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Question 1
Incorrect
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A 21-year-old, asymptomatic man presents to you with a family history of colorectal cancer. His father passed away from the disease at the age of 35, and the patient is worried about his own risk. He has no knowledge of any other cancer in his family.
What is the most suitable approach to managing this patient?Your Answer: Reassurance
Correct Answer: Arrange colonoscopy
Explanation:Importance of Colonoscopy in Patients with Familial Adenomatous Polyposis
Explanation:
It is crucial to consider familial adenomatous polyposis (FAP) in patients with a family history of colorectal cancer at a young age. FAP is an autosomal dominant condition associated with a mutation in the adenomatous polyposis coli gene, leading to the development of numerous polyps in the colon. If left untreated, patients with FAP develop colorectal cancer by the age of 35-40.In this scenario, the patient’s father likely had FAP, and the patient has a 50% chance of inheriting the mutation and developing the disease. Therefore, regardless of the patient’s symptoms or blood results, a colonoscopy is necessary to review the colon and identify any polyps. Treatment for FAP involves a total colectomy at around the age of 20.
Reassurance would be inappropriate in this scenario, and a digital rectal examination alone is not sufficient. It is essential to arrange a colonoscopy for patients with a family history of FAP to detect and treat the condition early. Additionally, it is recommended to review the patient with a view to colonoscopy at the age of 30 to monitor for any polyp development.
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This question is part of the following fields:
- Colorectal
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Question 2
Correct
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A 70-year-old man with a recent chest infection arrives at the Emergency Department complaining of severe pain in his right knee. Upon conducting a joint aspirate, analysis of the synovial fluid reveals the presence of positively birefringent crystals. The patient is currently undergoing treatment with desferrioxamine for his iron overload. What would be the most suitable initial management for his musculoskeletal symptoms?
Your Answer: Ibuprofen
Explanation:Pseudogout, which is caused by an excess of calcium pyrophosphate levels in the body, has several risk factors including haemochromatosis, hyperparathyroidism, hypophosphataemia, hypothyroidism, hypomagnesemia, and old age. This patient, who has haemochromatosis, is currently taking iron chelating agents to manage their iron overload. The recommended first line treatment for pseudogout is NSAIDs and colchicine. Allopurinol is not effective for pseudogout as it is not caused by uric acid overload. Methotrexate may be used for chronic pseudogout, but it is not typically the first line treatment. Sulfasalazine is not indicated for pseudogout.
Pseudogout, also known as acute calcium pyrophosphate crystal deposition disease, is a type of microcrystal synovitis that occurs when calcium pyrophosphate dihydrate crystals are deposited in the synovium. This condition is more common in older individuals, but those under 60 years of age may develop it if they have underlying risk factors such as haemochromatosis, hyperparathyroidism, low magnesium or phosphate levels, acromegaly, or Wilson’s disease. The knee, wrist, and shoulders are the most commonly affected joints, and joint aspiration may reveal weakly-positively birefringent rhomboid-shaped crystals. X-rays may show chondrocalcinosis, which appears as linear calcifications of the meniscus and articular cartilage in the knee. Treatment involves joint fluid aspiration to rule out septic arthritis, as well as the use of NSAIDs or steroids, as with gout.
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This question is part of the following fields:
- Musculoskeletal
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Question 3
Correct
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A 28-year-old mother of a three-month-old baby visits the clinic with a concern of experiencing wrist pain for a week. The pain is located on the radial side of her wrist, and she feels tenderness over the radial styloid process. What is the probable diagnosis?
Your Answer: De Quervain's tenosynovitis
Explanation:The patient is experiencing pain on the radial side of the wrist and tenderness over the radial styloid process, which is indicative of de Quervain’s tenosynovitis. This condition is caused by inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons and is commonly seen in women aged 30-50 years old. Finkelstein’s test is positive, which involves grasping the patient’s thumb and abducting the hand to the ulnar side, resulting in pain over the radial styloid process. Carpal tunnel syndrome, osteoarthritis, radial nerve entrapment, and scaphoid fracture are unlikely causes of the patient’s symptoms.
De Quervain’s Tenosynovitis: Symptoms, Diagnosis, and Treatment
De Quervain’s tenosynovitis is a condition that commonly affects women between the ages of 30 and 50. It occurs when the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons becomes inflamed. The condition is characterized by pain on the radial side of the wrist, tenderness over the radial styloid process, and pain when the thumb is abducted against resistance. A positive Finkelstein’s test, in which the thumb is pulled in ulnar deviation and longitudinal traction, can also indicate the presence of tenosynovitis.
Treatment for De Quervain’s tenosynovitis typically involves analgesia, steroid injections, and immobilization with a thumb splint (spica). In some cases, surgical treatment may be necessary. With proper diagnosis and treatment, most patients are able to recover from this condition and resume their normal activities.
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This question is part of the following fields:
- Musculoskeletal
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Question 4
Incorrect
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A 70-year-old female presents to breast clinic following a left total mastectomy and sentinel lymph node biopsy for breast cancer. The histological analysis reveals complete excision of the tumour and clear malignancy in all 3 lymph nodes. The tumour is an invasive ductal carcinoma of grade 1, with ER and PR positivity and HER2 negativity. What additional treatment options should be considered for this patient?
Your Answer: Tamoxifen
Correct Answer: Anastrozole
Explanation:The recommended adjuvant hormonal therapy for postmenopausal women with ER+ breast cancer is anastrozole. This medication is an aromatase inhibitor that reduces estrogen levels in the body and is typically given for 5 years. Common side effects include hot flashes, insomnia, and low mood.
Axillary node clearance (ANC) is not necessary in this case since the lymph nodes sampled from the sentinel lymph node biopsy (SLNB) did not show any evidence of malignancy. ANC can increase the risk of lymphoedema, so it should only be performed if needed to clear disease.
