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Question 1
Correct
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A 70-year-old man presents to his GP with a complaint of difficulty swallowing that has been occurring for the past four weeks. He reports that solid foods are particularly problematic and feel as though they are getting stuck. The patient has a medical history of hypertension and osteoarthritis of the knees, for which he takes amlodipine 5 mg OD and paracetamol 1 g as required respectively. He has a 20-pack year smoking history but does not consume alcohol. On examination, the patient appears well at rest and has a normal body habitus. Abdominal examination is largely unremarkable, except for some mild epigastric discomfort. What is the most appropriate next step in management?
Your Answer: Refer to gastroenterology for OGD (oesophago-gastro-duodenoscopy) under the 2-week wait criteria
Explanation:Recognizing Red Flags for Oesophageal Cancer: Referring for OGD under the 2-Week Wait Criteria
When a patient presents with subacute and first-onset dysphagia limited to solids, it suggests a new mass obstructing the oesophagus. This symptom is a red flag for oesophageal cancer, and a 2-week wait referral for OGD is necessary to prevent a delay in diagnosis. If abnormal tissue is found during the OGD, biopsies will be taken for histological analysis to confirm the diagnosis.
PPI therapy and review in a month is not appropriate for dysphagia, as it may delay a potential cancer diagnosis. Emergency hospital admission is unnecessary, as the patient is not acutely unstable. Routine outpatient gastrointestinal appointment is appropriate, but it must be performed within two weeks in accordance with the UK’s referral guidelines for potential cancer diagnoses. Acute specialist care of the elderly clinic referral is not necessary, as the patient’s age alone does not indicate a need for geriatric care.
It is important to explain to the patient that while cancer is a possibility, there may be other explanations as well. Encouraging a step-by-step approach and informing the patient that the specialist who conducts the OGD will explain things in more detail when consenting them for the procedure is appropriate. The full criteria for a 2-week wait referral for OGD includes new-onset dysphagia at any age, and additional criteria for patients over 55 years old with weight loss, epigastric abdominal pain, dyspepsia, reflux, or a history of Barrett’s oesophagus.
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This question is part of the following fields:
- Gastroenterology
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Question 2
Correct
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A 28-year-old woman who is 20 weeks pregnant visits the obstetric clinic for a routine ultrasound scan. During the examination, it is observed that the mother's uterus is smaller than expected for her stage of pregnancy, and the ultrasound scan confirms the presence of intrauterine growth restriction (IUGR). The medical team inquires about any potential risk factors for IUGR that the mother may have.
What is a known maternal risk factor for intrauterine growth restriction?Your Answer: Smoking
Explanation:Understanding Risk Factors for Intrauterine Growth Restriction (IUGR)
Intrauterine growth restriction (IUGR) is a condition where a baby does not grow properly in the womb. There are various risk factors associated with IUGR, including smoking during pregnancy, which can increase the likelihood of developing the condition.
There are two types of IUGR: symmetrical and asymmetrical. Symmetrical growth retardation occurs at the start or during early pregnancy and is characterized by a small head and short length. Asymmetrical growth retardation occurs in advanced pregnancy and is characterized by reduced abdominal growth compared to head circumference, due to selective shunting of blood to the brain.
It’s important to note that a baby with a birthweight below the tenth centile is considered small for gestational age (SGA), which may be normal or due to IUGR.
Contrary to popular belief, hypotension (low blood pressure), obesity, and stress are not recognized risk factors for IUGR. However, poorly controlled diabetes is a risk factor for IUGR, while well-controlled diabetes is not.
Understanding these risk factors can help healthcare providers identify and manage IUGR early on, leading to better outcomes for both mother and baby.
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This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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A 40-year-old man presents with blood in his ejaculate. He reports no lower urinary tract symptoms and no abdominal pain and is generally healthy. He has been in a long-term monogamous relationship and denies any history of trauma. Examination of his scrotum and penis is unremarkable, and his prostate is normal and non-tender upon digital rectal examination. Urinalysis results are within normal limits, and there is no family history of cancer.
What is the most appropriate next step, in addition to obtaining a urine sample for microscopy, culture, and sensitivities?Your Answer: Arrange a prostate-specific antigen (PSA) blood test
Correct Answer: Reassure him that this symptom is not a sign of anything serious but ask him to return if he has >3 episodes or the problem persists for over a month
Explanation:Haematospermia, or blood in semen, is usually not a cause for concern in men under 40 years old. The most common causes are trauma, urinary tract infection (especially prostatitis), and sexually transmitted infection. However, it is important to rule out cancer through appropriate physical examination. If the symptom persists for over a month or there are more than three episodes, referral is recommended, especially for men over 40 years old. While reassurance is appropriate, patients should be encouraged to seek medical attention if the problem persists. Antibiotics may be prescribed if a urinary tract infection is suspected, but this is unlikely in cases with normal urinalysis. Urgent referral is necessary for men with signs and symptoms suggestive of prostate or urological malignancies, or if the underlying cause of haematospermia may be cysts or calculi of the prostate or seminal vesicles.
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This question is part of the following fields:
- Urology
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Question 4
Incorrect
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A 29-year-old primiparous woman who is 20 weeks pregnant comes in for a consultation after her foetal anomaly scan revealed polyhydramnios and a midline sac containing bowel. She has no significant medical history and is not taking any regular medications. She had planned for a home birth and is now concerned about how this condition will affect her delivery.
What is the best course of action for managing this condition?Your Answer: Plan for delivery on the ward
Correct Answer: Schedule an elective caesarean section
Explanation:If a foetus is diagnosed with exomphalos before birth, it is recommended to schedule and perform a caesarean section at term to reduce the risk of sac rupture, infection, and atresia. While a ward delivery provides access to theatres, specific surgical planning is necessary to minimize complications. Instrumental delivery in theatre does not decrease the risk of sac rupture. It is important to explain to the mother why hospital delivery is necessary and the risks associated with a home birth. Induction of labour at 37 weeks is not advisable as it increases the risk of complications during vaginal delivery.
Gastroschisis and exomphalos are both types of congenital visceral malformations. Gastroschisis refers to a defect in the anterior abdominal wall located just beside the umbilical cord. In contrast, exomphalos, also known as omphalocoele, involves the protrusion of abdominal contents through the anterior abdominal wall, which are covered by an amniotic sac formed by amniotic membrane and peritoneum.
