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  • Question 1 - A 75-year-old woman is recuperating after an emergency Hartmann's procedure was carried out...

    Correct

    • A 75-year-old woman is recuperating after an emergency Hartmann's procedure was carried out for an obstructing sigmoid cancer. The pathology report reveals a moderately differentiated adenocarcinoma that has invaded the muscularis propria, with 3 out of 15 lymph nodes indicating signs of disease. What stage is this cancer at?

      Your Answer: Dukes stage C

      Explanation:

      This is classified as Dukes C due to the presence of lymph node involvement. In the Astler Coller classification system, subsets B and C are further divided into B1, B2, C1, and C2. C2 specifically indicates the involvement of lymph nodes along with the penetration of the muscularis propria.

      Dukes’ Classification: Stages of Colorectal Cancer

      Dukes’ classification is a system used to describe the extent of spread of colorectal cancer. It is divided into four stages, each with a different level of severity and prognosis. Stage A refers to a tumour that is confined to the mucosa, with a 95% 5-year survival rate. Stage B describes a tumour that has invaded the bowel wall, with an 80% 5-year survival rate. Stage C indicates the presence of lymph node metastases, with a 65% 5-year survival rate. Finally, Stage D refers to distant metastases, with a 5% 5-year survival rate (although this increases to 20% if the metastases are resectable).

      Overall, Dukes’ classification is an important tool for doctors to use when determining the best course of treatment for patients with colorectal cancer. By understanding the stage of the cancer, doctors can make more informed decisions about surgery, chemotherapy, and other treatments. Additionally, patients can use this information to better understand their prognosis and make decisions about their own care.

    • This question is part of the following fields:

      • Surgery
      25
      Seconds
  • Question 2 - A 30-year-old man visited his doctor to determine his cardiac risk. He had...

    Incorrect

    • A 30-year-old man visited his doctor to determine his cardiac risk. He had a significant family history of ischaemic heart disease, and his fasting plasma low-density lipoprotein (LDL) cholesterol level was 9.9 mmol/l. He was prescribed simvastatin 40 mg to be taken at night. What is the mode of action of simvastatin?

      Your Answer: Peroxisome proliferator-activated receptor (PPAR)-α receptor agonist

      Correct Answer: Decreases de novo cholesterol synthesis

      Explanation:

      Modes of Action of Cholesterol-Lowering Agents

      Cholesterol-lowering agents work through various mechanisms to reduce the levels of low-density lipoprotein (LDL) cholesterol, also known as bad cholesterol, in the blood. Here are some of the modes of action of these agents:

      1. HMG CoA reductase inhibitors: These agents, also known as statins, inhibit the enzyme that is responsible for the rate-limiting step in the synthesis of cholesterol. By reducing de novo cholesterol synthesis, statins decrease LDL cholesterol levels.

      2. Bile acid sequestrants: These agents bind bile acids in the intestine, preventing their reabsorption and promoting excretion in the faeces. As a result, the liver synthesises more bile acids, which requires cholesterol oxidation. By indirectly decreasing LDL cholesterol levels through increased bile acid synthesis, bile acid sequestrants are effective in treating hyperlipidaemia.

      3. HDL cholesterol increasers: Fibrates and niacin are agents that increase the levels of high-density lipoprotein (HDL) cholesterol, also known as good cholesterol. Fibrates activate PPAR-α, intracellular receptors that affect the transcription of genes involved in lipid metabolism. This results in an increase in HDL cholesterol, with a reduction in LDL cholesterol and triglycerides.

      4. Pancreatic lipase inhibitors: Orlistat is a drug that inhibits the action of pancreatic lipase, an enzyme that breaks down and absorbs fat from the diet. By decreasing the absorption of fat, orlistat can help with weight loss.

      Each of these modes of action has its own set of side-effects, which should be carefully considered before starting treatment.

    • This question is part of the following fields:

      • Pharmacology
      53.8
      Seconds
  • Question 3 - A man in his early 60s is undergoing treatment for high blood pressure....

    Incorrect

    • A man in his early 60s is undergoing treatment for high blood pressure. During a dental check-up, his dentist informs him that he has gingival hyperplasia. Which medication is the most probable culprit for this condition?