Herceptin (trastuzumab) is a type of adjuvant therapy for breast cancer that is used for patients with HER2+ breast cancer. However, since the patient in this case had HER2 receptor status that was negative, Herceptin is not indicated.
Radiotherapy is also not necessary in this case since the patient had a total mastectomy, the lesion was completely removed, and no lymph nodes were involved. Therefore, radiotherapy would unlikely provide any benefit.
Breast cancer management varies depending on the stage of the cancer, type of tumor, and patient’s medical history. Treatment options may include surgery, radiotherapy, hormone therapy, biological therapy, and chemotherapy. Surgery is typically the first option for most patients, except for elderly patients with metastatic disease who may benefit more from hormonal therapy. Prior to surgery, an axillary ultrasound is recommended for patients without palpable axillary lymphadenopathy, while those with clinically palpable lymphadenopathy require axillary node clearance. The type of surgery offered depends on various factors, such as tumor size, location, and type. Breast reconstruction is also an option for patients who have undergone a mastectomy.
Radiotherapy is recommended after a wide-local excision to reduce the risk of recurrence, while mastectomy patients may receive radiotherapy for T3-T4 tumors or those with four or more positive axillary nodes. Hormonal therapy is offered if tumors are positive for hormone receptors, with tamoxifen being used in pre- and perimenopausal women and aromatase inhibitors like anastrozole in postmenopausal women. Tamoxifen may increase the risk of endometrial cancer, venous thromboembolism, and menopausal symptoms. Biological therapy, such as trastuzumab, is used for HER2-positive tumors but cannot be used in patients with a history of heart disorders. Chemotherapy may be used before or after surgery, depending on the stage of the tumor and the presence of axillary node disease. FEC-D is commonly used in the latter case.
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This question is part of the following fields:
- Surgery
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Question 5
Correct
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A 25-year-old patient visits the GP complaining of lower back pain and stiffness that extends to the buttocks for the past 3 months. The pain is most severe upon waking up, but cycling seems to alleviate it. The patient denies any injury but is an avid cyclist. Additionally, the patient experiences fatigue. The patient had Chlamydia and was treated with doxycycline 8 months ago. The patient has a history of anxiety and does not take any regular medication, but ibuprofen helps alleviate the pain. What is the most probable diagnosis?
Your Answer: Ankylosing spondylitis
Explanation:Exercise is typically beneficial for patients with inflammatory back pain, such as those with ankylosing spondylitis. This condition is more common in males and presents with symptoms such as morning stiffness, back pain lasting over 3 months, and improvement with exercise. Inflammation can also affect the sacroiliac joints, causing buttock pain, and patients may experience fatigue. Lumbar spinal stenosis is an unlikely differential as it presents with back and buttock pain due to nerve compression, and patients may have leg weakness. Psoriatic arthritis can also cause spondyloarthritis, but it typically presents with peripheral arthritis and/or dactylitis, and patients may have a history of psoriasis. Reactive arthritis is also an unlikely differential as it typically presents 1-4 weeks after infection, and patients may have other symptoms such as enthesitis, peripheral arthritis, conjunctivitis, skin lesions, and urethritis.
Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in young males, with a sex ratio of 3:1, and typically presents with lower back pain and stiffness that develops gradually. The stiffness is usually worse in the morning and improves with exercise, while pain at night may improve upon getting up. Clinical examination may reveal reduced lateral and forward flexion, as well as reduced chest expansion. Other features associated with ankylosing spondylitis include apical fibrosis, anterior uveitis, aortic regurgitation, Achilles tendonitis, AV node block, amyloidosis, cauda equina syndrome, and peripheral arthritis (more common in females).
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This question is part of the following fields:
- Musculoskeletal
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Question 6
Incorrect
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What is the mechanism of action of denosumab in the management of osteoporosis?
Your Answer: Inhibition of osteoclast activity
Correct Answer: Inhibition of the RANK ligand (RANKL)
Explanation:Denosumab and its Mechanism of Action in Osteoporosis Treatment
Denosumab is a monoclonal antibody therapy used to treat osteoporosis. It is typically used as a second- or third-line agent due to its higher cost compared to bisphosphonate therapy. Bone is a dynamic tissue that undergoes continuous changes through the processes of bone formation by osteoblasts and bone resorption by osteoclasts. Many bone diseases are associated with an imbalance in this process.
The interaction between osteoblasts and osteoclasts is complex. Both cell types originate from the same precursor cell, and certain signals can favor the development of one cell type over the other. For example, inflammation promotes osteoclast development. Another interaction between these cells is through the RANK-RANKL system. RANK is a receptor present on osteoclasts that binds to a ligand on osteoblasts. This binding promotes osteoclast activity and reduces osteoblast activity.
Denosumab works by preventing the binding of RANKL to RANK, thereby inhibiting osteoclast activity and promoting bone formation. This mechanism of action makes it an effective treatment option for osteoporosis.
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This question is part of the following fields:
- Pharmacology
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Question 7
Incorrect
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Which therapy is unsuitable for the given condition?
Your Answer: 1% hydrocortisone for infantile eczema
Correct Answer: Surgical excision for a cavernous haemangioma 3 cm × 4 cm on the arm
Explanation:Cavernous Haemangiomas and Alopecia Areata: Conditions and Treatment Options
Cavernous haemangiomas are benign growths that typically appear within the first two weeks of life. They are usually found on the face, neck, or trunk and are well-defined and lobulated. Surgical excision is not recommended, but treatment may be necessary if the growths inhibit normal development, such as obstructing vision in one eye. Treatment options include systemic or local steroids, sclerosants, interferon, or laser treatment.
Alopecia areata is an autoimmune condition that causes hair loss in discrete areas. Treatment options include cortisone injections into the affected areas and the use of topical cortisone creams. It is important to note that both conditions require medical attention and treatment to prevent further complications. With proper care and treatment, individuals with cavernous haemangiomas and alopecia areata can manage their conditions and improve their quality of life.