When it comes to managing gastroschisis, vaginal delivery may be attempted, but newborns should be taken to the operating theatre as soon as possible after delivery, ideally within four hours. As for exomphalos, a caesarean section is recommended to reduce the risk of sac rupture. In cases where primary closure is difficult due to lack of space or high intra-abdominal pressure, a staged repair may be undertaken. This involves allowing the sac to granulate and epithelialise over several weeks or months, forming a shell. As the infant grows, the sac contents will eventually fit within the abdominal cavity, at which point the shell can be removed and the abdomen closed.
Overall, both gastroschisis and exomphalos require careful management to ensure the best possible outcome for the newborn. By understanding the differences between these two conditions and the appropriate steps to take, healthcare professionals can provide effective care and support to both the infant and their family.
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This question is part of the following fields:
- Paediatrics
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Question 5
Incorrect
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A 28-year-old G2P1 attends the clinic at 37 weeks’ gestation, complaining of ongoing nausea and vomiting for most of the pregnancy. Blood tests show abnormal results for sodium, alkaline phosphatase, and creatinine. What is the most appropriate management?
Your Answer: Arrange admission for intravenous (iv) hydration
Correct Answer: Reassure the patient and follow up in 1 week
Explanation:Management of Abnormal Alkaline Phosphatase in Pregnancy
Alkaline phosphatase is an enzyme produced by the placenta during pregnancy. If a pregnant patient presents with elevated levels of alkaline phosphatase, it can be concerning. However, in the absence of other abnormal blood results and symptoms, further work-up is not indicated. The most appropriate management in this situation is to reassure the patient and follow up in one week.
It is important to note that dehydration and severe electrolyte abnormalities can cause elevated alkaline phosphatase levels. However, if there is no evidence of these issues, there is no need for admission for intravenous hydration.
Additionally, an urgent ultrasound of the liver is not necessary if the rest of the liver enzymes are normal. Induction of labor is not indicated in this situation either.
If the patient has cholestasis of pregnancy, cholestyramine may be used to bind bile acids. However, if the patient has normal bile acids and no evidence of cholestasis, cholestyramine is not necessary.
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This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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Select the phrase that accurately characterizes the method by which gene transcription is triggered.
Your Answer: Introns
Correct Answer: Promoters
Explanation:Understanding Gene Transcription: Promoters, Silencers, Exons, Introns, and Enhancers
Gene transcription is the process by which genetic information is copied from DNA to RNA. This process involves several key elements, including promoters, silencers, exons, introns, and enhancers.
Promoters are specialized sequences found upstream of a gene that serve as binding sites for RNA polymerase, the enzyme responsible for RNA synthesis from DNA. Silencers, on the other hand, are sequences found upstream or downstream of a gene that can prevent RNA polymerase from binding, thereby inhibiting gene transcription.
Following transcription, an RNA transcript is produced that contains both introns and exons. Exons are the sections of the RNA transcript that will be translated to protein, while introns are non-coding sections that are spliced out prior to translation.
Enhancers are sequences found upstream or downstream of a gene that promote transcription when bound by specific transcription factors. They can be located thousands of base pairs from the promoter region of the gene in question.
Understanding these key elements of gene transcription is essential for understanding how genetic information is expressed and regulated in cells.
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This question is part of the following fields:
- Genetics
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Question 7
Correct
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A 27-year-old construction worker complains of worsening pain in his feet over the past two weeks, describing it as feeling like he is walking on gravel. He also reports experiencing lower back pain.
The patient recently returned from a trip to Spain two months ago and recalls having a brief episode of urethral discharge, but did not seek medical attention for it.
What is a possible diagnosis?Your Answer: Reactive arthritis
Explanation:Reactive Arthritis
Reactive arthritis is a medical condition that is characterized by a combination of symptoms including seronegative arthritis, urethritis, and conjunctivitis. The condition is often associated with sacroiliitis and painful feet, which reflects plantar fasciitis. Reactive arthritis is known to occur after gastrointestinal infections with Shigella or Salmonella, as well as following non-specific urethritis.
Gonococcal arthritis, on the other hand, tends to occur in patients who are systemically unwell and have features of septic arthritis. It is important to note that reactive arthritis is not contagious and cannot be spread from one person to another.
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This question is part of the following fields:
- Rheumatology
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Question 8
Incorrect
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A 29-year-old man with valvular heart disease is urgently admitted with fever, worsening shortness of breath and a letter from his GP confirming the presence of a new murmur. During examination, a harsh pansystolic murmur and early diastolic murmur are detected, along with a temperature of 38.3 °C and bilateral fine basal crepitations. Initial blood cultures have been collected.
What is the most pressing concern that needs to be addressed immediately?Your Answer: Echocardiogram (ECHO)
Correct Answer: Administration of intravenous antibiotics
Explanation:Prioritizing Interventions in Suspected Infective Endocarditis
When dealing with suspected infective endocarditis, time is of the essence. The following interventions should be prioritized in order to limit valve destruction and improve patient outcomes.
Administration of Intravenous Antibiotics
Prompt initiation of intravenous antibiotics is crucial. An empirical regime of gentamicin and benzylpenicillin may be used until microbiological advice suggests any alternative.Electrocardiogram (ECG)
An ECG provides important diagnostic information and should be performed as part of the initial work-up. However, it does not take priority over antibiotic administration.Echocardiogram (ECHO)
An ECHO should be performed in all patients with suspected infective endocarditis, but it does not take priority over administration of antibiotics. A transoesophageal ECHO is more sensitive and should be considered if necessary.Throat Swab
While a throat swab may be useful in identifying the causative organism of infective endocarditis, it should not take precedence over commencing antibiotics. Careful examination of a patient’s dentition is also crucial to evaluate for a possible infectious source.Administration of Paracetamol
Symptomatic relief is important, but administration of paracetamol should not take priority over antibiotic delivery. Both interventions should be given as soon as possible to improve patient outcomes. -
This question is part of the following fields:
- Cardiology
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Question 9
Correct
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A 68-year-old man presents to the Emergency Department with hypotension and maelena despite receiving 6 units of blood. He has a medical history of arthritis and takes methotrexate and ibuprofen. What is the next most appropriate course of action from the following options?
