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  • Question 1 - A 28-year-old female patient arrives at the Emergency Department at 37 weeks gestation...

    Incorrect

    • A 28-year-old female patient arrives at the Emergency Department at 37 weeks gestation with blurred vision and severe headache. She reports upper abdominal pain for the last few hours. Upon examination, her blood pressure is 160/110 mmHg and urinalysis shows proteinuria. While taking her medical history, she experiences a tonic-clonic seizure. What is the appropriate pharmacological treatment to stop this seizure?

      Your Answer: Oral midazolam

      Correct Answer: Intravenous magnesium sulfate

      Explanation:

      When a seizure is suspected to be caused by eclampsia, the recommended first-line treatment is intravenous magnesium sulfate, given as a loading dose followed by an infusion. In the case of convulsive status epilepticus, intravenous lorazepam is the preferred in-hospital treatment, with phenytoin as an alternative if lorazepam is ineffective. Glucose may be administered if hypoglycemia is a contributing factor. It is not appropriate to administer oral medications to a patient with a decreased level of consciousness. (Adapted from BMJ Best Practice – Pre-eclampsia)

      Understanding Eclampsia and its Treatment

      Eclampsia is a condition that occurs when seizures develop in association with pre-eclampsia, a pregnancy-induced hypertension that is characterized by proteinuria and occurs after 20 weeks of gestation. To prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop, magnesium sulphate is commonly used. However, it is important to note that this medication should only be given once a decision to deliver has been made. In cases of eclampsia, an IV bolus of 4g over 5-10 minutes should be given, followed by an infusion of 1g/hour. During treatment, it is crucial to monitor urine output, reflexes, respiratory rate, and oxygen saturations. Respiratory depression can occur, and calcium gluconate is the first-line treatment for magnesium sulphate-induced respiratory depression. Treatment should continue for 24 hours after the last seizure or delivery, as around 40% of seizures occur post-partum. Additionally, fluid restriction is necessary to avoid the potentially serious consequences of fluid overload.

      In summary, understanding the development of eclampsia and its treatment is crucial in managing this potentially life-threatening condition. Magnesium sulphate is the primary medication used to prevent and treat seizures, but it should only be given once a decision to deliver has been made. Monitoring vital signs and urine output is essential during treatment, and calcium gluconate should be readily available in case of respiratory depression. Finally, fluid restriction is necessary to avoid complications associated with fluid overload.

    • This question is part of the following fields:

      • Neurology
      27.3
      Seconds
  • Question 2 - A 35-year-old overweight man visits the clinic with concerns about abdominal discomfort he...

    Correct

    • A 35-year-old overweight man visits the clinic with concerns about abdominal discomfort he experienced over the weekend. He reports that the discomfort began in his upper abdomen shortly after eating a large pizza on Friday night. The discomfort then shifted to the left side of his abdomen. He also vomited a few times. Most of the symptoms subsided within 24 hours. During the examination, he is still slightly tender in the left upper quadrant and has no fever or jaundice.
      What is the most probable diagnosis?

      Your Answer: Biliary colic

      Explanation:

      Biliary colic is a common symptom of gallstones, occurring in 1-4% of patients with choledocholithiasis. The pain is intense and dull, usually resolving within 30-90 minutes, and often occurs after consuming fatty meals. This matches the patient’s symptoms and risk factors. If left untreated, biliary colic can progress to acute cholecystitis, which presents with upper abdominal pain, nausea, vomiting, and fever. However, since the patient’s symptoms resolved within 24 hours, acute cholecystitis is unlikely. Acute viral hepatitis is also an unlikely diagnosis, as the patient has no known exposure to the viruses and her symptoms resolved too quickly. Acute pancreatitis presents with severe abdominal pain, nausea, vomiting, and fever, which does not match the patient’s symptoms. Ascending cholangitis is also unlikely, as the patient is afebrile and not jaundiced, and her symptoms resolved within 24 hours.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      7086.8
      Seconds
  • Question 3 - A 50-year-old woman who recently finished a round of chemotherapy reports experiencing tingling...

    Incorrect

    • A 50-year-old woman who recently finished a round of chemotherapy reports experiencing tingling sensations and difficulty using her hands. Additionally, she has noticed hesitancy in her urinary function. Which specific cytotoxic medication is the likely culprit for these symptoms?

      Your Answer: Cyclophosphamide

      Correct Answer: Vincristine

      Explanation:

      Peripheral neuropathy is a known side effect of Vincristine. Additionally, bladder atony may cause urinary hesitancy.

      Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin, degrade preformed DNA and can lead to lung fibrosis. Anthracyclines, such as doxorubicin, stabilize the DNA-topoisomerase II complex and inhibit DNA and RNA synthesis, but can also cause cardiomyopathy. Antimetabolites, like methotrexate, inhibit dihydrofolate reductase and thymidylate synthesis, leading to myelosuppression, mucositis, liver fibrosis, and lung fibrosis. Fluorouracil (5-FU) is a pyrimidine analogue that induces cell cycle arrest and apoptosis by blocking thymidylate synthase, but can also cause myelosuppression, mucositis, and dermatitis. Cytarabine is a pyrimidine antagonist that interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase, but can also cause myelosuppression and ataxia. Drugs that act on microtubules, like vincristine and vinblastine, inhibit the formation of microtubules and can cause peripheral neuropathy, paralytic ileus, and myelosuppression. Docetaxel prevents microtubule depolymerisation and disassembly, decreasing free tubulin, but can also cause neutropaenia. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I which prevents relaxation of supercoiled DNA, but can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin, cause cross-linking in DNA and can lead to ototoxicity, peripheral neuropathy, and hypomagnesaemia. Hydroxyurea (hydroxycarbamide) inhibits ribonucleotide reductase, decreasing DNA synthesis, but can also cause myelosuppression.

    • This question is part of the following fields:

      • Haematology/Oncology
      13.2
      Seconds
  • Question 4 - A 26-year-old female patient visits the sexual health clinic seeking emergency contraception after...

    Correct

    • A 26-year-old female patient visits the sexual health clinic seeking emergency contraception after having unprotected sex 2 days ago. She is currently on the combined oral contraceptive pill but has missed the last 3 pills. The patient is on the 8th day of her menstrual cycle and has asthma, for which she uses fluticasone and salbutamol inhalers. The healthcare provider prescribes levonorgestrel. What advice should be given to the patient?

      Your Answer: She can restart her pill immediately

      Explanation:

      Levonorgestrel (Levonelle) can be followed immediately by hormonal contraception for emergency contraception.

