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  • Question 1 - A 29-year-old female patient visits her general practitioner complaining of dyspareunia and intermenstrual...

    Incorrect

    • A 29-year-old female patient visits her general practitioner complaining of dyspareunia and intermenstrual bleeding. She is not on any hormonal contraceptives. Following the exclusion of sexually transmitted infections and fibroids, she is referred for colposcopy. The diagnosis is a grade 1A squamous cell carcinoma of the cervix. The patient is married and desires to have children in the future. What is the best treatment option for her cancer?

      Your Answer: Laser ablation

      Correct Answer: Cone biopsy

      Explanation:

      If a woman with stage IA cervical cancer desires to preserve her fertility, a cone biopsy with negative margins may be considered as an option. However, for women who do not wish to have children, a hysterectomy with lymph node clearance is recommended. Cisplatin chemotherapy and radiotherapy are not appropriate for this stage of cervical cancer, while laser ablation is only used for cervical intraepithelial dysplasias. Radical trachelectomy is not recommended as it may negatively impact fertility.

      Management of Cervical Cancer Based on FIGO Staging

      Cervical cancer management is determined by the FIGO staging and the patient’s desire to maintain fertility. The FIGO staging system categorizes cervical cancer into four stages based on the extent of the tumor’s spread. Stage IA and IB tumors are confined to the cervix, with IA tumors only visible under a microscope and less than 7 mm wide. Stage II tumors have spread beyond the cervix but not to the pelvic wall, while stage III tumors have spread to the pelvic wall. Stage IV tumors have spread beyond the pelvis or involve the bladder or rectum.

      The management of stage IA tumors involves a hysterectomy with or without lymph node clearance. For patients who want to maintain fertility, a cone biopsy with negative margins can be performed, but close follow-up is necessary. Stage IB tumors are managed with radiotherapy and concurrent chemotherapy for B1 tumors and radical hysterectomy with pelvic lymph node dissection for B2 tumors.

      Stage II and III tumors are managed with radiation and concurrent chemotherapy, with consideration for nephrostomy if hydronephrosis is present. Stage IV tumors are treated with radiation and/or chemotherapy, with palliative chemotherapy being the best option for stage IVB. Recurrent disease is managed with either surgical treatment followed by chemoradiation or radiotherapy followed by surgical therapy.

      The prognosis of cervical cancer depends on the FIGO staging, with higher survival rates for earlier stages. Complications of treatments include standard surgical risks, increased risk of preterm birth with cone biopsies and radical trachelectomy, and ureteral fistula with radical hysterectomy. Complications of radiotherapy include short-term symptoms such as diarrhea and vaginal bleeding and long-term effects such as ovarian failure and fibrosis of various organs.

    • This question is part of the following fields:

      • Gynaecology
      2365.5
      Seconds
  • Question 2 - A 35-year-old woman with haematuria underwent a kidney biopsy, but light microscopy results...

    Incorrect

    • A 35-year-old woman with haematuria underwent a kidney biopsy, but light microscopy results were inconclusive. As a result, the specimen was sent for electron microscopy. Which renal disease requires electron microscopy for diagnosis?

      Your Answer: Anti-GBM (glomerular basement membrane) disease

      Correct Answer: Thin membrane disease

      Explanation:

      Renal Diseases and their Diagnostic Methods

      Renal diseases can be diagnosed through various methods, including electron microscopy, blood tests, and renal biopsy. Here are some examples:

      Thin Membrane Disease: Electron microscopy is crucial in diagnosing thin membrane disease, as well as Alport syndrome and fibrillary glomerulopathy.

      Anti-GBM Disease: Blood tests for anti-GBM can confirm Goodpasture’s syndrome, but a renal biopsy can also be taken to show IgG deposits along the basement membrane.

      Lupus Nephritis: While electron microscopy can show dense immune deposits in lupus nephritis, diagnosis can also be made through immunofluorescence without the need for electron microscopy.

      IgA Nephropathy: A renal biopsy can confirm IgA nephropathy, showing mesangium proliferation and IgA deposits on immunofluorescence.

      Churg-Strauss Syndrome: Also known as eosinophilic granulomatosis with polyangiitis (EGPA), Churg-Strauss syndrome can be diagnosed through blood tests showing high eosinophils and ANCA, as well as renal biopsy showing eosinophil granulomas.

      Diagnostic Methods for Renal Diseases

    • This question is part of the following fields:

      • Renal
      217.1
      Seconds
  • Question 3 - What are the potential adverse effects of using recombinant human growth hormone (rhGH)...

    Incorrect

    • What are the potential adverse effects of using recombinant human growth hormone (rhGH) therapy?

      Your Answer: Hypothyroidism

      Correct Answer: Idiopathic intracranial hypertension

      Explanation:

      Side Effects of Recombinant Human Growth Hormone Therapy

      Recombinant human growth hormone (RHGH) is a safer alternative to the old pituitary derived growth hormone (GH) as it is not associated with Creutzfeldt-Jakob disease (CJD). However, RHGH therapy has been linked to certain side effects. Patients undergoing RHGH therapy may experience headaches and idiopathic intracranial hypertension (IIH) due to fluid retention caused by the therapy. Additionally, RHGH therapy may lead to proliferative retinopathy in patients with diabetes and aplastic anemia in those with Paroxysmal nocturnal hemoglobinuria. It is important for patients to be aware of these potential side effects and to discuss any concerns with their healthcare provider.

      Overall, while RHGH therapy is a beneficial treatment for growth hormone deficiency, it is important to monitor for potential side effects and adjust treatment as necessary. Proper communication between patients and healthcare providers can help ensure the best possible outcomes for patients undergoing RHGH therapy.

    • This question is part of the following fields:

      • Endocrinology
      329.7
      Seconds
  • Question 4 - A 4 month old boy is suspected of having hypospadias. In boys with...

    Incorrect

    • A 4 month old boy is suspected of having hypospadias. In boys with this condition, where is the urethral opening most commonly located?

      Your Answer: On the distal dorsal surface of the penis

      Correct Answer: On the distal ventral surface of the penis

      Explanation:

      The anomaly is typically situated on the underside and frequently towards the end. Urethral openings found closer to the body are a known occurrence. Surgical removal of the foreskin may hinder the process of repairing the defect.

      Understanding Hypospadias: A Congenital Abnormality of the Penis

      Hypospadias is a condition that affects approximately 3 out of 1,000 male infants. It is a congenital abnormality of the penis that is usually identified during the newborn baby check. However, if missed, parents may notice an abnormal urine stream. This condition is characterized by a ventral urethral meatus, a hooded prepuce, and chordee in more severe forms. The urethral meatus may open more proximally in the more severe variants, but 75% of the openings are distally located. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.