      Your Answer: Telmisartan

      Correct Answer: Nifedipine

      Explanation:

      Drugs Associated with Gingival Hyperplasia

      Gingival hyperplasia is a condition characterized by an overgrowth of gum tissue, which can lead to discomfort, difficulty in maintaining oral hygiene, and even tooth loss. There are several drugs that have been associated with this condition, including Phenytoin, Ciclosporin, and Nifedipine. These drugs are commonly used to treat various medical conditions, such as epilepsy, organ transplant rejection, and hypertension.

      According to Medscape, drug-induced gingival hyperplasia is a well-known side effect of these medications. The exact mechanism by which these drugs cause gingival hyperplasia is not fully understood, but it is believed to be related to their effect on the immune system and the production of collagen in the gums.

      It is important for healthcare providers to be aware of this potential side effect when prescribing these medications, and to monitor patients for any signs of gingival hyperplasia. Patients who are taking these drugs should also be advised to maintain good oral hygiene and to visit their dentist regularly for check-ups and cleanings.

      In summary, Phenytoin, Ciclosporin, and Nifedipine are drugs that have been associated with gingival hyperplasia. Healthcare providers should be aware of this potential side effect and monitor patients accordingly, while patients should maintain good oral hygiene and visit their dentist regularly.

    • This question is part of the following fields:

      • Cardiology
      20.6
      Seconds
  • Question 4 - A 50-year-old male has a history of severe rheumatoid arthritis for the past...

    Correct

    • A 50-year-old male has a history of severe rheumatoid arthritis for the past four years. Despite being compliant with therapy (NSAIDs and methotrexate), the disease remains poorly controlled. Recently, he has been experiencing extreme fatigue. Upon conducting an FBC, the following results were obtained:
      - Haemoglobin 70 g/L (120-160)
      - White cell count 1.5 ×109/L (4-11)
      - Platelet count 40 ×109/L (150-400)

      What could be the possible cause of his pancytopenia?

      Your Answer: Methotrexate

      Explanation:

      Pancytopenia in a Patient with Erosive Rheumatoid Arthritis

      This patient is showing signs of pancytopenia, a condition where there is a decrease in all three blood cell types (red blood cells, white blood cells, and platelets). Given her history of erosive rheumatoid arthritis for the past three years, it is likely that she has been on immunosuppressive therapy, which can lead to this type of blood disorder.

      Immunosuppressive drugs such as methotrexate, sulfasalazine, penicillamine, and gold can all have an impact on blood cell production and lead to pancytopenia. It is important to monitor patients on these medications for any signs of blood disorders and adjust treatment accordingly. Early detection and management can prevent further complications and improve patient outcomes.

    • This question is part of the following fields:

      • Haematology
      40.6
      Seconds
  • Question 5 - A 25 year old patient presents to the accident and emergency department after...

    Correct

    • A 25 year old patient presents to the accident and emergency department after being involved in a fight an hour ago. Due to being intoxicated, the patient is unable to provide much history. Upon examination, the patient has significant facial swelling on the lower left side and bruising around the left eye. The patient does not experience tenderness when palpated on either side of the nose. However, when asked to bite down, the patient complains of an unusual sensation in their mouth, and the left side teeth come together before the right side. Additionally, two teeth are missing on the left side. What would be the most appropriate next investigation?

      Your Answer: Mandible radiography with (orthopantogram)

      Explanation:

      Imaging for Mandibular Fractures: Options and Considerations

      Mandibular fractures are less common now with the use of seat belts in motor vehicles, but they still occur, especially in young males. A standard mandible series, including a PA view, Towne view, and left and right oblique views, along with an orthopantogram (OPG), can provide a full evaluation of the mandible and teeth. If further imaging is needed, a CT of the facial skeleton and mandible may be necessary.

      In cases of suspected mandibular fractures, it is important to document the function of the marginal mandibular nerve and sensation over the chin. If teeth are missing, a chest X-ray may be necessary to check for inhaled foreign bodies. Lateral facial radiographs are not typically used for the facial skeleton, and MRI is not the first choice for bony injuries but can be useful for evaluating TMJ pathology.

