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  • Question 1 - A 47-year-old man is diagnosed with hypertension after multiple readings show a blood...

    Incorrect

    • A 47-year-old man is diagnosed with hypertension after multiple readings show a blood pressure of 180/110 mmHg. Further investigation reveals a 4.3-cm right-sided adrenal lesion, and he is found to have elevated plasma free metanephrines at 3000 pmol/l (normal range: 80-510 pmol/l). He is scheduled for elective adrenalectomy. What initial treatment should be initiated to prepare this patient for surgery to remove his adrenal phaeochromocytoma?

      Your Answer: Beta-adrenergic receptor blockers

      Correct Answer: Alpha-adrenergic receptor blockers

      Explanation:

      Management of Phaeochromocytoma: Medications and Precautions

      Phaeochromocytoma is a neuroendocrine tumour that secretes adrenaline and noradrenaline, leading to sympathetic stimulation and clinical symptoms such as tachycardia, hypertension, anxiety, diaphoresis, and weight loss. Diagnosis is through measurement of catecholamines and metanephrines in plasma or urine. Surgery is required, but patients are at high risk due to potential life-threatening tachycardia and hypertension. Management includes the use of alpha-adrenergic receptor blockers such as phenoxybenzamine or doxazosin to dampen sympathetic activity. IV fluids should be readily available for potential blood loss during surgery. Beta-adrenergic receptor blockers can be used after alpha blockers, but not before to avoid unopposed alpha receptor stimulation and hypertensive crisis. Calcium channel blockers are not commonly used in phaeochromocytoma management. Low-salt diet and low fluid intake are not necessary precautions in this case, as the drop in blood pressure following surgery eliminates the risk of fluid overload.

    • This question is part of the following fields:

      • Endocrinology
      19.6
      Seconds
  • Question 2 - A 79-year-old woman presents with recent-onset confusion. She had been in her usual...

    Correct

    • A 79-year-old woman presents with recent-onset confusion. She had been in her usual state of health until she was observed to be confused and agitated during dinner yesterday. This morning, she was alert and oriented, but later in the evening, she became completely confused, agitated, and hostile. She was subsequently transported to the Emergency Department by ambulance. Additional history reveals no prior instances of confusion, but she has experienced increased frequency of urination over the past few days.
      What is the probable reason for her confusion?

      Your Answer: Urinary tract infection (UTI)

      Explanation:

      Diagnosing Delirium in an Elderly Patient: UTI vs. Dementia vs. Pyelonephritis

      When an 89-year-old woman presents with waxing and waning consciousness, punctuated by ‘sun-downing’, it is important to consider the possible causes of delirium. In this case, the patient has normal cognitive function but is experiencing acute global cerebral dysfunction. One possible cause of delirium in the elderly is a urinary tract infection (UTI), which can present with symptoms such as frequency and confusion.

      However, it is important to rule out other potential causes of delirium, such as vascular dementia or Alzheimer’s dementia. In these conditions, cognitive decline is typically steady and progressive, whereas the patient in this case is experiencing waxing and waning consciousness. Additionally, neither of these conditions would account for the patient’s new urinary symptoms.

      Another possible cause of delirium is pyelonephritis, which can present with similar symptoms to a UTI but may also include pyrexia, renal angle tenderness, and casts on urinalysis. However, in this case, the patient does not exhibit these additional symptoms.

      Finally, pseudodementia is unlikely in this scenario as the patient does not exhibit any affective signs. Overall, it is important to consider all possible causes of delirium in an elderly patient and conduct a thorough evaluation to determine the underlying condition.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      39.7
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  • Question 3 - A senior citizen is inquiring about the power of a statistical test.
    Which statement...

    Incorrect

    • A senior citizen is inquiring about the power of a statistical test.
      Which statement best describes the power of a statistical test?

      Your Answer: The probability of a type 1 error

      Correct Answer: The probability of not committing a type 2 error

      Explanation:

      Understanding Type 1 and Type 2 Errors in Scientific Studies

      When conducting a scientific study, it is important to determine whether there is a difference between two populations. A statistical test is used to analyze the results and determine if the difference is significant. However, there are two types of errors that can occur in this process.

      Type 1 errors occur when the null hypothesis is rejected, in favor of the alternative hypothesis, even though the null hypothesis is true. This is also known as a false positive and is typically set at a 5% or 1% probability level.

      Type 2 errors occur when the null hypothesis is accepted, in favor of the alternative hypothesis, even though the alternative hypothesis is true. This is also known as a false negative and is undesirable as it means that the study failed to detect a significant difference.

      The power of a test is the probability of not making a type 2 error. It depends on the sample size, effect size, and statistical significance criterion used. The p-value is the lowest level of significance at which the null hypothesis is rejected. The smaller the p-value, the stronger the evidence is in favor of the alternative hypothesis.

      Understanding these types of errors is crucial in scientific research as it helps researchers to interpret their results accurately and avoid making false conclusions.

    • This question is part of the following fields:

      • Statistics
      17.4
      Seconds
  • Question 4 - A 35-year-old woman with hypertension is considering pregnancy and seeks pre-pregnancy planning. She...

    Correct

    • A 35-year-old woman with hypertension is considering pregnancy and seeks pre-pregnancy planning. She is currently taking losartan 50 mg daily and her BP measures 130/88 mmHg. What guidance should be provided to this patient in this scenario?

      Your Answer: She should switch losartan to labetolol and ensure her BP is well controlled prior to attempting to get pregnant

      Explanation:

      Safe antihypertensive Medications for Pregnancy

      Explanation:
      When planning to get pregnant, it is important to ensure that any medications being taken are safe for the developing fetus. In the case of hypertension, switching to a safe medication prior to conception is recommended. Labetalol is the best-studied antihypertensive in pregnancy and is considered safe. Losartan, on the other hand, is contraindicated as it may affect renal development. Simply reducing the dosage of losartan is not enough to mitigate the risks of fetal maldevelopment. It is also important to maintain good blood pressure control prior to conception. Stopping antihypertensive medications abruptly is not recommended as it may lead to uncontrolled hypertension, which is associated with increased fetal loss. By taking these precautions, women can increase their chances of carrying a healthy fetus to term.

    • This question is part of the following fields:

      • Obstetrics
      118.5
      Seconds
  • Question 5 - A 35-year-old woman presents with an incidental finding of a blood pressure of...

    Correct

    • A 35-year-old woman presents with an incidental finding of a blood pressure of 180/130 mmHg on three separate occasions. Her cardiovascular examination is unremarkable, but further investigation reveals a significantly smaller left kidney with a 'string of beads' appearance in the left renal artery. What is the most appropriate management option for this patient?