      Hypospadias most commonly occurs as an isolated disorder, but it can also be associated with other conditions such as cryptorchidism (present in 10%) and inguinal hernia. Once hypospadias has been identified, infants should be referred to specialist services. Corrective surgery is typically performed when the child is around 12 months of age. It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure. In boys with very distal disease, no treatment may be needed. Understanding hypospadias is important for parents and healthcare providers to ensure proper management and treatment of this condition.

    • This question is part of the following fields:

      • Paediatrics
      13.6
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  • Question 5 - A 59-year-old librarian has been experiencing more frequent episodes of intermittent abdominal discomfort...

    Correct

    • A 59-year-old librarian has been experiencing more frequent episodes of intermittent abdominal discomfort and bloating. She also reports having episodes of diarrhea with mucous in her stool, but no blood. The pain tends to worsen after meals and improve after having a bowel movement. Despite her symptoms, she has not experienced any weight loss and maintains a healthy appetite. She has undergone surgery for osteoarthritis in her hip, but has no other significant medical history.
      Upon investigation, the patient has been diagnosed with diverticular disease. What is the most likely complication this patient may develop?

      Your Answer: Colovesical fistulae

      Explanation:

      Complications and Associations of Diverticular Disease

      Diverticular disease is a condition that can lead to various complications. One of the most common complications is the formation of fistulae, which are abnormal connections between different organs. The most frequent type of fistula associated with diverticular disease is the colovesical fistula, which connects the colon and the bladder. Other types of fistulae include colovaginal, colouterine, and coloenteric. Colocutaneous fistulae, which connect the colon and the skin, are less common.

      Diverticular disease does not increase the risk of developing colorectal carcinoma, a type of cancer that affects the bowel. However, it can cause other symptoms such as haemorrhoids, which are not directly related to the condition. Anal fissure, another medical condition that affects the anus, is not associated with diverticular disease either. Instead, it is linked to other conditions such as HIV, tuberculosis, inflammatory bowel disease, and syphilis.

      In summary, diverticular disease can lead to various complications and associations, but it is not a pre-malignant condition and does not directly cause haemorrhoids or anal fissure.

    • This question is part of the following fields:

      • Colorectal
      149.2
      Seconds
  • Question 6 - A 6-year-old girl presents to your clinic with her parents for a follow-up...

    Correct

    • A 6-year-old girl presents to your clinic with her parents for a follow-up appointment. She has been experiencing nocturnal enuresis for the past eight months. During her last visit four months ago, she was wetting the bed six to seven nights a week. You advised her parents to limit her fluid intake before bedtime, establish a toileting routine before bed, and implement a reward system for positive behavior. Despite following these recommendations, she continues to wet the bed six to seven nights a week. What would be the most appropriate next step in managing her nocturnal enuresis?

      Your Answer: Enuresis alarm

      Explanation:

      When general advice has not been effective, an enuresis alarm is typically the initial treatment option for nocturnal enuresis. However, there are exceptions to this, such as when the child and family find the alarm unacceptable or if the child is over 8 years old and needs rapid short-term reduction in enuresis. Additionally, it is important to note that enuresis alarms have a lower relapse rate compared to other treatments.

      Nocturnal enuresis, or bedwetting, is when a child involuntarily urinates during the night. Most children achieve continence by the age of 3 or 4, so enuresis is defined as the involuntary discharge of urine in a child aged 5 or older without any underlying medical conditions. Enuresis can be primary, meaning the child has never achieved continence, or secondary, meaning the child has been dry for at least 6 months before.

      When managing bedwetting, it’s important to look for any underlying causes or triggers, such as constipation, diabetes mellitus, or recent onset UTIs. General advice includes monitoring fluid intake and encouraging regular toileting patterns, such as emptying the bladder before sleep. Reward systems, like star charts, can also be helpful, but should be given for agreed behavior rather than dry nights.

      The first-line treatment for bedwetting is an enuresis alarm, which has a high success rate. These alarms have sensor pads that detect wetness and wake the child up to use the toilet. If short-term control is needed, such as for sleepovers, or if the alarm is ineffective or not acceptable to the family, desmopressin may be prescribed. Overall, managing bedwetting involves identifying any underlying causes and implementing strategies to promote continence.

    • This question is part of the following fields:

      • Paediatrics
      163.2
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  • Question 7 - A person in their mid-30s has been taking an anti-psychotic medication for a...

    Incorrect

    • A person in their mid-30s has been taking an anti-psychotic medication for a few years. They have also recently begun taking fluoxetine. During a visit to their general practitioner, they reported experiencing troubling symptoms such as lip smacking, difficulty swallowing, and excessive blinking. What is the probable diagnosis?

      Your Answer: Acute dystonia

      Correct Answer: Tardive dyskinesia

      Explanation:

      Tardive dyskinesia is a side effect that occurs after taking antipsychotics for an extended period of time. The patient’s recent use of fluoxetine is not relevant to this condition. Neuroleptic malignant syndrome and acute dystonia typically manifest within the first few days or weeks of starting an antipsychotic medication, making them unlikely in this case. Malignant hyperthermia, on the other hand, is a potential side effect of anaesthetic drugs.

      Antipsychotics are a group of drugs used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. They are associated with extrapyramidal side-effects and hyperprolactinaemia, which are less common with atypical antipsychotics.

      Extrapyramidal side-effects (EPSEs) are common with typical antipsychotics and include Parkinsonism, acute dystonia, sustained muscle contraction, akathisia, and tardive dyskinesia. The latter is a late onset of choreoathetoid movements that may be irreversible and occur in 40% of patients. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients, including an increased risk of stroke and venous thromboembolism. Other side-effects include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval.

    • This question is part of the following fields:

      • Psychiatry
      97.5
      Seconds
  • Question 8 - An 80-year-old man presents to the clinic with an 8-month history of uncorrectable...

    Correct

    • An 80-year-old man presents to the clinic with an 8-month history of uncorrectable poor vision. He has a medical history of hypertension, allergic conjunctivitis, and type 1 diabetes mellitus, and has been a heavy smoker for the past 20 years. On examination, his right eye has a visual acuity of 6/30 while the left eye is normal. Fundoscopy reveals increased retinal blood vessels, blot haemorrhages, and hard exudates in the nasal upper quadrant of the right eye. He denies any sudden visual loss or ocular trauma. What is the most likely diagnosis?

      Your Answer: Proliferative diabetic retinopathy

      Explanation:

      The most likely diagnosis for this patient is proliferative diabetic retinopathy, as evidenced by the presence of neovascularisation, microaneurysms, and hard exudates on fundoscopy. This condition is more common in type 1 diabetes mellitus. Dry age-related macular degeneration and hypertensive retinopathy are less likely diagnoses, as they do not explain all of the patient’s symptoms and findings.