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This question is part of the following fields:
- Dermatology
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Question 8
Incorrect
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Dr. Patel is a nephrologist who has five patients attending his clinic. The patients' results are as follows:
Adam Ahmed Bella Brownie Charlie Chen David Davis
Urine protein mg/24 hrs: 150 4000 3000 200 300
Haematuria: Present Absent Present Present Absent
Oedema: Absent Present Present Absent Absent
Serum albumin g/l: 24 18 26 17 32
Serum creatinine µmol/l: 430 110 280 560 120
Which patient is diagnosed with nephrotic syndrome?Your Answer: Celia Creutzfeldt
Correct Answer: Bella Barnard
Explanation:Nephrotic Syndrome
Nephrotic syndrome is a condition characterized by low serum albumin levels, high urinary protein levels, and marked pitting edema. Only individuals who meet all three criteria are diagnosed with this syndrome. Other features of nephrotic syndrome include little or no hematuria, glomerular pathology as the cause, marked hyperlipidemia that increases cardiovascular risk, reduced immunoglobulins that increase the risk of infection, and loss of certain proteins that increase the risk of thrombosis, including renal vein thrombosis. Creatinine levels can be normal or elevated.
The causes of nephrotic syndrome include glomerulonephritis, such as minimal change disease and membranous glomerulonephritis, focal segmental glomerulosclerosis, diabetic nephropathy, amyloid (AL form), and connective tissue disease such as systemic lupus erythematosus. the diagnostic criteria and features of nephrotic syndrome is crucial for early detection and management of this condition.
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This question is part of the following fields:
- Nephrology
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Question 9
Correct
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An older woman presents with an intermittent frontal headache associated with pain around her right eye which looks slightly red. She describes episodes occurring while she watches television in the evening, during which she sees halos around lights in the room. On examination, there is no tenderness around her temporal artery and her eye appears normal. She has normal visual acuity.
What is the most likely diagnosis?Your Answer: Closed angle glaucoma
Explanation:Differential Diagnosis for a Painful Red Eye with Headache and Visual Symptoms
When a patient presents with a painful red eye, headache, and visual symptoms, several conditions should be considered. One possible diagnosis is primary closed angle glaucoma, which can present as latent, subacute, or acute. Subacute closed angle glaucoma causes intermittent attacks with blurring of vision and halos around light sources, while acute glaucoma is more severe and requires urgent reduction in intraocular pressure. Another possible diagnosis is anterior uveitis, which presents with a persistent painful red eye and photophobia but does not cause headaches or halos in the vision.
Migraine is also an important differential, as its symptoms can be mistaken for acute glaucoma. Tension headaches are less likely, as they are not associated with visual symptoms. Finally, giant cell arthritis should be considered, especially if the patient has symptoms of claudication such as temporal headache and jaw pain when chewing food, as well as scalp tenderness and pulseless beaded temporal arteries on examination.
In summary, a painful red eye with headache and visual symptoms can have several possible causes, and a thorough differential diagnosis is necessary to determine the appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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A 70-year-old man presents with a history of intermittent constipation and diarrhoea and progressive weight loss over the past 3 months. During examination, he appears cachectic and has nodular hepatomegaly. He does not exhibit jaundice and his liver function tests are normal.
What is the most probable diagnosis?Your Answer: Myelofibrosis
Correct Answer: Liver metastases
Explanation:Liver Metastases: Causes and Differential Diagnosis
Liver metastases are a common cause of nodular hepatomegaly, with the most frequent primary sites being the bowel and breast. While palpable metastases may not affect liver function, obstruction to the biliary tract or involvement of over half of the liver can lead to impaired function and the presence of ascites. Autopsy studies have shown that 30-70% of cancer patients have liver metastases, with the frequency depending on the primary site. Most liver metastases are multiple and affect both lobes.
When considering a differential diagnosis, cirrhosis can be ruled out as it is the end-stage of chronic liver disease and would typically present with elevated serum alanine aminotransferase (ALT). Hepatoma is less common than metastases and lymphoma may present with evidence of involvement in other sites, such as lymphadenopathy. Myelofibrosis, which is associated with bone marrow fibrosis and abnormal stem cell appearance in the liver and spleen, may be asymptomatic in its early stages or present with leuko-erythroblastic anemia, malaise, weight loss, and night sweats. However, it is much less common than liver metastases.
In summary, liver metastases should be considered as a potential cause of nodular hepatomegaly, particularly in patients with a history of cancer. A thorough differential diagnosis should be conducted to rule out other potential causes.
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This question is part of the following fields:
- Gastroenterology
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Question 11
Incorrect
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A 28-year-old female patient complains of abdominal pain, weight loss, and bloody diarrhea for the past month. After being referred for colonoscopy and biopsy, it was discovered that she has continuous inflammation in the mucosa and crypt abscesses. What is the most specific antibody associated with her probable diagnosis?
Your Answer: Anti-smooth muscle
Correct Answer: pANCA
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.
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This question is part of the following fields:
- Musculoskeletal
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Question 12
Correct
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A 65-year-old man without significant medical history presents with a lump in his right groin that he noticed while showering. The lump has been present for two weeks and disappears when he lies down. He does not experience any discomfort, and there are no other gastrointestinal symptoms. Upon examination, a small reducible swelling is found in the right groin, consistent with an inguinal hernia. What is the best course of action for management?
Your Answer: Routine referral for surgical repair
Explanation:This patient has an inguinal hernia without any symptoms. Research suggests that conservative treatment is often ineffective as many patients eventually develop symptoms and require surgery. Therefore, most healthcare providers would recommend surgical repair, especially since the patient is in good health. It is important to note that inguinal hernias cannot heal on their own.
