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  • Question 1 - What is the deficiency associated with Marfan's syndrome, a connective tissue disorder that...

    Incorrect

    • What is the deficiency associated with Marfan's syndrome, a connective tissue disorder that affects multiple systems including musculoskeletal, visual, and cardiovascular, in individuals of all ages?

      Your Answer: Fibrinogen

      Correct Answer: Fibrillin

      Explanation:

      A mutation in the fibrillin-1 protein is responsible for causing Marfan’s syndrome. This protein is coded by the Marfan syndrome gene (MSF1) located on chromosome 15. Connective tissue contains fibrillin, which is a glycoprotein. Synovial fluid contains hyaluronic acid, while elastin is an extracellular matrix protein found in connective tissue. Laminin is another extracellular matrix protein that forms part of the basement membrane.

    • This question is part of the following fields:

      • Musculoskeletal
      6.8
      Seconds
  • Question 2 - Sophie is a 32-year-old mother of two, who is uncertain if she wants...

    Incorrect

    • Sophie is a 32-year-old mother of two, who is uncertain if she wants to have more children. She comes to you with a history of not having a period for the past 9 months. Sophie had regular menstrual cycles for 28 months after giving birth to her last child. She has never used any hormonal birth control or undergone any surgeries. Upon examination, her abdomen and gynecological areas appear normal, and there are no signs of hyperandrogenism. A pregnancy test confirms that she is not pregnant.

      Lab results show a decrease in follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels, while prolactin, thyroid-stimulating hormone (TSH), and T4 levels are normal. A 10-day progestin challenge fails to induce a withdrawal bleed.

      What is the underlying cause of Sophie's amenorrhea?

      Your Answer: Pituitary adenoma

      Correct Answer: Hypothalamic dysfunction

      Explanation:

      Caroline’s case of secondary amenorrhoea suggests a hypothalamic cause, as indicated by low levels of gonadotrophins (FSH and LH) and oestradiol. This is different from pituitary adenoma, which often presents with panhypopituitarism and normal prolactin levels, and premature ovarian failure, which is diagnosed in women under 40 with increased FSH levels and menopausal-like symptoms. PCOS is also unlikely as there is no hyperandrogenism or other symptoms present. Hypothalamic dysfunction can be caused by excessive exercise, stress, or dieting, which should be explored in the patient’s history.

      Understanding Amenorrhoea: Causes, Investigations, and Management

      Amenorrhoea is a condition characterized by the absence of menstrual periods in women. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls without secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.

      There are various causes of amenorrhoea, including gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, Sheehan’s syndrome, Asherman’s syndrome, and thyrotoxicosis. To determine the underlying cause of amenorrhoea, initial investigations such as full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels are necessary.

      The management of amenorrhoea depends on the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause in women 40 years of age or older and treat the underlying cause accordingly. It is important to note that hypothyroidism may also cause amenorrhoea.

    • This question is part of the following fields:

      • Gynaecology
      83.6
      Seconds
  • Question 3 - A 28-week pregnant primiparous woman comes to your clinic for a routine check-up....

    Incorrect

    • A 28-week pregnant primiparous woman comes to your clinic for a routine check-up. She has been diagnosed with intrahepatic cholestasis and is currently taking ursodeoxycholic acid while being closely monitored by her maternity unit. She asks you about the likely plan for her delivery.

      What is the most probable plan for delivery for a 28-week pregnant primiparous woman with intrahepatic cholestasis? Is normal vaginal delivery possible, or will an elective caesarian section be planned? Will induction of labour be offered at 37-38 weeks, or will it be delayed until 40 weeks if she has not delivered by then? Is an emergency caesarian section indicated?

      Your Answer: Elective caesarian section at 39 weeks will be planned

      Correct Answer: Induction of labour will be offered at 37-38 weeks

      Explanation:

      The risk of stillbirth is higher in cases of intrahepatic cholestasis of pregnancy, also known as obstetric cholestasis. As a result, it is recommended to induce labour at 37-38 weeks gestation. It is not advisable to wait for a normal vaginal delivery, especially in primiparous women who may go past their due date. Caesarean delivery is not typically necessary for intrahepatic cholestasis, and emergency caesarean section is not warranted in this situation.

      Intrahepatic Cholestasis of Pregnancy: Symptoms and Management

      Intrahepatic cholestasis of pregnancy, also known as obstetric cholestasis, is a condition that affects approximately 1% of pregnancies in the UK. It is characterized by intense itching, particularly on the palms, soles, and abdomen, and may also result in clinically detectable jaundice in around 20% of patients. Raised bilirubin levels are seen in over 90% of cases.

      The management of intrahepatic cholestasis of pregnancy typically involves induction of labor at 37-38 weeks, although this practice may not be evidence-based. Ursodeoxycholic acid is also widely used, although the evidence base for its effectiveness is not clear. Additionally, vitamin K supplementation may be recommended.

      It is important to note that the recurrence rate of intrahepatic cholestasis of pregnancy in subsequent pregnancies is high, ranging from 45-90%. Therefore, close monitoring and management are necessary for women who have experienced this condition in the past.

    • This question is part of the following fields:

      • Obstetrics
      136.3
      Seconds
  • Question 4 - A 7-month-old infant is brought to the emergency department with symptoms of vomiting,...

    Correct

    • A 7-month-old infant is brought to the emergency department with symptoms of vomiting, blood in stools, and irritability. During the physical examination, the baby's abdomen is found to be tense, and he draws his knees up in response to palpation.

      What would be the most suitable course of action for this baby?

      Your Answer: Refer to paediatric surgeons

      Explanation:

      Intussusception in Children: Diagnosis and Treatment

      Intussusception is a medical condition that occurs when one part of the intestine slides into another part, causing a blockage. Children with this condition may experience severe abdominal pain, vomiting, and bloody stools. If left untreated, intussusception can lead to bowel perforation, sepsis, and even death. Therefore, it is crucial to diagnose and treat this condition promptly.

      When a child presents with symptoms of intussusception, the most appropriate course of action is to refer them immediately to a paediatric surgical unit. There, doctors will attempt to relieve the intussusception through air reduction, which involves pumping air into the intestine to push the telescoped section back into place. If this method fails, surgery may be necessary to correct the blockage.

      Several risk factors can increase a child’s likelihood of developing intussusception, including viral infections and intestinal lymphadenopathy. Therefore, parents should seek medical attention if their child experiences any symptoms of this condition. With prompt diagnosis and treatment, most children with intussusception can make a full recovery.

    • This question is part of the following fields:

      • Paediatrics
      70.6
      Seconds
  • Question 5 - A 26-year-old male comes to his doctor's office at the request of his...

    Correct

    • A 26-year-old male comes to his doctor's office at the request of his friends. Upon examination, he discloses that he thinks everyone can hear his thoughts, as if he were a radio station, and that he hears voices commenting on his actions. The doctor observes that he has a blunted affect, alogia, and avolition. Additionally, the doctor notes that the patient repeats the final word of any inquiry posed to him.

