing treatment is necessary.

      Patients are divided into high and low-risk groups based on certain criteria. To be considered high-risk, patients must meet one of the following criteria: age over 75, receiving glucocorticoid therapy, previous hip/vertebral fractures, further fractures while on treatment, high-risk FRAX score, or a T score of less than -2.5 after treatment. If any of these criteria apply, treatment should be continued indefinitely or until the criteria no longer apply.

      For patients in the low-risk group, treatment may be discontinued and re-assessed after two years or if a further fracture occurs. In the case of a patient without high-risk factors, a recent DEXA scan should be conducted to determine if a two-year break from treatment is appropriate, provided their T score is greater than -2.5.

      Bisphosphonates: Uses and Adverse Effects

      Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, which are cells that break down bone tissue. This reduces the risk of bone fractures and can be used to treat conditions such as osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

      However, bisphosphonates can have adverse effects, including oesophageal reactions such as oesophagitis and ulcers, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which can cause fever, myalgia, and arthralgia. Hypocalcemia, or low calcium levels, can also occur due to reduced calcium efflux from bone, but this is usually not clinically significant.

      To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or other oral medications and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment, and calcium supplements should only be prescribed if dietary intake is inadequate. The duration of bisphosphonate treatment varies depending on the patient’s level of risk, and some authorities recommend stopping treatment after five years for low-risk patients with a femoral neck T-score of > -2.5.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 21 - A 35-year-old woman has Addison’s disease.
    Which of the following medications is she likely...

    Incorrect

    • A 35-year-old woman has Addison’s disease.
      Which of the following medications is she likely to be taking long term?

      Your Answer:

      Correct Answer: Hydrocortisone and fludrocortisone

      Explanation:

      Common Medications for Adrenal Disorders

      Adrenal disorders such as Addison’s disease and Cushing’s syndrome require specific medications for treatment. Here are some commonly used drugs and their indications:

      Hydrocortisone and Fludrocortisone: These are the mainstays of treatment for Addison’s disease, as they replace the deficient glucocorticosteroids and mineralocorticoids.

      Phenoxybenzamine: This medication is used to treat phaeochromocytoma before surgery.

      Metyrapone: It can be used to diagnose or treat Cushing’s syndrome by reducing the amount of aldosterone and cortisol in the body.

      Prednisolone and Levothyroxine: Prednisolone can be used instead of hydrocortisone in Addison’s disease to avoid peaks and troughs. However, levothyroxine is not used to treat Addison’s disease, but it’s important to check for concurrent thyroid disease.

      Spironolactone: It’s used to treat Conn’s disease, which causes hyperaldosteronism. It’s not appropriate for Addison’s disease treatment, as both can cause hyperkalaemia.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
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  • Question 22 - A mother brings her 8-year-old daughter to her General Practitioner, who is acutely...

    Incorrect

    • A mother brings her 8-year-old daughter to her General Practitioner, who is acutely unwell and has a high temperature, runny nose and inflamed eyes. The mother explains that her daughter has not had her vaccinations as she is worried about the long-term effects of the measles, mumps and rubella (MMR) jab.
      Which of the following best reflects the current understanding of measles infection?

      Your Answer:

      Correct Answer: It is more dangerous in overcrowded households

      Explanation:

      Measles: Symptoms, Complications, and Prevention

      Measles is a highly contagious viral infection that can lead to serious respiratory complications such as pneumonia, bronchiolitis, and bronchiectasis. While it does not cause recurrent pneumothoraces, severe infection from prolonged exposure to infected siblings in overcrowded households can be fatal.

      Koplik’s spots, small red spots with bluish-white centers, are a characteristic late sign of measles infection that may appear on the mucous membranes of the mouth 1-2 days before the rash appears.

      Contrary to popular belief, lifelong immunity is often established after natural infection with measles. This is also the mechanism by which the MMR vaccine prevents measles infection in later life.

      Measles can also lead to corneal ulceration, especially in cases of vitamin A deficiency. High-dose oral vitamin A supplementation is recommended for all children with measles in developing countries to prevent this complication.

      Overall, prevention through vaccination is the best way to avoid the serious complications of measles.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 23 - A 62-year-old female presents with a red eye on one side that is...

    Incorrect

    • A 62-year-old female presents with a red eye on one side that is watering but not causing any pain. She has a history of well-managed Crohn's disease and reports feeling generally healthy. Her vital signs are normal. Upon examination, a small area of redness is observed, but there is no vision impairment, and the patient does not display any sensitivity to light. Eye drops are given, resulting in a brief whitening of the blood vessels. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Episcleritis

      Explanation:

      Episcleritis is a condition that can cause redness in the eye, but it is typically not accompanied by pain.

