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  • Question 1 - The parents of a 7-year-old boy seek your consultation regarding their son's lifelong...

    Incorrect

    • The parents of a 7-year-old boy seek your consultation regarding their son's lifelong bed wetting problem. They are worried that the issue is not improving despite his age. The boy has never had any daytime accidents and has regular bowel movements. He was potty-trained at the age of 3 and has no relevant family history except for hay fever. Physical examination shows no abnormalities, and urinalysis is normal. The parents are particularly concerned as their son is going on a camping trip with his friend's parents in 2 weeks, and they do not want him to wet the bed. What is the most appropriate management plan?

      Your Answer: Give general advice on enuresis, reassure the parents that he is almost certain to grow out of the problem and commence treatment with an enuresis alarm to prepare him for his camping trip and advise to restrict fluid from 1600 h to prevent bedwetting during the camping trip

      Correct Answer: Give general advice on enuresis, reassure the parents that he is almost certain to grow out of the problem and prescribe desmopressin to be taken during the camping trip to prevent bedwetting

      Explanation:

      Managing Primary Enuresis in Children: Advice and Treatment Options

      Primary enuresis, or bedwetting, is a common condition affecting 15-20% of children. It is characterized by nocturnal enuresis without daytime symptoms and is thought to be caused by bladder dysfunction. However, parents can be reassured that most children will grow out of the problem by the age of 15, with only 1% continuing to have symptoms into adulthood.

      The first-line treatment for primary enuresis without daytime symptoms is an enuresis alarm combined with a reward system. Fluid should not be restricted, and the child should be involved in the management plan. However, if short-term control is required, a prescription of desmopressin can be given to children over 5 years of age.

      It is important to refer children to a pediatric urologist if they have primary enuresis with daytime symptoms or if two complete courses of either an enuresis alarm or desmopressin have failed to resolve the child’s symptoms.

      Overall, while there may be little that can be done to cure the problem prior to a camping trip, there are still treatment options available to manage primary enuresis in children.

    • This question is part of the following fields:

      • Paediatrics
      40.4
      Seconds
  • Question 2 - To evaluate the effectiveness of a home cholesterol testing kit, a group of...

    Incorrect

    • To evaluate the effectiveness of a home cholesterol testing kit, a group of 500 individuals under the age of 40 were recruited. Each participant provided a blood sample for analysis. The results showed that 480 individuals had normal cholesterol levels and 20 individuals had high cholesterol levels. What is the sensitivity of the test?

      Your Answer: 2%

      Correct Answer: 98%

      Explanation:

      Specificity in Medical Testing

      Specificity is a crucial concept in medical testing that refers to the accuracy of a test in identifying individuals who do not have a particular condition. In simpler terms, it measures the proportion of people who are correctly identified as not having the condition by the test. For instance, if a test has a specificity of 98%, it means that 98 out of 100 people who do not have the condition will be correctly identified as negative by the test.

      To calculate specificity, we use the formula: Specificity = True Negative / (False Positive + True Negative). This means that we divide the number of true negatives (people who do not have the condition and are correctly identified as negative) by the sum of false positives (people who do not have the condition but are incorrectly identified as positive) and true negatives.

      It is important to note that highly specific tests are useful for ruling conditions in, which means that if the test is positive, the person is very likely to have the disease. However, it is rare to find tests with 100% sensitivity and/or specificity, including pregnancy tests. Therefore, it is crucial to interpret test results in conjunction with other clinical information and to consult with a healthcare professional for proper diagnosis and treatment.

      In summary, specificity is essential in medical testing as it helps to determine the accuracy of a test in identifying individuals who do not have a particular condition. By using the formula and interpreting test results in conjunction with other clinical information, healthcare professionals can make informed decisions about diagnosis and treatment.

    • This question is part of the following fields:

      • Clinical Sciences
      7.6
      Seconds
  • Question 3 - A 25-year-old university student comes to the Emergency Department following a fireworks injury....

    Correct

    • A 25-year-old university student comes to the Emergency Department following a fireworks injury. She reports experiencing intense pain in her forearm. Upon examination, her left forearm appears pale pink and is extremely sensitive, with visible blisters. You conduct a palpation of the affected area and find no loss of sensation throughout the region.
      What is the probable diagnosis?

      Your Answer: Second-degree, superficial

      Explanation:

      Different Types of Burns and Their Characteristics

      Burns can be classified into different types based on their severity and depth of tissue damage. Understanding the characteristics of each type of burn is important for proper management and treatment.

      First-degree burn: This type of burn affects only the epidermis and presents with redness, pain, and mild swelling. Blisters are not a feature of this type of burn.

      Second-degree, superficial burn: This type of burn affects the epidermis and part of the dermis, resulting in pink-colored skin with painful blisters. Management involves cleansing the wound, leaving the blisters intact, using a non-adherent dressing, and reviewing in 24 hours.

      Second-degree, deep burn: This type of burn affects the epidermis and deeper layers of the dermis, resulting in waxy skin with reduced blanching to pressure and reduced sensation. It is frequently less painful than superficial dermal burns.

      Third-degree burn: This type of burn affects the epidermis and all of the dermis, resulting in white/brown/black-colored skin without pain or blister formation. The skin will be dry and leathery and will not heal.

      Mixed-depth burn: This type of burn involves features of different types of burns and requires individualized management.

      Understanding the characteristics of each type of burn is crucial for proper management and treatment.

    • This question is part of the following fields:

      • Plastics
      18
      Seconds
  • Question 4 - A 72-year-old woman presents to the General Practitioner complaining of ‘bulging blue veins’...

    Incorrect

    • A 72-year-old woman presents to the General Practitioner complaining of ‘bulging blue veins’ on her legs. While examining the patient’s legs, you note the presence of tortuous, dilated veins, accompanied by brown patches of pigmentation and dry, scaly plaques of skin. A diagnosis of varicose veins is made.
      Which vein is most likely to be affected?

