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  • Question 1 - An 82-year-old man presents to his General Practitioner (GP) with a 4-month history...

    Correct

    • An 82-year-old man presents to his General Practitioner (GP) with a 4-month history of progressively worsening jaundice. His wife says that she noticed it a while ago, but her husband has been reluctant to come to see the GP. The man does not complain of any abdominal pain and on examination no masses are felt. He agrees when asked by the GP that he has lost quite some weight recently. The patient has a strong alcohol history and has been smoking 20 cigarettes daily since he was in his twenties. The GP refers the patient to secondary care.
      Which one of the following is the most likely diagnosis for this patient?

      Your Answer: Pancreatic cancer

      Explanation:

      Differential Diagnosis of Painless Jaundice in a Patient with Risk Factors for Pancreatic Cancer

      This patient presents with painless jaundice, which is most suggestive of obstructive jaundice due to a tumour in the head of the pancreas. The patient also has strong risk factors for pancreatic cancer, such as smoking and alcohol. However, other conditions should be considered in the differential diagnosis, such as chronic cholecystitis, chronic pancreatitis, cholangiocarcinoma, and chronic liver disease.

      Chronic cholecystitis is unlikely to be the cause of painless jaundice, as it typically presents with colicky abdominal pain and gallstones on ultrasound. Chronic pancreatitis is a possible diagnosis, given the patient’s risk factors, but it usually involves abdominal pain and fatty diarrhoea. Cholangiocarcinoma is a rare cancer that develops in the bile ducts and can cause jaundice, abdominal pain, and itching. Primary sclerosing cholangitis is a risk factor for cholangiocarcinoma. Chronic liver disease is also a possible consequence of alcohol abuse, but it usually involves other signs such as nail clubbing, palmar erythema, and spider naevi.

      Therefore, a thorough evaluation of the patient’s medical history, physical examination, laboratory tests, and imaging studies is necessary to confirm the diagnosis of pancreatic cancer and rule out other potential causes of painless jaundice. Early detection and treatment of pancreatic cancer are crucial for improving the patient’s prognosis and quality of life.

    • This question is part of the following fields:

      • Gastroenterology
      45.2
      Seconds
  • Question 2 - A 75-year-old woman presents to the oncology clinic with a breast lump that...

    Correct

    • A 75-year-old woman presents to the oncology clinic with a breast lump that was confirmed to be malignant through a biopsy. Cancer receptor testing reveals the presence of oestrogen receptors, and as she is postmenopausal, the plan is to start her on an aromatase inhibitor. However, due to potential adverse effects of the medication, a DEXA scan is conducted before initiating treatment. What is the name of the drug that the patient is supposed to start taking?

      Your Answer: Anastrozole

      Explanation:

      Anastrozole and letrozole are drugs that inhibit aromatase, reducing the production of oestrogen in the body. They are commonly used to treat oestrogen receptor-positive breast cancer in postmenopausal women, as aromatisation is the primary source of oestrogen in this group.

      Docetaxel is a taxane drug that is often added to chemotherapy regimens for breast cancer treatment. It works by destroying fast-replicating cancer cells and does not affect aromatisation.

      Levonorgestrel is a progestin that mimics the effects of progesterone. It is used in combination with oestrogen for birth control and menopausal hormone therapy, but has no role in the management of breast cancer. In fact, research suggests that its use may slightly increase the risk of malignancy.

      Tamoxifen is a selective oestrogen receptor modulator (SERM) that directly blocks cancer oestrogen receptors, inhibiting their growth. It is commonly used to treat oestrogen receptor-positive breast cancer.

      Anti-oestrogen drugs are used in the management of oestrogen receptor-positive breast cancer. Selective oEstrogen Receptor Modulators (SERM) such as Tamoxifen act as an oestrogen receptor antagonist and partial agonist. However, Tamoxifen can cause adverse effects such as menstrual disturbance, hot flashes, venous thromboembolism, and endometrial cancer. On the other hand, aromatase inhibitors like Anastrozole and Letrozole reduce peripheral oestrogen synthesis, which is important in postmenopausal women. Anastrozole is used for ER +ve breast cancer in this group. However, aromatase inhibitors can cause adverse effects such as osteoporosis, hot flashes, arthralgia, myalgia, and insomnia. NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer.

    • This question is part of the following fields:

      • Surgery
      30.8
      Seconds
  • Question 3 - A client is given local anaesthetic after a procedure. The physician injects 25...

    Incorrect

    • A client is given local anaesthetic after a procedure. The physician injects 25 ml of 1.5% lidocaine.
      What is the total amount of lidocaine in milligrams?

      Your Answer: 1g

      Correct Answer: 400mg

      Explanation:

      The strength of the solution is such that 2g are dissolved in every 100ml. This means that for every 100 ml of solution, 2g of lidocaine are dissolved. If 20 ml of the solution is infiltrated (which is one-fifth of 100ml), then the amount of lidocaine present in the infiltrated solution can be calculated by dividing 2g (which is equal to 2000mg) by 5.

      Local anaesthetic agents include lidocaine, cocaine, bupivacaine, and prilocaine. Lidocaine is an amide that is metabolized in the liver, protein-bound, and renally excreted. Toxicity can occur with IV or excess administration, and increased risk is present with liver dysfunction or low protein states. Cocaine is rarely used in mainstream surgical practice and is cardiotoxic. Bupivacaine has a longer duration of action than lignocaine and is cardiotoxic, while levobupivacaine is less cardiotoxic. Prilocaine is less cardiotoxic and is the agent of choice for intravenous regional anesthesia. Adrenaline can be added to local anesthetic drugs to prolong their duration of action and permit higher doses, but it is contraindicated in patients taking MAOI’s or tricyclic antidepressants.

    • This question is part of the following fields:

      • Surgery
      54.9
      Seconds
  • Question 4 - A 42-year-old woman, who has completed her family, visits the Gynaecology Clinic following...

    Incorrect

    • A 42-year-old woman, who has completed her family, visits the Gynaecology Clinic following the detection of abnormal cervical cytology on a cervical smear screen. A biopsy is taken from a lesion found on the ectocervix during clinical examination under anaesthesia. Further investigations and histology confirm stage 1b cervical cancer.

      What treatment option would be most suitable for this patient, taking into account the stage of the cancer?

      Your Answer: Simple hysterectomy

      Correct Answer: Radical hysterectomy

      Explanation:

      Treatment Options for Cervical Carcinoma: A Comparison

      Cervical carcinoma is a type of cancer that primarily affects the squamous cells of the cervix. Its main symptoms include abnormal bleeding or watery discharge, especially after sexual intercourse. The risk of developing cervical cancer increases with sexual activity.