      It is important to consider the potential risks and benefits of each imaging option, especially in terms of ionizing radiation exposure. Chest radiographs and CT scans involve higher doses of radiation and should not be the first choice unless necessary. Overall, a thorough evaluation of mandibular fractures requires careful consideration of the patient’s individual needs and circumstances.

    • This question is part of the following fields:

      • Plastics
      35.9
      Seconds
  • Question 6 - A 54-year-old construction worker presents with complaints of pain and swelling in the...

    Incorrect

    • A 54-year-old construction worker presents with complaints of pain and swelling in the right kneecap. The patient reports difficulty bending the knee, and the symptoms are impacting his ability to work.
      Based on the history and examination, the clinician suspects a diagnosis of 'housemaid's knee'.
      'Housemaid's knee' is characterized by inflammation of the:

      Your Answer: Infrapatellar bursa

      Correct Answer: Prepatellar bursa

      Explanation:

      Bursae of the Knee: Locations and Causes of Inflammation

      The knee joint is surrounded by several small fluid-filled sacs called bursae, which act as cushions between bones, tendons, and muscles. However, these bursae can become inflamed due to repetitive stress or injury, causing pain and discomfort. Here are some of the bursae located around the knee joint and their associated conditions:

      1. Prepatellar bursa: This bursa is located between the skin and the kneecap and can become inflamed due to repeated friction, such as in professions that require prolonged kneeling.

      2. Popliteus bursa: This bursa lies between the popliteus tendon and the lateral condyle of the tibia and can become inflamed due to overuse or injury.

      3. Suprapatellar bursa: This bursa can be felt during a knee exam and may become inflamed due to trauma or infection.

      4. Infrapatellar bursa: This bursa is located below the kneecap and can become inflamed due to repetitive kneeling, hence the name clergyman’s knee.

      5. Semimembranous bursa: This bursa is located at the back of the knee and can become inflamed due to injury or underlying conditions such as arthritis.

      In conclusion, understanding the locations and causes of knee bursitis can help individuals take preventive measures and seek appropriate treatment when necessary.

    • This question is part of the following fields:

      • Orthopaedics
      26.2
      Seconds
  • Question 7 - A 55-year-old male in the postoperative ICU with a central line catheter is...

    Incorrect

    • A 55-year-old male in the postoperative ICU with a central line catheter is experiencing intermittent fevers. What is the probable microorganism responsible for this condition?

      Your Answer: Pseudomonas spp.

      Correct Answer: Coagulase-negative Staphylococci

      Explanation:

      Coagulase-Negative Staphylococci: Commonly Isolated Bacteria in Clinical Microbiology Laboratories

      Coagulase-negative Staphylococci are frequently encountered in clinical microbiology laboratories. These bacteria, including Staphylococcus epidermidis, are susceptible to novobiocin and have become a significant cause of infection, especially in patients who are hospitalized and have foreign bodies implanted or those who have weakened immune systems.

      The prevalence of coagulase-negative Staphylococci in clinical settings highlights the importance of identifying and treating these bacteria promptly. With the rise of antibiotic resistance, it is crucial to monitor the susceptibility patterns of these organisms to ensure effective treatment. By the characteristics and potential risks associated with coagulase-negative Staphylococci, healthcare providers can take appropriate measures to prevent and manage infections caused by these bacteria.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      20.6
      Seconds
  • Question 8 - How should a double blind placebo control clinical trial be conducted correctly? ...

    Correct

    • How should a double blind placebo control clinical trial be conducted correctly?

      Your Answer: The clinician assessing the effects of the treatment does not know which treatment the patient has been given

      Explanation:

      Double Blind Placebo Control Clinical Trials

      Double blind placebo control clinical trials are a common method used in medical research to test the effectiveness of new treatments. In this type of trial, all patients are blind to the treatment choice, meaning they do not know whether they are receiving the actual treatment or a placebo. However, it is important to note that not all patients may receive treatment in this type of trial, as some may be assigned to a control group that does not receive any treatment.