      What term describes this phenomenon?

      Your Answer: Echolalia

      Explanation:

      Echolalia is when someone repeats the speech of another person, including any questions asked. This is often seen in individuals with schizophrenia, particularly catatonic schizophrenia, which is characterized by negative symptoms such as a lack of emotional expression, poverty of speech, and poor motivation. The patient in question exhibits two of Schneider’s first-rank symptoms: thought broadcasting and third-person auditory hallucinations, and is therefore diagnosable with schizophrenia. Copropraxia refers to the involuntary performance of obscene or forbidden gestures or inappropriate touching, while echopraxia involves the meaningless repetition or imitation of others’ movements. Finally, a neologism is a word that has been made up.

      Thought disorders can manifest in various ways, including circumstantiality, tangentiality, neologisms, clang associations, word salad, Knight’s move thinking, flight of ideas, perseveration, and echolalia. Circumstantiality involves providing excessive and unnecessary detail when answering a question, but eventually returning to the original point. Tangentiality, on the other hand, refers to wandering from a topic without returning to it. Neologisms are newly formed words, often created by combining two existing words. Clang associations occur when ideas are related only by their similar sounds or rhymes. Word salad is a type of speech that is completely incoherent, with real words strung together into nonsensical sentences. Knight’s move thinking is a severe form of loosening of associations, characterized by unexpected and illogical leaps from one idea to another. Flight of ideas is a thought disorder that involves jumping from one topic to another, but with discernible links between them. Perseveration is the repetition of ideas or words despite attempts to change the topic. Finally, echolalia is the repetition of someone else’s speech, including the question that was asked.

    • This question is part of the following fields:

      • Psychiatry
      30.4
      Seconds
  • Question 6 - A 75-year-old man comes to the General Practitioner (GP) complaining of painless sudden...

    Incorrect

    • A 75-year-old man comes to the General Practitioner (GP) complaining of painless sudden vision loss in his eyes. Upon examination, the GP observes a right homonymous superior quadrantanopia. Where is the lesion located that is responsible for this visual field defect?

      Your Answer: Right optic tract

      Correct Answer: Left temporal lobe optic radiation

      Explanation:

      Lesions and their corresponding visual field defects

      Visual field defects can be caused by lesions in various parts of the visual pathway. Here are some examples:

      Left temporal lobe optic radiation
      Lesion in this area can cause a left superior quadrantanopia.

      Optic chiasm
      A lesion in the optic chiasm can cause a bitemporal hemianopia.

      Left occipital visual cortex
      A lesion in the left occipital visual cortex can cause a right homonymous hemianopia with macular sparing.

      Right optic tract
      A lesion in the right optic tract can cause a left homonymous hemianopia.

      Right parietal lobe optic radiation
      A lesion in the right parietal lobe optic radiation can cause a left inferior quadrantanopia.

      Understanding the location of the lesion and its corresponding visual field defect can aid in diagnosis and treatment of visual impairments.

    • This question is part of the following fields:

      • Ophthalmology
      71.6
      Seconds
  • Question 7 - A 65-year-old man experiences bilateral calf pain that forces him to stop walking...

    Correct

    • A 65-year-old man experiences bilateral calf pain that forces him to stop walking after 100 yards. He discovers that walking uphill and bending forward alleviates the pain. However, he can ride a bike without any discomfort. What is the probable root cause of his condition?

      Your Answer: Lumbar canal stenosis

      Explanation:

      The pain’s position and its improvement when walking uphill make it unlikely that there is a vascular cause underlying it.

      Lumbar spinal stenosis is a condition where the central canal in the lower back is narrowed due to degenerative changes, such as a tumor or disk prolapse. Patients may experience back pain, neuropathic pain, and symptoms similar to claudication. However, one distinguishing factor is that the pain is positional, with sitting being more comfortable than standing, and walking uphill being easier than downhill. Degenerative disease is the most common cause, starting with changes in the intervertebral disk that lead to disk bulging and collapse. This puts stress on the facet joints, causing cartilage degeneration, hypertrophy, and osteophyte formation, which narrows the spinal canal and compresses the nerve roots of the cauda equina. MRI scanning is the best way to diagnose lumbar spinal stenosis, and treatment may involve a laminectomy.

      Overall, lumbar spinal stenosis is a condition that affects the lower back and can cause a range of symptoms, including pain and discomfort. It is often caused by degenerative changes in the intervertebral disk, which can lead to narrowing of the spinal canal and compression of the nerve roots. Diagnosis is typically done through MRI scanning, and treatment may involve a laminectomy. It is important to note that the pain associated with lumbar spinal stenosis is positional, with sitting being more comfortable than standing, and walking uphill being easier than downhill.

    • This question is part of the following fields:

      • Musculoskeletal
      95.3
      Seconds
  • Question 8 - A 28-year-old male presents with a blood pressure reading of 170/100 mmHg. Upon...

    Incorrect

    • A 28-year-old male presents with a blood pressure reading of 170/100 mmHg. Upon examination, he exhibits a prominent aortic ejection click and murmurs are heard over the ribs anteriorly and over the back. Additionally, he reports experiencing mild claudication with exertion and has feeble pulses in his lower extremities. What is the most probable diagnosis?

      Your Answer: Aortic stenosis

      Correct Answer: Coarctation of the aorta

      Explanation:

      Coarctation of the Aorta: Symptoms and Diagnosis

      Coarctation of the aorta is a condition that can present with various symptoms. These may include headaches, nosebleeds, cold extremities, and claudication. However, hypertension is the most typical symptom. A mid-systolic murmur may also be present over the anterior part of the chest, back, spinous process, and a continuous murmur may also be heard.

      One important radiographic finding in coarctation of the aorta is notching of the ribs. This is due to erosion by collaterals. It is important to diagnose coarctation of the aorta early on, as it can lead to serious complications such as heart failure, stroke, and aortic rupture.

    • This question is part of the following fields:

      • Cardiology
      198.8
      Seconds
  • Question 9 - A 72-year-old man presents in a severely unwell state. He is unrousable and,...

    Incorrect

    • A 72-year-old man presents in a severely unwell state. He is unrousable and, on examination, has a blood pressure of 85/40 mmHg with a tachycardia of 110 bpm. His respiratory rate is 35 breaths per minute. There is a past medical history of type II diabetes. A neighbour who attends with the ambulance tells you that the man’s wife died two months earlier. You arrange some investigations.
      Investigations:
      Investigation Result Normal value
      Hameolgobin 122 g/l 135–175 g/l
      White cell count (WCC) 10.3 × 109/l 4–11 × 109/l
      Platelets 205 × 109/l 150–400 × 109/l
      Sodium (Na+) 139 mmol/l 135–145 mmol/l
      Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
      Chloride 102 mmol/l 98-106 mmol/l
      Bicarbonate 14 mmol/l 24–30 mmol/l
      Creatinine 190 μmol/l 50–120 µmol/l
      Glucose 5.0 mmol/l 3.5–5.5 mmol/l
      Lactate 7 mmol/l 0.5–2.2 mmol/l
      pH 7.19 7.35–7.45
      pO2 10.1 kPa (on oxygen) 10.5–13.5 kPa
      pCO2 3.9 kPa 4.6–6.0 kPa
      Which of the following is the most likely diagnosis?