      Patients can resume their regular pill regimen right after taking levonorgestrel for emergency contraception. Levonorgestrel is an approved method of emergency contraception that can be used within 72 hours of unprotected sexual intercourse. It is the preferred oral emergency contraceptive for patients with asthma, as ulipristal is not recommended for those with severe asthma. Unlike ulipristal, which requires a waiting period of 5 days, patients can start hormonal contraception immediately after taking levonorgestrel. However, patients should use condoms for 7 days after restarting their combined oral contraceptive pill (COCP). It is important to note that the other options provided are incorrect. The progesterone-only pill requires condom use for 48 hours, unless initiated within the first 5 days of the menstrual cycle. Ulipristal acetate requires a waiting period of 5 days before restarting hormonal contraception. The COCP requires condom use for 7 days after restarting.

      Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, while ulipristal primarily inhibits ovulation. Levonorgestrel should be taken as soon as possible after unprotected sexual intercourse, within 72 hours, and is 84% effective when used within this time frame. The dose should be doubled for those with a BMI over 26 or weight over 70kg. Ulipristal should be taken within 120 hours of intercourse and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which can be inserted within 5 days of unprotected intercourse or up to 5 days after the likely ovulation date. It may inhibit fertilization or implantation and is 99% effective regardless of where it is used in the cycle. Prophylactic antibiotics may be given if the patient is at high risk of sexually transmitted infection.

    • This question is part of the following fields:

      • Reproductive Medicine
      17.2
      Seconds
  • Question 5 - A 32-year-old woman comes in for a check-up. She has been experiencing fatigue...

    Incorrect

    • A 32-year-old woman comes in for a check-up. She has been experiencing fatigue and has not had a regular period for the past 5 months. She previously had a consistent 28-day cycle. A pregnancy test is negative, her pelvic exam is normal, and routine blood work is ordered:

      - Complete blood count: Normal
      - Blood urea nitrogen and electrolytes: Normal
      - Thyroid function test: Normal
      - Follicle-stimulating hormone: 40 iu/l ( < 35 iu/l)
      - Luteinizing hormone: 30 mIU/l (< 20 mIU/l)
      - Oestradiol: 75 pmol/l ( > 100 pmol/l)

      What is the most likely diagnosis?

      Your Answer: Gonadotropin-producing pituitary adenoma

      Correct Answer: Premature ovarian failure

      Explanation:

      Premature Ovarian Insufficiency: Causes and Management

      Premature ovarian insufficiency is a condition where menopausal symptoms and elevated gonadotrophin levels occur before the age of 40. It affects approximately 1 in 100 women and can be caused by various factors such as idiopathic reasons, family history, bilateral oophorectomy, radiotherapy, chemotherapy, infection, autoimmune disorders, and resistant ovary syndrome. The symptoms of premature ovarian insufficiency are similar to those of normal menopause, including hot flushes, night sweats, infertility, secondary amenorrhoea, raised FSH and LH levels, and low oestradiol.

      Management of premature ovarian insufficiency involves hormone replacement therapy (HRT) or a combined oral contraceptive pill until the age of the average menopause, which is 51 years. It is important to note that HRT does not provide contraception in case spontaneous ovarian activity resumes. Early diagnosis and management of premature ovarian insufficiency can help alleviate symptoms and improve quality of life for affected women.

    • This question is part of the following fields:

      • Reproductive Medicine
      39.4
      Seconds
  • Question 6 - A 40-year-old patient presents with sudden monocular visual loss on the left, associated...

    Correct

    • A 40-year-old patient presents with sudden monocular visual loss on the left, associated with pain behind the eye and alteration of depth perception. Examination on the following day reveals a relative afferent pupillary defect (RAPD) in the left eye.
      Which of the following diagnoses is most likely?

      Your Answer: Optic neuritis

      Explanation:

      Understanding Optic Neuritis: Symptoms, Causes, and Differential Diagnosis

      Optic neuritis is a condition characterized by inflammation, degeneration, or demyelination of the optic nerve. It typically presents with sudden-onset unilateral visual loss, retro-orbital pain, and altered color vision, and is more common in women aged 20-40. Patients with optic neuritis have up to a 50% risk of developing multiple sclerosis (MS) after an episode.

      There are three types of optic neuritis: papillitis or anterior optic neuritis, retrobulbar neuritis, and neuroretinitis. Papillitis affects the intraocular portion of the nerve and causes optic disc swelling, while retrobulbar neuritis does not involve the disc and is often associated with MS. Neuroretinitis affects the optic disc and adjacent temporal retina.

      The most common cause of retrobulbar neuritis is MS, but it can also be caused by toxic exposure, vitamin deficiency (especially B12), ischaemia (diabetes, giant cell arteritis), or infection. Symptoms include variable loss of central vision, dull aching pain in the eye, and a central scotoma on examination.

      Cerebral infarction is an unlikely diagnosis in a young patient without significant risk factors. Optic nerve glioma typically presents with gradual reduction in visual acuity, while migraine aura presents with positive visual phenomena and is associated with unilateral headache. Temporal arteritis, which causes sudden loss of vision associated with ischaemic optic neuropathy, is rare in people under 50 and is associated with polymyalgia rheumatica.

      Diagnosis of temporal arteritis requires three of five criteria: >50 years at disease onset, new headache, raised erythrocyte sedimentation rate (ESR), temporal artery abnormality, and abnormal temporal artery biopsy. Understanding the symptoms, causes, and differential diagnosis of optic neuritis is crucial for accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Neurology
      9.6
      Seconds
  • Question 7 - A 42-year-old female complains of a burning sensation on the anterolateral aspect of...

    Incorrect

    • A 42-year-old female complains of a burning sensation on the anterolateral aspect of her right thigh. The doctor suspects meralgia paraesthetica. Which nerve is the most probable cause of this condition?

      Your Answer: Anterior cutaneous nerve of thigh

      Correct Answer: Lateral cutaneous nerve of thigh

      Explanation:

      A possible cause of burning pain in the thigh is compression of the lateral cutaneous nerve, which can lead to a condition called meralgia paraesthetica. Meralgia paraesthetica, a condition characterized by burning pain in the thigh, may result from compression of the lateral cutaneous nerve of the thigh.

      Understanding Meralgia Paraesthetica

      Meralgia paraesthetica is a condition characterized by paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN). It is caused by entrapment of the LFCN, which can be due to various factors such as trauma, iatrogenic causes, or neuroma. Although not rare, it is often underdiagnosed.

      The LFCN is a sensory nerve that originates from the L2/3 segments and runs beneath the iliac fascia before exiting through the lateral aspect of the inguinal ligament. Compression of the nerve can occur anywhere along its course, but it is most commonly affected as it curves around the anterior superior iliac spine. Meralgia paraesthetica is more common in men than women and is often seen in those aged between 30 and 40.

