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  • Question 1 - A 50-year-old woman presents to her GP on the same day with a...

    Correct

    • A 50-year-old woman presents to her GP on the same day with a sudden onset of hearing loss in her right ear while having breakfast. She reports feeling well otherwise and denies any ear pain, discharge, or previous ENT issues. The patient has no significant medical history and is not taking any regular medications. Otoscopy reveals no abnormalities, and tuning fork tests confirm a sensorineural loss. What is the best course of action for managing this patient's condition?

      Your Answer: Refer urgently to ENT

      Explanation:

      If someone experiences sudden onset sensorineural hearing loss, it is important to refer them to an ENT specialist within 24 hours for investigation and potential treatment with steroids.

      Understanding Hearing Loss with Weber and Rinnes Tests

      Hearing loss can be classified as either conductive or sensorineural, and a formal assessment with pure tone audiometry is often necessary to determine which type is present. However, in a clinical setting, Weber and Rinnes tests can also be helpful in categorizing different types of hearing loss.

      The Weber test involves using a tuning fork to determine if a patient has symmetrical or asymmetrical hearing loss. In a normal patient, the sound is heard equally loud in both ears. However, in a patient with asymmetrical hearing loss, the sound is heard louder in one ear than the other. This finding should be confirmed by repeating the procedure and having the patient occlude one ear with a finger.

      The Rinne test involves comparing air conduction to bone conduction in both ears. In a patient with normal hearing, air conduction is greater than bone conduction in both ears. However, in a patient with sensorineural hearing loss, air conduction is greater than bone conduction in the unaffected ear. In a patient with conductive hearing loss, bone conduction is greater than air conduction in the affected ear.

      Understanding the results of these tests can help healthcare professionals diagnose and treat hearing loss. By identifying the type and severity of hearing loss, appropriate interventions such as hearing aids or cochlear implants can be recommended.

    • This question is part of the following fields:

      • ENT
      13.5
      Seconds
  • Question 2 - A 25-year-old man presents with sudden onset of pain in his right elbow...

    Correct

    • A 25-year-old man presents with sudden onset of pain in his right elbow and left Achilles tendon. He reports dysuria, conjunctivitis, and fever, and recently returned from a trip to the Far East where he had unprotected sex. He has also developed macules and pustules on his hands. What is the most likely diagnosis?

      Your Answer: Reactive arthritis

      Explanation:

      Reactive arthritis is a type of arthritis that occurs after an infection, typically dysentery or a sexually transmitted disease. It affects 1-2% of patients who have had these infections, with Salmonella, Shigella, and Yersinia causing diarrheal illness that can lead to reactive arthritis, and Chlamydia trichomonas and Ureaplasma urealyticum causing STDs. Those who are HLA-B27-positive are at a higher risk of developing reactive arthritis. Symptoms include acute, asymmetrical lower limb arthritis, enthesitis causing plantar fasciitis or Achilles tendinosis, and back pain from sacroiliitis and spondylosis. Other symptoms may include acute anterior uveitis, circinate balanitis, keratoderma blenorrhagia, nail dystrophy, mouth ulcers, and bilateral conjunctivitis. The classic triad of conjunctivitis, urethritis, and arthritis may also be present. In this scenario, the patient’s symptoms and history of unprotected sexual intercourse suggest reactive arthritis as the correct diagnosis. Other potential diagnoses, such as UTI, HIV, psoriatic arthritis, and syphilitic arthritis, can be ruled out based on the patient’s symptoms and history.

    • This question is part of the following fields:

      • Musculoskeletal
      18.7
      Seconds
  • Question 3 - A 30-year-old man presents with fatigue, joint pain, and abnormal liver function tests....

    Correct

    • A 30-year-old man presents with fatigue, joint pain, and abnormal liver function tests. After investigation, he is diagnosed with hereditary hemochromatosis. His wife undergoes genetic testing and is found to not carry the disease. What is the likelihood that their child will develop hemochromatosis?

      Your Answer: 0%

      Explanation:

      Understanding Haemochromatosis: Symptoms, Causes, and Complications

      Haemochromatosis is a genetic disorder that affects iron absorption and metabolism, leading to the accumulation of iron in the body. It is caused by mutations in the HFE gene on both copies of chromosome 6. This disorder is more common in people of European descent, with a prevalence of 1 in 200.