      Your Answer: Cephalic vein

      Correct Answer: Long saphenous vein

      Explanation:

      Understanding the Venous System and Varicose Veins

      Varicose veins are a common condition that affects the superficial venous system. The long saphenous vein, which ascends the medial side of the leg and passes anteriorly to the medial malleolus of the ankle, is the most common cause of varicose veins. However, insufficiencies in the deep venous system, such as the femoral vein and popliteal vein, can also contribute to chronic venous insufficiency.

      It is important to note that not all superficial veins are affected by varicose veins. The cephalic vein, for example, is an upper limb vein and is not likely to be affected. The short saphenous vein, which ascends the posterior side of the leg and passes posteriorly to the lateral malleolus of the ankle, can also cause varicose veins but is not the most common distribution.

      Understanding the different veins in the venous system and their potential for insufficiency can help in the diagnosis and treatment of varicose veins and other venous conditions. It is important to consult with a healthcare professional for proper evaluation and management.

    • This question is part of the following fields:

      • Vascular
      17.8
      Seconds
  • Question 5 - A 38-year-old woman, who lived alone, scheduled a follow-up appointment with her GP....

    Correct

    • A 38-year-old woman, who lived alone, scheduled a follow-up appointment with her GP. She had been self-isolating at home for several months due to the COVID-19 pandemic and continued to feel anxious about going out even after the lockdown was lifted.

      Prior to the pandemic, she had experienced a traumatic event and was struggling with post-traumatic stress disorder (PTSD). She had also recently lost her job and was facing financial difficulties.

      During a telephone consultation with her GP 4 weeks ago, she was diagnosed with moderate depression and referred for computerised cognitive behavioural therapy. She was also advised to increase her physical activity levels.

      However, her mental health had since deteriorated, and she was experiencing difficulty sleeping, early morning awakening, and occasional thoughts of self-harm. She expressed reluctance to engage in one-to-one psychological treatments.

      The GP discussed the next steps in managing her depression and PTSD.

      What treatment options should be considered for this patient?

      Your Answer: Commence citalopram

      Explanation:

      For patients with ‘less severe’ depression, SSRIs are the recommended first-line antidepressant. However, in the case of a patient with moderate depression who is not responding well to low-level therapy and has refused psychological treatments, an antidepressant should be offered. While mirtazapine and venlafaxine are valid options, they are not considered first-line. NICE recommends considering the higher likelihood of patients stopping treatment with venlafaxine due to side effects and its higher cost compared to SSRIs, which are equally effective. Mirtazapine and venlafaxine are typically reserved as second-line agents when the response to an SSRI has been poor. NICE advises offering an SSRI first-line as they have fewer side effects than other antidepressants and are just as effective. In this patient’s case, referral to a crisis team is unlikely as he has not expressed any true suicidal plans or intent.

      In 2022, NICE updated its guidelines on managing depression and now classifies it as either less severe or more severe based on a patient’s PHQ-9 score. For less severe depression, NICE recommends discussing treatment options with patients and considering the least intrusive and resource-intensive treatment first. Antidepressant medication should not be routinely offered as first-line treatment unless it is the patient’s preference. Treatment options for less severe depression include guided self-help, group cognitive behavioral therapy, group behavioral activation, individual CBT or BA, group exercise, group mindfulness and meditation, interpersonal psychotherapy, SSRIs, counseling, and short-term psychodynamic psychotherapy. For more severe depression, NICE recommends a shared decision-making approach and suggests a combination of individual CBT and an antidepressant as the preferred treatment option. Other treatment options for more severe depression include individual CBT or BA, antidepressant medication, individual problem-solving, counseling, short-term psychodynamic psychotherapy, interpersonal psychotherapy, guided self-help, and group exercise.

    • This question is part of the following fields:

      • Psychiatry
      11.1
      Seconds
  • Question 6 - What are the characteristics of Brown-Sequard syndrome? ...

    Correct

    • What are the characteristics of Brown-Sequard syndrome?

      Your Answer: There is loss of motor function ipsilateral to the lesion

      Explanation:

      Brown-Sequard Syndrome

      Brown-Sequard syndrome is a condition that results in the loss of motor function on one side of the body and the loss of pain and temperature sensation on the opposite side. This syndrome is typically caused by a penetrating injury to the spinal cord. Despite the severity of the injury, Brown-Sequard syndrome has a relatively good prognosis compared to other incomplete spinal cord syndromes.

      To summarise, Brown-Sequard syndrome is characterised by a specific set of symptoms that occur as a result of a spinal cord injury. While it can be a serious condition, it is important to note that it has a better prognosis than other incomplete spinal cord syndromes. the symptoms and causes of Brown-Sequard syndrome can help individuals better manage and cope with this condition.

    • This question is part of the following fields:

      • Neurology
      5.3
      Seconds
  • Question 7 - A 32-year-old female presents to the emergency department with abdominal pain and inability...

    Incorrect

    • A 32-year-old female presents to the emergency department with abdominal pain and inability to urinate for the past 3 days. She has been taking antibiotics prescribed by her primary care physician for a urinary tract infection. She has been able to eat, drink, and have a bowel movement today. Her medical history includes irritable bowel syndrome and depression, which is managed with sertraline. She had her last menstrual period a week ago, and she does not experience heavy menstrual bleeding. What is the most probable cause of her symptoms?

      Your Answer:

      Correct Answer: Lower urinary tract infection

      Explanation:

      Acute urinary retention can be caused by a lower urinary tract infection, as seen in this patient. Urethritis and urethral edema resulting from the infection can lead to the retention. While sertraline may cause abdominal pain, constipation, or diarrhea, acute urinary retention is not a typical side effect of the medication.

      Acute urinary retention is a condition where a person suddenly becomes unable to pass urine voluntarily, typically over a period of hours or less. It is a common urological emergency that requires investigation to determine the underlying cause. While it is more common in men, it rarely occurs in women, with an incidence ratio of 13:1. Acute urinary retention is most frequently seen in men over 60 years of age, and the incidence increases with age. It has been estimated that around a third of men in their 80s will develop acute urinary retention over a five-year period.