      Your Answer: Balloon angioplasty

      Explanation:

      Management of Renal Artery Stenosis: Fibromuscular Dysplasia

      Fibromuscular dysplasia is a rare cause of renal artery stenosis, typically affecting young women and presenting with hypertension. The characteristic ‘string of beads’ appearance on CT imaging helps in diagnosis. While atherosclerotic disease is the most common cause of renal artery stenosis, a combination of antihypertensive therapy and renal artery balloon angioplasty is curative for fibromuscular dysplasia. Kidney transplantation is not usually required, but it is important to recognize the condition in donors to prevent complications in recipients. Nephrectomy is not typically necessary, and surgical reconstruction is rarely recommended. Statins are not used in the management of fibromuscular dysplasia, but may be used in atherosclerotic renal artery stenosis.

    • This question is part of the following fields:

      • Renal
      26.5
      Seconds
  • Question 6 - A 98-year-old gentleman is admitted for an incarcerated hernia. He has a past...

    Incorrect

    • A 98-year-old gentleman is admitted for an incarcerated hernia. He has a past medical history of chronic kidney disease stage 3, secondary to hypertension, and a background of transient ischaemic attacks (TIAs) and osteoarthritis of both knees.
      He has four good twitches on train of four testing (normal response), following which reversal of his muscle relaxant was given. Intraoperatively, he received a total of 100 micrograms of fentanyl, 20 mg of morphine and 1 g of paracetamol for pain. He has an arterial line in situ. Blood gas prior to finishing the procedure showed a pH of 7.35, PaCO2 of 5.4 kPa, HCO3− of 21 mmol/l, with a blood sugar of 7.2.
      You attempt to wean him off ventilation, but 20 minutes later he still does not want to breathe unsupported or wake up.
      What should your next course of action be?

      Your Answer: Give a second dose of muscle relaxant reversal

      Correct Answer: Give naloxone 100 micrograms iv

      Explanation:

      Medical Interventions for a Post-Operative Patient with Reduced Consciousness

      When dealing with a post-operative patient with reduced consciousness, it is important to rule out any reversible causes before administering any medical interventions. In the case of opiate toxicity, administering naloxone, an opiate antidote, can reverse the effects of the opiates. However, if the patient’s reduced Glasgow Coma Scale score and lack of respiratory effort are not caused by hypoglycemia, giving intravenous glucose is not necessary. It is also important to consider the patient’s age and wait a little longer to rule out any reversible causes. Administering a second dose of muscle relaxant reversal is unlikely to help if the patient has adequate contraction on train of four testing. Lastly, before re-sedating the patient for a CT head, it is necessary to rule out any reversible causes such as opiate toxicity.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      300.3
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  • Question 7 - A 68-year-old lady presents following a fall on her outstretched hand (FOOSH). She...

    Correct

    • A 68-year-old lady presents following a fall on her outstretched hand (FOOSH). She has marked pain around the wrist joint with bony tenderness on palpation. A wrist X-ray demonstrates a fracture of the distal radius with anterior (palmar) displacement of the distal fragment. There is no neurovascular compromise.
      Select the most appropriate initial management option.

      Your Answer: Referral to orthopaedics for reduction under anaesthetic

      Explanation:

      Treatment Options for Smith’s Fracture

      Smith’s fracture, also known as a reverse Colles’ fracture, is a type of wrist fracture where the distal radius fragment is displaced anteriorly/volarly. The following are treatment options for this type of fracture:

      Reduction under local anaesthesia: This method is not recommended for best cosmetic and functional results.

      Reduction under anaesthetic: This method involves either a manipulation under anaesthetic (MUA) or an open reduction and fixation (ORIF) for best cosmetic and functional results.

      Application of a scaphoid cast and referral to Fracture clinic: This method is not indicated for prompt reduction and possibly fixation.

      Application of a backslab plaster of Paris cast and referral to Fracture clinic the next day: This method is not appropriate for prompt reduction and possibly fixation.

      Application of a backslab plaster of Paris cast and referral to Fracture clinic in 2-6 weeks: This method is not appropriate for prompt reduction and possibly fixation.

      Treatment Options for Smith’s Fracture

    • This question is part of the following fields:

      • Orthopaedics
      31.2
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  • Question 8 - A 32-year-old Afro-Caribbean woman comes to the clinic with concerns about her appearance....

    Correct

    • A 32-year-old Afro-Caribbean woman comes to the clinic with concerns about her appearance. She has noticed hair loss, a rash on her face, and mouth ulcers. Additionally, she has been experiencing joint pain and has been taking paracetamol and ibuprofen to manage it. This is her second visit to the clinic, and the registrar has already sent off some immunology tests. The results show a positive dsDNA antibody. What is the most probable diagnosis?

      Your Answer: Systemic lupus erythematosus (SLE)

      Explanation:

      Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. It is caused by the deposition of immune complexes and can have a wide range of clinical effects, including a butterfly-shaped rash on the cheeks and nose, joint pain, and involvement of multiple organ systems such as the kidneys, lungs, and heart. SLE is associated with the presence of ANA and dsDNA antibodies, as well as low levels of C3 and C4 in the blood.

      Mixed connective tissue disease (MCTD) is a syndrome that shares features with several other rheumatological conditions, including SLE, scleroderma, myositis, and rheumatoid arthritis. Common symptoms include fatigue, joint pain, pulmonary involvement, and Raynaud’s phenomenon. MCTD is strongly associated with anti-RNP antibodies.

      Rheumatoid arthritis is an inflammatory arthritis that typically affects middle-aged women and causes symmetrical joint pain and stiffness, particularly in the hands and feet. If left untreated, it can lead to deformities that affect function. Rheumatoid arthritis is associated with the presence of autoantibodies such as rheumatoid factor and anti-CCP.

      Polymyositis is an autoimmune myositis that causes weakness and loss of muscle mass, particularly in the proximal muscles. Other symptoms may include malaise and difficulty swallowing. Polymyositis is associated with anti-Jo1 autoantibodies.

      Systemic sclerosis, also known as diffuse scleroderma, is an autoimmune disease that primarily affects women aged 30-50. It causes collagen accumulation, leading to thickening of the skin and vasculitis affecting small arteries. Systemic sclerosis can affect multiple organ systems, including the skin, lungs, kidneys, and gastrointestinal tract. It is associated with anti-Scl70 antibodies.

    • This question is part of the following fields:

      • Rheumatology
      133.6
      Seconds
  • Question 9 - A 50-year-old woman presents to the Gastroenterology Clinic with constipation that has worsened...