      Understanding Diabetic Retinopathy

      Diabetic retinopathy is a leading cause of blindness among adults aged 35-65 years old. The condition is caused by hyperglycemia, which leads to abnormal metabolism in the retinal vessel walls and damage to endothelial cells and pericytes. This damage causes increased vascular permeability, resulting in exudates seen on fundoscopy. Pericyte dysfunction predisposes to the formation of microaneurysms, while neovascularization is caused by the production of growth factors in response to retinal ischemia.

      Patients with diabetic retinopathy are classified into those with nonproliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy. NPDR is further classified into mild, moderate, and severe, depending on the presence of microaneurysms, blot hemorrhages, hard exudates, cotton wool spots, venous beading/looping, and intraretinal microvascular abnormalities. PDR is characterized by retinal neovascularization, which may lead to vitreous hemorrhage, and fibrous tissue forming anterior to the retinal disc. Maculopathy is based on location rather than severity and is more common in Type II DM.

      Management of diabetic retinopathy involves optimizing glycaemic control, blood pressure, and hyperlipidemia, as well as regular review by ophthalmology. Treatment options include intravitreal vascular endothelial growth factor (VEGF) inhibitors for maculopathy, regular observation for nonproliferative retinopathy, and panretinal laser photocoagulation and intravitreal VEGF inhibitors for proliferative retinopathy. Vitreoretinal surgery may be necessary in cases of severe or vitreous hemorrhage.

    • This question is part of the following fields:

      • Ophthalmology
      62.3
      Seconds
  • Question 9 - A 28-year-old amateur football player arrives at the emergency department complaining of knee...

    Incorrect

    • A 28-year-old amateur football player arrives at the emergency department complaining of knee pain. During the game, she experienced a popping sensation in her left knee. Upon examination, her knee is swollen, and she cannot fully extend it. Which diagnostic test is most likely to reveal the underlying cause?

      Your Answer: Plain film radiograph (X-ray)

      Correct Answer: Magnetic resonance imaging (MRI)

      Explanation:

      When it comes to detecting lateral and medial meniscal tears, an MRI is the most sensitive option available. It surpasses the other choices in terms of sensitivity and should be requested for all patients who are suspected of having a meniscal injury. Ultrasound may be challenging to perform due to the patient’s probable swelling and pain. An X-ray may be necessary for patients with arthritis or a history of repeated meniscal tears.

      Understanding Meniscal Tear and its Symptoms

      Meniscal tear is a common knee injury that usually occurs due to twisting injuries. Its symptoms include pain that worsens when the knee is straightened, a feeling that the knee may give way, tenderness along the joint line, and knee locking in cases where the tear is displaced. To diagnose a meniscal tear, doctors may perform Thessaly’s test, which involves weight-bearing at 20 degrees of knee flexion while the patient is supported by the doctor. If the patient experiences pain on twisting the knee, the test is considered positive.

    • This question is part of the following fields:

      • Musculoskeletal
      17.8
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  • Question 10 - A 38-year-old male librarian presents with sudden loss of hearing in both ears....

    Correct

    • A 38-year-old male librarian presents with sudden loss of hearing in both ears. There is no ear pain, history of recent upper respiratory tract infection or history of trauma. He has no past medical history of note and does not take any regular prescribed or over-the-counter medications. Tuning fork testing suggests right side sensorineural hearing loss. Examination of the auditory canals and tympanic membranes is unremarkable, as is neurological examination. He is referred to the acute ear, nose and throat (ENT) clinic. Audiometry reveals a 40 db hearing loss in the right ear at multiple frequencies.
      Which of the following represents the most appropriate initial management plan?

      Your Answer: Arrange an urgent magnetic resonance (MR) of the brain

      Explanation:

      Management of Sudden Sensorineural Hearing Loss

      Sudden sensorineural hearing loss (SSNHL) is a medical emergency that requires urgent evaluation and management. Patients with unexplained sudden hearing loss should be referred to an ENT specialist and offered an MRI scan. A CT scan may also be indicated to rule out stroke, although it is unlikely to cause unilateral hearing loss.

      Antiviral medication such as acyclovir is not recommended unless there is evidence of viral infection. Antibiotics are also not indicated unless there is evidence of bacterial infection.

      The mainstay of treatment for SSNHL is oral prednisolone, which should be started as soon as possible and continued for 14 days. While the cause of SSNHL is often unknown, it is important to consider a wide range of differential diagnoses, including trauma, drugs, space-occupying lesions, autoimmune inner ear disease, and many other conditions. Prompt evaluation and treatment can improve the chances of recovery and prevent further hearing loss.

    • This question is part of the following fields:

      • ENT
      1281.2
      Seconds
  • Question 11 - A 65-year-old man presents to your GP Surgery with worry about an incident...

    Correct

    • A 65-year-old man presents to your GP Surgery with worry about an incident that occurred earlier in the day. He vaguely describes experiencing epigastric discomfort, followed by a tingling sensation down his arms and the scent of cooking bacon. Additionally, he reports feeling generally unwell. He did not lose consciousness during the episode. Upon further questioning, he mentions having experienced similar symptoms before. You observe that he has a medical history of ischaemic heart disease and had a stroke four months ago.
      What is the most probable diagnosis for this patient?

      Your Answer: Focal aware seizure

      Explanation:

      Differential Diagnosis for a Patient with Focal Aware Seizures

      Focal aware seizures, also known as simple focal seizures or auras, are a type of seizure that do not result in loss of awareness. Patients may experience vague discomfort, unusual smells or tastes, tingling, or twitching in an arm or leg. It is important to note that these seizures can be a sign of another type of seizure to come. Risk factors include head trauma and previous stroke.

      Malingering, or feigning symptoms for secondary gain, should be considered but is a diagnosis of exclusion. It is important to thoroughly investigate the patient’s symptoms before making this diagnosis.

      Focal impaired awareness seizures, previously known as complex focal seizures, result in memory loss, loss of awareness, and automatic bodily movements. This is not the case for a patient with focal aware seizures.

      Gastritis may be a differential due to the patient’s epigastric pain, but it does not fit with the other neurological symptoms.

      Psychotic hallucinations should be considered but are less likely given the patient’s coherent description of events and lack of history or risk factors for mental illness.

      In summary, when presented with a patient experiencing focal aware seizures, it is important to consider other neurological conditions before making a diagnosis.

    • This question is part of the following fields:

      • Neurology
      28.2
      Seconds
  • Question 12 - A 15-year-old boy arrives at the emergency department complaining of a severe headache....

    Correct

    • A 15-year-old boy arrives at the emergency department complaining of a severe headache. He has been experiencing this headache for the past 4 hours and has noticed that lights appear brighter and hurt his eyes. The boy is unable to touch his chin to his neck due to pain. Upon examination, there are no neurological deficits, but papilloedema is observed during fundoscopy. No rash is detected during the examination. The boy's early warning score is 1 due to a raised temperature, but otherwise, he is stable.
      What is the most appropriate course of action for managing this patient's presentation?