      Your Answer: Diabetic ketoacidosis

      Correct Answer: Lactic acidosis

      Explanation:

      Interpreting Blood Gas Results: Differentiating Acid-Base Disorders

      When interpreting blood gas results, it is important to understand the different acid-base disorders that can occur. One such disorder is lactic acidosis, which is characterized by a raised anion gap and raised serum lactate. Possible causes include ingestion of certain substances or medication overdose, such as metformin in patients with type II diabetes. Accurate fluid management and intensive care unit support are crucial in managing these patients.

      Respiratory alkalosis, on the other hand, would show a low pH with a raised level of CO2. Metabolic alkalosis is indicated by a pH above 7.45, while an acidosis is indicated by a pH below 7.35. In cases of diabetic ketoacidosis, blood glucose levels are typically elevated along with excess ketones, leading to an acidosis. However, in the case of excess lactate production, as seen in lactic acidosis, blood glucose levels may be within normal limits.

      Hyperosmolar non-ketotic coma, which is characterized by extremely high blood glucose levels, is not indicated in this particular blood gas result. Understanding the different acid-base disorders and their corresponding blood gas results is crucial in making an accurate diagnosis and providing appropriate treatment.

    • This question is part of the following fields:

      • Clinical Biochemistry
      184.3
      Seconds
  • Question 10 - A 35-year-old woman visits her GP with complaints of worsening menstrual pain and...

    Incorrect

    • A 35-year-old woman visits her GP with complaints of worsening menstrual pain and heavier bleeding in the past year. During a bimanual pelvic exam, an enlarged, non-tender uterus is palpated. A transvaginal ultrasound reveals a 2 cm fibroid. The patient is nulliparous and desires to have children in the future but not within the next three years. What is the most appropriate initial treatment for this patient?

      Your Answer: Combined oral contraceptive pill

      Correct Answer: Progesterone-releasing intrauterine system

      Explanation:

      Management Options for Fibroids in Women

      Fibroids are a common gynecological condition that can cause symptoms such as dysmenorrhoea and menorrhagia. There are several management options available for women with fibroids, depending on their individual circumstances.

      Progesterone-releasing intrauterine system: This is recommended as a first-line treatment for women with fibroid-associated menorrhagia, where the fibroids are < 3 cm and do not distort the uterine cavity. It also provides a long-term form of contraception for up to two years. Combined oral contraceptive pill: This can be used as a management option for fibroids and is a suitable option for women who do not wish to conceive at present. However, the intrauterine system is more effective and provides longer-term contraception. Expectant management: This can be considered for women who have asymptomatic fibroids. However, it is not appropriate for women who are experiencing symptoms such as dysmenorrhoea and menorrhagia. Hysterectomy: This is a surgical option for women with symptomatic fibroids who do not wish to preserve their fertility. It is not appropriate for women who wish to become pregnant in the future. Non-steroidal anti-inflammatory drugs (NSAIDs): These can be a useful management option for fibroid-related dysmenorrhoea and menorrhagia. However, hormonal contraceptives may be more appropriate for women who do not wish to conceive. Management Options for Women with Fibroids

    • This question is part of the following fields:

      • Gynaecology
      83.4
      Seconds
  • Question 11 - A 25-year-old man is worried about several recent incidents related to his sleep....

    Correct

    • A 25-year-old man is worried about several recent incidents related to his sleep. He reports experiencing paralysis upon waking up and occasionally when falling asleep, accompanied by what he describes as 'hallucinations' such as seeing another person in the room. These episodes are causing him increasing anxiety. What is the probable diagnosis?

      Your Answer: Sleep paralysis

      Explanation:

      Understanding Sleep Paralysis

      Sleep paralysis is a condition that affects many people and is characterized by a temporary inability to move the skeletal muscles when waking up or falling asleep. It is believed to be linked to the natural paralysis that occurs during REM sleep. This phenomenon is recognized in various cultures and is often accompanied by hallucinations or vivid images.

      The paralysis occurs either before falling asleep or after waking up, and it can be a frightening experience for those who are not familiar with it. However, it is a relatively harmless condition that does not require medical attention in most cases. If the symptoms are particularly bothersome, medication such as clonazepam may be prescribed to alleviate the symptoms.

      In summary, sleep paralysis is a common occurrence that affects many people. It is characterized by temporary paralysis of the skeletal muscles and is often accompanied by hallucinations. While it can be a frightening experience, it is generally harmless and does not require medical attention.

    • This question is part of the following fields:

      • Psychiatry
      75.8
      Seconds
  • Question 12 - A 25-year-old female arrives at the Emergency Department complaining of sudden onset abdominal...

    Incorrect

    • A 25-year-old female arrives at the Emergency Department complaining of sudden onset abdominal pain. The pain is intermittent, concentrated in the right iliac fossa, and is rated at a 7/10 intensity. The patient is experiencing nausea and has vomited twice. She reports her last menstrual cycle was 4 weeks ago. An ultrasound of the abdomen shows a whirlpool pattern in the right iliac fossa. What is the probable diagnosis?

      Your Answer: Ectopic pregnancy

      Correct Answer: Ovarian torsion

      Explanation:

      On ultrasound imaging, the presence of a whirlpool sign and free fluid may indicate ovarian torsion. This sign occurs when a structure twists upon itself. It is important to note that appendicitis and ectopic pregnancy do not show this sign on imaging. Additionally, the pain associated with Mittelschmerz is typically less severe and would not be accompanied by the ultrasound finding.

      Understanding Ovarian Torsion

      Ovarian torsion is a medical condition that occurs when the ovary twists on its supporting ligaments, leading to a compromised blood supply. This condition can be partial or complete and may also affect the fallopian tube, which is then referred to as adnexal torsion. Women who have an ovarian mass, are of reproductive age, pregnant, or have ovarian hyperstimulation syndrome are at a higher risk of developing ovarian torsion.

      The most common symptom of ovarian torsion is sudden, severe abdominal pain that is colicky in nature. Patients may also experience vomiting, distress, and in some cases, fever. Upon examination, adnexal tenderness may be detected, and an ultrasound may show free fluid or a whirlpool sign. Laparoscopy is usually both diagnostic and therapeutic for this condition.

