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  • Question 1 - What is the initial indication of puberty in males? ...

    Incorrect

    • What is the initial indication of puberty in males?

      Your Answer: Development of axillary hair

      Correct Answer: Increase in testicular volume

      Explanation:

      Puberty: Normal Changes in Males and Females

      Puberty is a natural process that marks the transition from childhood to adulthood. In males, the first sign of puberty is testicular growth, which typically occurs around the age of 12. A testicular volume greater than 4 ml indicates the onset of puberty. The maximum height spurt for males occurs at the age of 14.

      For females, the first sign of puberty is breast development, which typically occurs around the age of 11.5. The height spurt for females reaches its maximum early in puberty, at the age of 12, before menarche. Menarche, the onset of menstruation, typically occurs at the age of 13.

      Following menarche, there is only a small increase of about 4% in height. It is important to note that normal changes in puberty may include gynaecomastia in boys, asymmetrical breast growth in girls, and diffuse enlargement of the thyroid gland. These changes are a natural part of the process and should not cause alarm. Understanding the normal changes that occur during puberty can help individuals navigate this important stage of development with confidence.

    • This question is part of the following fields:

      • Paediatrics
      18.9
      Seconds
  • Question 2 - You are asked to take over a patient halfway through a case to...

    Incorrect

    • You are asked to take over a patient halfway through a case to relieve the consultant anaesthetist for a comfort break. The patient, who is 65 years old, has an endotracheal tube (ETT) in situ and is maintained on sevoflurane and ventilated at a rate of 14 breaths per minute, with a tidal volume of 600. You notice that the carbon dioxide (CO2) trace is high (ET 6.9) and increasing quite rapidly. The maxillofacial surgeon remarks that the patient’s jaw is quite tight and asks for more muscle relaxant. You check the patient’s temperature and find that it is high at 39.6 °C.
      Which one of the following is your priority?

      Your Answer: Actively cool the patient, increase the respiratory rate and give antibiotics

      Correct Answer: Actively cool the patient, stop sevoflurane and give dantrolene

      Explanation:

      Managing Malignant Hyperpyrexia: An Anaesthetic Emergency

      Malignant hyperpyrexia is a life-threatening anaesthetic emergency triggered by inhalational anaesthetics and muscle relaxants in genetically susceptible individuals. It causes a hypermetabolic state, leading to increased CO2 production, oxygen consumption, heat production, metabolic and respiratory acidosis, hyperkalaemia, activation of the sympathetic nervous system, and disseminated intravascular coagulation.

      Early signs include a rise in end-tidal CO2, rigid muscles, tachycardia, and tachypnoea. Treatment involves discontinuation of the triggering agent, rapid administration of dantrolene, active cooling, and treatment of hyperkalaemia. Dantrolene inhibits calcium release from the sarcoplasmic reticulum and reverses the hypermetabolic state.

      It is important to inform the surgeon and stop the operation. Once the initial reaction is controlled, the patient will require transfer to the ICU and monitoring for 24-48 hours.

      In contrast, giving more muscle relaxant or antibiotics is not recommended. Active management and stabilisation of the patient should precede discussion with the ICU. Malignant hyperpyrexia requires prompt recognition and management to prevent serious complications and death.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      66.7
      Seconds
  • Question 3 - You're a medical student on your psychiatry placement. You are performing a mental...

    Correct

    • You're a medical student on your psychiatry placement. You are performing a mental state examination on one of the patients on the inpatient psychiatry ward, a 22-year-old man who was admitted 2 days ago.

      Whenever you ask him a question, you notice that he repeats the question back to you. You notice that he is also repeating some of the phrases you use.

      What form of thought disorder is this an example of?

      Your Answer: Echolalia

      Explanation:

      Echolalia is the repetition of someone else’s speech, including the questions being asked. Clang association is when someone uses words that rhyme with each other or sound similar. Neologism is the formation of new words. Perseveration is when ideas or words are repeated several times.

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

    • This question is part of the following fields:

      • Psychiatry
      111.7
      Seconds
  • Question 4 - You are considering commencing a patient in their 60s on cilazapril. In discussion...

    Correct

    • You are considering commencing a patient in their 60s on cilazapril. In discussion with the patient you mention that this is an ACE inhibitor.
      The patient asks you what 'ACE' is.
      What is the primary function of 'ACE'?

      Your Answer: Conversion of angiotensin 1 to angiotensin 2

      Explanation:

      The Renin-Angiotensin-Aldosterone System

      The renin-angiotensin-aldosterone system is a pathway in the body that regulates blood pressure and fluid balance. It begins with the production of angiotensinogen in the liver, which is then converted to angiotensin 1 by the enzyme renin, produced in the kidneys. Angiotensin 1 is then converted to angiotensin 2 by the enzyme ACE, found in the lungs and kidneys. Angiotensin 2 has several functions, including the stimulation of aldosterone production by the adrenal gland. This hormone promotes the retention of sodium and water in the body, leading to an increase in blood volume and blood pressure.

      This pathway is commonly tested in medical school and beyond due to its clinical relevance in conditions such as hypertension and heart failure. the renin-angiotensin-aldosterone system is crucial in the management of these conditions, as medications that target this pathway can be used to lower blood pressure and improve outcomes.

    • This question is part of the following fields:

      • Nephrology
      16.8
      Seconds
  • Question 5 - A 25 year old woman presents to her GP with breast pain. She...

    Incorrect

    • A 25 year old woman presents to her GP with breast pain. She gave birth 3 weeks ago and is exclusively breastfeeding. She reports a 4 day history of increasing pain in her left breast, which has not improved with continued feeding and expressing. During examination, she appears healthy, but her temperature is 38.5ºC. There is a small area of redness above the left nipple, which is sensitive to touch. She has no known allergies.
      What is the best course of action for management?

      Your Answer: Oral cephalexin & encourage to continue breastfeeding

      Correct Answer: Oral flucloxacillin & encourage to continue breastfeeding

      Explanation:

      Lactation mastitis is a prevalent inflammatory condition of the breast that can have infectious or non-infectious origins. The primary cause is milk stasis, which can occur due to either overproduction or insufficient removal.