      Patients with meralgia paraesthetica typically experience burning, tingling, coldness, or shooting pain, as well as numbness and deep muscle ache in the upper lateral aspect of the thigh. Symptoms are usually aggravated by standing and relieved by sitting. The condition can be mild and resolve spontaneously or severely restrict the patient for many years.

      Diagnosis of meralgia paraesthetica can be made based on the pelvic compression test, which is highly sensitive. Injection of the nerve with local anaesthetic can also confirm the diagnosis and provide relief. Ultrasound is effective both for diagnosis and guiding injection therapy. Nerve conduction studies may also be useful. Overall, understanding meralgia paraesthetica is important for prompt diagnosis and management of this condition.

    • This question is part of the following fields:

      • Musculoskeletal
      9
      Seconds
  • Question 8 - For what has the National Institute for Health and Care Excellence (NICE) recommended...

    Correct

    • For what has the National Institute for Health and Care Excellence (NICE) recommended the use of varenicline?

      Your Answer: Smoking cessation (cigarettes)

      Explanation:

      The Use of Varenicline in Smoking Cessation and Other Substance Withdrawals

      Varenicline, marketed as Champix®, is a medication used in combination with motivational support to aid smoking cessation. The National Institute for Health and Care Excellence (NICE) recommends offering varenicline or nicotine replacement therapy (NRT) to all smokers, along with advice and encouragement to quit. The choice of therapy depends on factors such as the smoker’s compliance, availability of counseling and support, previous experience with cessation aids, contraindications, and personal preference. However, varenicline use has been associated with changes in behavior and thinking, anxiety, psychosis, mood swings, depression, and suicidal ideation, so monitoring is advised.

      While varenicline is not currently indicated for cannabis cessation, some studies suggest that it may reduce the enjoyment reported from using cannabis, which could lead to further investigation in this area. However, varenicline has no role in the treatment of alcohol withdrawal, and the FDA has warned that people taking varenicline should reduce their alcohol intake due to the potential for unusual behavior, including aggression. The use of varenicline for opioid withdrawal in patients with chronic pain is also under investigation but is not currently recommended. Finally, varenicline is not indicated for cocaine cessation.

    • This question is part of the following fields:

      • Psychiatry
      6.1
      Seconds
  • Question 9 - Prolonged use of which drug can result in tachyphylaxis, which is an acute...

    Incorrect

    • Prolonged use of which drug can result in tachyphylaxis, which is an acute and sudden decrease in response to a drug after its administration, leading to a rapid and short-term onset of drug tolerance?

      Your Answer: Naproxen

      Correct Answer: Xylometazoline (eg Sudafed® nasal spray)

      Explanation:

      Common Drugs and Tachyphylaxis: Understanding the Risk

      Nasal decongestants, such as xylometazoline, are often used to relieve nasal congestion. However, prolonged use can lead to rebound congestion, known as rhinitis medicamentosa. Amiodarone, an antiarrhythmic drug, has a long half-life and potential for drug interactions even after treatment has stopped. Metronidazole, an antimicrobial drug, can be absorbed systemically and may interact with other medications. Naproxen, a non-steroidal anti-inflammatory drug, has no evidence of tachyphylaxis. Phenoxymethylpenicillin, an antibiotic, is not associated with tachyphylaxis. Understanding the risk of tachyphylaxis with common drugs is important for safe and effective use.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      25
      Seconds
  • Question 10 - A 5-year-old girl is discovered collapsed and unresponsive. Upon examination, there are no...

    Incorrect

    • A 5-year-old girl is discovered collapsed and unresponsive. Upon examination, there are no apparent obstructions in her airway. There are no signs of life and no indication of any respiratory efforts being made. Emergency assistance has been summoned and is en route.
      What is the most suitable course of action to take next in her treatment?

      Your Answer: Start chest compressions at a ratio of 15:2

      Correct Answer: Give 5 rescue breaths

      Explanation:

      The correct initial step for paediatric basic life support (BLS) is to give 5 rescue breaths immediately, even before checking for a pulse. This is because respiratory causes are the most common in children. Checking for a femoral pulse is not necessary to determine the need for chest compressions, as palpation of the pulse is not a reliable indicator of effective circulation. Giving 2 rescue breaths is incorrect for children, as they require 5 rescue breaths to mitigate hypoxia. The correct ratio of chest compressions to rescue breaths is 15:2, but the first step in paediatric BLS is always to give 5 rescue breaths.

      Paediatric Basic Life Support Guidelines

      Paediatric basic life support guidelines were updated in 2015 by the Resuscitation Council. Lay rescuers should use a compression:ventilation ratio of 30:2 for children under 1 year and between 1 year and puberty, a child is defined. If there are two or more rescuers, a ratio of 15:2 should be used.

      The algorithm for paediatric basic life support starts with checking if the child is unresponsive and shouting for help. The airway should be opened, and breathing should be checked by looking, listening, and feeling for breaths. If the child is not breathing, five rescue breaths should be given, and signs of circulation should be checked.

      For infants, the brachial or femoral pulse should be used, while children should use the femoral pulse. Chest compressions should be performed at a ratio of 15:2, with a rate of 100-120 compressions per minute for both infants and children. The depth of compressions should be at least one-third of the anterior-posterior dimension of the chest, which is approximately 4 cm for an infant and 5 cm for a child.

      In children, the lower half of the sternum should be compressed, while in infants, a two-thumb encircling technique should be used for chest compressions. These guidelines are crucial for anyone who may need to perform basic life support on a child, and it is essential to follow them carefully to ensure the best possible outcome.

    • This question is part of the following fields:

      • Paediatrics
      39.3
      Seconds
  • Question 11 - The cardiac arrest team is summoned to the bedside of a 68-year-old male...

    Correct

    • The cardiac arrest team is summoned to the bedside of a 68-year-old male patient, 3 days post-myocardial infarction. Two nurses are currently administering chest compressions and a manual defibrillator has just been connected. Chest compressions are momentarily halted to analyze the rhythm, which reveals pulseless electrical activity. What actions should be taken in this situation?

      Your Answer: Adrenaline should be commenced immediately

      Explanation:

      In the case of a non-shockable rhythm, it is crucial to administer adrenaline as soon as possible according to the ALS protocol. This should be done immediately and during alternate cycles. However, if the rhythm is shockable, adrenaline should be given after the third shock and then during alternate cycles. Amiodarone should be administered after the third shock, and a second dose may be considered after five shocks. Therefore, the other options are not appropriate.