      The disease is staged based on the extent of its spread, with stages 0 to 4 indicating increasing severity. For stage 1b cervical cancer, the recommended treatment is a Wertheim’s radical abdominal hysterectomy. This procedure involves removing the uterus, tubes, ovaries, broad ligaments, parametrium, upper half or two-thirds of the vagina, and regional lymph glands. However, in older patients, the surgeon may try to preserve the ovaries to avoid premature menopause.

      Other treatment options include simple hysterectomy, which is not suitable for cervical cancer that has spread beyond the cervix, and radical trachelectomy, which is appropriate for stage 1 cancers in women who wish to preserve their fertility. Close cytological follow-up is not recommended for confirmed cases of cervical cancer, while platinum-based chemotherapy is typically used only when surgery is not possible.

      In summary, the choice of treatment for cervical carcinoma depends on the stage of the disease, the patient’s age and fertility preferences, and the feasibility of surgical intervention.

    • This question is part of the following fields:

      • Gynaecology
      27
      Seconds
  • Question 5 - A 20-year-old man visits his GP clinic with a chief complaint of headaches....

    Correct

    • A 20-year-old man visits his GP clinic with a chief complaint of headaches. During the physical examination, no abnormalities are detected, but his blood pressure is found to be 178/90 mmHg. The doctor suspects a renal origin for the hypertension and wants to perform an initial screening test for renovascular causes. What is the most appropriate investigation for this purpose?

      Your Answer: Abdominal duplex ultrasound

      Explanation:

      Diagnostic Tests for Renal Hypertension

      Renal hypertension, or high blood pressure caused by kidney disease, can be diagnosed through various diagnostic tests. The appropriate initial screening investigation is an abdominal duplex ultrasound, which can detect renal vascular or anatomical pathologies such as renal artery stenosis or polycystic kidney disease. If abnormalities are found, more advanced testing such as a CTA, magnetic resonance angiography, or nuclear medicine testing may be necessary. However, an ultrasound is the best initial screening investigation for renal hypertension.

      A CTA is a follow-up test that may be performed if an initial abdominal duplex ultrasound suggests a renal cause for the hypertension. It is an advanced, specialist test that would not be appropriate as an initial screening investigation. On the other hand, a magnetic resonance angiography is an advanced, gold-standard test that can be performed if an initial abdominal duplex ultrasound suggests a renal cause for the hypertension.

      HbA1c is a blood test that tests your average blood glucose levels over the last 2–3 months. It can indicate if diabetes may have contributed to the hypertension, but will not clarify whether there is a renal cause. Lastly, a urine albumin: creatinine ratio tests for the presence of protein in the urine, which is a reflection of kidney disease, but does not give us any indication of the cause.

    • This question is part of the following fields:

      • Renal
      2937.9
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  • Question 6 - A 26-year-old man visits his GP complaining of watery diarrhoea that has persisted...

    Correct

    • A 26-year-old man visits his GP complaining of watery diarrhoea that has persisted for a few days. The patient had received IM ceftriaxone for gonorrhoeae treatment the previous week. He has not traveled recently and has maintained his regular diet. This is the first time the patient has encountered diarrhoea in his life. The GP conducted some tests and found that the patient is positive for C.difficile toxin. What is the best course of action to take?

      Your Answer: Prescribe oral vancomycin

      Explanation:

      The recommended first-line antibiotic for patients with C. difficile infection is oral vancomycin. This is the appropriate treatment for the patient in question, who has tested positive for C. difficile toxin in their stool while taking IM ceftriaxone. As this is their first episode of C. difficile, oral vancomycin should be prescribed. Prescribing oral fidaxomicin would be incorrect, as it is typically reserved for recurrent episodes of C. difficile within 12 weeks of symptom resolution. Oral metronidazole is an alternative but less effective option for non-severe cases, and should only be used if vancomycin is not available or contraindicated. Prescribing a combination of oral vancomycin and intravenous metronidazole would only be necessary in cases of life-threatening C. difficile infection, which is not the case for this patient.

      Clostridium difficile is a type of bacteria that is commonly found in hospitals. It is a Gram positive rod that produces an exotoxin which can cause damage to the intestines, leading to a condition called pseudomembranous colitis. This bacteria usually develops when the normal gut flora is suppressed by broad-spectrum antibiotics, with second and third generation cephalosporins being the leading cause of C. difficile. Other risk factors include proton pump inhibitors. Symptoms of C. difficile include diarrhea, abdominal pain, and a raised white blood cell count. The severity of the infection can be determined using the Public Health England severity scale, which ranges from mild to life-threatening.

      To diagnose C. difficile, a stool sample is tested for the presence of C. difficile toxin (CDT). Treatment for a first episode of C. difficile infection typically involves oral vancomycin for 10 days, with fidaxomicin or a combination of oral vancomycin and IV metronidazole being used as second and third-line therapies. Recurrent infections occur in around 20% of patients, increasing to 50% after their second episode. In such cases, oral fidaxomicin is recommended within 12 weeks of symptom resolution, while oral vancomycin or fidaxomicin can be used after 12 weeks. For life-threatening C. difficile infections, oral vancomycin and IV metronidazole are used, and surgery may be considered with specialist advice. Other therapies, such as bezlotoxumab and fecal microbiota transplant, may also be considered for preventing recurrences in certain cases.

    • This question is part of the following fields:

      • Medicine
      223.2
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  • Question 7 - Liam is a 22-year-old man who has had unprotected sexual intercourse and has...

    Incorrect

    • Liam is a 22-year-old man who has had unprotected sexual intercourse and has taken levonorgestrel 2 hours ago. He has vomited once since and is uncertain about what to do next. What is the most crucial advice to give Liam regarding his risk of pregnancy?

      Your Answer: Commence the combined oral contraceptive pill (COCP) as soon as possible

      Correct Answer: Take a second dose of levonorgestrel as soon as possible

      Explanation:

      If a patient vomits within 3 hours of taking levonorgestrel, it is recommended to prescribe a second dose of emergency hormonal contraception to be taken as soon as possible, according to NICE guidelines. Therefore, reassuring Zoe that she is protected from pregnancy is incorrect as she needs to take another dose. Additionally, while it may be advisable for Zoe to start a regular form of contraception, this is not the most important advice to give initially. Instead, she should be offered choices of contraception, including long-acting reversible contraceptives. It is also incorrect to recommend other forms of emergency contraception, such as ulipristal acetate and the IUD, as Zoe has already taken levonorgestrel and the guidelines are clear that a second dose of this should be taken in this circumstance. However, if Zoe experiences persistent vomiting or diarrhea for more than 24 hours after taking emergency hormonal contraception, then the IUD may be offered.