Your Answer: Endoscopy
Explanation:The Importance of Endoscopy in Diagnosing and Treating Upper GI Bleeds
When a patient presents with an upper GI bleed, it is important to determine the cause and provide appropriate treatment. In cases where the bleed is likely caused by a duodenal ulcer from non-steroidal anti-inflammatory drug use, an OGD (oesophago-gastro-duodenoscopy) is necessary for diagnosis and initial therapeutic management. Endoscopy allows for the identification of a bleeding ulcer, which can then be injected with adrenaline and clipped to prevent re-bleeding.
Continued transfusion may help resuscitate the patient, but it will not stop the bleeding. A CT scan with embolisation could be useful, but a CT scan alone would not be sufficient. Laparotomy should only be considered if endoscopic therapy fails. Diagnostic laparoscopy is not necessary as a clinical diagnosis can be made based on the patient’s history and condition.
In conclusion, endoscopy is crucial in diagnosing and treating upper GI bleeds, particularly in cases where a duodenal ulcer is suspected. It allows for immediate intervention to stop the bleeding and prevent further complications.
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This question is part of the following fields:
- Gastroenterology
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Question 10
Correct
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A 75-year-old woman presents to a respiratory outpatient clinic with a dry cough and shortness of breath that has been ongoing for 6 months. Despite being a non-smoker, her husband is a pigeon breeder. Upon examination, she has an SpO2 of 95% on room air and clubbing is present. Chest examination reveals symmetrical and bilateral reduced chest expansion with fine end-inspiratory crepitations. A chest radiograph shows increased interstitial markings in the lower zones of both lungs. High-resolution computed tomography (HRCT) confirms these findings and also shows bibasal honeycombing. There is no lymphadenopathy present on CT. What is the most likely diagnosis?
Your Answer: Idiopathic pulmonary fibrosis (usual interstitial pneumonia)
Explanation:Differential Diagnosis for Interstitial Lung Disease: A Case Study
Interstitial lung disease (ILD) is a group of lung disorders that affect the interstitium, the tissue and space surrounding the air sacs in the lungs. Idiopathic pulmonary fibrosis (IPF) is the most common type of ILD, characterized by chronic inflammation of the lung interstitium with lower zone predominance. This article discusses the differential diagnosis for ILD, using a case study of a patient presenting with subacute dry cough, exertional dyspnea, and general malaise and fatigue.
Idiopathic Pulmonary Fibrosis (IPF)
IPF is characterized by chronic inflammation of the lung interstitium with lower zone predominance. Patients present with subacute dry cough, exertional dyspnea, and general malaise and fatigue. Clinical examination reveals fine end-inspiratory crepitations throughout the chest with lower zone predominance. Radiological findings include reduced lung volumes and bilateral increased interstitial markings with lower zone predominance on chest X-ray (CXR), and honeycombing and microcyst formation in the lung bases on high-resolution CT (HRCT). Lung transplantation is the only definitive treatment, while steroids are not indicated.Tuberculosis
Tuberculosis presents with chronic cough, haemoptysis, fever, and night sweats. Imaging shows cavitating lesions ± lymphadenopathy.Bronchiectasis
Bronchiectasis presents with productive cough, recurrent chest infections, and haemoptysis. CXR findings are often non-specific, but dilated, thick-walled (ectatic) bronchi are easily seen on HRCT.Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)
Hypersensitivity pneumonitis may be caused by airborne irritants to lung parenchyma, such as pigeon breeding. Changes are classically found in lung apices, making it less likely than IPF/UIP.Sarcoidosis
End-stage sarcoidosis may present with lung fibrosis, but this does not spare the apices and typically affects the middle and upper zones of the lung.In conclusion, the differential diagnosis for ILD includes IPF, tuberculosis, bronchiectasis, hypersensitivity pneumonitis, and sarcoidosis. Accurate diagnosis is crucial for appropriate treatment and management of these conditions.
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This question is part of the following fields:
- Respiratory
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Question 11
Correct
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A 16-year-old girl and her mother rush to the Emergency department due to the girl's sudden onset of breathlessness and facial puffiness. The girl has a history of eczema and is currently taking oral contraceptives. Despite being well prior to this incident, she is now visibly distressed and experiencing laboured breathing with stridor but no wheezing. What is the most probable reason for her breathlessness?
Your Answer: Angio-oedema
Explanation:Noisy Breathing and Atopy in Adolescents
The presence of noisy breathing in an adolescent may indicate the possibility of stridor, which can be caused by an allergic reaction even in an otherwise healthy individual. The history of atopy, or a tendency to develop allergic reactions, further supports the diagnosis of angio-oedema. The sudden onset of symptoms also adds to the likelihood of this diagnosis.
While asthma is a possible differential diagnosis, it typically presents with expiratory wheezing. However, if the chest is silent, it may indicate a severe and life-threatening form of asthma. Therefore, it is important to consider all possible causes of noisy breathing and atopy in adolescents to ensure prompt and appropriate treatment.
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This question is part of the following fields:
- Emergency Medicine
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Question 12
Incorrect
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A patient with risk factors for atherosclerosis presents with pain (even when resting) in the leg.
About which sign or symptom are you most concerned in an elderly patient?Your Answer: Cold limb
Correct Answer: Paraesthesiae
Explanation:Understanding the Six Ps of Limb Ischaemia
Limb ischaemia is a serious condition that can lead to the loss of a limb if not treated promptly. To diagnose acute limb ischaemia, doctors look for the six Ps: pain, paraesthesiae, paralysis, pulselessness, pallor, and coldness. Of these, paraesthesiae and paralysis are the most concerning, as they indicate that the limb is at risk of being lost within 24 hours without intervention.
It’s important to note that pulselessness, pain, pallor, and coldness are also symptoms of acute limb ischaemia, but they don’t necessarily indicate the severity of the condition. For example, a patient may have a pulseless limb but still have time to save the limb with proper treatment. Similarly, a patient may experience pain, pallor, or coldness, but these symptoms alone don’t necessarily mean that the limb is in immediate danger.