      In the early stages of haemochromatosis, symptoms are often non-specific, such as fatigue and joint pain. As the disease progresses, patients may develop bronze skin pigmentation, diabetes mellitus, liver disease, cardiac failure, hypogonadism, and arthritis.

      Treatment for haemochromatosis involves regular phlebotomy to remove excess iron from the body. Reversible complications of haemochromatosis include cardiomyopathy, skin pigmentation, liver cirrhosis, diabetes mellitus, hypogonadotrophic hypogonadism, and arthropathy. However, irreversible complications include cirrhosis, which can lead to liver failure and other serious health problems.

      In conclusion, haemochromatosis is a genetic disorder that affects iron metabolism and can lead to serious health complications if left untreated. Early diagnosis and treatment can help prevent irreversible damage and improve quality of life for affected individuals.

    • This question is part of the following fields:

      • Haematology/Oncology
      25.5
      Seconds
  • Question 4 - A 72-year-old male presents to the emergency department with complaints of new-onset pain...

    Correct

    • A 72-year-old male presents to the emergency department with complaints of new-onset pain in his left groin. Upon examination, a large, warm, non-reducible mass located inferolateral to the pubic tubercle is observed, accompanied by erythema of the overlying skin. The patient reports vomiting twice and passing stools with blood mixed in them once. He appears to be in pain and is sweating profusely. His medical history includes peptic ulcer disease, which is managed with omeprazole. What is the most likely diagnosis?

      Your Answer: Strangulated femoral hernia

      Explanation:

      A femoral hernia can lead to the serious complication of strangulation. In this case, the patient has a non-reducible mass located below the pubic tubercle, which is typical of a femoral hernia. However, the accompanying symptoms of vomiting, bloody stools, and a toxic appearance suggest that the hernia has become strangulated, meaning that the blood supply to the herniated tissue has been compromised and may lead to tissue death.

      An incarcerated femoral hernia would also present as a non-reducible mass below the pubic tubercle, but without the symptoms of strangulation.

      In contrast, an incarcerated inguinal hernia would present as a non-reducible mass above and towards the middle of the pubic tubercle, and would not cause symptoms of strangulation.

      A perforated peptic ulcer would cause pain in the upper abdomen, syncope, and possibly vomiting blood, which is different from the patient’s symptoms.

      Similarly, a strangulated inguinal hernia would cause similar symptoms, but the mass would be located above and towards the middle of the pubic tubercle, rather than below it.

      Understanding Femoral Hernias

      Femoral hernias occur when a part of the bowel or other abdominal organs pass through the femoral canal, which is a potential space in the anterior thigh. This can result in a lump in the groin area that is mildly painful and typically non-reducible. Femoral hernias are less common than inguinal hernias, accounting for only 5% of abdominal hernias, and are more prevalent in women, especially those who have had multiple pregnancies. Diagnosis is usually clinical, but ultrasound may be used to confirm the presence of a femoral hernia and exclude other possible causes of a lump in the groin area.

      Complications of femoral hernias include incarceration, where the herniated tissue cannot be reduced, and strangulation, which is a surgical emergency. The risk of strangulation is higher with femoral hernias than with inguinal hernias and increases over time. Bowel obstruction and bowel ischaemia may also occur, leading to significant morbidity and mortality for the patient.

      Surgical repair is necessary for femoral hernias, and it can be done laparoscopically or via a laparotomy. Hernia support belts or trusses should not be used for femoral hernias due to the risk of strangulation. In an emergency situation, a laparotomy may be the only option. It is essential to distinguish femoral hernias from inguinal hernias, as they have different locations and require different management approaches.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      27.2
      Seconds
  • Question 5 - A 30-year-old woman visits her GP with a query regarding oral contraception. She...

    Incorrect

    • A 30-year-old woman visits her GP with a query regarding oral contraception. She gave birth to her fourth child 2 weeks ago and believes that her family is complete. After weighing the options, she has decided to begin taking the combined contraceptive pill. She has no significant medical history and only takes regular vitamin supplements without any allergies. She is not breastfeeding at the moment.
      What is the earliest possible time for her to start taking her preferred contraceptive?

