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  • Question 1 - You are a FY-1 doctor working in obstetrics. For one day a week...

    Incorrect

    • You are a FY-1 doctor working in obstetrics. For one day a week you are based in the early pregnancy assessment unit (EPAU). You are assessing a 28-year-old female with a suspected threatened miscarriage. How does this condition typically manifest?

      Your Answer: No per-vaginal bleeding but an open cervical os

      Correct Answer: Painless per-vaginal bleeding and a closed cervical os

      Explanation:

      A threatened miscarriage is characterized by bleeding, but the cervical os remains closed. Miscarriages can be classified as threatened, inevitable, incomplete, complete, or missed. Mild bleeding and little to no pain are typical symptoms of a threatened miscarriage. In contrast, an inevitable miscarriage is marked by heavy bleeding with clots and pain, and the cervical os is open. Inevitable miscarriages will not result in a continued pregnancy and will progress to incomplete or complete miscarriages.

      Miscarriage is a common complication that can occur in up to 25% of all pregnancies. There are different types of miscarriage, each with its own set of symptoms and characteristics. Threatened miscarriage is painless vaginal bleeding that occurs before 24 weeks, typically at 6-9 weeks. The bleeding is usually less than menstruation, and the cervical os is closed. Missed or delayed miscarriage is when a gestational sac containing a dead fetus is present before 20 weeks, without the symptoms of expulsion. The mother may experience light vaginal bleeding or discharge, and the symptoms of pregnancy may disappear. Pain is not usually a feature, and the cervical os is closed. Inevitable miscarriage is characterized by heavy bleeding with clots and pain, and the cervical os is open. Incomplete miscarriage occurs when not all products of conception have been expelled, and there is pain and vaginal bleeding. The cervical os is open in this type of miscarriage.

    • This question is part of the following fields:

      • Obstetrics
      86.9
      Seconds
  • Question 2 - A 67-year-old Indian woman presents to the Emergency Department with vomiting and central...

    Correct

    • A 67-year-old Indian woman presents to the Emergency Department with vomiting and central abdominal pain. She has vomited eight times over the last 24 hours. The vomit is non-bilious and non-bloody. She also reports that she has not moved her bowels for the last four days and is not passing flatus. She reports that she had some form of radiation therapy to her abdomen ten years ago in India for ‘stomach cancer’. There is no urinary urgency or burning on urination. She migrated from India to England two months ago. She reports no other past medical or surgical history.
      Her observations and blood tests results are shown below:
      Investigation Result Normal value
      Temperature 36.9 °C
      Blood pressure 155/59 mmHg
      Heart rate 85 beats per minute
      Respiratory rate 19 breaths per minute
      Sp(O2) 96% (room air)
      White cell count 8.9 × 109/l 4–11 × 109/l
      C-reactive protein 36 mg/l 0–10 mg/l
      The patient’s urine dipstick is negative for leukocytes and nitrites. Physical examination reveals a soft but distended abdomen. No abdominal scars are visible. There is mild tenderness throughout the abdomen. Bowel sounds are hyperactive. Rectal examination reveals no stool in the rectal vault, and no blood or melaena.
      Which of the following is the most likely diagnosis?

      Your Answer: Small bowel obstruction

      Explanation:

      Differential Diagnosis for Abdominal Pain: Small Bowel Obstruction, Acute Mesenteric Ischaemia, Diverticulitis, Pyelonephritis, and Viral Gastroenteritis

      Abdominal pain can have various causes, and it is important to consider different possibilities to provide appropriate management. Here are some differential diagnoses for abdominal pain:

      Small bowel obstruction (SBO) is characterized by vomiting, lack of bowel movements, and hyperactive bowel sounds. Patients who have had radiation therapy to their abdomen are at risk for SBO. Urgent management includes abdominal plain film, intravenous fluids, nasogastric tube placement, analgesia, and surgical review.

      Acute mesenteric ischaemia is caused by reduced arterial blood flow to the small intestine. Patients with vascular risk factors such as hypertension, smoking, and diabetes mellitus are at risk. Acute-onset abdominal pain that is out of proportion to examination findings is a common symptom.

      Diverticulitis presents with left iliac fossa pain, pyrexia, and leukocytosis. Vital signs are usually stable.

      Pyelonephritis is characterized by fevers or chills, flank pain, and lower urinary tract symptoms.

      Viral gastroenteritis typically presents with fast-onset diarrhea and vomiting after ingestion of contaminated food. However, the patient in this case has not had bowel movements for four days.

      In summary, abdominal pain can have various causes, and it is important to consider the patient’s history, physical examination, and laboratory findings to arrive at an accurate diagnosis and provide appropriate management.