    Incorrect

    • A 50-year-old woman presents to the Gastroenterology Clinic with constipation that has worsened over the past six weeks. She reports straining during defecation. She has a feeling of incomplete evacuation. She has two children who were born via vaginal delivery without history of tears. She has had bladder suspension surgery. On examination, her abdomen is soft and non-distended without palpable masses.
      On digital rectal examination, she has an empty rectum. Her resting anal tone is weak but her squeeze tone is normal. She does not relax the puborectalis muscle or the external anal sphincter when simulating defecation; she also has 4-cm perineal descent with straining.
      What is the most appropriate investigation to carry out next?

      Your Answer: Colonoscopy

      Correct Answer: Magnetic resonance defecography

      Explanation:

      Magnetic resonance defecography is the most appropriate investigation for a patient with abnormal pelvic floor muscle tone, perineal descent, and symptoms of incomplete evacuation during defecation. This test evaluates global pelvic floor anatomy and dynamic motion, identifying prolapse, rectocele, and pelvic floor dysfunctions. Other tests, such as abdominal ultrasound, barium enema, colonoscopy, and CT abdomen, may not provide sufficient information on the underlying pathology of the patient’s symptoms.

    • This question is part of the following fields:

      • Gastroenterology
      110.7
      Seconds
  • Question 10 - A 5-year-old girl is brought in by ambulance after her parents awoke in...

    Incorrect

    • A 5-year-old girl is brought in by ambulance after her parents awoke in the middle of the night to a harsh coughing episode and noted she had difficulty breathing. She has been coryzal over the last 2 days but has never had any episodes like this before. The paramedics have given a salbutamol nebuliser, to some effect, but she continues to have very noisy breathing. Oxygen saturations are 94% on air, with a respiratory rate of 50.
      What is the most likely diagnosis?

      Your Answer: Acute epiglottitis

      Correct Answer: Croup

      Explanation:

      Pediatric Respiratory Conditions: Croup and Acute Epiglottitis

      Croup is a common upper respiratory tract infection in children caused by the parainfluenza virus. It leads to laryngotracheobronchitis and upper airway obstruction, resulting in symptoms such as a barking cough, stridor, and difficulty breathing. Treatment involves a single dose of oral dexamethasone or inhaled budesonide, oxygen, and inhaled adrenaline in severe cases.

      Viral-induced wheeze and asthma are unlikely diagnoses in this case due to the lack of wheeze and minimal improvement with salbutamol. Inhalation of a foreign body is also unlikely given the absence of a history of playing with an object.

      Acute epiglottitis is a rare but serious condition that presents similarly to croup. It is caused by inflammation of the epiglottis, usually due to streptococci. Symptoms develop rapidly over a few hours and include difficulty swallowing, muffled voice, drooling, cervical lymphadenopathy, and fever. The tripod sign, where the child leans on outstretched arms to assist with breathing, is a characteristic feature.

      In conclusion, prompt recognition and appropriate management of pediatric respiratory conditions such as croup and acute epiglottitis are crucial to prevent complications and ensure optimal outcomes.

    • This question is part of the following fields:

      • Paediatrics
      218.5
      Seconds
  • Question 11 - An epidemiologist wants to investigate the impact of a new vaccine, vaccine X,...

    Correct

    • An epidemiologist wants to investigate the impact of a new vaccine, vaccine X, compared to the existing vaccine, vaccine Y. She plans a research study to test the theory that vaccine X will provide a higher immunity rate than the current vaccine.

      What is the null hypothesis?

      Your Answer: Drug A is no better than drug B in terms of survival rates

      Explanation:

      Type 1 and Type 2 Errors in Clinical Trials

      Clinical trials are often conducted to test the effectiveness of a new drug compared to an existing one. The hypothesis being tested is whether the new drug offers a significant improvement in patient survival compared to the standard treatment. The null hypothesis, on the other hand, assumes that the new drug does not offer a significant improvement in patient survival compared to the standard treatment.

      In some cases, clinical trials are designed to assess non-inferiority rather than overt superiority. When designing a clinical trial, researchers need to consider the likelihood of two types of errors: type 1 and type 2 errors.

      A type 1 error occurs when the study gives a falsely significant result, indicating that the treatments are different when they are actually the same. This happens when the null hypothesis is inappropriately rejected. The significance level, which is typically set at 0.05 (5%), determines the likelihood of a type 1 error.

      A type 2 error, on the other hand, occurs when the study fails to find a significant difference even when a difference genuinely exists. The power of the study, which is calculated from the anticipated type 2 error, determines the likelihood of a type 2 error. For example, a type 2 error of 0.2 gives a power of 80% (1-β).

      In conclusion, type 1 and type 2 errors is crucial in designing and interpreting the results of clinical trials. By minimizing the likelihood of these errors, researchers can ensure that their findings are reliable and accurate.

    • This question is part of the following fields:

      • Clinical Sciences
      93.2
      Seconds
  • Question 12 - A 25-year-old man visits his GP complaining of pain in his left eye,...

    Incorrect

    • A 25-year-old man visits his GP complaining of pain in his left eye, photophobia, and blurred vision that have been present for 2 days. He has no medical history but reports experiencing lower back pain that improves with exercise for the past year. During the examination, the doctor observes hyperemia of the sclera and yellow crusting on the patient's eyelashes. The patient experiences pain during cranial nerve examination, making it difficult to follow the doctor's finger with his eyes. Additionally, there is some swelling of his eyelids and constriction of the left pupil. What is the most appropriate next step, given the likely diagnosis?

      Your Answer: Topical chloramphenicol

      Correct Answer: Urgent ophthalmology review

      Explanation:

      The most appropriate course of action for a patient displaying symptoms consistent with anterior uveitis is to urgently refer them for assessment by an ophthalmologist on the same day. This condition is indicated by symptoms such as blurred vision, photophobia, miosis, and pain. Ankylosing spondylitis is a possible underlying cause, and anterior uveitis is a common feature of spondyloarthropathies. Prompt specialist evaluation is crucial as anterior uveitis can have significant morbidity. Treatment typically involves the use of topical steroids, mydriatics, non-steroidal anti-inflammatory drugs, and cycloplegics, with immunosuppression as an option under specialist guidance. Ocular steroid drops, systemic antibiotics, topical chloramphenicol, and high-dose oral steroids are not appropriate treatments for anterior uveitis in this scenario.

      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
      41.8
      Seconds
  • Question 13 - A 53-year-old woman presents with haematemesis. She has vomited twice, producing large amounts...

    Incorrect

    • A 53-year-old woman presents with haematemesis. She has vomited twice, producing large amounts of bright red blood, although the exact volume was not measured. On examination, you discover that there is a palpable spleen tip, and spider naevi over the chest, neck and arms.
      What is the diagnosis?