      One key aspect of double blind placebo control clinical trials is that the clinician assessing the effects of the treatment is also blind to the treatment choice. This means that the clinician does not know whether the patient has received the actual treatment or the placebo. This helps to eliminate any potential bias in the assessment of the treatment effectiveness.

      It is important to understand the difference between a double blind placebo control clinical trial and a double blind crossover study. In a double blind crossover study, every patient receives both treatments, whereas in a double blind placebo control clinical trial, only some patients may receive the actual treatment while others receive the placebo or no treatment at all.

      Overall, double blind placebo control clinical trials are a rigorous and effective method for testing the effectiveness of new treatments. By eliminating bias and ensuring that patients are blind to the treatment choice, these trials provide valuable insights into the safety and efficacy of new medical interventions.

    • This question is part of the following fields:

      • Clinical Sciences
      11
      Seconds
  • Question 9 - A 28-year-old woman who is 30 weeks pregnant arrives at the emergency assessment...

    Correct

    • A 28-year-old woman who is 30 weeks pregnant arrives at the emergency assessment unit with concerns of fluid leakage from her vagina. Upon examination, her pad is saturated with what appears to be amniotic fluid. What component of the fluid may indicate premature rupture of membranes (PROM)?

      Your Answer: Alpha fetoprotein

      Explanation:

      Using Biomarkers to Detect Premature Rupture of Membranes

      Premature rupture of membranes (PROM) can be difficult to diagnose in some cases. In 2006, a study was conducted to determine if measuring certain biomarkers in vaginal fluid could be used as an indicator of membrane rupture. The study found that alpha-fetoprotein (AFP) had the highest accuracy in predicting PROM, with a specificity and sensitivity of 94%. This suggests that AFP could be used as a marker in cases where diagnosis is uncertain.

      In addition to AFP, other biomarkers have been identified for different purposes. Carcinoembryonic antigen (CEA) is a tumor marker for colon cancer, while cancer antigen 125 (CA125) is a tumor marker for ovarian cancer. By measuring these biomarkers, doctors can detect the presence of cancer and monitor its progression. Overall, biomarkers have proven to be a valuable tool in diagnosing and monitoring various medical conditions.

    • This question is part of the following fields:

      • Haematology
      25.2
      Seconds
  • Question 10 - A 16-year-old girl is playing volleyball and suffers an anterior dislocation of her...

    Incorrect

    • A 16-year-old girl is playing volleyball and suffers an anterior dislocation of her right shoulder. She is taken to the Emergency department where her humerus is reduced under sedation. Which area should be tested for sensation to determine the nerve that is most likely to have been affected during the dislocation?

      Your Answer: Thumb

      Correct Answer: Regimental badge distribution

      Explanation:

      Nerve Damage from Shoulder Dislocation

      Shoulder dislocation can cause damage to the axillary nerve, which is responsible for supplying sensation to the upper part of the arm. This nerve is the most likely to be affected during a dislocation. The axillary nerve also controls the deltoid muscle, which can be examined to assess motor sensation.

    • This question is part of the following fields:

      • Clinical Sciences
      52.4
      Seconds
  • Question 11 - A 25-year-old woman who is a law student has severe anxiety about public...

    Correct

    • A 25-year-old woman who is a law student has severe anxiety about public speaking and in informal social settings. She avoids situations where she might have to enter into conversations with strangers. She reports that she thinks others are frustrated by her inability in casual social interactions and that she ‘feels stupid and awkward’. Her social problems are also affecting her academic performance. She is considering leaving university for a less stressful environment.
      Which is the most appropriate form of psychotherapy for this woman?

      Your Answer: Cognitive behavioural therapy

      Explanation:

      Choosing the Right Treatment for Social Phobia: Cognitive Behavioural Therapy

      Social phobia is a type of anxiety disorder that can cause panic and avoidance of social situations. For patients with this condition, cognitive behavioural therapy (CBT) is often the best treatment option. CBT can help patients identify and change negative thought patterns that contribute to their anxiety, and it often includes exposure therapy as a component.