      The 2015 Resus Council guidelines for adult advanced life support outline the steps to be taken when dealing with patients with shockable and non-shockable rhythms. For both types of patients, chest compressions are a crucial part of the process, with a ratio of 30 compressions to 2 ventilations. Defibrillation is recommended for shockable rhythms, with a single shock for VF/pulseless VT followed by 2 minutes of CPR. Adrenaline and amiodarone are the drugs of choice for non-shockable rhythms, with adrenaline given as soon as possible and amiodarone administered after 3 shocks for VF/pulseless VT. Thrombolytic drugs should be considered if a pulmonary embolus is suspected. Atropine is no longer recommended for routine use in asystole or PEA. Oxygen should be titrated to achieve saturations of 94-98% following successful resuscitation. The Hs and Ts should be considered as potential reversible causes of cardiac arrest.

    • This question is part of the following fields:

      • Respiratory Medicine
      28.5
      Seconds
  • Question 12 - A 28-year-old male patient complains of a painful rash on his forehead that...

    Correct

    • A 28-year-old male patient complains of a painful rash on his forehead that has been present for one day. The patient has no significant medical history. Upon examination, a vesicular rash is observed on the right side in the distribution of the ophthalmic nerve. There is no discharge or pus, and no ocular involvement is present. What is the recommended treatment for this condition?

      Your Answer: Oral acyclovir for 7-10 days

      Explanation:

      In the case of herpes zoster ophthalmicus, topical antiviral treatment is not recommended. The first line of treatment is oral acyclovir, which should be initiated promptly and continued for 7-10 days. If there are any indications of ocular involvement, the patient should be referred to an ophthalmologist immediately. While steroids can be administered concurrently, they do not decrease the likelihood of post-herpetic neuralgia. Topical mupirocin is not an appropriate treatment option.

      Herpes Zoster Ophthalmicus: Symptoms, Treatment, and Complications

      Herpes zoster ophthalmicus (HZO) is a condition that occurs when the varicella-zoster virus reactivates in the area supplied by the ophthalmic division of the trigeminal nerve. It is responsible for approximately 10% of shingles cases. The main symptom of HZO is a vesicular rash around the eye, which may or may not involve the eye itself. Hutchinson’s sign, a rash on the tip or side of the nose, is a strong indicator of nasociliary involvement and increases the risk of ocular involvement.

      Treatment for HZO involves oral antiviral medication for 7-10 days, ideally started within 72 hours of symptom onset. Intravenous antivirals may be necessary for severe infections or immunocompromised patients. Topical antiviral treatment is not recommended for HZO, but topical corticosteroids may be used to treat any secondary inflammation of the eye. Ocular involvement requires urgent ophthalmology review to prevent complications such as conjunctivitis, keratitis, episcleritis, anterior uveitis, ptosis, and post-herpetic neuralgia.

      In summary, HZO is a condition caused by the reactivation of the varicella-zoster virus in the ophthalmic division of the trigeminal nerve. It presents with a vesicular rash around the eye and may involve the eye itself. Treatment involves oral antiviral medication and urgent ophthalmology review is necessary for ocular involvement. Complications of HZO include various eye conditions, ptosis, and post-herpetic neuralgia.

    • This question is part of the following fields:

      • Ophthalmology
      14.4
      Seconds
  • Question 13 - Which of the following medications does not lead to galactorrhea? ...

    Incorrect

    • Which of the following medications does not lead to galactorrhea?

      Your Answer: Domperidone

      Correct Answer: Bromocriptine

      Explanation:

      Bromocriptine is used to treat galactorrhoea, not to induce it.

      Understanding Prolactin and Galactorrhoea

      Prolactin is a hormone produced by the anterior pituitary gland, and its release is regulated by various physiological factors. Dopamine is the primary inhibitor of prolactin release, and dopamine agonists like bromocriptine can be used to manage galactorrhoea. Galactorrhoea is a condition characterized by the production of breast milk in individuals who are not breastfeeding. It is important to distinguish the causes of galactorrhoea from those of gynaecomastia, which is the enlargement of male breast tissue.

      Excess prolactin can lead to different symptoms in men and women. Men may experience impotence, loss of libido, and galactorrhoea, while women may have amenorrhoea and galactorrhoea. Several factors can cause raised prolactin levels, including prolactinoma, pregnancy, oestrogens, stress, exercise, sleep, acromegaly, polycystic ovarian syndrome, and primary hypothyroidism. Additionally, certain medications like metoclopramide, domperidone, phenothiazines, haloperidol, SSRIs, and opioids can also increase prolactin levels.

      In summary, understanding prolactin and its effects on the body is crucial in diagnosing and managing conditions like galactorrhoea. Identifying the underlying causes of raised prolactin levels is essential in providing appropriate treatment and improving patient outcomes.

    • This question is part of the following fields:

      • Reproductive Medicine
      7.9
      Seconds
  • Question 14 - A 35-year-old man presents with a swollen, erythematous finger and right axillary tenderness,...

    Correct

    • A 35-year-old man presents with a swollen, erythematous finger and right axillary tenderness, 24 hours after being bitten by his pet dog.
      Which of the following is the best treatment?

      Your Answer: Co-amoxiclav

      Explanation:

      Antibiotics for Dog Bite Infections: Recommended and Not Recommended Options

      Dog bites can lead to infections caused by various micro-organisms, including anaerobic mouth flora and bacteria. Co-amoxiclav, a combination of amoxicillin and clavulanic acid, is the recommended antibiotic for dog bite-related infections, as it is effective against the most likely organisms. Fluconazole, an antifungal agent, is not indicated for such infections, as fungal micro-organisms in dogs usually cause only superficial skin rashes. Metronidazole, although effective against anaerobic bacteria, is not recommended for dog bite-related infections, except for patients allergic to penicillin. Aciclovir is not used for dog bite-related infections, as it is restricted to treating varicella-zoster and herpes zoster. Flucloxacillin, although recommended for skin infections, is not active against anaerobic bacteria and is not recommended for dog bite-related infections.

    • This question is part of the following fields:

      • Infectious Diseases
      11.6
      Seconds
  • Question 15 - Which of the following examples of infant jaundice from the list below is...

    Incorrect

    • Which of the following examples of infant jaundice from the list below is the most concerning?

      Your Answer: Jaundice which began at two days post-delivery and which has not resolved by six days post-delivery

      Correct Answer: Jaundice which develops on the day of delivery

      Explanation:

      Jaundice that appears within the first 24 hours after delivery is always considered to be pathological. Physiological jaundice typically develops 2-3 days after delivery and should resolve within 14 days. The risk of developing jaundice is higher in pre-term infants. In cases of physiological jaundice, bilirubin levels typically do not exceed 200 μmol/L.