      Both episcleritis and scleritis can cause unilateral redness in the eye, tearing, and no sensitivity to light. However, a key difference between the two is that the use of phenylephrine or neosynephrine eye drops will cause the blood vessels in episcleritis to become pale, while this will not occur in scleritis.

      In contrast, closed-angle glaucoma often presents with a painful, red eye that is unilateral. The cornea may appear hazy, and the pupil may be mid-dilated. Patients may also experience nausea, vomiting, and see halos around lights.

      A stye, or hordeolum, is a bacterial infection of one of the glands in the eyelid. This can cause a tender, red bump on the edge of the eyelid.

      Retrobulbar hemorrhage can occur due to various factors, such as AV malformation, trauma, or increased venous pressure. Symptoms include a painful, red eye that may protrude, particularly at night. Patients may also experience reduced vision, nausea, vomiting, and double vision.

      Understanding Episcleritis

      Episcleritis is a condition that involves the sudden onset of inflammation in the episclera of one or both eyes. While the majority of cases are idiopathic, there are some associated conditions such as inflammatory bowel disease and rheumatoid arthritis. Symptoms of episcleritis include a red eye, mild pain or irritation, watering, and mild photophobia. However, unlike scleritis, episcleritis is typically not painful.

      One way to differentiate between the two conditions is by applying gentle pressure on the sclera. If the injected vessels are mobile, it is likely episcleritis. In contrast, scleritis involves deeper vessels that do not move. Phenylephrine drops may also be used to distinguish between the two conditions. If the eye redness improves after phenylephrine, a diagnosis of episcleritis can be made.

      Approximately 50% of cases of episcleritis are bilateral. Treatment for episcleritis is typically conservative, with artificial tears sometimes being used. Understanding the symptoms and differences between episcleritis and scleritis can help individuals seek appropriate treatment and management for their eye condition.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 24 - You assess a patient's eye and discovered that both pupils constrict when focusing...

    Incorrect

    • You assess a patient's eye and discovered that both pupils constrict when focusing on a nearby object but fail to narrow when exposed to bright light. What is the most frequent reason for this pupillary response in the United Kingdom?

      Your Answer:

      Correct Answer: Diabetes mellitus

      Explanation:

      In the UK, diabetes mellitus is now the most frequent cause of Argyll-Robertson pupil, as neurosyphilis is no longer commonly observed due to effective antibiotic treatment. This condition is not caused by sexually transmitted diseases such as chlamydia or gonorrhoea, nor is it associated with optic neuritis, which instead causes a Marcus Gunn pupil or Relative afferent pupillary defect.

      Argyll-Robertson Pupil: A Classic Pupillary Syndrome

      The Argyll-Robertson Pupil (ARP) is a classic pupillary syndrome that is sometimes observed in neurosyphilis. It is characterized by small, irregular pupils that do not respond to light but do respond to accommodation. A useful mnemonic for remembering this syndrome is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA).

      The ARP can be caused by various factors, including diabetes mellitus and syphilis. It is important to note that the presence of an ARP may indicate underlying neurological or systemic disease and should prompt further evaluation and management. Proper diagnosis and treatment of the underlying condition can help prevent further complications and improve patient outcomes.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 25 - A 45-year-old woman presents to her General Practitioner (GP) four weeks after suffering...

    Incorrect

    • A 45-year-old woman presents to her General Practitioner (GP) four weeks after suffering from a vomiting illness. She complains of numbness and tingling in her lower limbs which has developed over the past three days. On examination, she has weakness of ankle and knee flexion and extension, diminished knee and ankle reflexes and sensory loss below the knee. The GP arranges urgent hospital admission and she is started on treatment as soon as she arrives at the hospital.
      Which of the following is the most appropriate treatment?
      Select the SINGLE most appropriate treatment from the list below.

      Your Answer:

      Correct Answer: Intravenous immunoglobulin (IVIG)

      Explanation:

      Treatment Options for Guillain-Barré Syndrome

      Guillain–Barré syndrome (GBS) is an autoimmune disorder that affects the peripheral nerves, resulting in symmetrical weakness, hyporeflexia, and paraesthesia. The condition often occurs after an infection, usually involving the respiratory or gastrointestinal tract. The most commonly used treatment for GBS is intravenous immunoglobulin (IVIG), which helps to reduce the severity and duration of symptoms. Plasmapheresis (plasma exchange) is another option that filters antibodies from the patient’s plasma.