      Your Answer:

      Correct Answer: Bleeding oesophageal varices

      Explanation:

      Causes of Upper Gastrointestinal Bleeding and Their Differentiation

      Upper gastrointestinal (GI) bleeding can have various causes, and it is important to differentiate between them to provide appropriate management. The following are some common causes of upper GI bleeding and their distinguishing features.

      Bleeding Oesophageal Varices
      Portal hypertension due to chronic liver failure can lead to oesophageal varices, which can rupture and cause severe bleeding, manifested as haematemesis. Immediate management includes resuscitation, proton pump inhibitors, and urgent endoscopy to diagnose and treat the source of bleeding.

      Mallory-Weiss Tear
      A Mallory-Weiss tear causes upper GI bleeding due to a linear mucosal tear at the oesophagogastric junction, secondary to a sudden increase in intra-abdominal pressure. It occurs in patients after severe retching and vomiting or coughing.

      Peptic Ulcer
      Peptic ulcer is the most common cause of serious upper GI bleeding, with the majority of ulcers in the duodenum. However, sudden-onset haematemesis of a large volume of fresh blood is more suggestive of a bleed from oesophageal varices. It is important to ask about a history of indigestion or peptic ulcers. Oesophagogastroduodenoscopy (OGD) can diagnose both oesophageal varices and peptic ulcers.

      Gastric Ulcer
      Sudden-onset haematemesis of a large volume of fresh blood is more suggestive of a bleed from oesophageal varices.

      Oesophagitis
      Oesophagitis may be very painful but is unlikely to lead to a significant amount of haematemesis.

      Understanding the Causes of Upper Gastrointestinal Bleeding

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - You are evaluating a 22-year-old male with depression who has had limited success...

    Incorrect

    • You are evaluating a 22-year-old male with depression who has had limited success with various antidepressants and counseling. You opt to initiate a trial of mirtazapine. What side effect of this antidepressant can you advise him is a common feature?

      Your Answer:

      Correct Answer: Increase in appetite

      Explanation:

      Mirtazapine is an effective antidepressant that works by blocking alpha-2 receptors, but it often causes unwanted side effects such as increased appetite and sedation, which can make it difficult for patients to tolerate. On the other hand, MAOI antidepressants like phenelzine can cause a dangerous reaction when consuming foods high in tyramine, such as cheese, leading to a hypertensive crisis. While tardive dyskinesia is typically associated with typical antipsychotics, it can rarely occur as a result of some antidepressants. It’s worth noting that headache is a common withdrawal symptom of mirtazapine, rather than a side effect during its use.

      Mirtazapine: An Effective Antidepressant with Fewer Side Effects

      Mirtazapine is an antidepressant medication that functions by blocking alpha2-adrenergic receptors, which leads to an increase in the release of neurotransmitters. Compared to other antidepressants, mirtazapine has fewer side effects and interactions, making it a suitable option for older individuals who may be more susceptible to adverse effects or are taking other medications.

      Mirtazapine has two side effects that can be beneficial for older individuals who are experiencing insomnia and poor appetite. These side effects include sedation and an increased appetite. As a result, mirtazapine is typically taken in the evening to help with sleep and to stimulate appetite.

      Overall, mirtazapine is an effective antidepressant that is well-tolerated by many individuals. Its unique side effects make it a valuable option for older individuals who may have difficulty sleeping or eating.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 15 - A 23-year-old woman injures her arm on a sharp object while hiking. Within...

    Incorrect

    • A 23-year-old woman injures her arm on a sharp object while hiking. Within a few days, a small blister forms at the site of the injury, which eventually turns into an open sore. The sore has an uneven purple edge and quickly becomes wider and deeper. The woman experiences severe pain at the site of the sore.
      What is the probable medical diagnosis for this patient?

      Your Answer:

      Correct Answer: Crohn’s disease

      Explanation:

      Skin Conditions Associated with Various Diseases

      Pyoderma gangrenosum is a skin condition associated with Crohn’s disease. It is diagnosed based on clinical history and examination, and treatment options include topical or systemic steroid therapy. Coeliac disease is not associated with pyoderma gangrenosum, but is linked to dermatitis herpetiformis, which causes itchy papules on the scalp, shoulders, buttocks, or knees. Pretibial myxoedema is a skin condition associated with Grave’s disease, characterized by waxy, discolored induration on the Pretibial areas. SLE is not associated with pyoderma gangrenosum, but is linked to a facial butterfly rash. T1DM is not associated with pyoderma gangrenosum, but is linked to necrobiosis lipoidica and granuloma annulare, which cause tender patches and discolored plaques, respectively.

    • This question is part of the following fields:

      • Dermatology
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  • Question 16 - A 22-year-old female patient comes to see her doctor, 2 weeks after undergoing...

    Incorrect

    • A 22-year-old female patient comes to see her doctor, 2 weeks after undergoing a medical abortion. She has concerns that the procedure may not have been successful as her home pregnancy test still shows a positive result. What is the expected timeframe for the pregnancy test to become negative if the abortion was effective?

      Your Answer:

      Correct Answer: Negative 2 weeks from today

      Explanation:

      After a termination of pregnancy, a urine pregnancy test can still show positive results for up to 4 weeks. If the test remains positive beyond this time frame, it may indicate an incomplete abortion or persistent trophoblast. In this case, the correct answer to when the pregnancy test should be negative is 2 weeks from now, as the termination occurred 2 weeks ago. A negative result one week ago is not relevant, and 4 weeks from today or 8 weeks from today are both incorrect as they fall outside of the 4-week window.

      Termination of Pregnancy in the UK

      The UK’s current abortion law is based on the 1967 Abortion Act, which was amended in 1990 to reduce the upper limit for termination from 28 weeks to 24 weeks gestation. To perform an abortion, two registered medical practitioners must sign a legal document, except in emergencies where only one is needed. The procedure must be carried out by a registered medical practitioner in an NHS hospital or licensed premise.

      The method used to terminate a pregnancy depends on the gestation period. For pregnancies less than nine weeks, mifepristone (an anti-progesterone) is administered, followed by prostaglandins 48 hours later to stimulate uterine contractions. For pregnancies less than 13 weeks, surgical dilation and suction of uterine contents is used. For pregnancies more than 15 weeks, surgical dilation and evacuation of uterine contents or late medical abortion (inducing ‘mini-labour’) is used.

      The 1967 Abortion Act outlines the circumstances under which a person shall not be guilty of an offence under the law relating to abortion. These include if two registered medical practitioners are of the opinion, formed in good faith, that the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family. The limits do not apply in cases where it is necessary to save the life of the woman, there is evidence of extreme fetal abnormality, or there is a risk of serious physical or mental injury to the woman.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 17 - A 40-year-old male visits his GP complaining of a painless lump in his...

