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Question 1
Incorrect
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A 28-year-old woman presents to a routine antenatal clinic at 16 weeks gestation. She has a history of occasional frontal headaches but no significant past medical history. During the examination, her blood pressure is measured at 148/76 mmHg. Urinalysis shows a pH of 6.5, +1 protein, 0 nitrates, 0 leucocytes, and 0 blood. What is the most probable diagnosis?
Your Answer: Gestational hypertension
Correct Answer: Chronic hypertension
Explanation:The correct diagnosis in this case is chronic hypertension. It is unlikely that the patient has developed any pregnancy-related causes of hypertension at only 16 weeks gestation. The small amount of protein in her urine suggests that she may have had hypertension for some time. The patient’s intermittent frontal headaches are a common occurrence and do not indicate pre-eclampsia. Pre-eclampsia and gestational hypertension typically occur after 20 weeks gestation, with pre-eclampsia being associated with significant proteinuria and gestational hypertension without. Nephrotic syndrome would typically present with a larger degree of proteinuria.
Hypertension during pregnancy is a common occurrence that requires careful management. In normal pregnancies, blood pressure tends to decrease in the first trimester and then gradually increase to pre-pregnancy levels by term. However, in cases of hypertension during pregnancy, the systolic blood pressure is usually above 140 mmHg or the diastolic blood pressure is above 90 mmHg. Additionally, an increase of more than 30 mmHg systolic or 15 mmHg diastolic from the initial readings may also indicate hypertension.
There are three categories of hypertension during pregnancy: pre-existing hypertension, pregnancy-induced hypertension (PIH), and pre-eclampsia. Pre-existing hypertension refers to a history of hypertension before pregnancy or elevated blood pressure before 20 weeks gestation. PIH occurs in the second half of pregnancy and resolves after birth. Pre-eclampsia is characterized by hypertension and proteinuria, and may also involve edema.
The management of hypertension during pregnancy involves the use of antihypertensive medications such as labetalol, nifedipine, and hydralazine. In cases of pre-existing hypertension, ACE inhibitors and angiotensin II receptor blockers should be stopped immediately and alternative medications should be prescribed. Women who are at high risk of developing pre-eclampsia should take aspirin from 12 weeks until the birth of the baby. It is important to carefully monitor blood pressure and proteinuria levels during pregnancy to ensure the health of both the mother and the baby.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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What is the odds ratio of mortality between patients treated with drug A and those treated with drug B in a randomised controlled trial for acute myocardial infarction, where 100 patients were assigned to each group and the mortality rate in group A was 20% and in group B was 30%?
Your Answer: 1.5
Correct Answer: 0.58
Explanation:Odds Ratio
The Odds Ratio is a statistical measure used to determine the likelihood of an outcome occurring based on a specific exposure. It compares the odds of the outcome happening when exposed to a particular factor to the odds of the outcome happening in the absence of that factor. To calculate the Odds Ratio, a table is constructed with the number of individuals who experienced the outcome and those who did not, for both the exposed and unexposed groups. The Odds Ratio is then calculated by multiplying the number of individuals who experienced the outcome in the exposed group by the number of individuals who did not experience the outcome in the unexposed group, and dividing it by the product of the number of individuals who did not experience the outcome in the exposed group and the number of individuals who experienced the outcome in the unexposed group. The resulting value represents the Odds Ratio. the Odds Ratio is important in determining the impact of a particular exposure on an outcome and can aid in making informed decisions.
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This question is part of the following fields:
- Clinical Sciences
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Question 3
Incorrect
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A 65-year-old woman presents to the Emergency Department with shortness of breath after being sat at home.