      Other treatment options, such as vocational counselling or psychoanalytic psychotherapy, may not be as effective for social phobia. Suggesting these options could reinforce the patient’s belief that their symptoms cannot be treated therapeutically. Network therapy is designed for substance abusers, and self-help groups may be helpful for some patients, but only if they can manage their anxiety enough to participate effectively.

      In summary, for patients with social phobia, cognitive behavioural therapy is the most effective treatment option. It can help patients overcome their anxiety and improve their quality of life.

    • This question is part of the following fields:

      • Psychiatry
      25.6
      Seconds
  • Question 12 - A 45-year-old male presents with symptoms of polyuria and polydipsia. He is a...

    Correct

    • A 45-year-old male presents with symptoms of polyuria and polydipsia. He is a non-smoker and drinks approximately 12 units of alcohol per week. He works as a taxi driver.

      During examination, his BMI is found to be 33.4 kg/m2, and his blood pressure is 132/82 mmHg. All other aspects of his cardiovascular examination are normal.

      Further investigations confirm a diagnosis of diabetes mellitus, with the following results:
      - Fasting blood glucose: 12.1 mmol/L (3.0-6.0)
      - HbA1c: 75 mmol/mol (20-42)
      - Total cholesterol: 5.8 mmol/L (<5.2)

      What would be the most appropriate initial treatment for this patient?

      Your Answer: Diet and lifestyle advice with metformin

      Explanation:

      Early Use of Metformin for Type 2 Diabetes

      Typical type 2 diabetes can be managed with diet and lifestyle advice along with metformin. However, the EASD/ADA guidelines were revised in 2007-2008 due to the growing evidence supporting the early use of metformin. As a result, relying solely on diet and lifestyle advice is no longer considered sufficient.

      The updated guidelines emphasize the importance of early intervention with metformin to improve glycemic control and prevent complications associated with type 2 diabetes. This approach is particularly important for patients who are at high risk of developing cardiovascular disease or have other comorbidities. By starting treatment early, patients can achieve better outcomes and reduce the risk of long-term complications.

      In summary, the early use of metformin is now recommended as a first-line treatment for type 2 diabetes, along with diet and lifestyle modifications. This approach can help patients achieve better glycemic control and reduce the risk of complications associated with the disease.

    • This question is part of the following fields:

      • Endocrinology
      36.8
      Seconds
  • Question 13 - A 6-month-old baby girl is presented to the GP by her mother who...

    Incorrect

    • A 6-month-old baby girl is presented to the GP by her mother who noticed a bulge in her groin area. The baby is healthy and there are no other concerns reported. During the examination, a mass is observed and palpated in the right inguinal region. The mass cannot be transilluminated but can be reduced. What is the most suitable management plan for this probable diagnosis?

      Your Answer: Reassure and observe over the next 3 months

      Correct Answer: Urgent referral for surgery

      Explanation:

      An infant with a mass in the inguinal region is diagnosed with an inguinal hernia. Urgent surgery is necessary due to the high risk of strangulation in infants. If signs of strangulation are present, emergency care should be sought immediately. Referring for an ultrasound scan is not necessary as the diagnosis is clear. Routine referral is not appropriate as urgent referral is required. Re-review in 1 week with safety-netting is inadequate and reassuring and observing over the next 3 months is not an option as this condition requires urgent intervention.

      Paediatric Inguinal Hernia: Common Disorder in Children

      Inguinal hernias are a frequent condition in children, particularly in males, as the testis moves from its location on the posterior abdominal wall down through the inguinal canal. A patent processus vaginalis may persist and become the site of subsequent hernia development. Children who present in the first few months of life are at the highest risk of strangulation, and the hernia should be repaired urgently. On the other hand, children over one year of age are at a lower risk, and surgery may be performed electively. For paediatric hernias, a herniotomy without implantation of mesh is sufficient. Most cases are performed as day cases, while neonates and premature infants are kept in the hospital overnight due to the recognized increased risk of postoperative apnoea.

    • This question is part of the following fields:

      • Surgery
      26
      Seconds
  • Question 14 - In clozapine-treated patients, what is the treatment for hypersalivation? ...