      Your Answer: Commence 6 weeks post-partum

      Correct Answer: Commence 3 weeks post-partum

      Explanation:

      Women need to start using contraception only 21 days after giving birth during the post-partum period. It is recommended that they begin taking the combined contraceptive pill three weeks after delivery. However, if they are breastfeeding, they should wait for six weeks before starting the pill.

      After giving birth, women need to use contraception after 21 days. The progestogen-only pill (POP) can be started at any time postpartum, according to the FSRH. Additional contraception should be used for the first two days after day 21. A small amount of progestogen enters breast milk, but it is not harmful to the infant. On the other hand, the combined oral contraceptive pill (COCP) is absolutely contraindicated (UKMEC 4) if breastfeeding is less than six weeks post-partum. If breastfeeding is between six weeks and six months postpartum, it is a UKMEC 2. The COCP may reduce breast milk production in lactating mothers. It should not be used in the first 21 days due to the increased venous thromboembolism risk post-partum. After day 21, additional contraception should be used for the first seven days. The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after four weeks.

      The lactational amenorrhoea method (LAM) is 98% effective if the woman is fully breastfeeding (no supplementary feeds), amenorrhoeic, and less than six months post-partum. It is important to note that an inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight, and small for gestational age babies.

    • This question is part of the following fields:

      • Reproductive Medicine
      18.6
      Seconds
  • Question 6 - A 52-year-old woman visits her doctor seeking guidance on managing recurrent episodes of...

    Correct

    • A 52-year-old woman visits her doctor seeking guidance on managing recurrent episodes of urinary incontinence that occur during laughter or coughing. She reports no symptoms of dysuria, frequency, or urgency. Additionally, she has been experiencing night sweats and irregular periods for the past year. The patient's medical history includes hypertension and depression. A urine dipstick and examination of the vulva/vagina reveal no abnormalities. What is the recommended initial treatment?

      Your Answer: Pelvic floor muscle exercises

      Explanation:

      The primary treatment for stress incontinence is pelvic floor muscle training.

      Understanding Urinary Incontinence: Causes, Classification, and Management

      Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.

      Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.

      In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.

    • This question is part of the following fields:

      • Renal Medicine/Urology
      30.5
      Seconds
  • Question 7 - A 25-year-old female patient visits her GP complaining of thick, white vaginal discharge...

    Incorrect

    • A 25-year-old female patient visits her GP complaining of thick, white vaginal discharge that is causing itchiness and hindering her ability to focus on her studies. She reveals that she has previously attempted to treat these symptoms with over-the-counter remedies, as she has experienced two similar episodes within the past five months. The patient is sexually active and uses both condoms and oral contraceptives. During her visit, a urine dip test is conducted, which yields negative results for pregnancy, protein, leucocytes, and nitrites. What would be the most effective course of action for managing this patient's recurring symptoms?

      Your Answer: Topical fluconazole

      Correct Answer: Oral fluconazole

      Explanation:

      For patients experiencing recurrent vaginal candidiasis, it is recommended to consider an induction-maintenance regime of oral fluconazole. Over the counter antifungal treatments, such as clotrimazole cream, are typically effective for one-off episodes of thrush. However, in cases of recurrent symptoms, a more comprehensive treatment plan may be necessary. It is important to ensure that the patient is not taking SSRI medications or has hypersensitivity to ‘azole’ antifungal medications before prescribing fluconazole. It should be noted that IM ceftriaxone and oral ciprofloxacin are used to manage Neisseria gonorrhoea, not thrush, and oral metronidazole is used to manage bacterial vaginosis, not thrush.

      Vaginal candidiasis, also known as thrush, is a common condition that many women can diagnose and treat themselves. Candida albicans is responsible for about 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain factors such as diabetes mellitus, antibiotics, steroids, pregnancy, and HIV can increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, itching, vulval erythema, fissuring, and satellite lesions. A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy, with oral fluconazole 150 mg as a single dose being the first-line treatment according to NICE Clinical Knowledge Summaries. If there are vulval symptoms, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments. Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and a high vaginal swab for microscopy and culture should be performed to confirm the diagnosis. A blood glucose test may be necessary to exclude diabetes, and differential diagnoses such as lichen sclerosus should be ruled out. An induction-maintenance regime involving oral fluconazole may be considered. Induction involves taking oral fluconazole every three days for three doses, while maintenance involves taking oral fluconazole weekly for six months.