      Your Answer: Start ceftriaxone

      Explanation:

      A young man with symptoms of meningitis, including headache, photophobia, and neck stiffness, presents with papilloedema indicating raised intracranial pressure. Due to the risk of coning, an LP is contraindicated, and antibiotics should be started immediately. The choice of antibiotics depends on the patient’s age and location, with ceftriaxone being appropriate in this case. A CT head is not necessary as the symptoms point towards meningitis. Co-amoxiclav should not be used in the treatment of meningitis.

      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
      29
      Seconds
  • Question 13 - A 65-year-old woman presents with backache over the past 5 days, which did...

    Incorrect

    • A 65-year-old woman presents with backache over the past 5 days, which did not respond to over-the-counter analgesics. Pain is increasing in the night and is constant. It is not subsiding with rest. There is no history of trauma. She is a known diabetic and hypertensive. She had an episode of deep vein thrombosis 1 month ago and was on heparin for 3 weeks. She had no children and her husband passed away a year ago. Her current medications include captopril, metformin, warfarin, atorvastatin and aspirin 375 mg. X-ray of the spine shows a fracture of C6 vertebra.
      Which one of the following is the most likely underlying disease causing the fracture at this vertebral level?

      Your Answer: Renal osteodystrophy due to diabetic nephropathy

      Correct Answer: Metastatic carcinoma due to occult primary

      Explanation:

      Distinguishing Causes of Vertebral Fractures: A Guide for Clinicians

      When a patient presents with thoracic back pain and a vertebral fracture, it is important to consider the underlying cause. Fractures at or above the T4 level are suggestive of cancer, rather than osteoporosis. This is especially true if the patient has no known primary cancer, as it may be a case of metastatic carcinoma due to occult primary.

      postmenopausal osteoporosis and heparin-induced osteoporosis typically do not cause fractures at or above T4. Instead, fractures below T4 are more commonly seen in osteoporosis. However, a higher fracture associated with thoracic back pain is a red flag feature that should be investigated further with imaging, such as an MRI spine, as cancer is suspected.

      Statin-induced myopathy is another condition that can cause muscle pain and weakness, but it does not typically present with back pain or vertebral fractures. Similarly, renal osteodystrophy due to diabetic nephropathy can affect the spine, but this patient does not have chronic renal failure. If diabetic nephropathy is present, it may progress to renal failure, which can lead to renal osteodystrophy.

      In summary, when evaluating a patient with thoracic back pain and a vertebral fracture, it is important to consider the location of the fracture and any other symptoms or risk factors. This can help clinicians distinguish between potential causes and guide appropriate diagnostic testing and treatment.

    • This question is part of the following fields:

      • Orthopaedics
      87.2
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  • Question 14 - A 7-year-old girl arrives at the emergency department with severe wheezing and shortness...

    Incorrect

    • A 7-year-old girl arrives at the emergency department with severe wheezing and shortness of breath. She is struggling to speak in full sentences and her peak expiratory flow rate is 320 l/min (45% of normal). Her oxygen saturation levels are at 92%. Her pCO2 is 4.8 kPa.

      What is the most concerning finding from the above information?

      Your Answer: Oxygen saturations

      Correct Answer: pCO2 (kPa)

      Explanation:

      Assessing Acute Asthma Attacks in Children

      When assessing the severity of asthma attacks in children, the 2016 BTS/SIGN guidelines recommend using specific criteria. These criteria can help determine whether the attack is severe or life-threatening. For a severe attack, the child may have a SpO2 level below 92%, a PEF level between 33-50% of their best or predicted, and may be too breathless to talk or feed. Additionally, their heart rate may be over 125 (for children over 5 years old) or over 140 (for children between 1-5 years old), and their respiratory rate may be over 30 breaths per minute (for children over 5 years old) or over 40 (for children between 1-5 years old). They may also be using accessory neck muscles to breathe.

      For a life-threatening attack, the child may have a SpO2 level below 92%, a PEF level below 33% of their best or predicted, and may have a silent chest, poor respiratory effort, agitation, altered consciousness, or cyanosis. It is important for healthcare professionals to be aware of these criteria and to take appropriate action to manage the child’s asthma attack. By following these guidelines, healthcare professionals can help ensure that children with asthma receive the appropriate care and treatment they need during an acute attack.

    • This question is part of the following fields:

      • Paediatrics
      14.7
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  • Question 15 - At what age do children typically begin to play alongside their peers without...

    Incorrect

    • At what age do children typically begin to play alongside their peers without actively engaging with them?

      Your Answer: 3 months

      Correct Answer: 2 years

      Explanation:

      The table summarizes developmental milestones for social behavior, feeding, dressing, and play. Milestones include smiling at 6 weeks, using a spoon and cup at 12-15 months, and playing with other children at 4 years.

    • This question is part of the following fields:

      • Paediatrics
      13.5
      Seconds
  • Question 16 - A 5-year-old girl is seen by the orthopaedic specialist after experiencing a worsening...

    Incorrect

    • A 5-year-old girl is seen by the orthopaedic specialist after experiencing a worsening limp for 4 weeks. Her blood tests were normal, and x-rays revealed a hip joint effusion without any significant femoral head structural abnormalities. The doctor diagnosed her with Perthes' disease. What would be the most suitable initial management plan for this child?

      Your Answer: Pavlik harness

      Correct Answer: Observation

      Explanation:

      If Perthes’ disease is diagnosed in children under the age of 6 years and there is no significant collapse of the femoral head or gross structural abnormalities, observation is the recommended course of action. This involves regular x-rays, monitoring, and physiotherapy. The Pavlik harness, serial casting, and steroid injections are not appropriate treatments for this condition.

      Understanding Perthes’ Disease

      Perthes’ disease is a degenerative condition that affects the hip joints of children, typically between the ages of 4-8 years. It is caused by a lack of blood supply to the femoral head, which leads to bone infarction and avascular necrosis. This condition is more common in boys, with around 10% of cases being bilateral. The symptoms of Perthes’ disease include hip pain, stiffness, reduced range of hip movement, and a limp. Early changes can be seen on an x-ray, such as widening of the joint space, while later changes include decreased femoral head size and flattening.

      To diagnose Perthes’ disease, a plain x-ray is usually sufficient. However, if symptoms persist and the x-ray is normal, a technetium bone scan or magnetic resonance imaging may be necessary. If left untreated, Perthes’ disease can lead to complications such as osteoarthritis and premature fusion of the growth plates.