      Jaundice in newborns can occur within the first 24 hours of life and is always considered pathological. The causes of jaundice during this period include rhesus and ABO haemolytic diseases, hereditary spherocytosis, and glucose-6-phosphodehydrogenase deficiency. On the other hand, jaundice in neonates from 2-14 days is common and usually physiological, affecting up to 40% of babies. This type of jaundice is due to a combination of factors such as more red blood cells, fragile red blood cells, and less developed liver function. Breastfed babies are more likely to develop this type of jaundice.

      If jaundice persists after 14 days (21 days for premature babies), a prolonged jaundice screen is performed. This includes tests for conjugated and unconjugated bilirubin, direct antiglobulin test, thyroid function tests, full blood count and blood film, urine for MC&S and reducing sugars, and urea and electrolytes. Prolonged jaundice can be caused by biliary atresia, hypothyroidism, galactosaemia, urinary tract infection, breast milk jaundice, prematurity, and congenital infections such as CMV and toxoplasmosis. Breast milk jaundice is more common in breastfed babies and is thought to be due to high concentrations of beta-glucuronidase, which increases the intestinal absorption of unconjugated bilirubin. Prematurity also increases the risk of kernicterus.

    • This question is part of the following fields:

      • Paediatrics
      33.9
      Seconds
  • Question 16 - A 55-year-old woman presents with a 4-week history of proximal muscle weakness. She...

    Correct

    • A 55-year-old woman presents with a 4-week history of proximal muscle weakness. She has a significant history of alcohol and smoking. Her blood tests reveal macrocytosis, abnormal liver function tests, elevated TSH (thyroid-stimulating hormone) and normal free thyroxine (fT4) levels.
      Which of the following is the most likely cause of her symptoms & blood results?

      Your Answer: Alcohol excess

      Explanation:

      Differential diagnosis of a patient with alcohol excess, elevated liver function tests, macrocytosis, and compensated hypothyroidism

      Chronic excess alcohol consumption can lead to a variety of health problems, including liver disease, neurological damage, and endocrine dysfunction. In this case, the patient presents with elevated liver function tests and macrocytosis, which are consistent with alcohol excess. The thyroid function tests show compensated hypothyroidism, which can also be caused by alcohol-related liver damage. However, the proximal myopathy is not typical of hypothyroidism, which usually causes muscle weakness in a more diffuse pattern. Cushing’s syndrome, pernicious anaemia, and thyrotoxicosis are less likely diagnoses based on the absence of specific clinical features and laboratory findings. Therefore, the most likely explanation for this patient’s presentation is alcohol excess, which may require further evaluation and management to prevent further complications.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      33.8
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  • Question 17 - A 42-year-old man with a history of psoriasis develops plaques on his scalp....

    Correct

    • A 42-year-old man with a history of psoriasis develops plaques on his scalp. What is the most suitable treatment option among the following choices?

      Your Answer: Hydrocortisone 1%

      Explanation:

      It’s a challenging question, especially since the decision on psoriasis treatment often involves the patient and doctor’s preference. While vitamin D analogues can be an option, calcipotriol is not advisable due to its potential to cause irritation. Instead, calcitriol and tacalcitol can be considered. For facial psoriasis, mild potency topical steroids can be effective. However, coal tar may not be well-tolerated for facial application due to its unpleasant odor and messiness.

      NICE recommends a step-wise approach for chronic plaque psoriasis, starting with regular emollients and then using a potent corticosteroid and vitamin D analogue separately, followed by a vitamin D analogue twice daily, and then a potent corticosteroid or coal tar preparation if there is no improvement. Phototherapy, systemic therapy, and topical treatments are also options for management. Topical steroids should be used cautiously and vitamin D analogues may be used long-term. Dithranol and coal tar have adverse effects but can be effective.

    • This question is part of the following fields:

      • Dermatology
      28.7
      Seconds
  • Question 18 - A 32-year-old man presents to his General Practitioner with a 3-day history of...

    Incorrect

    • A 32-year-old man presents to his General Practitioner with a 3-day history of flu-like symptoms and jaundice. He is a prison doctor. He sustained a needlestick injury six weeks ago from a high-risk patient after performing venepuncture. He immediately presented to the Emergency Department (ED) and was given a booster vaccination and post-exposure prophylaxis (PPE) treatment for human immunodeficiency virus (HIV). He is awaiting blood-borne virus (BBV) screening.
      What is the most likely diagnosis?
      Select ONE option only.

      Your Answer: Hepatitis A

      Correct Answer: Hepatitis C

      Explanation:

      Overview of Viral Hepatitis: Types, Transmission, and Risk Factors

      Viral hepatitis is a group of infectious diseases that affect the liver and can cause serious health complications. There are five main types of viral hepatitis: A, B, C, D, and E. Each type has its own unique characteristics, transmission routes, and risk factors.

      Hepatitis A is transmitted via the faecal-oral route and is most common in developing countries. It can cause symptoms similar to other types of viral hepatitis, but is less severe. Hepatitis B is transmitted via blood-to-blood and bloody fluid contact, and is most prevalent in migrant populations from certain regions. Hepatitis C is highly infectious and is commonly transmitted through shared needles or other injecting paraphernalia used for illicit drugs. Hepatitis D is a rare type of viral hepatitis that can only occur in patients with existing hepatitis B infection. Hepatitis E is also transmitted via the faecal-oral route, but is less common and usually only causes mild illness.

      If a healthcare professional sustains a needlestick injury or other high-risk exposure to hepatitis C, they should have blood tests taken at specific intervals to confirm active infection. Hepatitis B vaccination is recommended for individuals working in high-risk clinical areas, and can also prevent hepatitis D infection. Chronic infection is rare for hepatitis E, unless the affected person is immunocompromised.

      Understanding the different types of viral hepatitis, their transmission routes, and risk factors is important for preventing and managing these infections.

    • This question is part of the following fields:

      • Immunology/Allergy
      20.9
      Seconds
  • Question 19 - A 60-year-old man came to your GP clinic complaining of blurred vision for...

    Incorrect

    • A 60-year-old man came to your GP clinic complaining of blurred vision for the past month. He has a history of type 2 diabetes mellitus. During direct ophthalmoscopy, you observed a ring of hard exudates at the fovea, but the rest of the retina appeared normal. What is the probable diagnosis for his vision blurring?

      Your Answer: Vitreous haemorrhage

      Correct Answer: Diabetic maculopathy

      Explanation:

      Diabetic maculopathy refers to any structural anomaly in the macula caused by diabetes. The patient in this case had hard exudates in the macula, which resulted in blurred vision. As there were no abnormalities in the rest of the retina, options 1-3 (background, pre-proliferative and proliferative diabetic retinopathies) are incorrect. Although vitreous hemorrhage can cause blurred vision in cases of proliferative retinopathy, there is no indication of it in the given history.