    • This question is part of the following fields:

      • Reproductive Medicine
      31.9
      Seconds
  • Question 8 - A 35-year-old woman presents to the Emergency Department with a 2-day history of...

    Correct

    • A 35-year-old woman presents to the Emergency Department with a 2-day history of central abdominal pain, extreme thirst and polyuria. She has no past medical history but her mother and sister both have diabetes. She is noted to be breathing heavily with breath that smells of acetone. An urgent set of investigations is taken.
      Which of the following test results are most likely in this patient?
      Select the SINGLE most likely results from the list below.

      Your Answer: pH 7.21, partial pressure of pCO2 2.1 kPa, partial pressure of pO211.2 kPa, Na+ 131 mmol/l, K+ 3.1 mmol/l, HCO3 12 mmol/l, glucose 31 mmol/l, ketones 4.2 mmol/l

      Explanation:

      Interpreting Blood Test Results: Distinguishing Diabetic Ketoacidosis from Other Conditions

      Diabetic ketoacidosis (DKA) is a life-threatening condition that requires urgent treatment. It can occur as a complication of existing type I diabetes mellitus (DM) or be the first presentation of type I DM. To diagnose DKA, the Joint British Diabetes Societies have established specific criteria, including a blood glucose of more than 11 mmol/l or known DM, a venous pH of less than 7.3 and/or a serum bicarbonate of less than 15 mmol/l, and ketonaemia of more than 3 mmol/l or ketonuria 2+ on dipstick.

      When interpreting blood test results, it is important to distinguish DKA from other conditions that may present with similar symptoms. For example, a metabolic acidosis may indicate DKA, but it would also be present in other conditions. In DKA, you would expect a combination of high blood glucose, low pH and serum bicarbonate, and high ketone levels.

      Normal blood test results would rule out DKA, but hyperkalaemia may be present despite low total body potassium levels. Potassium levels may need to be monitored and adjusted during treatment. Respiratory alkalosis, indicated by low pCO2 and high pH, would suggest hyperventilation rather than DKA.

      In summary, interpreting blood test results is crucial in diagnosing and distinguishing DKA from other conditions. Understanding the specific criteria for DKA diagnosis and recognizing the patterns of abnormal results can help healthcare professionals provide timely and appropriate treatment.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      49.5
      Seconds
  • Question 9 - A healthy toddler is 18 months old and was born in the breech...

    Correct

    • A healthy toddler is 18 months old and was born in the breech position. The toddler's mother is concerned about developmental dysplasia of the hip (DDH), as she has heard that this can be associated with breech delivery.
      Which of the following is the most appropriate investigation for this toddler?

      Your Answer: Ultrasound scan of the hips before six weeks of age

      Explanation:

      An ultrasound scan of the hips is recommended for all babies born in the breech position after 36 weeks of pregnancy, even if they are not born in the breech position. It is also necessary for babies born before 36 weeks in the breech position or those with a family history of hip problems in early life. This is to detect developmental dysplasia of the hip (DDH) early, which can be treated with a Pavlik harness before six months of age. Surgery may be required if non-operative treatment is not successful. An ultrasound scan should be performed before six weeks of age to ensure early diagnosis and treatment. If a baby is found to have an unstable hip joint during their newborn examination, they should have an ultrasound of the hip before two weeks of age. X-rays are not recommended for detecting DDH in infants, and ultrasound is the preferred imaging modality.

    • This question is part of the following fields:

      • Paediatrics
      17.2
      Seconds
  • Question 10 - A primigravid 44 year-old woman, who is at 28 weeks gestation, arrives at...

    Correct

    • A primigravid 44 year-old woman, who is at 28 weeks gestation, arrives at the maternity unit with regular weak contractions. Upon examination, her cervix is found to be 3 cm dilated and her membranes are intact. What is the most suitable course of action?