      In cases of non-infectious mastitis, the accumulation of milk leads to an inflammatory response. Occasionally, an infection may develop through retrograde spread via a lactiferous duct or a traumatised nipple, with Staphylococcus aureus being the most common organism.

      Symptoms of lactation mastitis include breast pain (usually unilateral) accompanied by an erythematosus, warm, and tender area. Patients may also experience fever and flu-like symptoms.

      The first-line approach to managing lactation mastitis is conservative, involving analgesia and encouraging effective milk removal (either through continued breastfeeding or expressing from the affected side) to prevent further milk stasis. It is also crucial to ensure proper positioning and attachment during feeding.

      If symptoms do not improve after 12-24 hours of conservative management, antibiotics should be prescribed. The first-line choice is oral flucloxacillin (500 mg four times a day for 14 days), or erythromycin if the patient is allergic to penicillin. Co-amoxiclav is the second-line choice.

      In cases where conservative and antibiotic management do not improve symptoms, other more serious causes, such as inflammatory breast cancer, should be considered. (Source – CKS mastitis)

      Breastfeeding Problems and Their Management

      Breastfeeding is a natural process, but it can come with its own set of challenges. Some of the minor problems that breastfeeding mothers may encounter include frequent feeding, nipple pain, blocked ducts, and nipple candidiasis. These issues can be managed by seeking advice on proper positioning, trying breast massage, and using appropriate medication.

      Mastitis is a more serious problem that affects around 1 in 10 breastfeeding women. It is characterized by symptoms such as fever, nipple fissure, and persistent pain. Treatment involves the use of antibiotics, such as flucloxacillin, for 10-14 days. Breastfeeding or expressing milk should continue during treatment to prevent complications such as breast abscess.

      Breast engorgement is another common problem that causes breast pain in breastfeeding women. It occurs in the first few days after birth and affects both breasts. Hand expression of milk can help relieve the discomfort of engorgement. Raynaud’s disease of the nipple is a less common problem that causes nipple pain and blanching. Treatment involves minimizing exposure to cold, using heat packs, and avoiding caffeine and smoking.

      If a breastfed baby loses more than 10% of their birth weight in the first week of life, it may be a sign of poor weight gain. This should prompt consideration of the above breastfeeding problems and an expert review of feeding. Monitoring of weight should continue until weight gain is satisfactory.

    • This question is part of the following fields:

      • Obstetrics
      366.1
      Seconds
  • Question 6 - A 42-year-old previously healthy teacher visits her doctor complaining of headache and itching....

    Correct

    • A 42-year-old previously healthy teacher visits her doctor complaining of headache and itching. During her urine test, protein (3+) and blood (1+) are detected, but there are no splinter haemorrhages. What other bedside examination would be beneficial in evaluating her condition?

      Your Answer: Blood pressure

      Explanation:

      Assessment and Further Testing for Kidney Disease

      Assessing kidney disease at the bedside involves several steps, including urinalysis, blood pressure measurement, and assessment of volume status. However, further testing is necessary to confirm the diagnosis and determine the underlying cause of the disease. Blood testing for U&Es, autoantibodies, glucose, HbA1c, complement, and ANCA serology, as well as hepatitis and HIV viral screening, can provide valuable information.

      In this case, the patient presents with features consistent with kidney disease, including an abnormal urinalysis. While diabetes could be a possible cause, the patient’s age makes it less likely. Therefore, additional testing is necessary to determine the underlying cause of the disease. Checking the patient’s blood pressure is also important, as hypertension is often associated with renal diseases. Aggressive management of hypertension can help prevent the progression of chronic renal failure.

    • This question is part of the following fields:

      • Nephrology
      1183.5
      Seconds
  • Question 7 - A 68-year-old man is referred to Ophthalmology with bilateral cataracts. He reports gradual...

    Incorrect

    • A 68-year-old man is referred to Ophthalmology with bilateral cataracts. He reports gradual worsening of his vision over many years and struggles with night-time driving due to glare. He is put on the waiting list for surgical repair.
      What structure in the eye is affected by cataract formation?

      Your Answer: Sclera

      Correct Answer: Lens

      Explanation:

      Anatomy of the Eye: Understanding the Different Parts and Their Disorders

      The eye is a complex organ that allows us to see the world around us. It is made up of several parts, each with its own function. Understanding the anatomy of the eye and the disorders that can affect it is important for maintaining good eye health.

      Lens: The lens is a transparent structure located behind the pupil and iris. It helps to focus light onto the retina. Cataracts occur when the lens becomes cloudy or opaque, causing vision problems.

      Cornea: The cornea is the clear dome-shaped surface of the eye that sits over the iris. It plays a role in refracting light. Damage to the cornea can cause pain and light sensitivity.

      Iris: The iris is the colored part of the eye. It can be affected by disorders such as uveitis, which causes inflammation of the uvea (iris, ciliary body, and choroid).

      Retina: The retina is located at the back of the eye and contains rods and cones that process incoming light. Disorders of the retina include retinitis pigmentosa, diabetic retinopathy, and retinal detachment.

      Sclera: The sclera is the white part of the eye. Disorders of the sclera include scleritis, which causes redness, pain, and reduced visual acuity. It can be associated with rheumatoid arthritis.

      Understanding the different parts of the eye and their functions can help you identify potential problems and seek treatment early. Regular eye exams are important for maintaining good eye health and preventing vision loss.

    • This question is part of the following fields:

      • Ophthalmology
      1289.2
      Seconds
  • Question 8 - Perinuclear antineutrophil cytoplasmic antibodies (pANCA) are most commonly associated with which medical condition?...

    Incorrect

    • Perinuclear antineutrophil cytoplasmic antibodies (pANCA) are most commonly associated with which medical condition?