      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:

      • Gynaecology
      70.4
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  • Question 8 - These results were obtained from a 43-year-old female. Her serum levels showed an...

    Correct

    • These results were obtained from a 43-year-old female. Her serum levels showed an elevated level of aldosterone and a low level of renin. Specifically, her Na+ level was 154 mmol/l (135–145 mmol/l) and her K+ level was 3.7 mmol/l (3.5–5 mmol/l). What condition are these results consistent with?

      Your Answer: Conn’s syndrome

      Explanation:

      Electrolyte Imbalances in Various Conditions and Treatments

      Conn’s Syndrome and Hyperaldosteronism
      Conn’s syndrome is a type of primary hyperaldosteronism caused by the overproduction of aldosterone in the adrenal glands due to an adrenal adenoma. This results in elevated levels of aldosterone, causing water retention and increased excretion of potassium. Renin levels are low in this condition due to the raised sodium and plasma volume. Patients with Conn’s syndrome are typically hypertensive, but it is important to note that some patients may have normal potassium levels.

      Addison’s Disease and Adrenal Gland Failure
      Addison’s disease is caused by adrenal gland failure, resulting in a deficiency of glucocorticoids and mineralocorticoids. This leads to sodium loss and potassium retention.

      Renal Artery Stenosis and Secondary Hyperaldosteronism
      Patients with renal artery stenosis may also exhibit elevated sodium and low potassium levels. However, in this case, renin levels are elevated due to reduced renal perfusion, leading to secondary hyperaldosteronism.

      Bartter Syndrome and Congenital Salt-Wasting
      Bartter syndrome is a congenital condition that causes salt-wasting due to a defective channel in the loop of Henle. This results in sodium and chloride leakage, leading to hypokalemia and metabolic alkalosis. Renin and aldosterone production are increased in response to sodium and volume depletion.

      Furosemide Treatment and Loop Diuretics
      Furosemide is a loop diuretic that promotes sodium and chloride excretion, leading to potassium loss. Patients undergoing furosemide treatment may exhibit hyponatremia and hypokalemia.

    • This question is part of the following fields:

      • Endocrinology
      201.2
      Seconds
  • Question 9 - A 65-year-old postal worker underwent a routine screening appointment for abdominal aortic aneurysm...

    Incorrect

    • A 65-year-old postal worker underwent a routine screening appointment for abdominal aortic aneurysm (AAA) and was diagnosed with an AAA measuring 4.2 cm at its widest diameter. What would be the appropriate management for this patient?

      Your Answer: Three-monthly monitoring with ultrasound scanning

      Correct Answer: Annual monitoring with ultrasound scanning

      Explanation:

      Management of Abdominal Aortic Aneurysm (AAA)

      Abdominal Aortic Aneurysm (AAA) is a condition that affects men aged 65 and over, putting them at risk of developing an enlarged aorta. To manage this condition, different approaches are taken depending on the size of the aneurysm.

      Annual Monitoring with Ultrasound Scanning
      Men aged 65 and over are offered screening via ultrasound scanning during the year they turn 65. Patients diagnosed with a small AAA (3.0-4.4 cm in diameter) are invited to return annually for monitoring. They are also given lifestyle advice, including smoking cessation, diet, and exercise.

      Discharge with Reassurance
      Patients with a normal result (measurement of <3 cm in diameter) are discharged and do not require further screening tests as the condition is unlikely to progress to a dangerous extent. Three-Monthly Monitoring with Ultrasound Scanning
      Patients with a medium-sized AAA (4.5-5.4 cm in diameter) are offered three-monthly ultrasound scanning.

      Referral to a Specialist Surgeon within Two Weeks for Further Assessment
      Patients with a large AAA (5.5 cm or more in diameter) are referred to a specialist surgeon to be seen within two weeks to discuss treatment options. Surgical repair is usually advised, as long as there are no contraindications to surgery.

      Immediate Admission under a Surgical Team for Surgical Repair
      Emergency repair is not indicated for an aneurysm measuring 4.2 cm. Emergency repair is usually only indicated if a patient has a leaking or ruptured aortic aneurysm.

      Managing Abdominal Aortic Aneurysm (AAA) According to Size

    • This question is part of the following fields:

      • Vascular
      16
      Seconds
  • Question 10 - A 66-year-old man visits his primary care physician for his annual check-up, reporting...

    Incorrect

    • A 66-year-old man visits his primary care physician for his annual check-up, reporting constant fatigue and thirst. He has a medical history of hypertension, hyperlipidemia, and obesity. The doctor orders a screening for type II diabetes and the results are as follows:
      Test Result Normal Range
      HbA1C 48 mmol/mol < 53 mmol/mol (<7.0%)
      Fasting plasma glucose 7.2 mmol/l < 7 mmol/l
      Glomerular filtration rate (GFR) 90 ml/min > 90 ml/min
      Which of the following is included in the diagnostic criteria for type II diabetes?

      Your Answer: Random plasma glucose ≥10 mmol/l in a patient with classic symptoms of diabetes or hyperglycaemic crisis

      Correct Answer: Fasting plasma glucose ≥7.0 mmol/l

      Explanation:

      To diagnose diabetes, several criteria must be met. One way is to measure fasting plasma glucose levels, which should be at least 7.0 mmol/l after an eight-hour fast. Another method is to test for HbA1C levels, which should be at least 48 mmol/mol (6.5%) using a certified and standardized method. A 2-hour plasma glucose test after a 75 g glucose load should result in levels of at least 11.1 mmol/l. If a patient exhibits classic symptoms of diabetes or hyperglycemic crisis, a random plasma glucose test should show levels of at least 11.1 mmol/l. All results should be confirmed by repeat testing. It’s important to note that 1-hour plasma glucose levels are not used in the diagnostic criteria for type II diabetes, but are part of screening tests for gestational diabetes.

    • This question is part of the following fields:

      • Endocrinology
      1955.8
      Seconds
  • Question 11 - A 47-year-old female collapses at home and is referred to the medical team....

    Correct

    • A 47-year-old female collapses at home and is referred to the medical team. She has had two episodes of haematemesis in the emergency department, but no melaena. Her family denies any history of alcohol excess, and she has been otherwise healthy.