      The severity of Perthes’ disease is classified using the Catterall staging system, which ranges from stage 1 (clinical and histological features only) to stage 4 (loss of acetabular integrity). Treatment options include keeping the femoral head within the acetabulum using a cast or braces, observation for children under 6 years old, and surgical management for older children with severe deformities. The prognosis for Perthes’ disease is generally good, with most cases resolving with conservative management. Early diagnosis is key to improving outcomes.

    • This question is part of the following fields:

      • Paediatrics
      83.3
      Seconds
  • Question 17 - A 32-year-old woman comes to the antenatal clinic at 14 weeks pregnant. She...

    Correct

    • A 32-year-old woman comes to the antenatal clinic at 14 weeks pregnant. She was surprised to discover her pregnancy just last week, as it was unexpected. This is her fourth pregnancy, but she has had three miscarriages in the past. The midwife suggests a quadruple test due to the late discovery of her pregnancy, which reveals the following results:

      - Alpha-fetoprotein (AFP) is low
      - Unconjugated oestriol (uE3) is low
      - Total human chorionic gonadotrophin (hCG) is low
      - Inhibin-A is normal

      What is the most likely diagnosis?

      Your Answer: Edward's syndrome

      Explanation:

      The quadruple test result shows a decrease in AFP, oestriol, and hCG, without change in inhibin A, indicating Edward’s syndrome. This condition is caused by trisomy 18 and can present with physical features such as micrognathia, low-set ears, rocker bottom feet, and overlapping fingers. The quadruple test is a screening test used to identify pregnancies with a higher risk of Down’s syndrome, Edwards’ syndrome, Patau’s syndrome, or neural tube defects. It is typically offered to patients who discover their pregnancy late and are no longer eligible for the combined test. ARPKD cannot be diagnosed with a quadruple test, but it can be detected prenatally with an ultrasound. Down’s syndrome would present with low AFP, low unconjugated oestriol, high hCG, and inhibin A, while neural tube defects would present with high AFP and normal oestriol, hCG, and inhibin A.

      NICE updated guidelines on antenatal care in 2021, recommending the combined test for screening for Down’s syndrome between 11-13+6 weeks. The test includes nuchal translucency measurement, serum B-HCG, and pregnancy-associated plasma protein A (PAPP-A). The quadruple test is offered between 15-20 weeks for women who book later in pregnancy. Results are interpreted as either a ‘lower chance’ or ‘higher chance’ of chromosomal abnormalities. If a woman receives a ‘higher chance’ result, she may be offered a non-invasive prenatal screening test (NIPT) or a diagnostic test. NIPT analyzes cell-free fetal DNA in the mother’s blood and has high sensitivity and specificity for detecting chromosomal abnormalities. Private companies offer NIPT screening from 10 weeks gestation.

    • This question is part of the following fields:

      • Obstetrics
      189.7
      Seconds
  • Question 18 - A 22-year-old woman who is 26 weeks pregnant comes to the emergency department...

    Incorrect

    • A 22-year-old woman who is 26 weeks pregnant comes to the emergency department complaining of severe headache and epigastric pain that has been worsening for the past 48 hours. Upon examination, she has a heart rate of 110 beats/min, a respiratory rate of 21 /min, a temperature of 36.8ºC, mild pitting oedema of the ankles, and brisk tendon reflexes. As pre-eclampsia is the likely diagnosis, what is the most crucial sign to look for?

      Your Answer: Heart rate 110/min

      Correct Answer: Brisk tendon reflexes

      Explanation:

      Brisk reflexes are a specific clinical sign commonly linked to pre-eclampsia, unlike the other answers which are more general.

      Pre-eclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure, proteinuria, and edema. It can lead to complications such as eclampsia, neurological issues, fetal growth problems, liver involvement, and cardiac failure. Severe pre-eclampsia is marked by hypertension, proteinuria, headache, visual disturbances, and other symptoms. Risk factors for pre-eclampsia include hypertension in a previous pregnancy, chronic kidney disease, autoimmune disease, diabetes, chronic hypertension, first pregnancy, and age over 40. Aspirin may be recommended for women with high or moderate risk factors. Treatment involves emergency assessment, admission for observation, and medication such as labetalol, nifedipine, or hydralazine. Delivery of the baby is the most important step in management, with timing depending on the individual case.

    • This question is part of the following fields:

      • Obstetrics
      34.2
      Seconds
  • Question 19 - A 58-year-old man comes to the clinic with a lump in the anterior...

    Correct

    • A 58-year-old man comes to the clinic with a lump in the anterior of his neck. He denies any symptoms of thyrotoxicosis. His family members have noticed that his voice has become increasingly hoarse over the past few weeks. Fine-needle aspiration indicates papillary carcinoma of the thyroid.

      Which of the following statements is true?

      Your Answer: Thyroidectomy is curative in most cases

      Explanation:

      Myth-busting Facts about Thyroid Cancer

      Thyroidectomy is a common treatment for thyroid cancer, and it is curative in most cases. However, there are several misconceptions about this type of cancer that need to be addressed.

      Firstly, papillary carcinoma, the most common type of thyroid cancer, is the least aggressive and can be cured with thyroidectomy. Secondly, a hoarse voice is not necessarily an indication of laryngeal involvement, but rather recurrent laryngeal nerve invasion.

      Thirdly, while calcitonin levels are raised in medullary carcinoma of the thyroid, this type of cancer is rare and accounts for only a small percentage of cases. Finally, contrary to popular belief, most cases of thyroid cancer are sporadic, and only a small percentage are familial.

      It is important to dispel these myths and educate the public about the realities of thyroid cancer to ensure accurate diagnosis and effective treatment.

    • This question is part of the following fields:

      • Endocrinology
      19.4
      Seconds
  • Question 20 - A 6-year-old girl is brought to the paediatric clinic by her father with...

    Correct

    • A 6-year-old girl is brought to the paediatric clinic by her father with a sore throat that worsens with swallowing, headaches, and malaise. He reports no coughing.

      Upon examination, her temperature is 38.5ºC, her heart rate is 100 bpm, and her tonsils are symmetrically enlarged and red, with white patches present. There is tender anterior cervical lymphadenopathy. The doctor's overall impression is that of an ill child.

      The patient has no medical history but is allergic to penicillin. What is the most appropriate immediate step in her management?

      Your Answer: Immediate hospital admission

      Explanation:

      Immediate hospital admission is necessary for a child with fevers who appears unwell to a paediatric healthcare professional, as this is considered a red flag indicating severe illness. In this case, the child has a Centor score of 4 and presents with tonsillitis symptoms, including tonsillar exudate, tender cervical lymphadenopathy, fever, and no cough. While antibiotic treatment may be warranted, the priority is to admit the child for assessment and management of their condition. Delayed antibiotic prescription or prescribing a specific antibiotic, such as clarithromycin or phenoxymethylpenicillin, would not be appropriate in this situation.