      Your Answer: Granulomatosis with polyangiitis

      Correct Answer: Churg-Strauss syndrome

      Explanation:

      ANCA Associated Vasculitis: Common Findings and Management

      Anti-neutrophil cytoplasmic antibodies (ANCA) are associated with small-vessel vasculitides such as granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and microscopic polyangiitis. ANCA associated vasculitis is more common in older individuals and presents with renal impairment, respiratory symptoms, systemic symptoms, and sometimes a vasculitic rash or ear, nose, and throat symptoms. First-line investigations include urinalysis, blood tests for renal function and inflammation, ANCA testing, and chest x-ray. There are two main types of ANCA – cytoplasmic (cANCA) and perinuclear (pANCA) – with varying levels found in different conditions. ANCA associated vasculitis should be managed by specialist teams and the mainstay of treatment is immunosuppressive therapy.

      ANCA associated vasculitis is a group of small-vessel vasculitides that are associated with ANCA. These conditions are more common in older individuals and present with renal impairment, respiratory symptoms, systemic symptoms, and sometimes a vasculitic rash or ear, nose, and throat symptoms. To diagnose ANCA associated vasculitis, first-line investigations include urinalysis, blood tests for renal function and inflammation, ANCA testing, and chest x-ray. There are two main types of ANCA – cytoplasmic (cANCA) and perinuclear (pANCA) – with varying levels found in different conditions. ANCA associated vasculitis should be managed by specialist teams and the mainstay of treatment is immunosuppressive therapy.

    • This question is part of the following fields:

      • Musculoskeletal
      25.3
      Seconds
  • Question 9 - A 5-year-old child is brought to the Emergency Department with a displaced supracondylar...

    Incorrect

    • A 5-year-old child is brought to the Emergency Department with a displaced supracondylar fracture. It necessitates manipulation using procedural sedation.
      What would be the most appropriate option?

      Your Answer: Morphine

      Correct Answer: Midazolam

      Explanation:

      Procedural Sedation: Comparing the Benefits and Risks of Different Drugs

      Procedural sedation is a common practice in medical procedures to reduce pain and anxiety in patients. However, choosing the right drug for sedation can be challenging as each drug has its own benefits and risks. In this article, we will compare the benefits and risks of different drugs commonly used for procedural sedation.

      Midazolam is a drug used for mild to moderate pain levels. It can be administered orally or intranasally and has fewer side effects than other drugs. On the other hand, ketamine is an excellent choice for procedural sedation, especially in children. It has powerful analgesic and sedative effects and can be administered intranasally, reducing the need for invasive interventions. However, ketamine has side effects such as tachycardia, hypertension, muscle twitching, rash, laryngospasm, apnea, vomiting, and recovery agitation.

      Morphine is helpful for pain management but is not suitable for procedural sedation due to respiratory depression. Propofol is a general anesthetic agent with a longer half-life than midazolam and ketamine. It can adversely affect hemodynamic status, making midazolam a better choice for sedation. Finally, lorazepam is primarily used for managing agitation and not procedural sedation.

      In conclusion, choosing the right drug for procedural sedation requires careful consideration of the patient’s condition and the benefits and risks of each drug. Midazolam and ketamine are commonly used for procedural sedation, but each has its own benefits and risks that should be carefully evaluated before administration.

    • This question is part of the following fields:

      • Paediatrics
      47.9
      Seconds
  • Question 10 - What percentage of infants born with any level of hearing impairment are identified...

    Incorrect

    • What percentage of infants born with any level of hearing impairment are identified through neonatal screening as being at a high risk of having congenital hearing loss?

      Your Answer: 75%

      Correct Answer: 50%

      Explanation:

      Importance of Universal Newborn Hearing Screening

      A variety of factors can increase the risk of neonatal hearing loss, including prematurity, low birth weight, neonatal jaundice, and bacterial meningitis. Traditional screening methods only target high-risk infants with these risk factors, but this approach only detects half of all cases of hearing impairment. The other half of cases have no obvious risk factors, making it difficult for parents and professionals to identify the problem.

      To address this issue, universal newborn hearing screening has been introduced to ensure that all infants have their hearing tested from birth. This approach is crucial for detecting hearing loss early and providing appropriate interventions to support language and communication development. By identifying hearing loss in all infants, regardless of risk factors, we can ensure that no child goes undetected and untreated. Universal newborn hearing screening is an important step towards improving outcomes for children with hearing loss.

    • This question is part of the following fields:

      • Surgery
      53.8
      Seconds
  • Question 11 - A 33-year-old construction worker presents with an area of redness on his right...

    Incorrect

    • A 33-year-old construction worker presents with an area of redness on his right foot. The area of redness has grown in size over the past day and is warmer than the surrounding normal skin. The patient mentions that the area is also tender to touch.
      Following taking a history and examining the patient, the physician suspects a diagnosis of cellulitis.
      Which of these terms is best used to describe ‘cellulitis’?

      Your Answer: Inflammation of the epidermis

      Correct Answer: Localised inflammation and cellular debris accumulation

      Explanation:

      Understanding Different Forms of Skin Inflammation

      Cellulitis, inflammation of subcutaneous tissue, is caused by Streptococcus pyogenes and requires urgent treatment with antibiotics. Surgical wounds and malignant tumors can also cause inflammation, but the latter is a response by the immune system to control malignancy. Inflammation of the epidermis can be caused by various non-infective processes, such as sunburns or abrasions. Localized infection may lead to an abscess, which requires incision and drainage. It is important to understand the distinct pathology and treatment for each form of skin inflammation.

    • This question is part of the following fields:

      • Dermatology
      40.4
      Seconds
  • Question 12 - A 45-year-old woman with a history of rheumatoid arthritis complains of a painful,...

    Incorrect

    • A 45-year-old woman with a history of rheumatoid arthritis complains of a painful, red eye with excessive tearing and blurred vision that has been ongoing for a few days. She has a family history of glaucoma and is also nearsighted. Upon examination, you diagnose her with scleritis. What potential complication should you be concerned about?

      Your Answer: Decreased intraocular pressure

      Correct Answer: Perforation of the globe

      Explanation:

      Scleritis is a serious condition that requires urgent ophthalmology attention within 24 hours to prevent complications such as perforation of the globe. Other potential complications of scleritis include glaucoma, cataracts, raised intraocular pressure, retinal detachment, and uveitis. It is important to note that scleritis can lead to raised intraocular pressure, not decreased, and that entropion and episcleritis are not complications of this condition.