In summary, understanding the six Ps of limb ischaemia is crucial for diagnosing and treating this serious condition. If you or someone you know is experiencing symptoms of acute limb ischaemia, seek medical attention immediately to prevent the loss of the limb.
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This question is part of the following fields:
- Vascular
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Question 13
Correct
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A 38-year-old man presents to his GP for a routine health check. Upon physical examination, no abnormalities are found. However, laboratory test results reveal the following:
- Serum glucose: 4.5 mmol/L
- Haemoglobin A1c: 4.2% (22 mmol/mol)
- Total cholesterol: 5.8 mmol/L
- LDL cholesterol: 4.2 mmol/L
- HDL cholesterol: 0.6 mmol/L
Based on these results, what is the most likely mechanism for injury to the vascular endothelium in this patient?Your Answer: Collection of lipid in foam cells
Explanation:Atherosclerosis and Related Conditions
Atherosclerosis is a condition characterized by the accumulation of lipids in arterial walls, leading to the formation of atheromas. This process is often associated with hypercholesterolemia, where there is an increase in LDL cholesterol that can become oxidized and taken up by arterial wall LDL receptors. The oxidized LDL is then collected in macrophages, forming foam cells, which are precursors to atheromas. This process is exacerbated by hypertension, smoking, and diabetes, which can lead to the degradation of LDL to oxidized LDL and its uptake into arterial walls via scavenger receptors in macrophages.
Diabetes mellitus with hyperglycemia is also associated with the accumulation of sorbitol in tissues that do not require insulin for glucose uptake. This accumulation can contribute to the development of atherosclerosis. However, neutrophilic inflammation, which is often the result of infection, is not related to atherosclerosis and is unusual in arteries. Additionally, atherosclerosis is not a neoplastic process, although mutations can result in neoplastic transformation.
Overall, the process of atherogenesis is slow and does not involve significant inflammation or activation of complement. the underlying mechanisms of atherosclerosis and related conditions can help in the development of effective prevention and treatment strategies.
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This question is part of the following fields:
- Cardiology
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Question 14
Incorrect
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After an uncomplicated pregnancy, a 20-year-old woman gives birth to a baby boy through vaginal delivery. During the one-week check-up, the infant is observed to have crusting and purulent discharge in the eyes. What should be the next course of action for the baby's care?
Your Answer: Prescribe erythromycin ophthalmic ointment empirically
Correct Answer: Take urgent swabs of the discharge for microbiological investigation
Explanation:While minor conjunctivitis with encrusting of the eyelids is usually harmless, a purulent discharge could be a sign of a severe infection such as chlamydia or gonococcus. In infants with a purulent eye discharge, it is crucial to take swab samples immediately for microbiological testing that can detect chlamydia and gonococcus. Although it is recommended to begin systemic antibiotic treatment for potential gonococcal infection while waiting for the swab results, the swabs must be taken first.
Conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes with a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.
In most cases, infective conjunctivitis is a self-limiting condition that resolves without treatment within one to two weeks. However, topical antibiotic therapy is often offered to patients, such as Chloramphenicol drops given every two to three hours initially or Chloramphenicol ointment given four times a day initially. Alternatively, topical fusidic acid can be used, especially for pregnant women, and treatment is twice daily.
For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. During an episode of conjunctivitis, contact lenses should not be worn, and patients should be advised not to share towels. School exclusion is not necessary.
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This question is part of the following fields:
- Ophthalmology
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Question 15
Correct
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A 28-year-old woman who is 20 weeks pregnant comes to you with worries. She recently had contact with her friend's child who has been diagnosed with chickenpox. She cannot remember if she has had chickenpox before and is not experiencing any symptoms of infection at the moment.
Varicella Zoster Antibodies Negative
What steps should you take in this situation?Your Answer: Commence varicella-zoster immunoglobulin (VZIG)
Explanation:If a pregnant woman is exposed to chickenpox before 20 weeks of pregnancy and is not immune, she should be given VZIG to prevent fetal varicella syndrome. This condition can cause serious birth defects such as microcephaly, cataracts, and limb hypoplasia. Chickenpox can also lead to severe illness in the mother, including varicella pneumonia. It is important to test for varicella antibodies if the woman is unsure if she has had chickenpox before. Without PEP, the risk of developing a varicella infection is high for susceptible contacts.
Chickenpox exposure in pregnancy can pose risks to both the mother and fetus, including fetal varicella syndrome. Post-exposure prophylaxis (PEP) with varicella-zoster immunoglobulin (VZIG) or antivirals should be given to non-immune pregnant women, with timing dependent on gestational age. If a pregnant woman develops chickenpox, specialist advice should be sought and oral acyclovir may be given if she is ≥ 20 weeks and presents within 24 hours of onset of the rash.
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This question is part of the following fields:
- Obstetrics
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Question 16
Correct
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A 25-year-old male is stabbed outside a bar, he presents with brisk haemoptysis and a left chest drain is inserted in the ED which drained 750ml frank blood. Despite receiving 4 units of blood, his condition does not improve. His CVP is now 13. What is the most appropriate definitive management plan?
Your Answer: Thoracotomy in theatre
Explanation:The patient is suffering from cardiac tamponade, as evidenced by the elevated CVP and hemodynamic instability. The urgent and definitive treatment for this condition is an emergency thoracotomy, ideally performed in a surgical theater using a clam shell approach for optimal access. While pericardiocentesis may be considered in cases where surgery is delayed, it is not a commonly used option.
Thoracic Trauma: Common Conditions and Treatment
Thoracic trauma can result in various conditions that require prompt medical attention. Tension pneumothorax, for instance, occurs when pressure builds up in the thorax due to a laceration to the lung parenchyma with a flap. This condition is often caused by mechanical ventilation in patients with pleural injury. Symptoms of tension pneumothorax overlap with cardiac tamponade, but hyper-resonant percussion note is more likely. Flail chest, on the other hand, occurs when the chest wall disconnects from the thoracic cage due to multiple rib fractures. This condition is associated with pulmonary contusion and abnormal chest motion.