      Your Answer: Admit and administer tocolytics and steroids

      Explanation:

      At present, the woman is experiencing premature labour, but it is still in its early stages as she is only 3 cm dilated. As a result, tocolytic medication may be used to halt the labour. However, if the labour persists and delivery becomes necessary, steroids will be administered beforehand to aid in the development of the foetal lungs. Antibiotics are unnecessary since there is no evidence of an infection. The Syntocinon injection contains oxytocin, which increases the strength of uterine contractions.

      Risks Associated with Prematurity

      Prematurity is a condition that poses several risks to the health of newborns. The risk of mortality increases with decreasing gestational age. Premature babies are at risk of developing respiratory distress syndrome, intraventricular haemorrhage, necrotizing enterocolitis, chronic lung disease, hypothermia, feeding problems, infection, jaundice, and retinopathy of prematurity. Retinopathy of prematurity is a significant cause of visual impairment in babies born before 32 weeks of gestation. The cause of this condition is not fully understood, but it is believed that over oxygenation during ventilation can lead to the proliferation of retinal blood vessels, resulting in neovascularization. Screening for retinopathy of prematurity is done in at-risk groups. Premature babies are also at risk of hearing problems.

    • This question is part of the following fields:

      • Reproductive Medicine
      23.9
      Seconds
  • Question 11 - A 16-year-old girl comes to the eye clinic with a painful red eye...

    Correct

    • A 16-year-old girl comes to the eye clinic with a painful red eye after a minor injury. The doctor diagnoses her with a corneal ulcer in her left eye and prescribes topical antibiotics for treatment. She asks for a prescription of the same numbing eye drops that were used during the examination to use at home. What is the most appropriate pain management for this condition?

      Your Answer: Oral analgesics

      Explanation:

      It is not recommended to prescribe anaesthetic eye drops to patients with corneal ulcers as it can potentially worsen the condition by slowing down the healing process.

      Understanding Corneal Ulcers

      A corneal ulcer is a condition that occurs when there is a defect in the cornea, which is usually caused by an infection. It is important to note that corneal abrasions, on the other hand, are typically caused by physical trauma. There are several risk factors that can increase the likelihood of developing a corneal ulcer, including contact lens use and vitamin A deficiency, which is particularly common in developing countries.

      The pathophysiology of corneal ulcers can vary depending on the underlying cause. Bacterial, fungal, and viral infections can all lead to the development of a corneal ulcer. In some cases, contact lens use can also be associated with a type of infection called Acanthamoeba keratitis.

      Symptoms of a corneal ulcer typically include eye pain, sensitivity to light, and excessive tearing. Additionally, a focal fluorescein staining of the cornea may be present.

    • This question is part of the following fields:

      • Ophthalmology
      13.5
      Seconds
  • Question 12 - A 35-year-old pregnant woman and her husband are informed at the 20-week antenatal...

    Correct

    • A 35-year-old pregnant woman and her husband are informed at the 20-week antenatal scan of the presence of echogenic bowel in the male fetus. They had been trying to conceive unsuccessfully for three years until investigations revealed oligospermia and this pregnancy was a result of intrauterine insemination. Both parents are aged 35 years old. The father has had several episodes of upper respiratory tract infections that have required antibiotics and he has been admitted to hospital in the past with acute gastritis. The mother is fit and well without any significant past medical history.
      Which of the following would be the most appropriate next investigation?

      Your Answer: Testing for the CFTR gene mutation in both parents

      Explanation:

      Cystic fibrosis (CF) is a genetic condition that requires two copies of a faulty CFTR gene, one from each parent. If symptoms are present, it is important to confirm the diagnosis in the father and determine if the mother is a carrier of the faulty gene before pursuing further testing. While a sweat test can diagnose CF in the father, it cannot determine carrier status in the mother. Invasive procedures such as amniocentesis and chorionic villous sampling should only be performed if there is strong suspicion of a chromosomal or genetic abnormality, and less invasive genetic testing of both parents should be considered first. Karyotyping is not a useful diagnostic tool for CF, as it only detects chromosomal abnormalities and not genetic ones.