      Understanding Scleritis: Causes, Symptoms, and Treatment

      Scleritis is a condition that involves inflammation of the sclera, which is the white outer layer of the eye. This condition is typically non-infectious and can cause a red, painful eye. The most common risk factor associated with scleritis is rheumatoid arthritis, but it can also be linked to other conditions such as systemic lupus erythematosus, sarcoidosis, and granulomatosis with polyangiitis.

      Symptoms of scleritis include a red eye, which is often accompanied by pain and discomfort. Patients may also experience watering and photophobia, as well as a gradual decrease in vision.

      Treatment for scleritis typically involves the use of oral NSAIDs as a first-line treatment. In more severe cases, oral glucocorticoids may be used. For resistant cases, immunosuppressive drugs may be necessary, especially if there is an underlying associated disease. With proper treatment, most patients with scleritis can achieve relief from their symptoms and prevent further complications.

    • This question is part of the following fields:

      • Ophthalmology
      5840.8
      Seconds
  • Question 13 - A 50-year-old man is scheduled for a routine tooth extraction with his dentist....

    Correct

    • A 50-year-old man is scheduled for a routine tooth extraction with his dentist. He has a history of type 2 diabetes and depression, but is otherwise in good health. His daily medications include metformin 850 mg three times a day, glimepiride 1 mg once a day, ramipril 5 mg once a day, isocarboxazid 20 mg once a day, and aspirin 75 mg once a day. Which medication should the dentist be informed about as a priority?

      Your Answer: Isocarboxazid

      Explanation:

      Isocarboxazid is an antidepressant drug that inhibits both MAO-A and MAO-B, leading to increased neurotransmitter concentration and improved symptoms of depression and other psychiatric conditions. MAOIs have dietary restrictions and can interact with certain drugs, such as synthetic catecholamines. Aspirin may increase bleeding during dental procedures, but it is still recommended to continue use. Metformin increases the risk of lactic acidosis if the patient becomes dehydrated post-procedure. Ramipril and Glimepiride are considered safe to continue during dental extraction.

    • This question is part of the following fields:

      • Pharmacology
      202
      Seconds
  • Question 14 - A 19-year-old Afro-Caribbean male with sickle cell disease complains of right upper abdominal...

    Incorrect

    • A 19-year-old Afro-Caribbean male with sickle cell disease complains of right upper abdominal pain and exhibits tenderness upon palpation. What diagnostic test should be performed to confirm the diagnosis?

      Your Answer: Abdominal X ray

      Correct Answer: Abdominal ultrasound scan

      Explanation:

      Pigment Gallstones and High Haem Turnover

      In cases of chronic haemolysis, such as sickle cell disease or thalassaemia, the presence of unconjugated bilirubin in bile can lead to the formation of pigment gallstones. These stones are black in color and are caused by the precipitation of calcium bilirubinate from solution. The high concentration of unconjugated bilirubin in bile is a result of the increased turnover of haemoglobin. This can cause pain and discomfort for the patient. It is important to manage the underlying condition causing the high haem turnover to prevent the formation of pigment gallstones.

    • This question is part of the following fields:

      • Haematology
      87.9
      Seconds
  • Question 15 - An 80-year-old man arrives at the emergency department with a complaint of severe...

    Correct

    • An 80-year-old man arrives at the emergency department with a complaint of severe headache. He has a medical history of hypertension and takes Ramipril 10 mg and Amlodipine 10 mg. During the full workup, fundoscopy is conducted and reveals scattered cotton wool spots, tortuous vessels throughout, and AV nipping in both eyes. According to the Keith-Wagener classification, what stage of hypertensive retinopathy does this patient have?

      Your Answer: Stage 3

      Explanation:

      Hypertensive retinopathy can be detected through fundoscopy, which may reveal end organ damage. This condition can progress through stages 1 to 3, and is often tested on as a final exam question. Diabetic retinopathy is also a commonly tested topic.

      Understanding Hypertensive Retinopathy: Keith-Wagener Classification

      Hypertensive retinopathy is a condition that affects the eyes due to high blood pressure. The Keith-Wagener classification is a system used to categorize the different stages of hypertensive retinopathy. Stage I is characterized by narrowing and twisting of the blood vessels in the eyes, as well as an increased reflection of light known as silver wiring. In stage II, the blood vessels become compressed where they cross over veins, leading to arteriovenous nipping. Stage III is marked by the appearance of cotton-wool exudates, which are white patches on the retina caused by blocked blood vessels. Additionally, there may be flame and blot hemorrhages that can collect around the fovea, resulting in a ‘macular star.’ Finally, stage IV is the most severe stage and is characterized by papilloedema, which is swelling of the optic disc at the back of the eye. Understanding the Keith-Wagener classification can help healthcare professionals diagnose and manage hypertensive retinopathy.

    • This question is part of the following fields:

      • Ophthalmology
      1943.8
      Seconds
  • Question 16 - A 62-year-old woman undergoes a routine health check-up. She reports feeling well, having...

    Correct

    • A 62-year-old woman undergoes a routine health check-up. She reports feeling well, having recently quit smoking, and having no complaints. Upon examination, no abnormalities are found. However, microscopic haematuria is detected in her urine, and the following results are obtained. The patient did not experience any pain, dysuria, or engage in physical activity before the sample collection.

      Hb 150 g/L
      Platelets 250 * 109/L (150 - 400)
      WBC 12 * 109/L (4.0 - 11.0)

      What is the most appropriate course of action in this scenario?

      Your Answer: Urgent (2-week) referral to a urologist

      Explanation:

      If a patient is over 60 years old and has unexplained non-visible haematuria along with dysuria or a raised white cell count on a blood test, they should be referred to a urologist using the suspected cancer pathway within 2 weeks to rule out bladder cancer. It is important to exclude bladder cancer as a potential cause, especially if the patient has a history of smoking. The urologist may request investigations such as a urine red cell morphology, CT intravenous pyelogram, and urine cytology. However, a CT scan of the kidneys, ureter, and bladder is not appropriate at this stage as it is used to detect radio-opaque stones in the renal tract. If resources are limited, the GP should initiate relevant investigations for bladder cancer while waiting for the urology appointment. In lower risk cases, reassurance and re-checking in 2-6 weeks may be considered.