      Upon examination, the patient appears pale and sweaty with a pulse of 110 bpm. Her lying blood pressure is 95/60 mmHg, which drops by 30 mmHg systolic upon standing. Palmar erythema, purpura, and spider naevi are noted. There is no hepatomegaly, but a fullness is present in the left hypochondrium.

      What is the appropriate course of action for this patient?

      Your Answer: Emergency upper GI endoscopy

      Explanation:

      Upper Gastrointestinal Bleeding with Haemodynamic Compromise

      This patient is experiencing upper gastrointestinal bleeding and is showing signs of significant haemodynamic compromise, as indicated by her hypotension and postural drop. The most likely cause of this bleeding is variceal bleeding, which is often associated with chronic liver disease and portal hypertension. Urgent endoscopy is necessary in this case, as over 50% of patients with variceal bleeding require intervention such as banding or sclerotherapy, and the condition is associated with a high mortality rate. The underlying cause of the portal hypertension is unknown, so there is no need for vitamin supplementation unless alcohol excess is suspected.

    • This question is part of the following fields:

      • Emergency Medicine
      3338.5
      Seconds
  • Question 12 - An 80-year-old man comes to the doctor with complaints of widespread aches, bone...

    Incorrect

    • An 80-year-old man comes to the doctor with complaints of widespread aches, bone pains, headaches, and nerve entrapment syndromes that have been bothering him for several years. His blood work reveals an elevated serum alkaline phosphatase, and his urine test shows an increased urinary hydroxyproline. The X-ray of his skull displays a mix of lysis and sclerosis with thickened trabeculae. What medication would be appropriate for this patient?

      Your Answer: Chemotherapy for osteosarcoma

      Correct Answer: Oral bisphosphonates to inhibit osteoclastic activity

      Explanation:

      Treatment Options for Paget’s Disease: Oral Bisphosphonates and More

      Paget’s disease is a condition characterized by abnormal bone remodeling, which can lead to a range of symptoms including bone pain, fractures, and osteoarthritis. Diagnosis is typically made through radiograph findings and laboratory tests. Treatment options vary depending on the severity of symptoms, with physiotherapy and NSAIDs being effective for mild cases. However, for more severe cases, oral bisphosphonates and calcitonin may be necessary to inhibit osteoclastic activity. Chelation therapy, antidepressant medication, and chemotherapy for osteosarcoma are not indicated for Paget’s disease. Operative therapy may be necessary for patients with degenerative joint disease and pathological fractures, but should be preceded by treatment with oral bisphosphonates or calcitonin to reduce bleeding.

    • This question is part of the following fields:

      • Rheumatology
      419.7
      Seconds
  • Question 13 - An 80-year-old woman presents to the Emergency Department with a 3-day history of...

    Incorrect

    • An 80-year-old woman presents to the Emergency Department with a 3-day history of fever, anorexia, and right upper quadrant pain. She appears lethargic and confused about her surroundings. Upon examination, there is significant tenderness in the abdomen, particularly in the right upper quadrant. What is the probable bacterial source of her infection?

      Your Answer: Enterococcus

      Correct Answer: Escherichia

      Explanation:

      Common Bacteria Associated with Cholecystitis

      Cholecystitis is a condition characterized by inflammation of the gallbladder. The most likely cause of this condition is Escherichia, a Gram-negative bacilli belonging to the Enterobacteriaceae family. Although Enterococcus can also cause cholecystitis, E Coli is more common. Bacteroides, an obligate anaerobic, Gram-negative bacterium, is a significant component of bacterial flora on mucous membranes but is not a common cause of cholecystitis. Pseudomonas, a Gram-negative aerobic bacterium, is a far less likely cause of acute cholecystitis and is associated with lung infections in those with underlying chronic lung pathology. Proteus, another member of the Enterobacteriaceae family, is a less likely cause of acute cholecystitis and is commonly associated with urinary tract infections. Understanding the common bacteria associated with cholecystitis can aid in the diagnosis and treatment of this condition.

    • This question is part of the following fields:

      • Microbiology
      78
      Seconds
  • Question 14 - A 68-year-old man is 2 days post-op for a laparoscopic prostatectomy and experiences...

    Incorrect

    • A 68-year-old man is 2 days post-op for a laparoscopic prostatectomy and experiences difficulty breathing. He has been unable to move around since his surgery and is experiencing poorly managed pain. He has no significant medical history.
      During the examination, he is lying flat in bed and his oxygen saturation is at 95% on room air. His calves are soft and non-tender. A chest X-ray reveals basal atelectasis.
      What immediate measures should be taken to improve his breathing?

      Your Answer: 4L via nasal specs

      Correct Answer: Reposition the patient to an upright position

      Explanation:

      If the patient’s oxygen saturation levels remain low, administering high flow oxygen would not be appropriate as it is not an emergency situation. Instead, it would be more reasonable to begin with 1-2L of oxygen and reevaluate the need for further oxygen therapy, as weaning off oxygen could potentially prolong the patient’s hospital stay.

      Atelectasis is a frequent complication that can occur after surgery, where the collapse of the alveoli in the lower part of the lungs can cause breathing difficulties. This condition is caused by the blockage of airways due to the accumulation of bronchial secretions. Symptoms of atelectasis may include shortness of breath and low oxygen levels, which typically appear around 72 hours after surgery. To manage this condition, patients may be positioned upright and undergo chest physiotherapy, which includes breathing exercises.

    • This question is part of the following fields:

      • Medicine
      136.8
      Seconds
  • Question 15 - A 28-year-old male presents to the clinic with complaints of increasing pain in...

    Incorrect

    • A 28-year-old male presents to the clinic with complaints of increasing pain in his left forefoot over the past three weeks. He is an avid runner, typically running for two to three hours daily, but has never experienced this issue before. There is no history of direct injury to the foot. Upon examination, he is afebrile with a pulse rate of 88 beats per minute, blood pressure of 120/80 mmHg, and respiratory rate of 16 breaths per minute. Point tenderness is noted on the left foot, but there is no swelling. X-ray results reveal periosteal thickening, and a diagnosis of metatarsal stress fracture is made. Which metatarsal is most likely affected?

      Your Answer: Fifth

      Correct Answer: Second

      Explanation:

      Metatarsal stress fractures are commonly caused by repeated stress over time and typically occur in healthy athletes, such as runners. The second metatarsal shaft is the most frequent site of these fractures due to its firm fixation at the tarsometatarsal joint, which results in increased rigidity and a higher risk of fracture. Diagnosis is often based on clinical history and examination, as early x-rays may not show any abnormalities. The first metatarsal is the least commonly fractured due to its larger size, which requires greater force to break. On the other hand, the fifth metatarsal is the most commonly fractured as a result of direct trauma or crush injuries.