Pneumothorax is another common condition resulting from lung laceration with air leakage. Traumatic pneumothoraces should have a chest drain, and patients should never be mechanically ventilated until a chest drain is inserted. Haemothorax, which is most commonly due to laceration of the lung, intercostal vessel, or internal mammary artery, is treated with a large bore chest drain if it is large enough to appear on CXR. Surgical exploration is warranted if more than 1500 ml blood is drained immediately.
Cardiac tamponade is characterized by elevated venous pressure, reduced arterial pressure, and reduced heart sounds. Pulsus paradoxus may also occur with as little as 100 ml blood. Pulmonary contusion is the most common potentially lethal chest injury, and arterial blood gases and pulse oximetry are important. Early intubation within an hour is necessary if significant hypoxia is present. Blunt cardiac injury usually occurs secondary to chest wall injury, and ECG may show features of myocardial infarction. Aorta disruption, diaphragm disruption, and mediastinal traversing wounds are other conditions that require prompt medical attention.
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This question is part of the following fields:
- Surgery
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Question 17
Incorrect
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A 25-year-old man was driving under the influence of alcohol at a high speed, with his seat belt on. He crashed into a brick wall at approximately 140 km/h. Upon arrival at the emergency department, he was found to be in a comatose state. Although his CT scan showed no abnormalities, he remained in a persistent vegetative state. What is the probable underlying reason for this?
Your Answer: Subdural haemorrhage
Correct Answer: Diffuse axonal injury
Explanation:Types of Traumatic Brain Injury
Traumatic brain injury can result in primary and secondary brain injury. Primary brain injury can be focal or diffuse. Diffuse axonal injury occurs due to mechanical shearing, which causes disruption and tearing of axons. intracranial haematomas can be extradural, subdural, or intracerebral, while contusions may occur adjacent to or contralateral to the side of impact. Secondary brain injury occurs when cerebral oedema, ischaemia, infection, tonsillar or tentorial herniation exacerbates the original injury. The normal cerebral auto regulatory processes are disrupted following trauma rendering the brain more susceptible to blood flow changes and hypoxia. The Cushings reflex often occurs late and is usually a pre-terminal event.
Extradural haematoma is bleeding into the space between the dura mater and the skull. It often results from acceleration-deceleration trauma or a blow to the side of the head. The majority of epidural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery. Subdural haematoma is bleeding into the outermost meningeal layer. It most commonly occurs around the frontal and parietal lobes. Risk factors include old age, alcoholism, and anticoagulation. Subarachnoid haemorrhage classically causes a sudden occipital headache. It usually occurs spontaneously in the context of a ruptured cerebral aneurysm but may be seen in association with other injuries when a patient has sustained a traumatic brain injury. Intracerebral haematoma is a collection of blood within the substance of the brain. Causes/risk factors include hypertension, vascular lesion, cerebral amyloid angiopathy, trauma, brain tumour, or infarct. Patients will present similarly to an ischaemic stroke or with a decrease in consciousness. CT imaging will show a hyperdensity within the substance of the brain. Treatment is often conservative under the care of stroke physicians, but large clots in patients with impaired consciousness may warrant surgical evacuation.
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This question is part of the following fields:
- Surgery
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Question 18
Incorrect
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A 42-year-old man visits his GP complaining of leg and back pain that has been bothering him for 6 weeks. The pain is exacerbated by sitting. During the examination, the GP observes weakness in left hip abduction and left foot drop. However, power in the right limb is normal, and lower limb reflexes are normal in both legs. The GP suspects a prolapsed disc. Which nerve root is most likely to have been affected?
Your Answer:
Correct Answer: L5
Explanation:Understanding Prolapsed Disc and its Features
A prolapsed lumbar disc is a common cause of lower back pain that can lead to neurological deficits. It is characterized by clear dermatomal leg pain, which is usually worse than the back pain. The pain is often aggravated when sitting. The features of the prolapsed disc depend on the site of compression. For instance, L3 nerve root compression can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, L4 nerve root compression can lead to sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.
The management of prolapsed disc is similar to that of other musculoskeletal lower back pain. It involves analgesia, physiotherapy, and exercises. According to NICE, the first-line treatment for back pain without sciatica symptoms is NSAIDs +/- proton pump inhibitors, rather than neuropathic analgesia. If the symptoms persist after 4-6 weeks, referral for consideration of MRI is appropriate. Understanding the features of prolapsed disc can help in the diagnosis and management of this condition.
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This question is part of the following fields:
- Musculoskeletal
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Question 19
Incorrect
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A woman experiences a significant post-partum haemorrhage leading to shock. Subsequently, she develops a visual field defect and severe headache. What are the most probable complications that may arise?
Your Answer:
Correct Answer: Sheehan’s syndrome
Explanation:Peripartum Complications: Sheehan’s Syndrome, Eclampsia, and Other Causes of Headache and Visual Disturbances
Peripartum complications can present with a variety of symptoms, including headache and visual disturbances. Sheehan’s syndrome is a condition that results from pituitary infarction due to haemorrhagic shock during labour and the peripartum period. It typically affects the anterior pituitary, leading to hormonal deficiencies that may present acutely or more indolently. Hormone replacement is the mainstay of treatment.
Eclampsia is another peripartum complication that can cause high blood pressure and seizures, sometimes leading to loss of consciousness. It requires urgent medical attention.
Other causes of headache and visual disturbances in the peripartum period include subarachnoid haemorrhage, which may present with sudden onset headache and visual disturbances, and extradural haemorrhage, which is typically found in trauma adjacent to fractures of the temporal bone. Occipital haemorrhagic infarction can also cause these symptoms, but a visual field defect is more suggestive of Sheehan’s syndrome.
It is important for healthcare providers to be aware of these potential complications and to promptly evaluate and manage them to ensure the best possible outcomes for both mother and baby.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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A 32-year-old man presents to the emergency department with bright red rectal bleeding. The bleeding started several hours ago after he has been to the toilet to defecate and he states that if he had to guess he has lost around 'a mug's worth' of blood. He is normally fit and well and has no significant past medical history. His observations are BP 115/84 mmHg, heart rate 74/min, temperature 37.3ºC, respiration rate 12/min, and oxygen saturation 98% on room air.