      Bladder cancer is the second most common urological cancer, with males aged between 50 and 80 years being the most commonly affected. Smoking and exposure to hydrocarbons such as 2-Naphthylamine increase the risk of the disease. Chronic bladder inflammation from Schistosomiasis infection is a common cause of squamous cell carcinomas in countries where the disease is endemic. Benign tumors of the bladder, including inverted urothelial papilloma and nephrogenic adenoma, are uncommon.

      Urothelial (transitional cell) carcinoma is the most common type of bladder malignancy, accounting for over 90% of cases. Squamous cell carcinoma and adenocarcinoma are less common. Urothelial carcinomas may be solitary or multifocal, with up to 70% having a papillary growth pattern. Superficial tumors have a better prognosis, while solid growths are more prone to local invasion and may be of higher grade, resulting in a worse prognosis. TNM staging is used to determine the extent of the tumor and the presence of nodal or distant metastasis.

      Most patients with bladder cancer present with painless, macroscopic hematuria. Incidental microscopic hematuria may also indicate malignancy in up to 10% of females over 50 years old. Diagnosis is made through cystoscopy and biopsies or transurethral resection of bladder tumor (TURBT), with pelvic MRI and CT scanning used to determine locoregional spread and distant disease. Treatment options include TURBT, intravesical chemotherapy, radical cystectomy with ileal conduit, or radical radiotherapy, depending on the extent and grade of the tumor. Prognosis varies depending on the stage of the tumor, with T1 having a 90% survival rate and any T with N1-N2 having a 30% survival rate.

    • This question is part of the following fields:

      • Surgery
      87.9
      Seconds
  • Question 17 - A 23-year-old man comes to the clinic complaining of sudden onset of difficulty...

    Correct

    • A 23-year-old man comes to the clinic complaining of sudden onset of difficulty breathing and sharp chest pain that worsens when he inhales. He has no significant medical history and is generally healthy and active. He admits to smoking and drinking occasionally. The patient is diagnosed with a pneumothorax caused by the spontaneous rupture of an apical bulla.
      What is the most accurate description of the lung volume and chest wall position in this patient?

      Your Answer: The lung collapses inward and the chest wall expands outward

      Explanation:

      Understanding Pneumothorax: Causes and Management

      Pneumothorax is a common thoracic disease characterized by the presence of air in the pleural space. It can be spontaneous, traumatic, secondary, or iatrogenic. When air enters the pleural space, it causes the lung to collapse inward and the chest wall to expand outward. In cases of tension pneumothorax, immediate medical attention is required to decompress the pleural space with a wide-bore needle. For non-tension pneumothorax, management depends on the patient’s symptoms. If the pneumothorax is larger than 2 cm and the patient is breathless, aspiration with a large-bore cannula and oxygen therapy may be necessary. If the pneumothorax is small and the patient is asymptomatic, they can be discharged with an outpatient appointment in 6 weeks. However, if the pneumothorax is larger than 2 cm or the patient remains breathless after decompression, a chest drain will need to be inserted. It is important to understand the causes and management of pneumothorax to ensure prompt and effective treatment.

    • This question is part of the following fields:

      • Respiratory
      94.8
      Seconds
  • Question 18 - 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
      15.8
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  • Question 19 - A 25-year-old female comes to the clinic with sudden onset of left foot...

    Correct

    • A 25-year-old female comes to the clinic with sudden onset of left foot drop. Upon examination, it is found that she has weakness in ankle dorsiflexion and eversion. There is also a loss of sensation over the dorsum of her foot. All reflexes are present and plantars flexor. Which nerve is most likely to be affected?

      Your Answer: Common peroneal nerve

      Explanation:

      Peroneal Neuropathy

      Peroneal neuropathy is a condition that typically manifests as sudden foot drop. When a patient is examined, the weakness in the foot and ankle is limited to dorsiflexion of the ankle and toes, as well as eversion of the ankle. However, the ankle reflex (which is mediated by the tibial nerve) and the knee reflex (which is mediated by the femoral nerve) remain intact. In terms of sensory involvement, the lower two-thirds of the lateral leg and the dorsum of the foot may be affected.

      It is important to note that peroneal neuropathy is distinct from other nerve issues that may affect the lower leg and foot. For example, sciatic nerve problems may result in impaired knee flexion, while tibial nerve lesions may lead to weakness in foot flexion and pain on the plantar surface. By the specific symptoms and signs of peroneal neuropathy, healthcare providers can make an accurate diagnosis and develop an appropriate treatment plan.

    • This question is part of the following fields:

      • Neurology
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  • Question 20 - A 75-year-old male with a history of prostate cancer treated with external beam...

    Incorrect

    • A 75-year-old male with a history of prostate cancer treated with external beam radiation therapy 3 years ago visits his general practitioner complaining of crampy abdominal pain, urgency, and diarrhea that have persisted for 4 months. The patient is in good health and has no other medical conditions.
      During the examination, the patient appears thin and has conjunctival pallor. The abdomen is soft and non-tender, and there is no blood or mucous on digital rectal examination.
      What possible diagnosis could account for these symptoms?

      Your Answer: Diverticular disease

      Correct Answer: Colorectal cancer

      Explanation:

      After undergoing radiotherapy for prostate cancer, patients have a higher likelihood of developing bladder, colon, and rectal cancer. This suggests that the pathology is related to the digestive system, rather than a recurrence of prostate cancer. The patient’s lack of symptoms such as bleeding or pain during bowel movements makes anal cancer less probable. Additionally, the patient’s age and lack of prior diagnosis make it unlikely that they have inflammatory bowel disease.

      Management of Prostate Cancer

      Localised prostate cancer (T1/T2) can be managed through various treatment options depending on the patient’s life expectancy and preference. Conservative approaches such as active monitoring and watchful waiting can be considered, as well as radical prostatectomy and radiotherapy (external beam and brachytherapy). On the other hand, localised advanced prostate cancer (T3/T4) may require hormonal therapy, radical prostatectomy, or radiotherapy. However, patients who undergo radiotherapy may develop proctitis and are at a higher risk of bladder, colon, and rectal cancer.