Understanding Inguinal Hernias
Inguinal hernias are the most common type of abdominal wall hernias, with 75% of cases falling under this category. They are more prevalent in men, with a 25% lifetime risk of developing one. The main feature of an inguinal hernia is a lump in the groin area, which is located superior and medial to the pubic tubercle. This lump disappears when pressure is applied or when the patient lies down. Discomfort and aching are common symptoms, which can worsen with activity, but severe pain is rare. Strangulation, a serious complication, is uncommon.
The clinical management of inguinal hernias involves treating medically fit patients, even if they are asymptomatic. A hernia truss may be an option for patients who are not fit for surgery, but it has little role in other patients. Mesh repair is the preferred method of treatment, as it is associated with the lowest recurrence rate. Unilateral hernias are generally repaired with an open approach, while bilateral and recurrent hernias are repaired laparoscopically. Patients can return to non-manual work after 2-3 weeks following an open repair and after 1-2 weeks following laparoscopic repair, according to the Department for Work and Pensions.
Complications of inguinal hernias include early bruising and wound infection, as well as late chronic pain and recurrence. While traditional textbooks describe the anatomical differences between indirect and direct hernias, this is not relevant to clinical management. Overall, understanding the features, management, and complications of inguinal hernias is crucial for proper diagnosis and treatment.
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This question is part of the following fields:
- Surgery
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Question 13
Incorrect
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A middle-aged woman presented to her General Practitioner (GP) with a 3-month history of epigastric pain and weight loss. She mentions that she tried over-the-counter antacids which provided some relief initially, but the pain has got worse. She decided to see her GP after realising she had lost about 5 kg. She denies any vomiting or loose stools. She has never had problems with her stomach before and she has no significant family history. Endoscopy and biopsy are performed; histology shows active inflammation.
What is the most likely diagnosis?Your Answer: Invasive carcinoma
Correct Answer: Helicobacter pylori gastritis
Explanation:Helicobacter pylori gastritis is a common condition that can cause gastritis and peptic ulcers in some individuals. It is caused by a Gram-negative bacterium and can increase the risk of gastric adenocarcinoma. Treatment with antibiotics is necessary to eradicate the infection. Invasive carcinoma is unlikely in this patient as they do not have other symptoms associated with it. A duodenal ulcer is possible but not confirmed by the upper GI endoscopy. Crohn’s disease is unlikely as it presents with different symptoms. A gastrointestinal stromal tumour would have been detected during the endoscopy.
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This question is part of the following fields:
- Gastroenterology
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Question 14
Incorrect
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A 75-year-old man presents to his physician with concerns about alterations in his bowel movements, experiencing small droplets of stool, rectal bleeding, and abdominal discomfort. The physician orders a red flag colonoscopy, which reveals no signs of cancer but does show protrusions in the bowel wall that may be responsible for the patient's symptoms. Which section of the large intestine is most likely to exhibit these protrusions?
Your Answer: Descending colon
Correct Answer: Sigmoid colon
Explanation:Diverticula are typically located in the sigmoid colon, and their symptoms often mimic those of malignancy, including changes in bowel habits, rectal bleeding, and abdominal pain. As a result, individuals with these symptoms are often referred for colonoscopy. The sigmoid colon is the area of the colon with the highest pressure, making it the most common location for diverticular disease. It is rare to find diverticular disease in the rectum.
Understanding Diverticular Disease
Diverticular disease is a common condition that involves the protrusion of colonic mucosa through the muscular wall of the colon. This typically occurs between the taenia coli, where vessels penetrate the muscle to supply the mucosa. Symptoms of diverticular disease include altered bowel habits, rectal bleeding, and abdominal pain. Complications can arise, such as diverticulitis, haemorrhage, fistula development, perforation and faecal peritonitis, abscess formation, and diverticular phlegmon.
To diagnose diverticular disease, patients may undergo a colonoscopy, CT cologram, or barium enema. However, it can be challenging to rule out cancer, especially in diverticular strictures. For acutely unwell surgical patients, plain abdominal films and an erect chest x-ray can identify perforation, while an abdominal CT scan with oral and intravenous contrast can detect acute inflammation and local complications.
Treatment for diverticular disease includes increasing dietary fibre intake and managing mild attacks with antibiotics. Peri colonic abscesses may require surgical or radiological drainage, while recurrent episodes of acute diverticulitis may necessitate a segmental resection. Hinchey IV perforations, which involve generalised faecal peritonitis, typically require a resection and stoma, with a high risk of postoperative complications and HDU admission. Less severe perforations may be managed with laparoscopic washout and drain insertion.
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This question is part of the following fields:
- Surgery
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Question 15
Correct
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A 28-year-old woman has had >10 very short relationships in the past year, all of which she thought were the love of her life. She is prone to impulsive behaviour such as gambling and binge eating, and she has dabbled in drugs. She also engages in self-harm.
Which of the following personality disorders most accurately describes her?Your Answer: Borderline personality disorder
Explanation:Understanding Personality Disorders: Clusters and Traits
Personality disorders can be categorized into three main clusters based on their characteristics. Cluster A includes odd or eccentric personalities such as schizoid and paranoid personality disorder. Schizoid individuals tend to be emotionally detached and struggle with forming close relationships, while paranoid individuals are suspicious and distrustful of others.
Cluster B includes dramatic, erratic, or emotional personalities such as borderline and histrionic personality disorder. Borderline individuals often have intense and unstable relationships, exhibit impulsive behavior, and may have a history of self-harm or suicide attempts. Histrionic individuals are attention-seeking, manipulative, and tend to be overly dramatic.
Cluster C includes anxious personalities such as obsessive-compulsive personality disorder. These individuals tend to be perfectionists, controlling, and overly cautious.
Understanding the different clusters and traits associated with personality disorders can help individuals recognize and seek appropriate treatment for themselves or loved ones.
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This question is part of the following fields:
- Psychiatry
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Question 16
Correct
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What is the function of delta cells in the pancreas?