      The most common cause of acute urinary retention in men is benign prostatic hyperplasia, a non-cancerous enlargement of the prostate gland that presses on the urethra, making it difficult for the bladder to empty. Other causes include urethral obstructions, such as strictures, calculi, cystocele, constipation, or masses, as well as certain medications that affect nerve signals to the bladder. In some cases, there may be a neurological cause for the condition. Acute urinary retention can also occur postoperatively and in women postpartum, typically due to a combination of risk factors.

      Patients with acute urinary retention typically experience an inability to pass urine, lower abdominal discomfort, and considerable pain or distress. Elderly patients may also present with an acute confusional state. Unlike chronic urinary retention, which is typically painless, acute urinary retention is associated with pain and discomfort. A palpable distended urinary bladder may be detected on abdominal or rectal examination, and lower abdominal tenderness may also be present. All patients should undergo a rectal and neurological examination, and women should also have a pelvic examination.

      To confirm the diagnosis of acute urinary retention, a bladder ultrasound should be performed. The bladder volume should be greater than 300 cc to confirm the diagnosis, but if the history and examination are consistent with acute urinary retention, an inconsistent bladder scan does not rule out the condition. Acute urinary retention is managed by decompressing the bladder via catheterisation. Further investigation should be targeted by the likely cause, and patients may require IV fluids to correct any temporary over-diuresis that may occur as a complication.

    • This question is part of the following fields:

      • Surgery
      0
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  • Question 8 - A 9-week-old boy is presented to his GP by his parents who are...

    Incorrect

    • A 9-week-old boy is presented to his GP by his parents who are concerned about an undescended testis. The patient was born at term following an uncomplicated pregnancy and birth and has been healthy since birth. On examination, the left testicle is not palpable in the scrotal sac and is unretractable, while the right testicle has fully descended. What is the most suitable next step in managing this patient?

      Your Answer:

      Correct Answer: Review in 1 month

      Explanation:

      If a male child’s testes have not descended by 3 months of age, it is important to refer them for further evaluation. In the case of a 2-month-old child with a unilateral undescended testicle, the appropriate course of action is to review the situation again in 1 month. It is crucial to monitor the child’s condition as undescended testes can increase the risk of testicular cancer and infertility. While there is a chance that the testicle may descend on its own, it is important to ensure that it does so. Reassurance without follow-up would not be appropriate in this case. If the child were over 3 months of age, a routine referral would be necessary, but in this scenario, the child is only 2 months old. An urgent referral is not necessary at this stage. Waiting until the child is 1 year old to review the case would be inappropriate. If the testicle remains undescended by 3 months of age, the child should be referred to paediatric surgery for orchidopexy by 18 months of age.

      Undescended Testis: Causes, Complications, and Management

      Undescended testis is a condition that affects around 2-3% of male infants born at term, but it is more common in preterm babies. Bilateral undescended testes occur in about 25% of cases. This condition can lead to complications such as infertility, torsion, testicular cancer, and psychological issues.

      To manage unilateral undescended testis, NICE CKS recommends considering referral from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age. Orchidopexy, a surgical procedure, is typically performed at around 1 year of age, although surgical practices may vary.

      For bilateral undescended testes, it is crucial to have the child reviewed by a senior paediatrician within 24 hours as they may require urgent endocrine or genetic investigation. Proper management of undescended testis is essential to prevent complications and ensure the child’s overall health and well-being.

    • This question is part of the following fields:

      • Paediatrics
      0
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  • Question 9 - A 38-year-old overweight female has just undergone an elective laparoscopic cholecystectomy for gallstone...

    Incorrect

    • A 38-year-old overweight female has just undergone an elective laparoscopic cholecystectomy for gallstone disease. On the first day after the surgery, the nurse in charge asks you to review her as she is complaining of severe pain in the right upper quadrant. Upon examination, you find that she is tachycardic but normotensive and apyrexial. The patient's right upper quadrant is tender to palpation, but there is no evidence of jaundice. Additionally, the intra-abdominal drain in-situ has a small volume of green liquid draining from it. What is the most likely postoperative complication?

      Your Answer:

      Correct Answer: Biliary leak

      Explanation:

      If a patient experiences tenderness in the right upper quadrant and bilious fluid is present in the intra-abdominal drain after a cholecystectomy, it may indicate a bile leak. However, since the patient is not running a fever and has normal blood pressure, it is unlikely that they have an intra-abdominal collection or hemorrhage. Although a laparoscopic cholecystectomy can result in perforation, the patient would typically develop peritonitis rather than localized tenderness in the right upper quadrant. Lastly, an ileus would not cause pain in the right upper quadrant or the presence of bilious fluid in the drain.

      Complications can occur in all types of surgery and require vigilance in their detection. Anticipating likely complications and appropriate avoidance can minimize their occurrence. Understanding the anatomy of a surgical field will allow appreciation of local and systemic complications that may occur. Physiological and biochemical derangements may also occur, and appropriate diagnostic modalities should be utilized. Safe and timely intervention is the guiding principle for managing complications.

    • This question is part of the following fields:

      • Surgery
      0
      Seconds
  • Question 10 - In which part of the kidney does ADH mainly have an impact? ...

    Incorrect

    • In which part of the kidney does ADH mainly have an impact?

      Your Answer:

      Correct Answer: Collecting duct

      Explanation:

      ADH Role in Water Reabsorption

      ADH primarily affects the collecting duct, where it alters the permeability to water, resulting in the reabsorption of water and further concentration of urine. In simpler terms, ADH is a last-minute adjustment of the water content in urine. Its primary function is to regulate the amount of water in the body by controlling the amount of water that is excreted in urine. When the body is dehydrated, ADH levels increase, causing the kidneys to reabsorb more water and produce less urine. Conversely, when the body is well-hydrated, ADH levels decrease, resulting in the excretion of more water and the production of more dilute urine. Overall, ADH plays a crucial role in maintaining the body’s water balance.

    • This question is part of the following fields:

      • Clinical Sciences
      0
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  • Question 11 - An 82-year-old man presents to his General Practitioner (GP) with a 4-month history...

    Incorrect

    • 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:

      Correct 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
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  • Question 12 - You are asked to assess a woman who has given birth to her...