    • This question is part of the following fields:

      • Genetics
      38.8
      Seconds
  • Question 13 - A 25-year-old woman arrives at the Emergency Department accompanied by a colleague from...

    Incorrect

    • A 25-year-old woman arrives at the Emergency Department accompanied by a colleague from work. She complains of experiencing a 'fluttering' sensation in her chest for the past 30 minutes. Although she admits to feeling 'a bit faint,' she denies any chest pain or difficulty breathing. Upon conducting an ECG, the results show a regular tachycardia of 166 bpm with a QRS duration of 110 ms. Her blood pressure is 102/68 mmHg, and her oxygen saturation levels are at 99% on room air. What is the most appropriate course of action?

      Your Answer: Direct current cardioversion

      Correct Answer: Carotid sinus massage

      Explanation:

      Vagal manoeuvres, such as carotid sinus massage or the Valsalva manoeuvre, are the initial treatment for supraventricular tachycardia. Adenosine should only be administered if these manoeuvres are ineffective. According to the ALS guidelines, direct current cardioversion is not recommended for this condition.

      Understanding Supraventricular Tachycardia

      Supraventricular tachycardia (SVT) is a type of tachycardia that originates above the ventricles. It is commonly associated with paroxysmal SVT, which is characterized by sudden onset of a narrow complex tachycardia, usually an atrioventricular nodal re-entry tachycardia (AVNRT). Other causes include atrioventricular re-entry tachycardias (AVRT) and junctional tachycardias.

      When it comes to acute management, vagal maneuvers such as the Valsalva maneuver or carotid sinus massage can be used. Intravenous adenosine is also an option, with a rapid IV bolus of 6mg given initially, followed by 12mg and then 18mg if necessary. However, adenosine is contraindicated in asthmatics, and verapamil may be a better option for them. Electrical cardioversion is another option.

      To prevent episodes of SVT, beta-blockers can be used. Radio-frequency ablation is also an option. It is important to work with a healthcare provider to determine the best course of treatment for each individual case.

      Overall, understanding SVT and its management options can help individuals with this condition better manage their symptoms and improve their quality of life.

    • This question is part of the following fields:

      • Cardiovascular
      31.7
      Seconds
  • Question 14 - A 63-year-old woman complains of unsteadiness when walking. On examination, she has pyramidal...

    Correct

    • A 63-year-old woman complains of unsteadiness when walking. On examination, she has pyramidal weakness of her left lower limb, and reduced pinprick sensation of her right leg and right side of her trunk up to the level of the umbilicus. Joint position sense is impaired at her left great toe but is normal elsewhere. She has a definite left extensor plantar response, and the right plantar response is equivocal.
      Which of the following is the most likely site of the lesion?
      Select the SINGLE most appropriate site of the lesion from the list below. Select ONE option only.

      Your Answer: Left mid-thoracic cord

      Explanation:

      The patient’s symptoms suggest Brown-Séquard syndrome, which is caused by a hemisection of the spinal cord. This results in ipsilateral pyramidal weakness and loss of joint position/vibration sense, along with contralateral loss of pain/temperature sensation. The patient’s lesion is located in the left mid-thoracic cord. A lesion in the left lumbosacral plexus would only affect the left lower limb. A cervical cord lesion would affect the upper limbs. A central lesion would produce bilateral symmetrical defects, which is not the case here. A right mid-thoracic cord lesion would produce similar symptoms, but on the right side instead. Other spinal cord syndromes include complete cord transection, anterior cord syndrome, subacute combined degeneration of the cord, syringomyelia, and cauda equina syndrome. Each of these has a distinct set of symptoms and affected areas.

    • This question is part of the following fields:

      • Neurology
      42.1
      Seconds
  • Question 15 - A 57-year-old woman and her husband arrive at the hospital with concerns about...

    Incorrect

    • A 57-year-old woman and her husband arrive at the hospital with concerns about her increasing forgetfulness. The husband reports that she has lost her keys multiple times and struggles to remember her daily activities. The patient herself is worried about developing dementia, especially since her grandmother had it. She has diabetes, hypertension, and agitated depression, and has been taking medication for a recent urinary tract infection. Which of the listed medications is the most likely cause of her memory problems?