    • This question is part of the following fields:

      • Gastroenterology
      64.7
      Seconds
  • Question 3 - During a Monday lunchtime home visit, you encounter a 72-year-old patient with metastatic...

    Incorrect

    • During a Monday lunchtime home visit, you encounter a 72-year-old patient with metastatic colon cancer who has been experiencing a decline in health over the past 2 months. The patient has extensive disease with liver and peritoneal metastatic deposits and also suffers from type II diabetes mellitus and moderately severe chronic obstructive pulmonary disease (COPD). To manage her pain, she takes ibuprofen 400 mg three times daily (tid), paracetamol 1 g four times daily (qds), morphine sulfate modified-release tablets (MST) 30 mg twice daily (bd), and Oramorph® 10 mg as required (prn). However, her abdominal pain has worsened over the weekend, and she has required three doses of Oramorph® per day in addition to her other analgesia. Although the dose is effective, the pain returns after about 2-3 hours. The patient is able to consume small amounts of food and fluid but appears to be in poor health with jaundice and quick, shallow breathing. What is the most appropriate treatment for her pain?

      Your Answer: Commence a continuous subcutaneous infusion of morphine sulfate 45 mg per 24 h, with subcutaneous morphine for breakthrough pain

      Correct Answer: Increase her MST dose to 45 mg bd and Oramorph® dose to 15 mg prn

      Explanation:

      Managing Pain in a Palliative Care Patient: Dosage Adjustments and Adjuncts

      When managing pain in a palliative care patient, it is important to consider the appropriate dosage adjustments and adjuncts to provide effective pain relief. In the given scenario, the patient was taking 60 mg of morphine (as MST) and required another 30 mg of Oramorph® per day for breakthrough pain, resulting in a total daily dose of 90 mg. To address uncontrolled pain, the MST dose was increased to 45 mg bd and the Oramorph® dose was adjusted to 15 mg prn, with the breakthrough dose being one-sixth of the total daily dose.

      While dexamethasone may be considered as an adjunct for liver capsule pain, amitriptyline is not indicated for neuropathic pain in this case. Increasing the dose of ibuprofen is also unlikely to provide significant pain relief. Instead, it is advisable to stick to oral morphine and adjust the dosage accordingly.

      In some cases, a continuous subcutaneous infusion of morphine sulfate may be necessary, but it is preferable to use the oral route when possible to reduce the risk of infection and improve patient comfort. Overall, careful consideration of dosage adjustments and adjuncts can help provide effective pain relief for palliative care patients.

    • This question is part of the following fields:

      • Palliative Care
      47.2
      Seconds
  • Question 4 - A 70-year-old man has been diagnosed with benign prostatic hyperplasia (BPH) and his...

    Incorrect

    • A 70-year-old man has been diagnosed with benign prostatic hyperplasia (BPH) and his doctor is planning to prescribe tamsulosin. What are the potential side-effects he may encounter?

      Your Answer: Erectile dysfunction + reduced libido

      Correct Answer: Dizziness + postural hypotension

      Explanation:

      Understanding the Side-Effects of Tamsulosin

      Tamsulosin is a medication commonly used to treat symptoms of benign prostatic hyperplasia (BPH). While it is generally well-tolerated, it can cause some side-effects. It is important to understand these side-effects to ensure safe and effective use of the medication.

      Dizziness and postural hypotension are common side-effects of tamsulosin. This is because the medication works by decreasing smooth muscle tone in both the prostate and bladder, which can cause a drop in blood pressure when standing up. However, tamsulosin is not known to cause insomnia or urinary urgency.

      Urinary retention is a complication of BPH, not a side-effect of tamsulosin. Nausea is also not a common side-effect of the medication.

      While tamsulosin is not known to cause erectile dysfunction, it is a common adverse effect of 5 alpha-reductase inhibitors like finasteride. Similarly, reduced libido is also more commonly associated with finasteride than tamsulosin.

      In summary, understanding the potential side-effects of tamsulosin is important for safe and effective use of the medication. If you experience any concerning symptoms while taking tamsulosin, it is important to speak with your healthcare provider.

    • This question is part of the following fields:

      • Pharmacology
      42.4
      Seconds
  • Question 5 - A 22-year-old individual is brought to the medical team on call due to...

    Incorrect

    • A 22-year-old individual is brought to the medical team on call due to fever, neck stiffness, and altered Glasgow coma scale. The medical team suspects acute bacterial meningitis.

      What would be the most suitable antibiotic option for this patient?

      Your Answer: Cefuroxime and amoxicillin

      Correct Answer: Cefotaxime

      Explanation:

      Empirical Antibiotic Treatment for Acute Bacterial Meningitis

      Patients aged 16-50 years presenting with acute bacterial meningitis are most likely infected with Neisseria meningitidis or Streptococcus pneumoniae. The most appropriate empirical antibiotic choice for this age group is cefotaxime alone. However, if the patient has been outside the UK recently or has had multiple courses of antibiotics in the last 3 months, vancomycin may be added due to the increase in penicillin-resistant pneumococci worldwide.