    • This question is part of the following fields:

      • Gynaecology
      253.6
      Seconds
  • Question 13 - A 60-year-old gardener comes to the clinic with rough red papules on his...

    Incorrect

    • A 60-year-old gardener comes to the clinic with rough red papules on his knuckles. The rash has been developing gradually over the past few weeks, and he is unsure of the cause. He reports that the rash is both itchy and painful. Additionally, he has been experiencing difficulty with heavy lifting and climbing stairs. What is the most likely explanation for this patient's symptoms?

      Your Answer: Polymyalgia rheumatica

      Correct Answer: Dermatomyositis

      Explanation:

      Dermatomyositis is characterized by roughened red papules, known as Gottron’s papules, mainly over the knuckles. Psoriasis typically presents with scaly plaques on extensor surfaces and may be accompanied by arthritis. Eczema primarily affects the face and trunk of infants and the flexor surfaces of older children, but it is not associated with muscle weakness. Skin involvement is not a common feature of polymyalgia rheumatica.

      Dermatomyositis is a condition that causes inflammation and muscle weakness, as well as distinct skin lesions. It can occur on its own or be associated with other connective tissue disorders or underlying cancers, particularly ovarian, breast, and lung cancer. Screening for cancer is often done after a diagnosis of dermatomyositis. Polymyositis is a variant of the disease that does not have prominent skin manifestations.

      The skin features of dermatomyositis include a photosensitive macular rash on the back and shoulders, a heliotrope rash around the eyes, roughened red papules on the fingers’ extensor surfaces (known as Gottron’s papules), extremely dry and scaly hands with linear cracks on the fingers’ palmar and lateral aspects (known as mechanic’s hands), and nail fold capillary dilation. Other symptoms may include proximal muscle weakness with tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease (such as fibrosing alveolitis or organizing pneumonia), dysphagia, and dysphonia.

      Investigations for dermatomyositis typically involve testing for ANA antibodies, which are positive in around 80% of patients. Approximately 30% of patients have antibodies to aminoacyl-tRNA synthetases, including antibodies against histidine-tRNA ligase (also called Jo-1), antibodies to signal recognition particle (SRP), and anti-Mi-2 antibodies.

    • This question is part of the following fields:

      • Musculoskeletal
      49.5
      Seconds
  • Question 14 - A 20-year-old woman visits her GP complaining of discharge. She mentions having a...

    Correct

    • A 20-year-old woman visits her GP complaining of discharge. She mentions having a recent sexual partner without using barrier protection. During the examination, the doctor observes thick cottage-cheese-like discharge. The patient denies experiencing any other notable symptoms. What is the probable diagnosis?

      Your Answer: Candida albicans

      Explanation:

      Vaginal candidiasis, also known as thrush, is a common condition that many women can diagnose and treat themselves. Candida albicans is responsible for about 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain factors such as diabetes mellitus, antibiotics, steroids, pregnancy, and HIV can increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, itching, vulval erythema, fissuring, and satellite lesions. A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy, with oral fluconazole 150 mg as a single dose being the first-line treatment according to NICE Clinical Knowledge Summaries. If there are vulval symptoms, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments. Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and a high vaginal swab for microscopy and culture should be performed to confirm the diagnosis. A blood glucose test may be necessary to exclude diabetes, and differential diagnoses such as lichen sclerosus should be ruled out. An induction-maintenance regime involving oral fluconazole may be considered. Induction involves taking oral fluconazole every three days for three doses, while maintenance involves taking oral fluconazole weekly for six months.

    • This question is part of the following fields:

      • Gynaecology
      47.2
      Seconds
  • Question 15 - You are discussing conception with two parents who both have achondroplasia. They ask...

    Incorrect

    • You are discussing conception with two parents who both have achondroplasia. They ask you what the chances are that a child of theirs would be of average height. What is the appropriate answer?

      Your Answer: 75%

      Correct Answer: 25%

      Explanation:

      Understanding Achondroplasia

      Achondroplasia is a genetic disorder that is inherited in an autosomal dominant manner. It is caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene, which leads to abnormal cartilage development. This results in short stature, with affected individuals having short limbs (rhizomelia) and shortened fingers (brachydactyly). They also have a large head with frontal bossing and a narrow foramen magnum, midface hypoplasia with a flattened nasal bridge, ‘trident’ hands, and lumbar lordosis.

      In most cases, achondroplasia occurs as a sporadic mutation, with advancing parental age at the time of conception being a risk factor. There is no specific therapy for achondroplasia, but some individuals may benefit from limb lengthening procedures. These procedures involve the application of Ilizarov frames and targeted bone fractures, with a clearly defined need and endpoint being essential for success.

      Overall, understanding achondroplasia is important for individuals and families affected by this condition. While there is no cure, there are treatment options available that can improve quality of life for those living with achondroplasia.

    • This question is part of the following fields:

      • Paediatrics
      98.8
      Seconds
  • Question 16 - A 6-year-old boy spills boiling water on his hand. The lesion is wet,...

    Correct

    • A 6-year-old boy spills boiling water on his hand. The lesion is wet, pink, highly tender and blistered. How would you describe this burn?

      Your Answer: Superficial dermal burn

      Explanation:

      Types of Burns and Their Characteristics

      Burns are classified based on the depth of tissue damage and can help determine the severity and prognosis of the injury. Here are the different types of burns and their characteristics:

      1. Superficial Dermal Burn: This type of burn damages the epidermis and part of the dermis, resulting in pale pink, painful, small blisters. It usually heals within 2-3 weeks with minimal scarring.

      2. Superficial Epidermal Burn: This burn only damages the epidermis, causing redness and slight swelling without blistering. It heals within a week without scarring.

      3. Deep Dermal/Partial-Thickness Burn: Both the epidermis and dermis are damaged, resulting in red, blotchy, dry or moist, swollen, blistered burns that do not blanch and have reduced sensation due to nerve damage. It takes 3-8 weeks to heal with scarring.

      4. Mixed-Depth Burn: This burn is uniform without mixed features described.

      5. Full-Thickness Burn: This is the most severe type of burn, where all three layers of the skin are damaged. The skin is burnt away, and the tissue underneath is pale or blackened. The remaining skin is dry and white, brown, or black without blisters, and is leathery or waxy. It requires surgical repair and grafting.

      Understanding the different types of burns and their characteristics can help in proper diagnosis and treatment.

    • This question is part of the following fields:

      • Plastics
      18.2
      Seconds
  • Question 17 - A 40-year-old male visits his doctor two days after finishing a marathon. He...

    Incorrect

    • A 40-year-old male visits his doctor two days after finishing a marathon. He expresses worry about the reddish-brown hue of his urine and his overall feeling of illness. What is the pigment responsible for the urine discoloration?