    Incorrect

    • A 40-year-old male visits his GP complaining of a painless lump in his testicle that has been present for a month. After an ultrasound, the GP refers him to the hospital for suspected testicular cancer. The patient undergoes an orchidectomy and is diagnosed with stage 1 seminoma. What is the most likely tumour marker to be elevated in this patient?

      Your Answer:

      Correct Answer: HCG

      Explanation:

      Seminomas are often associated with elevated levels of LDH.
      Prostate cancer is frequently accompanied by an increase in PSA.
      Colorectal cancer is most commonly linked to elevated levels of CEA.
      Melanomas and schwannomas often result in elevated levels of S-100.

      Understanding Testicular Cancer

      Testicular cancer is a type of cancer that commonly affects men between the ages of 20 and 30. Germ-cell tumors are the most common type of testicular cancer, accounting for around 95% of cases. These tumors can be divided into seminomas and non-seminomas, which include embryonal, yolk sac, teratoma, and choriocarcinoma. Other types of testicular cancer include Leydig cell tumors and sarcomas. Risk factors for testicular cancer include infertility, cryptorchidism, family history, Klinefelter’s syndrome, and mumps orchitis.

      The most common symptom of testicular cancer is a painless lump, although some men may experience pain. Other symptoms may include hydrocele and gynaecomastia, which occurs due to an increased oestrogen:androgen ratio. Tumor markers such as hCG, AFP, and beta-hCG may be elevated in germ cell tumors. Ultrasound is the first-line diagnostic tool for testicular cancer.

      Treatment for testicular cancer depends on the type and stage of the tumor. Orchidectomy, chemotherapy, and radiotherapy may be used. Prognosis for testicular cancer is generally excellent, with a 5-year survival rate of around 95% for seminomas and 85% for teratomas if caught at Stage I. It is important for men to perform regular self-examinations and seek medical attention if they notice any changes or abnormalities in their testicles.

    • This question is part of the following fields:

      • Surgery
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  • Question 18 - A 48-year-old Nigerian patient presents with a 3-month history of jaundiced sclera, weight...

    Incorrect

    • A 48-year-old Nigerian patient presents with a 3-month history of jaundiced sclera, weight loss, and pale stools. Suspected malignancy is being worked up, and a pancreatic protocol CT reveals a low attenuating mass within the pancreatic body and neck, distension of the pancreatic duct within the pancreatic tail, and non-opacification of the portal confluence. Peritoneal nodular thickening and masses are also noted, along with a right hepatic lobe focal lesion in the arterial phase. After MDT discussion, it is determined that the extent of the disease is unresectable. What is the most appropriate management option for this patient?

      Your Answer:

      Correct Answer: Biliary stenting

      Explanation:

      Biliary stenting is the preferred treatment for patients with malignant distal obstructive jaundice caused by unresectable pancreatic carcinoma. Although it does not provide a cure, it can alleviate symptoms and reduce short-term morbidity and mortality. Percutaneous biliary drainage via transhepatic route may be considered if biliary stenting fails, but it is not the first option. However, due to the complexity of the procedure and the presence of peritoneal seeding and liver metastases, it requires careful consideration before being performed.

      A choledochoduodenostomy is an anastomosis between the common bile duct (CBD) and jejunum, which is used to relieve biliary obstruction distal to the junction of the hepatic duct and the cystic duct. Although it is indicated for chronic pancreatitis, it is not recommended for many patients with pancreatic head malignancies because the tumours can prevent proper repositioning of the duodenum, leading to a tension-filled surgical anastomosis that can cause bile leakage. As the patient has unresectable pancreatic cancer, this procedure is not appropriate.

      The CT report shows a significant pancreatic malignancy with metastases in the right liver lobe and peritoneum, making pancreaticoduodenectomy or pancreatic resection inappropriate options.

      Jaundice can present in various surgical situations, and liver function tests can help classify whether the jaundice is pre hepatic, hepatic, or post hepatic. Different diagnoses have typical features and pathogenesis, and ultrasound is the most commonly used first-line test. Relief of jaundice is important, even if surgery is planned, and management depends on the underlying cause. Patients with unrelieved jaundice have a higher risk of complications and death. Treatment options include stenting, surgery, and antibiotics.

    • This question is part of the following fields:

      • Surgery
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  • Question 19 - Which of the following accurately describes one of the anatomical relationships of the...

    Incorrect

    • Which of the following accurately describes one of the anatomical relationships of the oesophagus?

      Your Answer:

      Correct Answer: Azygous vein lies to the right of the oesophagus

      Explanation:

      Anatomy of the Oesophagus

      The oesophagus is a muscular tube that carries food from the larynx to the stomach. It is approximately 25 cm long and is divided into two parts: the thoracic and abdominal portions. The thoracic portion runs vertically in the posterior part of the superior and posterior mediastinum, entering the superior mediastinum between the trachea and vertebra column. It then passes behind and to the right of the aortic arch and descends into the posterior mediastinum along the right side of the descending aorta. The thoracic aorta lies posterior to the root of the left lung, the pericardium, and the oesophagus. The oesophagus exits the posterior mediastinum through the oesophageal hiatus in the right crus of the diaphragm and enters the stomach at the cardiac orifice of the stomach.

      The short abdominal part of the oesophagus passes from the oesophageal hiatus in the right crus of the diaphragm to the stomach. The azygous vein forms collateral pathways between the superior vena cava and inferior vena cava, draining blood from the posterior walls of the thorax and abdomen. The recurrent laryngeal nerve loops around the subclavian on the right and around the arch of the aorta on the left, ascending anteriorly to the oesophagus in the trachea-oesphageal groove. The intercostal arteries arise posterior to the oesophagus from the thoracic descending aorta. the anatomy of the oesophagus is important for diagnosing and treating conditions that affect it.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 20 - A young adult is a frequent attendee at hospital with recurrent attacks of...

    Incorrect

    • A young adult is a frequent attendee at hospital with recurrent attacks of drowsiness, sweating, and palpitations. The blood glucose level during one of the episodes is 2.9 mmol/l. Recovery occurs in response to intravenous 10% dextrose. C-peptide levels are measured and are found to be below the normal range.
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Factitious insulin use

      Explanation:

      Differentiating Causes of Recurrent Hypoglycaemia: Insulinoma, Factitious Insulin Use, Phaeochromocytoma, Gastrinoma, and Glucagonoma

      Recurrent episodes of hypoglycaemia can be caused by various conditions, including insulinoma and factitious insulin use. To differentiate between the two, C-peptide levels can be measured. C-peptide is secreted with insulin, so high levels indicate insulinoma, while suppressed levels suggest factitious insulin use.