      Understanding Diabetic Retinopathy

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

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

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

    • This question is part of the following fields:

      • Ophthalmology
      21.5
      Seconds
  • Question 20 - A 64-year-old man is scheduled for a follow-up after a positive faecal occult...

    Incorrect

    • A 64-year-old man is scheduled for a follow-up after a positive faecal occult blood test as part of the national screening programme. While discussing colonoscopy, he inquires about the percentage of patients with a positive faecal occult blood test who have colorectal cancer. What is the most precise response?

      Your Answer: 0.5 - 2%

      Correct Answer: 5 - 15%

      Explanation:

      The likelihood of having an adenoma increases with a positive result on a faecal occult blood test.

      Colorectal Cancer Screening: Faecal Immunochemical Test (FIT)

      Colorectal cancer is often developed from adenomatous polyps. Screening for this type of cancer has been proven to reduce mortality by 16%. The NHS offers a home-based screening programme called Faecal Immunochemical Test (FIT) to older adults. A one-off flexible sigmoidoscopy was trialled in England for people aged 55 years, but it was abandoned in 2021 due to the inability to recruit enough clinical endoscopists, which was exacerbated by the COVID-19 pandemic. The trial, partly funded by Cancer Research UK, showed promising early results, and it remains to be seen whether flexible sigmoidoscopy will be used as part of a future bowel screening programme.

      Faecal Immunochemical Test (FIT) Screening:
      The NHS now has a national screening programme that offers screening every two years to all men and women aged 60 to 74 years in England and 50 to 74 years in Scotland. Patients aged over 74 years may request screening. Eligible patients are sent FIT tests through the post. FIT is a type of faecal occult blood (FOB) test that uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect and quantify the amount of human blood in a single stool sample. FIT has advantages over conventional FOB tests because it only detects human haemoglobin, as opposed to animal haemoglobin ingested through diet. Only one faecal sample is needed compared to the 2-3 for conventional FOB tests. While a numerical value is generated, this is not reported to the patient or GP. Instead, they will be informed if the test is normal or abnormal. Patients with abnormal results are offered a colonoscopy. At colonoscopy, approximately 5 out of 10 patients will have a normal exam, 4 out of 10 patients will be found to have polyps that may be removed due to their premalignant potential, and 1 out of 10 patients will be found to have cancer.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      10
      Seconds
  • Question 21 - A 50-year-old woman with a history of severe disabling arthritis presents to the...

    Correct

    • A 50-year-old woman with a history of severe disabling arthritis presents to the Emergency Department with a 3-week history of dyspnoea. She reports a dry cough of similar duration. She has never smoked and has never been employed. On cardiovascular examination, no abnormalities are detected. Respiratory examination reveals reduced air entry at the left base, which is stony dull to percussion. A chest X-ray shows blunting of the left costophrenic angle.
      What is the most likely diagnosis associated with her current respiratory problem?

      Your Answer: Rheumatoid arthritis (RA)

      Explanation:

      Respiratory Manifestations of Rheumatoid Arthritis

      Rheumatoid arthritis (RA) is an inflammatory arthritis that can affect various parts of the body, including the respiratory tract. One common manifestation of RA in the respiratory system is pleural involvement, which can present as pleural effusion, pleural nodules, or pleurisy. Other respiratory complications associated with RA include pulmonary fibrosis and bronchiolitis obliterans.

      It is important to note that other types of arthritis, such as ankylosing spondylitis, Behçet’s disease, gout, and psoriatic arthritis, do not typically present with respiratory complications like pleural effusion. Ankylosing spondylitis is associated with apical fibrosis, while Behçet’s disease is known for neurological complications. Gout is caused by purine metabolism abnormality and affects the joints and renal tract, while psoriatic arthritis is strongly associated with psoriasis and can lead to ocular and cardiovascular complications.

      Overall, if a patient with RA presents with respiratory symptoms, it is important to consider the possibility of pleural involvement and other respiratory complications associated with the disease.

    • This question is part of the following fields:

      • Respiratory Medicine
      120.1
      Seconds
  • Question 22 - A 30-year-old woman complains that she has had pain in her left elbow,...

    Correct

    • A 30-year-old woman complains that she has had pain in her left elbow, left ankle, and right knee for the last few weeks. She recently returned from a trip to Brazil where she had been on a 3-week vacation with her family. She admits to having unprotected sex while on holiday. On examination, there is tenderness and swelling of the tendons around the affected joints, but no actual joint swelling. She also has a skin rash, which is vesiculopustular.
      What is the most likely diagnosis?

      Your Answer: Gonococcal arthritis

      Explanation:

      Gonococcal arthritis is characterized by migratory polyarthralgia, fever, tenosynovitis, and dermatitis, with a rash being a common feature. It is responsive to treatment and less destructive. Reactive arthritis is a triad of urethritis, seronegative arthritis, and conjunctivitis, often caused by infections of the digestive or reproductive systems. Tuberculous arthritis is caused by Mycobacterium tuberculosis and presents with pain, swelling, and stiffness of the affected joint, along with fatigue, malaise, and weight loss. Fungal arthritis is rare and causes a hot, swollen, red, and painful joint. Gout typically affects the first metatarsophalangeal joint and presents with hot, swollen, tender, and red joints, with normal uric acid levels not ruling out the diagnosis. Diagnosis is largely clinical, but synovial fluid examination can differentiate from pseudogout.

    • This question is part of the following fields:

      • Musculoskeletal
      341.6
      Seconds
  • Question 23 - A 16-year-old is brought to her General Practitioner by her parents after they...

    Correct

    • A 16-year-old is brought to her General Practitioner by her parents after they noticed her eating habits had become irregular. The parents report that the patient eats large volumes of foods and is sometimes found vomiting shortly after eating dinner. This behaviour has been occurring for the past six months.
      On examination, the patient’s vital signs are normal and she has a body mass index body mass index (BMI) of 23 kg/m2. She has excoriations on the knuckles of her right hand. She also has erosions on her teeth and swelling bilaterally on the lateral aspects of the face along the mandibular rami.
      What is the most likely diagnosis?

      Your Answer: Bulimia nervosa

      Explanation:

      Common Mental Health Disorders: Symptoms and Characteristics

      Bulimia Nervosa
      Bulimia nervosa is an eating disorder characterized by binge eating followed by purging, usually in the form of vomiting. Patients with bulimia nervosa tend to have normal BMI despite purging behavior. Symptoms include teeth erosion, swelling along the mandibular rami (parotitis), and excoriations of the knuckles (Russell’s sign).

      Gender Dysphoria
      Gender dysphoria is a condition where an individual experiences a strong identification with a gender other than that assigned at birth. This can be managed through social or medical transition, such as hormone or surgical treatments that are gender-affirming.