      Your Answer: Bilirubin

      Correct Answer: Myoglobin

      Explanation:

      Rhabdomyolysis and Myoglobinuria

      Rhabdomyolysis is a common condition that occurs after extreme physical exertion, such as running a marathon. It is characterized by the breakdown of muscle tissue, which releases myoglobin into the bloodstream. Myoglobin is a small molecule that is normally found in muscle cells, but when released into the circulation, it can cause urine to turn a dark color.

      There are several causes of rhabdomyolysis and myoglobinuria, including trauma, compartment syndrome, crush injuries, ischemia, severe electrolyte imbalances, bacterial and viral infections, and inherited metabolic disorders like McArdle’s disease. In rare cases, certain drugs like barbiturates and statins can also cause rhabdomyolysis.

      It is important to recognize the signs and symptoms of rhabdomyolysis, such as muscle pain, weakness, and dark urine, as it can lead to serious complications like kidney failure if left untreated. Treatment typically involves addressing the underlying cause, such as rehydration and electrolyte replacement, and may require hospitalization in severe cases.

    • This question is part of the following fields:

      • Nephrology
      17.2
      Seconds
  • Question 18 - Sarah is a 75-year-old woman who presents for a follow-up of her left...

    Incorrect

    • Sarah is a 75-year-old woman who presents for a follow-up of her left wrist in fracture clinic 3-weeks after a fall on an outstretched hand. Her X-ray at the time of injury was unremarkable but her wrist was immobilised in a Futuro splint as she was tender in the anatomical snuffbox. Subsequent imaging today shows a fracture of the proximal scaphoid pole.
      What is the recommended definitive treatment for this?

      Your Answer: Remain immobilised in the Futuro splint for a further 6 weeks

      Correct Answer: Surgical fixation

      Explanation:

      Surgical fixation is necessary for all proximal scaphoid pole fractures, including Colin’s injury. Referral to physiotherapy would not be sufficient for managing this type of fracture, as the risk of avascular necrosis is high. Removing the Futuro splint without further intervention would also be inappropriate, as imaging has shown that the fracture has not yet healed. However, if the fracture were an undisplaced scaphoid fracture not involving the proximal pole, immobilization of the wrist in a Futuro splint or below-elbow cast for an additional 6 weeks would be appropriate.

      Understanding Scaphoid Fractures

      A scaphoid fracture is a type of wrist fracture that typically occurs when a person falls onto an outstretched hand or during contact sports. It is important to recognize this type of fracture due to the unusual blood supply of the scaphoid bone. Interruption of the blood supply can lead to avascular necrosis, which is a serious complication. Patients with scaphoid fractures typically present with pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination is highly sensitive and specific when certain signs are present, such as tenderness over the anatomical snuffbox and pain on telescoping of the thumb.

      Plain film radiographs should be requested, including scaphoid views, but the sensitivity in the first week of injury is only 80%. A CT scan may be requested in the context of ongoing clinical suspicion or planning operative management, while MRI is considered the definite investigation to confirm or exclude a diagnosis. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the patient and type of fracture, with undisplaced fractures of the scaphoid waist typically treated with a cast for 6-8 weeks. Displaced scaphoid waist fractures require surgical fixation, as do proximal scaphoid pole fractures. Complications of scaphoid fractures include non-union, which can lead to pain and early osteoarthritis, and avascular necrosis.

    • This question is part of the following fields:

      • Musculoskeletal
      39
      Seconds
  • Question 19 - A 25-year-old woman visits the clinic with her father. He suspects that his...

    Correct

    • A 25-year-old woman visits the clinic with her father. He suspects that his daughter may have autism as she spends most of her time in her room playing video games. He mentions that she is emotionally distant and unresponsive when he tries to talk to her about his concerns. She has no close friends and has never been in a romantic relationship. However, she has recently been promoted at work. When asked for her thoughts on the matter, she seems disinterested and just wants to leave. What is the probable diagnosis?

      Your Answer: Schizoid personality disorder

      Explanation:

      The patient in question appears to have schizoid personality disorder, as he displays a lack of interest in social interaction, emotional detachment, and indifference to both positive and negative feedback. This diagnosis is more likely than others such as antisocial personality disorder, autism spectrum disorder, or avoidant personality disorder, as the patient does not exhibit the specific characteristics associated with these disorders.

      Personality disorders are a set of personality traits that are maladaptive and interfere with normal functioning in life. It is estimated that around 1 in 20 people have a personality disorder, which are typically categorized into three clusters: Cluster A, which includes Odd or Eccentric disorders such as Paranoid, Schizoid, and Schizotypal; Cluster B, which includes Dramatic, Emotional, or Erratic disorders such as Antisocial, Borderline (Emotionally Unstable), Histrionic, and Narcissistic; and Cluster C, which includes Anxious and Fearful disorders such as Obsessive-Compulsive, Avoidant, and Dependent.

      Paranoid individuals exhibit hypersensitivity and an unforgiving attitude when insulted, a reluctance to confide in others, and a preoccupation with conspiratorial beliefs and hidden meanings. Schizoid individuals show indifference to praise and criticism, a preference for solitary activities, and emotional coldness. Schizotypal individuals exhibit odd beliefs and magical thinking, unusual perceptual disturbances, and inappropriate affect. Antisocial individuals fail to conform to social norms, deceive others, and exhibit impulsiveness, irritability, and aggressiveness. Borderline individuals exhibit unstable interpersonal relationships, impulsivity, and affective instability. Histrionic individuals exhibit inappropriate sexual seductiveness, a need to be the center of attention, and self-dramatization. Narcissistic individuals exhibit a grandiose sense of self-importance, lack of empathy, and excessive need for admiration. Obsessive-compulsive individuals are occupied with details, rules, and organization to the point of hampering completion of tasks. Avoidant individuals avoid interpersonal contact due to fears of criticism or rejection, while dependent individuals have difficulty making decisions without excessive reassurance from others.

      Personality disorders are difficult to treat, but a number of approaches have been shown to help patients, including psychological therapies such as dialectical behavior therapy and treatment of any coexisting psychiatric conditions.

    • This question is part of the following fields:

      • Psychiatry
      35.4
      Seconds
  • Question 20 - Which diuretic inhibits the co-transport of Na+/K+/2Cl- in the thick ascending limb of...

    Correct

    • Which diuretic inhibits the co-transport of Na+/K+/2Cl- in the thick ascending limb of the loop of Henle?

      Your Answer: Furosemide

      Explanation:

      Types of Diuretics and Their Mechanisms of Action

      Diuretics are medications that increase urine output and are commonly used to treat conditions such as hypertension, heart failure, and edema. There are different types of diuretics, each with a unique mechanism of action.

      Loop diuretics, such as furosemide, inhibit the co-transport of Na+/K+/2Cl− in the thick ascending limb of the loop of Henle, leading to a significant increase in sodium and chloride concentration in the filtrate and massive diuresis.