Your Answer: Produce somatostatin
Explanation:Pancreatic Cell Functions
The pancreas is an important organ in the body that plays a crucial role in regulating blood sugar levels. It is made up of different types of cells that produce various hormones and enzymes. Alpha cells are responsible for producing glucagon, which helps increase blood sugar levels. On the other hand, beta cells produce insulin, which helps lower blood sugar levels. Lastly, PP cells produce pancreatic polypeptide, which helps regulate pancreatic secretion and digestion.
Aside from hormone production, the pancreas also produces enzymes that aid in digestion. Trypsinogen is one of these enzymes, which is produced in the ducts of the exocrine pancreas. It is then converted to trypsin by enzymes found in the gut mucosa. Trypsin plays a crucial role in breaking down proteins in the small intestine, allowing for better absorption of nutrients.
In summary, the pancreas is a complex organ that performs various functions to maintain the body’s overall health. Its different types of cells work together to regulate blood sugar levels and aid in digestion.
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This question is part of the following fields:
- Clinical Sciences
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Question 17
Correct
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A 27-year-old man dressed in casual attire has been admitted to the psychiatric intensive care unit. He is asked why he was admitted and he responds 'It all started at my workplace, everyone is so busy making money, I've been busy too. I'm investing in stocks, trying to make some extra cash, I keep a record of it in my notebook, I love writing, I write all the time because I'm trying to find a cure for Alzheimer's'. The speech is rapid and has a sense of urgency and when being asked further questions he demonstrates the same behaviour.
What best describes this patient's behaviour?Your Answer: Flight of ideas
Explanation:The patient’s speech pattern is most likely flight of ideas, as there are discernible links between each sentence despite conveying different messages. This is commonly seen in manic episodes. Knight’s move thinking, which involves random and illogical leaps between ideas, is not present in this case. Circumstantiality, where excessive and unnecessary detail is given before eventually answering a question, and perseveration, where a patient repeats a phrase or word despite moving on from the initial question, are also not applicable.
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.
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This question is part of the following fields:
- Psychiatry
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Question 18
Incorrect
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You are asked to obtain consent from a pediatric patient for electroconvulsive therapy (ECT).
Which of the following is not a risk associated with ECT?Your Answer: Induction of cardiac arrhythmia
Correct Answer: Induction of dementia
Explanation:Side Effects and Memory Loss Associated with Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a medical treatment that involves passing electrical currents through the brain to induce a seizure. While side effects of ECT are rare, some patients may experience memory loss. During the course of ECT, patients may have difficulty remembering newly learned information, but this typically improves in the days and weeks following treatment. However, some patients may experience partial loss of memory for events that occurred before ECT, which may take longer to recover.
Despite these potential memory issues, some patients report improved memory ability following ECT, as it can remove the amnesia associated with severe depression. It is important to note that cardiac arrhythmia may be stimulated by the electrical shock of ECT, but musculoskeletal injury is rare with adequate anesthesia.
It is also important to dispel the myth that ECT can cause dementia. Dementia is an organic illness that is not induced by ECT. Research has not found a link between ECT and dementia, but this remains an area of focus for further study. Overall, while ECT may have some potential side effects, it can be a highly effective treatment for severe depression and other mental health conditions.
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This question is part of the following fields:
- Psychiatry
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Question 19
Correct
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A 25-year-old woman with a history of systemic lupus erythematosus (SLE) visits her GP complaining of myalgia and fatigue. She is worried that her SLE is flaring up and has a tendency to develop health anxiety due to her condition. As lupus can affect multiple organs and systems, she frequently visits her GP practice whenever she experiences new symptoms. The GP conducts some blood tests, which reveal the following results:
- Hb: 111 g/L (Male: 135-180, Female: 115-160)
- MCV: 86 fl (84-96)
- WBC: 12.3 * 109/L (4.0-11.0)
- Urea: 6.7 mmol/L (2.0-7.0)
- Creatinine: 118 µmol/L (55-120)
- eGFR: 90 ml/min/1.73m² (>/= 90)
- CRP: 88 mg/L (<5)
- ESR: 34 mm/hr (0-20)
What is the probable cause of the patient's symptoms?Your Answer: Underlying infection
Explanation:If a patient with SLE has an elevated CRP, it could indicate the presence of an infection. The patient in question does not have AKI and her kidney function is normal. Although she has a slight normocytic anemia, it is unlikely to be the cause of her symptoms. Fibromyalgia is common in SLE patients, but the elevated CRP in this case suggests an underlying infection rather than fibromyalgia. The patient’s elevated white blood cell count and CRP levels indicate the presence of an infection, rather than a lupus flare.
Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive, making it useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%), but less sensitive (70%). Anti-Smith testing is also highly specific (>99%), but only 30% of SLE patients test positive. Other antibody tests include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).
Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, but a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Proper monitoring of SLE is crucial for effective management of the disease.
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This question is part of the following fields:
- Musculoskeletal
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Question 20
Correct
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A 22-year-old man with a history of hearing voices is brought to the Emergency Department by his family. He describes these voices as telling him to kill himself, ‘as he has a demon in him’. He also reports noting his intelligence being tapped through the television by a higher power. This has been going on for the past 3 months. His family denies either depression or manic episodes. The patient was admitted to the inpatient Psychiatry Unit and, after an evaluation, a diagnosis of schizophreniform disorder was made. He was started on Haldol (haloperidol) for his symptoms. Two days after initiation of therapy, the patient’s temperature rose to 41 °C, blood pressure 150/85 mmHg and pulse 110 bpm. Physical examination revealed muscular rigidity and delirium.
What is the most likely diagnosis?Your Answer: Neuroleptic malignant syndrome
Explanation:Understanding Neurological Disorders Caused by Medications
Neurological disorders can be caused by certain medications, such as high-potency anti-psychotic drugs like haloperidol. One such disorder is neuroleptic malignant syndrome, which can result from the use of these medications to treat conditions like schizophrenia. Symptoms include muscular rigidity, fever, and altered mental status. Treatment involves discontinuing the medication and managing symptoms with cooling measures and medications like dantrolene or bromocriptine.