      The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013. These guidelines use a ‘traffic light’ system to assess the risk of children under 5 years old presenting with a fever. It is important to note that these guidelines only apply until a clinical diagnosis of the underlying condition has been made. When assessing a febrile child, their temperature, heart rate, respiratory rate, and capillary refill time should be recorded. Signs of dehydration should also be looked for. Measuring temperature should be done with an electronic thermometer in the axilla if the child is under 4 weeks old or with an electronic/chemical dot thermometer in the axilla or an infrared tympanic thermometer.

      The risk stratification table includes green for low risk, amber for intermediate risk, and red for high risk. The table includes categories such as color, activity, respiratory, circulation and hydration, and other symptoms. If a child is categorized as green, they can be managed at home with appropriate care advice. If they are categorized as amber, parents should be provided with a safety net or referred to a pediatric specialist for further assessment. If a child is categorized as red, they should be urgently referred to a pediatric specialist. It is important to note that oral antibiotics should not be prescribed to children with fever without an apparent source, and a chest x-ray does not need to be routinely performed if a pneumonia is suspected but the child is not going to be referred to the hospital.

    • This question is part of the following fields:

      • Paediatrics
      105.1
      Seconds
  • Question 21 - A 10-year-old girl is brought to the Accident and Emergency department by her...

    Correct

    • A 10-year-old girl is brought to the Accident and Emergency department by her parents. On a background of high-grade fever and lethargy over the last 12 hours, the child had an episode of jerking of the limbs, frothing at the mouth and incontinence of urine. She has failed to recover full consciousness after the episode. At presentation, she is poorly responsive to name-calling, but responsive to pain. She is however maintaining her airway and oxygen saturation is 95% on air. Limited neurological examination is unremarkable. Non-contrast computerised tomography (CT) scan of the brain is normal. Lumbar puncture is performed and reveals a slightly raised opening pressure, moderately increased cerebrospinal fluid (CSF) protein, CSF lymphocytosis and normal glucose.
      What is the most important step in management?

      Your Answer: IV acyclovir

      Explanation:

      The child in question is suffering from viral encephalitis, which is typically treated with IV acyclovir. The recommended dosage is 5 mg/kg every 8 hours for 5 days, or 10 mg/kg every 8 hours for at least 14 days in cases of encephalitis. Encephalitis should be suspected when a patient presents with altered behavior, decreased consciousness, focal neurology, or seizures, along with a viral prodrome of fever and lethargy. The most common cause of encephalitis is the herpes simplex virus-1 (HSV-1), with other common causes including cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Japanese encephalitis. Diagnostic tests should include a full blood count, urea and electrolytes, inflammatory markers, blood glucose, blood cultures, and serum for viral polymerase chain reaction (PCR). A CT scan of the brain is necessary to rule out structural brain lesions and raised intracranial pressure. Lumbar puncture is then performed. Mortality in untreated viral encephalitis is high, so IV acyclovir should be started within 30 minutes of the patient arriving. Intubation and ventilation may be necessary in severe cases, but in this case, acyclovir is the most appropriate treatment. While MRI may aid in diagnosis, CSF analysis is sufficient, and IV cefotaxime and IV mannitol are not the most urgent steps in management.

    • This question is part of the following fields:

      • Paediatrics
      129.9
      Seconds
  • Question 22 - A 14-year-old male is brought in with acute severe asthma. During examination, it...

    Incorrect

    • A 14-year-old male is brought in with acute severe asthma. During examination, it is noted that his peripheral pulse volume decreases during inspiration. What is the most probable reason for this clinical finding?

      Your Answer: The cardiac effect of high dose beta agonist bronchodilator drugs

      Correct Answer: Reduced left atrial filling pressure on inspiration

      Explanation:

      Pulsus Paradoxus

      Pulsus paradoxus is a medical condition where there is an abnormal drop in blood pressure during inhalation. This occurs when the right heart responds directly to changes in intrathoracic pressure, while the filling of the left heart depends on the pulmonary vascular volume. In cases of severe airflow limitation, such as acute asthma, high respiratory rates can cause sudden negative intrathoracic pressure during inhalation. This enhances the normal fall in blood pressure, leading to pulsus paradoxus.

      It is important to understand the underlying mechanisms of pulsus paradoxus to properly diagnose and treat the condition. By recognizing the relationship between intrathoracic pressure and blood pressure, healthcare professionals can provide appropriate interventions to manage the symptoms and prevent complications. With proper management, patients with pulsus paradoxus can lead healthy and fulfilling lives.

    • This question is part of the following fields:

      • Respiratory
      53.4
      Seconds
  • Question 23 - A 72-year-old man visits his GP complaining of a sudden onset of unilateral...

    Correct

    • A 72-year-old man visits his GP complaining of a sudden onset of unilateral ptosis on the left side. During the examination, the doctor observes anisocoria with miosis of the left pupil and anhidrosis of his left face, arm, and trunk. The patient reports no pain in the left arm or scapular region. He has a history of smoking for 45 pack-years. A chest X-ray is performed, but it shows no abnormalities. What is the probable cause of this condition?

      Your Answer: Stroke

      Explanation:

      Causes of Horner Syndrome: A Differential Diagnosis

      Horner syndrome is a rare condition that affects the nerves that control the pupil, eyelid, and sweat glands in the face. It is characterized by a drooping eyelid, a constricted pupil, and decreased sweating on one side of the face. Here are some possible causes of Horner syndrome and their distinguishing features:

      1. Stroke: A central type Horner syndrome is often caused by a stroke, especially in patients with a history of smoking.

      2. Carotid artery dissection: This condition can cause a postganglionic or third-order Horner syndrome, which is characterized by neck pain, headache around the eye, pulsatile tinnitus, and Horner syndrome. Unlike the central and preganglionic types, there is no anhidrosis in postganglionic Horner syndrome.

      3. Cavernous sinus thrombosis: This condition can also cause a postganglionic Horner syndrome, but it is usually accompanied by unilateral periorbital edema, headache, photophobia, and proptosis. Patients may also exhibit signs of sepsis due to the infective cause of this condition.

      4. Multiple sclerosis: While multiple sclerosis can cause central Horner syndrome, it is not the most common cause. Patients with this condition should also present with other features of multiple sclerosis.

      5. Pancoast tumor: Although this patient is a chronic heavy smoker, a Pancoast tumor is not necessarily the cause of Horner syndrome. This type of tumor causes a preganglionic Horner syndrome, which presents with ptosis, miosis, and anhidrosis on the face. Additionally, a Pancoast tumor significant enough to cause Horner syndrome would be visible on a chest X-ray.

      In conclusion, Horner syndrome can have various causes, and a thorough differential diagnosis is necessary to determine the underlying condition.