      Potassium-sparing diuretics, like spironolactone, act as aldosterone antagonists, causing an increase in sodium excretion and a decrease in K+ and H+ excretion in the collecting tubules.

      Thiazide diuretics, such as bendroflumethiazide, inhibit NaCl transport in the distal convoluted tubule, resulting in a moderate increase in sodium excretion and moderate diuresis.

      Carbonic anhydrase inhibitors, like acetazolamide, increase bicarbonate excretion in the proximal convoluted tubule. While not commonly used as a diuretic, it is used to treat glaucoma, prevent altitude sickness, and idiopathic intracranial hypertension.

      Mannitol is a strong diuretic that remains in the lumen in a high concentration and retains water in the collecting systems by osmotic effect. Its use is controversial, but it is thought to reduce intracranial pressure by osmotically extracting water from CSF and brain parenchyma into the blood.

      Understanding the different types of diuretics and their mechanisms of action can help healthcare professionals choose the appropriate medication for their patients.

    • This question is part of the following fields:

      • Pharmacology
      15.5
      Seconds
  • Question 21 - A 40-year-old woman has been seen by her general practitioner (GP) with symptoms...

    Correct

    • A 40-year-old woman has been seen by her general practitioner (GP) with symptoms of moderate anxiety, including frequent panic attacks, feeling very tired all the time, poor appetite and a short temper. She is taking time off work, arguing with her family and friends and becoming increasingly isolated as a result of the symptoms. She has tried cognitive behavioural therapy but found no benefit. She would like to try medication, and the GP has agreed to start citalopram.
      What advice should she be given before starting the medication?

      Your Answer: There is a risk he will develop discontinuation symptoms if he abruptly stops taking the medication

      Explanation:

      Understanding Selective Serotonin Reuptake Inhibitors (SSRIs)

      When taking an SSRI, it is important to be aware of potential discontinuation symptoms if the medication is stopped abruptly. These symptoms can include rebound anxiety or depressive symptoms, flu-like symptoms, dizziness, nausea, or sleep disturbances. Patients should seek advice from a doctor before reducing or withdrawing the medication, and it is recommended that the discontinuation is done over four weeks.

      While patients may feel some benefit after one week of taking an SSRI, the full benefit can take up to 12 weeks. It is important to be patient and continue taking the medication as prescribed.

      During the first three months of starting medication, patients should be seen every two to four weeks to monitor for adverse effects such as increased anxiety symptoms, sleep disturbance, or gastrointestinal upset. After this initial period, patients should be seen every three months, with the frequency of reviews potentially increasing if symptoms worsen.

      Possible side-effects of taking an SSRI include dyspepsia, worsening of anxiety symptoms, agitation, and sleep problems. Patients should be aware of these potential side-effects.

      While there is an increased risk of suicidal thinking and self-harm for patients under the age of 30 starting an SSRI, this risk is not present for everyone. Patients under 30 should be monitored more closely for signs of suicidal thoughts or self-harm and seen weekly for the first month after medication is started.

      In summary, understanding the potential risks and benefits of taking an SSRI is important for patients to make informed decisions about their mental health treatment.

    • This question is part of the following fields:

      • Psychiatry
      93.2
      Seconds
  • Question 22 - A 72-year-old man is diagnosed with right-sided pleural effusion. The aspirated sample reveals...

    Correct

    • A 72-year-old man is diagnosed with right-sided pleural effusion. The aspirated sample reveals a protein level of 15g/l. What could be the potential reason for the pleural effusion?

      Your Answer: Renal failure

      Explanation:

      Differentiating between transudate and exudate effusions in various medical conditions

      Effusions can occur in various medical conditions, and it is important to differentiate between transudate and exudate effusions to determine the underlying cause. A transudate effusion is caused by increased capillary hydrostatic pressure or decreased oncotic pressure, while an exudate effusion is caused by increased capillary permeability.

      In the case of renal failure, the patient has a transudative effusion as the effusion protein is less than 25 g/l. Inflammation from SLE would cause an exudate effusion, while pancreatitis and right-sided mesothelioma would also cause exudative effusions. Right-sided pneumonia would result in an exudate effusion as well.

      Therefore, understanding the type of effusion can provide valuable information in diagnosing and treating various medical conditions.

    • This question is part of the following fields:

      • Respiratory
      40.6
      Seconds
  • Question 23 - A 65-year-old male presents to the emergency department with a 2-day history of...

    Incorrect

    • A 65-year-old male presents to the emergency department with a 2-day history of worsening upper abdominal pain, accompanied by nausea and vomiting. The pain is exacerbated by meals, and he is unable to tolerate oral intake.
      Upon examination, the patient appears distressed and in pain. His vital signs are as follows:
      Temperature: 38.2 ℃
      Heart rate: 110 beats/minute
      Respiratory rate: 20/min
      Blood pressure: 130/90 mmHg
      Oxygen saturation: 98% on room air
      There is tenderness in the right upper quadrant of his abdomen, but no distension, guarding, or rigidity on light palpation. Murphy's sign is negative. The sclera of his eyes has a yellow tinge.
      Blood lab results are as follows:
      Hb 130 g/L Male: (135-180)
      Female: (115 - 160)
      Platelets 180 * 109/L (150 - 400)
      WBC 15 * 109/L (4.0 - 11.0)
      Bilirubin 30 µmol/L (3 - 17)
      ALP 360 u/L (30 - 100)
      ALT 40 u/L (3 - 40)
      γGT 50 u/L (8 - 60)
      Albumin 38 g/L (35 - 50)
      An ultrasound of the right upper quadrant reveals dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder. The patient is started on IV antibiotics and fluid resuscitation, but his condition remains critical.
      What is the most appropriate next step in management?

      Your Answer: Magnetic retrograde cholangiopancreatography (MRCP)

      Correct Answer: Endoscopic retrograde cholangiopancreatography (ERCP)

      Explanation:

      Ascending cholangitis patients are typically recommended to undergo ERCP within 24-48 hours of diagnosis to alleviate any obstructions. This patient displays Charcot’s triad, leukocytosis, and elevated markers of cholestasis, as well as an ultrasound confirming acute ascending cholangitis. ERCP is the preferred treatment for acute cholangitis, with elective ERCP being performed after clinical improvement in mild cases and immediate ERCP in severe cases. While MRCP can assess biliary tree obstructions, it does not provide therapeutic drainage. Laparoscopic cholecystectomy is not recommended for septic patients and is only indicated once sepsis has been resolved, as it does not remove gallstones in the common bile duct.

      Understanding Ascending Cholangitis

      Ascending cholangitis is a bacterial infection that affects the biliary tree, with E. coli being the most common culprit. This condition is often associated with gallstones, which can predispose individuals to the infection. Patients with ascending cholangitis may present with Charcot’s triad, which includes fever, right upper quadrant pain, and jaundice. However, this triad is only present in 20-50% of cases. Other common symptoms include hypotension and confusion. In severe cases, Reynolds’ pentad may be observed, which includes the additional symptoms of hypotension and confusion.