What is the appropriate course of action for managing this patient?Your Answer:
Correct Answer: Supportive management
Explanation:When a patient with acute PR bleeds is haemodynamically stable, the primary treatment approach is supportive management. In this scenario, the patient is likely suffering from haemorrhoids. Supportive management involves providing analgesia for pain relief, regular monitoring of the patient’s condition, and administering fluids and oxygen as necessary.
If the patient shows signs of haemodynamic compromise, intravenous fluids and/or blood transfusions may be necessary. Endoscopy is a useful tool for identifying the underlying cause of the bleed. Colonoscopy is typically used in elective settings, while flexible sigmoidoscopy is effective in identifying haemorrhoids as the source of the bleed.
Understanding Lower Gastrointestinal Bleeding
Lower gastrointestinal bleeding, also known as colonic bleeding, is characterized by the presence of bright red or dark red blood in the rectum. Unlike upper gastrointestinal bleeding, colonic bleeding rarely presents as melaena type stool. This is because blood in the colon has a powerful laxative effect and is rarely retained long enough for transformation to occur. Additionally, the digestive enzymes present in the small bowel are not present in the colon. It is important to note that up to 15% of patients presenting with hematochezia will have an upper gastrointestinal source of haemorrhage.
Right-sided bleeds tend to present with darker coloured blood than left-sided bleeds. Haemorrhoidal bleeding, on the other hand, typically presents as bright red rectal bleeding that occurs post defecation either onto toilet paper or into the toilet pan. However, it is very unusual for haemorrhoids alone to cause any degree of haemodynamic compromise.
There are several causes of lower gastrointestinal bleeding, including colitis, diverticular disease, cancer, and angiodysplasia. The management of lower gastrointestinal bleeding involves prompt correction of any haemodynamic compromise. Unlike upper gastrointestinal bleeding, the first-line management is usually supportive. When haemorrhoidal bleeding is suspected, a proctosigmoidoscopy is reasonable as attempts at full colonoscopy are usually time-consuming and often futile. In the unstable patient, the usual procedure would be an angiogram, while in others who are more stable, a colonoscopy in the elective setting is the standard procedure. Surgery may be necessary in some cases, particularly in patients over 60 years, those with continued bleeding despite endoscopic intervention, and those with recurrent bleeding.
In summary, lower gastrointestinal bleeding is a serious condition that requires prompt attention. It is important to identify the cause of the bleeding and manage it accordingly to prevent further complications.
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This question is part of the following fields:
- Surgery
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Question 21
Incorrect
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A 70-year-old man has been recommended for colonoscopy due to ongoing rectal bleeding and unexplained weight loss over the past 3 months. During a direct rectal examination, his GP detected a mass in the anal sphincter area. Unfortunately, further testing confirmed the presence of a mass in the distal part of his rectum. What would be the most suitable surgical procedure for this patient?
Your Answer:
Correct Answer: Abdominoperineal resection
Explanation:Surgical Options for Rectal Tumours
When a patient presents with a rectal tumour, there are several surgical options available depending on the location of the tumour. In the case of a tumour in the lower third of the rectum, near the anal margin, an abdominoperineal (AP) resection is the appropriate treatment. This involves the removal of the anus, rectum, and part of the descending colon, resulting in a permanent end-colostomy.
An anterior resection, on the other hand, is the removal of the rectum and can be either high or low depending on the tumour’s position. However, this procedure does not involve the removal of the anus and would not be suitable for a tumour near the anal margin.
In some cases, a Hartmann’s procedure may be performed as an emergency surgery, involving the removal of the sigmoid colon and upper rectum, and the formation of an end-colostomy. This procedure may be reversed at a later date with an anastomosis formed between the remaining bowel and lower rectum.
Finally, a right or left hemicolectomy may be performed, involving the removal of the right or left hemicolon, respectively. However, these procedures are not appropriate for rectal tumours near the anal margin.
In conclusion, the appropriate surgical option for a rectal tumour depends on the tumour’s location and the patient’s individual circumstances.
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This question is part of the following fields:
- Colorectal
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Question 22
Incorrect
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A 16-year-old girl presents with primary amenorrhoea. She has never had a menstrual period. Upon physical examination, downy hair is observed in the armpits and genital area, but there is no breast development. A vagina is present, but no uterus can be felt during pelvic examination. Genetic testing reveals a 46,XY karyotype. All other physical exam findings are unremarkable, and her blood work is normal. What is the most probable diagnosis?
Your Answer:
Correct Answer: Male intersex
Explanation:Intersex and Genetic Disorders: Understanding the Different Types
Intersex conditions and genetic disorders can affect an individual’s physical and biological characteristics. Understanding the different types can help in diagnosis and treatment.
Male Pseudointersex
Male pseudointersex is a condition where an individual has a 46XY karyotype and testes but presents phenotypically as a woman. This is caused by androgen insensitivity, deficit in testosterone production, or deficit in dihydrotestosterone production. Androgen insensitivity syndrome is the most common mechanism, which obstructs the development of male genitalia and secondary sexual characteristics, resulting in a female phenotype.True Intersex
True intersex is when an individual carries both male and female gonads.Female Intersex
Female intersex is a term used to describe an individual who is phenotypically male but has a 46XX genotype and ovaries. This is usually due to hyperandrogenism or a deficit in estrogen synthesis, leading to excessive androgen synthesis.Fragile X Syndrome
Fragile X syndrome is an X-linked dominant disorder that affects more men than women. It is associated with a long and narrow face, large ears, large testicles, significant intellectual disability, and developmental delay. The karyotype correlates with the phenotype and gonads.Turner Syndrome
Turner syndrome is associated with the genotype 45XO. Patients are genotypically and phenotypically female, missing part of, or a whole, X chromosome. They have primary or secondary amenorrhea due to premature ovarian failure and failure to develop secondary sexual characteristics. -
This question is part of the following fields:
- Gynaecology
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Question 23
Incorrect
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During a routine examination of a 4 day old baby born at 36 weeks gestation, a very prominent murmur is heard during systole and diastole, with the loudest point being over the left sternal edge. A chest X-Ray reveals massive cardiomegaly, particularly in the right atrium. The mother of the child has bipolar disorder but is otherwise healthy and has no congenital heart problems. There is no significant family history except for a paternal cousin who developed cardiomyopathy in their early twenties. Based on the given information, what is the most probable underlying diagnosis?