    Incorrect

    • You are asked to assess a woman who has given birth to her third child 2 hours ago. The baby was born at term, weighed 4.2kg, and was in good health. She had a natural delivery that lasted for 7 hours, and opted for a physiological third stage. According to the nurse, she has lost around 750ml of blood, but her vital signs are stable and the bleeding seems to be decreasing. What is the leading reason for her blood loss?

      Your Answer:

      Correct Answer: Uterine atony

      Explanation:

      PPH, which is the loss of 500ml or more from the genital tract within 24 hours of giving birth, is primarily caused by uterine atony. It can be classified as minor (500-1000ml) or major (>1000ml) and has a mortality rate of 6 deaths/million deliveries. The causes of PPH can be categorized into the ‘four T’s’: tone, tissue (retained placenta), trauma, and thrombin (coagulation abnormalities).

      Understanding Postpartum Haemorrhage

      Postpartum haemorrhage (PPH) is a condition where a woman experiences blood loss of more than 500 ml after giving birth vaginally. It can be classified as primary or secondary. Primary PPH occurs within 24 hours after delivery and is caused by the 4 Ts: tone, trauma, tissue, and thrombin. The most common cause is uterine atony. Risk factors for primary PPH include previous PPH, prolonged labour, pre-eclampsia, increased maternal age, emergency Caesarean section, and placenta praevia.

      In managing PPH, it is important to involve senior staff immediately and follow the ABC approach. This includes two peripheral cannulae, lying the woman flat, blood tests, and commencing a warmed crystalloid infusion. Mechanical interventions such as rubbing up the fundus and catheterisation are also done. Medical interventions include IV oxytocin, ergometrine, carboprost, and misoprostol. Surgical options such as intrauterine balloon tamponade, B-Lynch suture, ligation of uterine arteries, and hysterectomy may be considered if medical options fail to control the bleeding.

      Secondary PPH occurs between 24 hours to 6 weeks after delivery and is typically due to retained placental tissue or endometritis. It is important to understand the causes and risk factors of PPH to prevent and manage this life-threatening emergency effectively.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 13 - A 67-year-old man presents with a complaint of passing small amounts of fresh...

    Incorrect

    • A 67-year-old man presents with a complaint of passing small amounts of fresh red blood with his stool. He also reports a small amount of mucous discharge with his stool and feeling pruritic and sore around his anus for the past couple of days. The patient denies any pain but has been more constipated than usual over the past few months. He denies any recent weight loss and has a BMI of approximately 35. The patient has a history of hypercholesterolaemia and chronic obstructive pulmonary disease. He recently completed a 7-day course of amoxicillin for a lower respiratory tract infection 5 days ago. What is the most likely cause of his rectal bleeding?

      Your Answer:

      Correct Answer: Haemorrhoids

      Explanation:

      Differential Diagnosis for Rectal Bleeding: Haemorrhoids, Colon Cancer, Diverticulitis, Anal Fissure, and Ulcerative Colitis

      Rectal bleeding can be a concerning symptom for patients and healthcare providers alike. In this case, the patient has multiple risk factors for haemorrhoids, which are the most likely cause of his symptoms. However, it is important to consider other potential diagnoses, such as colon cancer, diverticulitis, anal fissure, and ulcerative colitis.

      Haemorrhoids are caused by increased pressure in the blood vessels around the anus, which can be exacerbated by obesity, chronic constipation, and coughing. Symptoms include fresh red blood and mucous after passing stool, a pruritic anus, and soreness around the anus.

      Colon cancer is less likely in this case, as it typically presents with a change in bowel habit and blood in the stool, but not with a pruritic, sore anus. However, if there is no evidence of haemorrhoids on examination, colonoscopy may be recommended to rule out cancer.

      Diverticulitis is characterised by passing fresh, red blood per rectum, as well as nausea and vomiting, pyrexia, and abdominal pain.

      Anal fissure also involves the passage of small amounts of fresh red blood with stools, but is associated with sharp anal pain when stools are passed.

      Ulcerative colitis can be associated with passage of blood and mucous with stools, as well as weight loss, diarrhoea, anaemia, and fatigue. The patient has some risk factors for ulcerative colitis, which has two peak ages for diagnosis: 15-35 and 50-70 years old.

      In summary, while haemorrhoids are the most likely cause of this patient’s symptoms, it is important to consider other potential diagnoses and perform appropriate testing to rule out more serious conditions.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - A 30-year old man with severe learning disabilities and a known low IQ...

    Incorrect

    • A 30-year old man with severe learning disabilities and a known low IQ is being seen by his GP for review of his asthma medication. The GP believes that a slight adjustment to his treatment plan could improve his management. The patient resides in Scotland.
      Would this patient be able to provide consent for this minor modification to his treatment?

      Your Answer:

      Correct Answer: Maybe – it depends on an assessment of their capacity to consent

      Explanation:

      Consent and Learning Disabilities: Assessing Capacity for Treatment Changes

      When it comes to making changes to a patient’s treatment plan, it’s important to consider their capacity to consent. If the patient has a learning disability, this does not automatically mean they cannot give valid consent. Under the Adults with Incapacity (Scotland) Act 2000, a doctor must assess the patient’s capacity to understand the treatment and its risks and benefits. If the patient is deemed unable to consent, the doctor should act in their best interest after consulting with their nearest relative, carer, or legal guardian.

      However, if the patient is an adult and has capacity, they can consent to treatment changes themselves. It’s important to seek their capacity to consent, regardless of whether the change is small or large. Living arrangements also do not affect a patient’s ability to consent. Ultimately, the focus should be on ensuring the patient understands the proposed treatment and can make an informed decision.

    • This question is part of the following fields:

      • Ethics And Legal
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  • Question 15 - A 1-day-old child is found to have absent femoral pulses and a systolic...

    Incorrect

    • A 1-day-old child is found to have absent femoral pulses and a systolic ejection murmur over the left side of their chest and back upon their routine examination. Their brachial pulses are strong. They appear pale and are tachypnoeic. They have not managed to eat much solid food, as they become distressed.

      Which of the following statements about their condition is true?