    • This question is part of the following fields:

      • Ophthalmology
      140.3
      Seconds
  • Question 24 - A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She...

    Incorrect

    • A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She had been feeling well until three days ago when she started experiencing abdominal discomfort and frequent bowel movements. Her vital signs are stable with a blood pressure of 105/70 mmHg, pulse rate of 90 bpm, respiratory rate of 14 breaths/min, and body temperature of 38.1 °C. She is alert and oriented. Mild abdominal tenderness is present, particularly in the right lower quadrant, without rigidity or guarding. A tender mass is palpable in the right lower quadrant. The anterior lower leg has multiple erythematous and tender patches. A stool sample is sent for examination of red cells, leukocytes, bacteria, ova and parasites, and culture.

      Which of the following microorganisms is most likely responsible for this condition?

      Your Answer: Vibrio vulnificus

      Correct Answer: Yersinia enterocolitica

      Explanation:

      Bacterial Causes of Gastroenteritis: Yersinia, Vibrio, E. coli, Campylobacter, and Salmonella

      Gastroenteritis is a common condition caused by various bacterial pathogens. Yersinia enterocolitica is one such pathogen that can cause invasive gastroenteritis, leading to mesenteric lymphadenitis and erythema nodosum. Vibrio vulnificus is another Gram-negative bacterium that causes gastroenteritis and skin blisters after consuming contaminated oysters, with chronic liver disease patients at higher risk. Escherichia coli has several pathogenic strains, including enterotoxigenic, enteropathogenic, enteroinvasive, and enterohaemorrhagic, each causing different types of gastroenteritis. Campylobacter is the most common cause of bacterial gastroenteritis worldwide, with invasive symptoms and often bloody stool. Salmonella, a non-lactose fermenter, can also cause gastroenteritis and diarrhea, usually non-bloody. Understanding the different bacterial causes of gastroenteritis is crucial for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Infectious Diseases
      65.1
      Seconds
  • Question 25 - As an Emergency department doctor, a 50-year-old man presents with intense left flank...

    Correct

    • As an Emergency department doctor, a 50-year-old man presents with intense left flank pain that extends to his groin. He reports that the pain began yesterday. Upon conducting a urinalysis, the following results were obtained:
      - Haemoglobin +++
      - Urobilinogen Negative
      - Bilirubin Negative
      - Protein Negative
      - Glucose Negative
      - Nitrites Negative
      - Leucocytes Negative
      - Ketones +

      What could be the possible cause of these findings?

      Your Answer: Renal calculus

      Explanation:

      Renal Calculi: Causes and Symptoms

      Renal calculi, commonly known as kidney stones, can be caused by various factors such as reduced urine output, changes in medication, and diet. These factors can lead to the formation of stones in the urinary tract, which can cause inflammation and damage to the lining of the urinary tract. Patients with renal calculi may experience symptoms such as blood in their urine due to the damage caused by the stones. Additionally, ketones may be present in the urine, indicating reduced oral intake due to severe pain.

      In summary, renal calculi can be caused by various factors and can lead to symptoms such as blood in the urine and reduced oral intake. It is important for patients to seek medical attention if they suspect they may have renal calculi to receive proper diagnosis and treatment.

    • This question is part of the following fields:

      • Nephrology
      83.6
      Seconds
  • Question 26 - An 80-year-old man who lives alone and prepares his own food is discovered...

    Correct

    • An 80-year-old man who lives alone and prepares his own food is discovered to have multiple ecchymotic haemorrhagic areas surrounding his hair follicles. The hairs are broken, and various haematomas are present in the muscles of his arms and legs. Other than the absence of teeth, the remainder of the physical examination is unremarkable. Laboratory testing reveals a normal prothrombin time, APTT, and a full blood count that is normal except for a haematocrit of 28%. Which deficiency is most likely to account for this patient's symptoms?

      Your Answer: Vitamin C

      Explanation:

      Scurvy: Symptoms and Causes

      Scurvy is a medical condition that occurs due to a lack of vitamin C in the diet. This deficiency leads to impaired collagen synthesis, which can cause a range of symptoms. The most common signs of scurvy include gum swelling, bleeding, and infection, as well as loose teeth and mucosal petechiae. In severe cases, patients may also experience scleral icterus, which is a yellowing of the eyes, and pale conjunctiva. Children with scurvy may suffer from fractures, dislocations, and tenderness of bones, while bleeding into muscles and joints is also possible.

      One of the most recognizable symptoms of scurvy is the appearance of the skin. Patients may develop perifollicular hyperkeratotic papules, which are small bumps around hair follicles. They may also experience perifollicular haemorrhages, which are small spots of bleeding around hair follicles. Other skin symptoms include purpura, which is a rash of purple spots, and ecchymoses, which are larger areas of bruising.

      In conclusion, scurvy is a serious medical condition that can cause a range of symptoms. It is caused by a lack of vitamin C in the diet, which leads to impaired collagen synthesis. If left untreated, scurvy can cause significant damage to the body, including bleeding, infection, and bone fractures.

    • This question is part of the following fields:

      • Clinical Sciences
      47.5
      Seconds
  • Question 27 - A 55-year-old woman arrives at the emergency department with a sudden and severe...

    Incorrect

    • A 55-year-old woman arrives at the emergency department with a sudden and severe headache, which she describes as the worst she has ever experienced. The headache came on while she was sitting at her desk. She also reports feeling nauseous and vomiting.

      During the examination, the woman displays neck stiffness, photophobia, and appears drowsy. A CT scan reveals hyperdense across the basal cisterns and sulci.

      What is the appropriate course of action for managing the complications of this condition?

      Your Answer: Diltiazem

      Correct Answer: Nimodipine

      Explanation:

      A subarachnoid haemorrhage (SAH) is a type of bleeding that occurs within the subarachnoid space of the meninges in the brain. It can be caused by head injury or occur spontaneously. Spontaneous SAH is often caused by an intracranial aneurysm, which accounts for around 85% of cases. Other causes include arteriovenous malformation, pituitary apoplexy, and mycotic aneurysms. The classic symptoms of SAH include a sudden and severe headache, nausea and vomiting, meningism, coma, seizures, and ECG changes.

      The first-line investigation for SAH is a non-contrast CT head, which can detect acute blood in the basal cisterns, sulci, and ventricular system. If the CT is normal within 6 hours of symptom onset, a lumbar puncture is not recommended. However, if the CT is normal after 6 hours, a lumbar puncture should be performed at least 12 hours after symptom onset to check for xanthochromia and other CSF findings consistent with SAH. If SAH is confirmed, referral to neurosurgery is necessary to identify the underlying cause and provide urgent treatment.