    Incorrect

    • In clozapine-treated patients, what is the treatment for hypersalivation?

      Your Answer: Propranolol

      Correct Answer: Hyoscine

      Explanation:

      Treatment for Clozapine-Induced Hypersalivation: Hyoscine and Other Options

      Hypersalivation, or excessive saliva production, is a common side effect of clozapine treatment. While it usually subsides over time, it can be distressing for patients and may even pose a risk of aspiration pneumonia. Limited trial data exists on treatments for clozapine-induced hypersalivation, but hyoscine, a type of anticholinergic medication, is commonly used. Other options include pirenzepine and benzhexol. It’s important to note that procyclidine is typically used for acute dystonia, not hypersalivation, and medications like propranolol, risperidone, and lorazepam are not indicated for this side effect.

    • This question is part of the following fields:

      • Psychiatry
      31.9
      Seconds
  • Question 15 - A 55-year-old man was brought to the Emergency Department following a car accident....

    Incorrect

    • A 55-year-old man was brought to the Emergency Department following a car accident. Upon examination, there are no visible signs of external bleeding, but his blood pressure is 90/40 mmHg and his heart rate is 120 bpm. He presents with distended neck veins and muffled heart sounds.

      What is the most probable echocardiogram finding in this case?

      Your Answer: Haemothorax

      Correct Answer: Pericardial effusion

      Explanation:

      Differential Diagnosis for a Trauma Patient with Beck’s Triad

      When a trauma patient presents with hypotension, tachycardia, distended neck veins, and muffled heart sounds, the clinician should suspect pericardial effusion, also known as cardiac tamponade. This condition occurs when fluid accumulates in the pericardial space, compressing the heart and impairing its function. In the context of chest trauma, pericardial effusion is a life-threatening emergency that requires prompt diagnosis and treatment.

      Other conditions that may cause similar symptoms but have different underlying mechanisms include mitral regurgitation, pneumothorax, haemothorax, and pleural effusion. Mitral regurgitation refers to the backflow of blood from the left ventricle to the left atrium due to a faulty mitral valve. While it can be detected on an echocardiogram, it is unlikely to cause Beck’s triad as it does not involve fluid accumulation outside the heart.

      Pneumothorax is the presence of air in the pleural space, which can cause lung collapse and respiratory distress. A tension pneumothorax, in which air accumulates under pressure and shifts the mediastinum, can also compress the heart and impair its function. However, it would not be visible on an echocardiogram, which focuses on the heart and pericardium.

      Haemothorax is the accumulation of blood in the pleural space, usually due to chest trauma or surgery. Like pneumothorax, it can cause respiratory compromise and hypovolemia, but it does not affect the heart directly and would not cause Beck’s triad.

      Pleural effusion is a generic term for any fluid accumulation in the pleural space, which can be caused by various conditions such as infection, cancer, or heart failure. While it may cause respiratory symptoms and chest pain, it does not affect the heart’s function and would not cause Beck’s triad or be visible on an echocardiogram.

      In summary, a trauma patient with Beck’s triad should be evaluated for pericardial effusion as the most likely cause, but other conditions such as tension pneumothorax or haemothorax should also be considered depending on the clinical context. An echocardiogram can help confirm or rule out pericardial effusion and guide further management.

    • This question is part of the following fields:

      • Cardiology
      17.5
      Seconds
  • Question 16 - A 4-year-old boy is brought to his pediatrician by his father. He has...

    Correct

    • A 4-year-old boy is brought to his pediatrician by his father. He has been experiencing a dry cough and runny nose for the past 7 days, along with a 6-day history of fevers up to 38.7ºC that have not responded to paracetamol and ibuprofen.

      During the examination, the boy appears generally unwell and unhappy. His tongue is bright red, and there is a maculopapular rash on his trunk. Bilateral conjunctival injection is present, but there is no apparent discharge. Additionally, palpable submandibular lymphadenopathy is observed.

      What investigation should be utilized to screen for long-term complications, given the probable diagnosis?