      However, corticosteroids such as intravenous prednisolone have not been shown to improve GBS symptoms and may even prolong recovery. Haemodialysis is not necessary unless the patient has concurrent renal failure. Antivirals such as intravenous acyclovir have no role in managing GBS as it is not a viral illness. Although a bacterial infection may precede GBS, antibiotics such as intravenous ceftriaxone are not used to treat the autoimmune process causing the neurological symptoms. In some cases, patients with GBS may require invasive ventilation, which may cause pneumonia and require treatment with antibiotics.

    • This question is part of the following fields:

      • Neurology
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  • Question 26 - A 56-year-old woman with a history of left hip osteoarthritis comes in for...

    Incorrect

    • A 56-year-old woman with a history of left hip osteoarthritis comes in for evaluation. She is presently on a regular dose of co-codamol 30/500 for pain relief, but it is not effectively managing her symptoms. There is no significant medical history, particularly no gastrointestinal or asthma issues. What would be the most appropriate course of action for treatment?

      Your Answer:

      Correct Answer: Add oral ibuprofen + proton pump inhibitor

      Explanation:

      According to NICE, it is recommended to prescribe a PPI alongside NSAIDs for all patients with osteoarthritis. However, topical NSAIDs should only be used for osteoarthritis affecting the knee or hand.

      The Role of Glucosamine in Osteoarthritis Management

      Osteoarthritis (OA) is a common condition that affects the joints, causing pain and stiffness. The National Institute for Health and Care Excellence (NICE) published guidelines in 2014 on the management of OA, which includes non-pharmacological and pharmacological treatments. Glucosamine, a normal constituent of glycosaminoglycans in cartilage and synovial fluid, has been studied for its potential benefits in OA management.

      Several double-blind randomized controlled trials (RCTs) have reported significant short-term symptomatic benefits of glucosamine in knee OA, including reduced joint space narrowing and improved pain scores. However, more recent studies have produced mixed results. The 2008 NICE guidelines do not recommend the use of glucosamine, and a 2008 Drug and Therapeutics Bulletin review advised against prescribing it on the NHS due to limited evidence of cost-effectiveness.

      Despite the conflicting evidence, some patients may still choose to use glucosamine as a complementary therapy for OA management. It is important for healthcare professionals to discuss the potential benefits and risks of glucosamine with their patients and to consider individual patient preferences and circumstances.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 27 - A 82-year-old man is admitted to the stroke unit with a left sided...

    Incorrect

    • A 82-year-old man is admitted to the stroke unit with a left sided infarct. After receiving thrombolysis, he is now stable on the ward. The medical team wants to initiate regular antiplatelet therapy, but the patient has allergies to both aspirin and clopidogrel. What alternative medication can be prescribed for him?

      Your Answer:

      Correct Answer: Dipyridamole

      Explanation:

      If aspirin and clopidogrel cannot be used after an ischaemic stroke, MR dipyridamole may be administered as the sole antiplatelet option. Warfarin and rivaroxaban may be considered, but are more suitable for patients with AF. Bisoprolol and enoxaparin are not antiplatelet medications.

      The Royal College of Physicians (RCP) and NICE have published guidelines on the diagnosis and management of patients following a stroke. The management of acute stroke includes maintaining normal levels of blood glucose, hydration, oxygen saturation, and temperature. Blood pressure should not be lowered in the acute phase unless there are complications. Aspirin should be given as soon as possible if a haemorrhagic stroke has been excluded. Anticoagulants should not be started until brain imaging has excluded haemorrhage. Thrombolysis with alteplase should only be given if administered within 4.5 hours of onset of stroke symptoms and haemorrhage has been definitively excluded. Mechanical thrombectomy is a new treatment option for patients with an acute ischaemic stroke. NICE recommends thrombectomy for people who have acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography or magnetic resonance angiography. Secondary prevention includes the use of clopidogrel and dipyridamole. Carotid artery endarterectomy should only be considered if carotid stenosis is greater than 70% according to ECST criteria or greater than 50% according to NASCET criteria.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 28 - A 38-year-old woman underwent bowel resection and 48 hours post-operation, she became breathless,...

    Incorrect

    • A 38-year-old woman underwent bowel resection and 48 hours post-operation, she became breathless, tachycardic, tachypnoeic and complained of pleuritic chest pain.
      Which of the following is the most definitive investigation to request?

      Your Answer:

      Correct Answer: CT pulmonary angiogram (CTPA)

      Explanation:

      Diagnostic Tests for Pulmonary Embolism: A Comparison

      Pulmonary embolism (PE) is a serious medical condition that requires prompt diagnosis and treatment. There are several diagnostic tests available for PE, but not all are equally effective. Here, we compare the most commonly used tests and their suitability for diagnosing PE.

      CT pulmonary angiogram (CTPA) is the gold standard diagnostic test for PE. It is highly sensitive and specific, making it the most definitive investigation for PE. Patients with a history of recent surgery and subsequent symptoms pointing towards PE should undergo a CTPA.