      For infants over 3 months old up to adults of 50 years old, cefotaxime is the preferred antibiotic. If the patient is under 3 months or over 50 years old, amoxicillin is added to cover for Listeria monocytogenes meningitis, although this is rare. Ceftriaxone can be used instead of cefotaxime.

      Once the results of culture and sensitivity are available, the antibiotic choice can be modified for optimal treatment. Benzylpenicillin is usually first line, but it is not an option in this case. It is important to choose the appropriate antibiotic treatment to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Emergency Medicine
      13
      Seconds
  • Question 6 - A 23-year-old male patient visits the clinic with a complaint of loss of...

    Correct

    • A 23-year-old male patient visits the clinic with a complaint of loss of smell. He mentions that he enjoys playing rugby and has suffered some nose injuries in the past. Despite this, he can still detect strong odors like ammonia. Can you identify the location of the olfactory neuroepithelium?

      Your Answer: Upper area of each nasal chamber

      Explanation:

      The Location and Function of the Olfactory Nerve

      The olfactory nerve is located in the upper area of each nasal chamber, adjacent to the cribriform plate, superior nasal septum, and superior-lateral nasal wall. Its main function is to detect smells and send signals to the brain for interpretation. However, there are also additional branches of the trigeminal nerve that can detect very noxious smells, even when the olfactory nerve is damaged.

      These nerves project into each of the olfactory bulbs, which then carry impulses to the olfactory cortex for further processing. The olfactory nerve plays a crucial role in our sense of smell and is responsible for detecting a wide range of scents, from pleasant aromas to unpleasant odors. Despite its importance, the olfactory nerve is often overlooked and taken for granted in our daily lives.

    • This question is part of the following fields:

      • Clinical Sciences
      15.4
      Seconds
  • Question 7 - A 16-year-old boy with learning difficulties was brought in by ambulance with his...

    Incorrect

    • A 16-year-old boy with learning difficulties was brought in by ambulance with his carer, he was found lying on the floor at home. He was suspected of having taken some pills at home as the carer found an empty bottle next to him. On arrival, he is very agitated with his jaw clenched, there is also involuntary upward deviation of his eyes.
      Which of the following drugs is most likely the causative agent?

      Your Answer: Carbamazepine

      Correct Answer: Metoclopramide

      Explanation:

      Medication Side-Effects: A Comparison

      When it comes to medication, it’s important to be aware of potential side-effects. Here’s a comparison of some commonly used medications and their associated side-effects:

      Metoclopramide: This medication can induce oculogyric crisis, a dystonic reaction in young women. The management for it is to give an intravenous antimuscarinic.

      Phenytoin: The acute side-effects of Phenytoin include dizziness, diplopia, nystagmus, slurred speech or ataxia.

      Amitriptyline: This medication is not known to cause oculogyric crisis.

      Carbamazepine: The side-effects profile of carbamazepine may cause dizziness and ataxia.

      Aspirin: Aspirin is not known to associate with any dystonia.

      It’s important to always consult with a healthcare provider about any potential side-effects of medication.

    • This question is part of the following fields:

      • Pharmacology
      34.5
      Seconds
  • Question 8 - A 5-year-old girl is brought to the emergency department by her mother. Her...

    Incorrect

    • A 5-year-old girl is brought to the emergency department by her mother. Her mother noticed her face twitching and mouth drooling while trying to wake her up this morning. The episode lasted for 30 seconds and the girl was fully aware of what was happening. The girl has been feeling drowsy and confused for the past 15 minutes. She has been healthy and has no medical conditions. Her mother is concerned that she has been staying up late for the past few nights, which may have contributed to her fatigue. What is the most probable diagnosis?

      Your Answer: Juvenile myoclonic epilepsy

      Correct Answer: Benign rolandic epilepsy

      Explanation:

      The correct answer is benign rolandic epilepsy, which is a syndrome that typically affects children between the ages of 4-12. The main symptom is a focal seizure that occurs before or after bedtime, involving facial twitching, drooling, and twitching of one limb or side of the body. The EEG will show centrotemporal spikes, indicating that the seizure originates in the rolandic fissure. This condition has a good prognosis and may not require treatment depending on the severity and frequency of the seizures.

      Incorrect answers include absence seizure, infantile spasms, and juvenile myoclonic epilepsy. Absence seizure is a generalised seizure that does not involve limb twitching or focal symptoms. Infantile spasms typically occur in infants and are associated with developmental delays. Juvenile myoclonic epilepsy is a focal syndrome that involves myoclonic jerks and daytime absences, which can progress to secondarily generalised seizures.