Another medication-induced neurological disorder is serotonin syndrome, which can occur when a patient takes multiple doses or an overdose of medications like selective serotonin reuptake inhibitors (SSRIs) or serotonin agonists. Symptoms include muscular twitching, agitation, and autonomic instability. Treatment involves discontinuing the medication and managing symptoms with supportive care.
Malignant hyperthermia is a similar disorder that can occur during anesthesia administration and is caused by an inherited genetic disorder. Symptoms include fever, muscle rigidity, and altered mental status. Treatment involves using medications like dantrolene and providing supportive care.
It’s important to note that not all neurological disorders are caused by medications. Meningitis, for example, is not a side effect of haloperidol. Acute dystonia, which presents with spasms of various muscle groups, can also be caused by haloperidol, but the presenting symptoms are more consistent with neuroleptic malignant syndrome. Understanding the different neurological disorders caused by medications can help healthcare providers make accurate diagnoses and provide appropriate treatment.
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This question is part of the following fields:
- Psychiatry
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Question 21
Incorrect
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A 45-year-old man with a history of alcohol abuse is admitted to the hospital with alcohol intoxication. During his admission, it was noted that he has mild hypomagnesemia. The hospital's protocol suggests oral magnesium replacement for patients with mild hypomagnesemia. What is the typical adverse effect of using this type of replacement therapy?
Your Answer: Constipation
Correct Answer: Diarrhoea
Explanation:Magnesium salts are known to cause diarrhoea, which is a major side effect that limits the dosage. ACE inhibitors like ramipril can cause angioedema, which is rapid swelling of the skin or mucosa, typically affecting the face and throat. Constipation is a possible side effect of certain medications, including anticholinergics, opiates, and iron tablets. Beta-blockers like bisoprolol can lead to erectile dysfunction. The primary cause of oedema induced by calcium channel blockers is the increased capillary hydrostatic pressure resulting from greater dilation of precapillary vessels compared to post-capillary vessels.
Understanding Hypomagnesaemia: Causes, Symptoms, and Treatment
Hypomagnesaemia is a condition characterized by low levels of magnesium in the blood. There are several causes of this condition, including the use of certain drugs such as diuretics and proton pump inhibitors, total parenteral nutrition, and chronic or acute diarrhoea. Alcohol consumption, hypokalaemia, hypercalcaemia, and metabolic disorders like Gitelman’s and Bartter’s can also lead to hypomagnesaemia. The symptoms of this condition may be similar to those of hypocalcaemia, including paraesthesia, tetany, seizures, and arrhythmias.
When the magnesium level drops below 0.4 mmol/L or when there are symptoms of tetany, arrhythmias, or seizures, intravenous magnesium replacement is commonly given. An example regime would be 40 mmol of magnesium sulphate over 24 hours. For magnesium levels above 0.4 mmol/L, oral magnesium salts are prescribed in divided doses of 10-20 mmol per day. However, diarrhoea can occur with oral magnesium salts. It is important to note that hypomagnesaemia can exacerbate digoxin toxicity.
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This question is part of the following fields:
- Pharmacology
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Question 22
Incorrect
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A 50-year-old man with a history of hypertension, asthma and porphyria requires emergency surgery. His blood pressure and asthma are under control. What is the most suitable anaesthetic induction agent for the rapid sequence induction (RSI) procedure?
Your Answer: Ketamine
Correct Answer: Propofol
Explanation:An Overview of Common Anaesthetic Induction Agents and Their Advantages and Adverse Effects
Propofol, ketamine, fentanyl, methohexital, and thiopental are commonly used anaesthetic induction agents. Propofol is the preferred choice for most people due to its rapid onset and offset of action, antiemetic and anticonvulsive effects, bronchodilation, and decreased cerebral metabolic oxygen demand and cerebral blood pressure. Ketamine is ideal for hypotensive patients due to its rapid onset, analgesic effects, bronchodilation, and maintenance of airway reflexes and respiratory drive. Fentanyl is an opiate analgesic used for pain relief, while methohexital is used for electroconvulsive therapy. Thiopental is a barbiturate used in general and regional anaesthesia. However, each agent has its own set of advantages and adverse effects that must be considered before use. For example, ketamine can increase intracranial pressure, cardiac output, and blood pressure, while thiopental can cause bronchoconstriction and is contraindicated in asthmatics and patients with a history of porphyria. It is important to carefully evaluate each patient’s medical history and condition before selecting an appropriate anaesthetic induction agent.
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This question is part of the following fields:
- Anaesthetics & ITU
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Question 23
Incorrect
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A 62-year-old man presents to his general practitioner (GP) for his routine diabetes assessment. He was diagnosed with type 2 diabetes one month ago. He also has a history of hypertension, obesity and hyperlipidaemia and smoking. He was recently commenced on metformin, ramipril, atorvastatin and aspirin. An electrocardiogram (ECG) is normal. The following laboratory results are obtained:
Investigation Result Normal value
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 5.6 mmol/l 3.5–5.0 mmol/l
Glucose 8 mmol/l 3.5–5.5 mmol/l
Urea 5 mmol/l 2.5–6.5 mmol/l
Creatinine 78 μmol/l 50–120 μmol/l
What is the most appropriate management for this patient’s hyperkalaemia?Your Answer: Prescribe a loop diuretic and recheck in one week
Correct Answer: Stop ramipril and recheck in one week
Explanation:Managing Mild Hyperkalaemia in Primary Care
Mild hyperkalaemia, with potassium levels between 5.5-5.9 mmol/l, can be managed in primary care with a review of medication and diet, as well as regular monitoring of serum potassium levels. In cases where the hyperkalaemia is likely secondary to ACE inhibitor therapy, it is recommended to discontinue the medication and recheck potassium levels in one week. Renal function should also be monitored before and after starting ACE inhibitor/ARB treatment.