      Metatarsal fractures are a common occurrence, with the potential to affect one or multiple metatarsals. These fractures can result from direct trauma or repeated mechanical stress, known as stress fractures. The metatarsals are particularly susceptible to stress fractures, with the second metatarsal shaft being the most common site. The proximal 5th metatarsal is the most commonly fractured metatarsal, while the 1st metatarsal is the least commonly fractured.

      Fractures of the proximal 5th metatarsal can be classified as either proximal avulsion fractures or Jones fractures. Proximal avulsion fractures occur at the proximal tuberosity and are often associated with lateral ankle sprains. Jones fractures, on the other hand, are transverse fractures at the metaphyseal-diaphyseal junction and are much less common.

      Symptoms of metatarsal fractures include pain, bony tenderness, swelling, and an antalgic gait. X-rays are typically used to distinguish between displaced and non-displaced fractures, which guides subsequent management options. However, stress fractures may not appear on X-rays and may require an isotope bone scan or MRI to establish their presence. Overall, metatarsal fractures are a common injury that can result from a variety of causes and require prompt diagnosis and management.

    • This question is part of the following fields:

      • Musculoskeletal
      725
      Seconds
  • Question 16 - A mother has delivered a baby with significant microcephaly and a missing philtrum....

    Correct

    • A mother has delivered a baby with significant microcephaly and a missing philtrum. During examination, a pansystolic murmur is detected. The mother did not receive any prenatal care at this hospital and cannot remember if any abnormalities were detected during the prenatal period. What maternal prenatal occurrences could have led to the infant's abnormalities and presentation?

      Your Answer: Maternal alcohol use

      Explanation:

      If a mother experiences a primary infection between weeks 3-28 of pregnancy, the developing foetus may be affected due to deactivation while still in the womb. This can result in various features such as skin scarring, eye defects (including small eyes, cataracts, or chorioretinitis), and neurological defects (such as reduced IQ, abnormal sphincter function, and microcephaly).

      Understanding Fetal Alcohol Syndrome

      Fetal alcohol syndrome is a condition that occurs when a pregnant woman consumes alcohol, which can lead to various physical and mental abnormalities in the developing fetus. At birth, the baby may exhibit symptoms of alcohol withdrawal, such as irritability, hypotonia, and tremors.

      The features of fetal alcohol syndrome include a short palpebral fissure, a thin vermillion border or hypoplastic upper lip, a smooth or absent philtrum, learning difficulties, microcephaly, growth retardation, epicanthic folds, and cardiac malformations. These physical characteristics can vary in severity and may affect the child’s overall health and development.

      It is important for pregnant women to avoid alcohol consumption to prevent fetal alcohol syndrome and other potential complications. Early diagnosis and intervention can also help improve outcomes for children with fetal alcohol syndrome. By understanding the risks and consequences of alcohol use during pregnancy, we can work towards promoting healthier pregnancies and better outcomes for children.

    • This question is part of the following fields:

      • Paediatrics
      159.4
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  • Question 17 - A 28-year-old farmer has been admitted to the emergency department after being discovered...

    Incorrect

    • A 28-year-old farmer has been admitted to the emergency department after being discovered unconscious in a barn. Upon initial assessment, the patient is displaying agitation and combativeness, along with excessive salivation and respiratory secretions. Additionally, there are indications of sweating, urinary and fecal incontinence, muscle fasciculations, and miosis. Based on the probable diagnosis, what observations are most likely to be present?

      Your Answer: Tachycardia

      Correct Answer: Bradycardia

      Explanation:

      Organophosphate insecticide poisoning is indicated by clinical examination, especially in a patient who is a farmer. The presence of bradycardia is a significant sign of severe organophosphate poisoning, which can progress to asystole. Organophosphate poisoning stimulates the vagus nerve, leading to parasympathetic symptoms such as bradycardia and hypotension. Administering atropine to block the vagus nerve can resolve bradycardia and hypotension by providing satisfactory muscarinic antagonism.
      Hypertension is a rare occurrence in organophosphate poisoning and is caused by nicotinic effects. Hypotension is a more common finding due to vagus nerve stimulation.
      Temperature is not a reliable indicator of organophosphate poisoning as it can vary depending on the environment and can present as hypothermia, normothermia, or hyperthermia.
      Although tachycardia can occur due to nicotinic stimulation, bradycardia is a more common finding in organophosphate poisoning.

      Understanding Organophosphate Insecticide Poisoning

      Organophosphate insecticide poisoning is a condition that occurs when there is an accumulation of acetylcholine in the body, leading to the inhibition of acetylcholinesterase. This, in turn, causes an upregulation of nicotinic and muscarinic cholinergic neurotransmission. In warfare, sarin gas is a highly toxic synthetic organophosphorus compound that has similar effects. The symptoms of organophosphate poisoning can be remembered using the mnemonic SLUD, which stands for salivation, lacrimation, urination, and defecation/diarrhea. Other symptoms include hypotension, bradycardia, small pupils, and muscle fasciculation.

      The management of organophosphate poisoning involves the use of atropine, which helps to counteract the effects of acetylcholine. However, the role of pralidoxime in the treatment of this condition is still unclear. Meta-analyses conducted to date have failed to show any clear benefit of pralidoxime in the management of organophosphate poisoning.

    • This question is part of the following fields:

      • Pharmacology
      119.3
      Seconds
  • Question 18 - As part of a learning exercise, an elderly person drew a small black...

    Correct

    • As part of a learning exercise, an elderly person drew a small black square and a black circle, 4 inches horizontally apart, on a piece of white paper. The elderly person then held the paper at arm’s length and closed their left eye, while focusing on the black square, which was to the left of the black circle, with their right eye. They moved the paper slowly towards them until the black circle disappeared.
      Which of the following anatomical structures is responsible for the disappearance of the black circle?

      Your Answer: Optic disc

      Explanation:

      Anatomy of the Eye: Optic Disc, Macula Lutea, Fovea Centralis, Dilator Pupillae, and Sphincter Pupillae

      The eye is a complex organ that allows us to see the world around us. Within the eye, there are several important structures that play a role in vision. Here are five key components of the eye and their functions:

      1. Optic Disc: This is the area where the optic nerve exits the retina. It lacks photoreceptor cells, creating a blind spot in our visual field. The optic disc is lighter in color than the surrounding retina and is the point from which branches of the central retinal artery spread out to supply the retina.