      Anorexia Nervosa
      Anorexia nervosa is characterized by decreased dietary intake with or without purging behavior. Patients with anorexia nervosa tend to have extremely low BMI due to low calorie intake. Symptoms include early osteoporosis and electrolyte abnormalities due to malnutrition.

      Avoidant Personality Disorder
      Avoidant personality disorder is characterized by a person who wishes to have friends and social outlets but is so shy that they are unable to form relationships out of fear of rejection. This is different from the schizoid personality, which prefers to be alone.

      Binge Eating Disorder
      Binge eating disorder is characterized by purely binge eating without purging behavior. Symptoms include distress and weight gain.

    • This question is part of the following fields:

      • Psychiatry
      12.7
      Seconds
  • Question 24 - A 55-year-old man is hospitalized for a chest infection and undergoes a standard...

    Incorrect

    • A 55-year-old man is hospitalized for a chest infection and undergoes a standard blood test in the emergency room. The results show his HbA1c level as follows:
      HbA1c 48 mmol/mol (27-48 mmol/mol)
      What medical condition could cause this reading to inaccurately reflect his blood sugar levels?

      Your Answer: G6PD deficiency

      Correct Answer: Splenectomy

      Explanation:

      If a person has undergone a splenectomy, their HbA1c level may be falsely elevated due to the longer lifespan of their red blood cells. HbA1c testing is commonly used to determine diabetes, as it provides an average blood glucose level over a three-month period, which is the lifespan of a typical red blood cell. A higher HbA1c reading can be caused by either a higher average blood glucose concentration or a longer red cell lifespan. Therefore, only a splenectomy would result in an overestimation of blood sugar levels, as it increases the lifespan of red blood cells, while all other conditions would decrease their lifespan and lower the HbA1c reading.

      Understanding Glycosylated Haemoglobin (HbA1c) in Diabetes Mellitus

      Glycosylated haemoglobin (HbA1c) is a commonly used measure of long-term blood sugar control in diabetes mellitus. It is produced when glucose attaches to haemoglobin in the blood at a rate proportional to the glucose concentration. The level of HbA1c is influenced by the lifespan of red blood cells and the average blood glucose concentration. However, certain conditions such as sickle-cell anaemia, GP6D deficiency, and haemodialysis can interfere with accurate interpretation of HbA1c levels.

      HbA1c is believed to reflect the blood glucose levels over the past 2-4 weeks, although it is generally thought to represent the previous 3 months. It is recommended that HbA1c be checked every 3-6 months until stable, then every 6 months. The Diabetes Control and Complications Trial (DCCT) has studied the complex relationship between HbA1c and average blood glucose. The International Federation of Clinical Chemistry (IFCC) has developed a new standardised method for reporting HbA1c in mmol per mol of haemoglobin without glucose attached.

      Understanding HbA1c is crucial in managing diabetes mellitus and achieving optimal blood sugar control.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      47.9
      Seconds
  • Question 25 - A 70-year-old man with a 12-year history of gastro-oesophageal reflux disease presents with...

    Incorrect

    • A 70-year-old man with a 12-year history of gastro-oesophageal reflux disease presents with dysphagia. Upon endoscopy, an obstructive lesion is observed that is highly suspicious of oesophageal cancer. What is the expected result of the biopsy?

      Your Answer: Squamous cell carcinoma

      Correct Answer: Adenocarcinoma

      Explanation:

      Gastroesophageal reflux disease (GORD) or Barrett’s esophagus are linked to the development of oesophageal adenocarcinoma.

      Oesophageal Cancer: Types, Risk Factors, Features, Diagnosis, and Treatment

      Oesophageal cancer used to be mostly squamous cell carcinoma, but adenocarcinoma is now becoming more common, especially in patients with a history of gastro-oesophageal reflux disease (GORD) or Barrett’s. Adenocarcinoma is usually located near the gastroesophageal junction, while squamous cell tumours are found in the upper two-thirds of the oesophagus.

      Risk factors for adenocarcinoma include GORD, Barrett’s oesophagus, smoking, achalasia, and obesity. Squamous cell cancer is more common in the developing world and is associated with smoking, alcohol, achalasia, Plummer-Vinson syndrome, and diets rich in nitrosamines.

      The most common presenting symptom for both types of oesophageal cancer is dysphagia, followed by anorexia and weight loss. Other possible features include odynophagia, hoarseness, melaena, vomiting, and cough.

      Diagnosis is done through upper GI endoscopy with biopsy, endoscopic ultrasound for locoregional staging, CT scanning for initial staging, and FDG-PET CT for detecting occult metastases. Laparoscopy may also be performed to detect occult peritoneal disease.

      Operable disease is best managed by surgical resection, with the most common procedure being an Ivor-Lewis type oesophagectomy. However, the biggest surgical challenge is anastomotic leak, which can result in mediastinitis. Adjuvant chemotherapy may also be used in many patients.

      Overall, oesophageal cancer is a serious condition that requires prompt diagnosis and treatment. Understanding the types, risk factors, features, diagnosis, and treatment options can help patients and healthcare providers make informed decisions about managing this disease.

    • This question is part of the following fields:

      • Haematology/Oncology
      9.2
      Seconds
  • Question 26 - A 50-year-old man comes to the Emergency Department complaining of right upper quadrant...

    Correct

    • A 50-year-old man comes to the Emergency Department complaining of right upper quadrant pain, dark urine, and pale stools that have been present for the past 24 hours. He reports being a part-time teacher and smoking 10 cigarettes daily. He has no significant medical history and is not taking any medications. Upon examination, his sclera are yellow, and his BMI is 29 kg/m². What investigation would be the most useful in this case?

      Your Answer: Ultrasound of abdomen

      Explanation:

      Gallstones: Symptoms, Diagnosis, and Treatment

      Gallstones are a common condition, with up to 24% of women and 12% of men affected. Local infection and cholecystitis may develop in up to 30% of cases, and 12% of patients undergoing surgery will have stones in the common bile duct. The majority of gallstones are of mixed composition, with pure cholesterol stones accounting for 20% of cases. Symptoms typically include colicky right upper quadrant pain that worsens after fatty meals. Diagnosis involves abdominal ultrasound and liver function tests, with magnetic resonance cholangiography or intraoperative imaging used to confirm the presence of stones in the bile duct. Treatment options include expectant management for asymptomatic gallstones, laparoscopic cholecystectomy for symptomatic gallstones, and early ERCP or surgical exploration for stones in the bile duct. Intraoperative cholangiography or laparoscopic ultrasound may be used to confirm anatomy or exclude CBD stones during surgery. ERCP carries risks such as bleeding, duodenal perforation, cholangitis, and pancreatitis.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      14.4
      Seconds
  • Question 27 - A 15-year-old boy presents to his General Practitioner as he has been suffering...