In contrast, metformin does not usually cause hyperkalaemia and should not be discontinued unless there are other underlying causes of elevated lactate levels. Hospital admission and administration of IV insulin and dextrose or bicarbonate are not necessary for mild hyperkalaemia with normal renal function and a normal ECG.
Adding a loop diuretic is also not recommended as the treatment for mild hyperkalaemia is to stop the offending agent and recheck potassium levels. It is important to manage mild hyperkalaemia appropriately to prevent further complications.
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This question is part of the following fields:
- Clinical Biochemistry
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Question 24
Incorrect
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A 25-year-old woman presents with fever and painful urination. She reports feeling unwell for the past three days and now has left flank pain. She is currently taking combined oral contraceptive pills. On examination, she has tenderness in the left renal angle and supra-pubic area, and her vital signs are as follows: temperature of 38.8°C, blood pressure of 105/60 mmHg, and pulse rate of 94 beats per minute. Laboratory results show a hemoglobin level of 114 g/L, white blood cell count of 14.9 ×109/L, platelet count of 193 ×109/L, sodium level of 140 mmol/L, potassium level of 4.1 mmol/L, and creatinine level of 132 µmol/L. Her urine analysis reveals the presence of blood, nitrites, and leukocytes. What is the most appropriate initial step in management?
Your Answer: Ultrasound renal tract
Correct Answer: IV antibiotics
Explanation:Urgent Treatment and Diagnosis for Suspected Pyelonephritis
Given the patient’s elevated white blood cell count, increased creatinine levels, and significant hypotension, it is crucial to administer intravenous antibiotics immediately. A broad-spectrum cephalosporin is recommended to combat the potential infection. The patient’s left renal angle pain raises concerns about pyelonephritis and possible ureteric obstruction. Therefore, it is necessary to rule out obstruction by conducting an ultrasound of the renal tract. If the ultrasound shows signs of ureteric dilation, it is advisable to seek an opinion from a urologist. In the case of a first episode of pyelonephritis, many urologists recommend an ultrasound as the first step in diagnosis.
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This question is part of the following fields:
- Pharmacology
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Question 25
Correct
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A 16-year-old presents to your clinic with worries about not having started her periods yet, despite most of her peers having done so. She is 150 cm tall and weighs 45 kg. The patient reports the onset of pubic hair at 14 years of age and has normal breast development. During speculum examination, the cervix is not visible and the patient experiences discomfort, making it difficult to continue. Hormone screening in the serum shows no significant abnormalities. What course of action would you recommend?
Your Answer: Refer to a gynaecologist
Explanation:When considering amenorrhoea, it is important to look at the underlying causes. There are two types: primary and secondary. Primary amenorrhoea occurs when a woman has never had a period, while secondary amenorrhoea occurs when a woman who has previously had periods now hasn’t for at least 6 months (or 12 months if she previously had irregular periods).
In cases of primary amenorrhoea, it is important to consider whether the woman has developed normal secondary sexual characteristics. If she has, then a mechanical obstruction may be the cause rather than a hormonal one. It is unusual for a 17-year-old girl with normal secondary sexual characteristics to have never had a period, so waiting a year before reassessment is not appropriate. Clinical judgement should be used, especially with younger women.
Understanding Amenorrhoea: Causes, Investigations, and Management
Amenorrhoea is a condition characterized by the absence of menstrual periods in women. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls without secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.
There are various causes of amenorrhoea, including gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, Sheehan’s syndrome, Asherman’s syndrome, and thyrotoxicosis. To determine the underlying cause of amenorrhoea, initial investigations such as full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels are necessary.
The management of amenorrhoea depends on the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause in women 40 years of age or older and treat the underlying cause accordingly. It is important to note that hypothyroidism may also cause amenorrhoea.
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This question is part of the following fields:
- Gynaecology
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Question 26
Correct
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A 72-year-old type 2 diabetic is scheduled for a vaginal hysterectomy tomorrow. Her usual medication regimen includes taking Metformin in the morning and Gliclazide during breakfast and dinner. What is the recommended approach for managing her medications prior to surgery?
Your Answer: Omit Metformin on the day of surgery. Omit the morning Gliclazide, and take the dinner time Gliclazide if she is able to eat.
Explanation:Medication Management for Diabetic Patients on the Day of Surgery
When managing medication for diabetic patients on the day of surgery, it is important to consider the potential risks and benefits of each medication. Here are some guidelines for different scenarios:
– Omit Metformin on the day of surgery. Omit the morning Gliclazide, and take the dinner time Gliclazide if she is able to eat.
– Omit Metformin the day before and on the day. Take Gliclazide as normal.
– Take Metformin as normal. Omit Gliclazide.
– Omit Metformin the day before and on the day. Omit Gliclazide on the day of surgery.
– Omit Metformin on the day of surgery. Halve the Gliclazide doses at lunchtime and dinner.It is important to note that these guidelines may vary depending on the individual patient’s medical history and current condition. It is recommended to consult with a healthcare professional for personalized medication management.
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This question is part of the following fields:
- Surgery
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Question 27
Incorrect
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In what way does an ion affect the overall membrane potential of a neuron?
Your Answer: By its concentration gradient alone
Correct Answer: By its valence, concentration gradient and membrane permeability
Explanation:The causes of clubbing are varied and complex. Clubbing is a medical condition that affects the fingers and toes, causing them to become enlarged and rounded. Although the exact cause of clubbing is not fully understood, it is commonly associated with respiratory, gastrointestinal, and cardiovascular disorders.