      Your Answer: Echocardiogram

      Explanation:

      An echocardiogram should be used to screen for coronary artery aneurysms, which are a complication of Kawasaki disease. To diagnose Kawasaki disease, a child must have a fever for at least 5 days and meet 4 out of 5 diagnostic criteria, including oropharyngeal changes, changes in the peripheries, bilateral non purulent conjunctivitis, polymorphic rash, and cervical lymphadenopathy. This disease is the most common cause of acquired cardiac disease in childhood, and it is important to exclude coronary artery aneurysms. Echocardiograms are a noninvasive and appropriate screening modality for this complication, as they do not expose the child to ionising radiation. Antistreptolysin O antibody titres, CT coronary angiogram, and ECG are not appropriate screening modalities for coronary artery aneurysms associated with Kawasaki disease.

      Understanding Kawasaki Disease

      Kawasaki disease is a rare type of vasculitis that primarily affects children. It is important to identify this disease early on as it can lead to serious complications, such as coronary artery aneurysms. The disease is characterized by a high-grade fever that lasts for more than five days and is resistant to antipyretics. Other symptoms include conjunctival injection, bright red, cracked lips, strawberry tongue, cervical lymphadenopathy, and red palms and soles that later peel.

      Diagnosis of Kawasaki disease is based on clinical presentation as there is no specific diagnostic test available. Management of the disease involves high-dose aspirin, which is one of the few indications for aspirin use in children. Intravenous immunoglobulin is also used as a treatment option. Echocardiogram is the initial screening test for coronary artery aneurysms, rather than angiography.

      Complications of Kawasaki disease can be serious, with coronary artery aneurysm being the most common. It is important to recognize the symptoms of Kawasaki disease early on and seek medical attention promptly to prevent potential complications.

    • This question is part of the following fields:

      • Paediatrics
      34.3
      Seconds
  • Question 17 - A 35-year-old man presents with a 5-day history of pain and swelling affecting...

    Correct

    • A 35-year-old man presents with a 5-day history of pain and swelling affecting the right knee and left ankle. On further questioning, he complained of dysuria and had woken with both eyes ‘stuck together’ for the last three days. He thinks that his urinary symptoms may be linked to the unprotected sex he had three weeks ago. Which of the following is the most likely diagnosis?

      Your Answer: Reactive arthritis

      Explanation:

      Differential Diagnosis for a Patient with Reactive Arthritis Symptoms

      A patient presents with arthropathy, conjunctivitis, and urethritis, which are classic symptoms of reactive arthritis. The probable underlying cause is chlamydial infection or gonorrhea, as the patient has had recent unprotected sex. Primary syphilis, genital herpes, trichomoniasis, and E. coli infection are unlikely differential diagnoses. Syphilis causes a painless sore on the genitals, while genital herpes presents with blisters and is not associated with arthropathy. Trichomoniasis is commonly asymptomatic and presents with dysuria, frequency, and balanitis in men. E. coli is a common cause of UTI, but the patient’s symptoms are broader than those of a typical UTI.

    • This question is part of the following fields:

      • Rheumatology
      30.5
      Seconds
  • Question 18 - Disease prevention measures can be categorized as primary or secondary. What is an...

    Incorrect

    • Disease prevention measures can be categorized as primary or secondary. What is an example of a secondary prevention measure?

      Your Answer: Offering smoking cessation services

      Correct Answer: Screening for breast cancer

      Explanation:

      Examples of Primary and Secondary Prevention Measures

      Primary and secondary prevention measures are important in healthcare to prevent the onset or progression of diseases. Primary prevention involves preventing a disease before it even starts, while secondary prevention involves early detection and treatment of a disease.

      Examples of primary prevention measures include annual influenzae vaccination, giving away free condoms in general practice to prevent STIs, introducing healthy school meals to prevent obesity, and offering smoking cessation services to prevent lung cancer.

      On the other hand, breast cancer screening is an example of a secondary prevention measure. Its aim is to detect early breast cancer so that it can be treated before it is too late. By implementing both primary and secondary prevention measures, healthcare providers can work towards reducing the burden of diseases and improving overall health outcomes.