      Medication list:
      - Metformin/Glicizide for diabetes
      - Lorazepam for sleep and anxiety
      - Citalopram for depression
      - Nitrofurantoin for urinary tract infection

      Your Answer: Citalopram

      Correct Answer: Lorazepam

      Explanation:

      Lorazepam is a benzodiazepine drug that can cause anterograde amnesia as a side effect, resulting in significant impairment of memory recall and the formation of new memories. Additionally, it is utilized in anesthesia.

      Benzodiazepines are drugs that enhance the effect of the neurotransmitter GABA, which inhibits brain activity. They are used for various purposes, including sedation, anxiety relief, muscle relaxation, and seizure prevention. However, patients can develop a tolerance and dependence on these drugs, so they should only be prescribed for a short period of time. When withdrawing from benzodiazepines, it is important to do so gradually to avoid withdrawal symptoms, which can include insomnia, anxiety, and seizures. Barbiturates are another type of drug that affect GABA, but they work differently than benzodiazepines by increasing the duration of chloride channel opening.

    • This question is part of the following fields:

      • Psychiatry
      35
      Seconds
  • Question 16 - A man with a 5-year history of human immunodeficiency virus (HIV) attends the...

    Incorrect

    • A man with a 5-year history of human immunodeficiency virus (HIV) attends the clinic for a routine check-up and to receive the results of his latest CD4 count and viral load. He is currently taking lopinavir, tenofovir and 3TC medications as part of his antiretroviral treatment. Management of HIV aims to reduce the patient’s viral load and improve their CD4 count.
      Above what level in the blood should you aim to keep this patient's CD4 count?

      Your Answer: > 500 cells/mm3

      Correct Answer: > 350 cells/mm3

      Explanation:

      A man with a 5-year history of HIV is on antiretroviral treatment with atazanavir, emtricitabine, and tenofovir. The aim of this treatment is to reduce viral load (< 50 copies/ml), improve CD4 count (above 350 cells/mm3), reduce transmission, and increase quality of life without unacceptable drug side-effects. During routine check-ups, the patient's CD4 count, HIV viral RNA load, renal and hepatic function, cholesterol, blood sugar, triglycerides, and lactate are assessed. The target level for this patient's CD4 count is above 350 cells/mm3. A CD4 count below 200 cells/mm3 greatly exposes the patient to opportunistic infections. Antiretroviral treatment usually involves a combination of at least three drugs classified as nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), or 'others'. These drugs may have side-effects such as lipoatrophy, hepatotoxicity, lipodystrophy syndrome, lactic acidosis, Steven-Johnson syndrome, drug-drug interactions, hyperbilirubinemia, peripheral neuropathy, bone marrow suppression, anaemia, pancreatitis, and insulin resistance/hyperglycaemia.

    • This question is part of the following fields:

      • Infectious Diseases
      43.7
      Seconds
  • Question 17 - A 47-year-old man, currently admitted to a medical ward for acute pancreatitis, experiences...

    Correct

    • A 47-year-old man, currently admitted to a medical ward for acute pancreatitis, experiences intermittent episodes of epistaxis. Blood tests are conducted and reveal the following results:
      - Platelets: 52 * 109/L (normal range: 150 - 400)
      - Prothrombin time (PT): 23 seconds (normal range: 10-14 seconds)
      - Activated partial thromboplastin time (APTT): 46 seconds (normal range: 25-35 seconds)
      - Fibrinogen: 0.8 g/L (normal range: 2 - 4)
      - D-Dimer: 1203 ng/mL (normal range: < 400)
      Based on the probable diagnosis, what would be the expected findings on a blood film?

      Your Answer: Schistocytes

      Explanation:

      The presence of schistocytes is indicative of microangiopathic hemolytic anemia, which is associated with disseminated intravascular coagulation (DIC). DIC is a condition where the coagulation pathways are activated, leading to a procoagulant state. It can be triggered by various factors, including acute illness. The patient’s blood tests show a depletion of platelets and coagulation factors, which is typical of DIC. However, elliptocytes, Heinz bodies, and Howell-Jolly bodies are not expected in DIC. Elliptocytes are usually seen in conditions like iron deficiency and thalassemia, while Heinz bodies are associated with alpha-thalassemia and glucose-6-phosphate dehydrogenase deficiency. Howell-Jolly bodies are characteristic of decreased splenic function, such as post-splenectomy.