An arterial blood gas (ABG) is performed and shows the following results:
Investigation Result Normal value
pH 7.48 7.35–7.45
pO2 7.3 kPa 10.5–13.5 kPa
pCO2 3.9 kPa 4.6–6 kPa
HCO3 24 mmol/l 24–30 mmol/l
Which one of the following conditions is most likely to account for these investigation results?Your Answer: Opiate overdose
Correct Answer: Pulmonary embolism
Explanation:Understanding Respiratory Failure: Causes and ABG Interpretation
Respiratory failure is a condition where the lungs fail to adequately oxygenate the blood or remove carbon dioxide. There are two types of respiratory failure: type I and type II. Type I respiratory failure is characterized by low levels of oxygen and normal or low levels of carbon dioxide, resulting in respiratory alkalosis. Type II respiratory failure, on the other hand, is characterized by low levels of oxygen and high levels of carbon dioxide, resulting in respiratory acidosis.
Pulmonary embolism is the only cause of type I respiratory failure. This condition results in reduced oxygenation of the blood due to a blockage in the pulmonary artery. The ABG of a patient with pulmonary embolism would show low levels of oxygen and carbon dioxide, as well as respiratory alkalosis.
Hypothyroidism, Guillain–Barré syndrome, and myasthenia gravis are all causes of type II respiratory failure. Hypothyroidism can result in decreased ventilatory drive, while Guillain–Barré syndrome and myasthenia gravis can cause respiratory muscle weakness, leading to hypoventilation and respiratory acidosis.
Opiate overdose is another cause of type II respiratory failure. Opiates act on the respiratory centers in the brain, reducing ventilation and causing respiratory acidosis.
In summary, understanding the causes and ABG interpretation of respiratory failure is crucial in identifying and managing this potentially life-threatening condition.
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This question is part of the following fields:
- Respiratory
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Question 4
Incorrect
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A 25-year-old woman comes to you with complaints of feeling low for about a week every month, just before her period starts. She reports feeling tearful and lacking motivation during this time, but her symptoms improve once her period begins. Although her symptoms are bothersome, they are not affecting her work or personal life. She has a regular 28-day cycle, experiences no heavy or painful periods, and denies any inter-menstrual bleeding. She is in a committed relationship and uses condoms for contraception, without plans to conceive in the near future. What treatment options can you suggest to alleviate her premenstrual symptoms?
Your Answer: Selective serotonin re-uptake inhibitor (SSRI)
Correct Answer: A new generation combined contraceptive pill
Explanation:Understanding Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and does not occur before puberty, during pregnancy, or after menopause.
Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.
Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.
Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this common condition.
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This question is part of the following fields:
- Gynaecology
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Question 5
Correct
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A 68-year-old retired caretaker with a well-documented history of chronic obstructive pulmonary disease (COPD) is admitted, for his fourth time this year, with shortness of breath and a cough productive of green sputum. Examination findings are: respiratory rate (RR) 32 breaths/min, temperature 37.4 °C, SpO2 86% on room air, asterixis and coarse crepitations at the left base. A chest X-ray (CXR) confirms left basal consolidation.
Which arterial blood gas (ABG) picture is likely to belong to the above patient?Your Answer: pH: 7.27, pa (O2): 7.1, pa (CO2): 8.9, HCO3–: 33.20, base excess (BE) 4.9 mmol
Explanation:Interpreting Blood Gas Results in COPD Patients
COPD is a common respiratory disease that can lead to exacerbations requiring hospitalization. In these patients, lower respiratory tract infections can quickly lead to respiratory failure and the need for respiratory support. Blood gas results can provide important information about the patient’s respiratory and metabolic status. In COPD patients, a type II respiratory failure with hypercapnia and acidosis is common, resulting in a low pH and elevated bicarbonate levels. However, blood gas results that show low carbon dioxide or metabolic acidosis are less likely to be in keeping with COPD. Understanding and interpreting blood gas results is crucial in managing COPD exacerbations and providing appropriate respiratory support.
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This question is part of the following fields:
- Respiratory
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Question 6
Correct
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An 80-year-old retired teacher complains of headache and scalp tenderness. She reports experiencing blurred vision for the past three days. What signs suggest a possible diagnosis of giant cell arthritis?