      2. Macula Lutea: This small, yellow-colored area is located next to the optic disc. It has a higher visual sensitivity than other areas of the retina.

      3. Fovea Centralis: This is the central depression of the macula lutea and contains the largest number of densely compact cone photoreceptors. It has the highest visual sensitivity of any area of the retina.

      4. Dilator Pupillae: This structure is found in the iris and is innervated by sympathetic fibers. It dilates the pupillary opening.

      5. Sphincter Pupillae: Also found in the iris, this structure is innervated by parasympathetics and constricts the pupillary opening.

      Understanding the anatomy of the eye and how these structures work together is essential for maintaining good vision and identifying potential problems.

    • This question is part of the following fields:

      • Ophthalmology
      150.8
      Seconds
  • Question 19 - Samantha is a 42-year-old woman who visits her GP complaining of a burning...

    Correct

    • Samantha is a 42-year-old woman who visits her GP complaining of a burning pain on the outer part of her left knee. The pain is felt during movement and she has not observed any swelling of the knee. There is no history of injury and no locking of the knee joint. Samantha is a long-distance runner and is preparing for a marathon. During examination, there is tenderness on palpation of the lateral aspect of the joint line. She has a good range of motion of her knee joint. However, a snapping sensation is noticed on the lateral aspect of the knee when her joint is repeatedly flexed and extended. What is the most probable diagnosis?

      Your Answer: Iliotibial band syndrome

      Explanation:

      Lateral knee pain in runners is often caused by iliotibial band syndrome. This condition can result in a sharp or burning sensation around the knee joint line. Meniscal tears, on the other hand, can cause joint locking, pain, and swelling. Patellofemoral syndrome may lead to knee cap pain that worsens with stair climbing and prolonged use. Meanwhile, rheumatoid arthritis usually affects the small joints in the hands and feet initially, causing stiffness, pain, and swelling in other joints as well.

      Understanding Iliotibial Band Syndrome

      Iliotibial band syndrome is a prevalent condition that causes lateral knee pain in runners. It affects approximately 10% of people who engage in regular running. The condition is characterized by tenderness 2-3 cm above the lateral joint line.

      To manage iliotibial band syndrome, activity modification and iliotibial band stretches are recommended. These measures can help alleviate the pain and discomfort associated with the condition. However, if the symptoms persist, it is advisable to seek physiotherapy referral for further assessment and treatment.

      In summary, iliotibial band syndrome is a common condition that affects runners. It is important to recognize the symptoms and seek appropriate management to prevent further complications. With the right treatment, individuals can continue to engage in running and other physical activities without experiencing pain and discomfort.

    • This question is part of the following fields:

      • Musculoskeletal
      167.9
      Seconds
  • Question 20 - Sophie is a 6-year-old overweight girl brought in by anxious parents who are...

    Correct

    • Sophie is a 6-year-old overweight girl brought in by anxious parents who are worried about her loud snoring and frequent interruptions in breathing which have been getting progressively worse. Although she has difficulty getting up from sleep, she does not have any daytime somnolence. However, her parents have been receiving complaints from the school teachers about her disruptive and inattentive behaviour in class. They have done a lot of research on the Internet and are demanding that Sophie has her tonsils removed. On examination, Sophie has a short, thick neck and grade III tonsils, but no other abnormalities.
      Which of the following is the next best step in management?

      Your Answer: Order an overnight polysomnographic study

      Explanation:

      Childhood Obstructive Sleep Apnoea: Diagnosis and Treatment Options

      Childhood obstructive sleep apnoea (OSA) is a pathological condition that requires proper diagnosis and treatment. A polysomnographic study should be performed before any intervention is undertaken, even though adenotonsillectomy is the treatment of choice for childhood OSA. Childhood OSA is characterised by disordered breathing during sleep, which includes both apnoea and hypopnoea. Symptoms such as mouth breathing, abnormal breathing during sleep, poor sleep with frequent awakening or restlessness, nocturnal enuresis, nightmares, difficulty awakening, excessive daytime sleepiness or hyperactivity and behavioural problems are typically observed.

      It is important to reassure parents that snoring loudly is normal in children of this age, and their child’s behaviour pattern will improve as they mature. Elective adenotonsillectomy as a day procedure is an option, but a polysomnographic study should be performed first to confirm the diagnosis.

      While dental splints have a small role to play in OSA, they are not the ideal treatment option. Intranasal budesonide is an option for mild to moderate OSA, but it is only a temporising measure and not a proven effective long-term treatment. Therefore, it is important to consider all available treatment options and choose the most appropriate one for each individual case.

    • This question is part of the following fields:

      • ENT
      200.9
      Seconds
  • Question 21 - A 46-year-old man visits his GP complaining of back pain that extends to...

    Correct

    • A 46-year-old man visits his GP complaining of back pain that extends to his right leg. He has no medical history and is not on any medications. During the examination, the doctor observes sensory loss on the posterolateral part of the right leg and the lateral aspect of the foot. The patient also exhibits weakness in plantar flexion and a decreased ankle reflex. Which nerve root is the most probable cause of these symptoms?

      Your Answer: S1

      Explanation:

      The patient’s symptoms suggest an S1 lesion, as evidenced by sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test. L3, L4, and L5 are not the correct answer as their respective nerve root involvement would cause different symptoms.

      Understanding Prolapsed Disc and its Features

      A prolapsed lumbar disc is a common cause of lower back pain that can lead to neurological deficits. It is characterized by clear dermatomal leg pain, which is usually worse than the back pain. The pain is often aggravated when sitting. The features of the prolapsed disc depend on the site of compression. For instance, L3 nerve root compression can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, L4 nerve root compression can lead to sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain. It involves analgesia, physiotherapy, and exercises. According to NICE, the first-line treatment for back pain without sciatica symptoms is NSAIDs +/- proton pump inhibitors, rather than neuropathic analgesia. If the symptoms persist after 4-6 weeks, referral for consideration of MRI is appropriate. Understanding the features of prolapsed disc can help in the diagnosis and management of this condition.

    • This question is part of the following fields:

      • Musculoskeletal
      54.1
      Seconds
  • Question 22 - In which part of the gastrointestinal system is water mainly taken up? ...

    Incorrect

    • In which part of the gastrointestinal system is water mainly taken up?