      Your Answer:

      Correct Answer: May be treated by balloon angioplasty with or without stenting

      Explanation:

      Coarctation of the Aorta: Diagnosis and Treatment Options

      Coarctation of the aorta is a congenital condition that causes narrowing of the aorta, most commonly at the site of insertion of the ductus arteriosus. Diagnosis can be made antenatally or after birth upon newborn examination. Treatment options include surgical repair or balloon angioplasty and/or stenting. If diagnosed antenatally, prostaglandin is given to encourage the ductus arteriosus to remain patent until repair is performed. Less severe cases can present in older children with symptoms such as leg pain, tiredness, dizzy spells, or an incidental finding of a murmur. Following repair, there are rarely any long-term complications, but re-coarctation can occur. Balloon angioplasty, with or without stenting, can be used in some circumstances, rather than surgical reconstruction. It is important to monitor for hypertension and/or premature cardiovascular or cerebrovascular disease in adults with a previous history of coarctation of the aorta.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 16 - A 56-year-old man has just been admitted to the medical ward. Two days...

    Incorrect

    • A 56-year-old man has just been admitted to the medical ward. Two days ago, he returned from a business trip and his history suggests he may have caught an atypical pneumonia. While examining the patient’s chest clinically, you try to determine whether the pneumonia is affecting one lobe in particular or is affecting the whole lung.
      On the right side of the patient’s chest, which one of the following surface landmarks would be most likely to mark the boundary between the middle and lower lobes?

      Your Answer:

      Correct Answer: Sixth rib

      Explanation:

      Surface Landmarks for Lung Lobes and Abdominal Planes

      The human body has several surface landmarks that can be used to locate important anatomical structures. In the case of the lungs, the position of the lobes can be estimated using the oblique and horizontal fissures. The sixth rib is the most likely surface landmark to mark the boundary between the right middle and lower lobes, while the fourth costal cartilage indicates the level of the horizontal fissure separating the superior from the middle lobes of the right lung.

      In the abdomen, the tip of the ninth costal cartilage is a useful landmark as it marks the position of the transpyloric plane. This imaginary axial plane is important as it is where many anatomical structures, such as the pylorus of the stomach and the neck of the pancreas, are located. Additionally, the horizontal line passing through the centre of the nipple, known as the mammillary line, can also be used as a surface landmark for certain procedures.

    • This question is part of the following fields:

      • Respiratory
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  • Question 17 - A mother brings her 18-day old baby to the emergency department with visible...

    Incorrect

    • A mother brings her 18-day old baby to the emergency department with visible jaundice and distress. The baby has been feeding poorly since yesterday. Upon examination, hepatomegaly and splenomegaly are observed. The newborn jaundice screen shows no infection, normal thyroid function tests, raised conjugated bilirubin, liver transaminases, and bile acids. Reducing substances are absent in the urine. What is the initial management option for the most probable diagnosis?

      Your Answer:

      Correct Answer: Surgical intervention

      Explanation:

      Biliary atresia is diagnosed when a newborn presents with prolonged jaundice, hepatomegaly, splenomegaly, abnormal growth, and cardiac murmurs. Surgery is the preferred treatment, specifically a hepatoportoenterostomy (HPE), also known as Kasai portoenterostomy. This procedure removes the blocked bile ducts and replaces them with a segment of the small intestine, restoring bile flow from the liver to the proximal small bowel. Ursodeoxycholic acid may be given as an adjuvant after surgery to facilitate bile flow and protect the liver. However, it should not be given if the total bilirubin is >256.6 micromol/L (>15 mg/dL). Frequent monitoring is not sufficient, urgent action is required. Liver transplant is not the first-line treatment, but may be considered if HPE is unsuccessful or if there are signs of end-stage liver disease, progressive cholestasis, hepatocellular decompensation, or severe portal hypertension.

      Understanding Biliary Atresia in Neonatal Children

      Biliary atresia is a condition that affects the extrahepatic biliary system in neonatal children, resulting in an obstruction in the flow of bile. This condition is more common in females than males and occurs in 1 in every 10,000-15,000 live births. There are three types of biliary atresia, with type 3 being the most common. Patients typically present with jaundice, dark urine, pale stools, and abnormal growth.

      To diagnose biliary atresia, doctors may perform various tests, including serum bilirubin, liver function tests, serum alpha 1-antitrypsin, sweat chloride test, and ultrasound of the biliary tree and liver. Surgical intervention is the only definitive treatment for biliary atresia, and medical intervention includes antibiotic coverage and bile acid enhancers following surgery.

      Complications of biliary atresia include unsuccessful anastomosis formation, progressive liver disease, cirrhosis, and eventual hepatocellular carcinoma. However, the prognosis is good if surgery is successful. In cases where surgery fails, liver transplantation may be required in the first two years of life. Overall, understanding biliary atresia is crucial for early diagnosis and effective management in neonatal children.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 18 - A 48-year-old man presents with constant abdominal pain that radiates to the back....

    Incorrect

    • A 48-year-old man presents with constant abdominal pain that radiates to the back. The pain came on suddenly. Examination of the abdomen reveals a central mass. You note that he has become clinically shocked.
      He has a blood pressure of 76/45, heart rate 150, respiratory rate 28.
      Which of these is the most important step in the definitive management of this patient?

      Your Answer:

      Correct Answer: Arrange for surgery

      Explanation:

      Emergency Management of a Ruptured Aortic Aneurysm

      When a patient presents with symptoms of a ruptured aortic aneurysm, immediate action is necessary to save their life. The first step is to prepare the patient for surgery by informing the theatre, a vascular surgeon, and an anaesthetist. Without surgery, the mortality rate for a ruptured aneurysm is 100%. During surgery, a Dacron graft is inserted after clamping the aorta above the rupture.

      While waiting for surgery, a blood transfusion may be necessary to replace lost blood. However, surgery is the definitive treatment. It is also important to crossmatch blood and transfuse as needed.

      A computed tomography (CT) scan may be useful in diagnosing the condition, but it should not be performed until the patient is haemodynamically stable. In the meantime, obtaining an amylase level is necessary to rule out acute pancreatitis, although the presence of a mass suggests an aneurysm.

      In summary, emergency management of a ruptured aortic aneurysm requires prompt action to prepare the patient for surgery, administer blood transfusions, and obtain necessary diagnostic tests. Without immediate intervention, the patient’s life is at risk.