      Phaeochromocytoma can also cause hypoglycaemia, along with symptoms such as sweating and palpitations. However, it also leads to elevated blood glucose levels due to increased lipolysis, glycogenolysis, and gluconeogenesis.

      Gastrinomas alone do not cause hypoglycaemia or affect C-peptide levels. However, when they occur in the context of MEN syndrome, insulinoma may coexist.

      Glucagonomas, on the other hand, lead to elevated blood sugar levels.

      In the case of insulinoma, C-peptide levels are low, indicating exogenous insulin as the cause of recurrent hypoglycaemia. If C-peptide levels were raised, this would suggest insulinoma.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 21 - An 82-year-old man presents to his General Practitioner (GP) with a 4-month history...

    Incorrect

    • An 82-year-old man presents to his General Practitioner (GP) with a 4-month history of progressively worsening jaundice. His wife says that she noticed it a while ago, but her husband has been reluctant to come to see the GP. The man does not complain of any abdominal pain and on examination no masses are felt. He agrees when asked by the GP that he has lost quite some weight recently. The patient has a strong alcohol history and has been smoking 20 cigarettes daily since he was in his twenties. The GP refers the patient to secondary care.
      Which one of the following is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Pancreatic cancer

      Explanation:

      Differential Diagnosis of Painless Jaundice in a Patient with Risk Factors for Pancreatic Cancer

      This patient presents with painless jaundice, which is most suggestive of obstructive jaundice due to a tumour in the head of the pancreas. The patient also has strong risk factors for pancreatic cancer, such as smoking and alcohol. However, other conditions should be considered in the differential diagnosis, such as chronic cholecystitis, chronic pancreatitis, cholangiocarcinoma, and chronic liver disease.

      Chronic cholecystitis is unlikely to be the cause of painless jaundice, as it typically presents with colicky abdominal pain and gallstones on ultrasound. Chronic pancreatitis is a possible diagnosis, given the patient’s risk factors, but it usually involves abdominal pain and fatty diarrhoea. Cholangiocarcinoma is a rare cancer that develops in the bile ducts and can cause jaundice, abdominal pain, and itching. Primary sclerosing cholangitis is a risk factor for cholangiocarcinoma. Chronic liver disease is also a possible consequence of alcohol abuse, but it usually involves other signs such as nail clubbing, palmar erythema, and spider naevi.

      Therefore, a thorough evaluation of the patient’s medical history, physical examination, laboratory tests, and imaging studies is necessary to confirm the diagnosis of pancreatic cancer and rule out other potential causes of painless jaundice. Early detection and treatment of pancreatic cancer are crucial for improving the patient’s prognosis and quality of life.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 22 - A 30-year-old female patient visits her GP complaining of a severe throbbing headache...

    Incorrect

    • A 30-year-old female patient visits her GP complaining of a severe throbbing headache that is most intense in the morning. Despite taking paracetamol, the symptoms have persisted for several weeks. She also experiences vomiting in the mornings and has noticed blurry vision. Upon examination, her pupils are equal and reactive, and there are no abnormalities in her systemic examination. What would you anticipate observing during fundoscopy?

      Your Answer:

      Correct Answer: Blurring of optic disc margin

      Explanation:

      Papilloedema is characterized by a blurry appearance of the optic disc margin during fundoscopy.

      The patient in question is experiencing elevated intracranial pressure, the cause of which is uncertain. Their symptoms, including a morning headache, vision impairment, and vomiting, are indicative of papilloedema. As such, it is expected that their fundoscopy would reveal signs of this condition, such as a blurred optic disc margin.

      Other potential indicators of papilloedema include a loss of optic cup and venous pulsation. However, increased arterial reflex is more commonly associated with hypertensive retinopathy, while retinal pigmentation is a hallmark of retinitis pigmentosa.

      Understanding Papilloedema: Optic Disc Swelling Caused by Increased Intracranial Pressure

      Papilloedema is a condition characterized by swelling of the optic disc due to increased pressure within the skull. This condition is typically bilateral and can be identified through fundoscopy. During this examination, venous engorgement is usually the first sign observed, followed by loss of venous pulsation, blurring of the optic disc margin, elevation of the optic disc, loss of the optic cup, and the presence of Paton’s lines, which are concentric or radial retinal lines cascading from the optic disc.

      There are several potential causes of papilloedema, including space-occupying lesions such as tumors or vascular abnormalities, malignant hypertension, idiopathic intracranial hypertension, hydrocephalus, and hypercapnia. In rare cases, papilloedema may also be caused by hypoparathyroidism and hypocalcaemia, or vitamin A toxicity.

      Overall, understanding papilloedema is important for identifying potential underlying conditions and providing appropriate treatment to prevent further complications.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 23 - A 35-year-old woman with known alcohol dependence is admitted to the Emergency Department...

    Incorrect

    • A 35-year-old woman with known alcohol dependence is admitted to the Emergency Department following a 32-hour history of worsening confusion. She complains of excessive sweating and feeling hot; she is also distressed as she says that ants are crawling on her body – although nothing is visible on her skin. She states that over the last few days she has completely stopped drinking alcohol in an attempt to become sober.
      On examination she is clearly agitated, with a coarse tremor. Her temperature is 38.2°C, blood pressure is 134/76 mmHg and pulse is 87 beats per minute. She has no focal neurological deficit. A full blood count and urinalysis is taken which reveals the following:
      Full blood count:
      Investigation Result Normal value
      Haemoglobin 144 g/l 135–175 g/l
      Mean corpuscular volume (MCV) 105 fl 76–98 fl
      White cell count (WCC) 6.8 × 109/l 4–11 × 109/l
      Platelets 220 × 109/l 150–400 × 109/l
      There are no abnormalities detected on urine and electrolytes (U&Es) and liver function tests (LFTs).
      Urinalysis:
      Investigations Results
      Leukocytes Negative
      Nitrites Negative
      Protein Negative
      Blood Negative
      Glucose Negative
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Delirium tremens

      Explanation:

      Differential Diagnosis for a Patient with Alcohol Withdrawal Symptoms

      Delirium Tremens, Korsakoff’s Psychosis, Wernicke’s Encephalopathy, Hepatic Encephalopathy, and Focal Brain Infection: Differential Diagnosis for a Patient with Alcohol Withdrawal Symptoms

      A patient presents with agitation, hyperthermia, and visual hallucinations after acute cessation of alcohol. What could be the possible diagnoses?

      Delirium tremens is the most likely diagnosis, given the severity of symptoms and timing of onset. It requires intensive care management, and oral lorazepam is recommended as first-line therapy according to NICE guidelines.