      For metastatic prostate cancer, the primary goal is to reduce androgen levels. A combination of approaches is often used, including anti-androgen therapy, synthetic GnRH agonist or antagonists, bicalutamide, cyproterone acetate, abiraterone, and bilateral orchidectomy. GnRH agonists such as Goserelin (Zoladex) may result in lower LH levels longer term by causing overstimulation, which disrupts endogenous hormonal feedback systems. This may cause a rise in testosterone initially for around 2-3 weeks before falling to castration levels. To prevent a rise in testosterone, anti-androgen therapy is often used initially. However, this may result in a tumour flare, which stimulates prostate cancer growth and may cause bone pain, bladder obstruction, and other symptoms. GnRH antagonists such as degarelix are being evaluated to suppress testosterone while avoiding the flare phenomenon. Chemotherapy with docetaxel may also be an option for the treatment of hormone-relapsed metastatic prostate cancer in patients who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated.

    • This question is part of the following fields:

      • Surgery
      32.1
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  • Question 21 - A 35-year-old male patient presents to his primary care physician with complaints of...

    Incorrect

    • A 35-year-old male patient presents to his primary care physician with complaints of progressive weakness and pain in his arms and hands, along with increasing fatigue, particularly during physical activity. During the examination, the physician detects faint fine crackles in the lower-mid zones and observes thickened and cracked skin on the patient's hands. The patient also experiences difficulty transitioning from the chair to the examination couch. What is the primary blood marker associated with this condition?

      Your Answer: Creatinine kinase

      Correct Answer: Anti-Jo 1 antibodies

      Explanation:

      Antisynthetase syndrome is a subtype of dermatomyositis that can lead to myositis and interstitial lung disease, particularly in patients with positive anti-Jo 1 antibodies. This condition is caused by antibodies against tRNA synthetase. Patients may experience hand symptoms such as arthralgia, mechanic’s hands, and Raynaud’s. It is important to note that patients with myositis and positive anti-Jo 1 antibodies are at an increased risk of developing interstitial lung disease. While all of the options listed may be present in myositis, ESR is typically normal. Elevated ESR levels are more commonly seen in other autoimmune conditions like polymyalgia rheumatica, which can present similarly to myositis.

      Understanding Antisynthetase Syndrome

      Antisynthetase syndrome is a medical condition that occurs when the body produces autoantibodies against aminoacyl-tRNA synthetase, specifically anti-Jo1. This condition is characterized by several symptoms, including myositis, interstitial lung disease, mechanic’s hands, and Raynaud’s phenomenon. Myositis refers to inflammation of the muscles, while interstitial lung disease is a condition that affects the tissue and space around the air sacs in the lungs. Mechanic’s hands is a term used to describe thickened and cracked skin on the hands, while Raynaud’s phenomenon is a condition that causes the blood vessels in the fingers and toes to narrow, leading to numbness and tingling sensations.

    • This question is part of the following fields:

      • Musculoskeletal
      208.8
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  • Question 22 - A 63-year-old woman comes to the clinic with a complaint of unilateral facial...

    Incorrect

    • A 63-year-old woman comes to the clinic with a complaint of unilateral facial droop. Upon examination, it is noted that she is unable to fully close her left eye. She has no significant medical history but reports having a recent viral upper respiratory tract infection. Her husband is worried that she may have had a stroke, but there are no other focal neurological deficits found except for the isolated left-sided facial nerve palsy.
      What clinical finding would you anticipate during the examination?

      Your Answer: Left-sided facial weakness with forehead sparing

      Correct Answer: Loss of lacrimation

      Explanation:

      Understanding Bell’s Palsy: Symptoms and Differences from a Stroke

      Bell’s palsy is a condition that affects the facial nerve, causing facial weakness and loss of lacrimation. It is important to distinguish it from a stroke, which can have similar symptoms but different underlying causes. Here are some key points to keep in mind:

      Loss of lacrimation: Bell’s palsy affects the parasympathetic fibers carried in the facial nerve, which are responsible for tear formation. This leads to a loss of lacrimation on the affected side.

      Loss of sensation: The trigeminal nerve carries the nerve fibers responsible for facial sensation, so there will be no sensory deficit in Bell’s palsy.

      Mydriasis: Bell’s palsy does not affect the fibers that supply the pupil, so there will be no mydriasis (dilation of the pupil).

      Facial weakness: Bell’s palsy is a lower motor neuron lesion, which means that innervation to all the facial muscles is interrupted. This leads to left-sided facial weakness without forehead sparing.

      Ptosis: Bell’s palsy affects the orbicularis oculi muscle, which prevents the eye from fully closing. This can lead to ptosis (drooping of the eyelid) and the need for eye patches and artificial tears to prevent corneal ulcers.

      By understanding these symptoms and differences from a stroke, healthcare professionals can provide accurate diagnoses and appropriate treatment for patients with Bell’s palsy.

    • This question is part of the following fields:

      • Neurology
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  • Question 23 - An astute pathologist examines tissue from a spontaneous abortion and observes the existence...

    Incorrect

    • An astute pathologist examines tissue from a spontaneous abortion and observes the existence of mature fetal tissue that contains Barr bodies. What possible genotypes could the fetus have had?

      Your Answer: Edwards’ syndrome (47,XY+18)

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

      Explanation:

      Understanding Chromosomal Abnormalities: Klinefelter’s Syndrome, Turner Syndrome, Edwards’ Syndrome, Normal Male, and XYY Syndrome

      Chromosomal abnormalities can have significant impacts on an individual’s health and development. Here, we will discuss five different karyotypes and their associated clinical features.

      Klinefelter’s syndrome (47,XXY) is a condition where a phenotypically male individual carries an extra X chromosome. This results in the presence of a Barr body, a condensed and inactivated X chromosome. Clinical features include tall stature, sparse facial/axillary and pubic hair, hypogonadism, gynaecomastia, infertility, and increased risk of breast cancer, autoimmune disorders, and osteoporosis. Management relies on behavioural and psychosocial therapy, and assisted conception treatments can be used for fertility.