Among the cardiovascular causes of clubbing, two main conditions stand out: infective endocarditis and tetralogy of Fallot. Tetralogy of Fallot is a congenital heart disorder that is characterized by four malformations in the heart. These include ventricular septal defect, pulmonary stenosis, over-riding aorta, and right ventricular hypertrophy.
As a result of these malformations, oxygenated and deoxygenated blood mix in the patient’s body, leading to low blood oxygen saturation. This can cause a range of symptoms, including sudden cyanosis followed by syncope, which is commonly referred to as tet spells in children. In older children, squatting can help relieve these symptoms by reducing circulation to the legs and relieving syncope.
Understanding the causes of clubbing is important, particularly for medical examinations, as it can help identify underlying conditions that may require further investigation and treatment. By recognizing the signs and symptoms of clubbing, healthcare professionals can provide appropriate care and support to patients with this condition.
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 26-year-old patient, who is 22 weeks pregnant, has been experiencing severe allergic rhinitis. She complains of bilateral eye puffiness and itching, rhinorrhoea, and chronic nasal congestion. She has tried nasal sprays before, but they were ineffective. Due to her pregnancy, she has refrained from taking any medication, but her symptoms are now affecting her work and sleep. What is the most suitable initial medication to recommend for this patient?
Your Answer: Oral montelukast
Correct Answer: Oral loratadine
Explanation:When treating allergic rhinitis in pregnant women, loratadine is the recommended first-line oral antihistamine if symptoms are severe enough to require treatment. It is a non-sedative antihistamine with the most available data and no reported teratogenicity. However, it may cause mild sedation, increased appetite, and headaches. If loratadine is ineffective or causes significant side effects, cetirizine or chlorphenamine can be used. Chlorphenamine is a sedative antihistamine and should only be used if other options fail. Nasal sodium cromoglicate spray is safe to use during pregnancy and breastfeeding, but if oral antihistamines are more effective for the patient, it may not be the best option. Oral chlorphenamine is another option, but non-sedative antihistamines should be preferred if they improve symptoms. Leukotriene receptor antagonists like oral montelukast have limited data on their safety in pregnancy and should be avoided unless the benefits outweigh the risks. Pseudoephedrine hydrochloride, a decongestant, should not be used during pregnancy as it can affect uteroplacental circulation and increase the risk of fetal complications.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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A 55-year-old obese woman, who recently returned from a trip to Japan, presents with chronic diarrhoea, fatigue, and greasy, bulky stools. She is a non-smoker and non-drinker who consumes meat. Stool examination confirms steatorrhoea, and blood tests reveal elevated folic acid levels and reduced vitamin B12 levels. The only abnormal finding on a CT scan of the abdomen is multiple diverticula in the jejunum. What is the most likely cause of this patient's macrocytic anaemia?
Your Answer: Acquired deficiency of intrinsic factor
Correct Answer: Increased utilisation of vitamin B12 by bacteria
Explanation:Causes of Vitamin B12 Deficiency: An Overview
Vitamin B12 deficiency can be caused by various factors, including bacterial overgrowth syndrome, acquired deficiency of intrinsic factor, chronic pancreatic insufficiency, dietary deficiency, and fish tapeworm infestation.
Bacterial Overgrowth Syndrome: This disorder is characterized by the proliferation of colonic bacteria in the small bowel, resulting in diarrhea, steatorrhea, and macrocytic anemia. The bacteria involved are usually Escherichia coli or Bacteroides, which can convert conjugated bile acids to unconjugated bile acids, leading to impaired micelle formation and steatorrhea. The bacteria also utilize vitamin B12, causing macrocytic anemia.
Acquired Deficiency of Intrinsic Factor: This condition is seen in pernicious anemia, which does not have diarrhea or steatorrhea.
Chronic Pancreatic Insufficiency: This is most commonly associated with chronic pancreatitis caused by high alcohol intake or cystic fibrosis. However, in this case, the patient has no history of alcohol intake or CF, and blood tests do not reveal hyperglycemia. CT abdomen can detect calcification of the pancreas, characteristic of chronic pancreatitis.
Dietary Deficiency of Vitamin B12: This is unlikely in non-vegetarians like the patient in this case.
Fish Tapeworm Infestation: This infestation can cause vitamin B12 deficiency, but it is more common in countries where people commonly eat raw freshwater fish. In this case, the presence of diarrhea, steatorrhea, and CT abdomen findings suggestive of jejunal diverticula make bacterial overgrowth syndrome more likely.
In conclusion, vitamin B12 deficiency can have various causes, and a thorough evaluation is necessary to determine the underlying condition.
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This question is part of the following fields:
- Gastroenterology
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Question 30
Incorrect
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In a study of 26,000 females, 1,300 subjects were found to have either overt or subclinical hypothyroidism. The prevalence of hypothyroidism in this population was 5%. What is the most appropriate term to describe the 1,300 cases of hypothyroidism?
Your Answer: Incidence
Correct Answer: Prevalence
Explanation:Prevalence and Incidence in Medical Terminology
Prevalence and incidence are two important terms used in medical terminology to describe the occurrence of a disorder in a specific population. Prevalence refers to the rate of a disorder in a particular population at a given time, while incidence refers to the number of new cases of the disorder that develop over a specific period.
In simpler terms, prevalence tells us how many people in a population have a particular disorder at a given time, while incidence tells us how many new cases of the disorder are diagnosed during a specific time frame. For example, if the prevalence of diabetes in a population is 10%, it means that 10% of the population has diabetes at a given time. On the other hand, if the incidence of diabetes in the same population is 2%, it means that 2% of the population was diagnosed with diabetes during a specific time frame, such as a year.
the difference between prevalence and incidence is important for healthcare professionals as it helps them to identify the burden of a particular disorder in a population and plan appropriate interventions. By knowing the prevalence and incidence of a disorder, healthcare professionals can also monitor trends over time and evaluate the effectiveness of interventions.
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This question is part of the following fields:
- Clinical Sciences
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