      Management of aneurysmal SAH involves supportive care, such as bed rest, analgesia, and venous thromboembolism prophylaxis. Vasospasm is prevented with oral nimodipine, and intracranial aneurysms require prompt intervention to prevent rebleeding. Most aneurysms are treated with a coil by interventional neuroradiologists, but some require a craniotomy and clipping by a neurosurgeon. Complications of aneurysmal SAH include re-bleeding, hydrocephalus, vasospasm, and hyponatraemia. Predictive factors for SAH include conscious level on admission, age, and amount of blood visible on CT head.

    • This question is part of the following fields:

      • Surgery
      406.3
      Seconds
  • Question 28 - A 25-year-old woman presents to the emergency department with an acutely painful and...

    Correct

    • A 25-year-old woman presents to the emergency department with an acutely painful and swollen right knee.

      On examination, the knee is tender and has a reduced range of motion. She is unable to weight bear on her right leg.

      Her observations are as follows, heart rate 98 beats/min, respiratory rate 18/min, blood pressure 110/76 mmHg, oxygen saturation 98%, temperature 38.2ºC.

      An aspiration of the joint is performed, producing a sample of yellow-looking synovial fluid from the knee joint.

      She has no other past medical history but admits that she missed a gynecology appointment recently.

      What is the most likely organism to be cultured from the synovial fluid?

      Your Answer: Neisseria gonorrhoeae

      Explanation:

      The most frequently identified organism in young adults with septic arthritis is Neisseria gonorrhoeae. This is evident in the case of the young woman who presents with acute knee pain, swelling, fever, limited range of motion, and inability to bear weight. While Chlamydia trachomatis can cause joint pain, it typically results in reactive arthritis, which has a more prolonged history, does not cause fever, and produces a sterile joint aspirate. Septic arthritis caused by Escherichia coli is rare, and Pseudomonas aeruginosa is not a common cause of this condition.

      Septic Arthritis in Adults: Causes, Symptoms, and Treatment

      Septic arthritis is a condition that occurs when bacteria infect a joint, leading to inflammation and pain. The most common organism that causes septic arthritis in adults is Staphylococcus aureus, but in young adults who are sexually active, Neisseria gonorrhoeae is the most common organism. The infection usually spreads through the bloodstream from a distant bacterial infection, such as an abscess. The knee is the most common location for septic arthritis in adults. Symptoms include an acute, swollen joint, restricted movement, warmth to the touch, and fever.

      To diagnose septic arthritis, synovial fluid sampling is necessary and should be done before administering antibiotics if necessary. Blood cultures may also be taken to identify the cause of the infection. Joint imaging may also be used to confirm the diagnosis.

      Treatment for septic arthritis involves intravenous antibiotics that cover Gram-positive cocci. Flucloxacillin or clindamycin is recommended if the patient is allergic to penicillin. Antibiotic treatment is typically given for several weeks, and patients are usually switched to oral antibiotics after two weeks. Needle aspiration may be used to decompress the joint, and arthroscopic lavage may be required in some cases.

    • This question is part of the following fields:

      • Musculoskeletal
      28.2
      Seconds
  • Question 29 - Among the various chromosomal anomalies, which one has the highest incidence of systemic...

    Correct

    • Among the various chromosomal anomalies, which one has the highest incidence of systemic lupus erythematosus (SLE), a multisystem autoimmune disease associated with genetic defects in the immune system and triggered by environmental factors?

      Your Answer: 47,XXY (Klinefelter’s syndrome)

      Explanation:

      Chromosomal Abnormalities and Their Association with Systemic Lupus Erythematosus (SLE)

      Individuals with Klinefelter’s syndrome have a 14-fold increased risk of developing SLE compared to those with a normal karyotype, although the exact mechanism for this is unknown. However, there is no evidence to suggest an increased risk of SLE in individuals with Down syndrome, Fragile X syndrome, or Trisomy 18 (Edwards’ syndrome). Bloom syndrome, which is associated with a short stature, skin sensitivity to sun exposure, and an increased risk of malignancies, also does not appear to increase the risk of SLE. It is important to understand the potential associations between chromosomal abnormalities and SLE to better manage and treat patients with these conditions.

    • This question is part of the following fields:

      • Genetics
      17
      Seconds
  • Question 30 - A 57-year-old man who smokes 20 cigarettes daily developed heart failure post-myocardial infarction....

    Correct

    • A 57-year-old man who smokes 20 cigarettes daily developed heart failure post-myocardial infarction. He is prescribed ramipril but decided to stop it due to a persistent dry cough.
      What is the mechanism of an angiotensin-converting enzyme (ACE) inhibitor-related cough?

      Your Answer: Increased bradykinin

      Explanation:

      How Ramipril Causes Cough: Mechanisms and Factors Involved

      Ramipril is an ACE inhibitor that reduces blood pressure by inhibiting the conversion of angiotensin I to angiotensin II. This leads to vasodilation and a drop in blood pressure. However, the use of ramipril has been associated with a common side effect of coughing. Here are some mechanisms and factors involved in how ramipril causes cough:

      Increased Bradykinin: ACE inhibitors also inhibit kininase II, an enzyme that degrades bradykinin, an inflammatory mediator. In the presence of an ACE inhibitor like ramipril, bradykinin accumulates in the blood, causing bronchoconstriction and cough.

      Acid Reflux: Acid reflux is a common cause of nocturnal cough, but it has not been linked to the use of ACE inhibitors.

      Reduced Angiotensin II: ACE inhibitors reduce the levels of angiotensin II, a potent vasoconstrictor, leading to vasodilation and a drop in blood pressure. However, this is not related to the cough caused by the use of ACE inhibitors.

      Increased Substance P: ACE inhibitors are not known to affect the levels of substance P, a neurotransmitter associated with pain and inflammation.

      Opioid Receptor Antagonism: ACE inhibitors do not interact with opioid receptors, which are targeted by cough suppressants like codeine phosphate.

      In conclusion, the accumulation of bradykinin due to the inhibition of kininase II is the most likely mechanism for the cough caused by ramipril. Other factors like acid reflux, reduced angiotensin II, substance P, and opioid receptor antagonism are not involved in this side effect.

    • This question is part of the following fields:

      • Pharmacology
      12.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gynaecology (0/1) 0%
Renal (0/1) 0%
Endocrinology (1/2) 50%
Paediatrics (3/7) 43%
Colorectal (1/1) 100%
Psychiatry (0/1) 0%
Ophthalmology (3/3) 100%
Musculoskeletal (1/2) 50%
ENT (1/1) 100%
Neurology (1/1) 100%
Orthopaedics (0/1) 0%
Obstetrics (1/2) 50%
Respiratory (0/1) 0%
Infectious Diseases (0/1) 0%
Nephrology (1/1) 100%
Clinical Sciences (1/1) 100%
Surgery (0/1) 0%
Genetics (1/1) 100%
Pharmacology (1/1) 100%
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