    • This question is part of the following fields:

      • Vascular
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  • Question 19 - A 67-year-old man presents to the emergency department with sudden onset epigastric pain...

    Incorrect

    • A 67-year-old man presents to the emergency department with sudden onset epigastric pain described as burning and radiating into his back. He reports vomiting and ongoing nausea. The patient has a history of recurrent gallstones and is awaiting a semi-elective cholecystectomy. He is not taking any regular medications. On examination, the patient has jaundiced sclera and diffuse abdominal tenderness with guarding. There is also periumbilical superficial oedema and bruising, and decreased bowel sounds on auscultation.

      What is a crucial aspect of the immediate management of this patient, given the likely diagnosis?

      Your Answer:

      Correct Answer: Aggressive fluid resuscitation

      Explanation:

      The patient’s history of gallstones, epigastric pain radiating to the back, nausea, vomiting, jaundice, periumbilical bruising, abdominal tenderness with guarding, and decreased bowel sounds suggest a diagnosis of acute pancreatitis. Tachycardia, fever, tachypnea, hypotension, and potential oliguria are expected observations in this patient. Early and aggressive fluid resuscitation is crucial in the management of acute pancreatitis to correct third space losses and increase tissue perfusion, preventing severe inflammatory response syndrome and pancreatic necrosis. Antibiotic administration is not mandatory, as there is no consensus on its effectiveness in preventing pancreatic necrosis. Cautious fluid resuscitation is inappropriate, and large volumes of IV fluids should be administered, with input/output monitoring. The patient should not be made nil by mouth unless there is a clear reason, and total parenteral nutrition should only be offered to patients with severe or moderately severe disease if enteral feeding has failed or is contraindicated. This patient requires enteral nutrition within 72 hours of admission, but may not require parenteral nutrition.

      Managing Acute Pancreatitis in a Hospital Setting

      Acute pancreatitis is a serious condition that requires management in a hospital setting. The severity of the condition can be stratified based on the presence of organ failure and local complications. Key aspects of care include fluid resuscitation, aggressive early hydration with crystalloids, and adequate pain management with intravenous opioids. Patients should not be made ‘nil-by-mouth’ unless there is a clear reason, and enteral nutrition should be offered within 72 hours of presentation. Antibiotics should not be used prophylactically, but may be indicated in cases of infected pancreatic necrosis. Surgery may be necessary for patients with acute pancreatitis due to gallstones or obstructed biliary systems, and those with infected necrosis may require radiological drainage or surgical necrosectomy.

    • This question is part of the following fields:

      • Surgery
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  • Question 20 - A mother presents with her 3-month-old baby boy to ask advice about his...

    Incorrect

    • A mother presents with her 3-month-old baby boy to ask advice about his failed newborn hearing screening. Further tests were normal; however, she has been advised to seek medical advice if she has any concerns about his hearing in the future. Which one of the following would warrant referral for a further hearing test?

      Your Answer:

      Correct Answer: Not babbling or imitating sounds by the age of nine months old

      Explanation:

      Developmental Milestones for Language Acquisition in Children

      Language acquisition is an important developmental milestone in children. Here are some key markers to look out for:

      – Not babbling or imitating sounds by the age of nine months old: If a baby is not babbling or imitating sounds by this age, it could be a sign of a social, cognitive, speech, or hearing problem. A full developmental assessment would be necessary to ensure there are no other areas of delay.

      – Putting two words together by the age of 18 months old: By this age, a child should be using 50+ words and be able to put two words together. If not, a full developmental assessment would be necessary to ensure there are no other areas of delay.

      – More than 200 spoken words by the age of two years: A 30-month-old child should be using 200+ words. If not, a full developmental assessment would be necessary to ensure there are no other areas of delay.

      – Not responding to his own name by the age of six months old: By the age of one year, a child should respond to their own name. If not, a full developmental assessment would be necessary to ensure there are no other areas of delay.

      – Speaking 6-20 words by the age of one year: By the age of one, a child should be using 6-20 words. If not, a full developmental assessment would be necessary to ensure there are no other areas of delay.

      It is important to monitor a child’s language development and seek professional help if there are any concerns. Early intervention can make a significant difference in a child’s language acquisition and overall development.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 21 - A 68 year old male has recently undergone transurethral resection of the prostate...

    Incorrect

    • A 68 year old male has recently undergone transurethral resection of the prostate (TURP) with the use of 1.5% glycine as the irrigation fluid. The operation took longer than expected (1 hour 45 minutes) due to the size of the resection required for optimal gland flow. The patient is now exhibiting signs of agitation, confusion, and worsening breathlessness. A venous blood gas reveals that the patient is hyponatremic (118 mmol/l). What is the probable diagnosis?

      Your Answer:

      Correct Answer: TURP syndrome

      Explanation:

      Transurethral resection of the prostate surgery can lead to a rare and potentially fatal complication known as TURP Syndrome. This condition is caused by the destruction of veins and absorption of the irrigation fluid. Certain factors increase the risk of developing this syndrome.

      Understanding TURP Syndrome

      TURP syndrome is a rare but serious complication that can occur during transurethral resection of the prostate surgery. This condition is caused by the use of large volumes of glycine during the procedure, which can be absorbed into the body and lead to hyponatremia. When the liver breaks down the glycine into ammonia, it can cause hyper-ammonia and visual disturbances.

      The symptoms of TURP syndrome can be severe and include CNS, respiratory, and systemic symptoms. There are several risk factors that can increase the likelihood of developing this condition, including a surgical time of more than one hour, a height of the bag greater than 70cm, resection of more than 60g, large blood loss, perforation, a large amount of fluid used, and poorly controlled CHF.

      It is important for healthcare professionals to be aware of the risk factors and symptoms of TURP syndrome in order to quickly identify and treat this condition if it occurs. By taking steps to minimize the risk of developing TURP syndrome and closely monitoring patients during and after the procedure, healthcare providers can help ensure the best possible outcomes for their patients.