      Korsakoff’s psychosis, caused by chronic vitamin B1 deficiency, is unlikely to have caused the patient’s symptoms, but the patient is susceptible to developing it due to alcohol dependence and associated malnutrition. Treatment with thiamine is necessary to prevent this syndrome from arising.

      Wernicke’s encephalopathy, also caused by thiamine deficiency, presents with ataxia, ophthalmoplegia, and confusion. As the patient has a normal neurological examination, this diagnosis is unlikely to have caused the symptoms. However, regular thiamine treatment is still necessary to prevent it from developing.

      Hepatic encephalopathy, a delirium secondary to hepatic insufficiency, is unlikely as the patient has no jaundice, abnormal LFTs, or hemodynamic instability.

      Focal brain infection is also unlikely as there is no evidence of meningitis or encephalitis, and the full blood count and urinalysis provide reassuring results. The high MCV is likely due to alcohol-induced macrocytosis. Although delirium secondary to infection is an important diagnosis to consider, delirium tremens is a more likely diagnosis in this case.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 24 - You are requested to evaluate a 75-year-old woman who underwent a left mastectomy...

    Incorrect

    • You are requested to evaluate a 75-year-old woman who underwent a left mastectomy yesterday to treat breast cancer. Her potassium level is low at 3.1 mmol/L (normal range is 3.5-4.9), but she is asymptomatic and currently having her lunch. She has a history of hypertension and takes a thiazide diuretic regularly. What would be the appropriate course of action?

      Your Answer:

      Correct Answer: Prescribe an oral potassium supplement

      Explanation:

      Treatment for Mild Hypokalaemia

      Mild hypokalaemia can be treated with oral supplementation. If a patient is able to eat, intravenous fluids are unnecessary. It is best to advise the patient to take oral supplements for a few days. Foods such as tomatoes and bananas contain high levels of potassium and could be offered as well. However, it is important to note that the maximum concentration of potassium that can be given via a peripheral line is 40 mmol/L. It is also important to avoid loop diuretics as they can make the patient’s potassium levels even lower. As long as the patient is asymptomatic and able to eat, mild hypokalaemia can be easily treated with oral supplementation.

    • This question is part of the following fields:

      • Anaesthetics & ITU
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  • Question 25 - A 23-year-old man is brought to the emergency department by ambulance after being...

    Incorrect

    • A 23-year-old man is brought to the emergency department by ambulance after being found shouting at shoppers in a corner of a supermarket. He claims that the shoppers were trying to kill him and he sees coloured halos around the shop shelves. He has no past medical history. His vital signs are as follows: heart rate of 120 bpm, respiratory rate of 20/min, blood pressure of 130/90 mmHg, and temperature of 38°C. He is agitated, clammy to touch, and has dilated pupils despite adequate lighting. Both hands show a fine tremor. What drug overdose is responsible for his symptoms?

      Your Answer:

      Correct Answer: LSD

      Explanation:

      Understanding LSD Intoxication

      LSD, also known as lysergic acid diethylamide, is a synthetic hallucinogen that gained popularity as a recreational drug in the 1960s to 1980s. While its usage has declined in recent years, it still persists, with adolescents and young adults being the most frequent users. LSD is one of the most potent psychoactive compounds known, and its psychedelic effects usually involve heightening or distortion of sensory stimuli and enhancement of feelings and introspection.

      Patients with LSD toxicity typically present following acute panic reactions, massive ingestions, or unintentional ingestions. The symptoms of LSD intoxication are variable and can include impaired judgments, amplification of current mood, agitation, and drug-induced psychosis. Somatic symptoms such as nausea, headache, palpitations, dry mouth, drowsiness, and tremors may also occur. Signs of LSD intoxication can include tachycardia, hypertension, mydriasis, paresthesia, hyperreflexia, and pyrexia.

      Massive overdoses of LSD can lead to complications such as respiratory arrest, coma, hyperthermia, autonomic dysfunction, and bleeding disorders. The diagnosis of LSD toxicity is mainly based on history and examination, as most urine drug screens do not pick up LSD.

      Management of the intoxicated patient is dependent on the specific behavioral manifestation elicited by the drug. Agitation should be managed with supportive reassurance in a calm, stress-free environment, and benzodiazepines may be used if necessary. LSD-induced psychosis may require antipsychotics. Massive ingestions of LSD should be treated with supportive care, including respiratory support and endotracheal intubation if needed. Hypertension, tachycardia, and hyperthermia should be treated symptomatically, while hypotension should be treated initially with fluids and subsequently with vasopressors if required. Activated charcoal administration and gastric emptying are of little clinical value by the time a patient presents to the emergency department, as LSD is rapidly absorbed through the gastrointestinal tract.

      In conclusion, understanding LSD intoxication is crucial for healthcare professionals to provide appropriate management and care for patients who present with symptoms of LSD toxicity.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 26 - A 50-year-old Chinese man arrives at the Emergency Department with a swollen belly....

    Incorrect

    • A 50-year-old Chinese man arrives at the Emergency Department with a swollen belly. He reports experiencing weight loss and a dull ache in his right upper abdomen. Upon examination, he appears sweaty and has a tender enlarged liver with fluid buildup. His temperature is 38 °C and blood tests indicate elevated levels of α-fetoprotein. An ultrasound of his liver reveals areas of abnormal tissue growth. What is the probable primary liver cancer diagnosis based on these findings?

      Your Answer:

      Correct Answer: Hepatocellular carcinoma (HCC)

      Explanation:

      Liver Tumours: Types, Risk Factors, and Diagnostic Methods

      Liver tumours are abnormal growths that develop in the liver. The most common primary liver tumour is hepatocellular carcinoma (HCC), which is often associated with hepatitis B infection, cirrhosis, male gender, and increasing age. Chronic hepatitis B is the major risk factor worldwide, while hepatitis C is the major risk factor in Europe. Patients with underlying cirrhosis may present with decompensation of liver disease, such as ascites, jaundice, worsening liver function tests, and variceal haemorrhage. Examination may reveal hepatomegaly or a right hypochondrial mass. Vascularity of the tumour may result in an audible bruit on auscultation.

      Diagnostic methods for liver tumours include increased α-fetoprotein, which is produced by 60% of HCCs. Ultrasound scanning will reveal focal lesions and may also show involvement of the portal vein. Helical triple-phase computed tomography (CT) scanning will identify HCC due to its hypervascular nature. Alternatively, magnetic resonance imaging (MRI) may be used.