      To diagnose ascending cholangitis, ultrasound is typically used as a first-line investigation to look for bile duct dilation and stones. Raised inflammatory markers may also be observed. Treatment involves intravenous antibiotics and endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction.

      Overall, ascending cholangitis is a serious condition that requires prompt diagnosis and treatment. Understanding the symptoms and risk factors associated with this condition can help individuals seek medical attention early and improve their chances of a successful recovery.

    • This question is part of the following fields:

      • Surgery
      191.3
      Seconds
  • Question 24 - A 55-year-old man is scheduled to undergo an elective laparoscopic cholecystectomy next week...

    Incorrect

    • A 55-year-old man is scheduled to undergo an elective laparoscopic cholecystectomy next week under general anaesthesia, due to recurring episodes of biliary colic. He has no known allergies or co-morbidities. What advice should he be given regarding eating and drinking before the surgery?

      Your Answer: No food or fluids from midnight before surgery

      Correct Answer: No food for 6 hours before surgery, clear fluids until 2 hours before surgery

      Explanation:

      Fasting Guidelines Prior to Surgery

      Fasting prior to surgery is important to reduce the risk of regurgitation and aspiration while under anesthesia, which can lead to aspiration pneumonia. The current guidance advises patients to refrain from consuming food for at least 6 hours before surgery. However, clear fluids such as water, fruit squash, tea, or coffee with small amounts of skimmed or semi-skimmed milk can be encouraged up to 2 hours before surgery to maintain hydration and aid in post-operative recovery.

      The previous practice of nil by mouth from midnight is now considered unnecessary and outdated. It is now known that maintaining hydration and nutrition peri-operatively can lead to faster post-operative recovery. Patients with diabetes may require a sliding-scale insulin infusion to manage their blood sugar levels before and after surgery.

      In summary, the recommended fasting guidelines prior to surgery are no food for 6 hours before surgery and clear fluids up to 2 hours before surgery. These guidelines help to minimize the risk of aspiration while under anesthesia and promote a smoother recovery process.

    • This question is part of the following fields:

      • Surgery
      246.6
      Seconds
  • Question 25 - An 80-year-old man undergoes surgery to remove his left lung due to advanced...

    Incorrect

    • An 80-year-old man undergoes surgery to remove his left lung due to advanced non-small cell lung cancer. What is the most fatal complication that may arise from this treatment?

      Your Answer: Arrhythmias

      Correct Answer: Pulmonary oedema

      Explanation:

      After a pneumonectomy, patients may experience various complications. Non-cardiogenic pulmonary edema affects a small percentage of patients but can be fatal. Treatment involves supportive measures and may require mechanical ventilation or extracorporeal membrane oxygenation. Pneumonia is a common complication but does not have a high mortality rate. Anastomotic dehiscence, particularly in right pneumonectomies involving the carina, is the most significant cause of mortality. Arrhythmias, such as atrial fibrillation, can occur but are not typically fatal. Pulmonary embolism affects a small percentage of patients but can be deadly if not recognized early. Mortality rates can be reduced to 10% or less with prompt treatment.

    • This question is part of the following fields:

      • Cardiothoracic
      26.2
      Seconds
  • Question 26 - As an F1 in the emergency department, you receive a 15-year-old girl who...

    Incorrect

    • As an F1 in the emergency department, you receive a 15-year-old girl who has been brought in from her high school due to complaints of abdominal pain and nausea. Upon examination, you discover that she is septic and can only provide a brief medical history before becoming drowsy. The surgical team suspects that she may have a perforated appendicitis and requires immediate surgery. Unfortunately, the patient's parents cannot be reached with the contact numbers provided by the school, and the patient is not in a state to provide consent for the operation. What would be the most appropriate course of action in this situation?

      Your Answer: Seek an urgent court order to gain consent on the patient's behalf

      Correct Answer: Take the patient to surgery immediately

      Explanation:

      According to GMC, it is permissible to administer emergency treatment to a child or young person without their consent in order to save their life or prevent their health from seriously deteriorating. This means that obtaining consent from their parents, seeking permission from others, or obtaining a court order is not required.

      Understanding Consent in Children

      The issue of consent in children can be complex and confusing. However, there are some general guidelines to follow. If a patient is under 16 years old, they may be able to consent to treatment if they are deemed competent. This is determined by the Fraser guidelines, which were previously known as Gillick competence. However, even if a child is competent, they cannot refuse treatment that is deemed to be in their best interest.

      For patients between the ages of 16 and 18, it is generally assumed that they are competent to give consent to treatment. Patients who are 18 years or older can consent to or refuse treatment.

      When it comes to providing contraceptives to patients under 16 years old, the Fraser Guidelines outline specific requirements that must be met. These include ensuring that the young person understands the advice given by the healthcare professional, cannot be persuaded to inform their parents, is likely to engage in sexual activity with or without treatment, and will suffer physical or mental health consequences without treatment. Ultimately, the young person’s best interests must be taken into account when deciding whether to provide contraceptive advice or treatment, with or without parental consent.

      In summary, understanding consent in children requires careful consideration of age, competence, and best interests. The Fraser Guidelines provide a useful framework for healthcare professionals to follow when providing treatment and advice to young patients.

    • This question is part of the following fields:

      • Paediatrics
      2965.5
      Seconds
  • Question 27 - A 29-year-old G1P0 28 weeks pregnant African American woman presents for her antenatal...

    Incorrect

    • A 29-year-old G1P0 28 weeks pregnant African American woman presents for her antenatal screening. Her BMI is 23 kg/m², her BP is 136/82 mmHg, her symphysis-fundal height is 29cm and her urine dipstick results are as follows:
      Test Results
      Ketones negative
      Blood negative
      Protein negative
      Glucose trace
      Nitrites negative
      Leukocytes negative
      What would be the most suitable course of action next?

      Your Answer: Request an oral glucose tolerance test

      Correct Answer: Reassure and safety-net

      Explanation:

      During pregnancy, hormonal changes can lead to increased blood flow to the kidneys and an increase in the glomerular filtration rate (GFR), allowing for more efficient filtering of the blood. The patient’s symphysis-fundal height is within the expected range, indicating that the baby is not macrosomic. The patient does not exhibit symptoms of gestational diabetes, such as polyuria, polydipsia, or nocturia, and does not have any risk factors for the condition. Therefore, arranging for a fasting glucose test is not the best option for diagnosing or excluding gestational diabetes. Instead, an OGTT should be considered the gold standard. Prescribing labetalol is not necessary as the patient does not exhibit any concerning signs of pre-eclampsia. Similarly, prescribing metformin is not indicated as the patient has not been diagnosed with gestational diabetes and does not require medication for diabetes at this time.