    • This question is part of the following fields:

      • Statistics
      24
      Seconds
  • Question 19 - A 67-year-old woman was admitted to the hospital after collapsing while shopping. During...

    Incorrect

    • A 67-year-old woman was admitted to the hospital after collapsing while shopping. During her inpatient investigations, she underwent cardiac catheterisation. The results of the procedure are listed below, including oxygen saturation levels, pressure measurements, and end systolic/end diastolic readings at various anatomical sites.

      - Superior vena cava: 75% oxygen saturation, no pressure measurement available
      - Right atrium: 73% oxygen saturation, 6 mmHg pressure
      - Right ventricle: 74% oxygen saturation, 30/8 mmHg pressure (end systolic/end diastolic)
      - Pulmonary artery: 74% oxygen saturation, 30/12 mmHg pressure (end systolic/end diastolic)
      - Pulmonary capillary wedge pressure: 18 mmHg
      - Left ventricle: 98% oxygen saturation, 219/18 mmHg pressure (end systolic/end diastolic)
      - Aorta: 99% oxygen saturation, 138/80 mmHg pressure

      Based on these results, what is the most likely diagnosis?

      Your Answer: Hypertrophic cardiomyopathy

      Correct Answer: Aortic stenosis

      Explanation:

      Diagnosis of Aortic Stenosis

      There is a significant difference in pressure (81 mmHg) between the left ventricle and the aortic valve, indicating a critical case of aortic stenosis. Although hypertrophic obstructive cardiomyopathy (HOCM) can also cause similar pressure differences, the patient’s age and clinical information suggest that aortic stenosis is more likely.

      To determine the severity of aortic stenosis, the valve area and mean gradient are measured. A valve area greater than 1.5 cm2 and a mean gradient less than 25 mmHg indicate mild aortic stenosis. A valve area between 1.0-1.5 cm2 and a mean gradient between 25-50 mmHg indicate moderate aortic stenosis. A valve area less than 1.0 cm2 and a mean gradient greater than 50 mmHg indicate severe aortic stenosis. A valve area less than 0.7 cm2 and a mean gradient greater than 80 mmHg indicate critical aortic stenosis.

    • This question is part of the following fields:

      • Cardiology
      139.3
      Seconds
  • Question 20 - You are an FY1 in a busy A&E department. In your haste to...

    Correct

    • You are an FY1 in a busy A&E department. In your haste to finish all the jobs in time, you attain a needle stick injury while taking blood samples from a patient. The patient is known as an IV drug user.
      Which of the following is the most appropriate action?

      You are an FY1 in a busy A&E department. In your haste to finish all the jobs in time, you attain a needle stick injury while taking blood samples from a patient. The patient is known as an IV drug user.
      Which of the following is the most appropriate action?

      Your Answer: Run the injury under a cold tap and allow it to bleed

      Explanation:

      Proper Response to Needlestick Injuries: Running the Injury Under a Cold Tap

      Needlestick injuries can be frightening, especially when dealing with patients with a history of IV drug use. However, it is important to remain calm and take immediate action. The most appropriate response is to run the injury under a cold tap and encourage it to bleed. This will help to flush out any potential pathogens. Afterward, seek advice and treatment from A&E or the Occupational Health department. It is also important to report the incident to Occupational Health, but only after taking care of the injury. Going through the patient’s notes may be helpful in ordering tests for HIV and hepatitis, but it is not the first thing to do. Leaving work and going home is not an option as it is a probity issue. Remember to prioritize your own safety and seek help when needed.

    • This question is part of the following fields:

      • Ethics And Legal
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SESSION STATS - PERFORMANCE PER SPECIALTY

Surgery (1/2) 50%
Pharmacology (0/1) 0%
Cardiology (0/3) 0%
Haematology (2/2) 100%
Plastics (1/1) 100%
Orthopaedics (0/1) 0%
Anaesthetics & ITU (0/1) 0%
Clinical Sciences (1/2) 50%
Psychiatry (1/2) 50%
Endocrinology (1/1) 100%
Paediatrics (1/1) 100%
Rheumatology (1/1) 100%
Statistics (0/1) 0%
Ethics And Legal (1/1) 100%
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