    Incorrect

    • A 15-year-old boy presents to his General Practitioner as he has been suffering from recurrent infections for the last few months. He has also been losing weight. He has taken four courses of antibiotics in the last six months for various respiratory tract infections. He also experienced an episode of shingles that took a few years to clear after becoming secondarily infected.
      On examination, he is pale and underweight, with a body mass index (BMI) of 17.5 kg/m2. He has fine, downy hair on his back, abdomen and forearms. His temperature is 35.9 °C. His blood pressure is 90/45 mmHg while his pulse is 52 bpm.
      What is the most likely cause of this patient’s immunodeficiency?

      Your Answer: Primary immunodeficiency

      Correct Answer: Malnutrition

      Explanation:

      Differential diagnosis of immunodeficiency in an adolescent with weight loss and recurrent infection

      Malnutrition, primary immunodeficiency, cytomegalovirus (CMV) infection, human immunodeficiency virus (HIV) infection, and diabetes mellitus are among the possible causes of immunodeficiency in an adolescent with weight loss and recurrent infection. Malnutrition can suppress the immune system and is often associated with anorexia nervosa, which can be characterized by a very low body mass index (BMI), lanugo hair growth, hypothermia, bradycardia, and hypotension. Primary immunodeficiency syndromes, which are usually inherited as single-gene disorders, tend to present in infancy or early childhood with poor growth and weight gain and recurrent, prolonged, severe, or atypical infections. Cytomegalovirus (CMV) is a herpes virus that can cause serious complications in immunocompromised individuals or congenital cases, but is usually asymptomatic in immunocompetent individuals. Human immunodeficiency virus (HIV) infection can result in immunodeficiency by infecting and destroying CD4 cells, and should be suspected in individuals with prolonged, severe, or recurrent infections, particularly if they are a member of a high-risk group. Diabetes mellitus, especially type I, can also cause dysfunction of the immune system and increase the risk of infection. However, in an adolescent with a low BMI, type II diabetes would be very unlikely.

    • This question is part of the following fields:

      • Immunology/Allergy
      22.6
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  • Question 28 - A 65-year-old woman comes to see her GP for a skin condition that...

    Correct

    • A 65-year-old woman comes to see her GP for a skin condition that has been slowly progressing over the years. She has had dry patches of skin that eventually turned into plaques, which have been treated as psoriasis. However, the lesions have continued to worsen and now have nodules. Some of these nodules have become painful and have discharged fluid. A biopsy is taken to further assess the lesions, and the pathology report shows lymphocytic and atypical T-cell infiltrates in the dermis and epidermis, with some Pautrier microabscesses. Based on this information, what is the most likely diagnosis?

      Your Answer: Mycosis fungoides

      Explanation:

      Mycosis fungoides, a severe form of T-cell lymphoma that mimics eczema or psoriasis, is a rare but concerning skin condition. The patient’s atypical medical history, previous diagnostic uncertainty, and laboratory results suggest that they may have cutaneous T-cell lymphoma. Biopsy results showing Pautrier microabscesses are a common feature of mycosis fungoides. Harlequin ichthyosis is a genetic disorder that manifests from birth, making it an unlikely diagnosis. Although syphilis can cause various skin symptoms, the biopsy findings do not support this diagnosis. Discoid eczema, also known as nummular dermatitis, has a different clinical course than the patient’s condition, and the biopsy results do not indicate it.

      Understanding Mycosis Fungoides

      Mycosis fungoides is a rare type of T-cell lymphoma that primarily affects the skin. It is characterized by the presence of itchy, red patches that may appear in different colors, unlike eczema or psoriasis where the lesions are more uniform in color. These patches may progress to form plaques, which can be seen in the later stages of the disease.

    • This question is part of the following fields:

      • Dermatology
      39.2
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  • Question 29 - A 9-year-old boy is being evaluated at the Enuresis clinic. Despite using an...

    Correct

    • A 9-year-old boy is being evaluated at the Enuresis clinic. Despite using an enuresis alarm for the past three months, he continues to wet the bed at night. He has no issues with urination during the day and has a daily bowel movement. What treatment option is most probable to be suggested?

      Your Answer: Desmopressin

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Paediatrics
      33
      Seconds
  • Question 30 - A new phlebotomist, who has only received one dose of hepatitis B vaccine,...

    Incorrect

    • A new phlebotomist, who has only received one dose of hepatitis B vaccine, accidentally pricks herself with a needle while drawing blood from a patient known to have hepatitis B. What steps should she take to reduce her risk of contracting the virus?

      Your Answer:

      Correct Answer: Give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin

      Explanation:

      Post-Exposure Prophylaxis for Infectious Diseases

      Post-exposure prophylaxis (PEP) is a preventive treatment given to individuals who have been exposed to an infectious disease. The type of PEP given depends on the specific disease and the circumstances of the exposure. For hepatitis A, either human normal immunoglobulin (HNIG) or the hepatitis A vaccine may be used. For hepatitis B, if the source is HBsAg positive, a booster dose of the HBV vaccine should be given to known responders. Non-responders require hepatitis B immune globulin (HBIG) and a booster vaccine. If the source is unknown, known responders may receive a booster dose of the HBV vaccine, while known non-responders require HBIG and a vaccine. Those in the process of being vaccinated should have an accelerated course of the HBV vaccine. For hepatitis C, monthly PCR is recommended, and if seroconversion occurs, interferon +/- ribavirin may be given. For HIV, the risk of transmission depends on the incident and the current viral load of the patient. Low-risk incidents such as human bites generally do not require PEP. However, for high-risk incidents, a combination of oral antiretrovirals should be given as soon as possible for four weeks. For varicella zoster, VZIG is recommended for IgG negative pregnant women or immunosuppressed individuals. It is important to note that the risk of transmission varies depending on the virus, with hepatitis B having a higher risk than hepatitis C and HIV.

    • This question is part of the following fields:

      • Infectious Diseases
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (1/2) 50%
Gastroenterology/Nutrition (2/3) 67%
Haematology/Oncology (0/2) 0%
Reproductive Medicine (1/3) 33%
Musculoskeletal (1/2) 50%
Psychiatry (2/2) 100%
Pharmacology/Therapeutics (0/1) 0%
Paediatrics (1/3) 33%
Respiratory Medicine (2/2) 100%
Ophthalmology (1/2) 50%
Infectious Diseases (1/1) 100%
Endocrinology/Metabolic Disease (1/2) 50%
Dermatology (2/2) 100%
Immunology/Allergy (0/2) 0%
Passmed