      Your Answer: Transverse colon

      Correct Answer: Small intestine

      Explanation:

      The Function of the Large Intestine

      Although many people believe that the primary function of the large intestine is to absorb water, this is not entirely accurate. In fact, the majority of water and fluids that are ingested or secreted are actually reabsorbed in the small intestine, which is located before the large intestine in the digestive tract. While the large intestine does play a role in absorbing some water and electrolytes, its primary function is to store and eliminate waste products from the body. This is achieved through the formation of feces, which are then eliminated through the rectum and anus. Overall, while the large intestine is an important part of the digestive system, its function is more complex than simply absorbing water.

    • This question is part of the following fields:

      • Clinical Sciences
      363.6
      Seconds
  • Question 23 - A 27-year-old female visits her GP complaining of left-sided ear pain with discharge....

    Correct

    • A 27-year-old female visits her GP complaining of left-sided ear pain with discharge. Upon examination, the GP diagnoses otitis media and prescribes oral erythromycin due to the patient's penicillin allergy. The patient has a history of severe asthma and takes salbutamol and budesonide inhalers regularly, as well as montelukast 10 mg once daily, aminophylline (as Phyllocontin Continus) 225 mg twice daily, and receives omalizumab infusions at her local respiratory center. Which of her regular medications require a dosage adjustment while she is taking antibiotics?

      Your Answer: Aminophylline

      Explanation:

      Drug Interactions with Erythromycin

      Erythromycin is a macrolide antibiotic that is safe to use in patients with penicillin allergies. However, it has many interactions that can limit its use. Macrolide antibiotics inhibit the cytochrome P450 hepatic enzyme system, which metabolizes many drugs. This inhibition leads to drug accumulation and an increased risk of toxicity and side effects. Aminophylline is a drug used to treat bronchial asthma that inhibits phosphodiesterase and has an antagonistic effect at adenosine receptors. When co-administered with erythromycin, aminophylline levels in the serum rise, leading to adenosine receptor blockade and toxicity. Other methylxanthine derivatives, such as caffeine, can also cause toxic effects when used with macrolides. Salbutamol is a beta-2 adrenergic agonist drug used to cause bronchodilation in asthma treatment. There is a theoretical risk of increase in QT interval prolongation with this class of drugs, which is exaggerated by concurrent use of macrolide antibiotics. Budesonide is an inhaled corticosteroid used to reduce bronchoconstriction in asthma treatment. It is metabolized by the cytochrome P450 system, and there is a theoretical risk of interaction with macrolides. Omalizumab is a monoclonal antibody used in patients with severe asthma with proven IgE mediated sensitivity. It causes few drug interactions, but it may precipitate an anaphylactic reaction in susceptible individuals at administration.

      Overall, erythromycin has many drug interactions that can limit its use. It is important to be aware of these interactions and adjust drug regimens accordingly to avoid toxicity and side effects.

    • This question is part of the following fields:

      • General Practice
      68.6
      Seconds
  • Question 24 - At what age do children typically begin to play alongside their peers without...

    Correct

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

      Your Answer: 2 years

      Explanation:

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

    • This question is part of the following fields:

      • Paediatrics
      7
      Seconds
  • Question 25 - Drug X activates an enzyme Y to produce a biochemical response. Drug Z,...

    Correct

    • Drug X activates an enzyme Y to produce a biochemical response. Drug Z, when administered, will bind to the same site on Y and halt the biochemical response. What term could be used to refer to drug Z?

      Your Answer: Competitive antagonist

      Explanation:

      An agonist is a drug that binds to a receptor and causes an increase in receptor activity. The effects of an agonist are determined by efficacy of agonism and degree of receptor occupancy. An antagonist is a ligand that binds to a receptor and reduces or inhibits receptor activity, causing no biological response. The effects of an antagonist are determined by degree of receptor occupancy, affinity to the receptor, and efficacy. A competitive antagonist has a similar structure to an agonist and will bind to the same site on the same receptor. A non-competitive antagonist has a different structure to the agonist and may cause an alteration in the receptor structure or the interaction of the receptor with downstream effects in the cell.

    • This question is part of the following fields:

      • Pharmacology
      12.2
      Seconds
  • Question 26 - A 32 year old man comes to the Emergency Department complaining of left...

    Correct

    • A 32 year old man comes to the Emergency Department complaining of left knee pain that has been bothering him for the past 2 days. He denies any history of injury and reports feeling well, except for a recent episode of food poisoning after eating a kebab 2 weeks ago. He has no personal or family history of rheumatological disorders and has never had any sexually transmitted infections. Upon examination, the knee appears swollen, red, and tender. Aspiration of the joint reveals clear fluid without white blood cells or crystals. What is the most probable diagnosis?

      Your Answer: Reactive arthritis

      Explanation:

      Septic arthritis and gout or pseudogout can be ruled out due to the lack of white cells and crystals. If there is a painful swelling behind the knee without erythema, it may indicate a ruptured baker’s cyst. However, in this case, the diagnosis is reactive arthritis (previously known as Reiter’s arthritis), which is linked to chlamydia and gonorrhoeae, as well as gastroenteritis.

      Understanding Reactive Arthritis: Symptoms and Features

      Reactive arthritis is a type of seronegative spondyloarthropathy that is associated with HLA-B27. It was previously known as Reiter’s syndrome, which was characterized by a triad of urethritis, conjunctivitis, and arthritis following a dysenteric illness during World War II. However, later studies revealed that patients could also develop symptoms after a sexually transmitted infection, now referred to as sexually acquired reactive arthritis (SARA).

      Reactive arthritis is defined as an arthritis that develops after an infection, but the organism cannot be recovered from the joint. The symptoms typically develop within four weeks of the initial infection and last for around 4-6 months. Approximately 25% of patients experience recurrent episodes, while 10% develop chronic disease. The arthritis is usually an asymmetrical oligoarthritis of the lower limbs, and patients may also experience dactylitis.

      Other symptoms of reactive arthritis include urethritis, conjunctivitis (seen in 10-30% of patients), and anterior uveitis. Skin symptoms may also occur, such as circinate balanitis (painless vesicles on the coronal margin of the prepuce) and keratoderma blennorrhagica (waxy yellow/brown papules on palms and soles). A helpful mnemonic to remember the symptoms of reactive arthritis is Can’t see, pee, or climb a tree.

      In conclusion, understanding the symptoms and features of reactive arthritis is crucial for early diagnosis and treatment. While the condition can be recurrent or chronic, prompt management can help alleviate symptoms and improve quality of life for affected individuals.

    • This question is part of the following fields:

      • Musculoskeletal
      154.8
      Seconds
  • Question 27 - A 21-year-old male is brought into resus by an ambulance after being found...