      Classic Turner syndrome (45,X) is characterized by the absence of one X chromosome, resulting in no Barr body. Patients have short stature, short webbed neck, low hairline, limb oedema, wide spaced nipples, primary amenorrhoea, delayed puberty, and coarctation of the aorta. Management includes growth hormone and oestrogen replacement therapy.

      Edwards’ syndrome (47,XY+18) is a male genotype with an extra chromosome 18. As there is only one X chromosome, there cannot be a Barr body. Babies born with this condition have significant abnormalities in major systems, including kidney malformations, congenital heart disease, microcephaly, micrognathia, cleft lip/palate, and severe developmental delays.

      A normal male karyotype is 46,XY, which means there is only one X chromosome and no Barr body present.

      XYY syndrome (47,XYY) is a male genotype with an extra Y chromosome. As there is only one X chromosome, there cannot be a Barr body. Individuals with XYY syndrome have tall stature, normal sexual development, and normal fertility. However, they may experience reduced intellectual ability, learning difficulties, and developmental/behavioural delays.

      Understanding these chromosomal abnormalities can aid in diagnosis and management of associated clinical features.

    • This question is part of the following fields:

      • Genetics
      16.2
      Seconds
  • Question 24 - A 33-year-old woman comes to see her GP to talk about her pregnancy....

    Correct

    • A 33-year-old woman comes to see her GP to talk about her pregnancy. She has a history of asthma and is concerned about the possibility of her child developing asthma as well. She has been a smoker since she was 16 years old but has reduced her smoking to ten cigarettes a day since becoming pregnant.

      What steps can she take to minimize the risk of her baby developing asthma?

      Your Answer: Stop smoking

      Explanation:

      Tips for a Healthy Pregnancy: Avoiding Risks and Taking Folic Acid

      Pregnancy is a crucial time for both the mother and the developing baby. To ensure a healthy pregnancy, there are certain things that should be avoided and others that should be taken. Here are some tips for a healthy pregnancy:

      Stop smoking: Smoking during pregnancy can increase the risk of stillbirth, premature labour, and low birth weight. Second-hand smoke can also increase the risk of sudden infant death syndrome and asthma in children. It is best for everyone to stop smoking, and support and advice can be obtained from GPs.

      Avoid alcohol: Alcohol can lead to fetal alcohol syndrome, which can cause a range of developmental issues in the baby. It is best to avoid alcohol during pregnancy.

      Avoid caffeine: Caffeine can increase the risk of low birth weight and miscarriage. It is advised to reduce caffeine consumption as much as possible during pregnancy.

      Avoid eating peanuts: Contrary to previous advice, it is now considered safe for pregnant women to eat peanuts as long as they do not have a history of allergy themselves.

      Take folic acid: Folic acid is important in reducing the risk of neural tube defects in the developing baby. The standard dose is 400 μg daily, but a higher dose may be recommended for those with other risk factors.

      By following these tips, pregnant women can help ensure a healthy pregnancy and a healthy baby.

    • This question is part of the following fields:

      • Paediatrics
      29.4
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  • Question 25 - As an F2 in psychiatry, you come across the notes of a 27-year-old...

    Correct

    • As an F2 in psychiatry, you come across the notes of a 27-year-old man who is noted to prefer solitude, has never been in a romantic relationship, and has no desire for one. He also displays minimal interest in engaging in sexual activities with others. Despite performing well at work, he places little importance on feedback from his colleagues. Based on this information, which personality disorder is most likely present in this individual?

      Your Answer: Schizoid

      Explanation:

      Schizoid personality disorder is characterized by a preference for solitude, a lack of interest in close relationships, and a low libido. It is important to note that while asexuality is recognized as part of the LGBTQ+ spectrum, it is not included in the diagnostic criteria for this disorder. The DSM-5 and ICD-10 both list a lack of desire for close relationships, a preference for solitary activities, and a limited capacity for expressing emotions as key features of schizoid personality disorder. Individuals with this disorder may also appear indifferent to praise or criticism, lack close friends or confidants, and exhibit emotional detachment or flattened affectivity. In contrast, borderline personality disorder is characterized by emotional instability in relationships, including sudden mood swings, rages, self-harming behaviors, and intense jealousy. Dependent personality disorder involves a reliance on others for reassurance and decision-making.

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

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

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

    • This question is part of the following fields:

      • Psychiatry
      107.9
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  • Question 26 - A study investigated the effectiveness of a new statin therapy in preventing ischaemic...

    Correct

    • A study investigated the effectiveness of a new statin therapy in preventing ischaemic heart disease in a diabetic population. Over a period of five years, 1000 patients were randomly assigned to receive the new therapy and 1000 were given a placebo. The placebo group experienced 150 myocardial infarctions (MIs), while the group treated with the new statin had 100 infarctions. What is the yearly percentage of MIs in the diabetic population who received the placebo?

      Your Answer: 3%

      Explanation:

      Incidence of Myocardial Infarction in Diabetic Patients

      This study found that out of 1000 diabetic patients treated with a placebo over a five-year period, there were 150 cases of myocardial infarction (MI). This means that the rate of infarction in this group was 15%, which translates to an annual MI rate of 3%. These findings provide important information for healthcare professionals treating diabetic patients, as they highlight the increased risk of MI in this population. It is important for healthcare providers to be aware of this risk and take appropriate measures to prevent and manage cardiovascular complications in diabetic patients. This study emphasizes the need for continued research and development of effective prevention and treatment strategies for diabetic patients at risk for MI.

    • This question is part of the following fields:

      • Clinical Sciences
      207.8
      Seconds
  • Question 27 - What is a true statement about gentamicin treatment? ...

    Correct

    • What is a true statement about gentamicin treatment?