Your Answer:
Correct Answer: Ebstein's anomaly
Explanation:Congenital heart disease can be categorized into two types: acyanotic and cyanotic. Acyanotic heart diseases are more common and include ventricular septal defects (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, and aortic valve stenosis. VSD is the most common acyanotic heart disease, accounting for 30% of cases. ASDs are less common than VSDs, but they are more frequently diagnosed in adult patients as they tend to present later. On the other hand, cyanotic heart diseases are less common and include tetralogy of Fallot, transposition of the great arteries (TGA), and tricuspid atresia. Fallot’s is more common than TGA, but TGA is the more common lesion at birth as patients with Fallot’s generally present at around 1-2 months. The presence of cyanosis in pulmonary valve stenosis depends on the severity and any other coexistent defects.
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This question is part of the following fields:
- Paediatrics
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Question 24
Incorrect
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A 29-year-old female attends the antenatal clinic for a booking appointment. What should be recognized as a risk factor for pre-eclampsia?
Your Answer:
Correct Answer: Pre-existing renal disease
Explanation:Identify the following as potential risk factors:
– Being 40 years old or older
– Never having given birth
– Having a pregnancy interval of over 10 years
– Having a family history of pre-eclampsia
– Having previously experienced pre-eclampsia
– Having a body mass index (BMI) of 30 kg/m^2 or higher
– Having pre-existing vascular disease, such as hypertension.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.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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A 36-year-old man complained of abdominal pain and weight loss. Upon investigation, he was diagnosed with coeliac disease. The biopsy of his small intestine revealed blunting of villi with crypt hyperplasia and intraepithelial lymphocytes ++. What is the stage of his disease?
Your Answer:
Correct Answer: III
Explanation:The Marsh Criteria: A Morphological Classification of Coeliac Disease Biopsy
Coeliac disease is a condition that affects the small intestine, causing damage to the lining and leading to malabsorption of nutrients. The Marsh criteria is a morphological classification system used to diagnose coeliac disease through intestinal biopsy.
The classification system consists of four stages, with stage 0 indicating a normal biopsy and stage IV indicating total villous atrophy. In between, stages I-III show varying degrees of damage to the duodenal villi, intraepithelial lymphocytes, and crypts.
Recently, the Marsh-Oberhuber classification was introduced, which subdivides stage III into three classes based on the degree of villous atrophy. Stage IV has been eliminated from this modified version.
In coeliac disease and other inflammatory conditions, such as milk protein allergy, the pattern of intraepithelial lymphocytes may be reversed. In stage I disease, only increased intraepithelial lymphocytes would be seen on biopsy, while stage 0 would appear normal. Class II disease would show normal duodenal villi, and stage IV would be associated with crypt atrophy.
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This question is part of the following fields:
- Gastroenterology
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Question 26
Incorrect
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A 55-year-old man comes to see his GP for a follow-up on his hypertension treatment, which was recently changed. Prior to the appointment, he underwent ambulatory blood pressure monitoring, which revealed an average reading of 130/78 mmHg. Despite being compliant with his medication, he has been experiencing occasional dizziness and palpitations since starting the new drug. He wants to explore other treatment options. During an episode, an ECG was performed, which showed only sinus tachycardia and no other abnormalities. What is the most probable cause of his symptoms?
Your Answer:
Correct Answer: Nifedipine
Explanation:Nifedipine is known to cause reflex tachycardia due to its peripheral vasodilation effects. This rapid decrease in blood pressure is perceived by the autonomic nervous system as excessive, leading to an increased heart rate to compensate. Patients may experience palpitations and dizziness as a result. Sustained-release preparations of nifedipine are less likely to cause reflex tachycardia. The BNF lists palpitations as a common or very common side effect of nifedipine.
Indapamide, on the other hand, is a thiazide-like diuretic that reduces blood volume and pressure through sodium diuresis. It does not cause peripheral vasodilation or reflex tachycardia. Palpitations and tachycardia are not listed as side effects of indapamide on the BNF. Dehydration, postural hypotension, and dizziness are more common side effects.
Ramipril is an ACE inhibitor that reduces blood pressure by inhibiting the conversion of angiotensin I to angiotensin II. It does not cause peripheral vasodilation or reflex tachycardia. Palpitations and tachycardia are not listed as side effects of ramipril on the BNF. A dry cough and angioedema are more common side effects of ACE inhibitors. Hyperkalemia, which can be associated with ACE inhibitors, may cause palpitations, but this would be evident on an ECG.
Understanding Calcium Channel Blockers
Calcium channel blockers are medications primarily used to manage cardiovascular diseases. These blockers target voltage-gated calcium channels present in myocardial cells, cells of the conduction system, and vascular smooth muscle cells. The different types of calcium channel blockers have varying effects on these three areas, making it crucial to differentiate their uses and actions.
Verapamil is an example of a calcium channel blocker used to manage angina, hypertension, and arrhythmias. However, it is highly negatively inotropic and should not be given with beta-blockers as it may cause heart block. Verapamil may also cause side effects such as heart failure, constipation, hypotension, bradycardia, and flushing.
Diltiazem is another calcium channel blocker used to manage angina and hypertension. It is less negatively inotropic than verapamil, but caution should still be exercised when patients have heart failure or are taking beta-blockers. Diltiazem may cause side effects such as hypotension, bradycardia, heart failure, and ankle swelling.
On the other hand, dihydropyridines such as nifedipine, amlodipine, and felodipine are calcium channel blockers used to manage hypertension, angina, and Raynaud’s. These blockers affect the peripheral vascular smooth muscle more than the myocardium, resulting in no worsening of heart failure but may cause ankle swelling. Shorter-acting dihydropyridines such as nifedipine may cause peripheral vasodilation, resulting in reflex tachycardia and side effects such as flushing, headache, and ankle swelling.
In summary, understanding the different types of calcium channel blockers and their effects on the body is crucial in managing cardiovascular diseases. It is also important to note the potential side effects and cautions when prescribing these medications.