    Incorrect

    • A 21-year-old male is brought into resus by an ambulance after being found extremely drowsy by his roommate, who wasn't able to bring him round. The patient is borderline unconscious, with widespread clonus, extreme diaphoresis and dilated pupils. His temperature was taken and it read at 41.6ºC. When asked, the roommate states he is not completely aware of the patient's past medical history but knows he has suffered from depression. He has also been asked to buy strange medicine from the shops for him but he cannot remember the name.
      What is the most likely diagnosis in this patient?

      Your Answer: Neuroleptic malignant syndrome

      Correct Answer: Serotonin syndrome

      Explanation:

      Serotonin syndrome may occur due to the interaction between St. John’s Wort and SSRIs, which the patient may have taken for their depression.

      Understanding Serotonin Syndrome

      Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the body. It can be triggered by a variety of medications and substances, including monoamine oxidase inhibitors, SSRIs, St John’s Wort, tramadol, ecstasy, and amphetamines. The condition is characterized by neuromuscular excitation, hyperreflexia, myoclonus, rigidity, autonomic nervous system excitation, hyperthermia, sweating, and altered mental state, including confusion.

      Management of serotonin syndrome is primarily supportive, with IV fluids and benzodiazepines used to manage symptoms. In more severe cases, serotonin antagonists such as cyproheptadine and chlorpromazine may be used. It is important to note that serotonin syndrome can be easily confused with neuroleptic malignant syndrome, which has similar symptoms but is caused by a different mechanism. Both conditions can cause a raised creatine kinase (CK), but it tends to be more associated with NMS. Understanding the causes, features, and management of serotonin syndrome is crucial for healthcare professionals to ensure prompt and effective treatment.

    • This question is part of the following fields:

      • Pharmacology
      172.3
      Seconds
  • Question 28 - A 40-year-old man presents with pyrexia, night sweats and has recently noticed changes...

    Correct

    • A 40-year-old man presents with pyrexia, night sweats and has recently noticed changes to his fingernails. He has no past medical history except he remembers that as a child he was in hospital with inflamed, painful joints, and a very fast heartbeat following a very sore throat.
      What is the most likely diagnosis?

      Your Answer: Infective endocarditis

      Explanation:

      Differential Diagnosis for a Patient with Pyrexia and Splinter Haemorrhages

      The patient’s past medical history suggests a possible case of rheumatic fever, which can lead to valvular damage and increase the risk of infective endocarditis later in life. The current symptoms of pyrexia, night sweats, and splinter haemorrhages point towards a potential diagnosis of infective endocarditis. There are no clinical signs of septic arthritis, hepatitis, or pneumonia. Aortic regurgitation may present with different symptoms such as fatigue, syncope, and shortness of breath, but it is less likely in this case. Overall, the differential diagnosis for this patient includes infective endocarditis as the most probable diagnosis.

    • This question is part of the following fields:

      • Cardiology
      179.2
      Seconds
  • Question 29 - A 75-year-old man visited his GP complaining of sudden, painless vision loss in...

    Incorrect

    • A 75-year-old man visited his GP complaining of sudden, painless vision loss in his right eye that occurred 2 hours ago. He has a medical history of type 2 diabetes requiring insulin, hypertension, and dyslipidemia. Upon further inquiry, he mentioned experiencing brief flashes of light before a dense shadow that began in the periphery and moved towards the center. What is the probable diagnosis?

      Your Answer: Vitreous haemorrhage

      Correct Answer: Retinal detachment

      Explanation:

      Retinal detachment is a condition that can cause a sudden and painless loss of vision. It is characterized by a dense shadow that starts in the peripheral vision and gradually moves towards the center, along with increased floaters and flashes of light.

      Central retinal artery occlusion, on the other hand, is a condition where the blood flow to the retina of one eye is blocked, resulting in sudden loss of vision in that eye. This is usually caused by an embolus and does not typically present with floaters, flashing lights, or dense shadows.

      Similarly, central retinal vein occlusion can cause sudden vision loss in one eye, but it is often described as blurry or distorted vision rather than the symptoms seen in retinal detachment.

      Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.

      Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.

      Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.

    • This question is part of the following fields:

      • Ophthalmology
      36.9
      Seconds
  • Question 30 - A 46-year-old alcoholic is brought in after a fall. He has a deep...

    Incorrect

    • A 46-year-old alcoholic is brought in after a fall. He has a deep cut on the side of his head and a witness tells the paramedics what happened. He opens his eyes when prompted by the nurses. He attempts to answer questions, but his speech is slurred and unintelligible. The patient pulls away from a trapezius pinch.
      What is the appropriate Glasgow Coma Scale (GCS) score for this patient?

      Your Answer:

      Correct Answer: E3V2M4

      Explanation:

      Understanding the Glasgow Coma Scale

      The Glasgow Coma Scale (GCS) is a standardized tool used to assess a patient’s level of consciousness following a head injury. It measures the best eye, verbal, and motor responses and assigns a total score. A fully conscious patient will score 15/15, while the lowest possible score is 3/15 (a score of 0 is not possible).

      The GCS is calculated as follows: for eyes, a score of 4 is given if they open spontaneously, 3 if they open to speech, 2 if they open to pain, and 1 if they do not open. For verbal response, a score of 5 is given if the patient is oriented, 4 if they are confused, 3 if they use inappropriate words, 2 if they make inappropriate sounds, and 1 if there is no verbal response. For motor response, a score of 6 is given if the patient obeys commands, 5 if they localize pain, 4 if they withdraw from pain, 3 if they exhibit abnormal flexion, 2 if they exhibit abnormal extension, and 1 if there is no response.

      If the GCS score is 8 or below, the patient will require airway protection as they will be unable to protect their own airway. This usually means intubation. It is important to use the GCS to objectively measure a patient’s conscious state and provide a common language between clinicians when discussing a patient with a head injury.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

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Surgery (1/2) 50%
Gynaecology (0/2) 0%
Renal (1/1) 100%
Medicine (1/2) 50%
Endocrinology (1/2) 50%
Vascular (0/1) 0%
Emergency Medicine (1/1) 100%
Rheumatology (0/1) 0%
Microbiology (0/1) 0%
Musculoskeletal (3/4) 75%
Paediatrics (2/2) 100%
Pharmacology (1/3) 33%
Ophthalmology (1/2) 50%
ENT (1/1) 100%
Clinical Sciences (0/1) 0%
General Practice (1/1) 100%
Cardiology (1/1) 100%
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