      Electrocardiography (ECG) is not a first-line diagnostic test for PE. Although classic ECG changes may occur in some patients with PE, they are not specific to the condition and may also occur in individuals without PE.

      Chest radiograph is less definitive than CTPA for diagnosing PE. While it may show some abnormalities, many chest radiographs are normal in PE. Therefore, it is not a reliable test for diagnosing PE.

      Echocardiogram may show right-sided heart dysfunction in very large PEs, but it is not a first-line diagnostic test for PE and is not definitive in the investigation of PE.

      Positron emission tomography (PET)/CT of the chest is not recommended for the investigation of PE. It is a radioisotope functional imaging technique used in the imaging of tumours and neuroimaging, but not for diagnosing PE.

      In conclusion, CTPA is the most definitive diagnostic test for PE and should be used in patients with a high suspicion of the condition. Other tests may be used in conjunction with CTPA or in specific cases, but they are not as reliable or definitive as CTPA.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 29 - A man of 45 years presents following the death of his wife.
    Which one...

    Incorrect

    • A man of 45 years presents following the death of his wife.
      Which one of the following is going to heighten your suspicion of an abnormal grief reaction?

      Your Answer:

      Correct Answer: Delayed or absent grief

      Explanation:

      Understanding Abnormal and Normal Grief Reactions

      Grief is a highly individualized experience that can be influenced by personal, social, and cultural factors. There are three recognized types of abnormal grief reactions: delayed, inhibited, and prolonged. Delayed grief is characterized by a delay of more than two weeks before grieving begins, or sometimes not occurring at all until triggered by another subsequent bereavement. Inhibited grief occurs when the bereaved person appears minimally affected by the death, and prolonged grief lasts significantly longer than average.

      On the other hand, normal grief reactions are characterized by features such as sadness, weeping, poor sleep, reduced appetite, motor restlessness, searching for the deceased, poor concentration and memory, low mood (but not frank depression), and the impression of seeing or hearing the deceased. Poor memory, brief episodes of seeing the dead person, poor concentration, and searching for the deceased are all common manifestations of a normal grief reaction.

      It is important to note that there is a great degree of flexibility when assessing whether a grief reaction is normal or abnormal, as it is a highly personal experience. Understanding the different types of grief reactions can help individuals and their loved ones navigate the grieving process and seek appropriate support.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 30 - A 61-year-old man with a known history of type 2 diabetes mellitus, atrial...

    Incorrect

    • A 61-year-old man with a known history of type 2 diabetes mellitus, atrial fibrillation and epilepsy presents with a complaint of feeling generally unwell. He reports a blue tinge to his vision. Which medication is most likely responsible for this symptom?

      Your Answer:

      Correct Answer: Sildenafil

      Explanation:

      Drug-induced visual alterations
      Viagra, also known as ‘the blue pill’, can cause blue-tinted vision. Digoxin, on the other hand, may result in yellow-green vision.

      Understanding Phosphodiesterase Type V Inhibitors

      Phosphodiesterase type V (PDE5) inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. These drugs work by increasing the levels of cGMP, which leads to the relaxation of smooth muscles in the blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which was the first drug of its kind. It is a short-acting medication that is usually taken one hour before sexual activity.

      Other PDE5 inhibitors include tadalafil (Cialis) and vardenafil (Levitra). Tadalafil is longer-acting than sildenafil and can be taken on a regular basis, while vardenafil has a similar duration of action to sildenafil. However, these drugs are not suitable for everyone. Patients taking nitrates or related drugs, those with hypotension, and those who have had a recent stroke or myocardial infarction should not take PDE5 inhibitors.

      Like all medications, PDE5 inhibitors can cause side effects. These may include visual disturbances, blue discolouration, non-arteritic anterior ischaemic neuropathy, nasal congestion, flushing, gastrointestinal side-effects, headache, and priapism. It is important to speak to a healthcare professional before taking any medication to ensure that it is safe and appropriate for you.

      Overall, PDE5 inhibitors are an effective treatment for erectile dysfunction and pulmonary hypertension. However, they should only be used under the guidance of a healthcare professional and with careful consideration of the potential risks and benefits.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (0/1) 0%
Gastroenterology/Nutrition (2/2) 100%
Infectious Diseases (1/1) 100%
Musculoskeletal (2/3) 67%
Psychiatry (1/2) 50%
Renal Medicine/Urology (1/1) 100%
Pharmacology/Therapeutics (0/1) 0%
Respiratory Medicine (0/1) 0%
Ophthalmology (1/2) 50%
Dermatology (1/1) 100%
Passmed