    • This question is part of the following fields:

      • Surgery
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  • Question 22 - A 32-year-old woman who is 9 weeks pregnant visits you for her booking...

    Incorrect

    • A 32-year-old woman who is 9 weeks pregnant visits you for her booking appointment. She has a brother with Down syndrome and wants to know more about the screening program. You provide information about the combined test. What other blood markers, in addition to nuchal translucency, are measured?

      Your Answer:

      Correct Answer: Beta-human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein A (PAPP-A)

      Explanation:

      NICE updated guidelines on antenatal care in 2021, recommending the combined test for screening for Down’s syndrome between 11-13+6 weeks. The test includes nuchal translucency measurement, serum B-HCG, and pregnancy-associated plasma protein A (PAPP-A). The quadruple test is offered between 15-20 weeks for women who book later in pregnancy. Results are interpreted as either a ‘lower chance’ or ‘higher chance’ of chromosomal abnormalities. If a woman receives a ‘higher chance’ result, she may be offered a non-invasive prenatal screening test (NIPT) or a diagnostic test. NIPT analyzes cell-free fetal DNA in the mother’s blood and has high sensitivity and specificity for detecting chromosomal abnormalities. Private companies offer NIPT screening from 10 weeks gestation.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 23 - A 6-year-old girl is brought to her general practitioner by her mother because...

    Incorrect

    • A 6-year-old girl is brought to her general practitioner by her mother because she is shorter than most of her classmates. She gets good grades and does well in school. She is below the fifth percentile for height for her age. On examination, she is short and has a webbed neck and widely spaced nipples.
      Which one of the following is karyotyping most likely to reveal?

      Your Answer:

      Correct Answer: 45,XO

      Explanation:

      Understanding Different Karyotypes and Associated Conditions

      Karyotypes are an important tool in diagnosing genetic disorders. Here are some common karyotypes and the associated conditions:

      Turner Syndrome (45,XO): This disorder affects females and is caused by the absence of one or part of an X chromosome. Symptoms include short stature, heart defects, and premature ovarian failure.

      Klinefelter’s Syndrome (47,XXY): This karyotype is associated with males who have an extra X chromosome. Symptoms include delayed puberty, small testes, and learning disabilities.

      Trisomy 21 (47,XX+21): This karyotype is associated with Down syndrome, which causes intellectual disability and physical characteristics such as slanted palpebral fissure and a wide space between the big and second toe.

      47,XYY: This karyotype is associated with males who have an extra Y chromosome. Symptoms include tall stature and an increased risk of learning difficulties and behavioral problems.

      Normal Karyotype: A normal karyotype for a woman is 46,XX. If a different karyotype is present, it may indicate a genetic disorder.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 24 - What are the expected urinalysis results for a 23-year-old patient with abdominal pain,...

    Incorrect

    • What are the expected urinalysis results for a 23-year-old patient with abdominal pain, dehydration, anorexia, and marked hyperglycemia who may have a new diagnosis of type 1 diabetes?

      A) Haemoglobin: Negative
      Urobilinogen: Negative
      Bilirubin: Negative
      Protein: Positive
      Glucose: Positive (+++)
      Nitrites: Negative
      Leucocytes: Positive

      B) Haemoglobin: Negative
      Urobilinogen: Negative
      Bilirubin: Negative
      Protein: Negative
      Glucose: Positive
      Nitrites: ++
      Leucocytes: ++

      C) Haemoglobin: Negative
      Urobilinogen: Negative
      Bilirubin: Negative
      Protein: Negative
      Glucose: +
      Nitrites: +++
      Leucocytes: +++

      D) Haemoglobin: Negative
      Urobilinogen: Negative
      Bilirubin: Negative
      Protein: Negative
      Glucose: Negative
      Nitrites: Negative
      Leucocytes: Negative

      E) Haemoglobin: +++
      Urobilinogen: +
      Bilirubin: +
      Protein: Negative
      Glucose: Negative
      Nitrites: Negative
      Leucocytes: Negative

      Your Answer:

      Correct Answer: B

      Explanation:

      Diabetic Ketoacidosis and Urinary Tract Infection

      This patient is exhibiting symptoms that are commonly associated with diabetic ketoacidosis (DKA), a serious complication of diabetes. The presence of high levels of glucose and ketones in the urine, as indicated by the urinalysis, further supports this diagnosis. DKA can occur in both new and established type 1 diabetic patients and is often triggered by an infection. In this case, it is likely that a urinary tract infection (UTI) was the precipitating factor.

      It is important to recognize the signs and symptoms of DKA, as prompt treatment is necessary to prevent serious complications. Patients with DKA may experience symptoms such as excessive thirst, frequent urination, nausea, vomiting, abdominal pain, and confusion. If left untreated, DKA can lead to coma or even death. In addition to treating the underlying infection, treatment for DKA typically involves insulin therapy, fluid replacement, and electrolyte management.

    • This question is part of the following fields:

      • Nephrology
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  • Question 25 - A 76-year-old man visits his doctor with his wife, who is concerned about...

    Incorrect

    • A 76-year-old man visits his doctor with his wife, who is concerned about his recent memory decline and difficulty concentrating. She also notes that he has become incontinent of urine and is walking with smaller steps. The patient's medical history includes a myocardial infarction one year ago, as well as hypertension and diabetes. There is no family history of similar symptoms. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Vascular dementia

      Explanation:

      Different Types of Dementia and Their Symptoms

      Dementia is a term used to describe a decline in cognitive function that affects daily life. There are several types of dementia, each with its own set of symptoms. Here are some of the most common types of dementia and their characteristic symptoms:

      1. Vascular dementia: This type of dementia is often associated with risk factors for vascular disease, such as hypertension and diabetes. Symptoms may include sudden or stepwise deterioration in cognitive function, early gait disturbances, urinary symptoms, changes in concentration, and mood.

      2. Alzheimer’s disease: Alzheimer’s disease is the most common cause of dementia. It typically results in progressive memory loss and behavioral changes, rather than sudden deterioration.

      3. Frontotemporal dementia: This type of dementia usually presents with personality changes, loss of insight, and stereotyped behaviors. It is a slowly progressive form of dementia, with onset usually before the age of 70 and a strong family history.