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This question is part of the following fields:
- Pharmacology
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Question 27
Incorrect
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A 68-year-old man presents to his GP after being discharged from the emergency department following multiple falls. He reports feeling dizzy upon standing up. During the examination, his blood pressure is measured in both lying and standing positions:
Lying 143/94 mmHg
Standing 110/78 mmHg
The patient's medical history includes benign prostatic hyperplasia, type 2 diabetes, and depression. Which medication is the most likely cause of his symptoms?Your Answer:
Correct Answer: Doxazosin
Explanation:The cause of the patient’s multiple falls is likely postural hypotension, which can be a side effect of doxazosin. This medication is an alpha-blocker used to treat hypertension and benign prostatic hypertension by reducing activation of alpha-1 adrenergic receptors, leading to vasodilation and decreased blood pressure. Atorvastatin, linagliptin, and metformin are not associated with postural hypotension, but may cause other side effects such as gastrointestinal upset, muscle pain, weight gain, and hypoglycemic episodes.
Understanding Alpha Blockers and Their Side-Effects
Alpha blockers are medications that are commonly used to treat benign prostatic hyperplasia and hypertension. These drugs work by blocking the alpha-adrenergic receptors in the body, which can help to relax the muscles in the prostate gland and blood vessels, leading to improved urine flow and lower blood pressure. Some examples of alpha blockers include doxazosin and tamsulosin.
While alpha blockers can be effective in treating these conditions, they can also cause some side-effects. One common side-effect is postural hypotension, which is a sudden drop in blood pressure when standing up from a sitting or lying position. This can cause dizziness or fainting and may be more common in older adults. Other side-effects of alpha blockers may include drowsiness, dyspnoea, and cough.
It is important to exercise caution when taking alpha blockers. This is because there is a risk of developing intra-operative floppy iris syndrome, which can make the surgery more difficult and increase the risk of complications.
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This question is part of the following fields:
- Pharmacology
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Question 28
Incorrect
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An 80-year-old man presents with complaints of blurred vision. Upon fundoscopy, drusen, retinal epithelial changes, and macular neovascularisation are noted. The clinician suspects age-related macular degeneration. What would be the most suitable follow-up investigation?
Your Answer:
Correct Answer: Fluorescein angiography
Explanation:Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.
To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with antioxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.
In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and antioxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.
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This question is part of the following fields:
- Ophthalmology
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Question 29
Incorrect
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A 25-year-old woman presents to the surgical assessment unit with a complaint of severe, slow onset pain in her left iliac fossa. Upon examination, left iliac fossa pain is confirmed, and she denies being sexually active. However, there is some clinical evidence of peritonitis. What investigation should be requested next?
Your Answer:
Correct Answer: Pregnancy test
Explanation:A pregnancy test is compulsory in all instances of acute abdomen in females who are of childbearing age.
Exam Features of Abdominal Pain Conditions
Abdominal pain can be caused by various conditions, and it is important to be familiar with their characteristic exam features. Peptic ulcer disease, for instance, may present with epigastric pain that is relieved by eating in duodenal ulcers and worsened by eating in gastric ulcers. Appendicitis, on the other hand, may initially cause pain in the central abdomen before localizing to the right iliac fossa, accompanied by anorexia, tenderness in the right iliac fossa, and a positive Rovsing’s sign. Acute pancreatitis, which is often due to alcohol or gallstones, may manifest as severe epigastric pain and vomiting, with tenderness, ileus, and low-grade fever on examination.
Other conditions that may cause abdominal pain include biliary colic, diverticulitis, and intestinal obstruction. Biliary colic may cause pain in the right upper quadrant that radiates to the back and interscapular region, while diverticulitis may present with colicky pain in the left lower quadrant, fever, and raised inflammatory markers. Intestinal obstruction, which may be caused by malignancy or previous operations, may lead to vomiting, absence of bowel movements, and tinkling bowel sounds.
It is also important to remember that some conditions may have unusual or medical causes of abdominal pain, such as acute coronary syndrome, diabetic ketoacidosis, pneumonia, acute intermittent porphyria, and lead poisoning. Therefore, being familiar with the characteristic exam features of various conditions can aid in the diagnosis and management of abdominal pain.
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This question is part of the following fields:
- Surgery
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Question 30
Incorrect
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A 35-year-old female patient arrives with an abrupt onset of hemiparesis on the right side, affecting the face, arm, and leg. During the examination, you observe right-sided hemiparesis, aphasia, and a right homonymous hemianopia. The patient has a medical history of recurrent miscarriages, pulmonary embolisms, and deep vein thrombosis. The blood test results show a prolonged APTT. What could be the probable reason for the stroke?
Your Answer:
Correct Answer: Antiphospholipid syndrome
Explanation:The symptoms indicate the possibility of antiphospholipid syndrome, which can be confirmed by a positive anti-Cardiolipin antibody test. It is crucial to keep in mind that hypercoagulable states and hyperviscosity can lead to strokes. Antiphospholipid syndrome is a type of thrombophilia disorder that causes hypercoagulation and a higher likelihood of forming clots, both arterial and venous. This increases the risk of ischaemic strokes.
Antiphospholipid syndrome is a condition that can be acquired and is characterized by a higher risk of both venous and arterial thrombosis, recurrent fetal loss, and thrombocytopenia. It can occur as a primary disorder or as a secondary condition to other diseases, with systemic lupus erythematosus being the most common. One important point to remember for exams is that antiphospholipid syndrome can cause a paradoxical increase in the APTT. This is due to an ex-vivo reaction of the lupus anticoagulant autoantibodies with phospholipids involved in the coagulation cascade. Other features of this condition include livedo reticularis, pre-eclampsia, and pulmonary hypertension.
Antiphospholipid syndrome can also be associated with other autoimmune disorders, lymphoproliferative disorders, and, rarely, phenothiazines. Management of this condition is based on EULAR guidelines. Primary thromboprophylaxis involves low-dose aspirin, while secondary thromboprophylaxis depends on the type of thromboembolic event. Initial venous thromboembolic events require lifelong warfarin with a target INR of 2-3, while recurrent venous thromboembolic events require lifelong warfarin and low-dose aspirin. Arterial thrombosis should be treated with lifelong warfarin with a target INR of 2-3.
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This question is part of the following fields:
- Musculoskeletal
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