Your Answer: Temporal artery biopsy demonstrating mononuclear cell infiltration
Explanation:Diagnosis of Giant Cell arthritis
Giant cell arthritis is a condition that affects the arteries, particularly those in the head and neck. To diagnose this condition, the American College of Rheumatology has developed criteria that require the fulfillment of at least three out of five criteria. These criteria have a 93% sensitivity of diagnosis.
The first criterion is age over 50, as this condition is more common in older individuals. The second criterion is the onset of a new type of localized headache, which is often severe and persistent. The third criterion is an elevated erythrocyte sedimentation rate (ESR) of over 50 mm/hr by the Westergreen method, which indicates inflammation in the body. The fourth criterion is temporal artery tenderness to palpation or decreased pulsation, which can be felt by a doctor during a physical exam. The fifth criterion is an arterial biopsy showing granulomatous inflammation or mononuclear cell infiltration, usually with multinucleated giant cells.
Overall, the diagnosis of giant cell arthritis requires a combination of clinical and laboratory findings. If a patient meets at least three of these criteria, further testing and treatment may be necessary to manage this condition.
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This question is part of the following fields:
- Neurology
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Question 7
Correct
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A 42-year-old woman comes in seeking advice on contraception. She has recently entered a new relationship and has been using barrier methods of contraception, but would like to explore other options for convenience. Her periods have become irregular over the past year, but she is otherwise healthy with a history of mild hypertension that is managed with ramipril. She does not drink but is a smoker, consuming around 20 cigarettes per day. What would be the most suitable form of contraception for this patient?
Your Answer: Progesterone-only pill (POP)
Explanation:The progesterone-only pill (POP) is a suitable contraceptive option for this patient, especially since she is over 35 years old and a smoker. Other options to consider include the copper intrauterine device (IUD), the levonorgestrel IUS, and sterilization. Natural family planning may not be effective due to the patient’s irregular periods, which could be a sign of approaching menopause. Hormone replacement therapy (HRT) is not a contraceptive and therefore not recommended. Even though the patient is approaching menopause, she is still having periods, so contraception is still necessary. The combined oral contraceptive pill (COCP) is not advisable due to the patient’s age and smoking status, but the POP or implant could be considered.
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This question is part of the following fields:
- Sexual Health
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Question 8
Correct
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A 35-year-old woman visits her General Practitioner, reporting crusting of both eyelids that is more severe in the morning and accompanied by an itchy feeling. She states that she has not experienced any changes in her vision. Upon examining her eyelids, the doctor observes crusting at the eyelid edges that are inflamed and red. The conjunctivae seem normal, and the pupils react equally to light. What is the probable diagnosis?
Your Answer: Blepharitis
Explanation:Common Eye Conditions and Their Symptoms
Blepharitis: This condition presents with crusting of both eyelids, redness, swelling, and itching. It can be treated with eyelid hygiene and warm compress. If these measures are not effective, chloramphenicol ointment can be used.
Chalazion: A painless swelling or lump on the eyelid caused by a blocked gland. Patients report a red, swollen, and painful area on the eyelid, which settles within a few days but leaves behind a firm, painless swelling. Warm compresses and gentle massaging can encourage drainage.
Conjunctivitis: Patients with conjunctivitis present with conjunctival erythema, watery/discharging eye, and a gritty sensation. Most cases are self-limiting, but some patients will require topical antibiotics if symptoms have not resolved.
Entropion: This condition is when the margin of the eyelid turns inwards towards the surface of the eye, causing irritation. It is more common in elderly patients and requires surgical treatment.
Hordeolum: An acute-onset localised swelling of the eyelid margin that is painful. It is usually localised around an eyelash follicle, in which case plucking the affected eyelash can aid drainage. Styes are usually self-limiting, but eyelid hygiene and warm compress can help with resolution.