      4. Huntington’s disease: Huntington’s disease typically presents at a much younger age between 20 and 40 years old with psychosis, choreiform movements, depression, and later on dementia. There is also a strong family history.

      5. Lewy body dementia: Lewy body dementia typically presents with parkinsonian symptoms, visual hallucinations, and sleep behavior disorders.

      Understanding the different types of dementia and their symptoms can help with early diagnosis and treatment. If you or a loved one is experiencing cognitive decline, it’s important to seek medical attention to determine the underlying cause.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 26 - A 52-year-old woman presented with abdominal pain, fever and weight loss. Abdominal imaging...

    Incorrect

    • A 52-year-old woman presented with abdominal pain, fever and weight loss. Abdominal imaging revealed multiple retroperitoneal lymph nodes. She was diagnosed with intestinal tuberculosis and received a full drug regimen for six months. However, after completion of treatment, her symptoms remain. She presents to us with a body weight of 38 kg. There is angular stomatitis and diffuse loss of hair. She looks tanned. Repeat abdominal imaging reveals persistence of the lymph nodes. Her son, who accompanied her, complains that his mother is becoming listless and she has even given up her favourite hobby of Sudoku. She also has a few involuntary movements of her face, such as chewing.
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Whipple’s disease

      Explanation:

      Whipple’s Disease: A Multisystem Disorder with Malabsorption and Cognitive Decline

      This patient presents with iron deficiency, abdominal lymphadenopathy, hyperpigmentation, and cognitive decline. Despite treatment for tuberculosis, there has been no improvement. These symptoms suggest a possible diagnosis of Whipple’s disease, a multisystem disorder caused by infection with Tropheryma whipplei. Malabsorption with abdominal lymphadenopathy is a common manifestation, and extraintestinal symptoms can include cognitive decline with facial involuntary movements, arthritis, hyperpigmentation, retinitis, and endocarditis. HIV dementia, prion disease, Huntington’s chorea, and coeliac disease are all ruled out based on the patient’s clinical presentation and lack of risk factors.

    • This question is part of the following fields:

      • Microbiology
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  • Question 27 - As part of a palliative care attachment for final-year medical students, the consultant...

    Incorrect

    • As part of a palliative care attachment for final-year medical students, the consultant is discussing non-pharmacological options for managing pain symptoms. The focus is on herbal therapies that have been clinically proven to provide analgesic benefits in palliative care.

      Your Answer:

      Correct Answer: Capsaicin

      Explanation:

      Natural Remedies for Pain Relief: A Look at Capsaicin, Arnica, Cod Liver Oil, Clove Oil, and Echinacea

      When it comes to managing pain, many people turn to natural remedies. Among these remedies are capsaicin, arnica, cod liver oil, clove oil, and echinacea. Capsaicin, which is found in chilli peppers, has been shown in several studies to be effective in treating neuropathic-type pain. Arnica, on the other hand, has been found to be no more effective than placebo for pain relief. Cod liver oil, when taken with NSAIDs, has not been shown to have a significant analgesic effect for osteoarthritis pain compared to placebo. Clove oil is commonly used for dental pain, gastrointestinal upset, nausea, and vomiting, but there is no published research on its pain relief properties. Finally, echinacea is often used for colds and respiratory infections, but there is no published research on its analgesic effects. While natural remedies can be a helpful addition to pain management, it’s important to do your research and consult with a healthcare professional before trying any new treatment.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 28 - A 35-year-old male with a history of daily alcohol consumption for the last...

    Incorrect

    • A 35-year-old male with a history of daily alcohol consumption for the last five years is admitted to the hospital emergency room. He is experiencing acute visual hallucinations, seeing spiders all around him, and is unable to recognize his family members. He is also exhibiting aggressive behavior and tremors. The patient had stopped drinking alcohol for two days prior to admission. On examination, he has a blood pressure of 170/100 mmHg, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgment, and insight. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Delirium tremens

      Explanation:

      Delirium Tremens

      Delirium tremens (DT) is a severe and potentially life-threatening condition that can occur when someone abruptly stops drinking alcohol. Symptoms can begin within a few hours of cessation, but they may not peak until 48-72 hours later. The symptoms of DT can include tremors, irritability, insomnia, nausea and vomiting, hallucinations (auditory, visual, or olfactory), confusion, delusions, severe agitation, and seizures. Physical findings may be non-specific and include tachycardia, hyperthermia, hypertension, tachypnea, diaphoresis, tremor, mydriasis, ataxia, altered mental status, hallucinations, and cardiovascular collapse.

      It is important to note that not everyone who stops drinking alcohol will experience DT. However, those who have a history of heavy alcohol use or have experienced withdrawal symptoms in the past are at a higher risk. DT can be a medical emergency and requires immediate treatment.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 29 - What is the sequence of male puberty feature development? ...

    Incorrect

    • What is the sequence of male puberty feature development?

      Your Answer:

      Correct Answer: Testicular enlargement, then pubic hair, then growth spurt

      Explanation:

      Puberty and Development of Sexual Characteristics

      During puberty, there is a general order of development for secondary sexual characteristics in both boys and girls. In boys, the growth of testicles is the first feature, followed by other characteristics such as pubic hair, axillary hair, body odor, and deepening of the voice. The growth spurt usually occurs 18 months after the onset of puberty, and physical development continues until the age of 25 with increasing muscle mass.

      On the other hand, girls develop secondary sexual features before menarche, with breast development being the first feature, followed by axillary and pubic hair. The growth spurt is an earlier event for girls, taking place not long after breasts begin to develop. Menarche marks the end of the growth spurt, which usually occurs two to three years after the beginning of puberty. Puberty is earlier in girls, ranging from 8 1/2 years to 12 1/2 years.

      It is worth noting that puberty occurs earlier for children of Afro-American origin and obese children due to raised estrogen levels, even in boys. the order of development of sexual characteristics during puberty can help individuals and parents prepare for the changes that come with this stage of life.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 30 - At what age do children typically begin to play alongside their peers without...

    Incorrect

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

      Your Answer:

      Correct 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
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Neurology (1/1) 100%
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