      Your Answer: May produce ventilatory failure in sensitive patients

      Explanation:

      Aminoglycosides and Their Side Effects

      Aminoglycosides are a class of antibiotics that can cause oto and renal toxicity, which is why drug concentrations need to be closely monitored during treatment. These antibiotics are primarily excreted by the kidneys, so any impairment in renal function can lead to increased toxicity. Additionally, a rare side effect of aminoglycosides is ventilatory failure, which is associated with impaired neuromuscular junction conduction. Therefore, patients with myasthenia gravis should not be given aminoglycosides.

      Aminoglycosides are administered intravenously and cannot be taken orally because they are denatured in the digestive system. It is important to note that these antibiotics are reserved for serious infections due to their potential for toxicity. Patients receiving aminoglycosides should be closely monitored for any signs of toxicity, including hearing loss, kidney damage, and neuromuscular weakness. Overall, aminoglycosides are effective antibiotics, but their use should be carefully considered and monitored to minimize the risk of adverse effects.

    • This question is part of the following fields:

      • Pharmacology
      94.9
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  • Question 28 - A 9-year-old girl is brought to the paediatrics department with a 2-day history...

    Correct

    • A 9-year-old girl is brought to the paediatrics department with a 2-day history of worsening abdominal pain, accompanied by fever, nausea and vomiting. The pain initially started in the middle of her abdomen but has now become focused on the right lower quadrant.
      What is the most frequent surgical diagnosis in children of this age group?

      Your Answer: Appendicitis

      Explanation:

      Common Causes of Acute Abdominal Pain in Children

      Acute abdominal pain is a common complaint among children, and it can be caused by a variety of conditions. Among the most common surgical diagnoses in children with acute abdominal pain is appendicitis, which typically presents with central colicky abdominal pain that localizes to the right iliac fossa. However, over half of children with abdominal pain have no identifiable cause.

      Intussusception is another common surgical diagnosis in children under two years of age, characterized by the telescoping of one portion of bowel over another. Symptoms include loud crying, drawing up of the knees, vomiting, and rectal bleeding that resembles redcurrant jelly.

      Mesenteric adenitis is a self-limiting condition that can present similarly to appendicitis but is not a surgical diagnosis. Cholecystitis, a common cause of abdominal pain in adults, is rare in children. Ovarian torsion is also a rare cause of acute abdominal pain in children, accounting for less than 5% of cases.

      Prompt diagnosis and treatment are crucial for conditions like appendicitis and intussusception, as delays can increase the risk of complications. However, it is important to consider a range of potential causes for acute abdominal pain in children and to seek medical attention if symptoms persist or worsen.

    • This question is part of the following fields:

      • Colorectal
      168.7
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  • Question 29 - A 29-year-old woman presents with dry, eczematous hands. She reports being a very...

    Incorrect

    • A 29-year-old woman presents with dry, eczematous hands. She reports being a very hygienic person, but since the onset of the COVID-19 pandemic, she has been washing her hands excessively - up to 60 times a day. She is aware that this is causing her skin to become dry and irritated, but her anxiety about contracting the virus is too great to stop. She works in a hospital and is worried about her colleagues noticing her frequent hand washing. You suspect she may have obsessive-compulsive disorder and decide to refer her to the community mental health team. What treatment options are likely to be offered to her?

      Your Answer: Eye movement desensitisation and reprocessing (EMDR)

      Correct Answer: Cognitive behavioural therapy

      Explanation:

      Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions that can cause significant functional impairment and distress. Risk factors include family history, age, pregnancy/postnatal period, and history of abuse, bullying, or neglect. Treatment options include low-intensity psychological treatments, SSRIs, and more intensive CBT (including ERP). Severe cases should be referred to the secondary care mental health team for assessment and may require combined treatment with an SSRI and CBT or clomipramine as an alternative. ERP involves exposing the patient to an anxiety-provoking situation and stopping them from engaging in their usual safety behavior. Treatment with SSRIs should continue for at least 12 months to prevent relapse and allow time for improvement.

    • This question is part of the following fields:

      • Psychiatry
      14.8
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  • Question 30 - A 28-year-old woman who has never given birth is currently 35 weeks pregnant...

    Incorrect

    • A 28-year-old woman who has never given birth is currently 35 weeks pregnant and has been admitted to the hospital due to severe pre-eclampsia. The obstetric team is worried about the possibility of eclampsia.

      What is the recommended treatment for this patient?

      Your Answer: Atenolol

      Correct Answer: Intravenous magnesium sulphate

      Explanation:

      Treatment for Severe Pre-eclampsia and Eclampsia

      The recommended treatment for severe pre-eclampsia or eclampsia is intravenous magnesium sulphate. In addition, antihypertensive treatment is also important, with labetalol being the first line of treatment for hypertension during pregnancy. Nifedipine and methyldopa also have a role to play.

      Magnesium sulphate should be administered to patients with severe hypertension and proteinuria, as well as those with mild or moderate hypertension and proteinuria who exhibit symptoms such as severe headache, problems with vision, severe pain just below the ribs or vomiting, papilloedema, signs of clonus, liver tenderness, HELLP syndrome, platelet count falling to below 100 ×109/L, or abnormal liver enzymes.

      The administration of magnesium sulphate involves a 4 g loading dose given intravenously over five minutes, followed by an infusion of 1 g/hr for 24 hours. In the event of recurrent seizures, an additional bolus dose of 2-4 g should be given over five minutes.

      Overall, the treatment for severe pre-eclampsia and eclampsia involves a combination of intravenous magnesium sulphate and antihypertensive medication, with the dosage and administration of magnesium sulphate varying depending on the patient’s symptoms and condition.

    • This question is part of the following fields:

      • Obstetrics
      10.6
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SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (1/3) 33%
Anaesthetics & ITU (0/1) 0%
Psychiatry (2/3) 67%
Nephrology (2/2) 100%
Obstetrics (0/2) 0%
Ophthalmology (1/3) 33%
Musculoskeletal (0/2) 0%
Surgery (1/3) 33%
Dermatology (0/1) 0%
Pharmacology (2/2) 100%
Haematology (0/1) 0%
Respiratory (1/1) 100%
Clinical Sciences (2/2) 100%
Neurology (1/2) 50%
Genetics (0/1) 0%
Colorectal (1/1) 100%
Passmed