Understanding Common Eye Conditions and Their Symptoms
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This question is part of the following fields:
- Ophthalmology
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Question 9
Correct
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A 55-year-old man comes to the doctor complaining of double vision. Upon examination, his eye is turned down and out, and he has limited adduction, elevation, and depression of the eye, as well as ptosis. Additionally, his pupil is fixed and dilated. What is the probable diagnosis?
Your Answer: Third nerve palsy
Explanation:Common Cranial Nerve Palsies and Their Symptoms
Cranial nerve palsies can cause a variety of symptoms depending on which nerve is affected. Here are some common cranial nerve palsies and their associated symptoms:
Third Nerve Palsy: This affects the oculomotor nerve and causes the eye to be positioned downward and outward, along with ptosis (drooping eyelid) and mydriasis (dilated pupil).
Sixth Nerve Palsy: This affects the abducens nerve and causes medial deviation of the eye.
Fourth Nerve Palsy: This affects the trochlear nerve and causes the eye to look out and down, resulting in vertical or oblique diplopia (double vision). Patients may tilt their head away from the affected side to correct this.
Horner’s Syndrome: This presents with miosis (constricted pupil), ptosis, and ipsilateral anhidrosis (lack of sweating on one side of the face).
Fifth Nerve Palsy: This affects the trigeminal nerve, which is responsible for facial sensation and some motor functions related to biting and chewing. It does not affect the eye.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A 50-year-old woman presents to her General Practitioner with increasing shortness of breath. She has also suffered from dull right iliac fossa pain over the past few months. Past history of note includes tuberculosis at the age of 23 and rheumatoid arthritis. On examination, her right chest is dull to percussion, consistent with a pleural effusion, and her abdomen appears swollen with a positive fluid thrill test. She may have a right adnexal mass.
Investigations:
Investigation
Result
Normal value
Chest X-ray Large right-sided pleural effusion
Haemoglobin 115 g/l 115–155 g/l
White cell count (WCC) 6.8 × 109/l 4–11 × 109/l
Platelets 335 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 5.4 mmol/l 3.5–5.0 mmol/l
Creatinine 175 μmol/l 50–120 µmol/l
Bilirubin 28 μmol/l 2–17 µmol/l
Alanine aminotransferase 25 IU/l 5–30 IU/l
Albumin 40 g/l 35–55 g/l
CA-125 250 u/ml 0–35 u/ml
Pleural aspirate: occasional normal pleural cells, no white cells, protein 24 g/l.
Which of the following is the most likely diagnosis?Your Answer: Ovarian carcinoma with lung secondaries
Correct Answer: Meig’s syndrome
Explanation:Possible Causes of Pleural Effusion: Meig’s Syndrome, Ovarian Carcinoma, Reactivation of Tuberculosis, Rheumatoid Arthritis, and Cardiac Failure
Pleural effusion is a condition where fluid accumulates in the pleural space, the area between the lungs and the chest wall. There are various possible causes of pleural effusion, including Meig’s syndrome, ovarian carcinoma, reactivation of tuberculosis, rheumatoid arthritis, and cardiac failure.
Meig’s syndrome is characterized by the association of a benign ovarian tumor and a transudate pleural effusion. The pleural effusion resolves when the tumor is removed, although a raised CA-125 is commonly found.
Ovarian carcinoma with lung secondaries is another possible cause of pleural effusion. However, if no malignant cells are found on thoracocentesis, this diagnosis becomes less likely.
Reactivation of tuberculosis may also lead to pleural effusion, but this would be accompanied by other symptoms such as weight loss, night sweats, and fever.
Rheumatoid arthritis can produce an exudative pleural effusion, but this presentation is different from the transudate seen in Meig’s syndrome. In addition, white cells would be present due to the inflammatory response.
Finally, cardiac failure can result in bilateral pleural effusions.
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This question is part of the following fields:
- Respiratory
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