      Benign rolandic epilepsy is a type of epilepsy that usually affects children between the ages of 4 and 12 years. This condition is characterized by seizures that typically occur at night and are often partial, causing sensations in the face. However, these seizures may also progress to involve the entire body. Despite these symptoms, children with benign rolandic epilepsy are otherwise healthy and normal.

      Diagnosis of benign rolandic epilepsy is typically confirmed through an electroencephalogram (EEG), which shows characteristic centrotemporal spikes. Fortunately, the prognosis for this condition is excellent, with seizures typically ceasing by adolescence. While the symptoms of benign rolandic epilepsy can be concerning for parents and caregivers, it is important to remember that this condition is generally not associated with any long-term complications or developmental delays.

    • This question is part of the following fields:

      • Paediatrics
      41.6
      Seconds
  • Question 9 - A 35-year-old woman has recently been diagnosed with breast cancer and is awaiting...

    Incorrect

    • A 35-year-old woman has recently been diagnosed with breast cancer and is awaiting surgery. She has started a new relationship and is seeking advice on contraception. In her previous relationship, she used the depo injection and is interested in restarting it. She is a non-smoker, has no history of migraines or venous thromboembolism, and has a BMI of 23 kg/m². Which contraception option would be most suitable for her?

      Your Answer: Levonorgestrel intrauterine system

      Correct Answer: Copper intrauterine device

      Explanation:

      Injectable progesterone contraceptives are not recommended for individuals with current breast cancer due to contraindications. This applies to all hormonal contraceptive options, including Depo-Provera, which are classified as UKMEC 4. The copper intrauterine device is the only suitable contraception option in such cases.

      Injectable Contraceptives: Depo Provera

      Injectable contraceptives are a popular form of birth control in the UK, with Depo Provera being the main option available. This contraceptive contains 150 mg of medroxyprogesterone acetate and is administered via intramuscular injection every 12 weeks. It can be given up to 14 weeks after the last dose without the need for extra precautions. The primary method of action is by inhibiting ovulation, while secondary effects include cervical mucous thickening and endometrial thinning.

      However, there are some disadvantages to using Depo Provera. Once the injection is given, it cannot be reversed, and there may be a delayed return to fertility of up to 12 months. Adverse effects may include irregular bleeding and weight gain, and there is a potential increased risk of osteoporosis. It should only be used in adolescents if no other method of contraception is suitable.

      It is important to note that there are contraindications to using Depo Provera, such as current breast cancer (UKMEC 4) or past breast cancer (UKMEC 3). While Noristerat is another injectable contraceptive licensed in the UK, it is rarely used in clinical practice and is given every 8 weeks. Overall, injectable contraceptives can be an effective form of birth control, but it is important to weigh the potential risks and benefits before deciding on this method.

    • This question is part of the following fields:

      • Gynaecology
      38.2
      Seconds
  • Question 10 - What distinguishes graded potentials from action potentials? ...

    Incorrect

    • What distinguishes graded potentials from action potentials?

      Your Answer: Action potentials involve voltage-gated sodium channels, while graded potentials involve voltage-gated calcium channels

      Correct Answer: Graded potentials are localised, while action potentials conduct across the entire axon

      Explanation:

      Graded Potentials vs. Action Potentials

      Graded potentials are changes in the transmembrane potential that occur mainly in the dendrites and soma of a neuron. These changes do not cause significant depolarization to spread far from the area surrounding the site of stimulation. Graded potentials may or may not lead to an action potential, depending on the magnitude of depolarization. On the other hand, action potentials exhibit a refractory phase and are not subject to either temporal or spatial summation.

      Graded potentials involve chemical, mechanical, or light-gated channels that allow for an influx of sodium ions into the cytosol. In contrast, action potentials involve only voltage-gated ion channels, specifically sodium and potassium. Graded potentials typically last from a few milliseconds to even minutes, while action potential duration ranges between 0.5 – 2 milliseconds.

      In summary, graded and action potentials are two distinct phenomena. Graded potentials are subject to modulation by both temporal and spatial summation, while action potentials are not. Graded potentials involve different types of ion channels compared to action potentials. the differences between these two types of potentials is crucial in the complex processes that occur in the nervous system.

    • This question is part of the following fields:

      • Neurology
      24.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Obstetrics (0/1) 0%
Gastroenterology (1/1) 100%
Palliative Care (0/1) 0%
Pharmacology (0/2) 0%
Emergency Medicine (0/1) 0%
Clinical Sciences (1/1) 100%
Paediatrics (0/1) 0%
Gynaecology (0/1) 0%
Neurology (0/1) 0%
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