      Other types of liver tumours include fibrosarcoma, which is an extremely rare primary tumour of the liver, cholangiocarcinoma, which are usually adenocarcinomas and are the second most common primary tumour of the hepatobiliary system, affecting biliary ducts, hepatoblastoma, which is a liver tumour that typically presents in childhood, in the first 3 years of life, and leiomyosarcoma, which is another rare primary tumour of the liver. Leiomyosarcoma is thought to affect women more than men and typically seems to present later in life, in the fifth and sixth decades of life. However, greater understanding of the epidemiology of these rare tumours is required.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 27 - A 55-year-old woman with a history of type I diabetes visits her GP...

    Incorrect

    • A 55-year-old woman with a history of type I diabetes visits her GP complaining of a 4-day decrease in visual acuity on her left side. During the examination, she reports that the object used appears to have a different color when using her left eye compared to her right eye. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Optic neuritis

      Explanation:

      The patient’s symptoms suggest optic neuritis as the most likely diagnosis, which can be associated with multiple sclerosis, diabetes, and syphilis. The patient has experienced a decrease in visual acuity in one eye over a few days and has difficulty distinguishing colors, particularly with red appearing washed out, pink, or orange when viewed with the affected eye. The blind spot assessment is significant because it typically involves a red-tipped object, which may further highlight the patient’s red desaturation. Other exam findings may include pain with eye movement, a relative afferent pupillary defect, and a central scotoma. Acute angle-closure glaucoma would not typically cause color desaturation, and type I diabetes is not a risk factor for this condition. While type I diabetes can increase the risk of age-related macular degeneration, patients typically present with a gradual reduction in visual acuity without affecting color vision. Cataracts can also cause faded color vision, but the history would typically span several weeks to months.

      Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 28 - A clinical trial compared the effectiveness of two anti-anginal medications in reducing stable...

    Incorrect

    • A clinical trial compared the effectiveness of two anti-anginal medications in reducing stable angina pain while walking on flat ground. The study found that 65% of patients who took drug A and 60% of patients who took drug B achieved the primary outcome.

      If a patient wants to avoid stable angina pain while walking on flat ground, how many more patients need to be treated with drug A compared to drug B?

      Your Answer:

      Correct Answer: 20

      Explanation:

      Number Needed to Treat (NNT)

      When analyzing the results of a randomized controlled clinical trial, the number needed to treat (NNT) is a useful metric to consider. It is calculated by taking 100 divided by the absolute risk reduction (ARR). For example, if the ARR is 5%, then the NNT would be 20 (100/5).

      The NNT provides a more intuitive of the results compared to other metrics such as relative risk reduction (RRR) or ARR. It represents the number of patients who need to be treated in order to prevent one additional negative outcome. In the example above, for every 20 patients treated, one negative outcome would be prevented.

      Overall, the NNT is a valuable tool for clinicians and researchers to evaluate the effectiveness of treatments and interventions. It allows for a more practical interpretation of study results and can aid in making informed decisions about patient care.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 29 - A 62-year-old male comes to the clinic complaining of pain during bowel movements...

    Incorrect

    • A 62-year-old male comes to the clinic complaining of pain during bowel movements for the past 4 days. Upon examination, a tender, oedematous, and purple subcutaneous mass is found at the anal margin. What is the most appropriate course of action for this patient?

      Your Answer:

      Correct Answer: Stool softeners, ice packs and analgesia

      Explanation:

      The patient is likely suffering from thrombosed haemorrhoids, which is characterized by anorectal pain and a tender lump on the anal margin. Since the patient has a 4-day history, stool softeners, ice packs, and analgesia are the recommended management options. Referral for excision and analgesia would be appropriate if the history was <72 hours. However, a 2-week wait referral for suspected cancer is not necessary as the patient's symptoms and examination findings are not indicative of cancer. Although this condition typically resolves within 10 days with supportive management, reassurance alone is not enough. The patient should be given analgesia and stool softeners to alleviate the pain. Thrombosed haemorrhoids are characterized by severe pain and the presence of a tender lump. Upon examination, a purplish, swollen, and tender subcutaneous perianal mass can be observed. If the patient seeks medical attention within 72 hours of onset, referral for excision may be necessary. However, if the condition has progressed beyond this timeframe, patients can typically manage their symptoms with stool softeners, ice packs, and pain relief medication. Symptoms usually subside within 10 days.

    • This question is part of the following fields:

      • Surgery
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  • Question 30 - A 21-year-old woman involved in a motorbike accident is brought to the Emergency...

    Incorrect

    • A 21-year-old woman involved in a motorbike accident is brought to the Emergency Department at 10 pm. Her airway is patent; the respiratory rate is 20/minute with normal pulse oximetry and a clear chest; she is slightly tachycardic but is well perfused with a normal blood pressure. She is found to have a tibial fracture on the right side. The broken bone is visible through a break in the skin.
      Which of the following is most appropriate?

      Your Answer:

      Correct Answer: Stabilise, give IV abx and take to theatre on the earliest scheduled trauma list

      Explanation:

      Management of Open Fractures

      Open fractures are a medical emergency that require urgent surgical intervention to reduce the risk of deep space infection and osteomyelitis. The management of these fractures should adhere to the principles of ATLS and undergo a full ABCDE assessment. After ensuring the patient is stable, the fracture can be assessed, including neurovascular status distal to the fracture.

      If the fracture is open, it is contaminated, and early surgery is required to allow thorough cleaning of the wound. Additional management whilst awaiting surgery includes adequate analgesia, documentation of the injury (including photographs), dressing the wound with sterile saline soaked gauze, IV antibiotics, and tetanus cover.

      All fractures require reduction and fixation, but open fractures require urgent washout and debridement to prevent deep space infection and osteomyelitis. This should not be delayed any longer than necessary. If the patient is stable, listing them for the trauma list the next day is appropriate, and they would likely be first on the list. If there is neurovascular compromise or the patient’s condition deteriorates, taking them to theatre overnight would be appropriate.

      Conservative management is not appropriate for open fractures. The injury necessitates surgical washout to reduce the risk of deep space infection and osteomyelitis.

      In conclusion, open fractures require urgent surgical intervention to reduce the risk of infection. Adequate analgesia, documentation, dressing, IV antibiotics, and tetanus cover are required whilst awaiting surgery. Conservative management is not appropriate, and surgical washout is necessary to prevent deep space infection and osteomyelitis.

    • This question is part of the following fields:

      • Orthopaedics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/1) 0%
Acute Medicine And Intensive Care (1/1) 100%
Statistics (0/1) 0%
Obstetrics (1/1) 100%
Renal (1/1) 100%
Anaesthetics & ITU (0/1) 0%
Orthopaedics (1/1) 100%
Rheumatology (1/1) 100%
Gastroenterology (0/1) 0%
Paediatrics (0/1) 0%
Clinical Sciences (1/1) 100%
Ophthalmology (0/1) 0%
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