      Physiological Changes During Pregnancy

      The human body undergoes significant physiological changes during pregnancy. The cardiovascular system experiences an increase in stroke volume by 30%, heart rate by 15%, and cardiac output by 40%. However, systolic blood pressure remains unchanged, while diastolic blood pressure decreases in the first and second trimesters, returning to non-pregnant levels by term. The enlarged uterus may interfere with venous return, leading to ankle edema, supine hypotension, and varicose veins.

      The respiratory system sees an increase in pulmonary ventilation by 40%, with tidal volume increasing from 500 to 700 ml due to the effect of progesterone on the respiratory center. Oxygen requirements increase by only 20%, leading to over-breathing and a fall in pCO2, which can cause a sense of dyspnea accentuated by the elevation of the diaphragm. The basal metabolic rate increases by 15%, possibly due to increased thyroxine and adrenocortical hormones, making warm conditions uncomfortable for women.

      The maternal blood volume increases by 30%, mostly in the second half of pregnancy. Red blood cells increase by 20%, but plasma increases by 50%, leading to a decrease in hemoglobin. There is a low-grade increase in coagulant activity, with a rise in fibrinogen and Factors VII, VIII, X. Fibrinolytic activity decreases, returning to normal after delivery, possibly due to placental suppression. This prepares the mother for placental delivery but increases the risk of thromboembolism. Platelet count falls, while white blood cell count and erythrocyte sedimentation rate rise.

      The urinary system experiences an increase in blood flow by 30%, with glomerular filtration rate increasing by 30-60%. Salt and water reabsorption increase due to elevated sex steroid levels, leading to increased urinary protein losses. Trace glycosuria is common due to the increased GFR and reduction in tubular reabsorption of filtered glucose.

      Calcium requirements increase during pregnancy, especially during the third trimester and lactation. Calcium is transported actively across the placenta, while serum levels of calcium and phosphate fall with a fall in protein. Ionized levels of calcium remain stable, and gut absorption of calcium increases substantially due to increased 1,25 dihydroxy vitamin D.

      The liver experiences an increase in alkaline phosphatase by 50%,

    • This question is part of the following fields:

      • Obstetrics
      443.7
      Seconds
  • Question 28 - A 35-year-old male is scheduled for his annual diabetic review. During the examination,...

    Correct

    • A 35-year-old male is scheduled for his annual diabetic review. During the examination, it is noted that his body mass index has increased to 31.5 kg/m2. How do you calculate body mass index?

      Your Answer: Weight/(Height)2

      Explanation:

      BMI is a calculation of weight over height squared and is used to determine if someone is underweight, normal weight, overweight, or obese. A BMI above 30 indicates obesity and is associated with increased risks for various health issues and surgical complications.

    • This question is part of the following fields:

      • Endocrinology
      18.9
      Seconds
  • Question 29 - A 65-year-old man, with a history of hypertension and atrial fibrillation being treated...

    Incorrect

    • A 65-year-old man, with a history of hypertension and atrial fibrillation being treated with warfarin, experiences a catastrophic intracranial hemorrhage. Despite receiving the highest level of organ support in the ICU, he fails to show any signs of improvement. Before deciding to withdraw organ support, he is evaluated for brain death.
      What healthcare professionals are necessary to diagnose brain death?

      Your Answer: Two consultants competent in the assessment, conduct and interpretation of brainstem examinations

      Correct Answer: Two doctors, one of whom must be a consultant, both fully registered for at least five years and both competent in the assessment, conduct and interpretation of brainstem examinations

      Explanation:

      Requirements for Diagnosis of Death by Neurological Criteria

      To diagnose death by neurological criteria, at least two medical practitioners must be involved. They should be fully registered for at least five years and competent in the assessment, conduct, and interpretation of brainstem examinations. At least one of the doctors must be a consultant, but not both.

      It is important to note that a nurse cannot be one of the medical practitioners involved in the diagnosis. Additionally, the number of doctors required for the diagnosis does not need to be three, as two competent doctors are sufficient.

      Overall, the diagnosis of death by neurological criteria should be taken seriously and conducted by qualified medical professionals to ensure accuracy and ethical considerations.

    • This question is part of the following fields:

      • Acute Medicine And Intensive Care
      49.7
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  • Question 30 - A 50-year-old woman presents with complaints of lower back pain, constipation, headaches, low...

    Incorrect

    • A 50-year-old woman presents with complaints of lower back pain, constipation, headaches, low mood, and difficulty concentrating. Which medication is most likely responsible for her symptoms?

      Your Answer: Quetiapine

      Correct Answer: Lithium

      Explanation:

      Hypercalcaemia, which is indicated by the presented signs and symptoms, can be a result of long-term use of lithium. The mnemonic ‘stones, bones, abdominal moans, and psychic groans’ can be used to identify the symptoms. The development of hyperparathyroidism and subsequent hypercalcaemia is believed to be caused by lithium’s effect on calcium homeostasis, leading to parathyroid hyperplasia. To diagnose this condition, a U&Es and PTH test can be conducted. Unlike lithium, other psychotropic medications are not associated with the development of hyperparathyroidism and hypercalcaemia.

      Lithium is a medication used to stabilize mood in individuals with bipolar disorder and as an adjunct in treatment-resistant depression. It has a narrow therapeutic range of 0.4-1.0 mmol/L and is primarily excreted by the kidneys. The mechanism of action is not fully understood, but it is believed to interfere with inositol triphosphate and cAMP formation. Adverse effects may include nausea, vomiting, diarrhea, fine tremors, nephrotoxicity, thyroid enlargement, ECG changes, weight gain, idiopathic intracranial hypertension, leucocytosis, hyperparathyroidism, and hypercalcemia.

      Monitoring of patients taking lithium is crucial to prevent adverse effects and ensure therapeutic levels. It is recommended to check lithium levels 12 hours after the last dose and weekly after starting or changing the dose until levels are stable. Once established, lithium levels should be checked every three months. Thyroid and renal function should be monitored every six months. Patients should be provided with an information booklet, alert card, and record book to ensure proper management of their medication. Inadequate monitoring of patients taking lithium is common, and guidelines have been issued to address this issue.

    • This question is part of the following fields:

      • Psychiatry
      15.7
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal (1/4) 25%
Gynaecology (1/4) 25%
Obstetrics (0/2) 0%
Paediatrics (1/3) 33%
Psychiatry (4/5) 80%
Ophthalmology (0/1) 0%
Cardiology (0/1) 0%
Clinical Biochemistry (0/1) 0%
Plastics (1/1) 100%
Nephrology (0/1) 0%
Pharmacology (1/1) 100%
Respiratory (1/1) 100%
Surgery (0/2) 0%
Cardiothoracic (0/1) 0%
Endocrinology (1/1) 100%
Acute Medicine And Intensive Care (0/1) 0%
Passmed