      Understanding Disseminated Intravascular Coagulation (DIC) Diagnosis

      Under normal conditions, coagulation and fibrinolysis work together to maintain homeostasis. However, in DIC, these processes become dysregulated, leading to widespread clotting and bleeding. One key factor in the development of DIC is the release of tissue factor (TF), a glycoprotein found on the surface of various cell types. Normally, TF is not in contact with the general circulation, but it is exposed after vascular damage or in response to certain cytokines. Once activated, TF triggers the extrinsic pathway of coagulation, which then triggers the intrinsic pathway. DIC can be caused by various factors, including sepsis, trauma, obstetric complications, and malignancy.

      To diagnose DIC, a typical blood picture will show decreased platelets and fibrinogen, increased fibrinogen degradation products, and the presence of schistocytes due to microangiopathic hemolytic anemia. Additionally, both the prothrombin time and activated partial thromboplastin time are prolonged, while bleeding time and platelet count are often low. Understanding the diagnosis of DIC is crucial for prompt and effective treatment.

    • This question is part of the following fields:

      • Haematology/Oncology
      23.4
      Seconds
  • Question 18 - A 49-year-old man is being evaluated at the smoking cessation clinic. Is there...

    Correct

    • A 49-year-old man is being evaluated at the smoking cessation clinic. Is there any medical condition that would make it inappropriate to prescribe bupropion for him?

      Your Answer: Epilepsy

      Explanation:

      Reduced seizure threshold is a contraindication for the use of bupropion in patients with epilepsy.

      NICE guidance recommends offering nicotine replacement therapy (NRT), varenicline, or bupropion to patients for smoking cessation, with no preference for one medication over another. NRT should be offered in combination for those with high nicotine dependence or inadequate response to single forms. Varenicline should be started a week before the target stop date and monitored for adverse effects, including nausea and suicidal behavior. Bupropion should also be started before the target stop date and is contraindicated in epilepsy, pregnancy, and breastfeeding. Pregnant women should be tested for smoking and referred to NHS Stop Smoking Services, with first-line interventions being cognitive behavior therapy, motivational interviewing, or structured self-help and support. NRT may be used if other measures fail, but varenicline and bupropion are contraindicated.

    • This question is part of the following fields:

      • Cardiovascular
      4.7
      Seconds
  • Question 19 - A 72-year-old patient with chronic lymphocytic leukaemia presents to the emergency department with...

    Correct

    • A 72-year-old patient with chronic lymphocytic leukaemia presents to the emergency department with haematemesis. Urgent blood tests are taken and blood products ordered from the laboratory.

      A full blood count shows:

      Hb 76 g/L Male: (135-180) Female: (115 - 160)

      Platelets 26 * 109/L (150 - 400)

      WBC 21.8 * 109/L (4.0 - 11.0)

      Which blood product carries the highest risk for this immunocompromised patient?

      Your Answer: Platelets

      Explanation:

      Platelet transfusions have the highest risk of bacterial contamination due to their short shelf life and refrigeration. This patient requires both red blood cells and platelets, but caution should be taken with platelet transfusions due to the risk of contamination. Cryoprecipitate and plasma have lower contamination risks and can be stored for longer periods. Packed red cells can also be used and have a longer shelf life.

      Platelet Transfusion Guidelines for Active Bleeding and Pre-Invasive Procedures

      Platelet transfusions are recommended for patients with thrombocytopenia and clinically significant bleeding, such as haematemesis, melaena, or prolonged epistaxis, with a platelet count of less than 30 x 10 9. For severe bleeding or bleeding at critical sites, such as the CNS, platelet thresholds for transfusion are higher, with a maximum of less than 100 x 10 9. However, it should be noted that platelet transfusions have a higher risk of bacterial contamination compared to other types of blood products.

      For pre-invasive procedures, platelet transfusions are recommended to maintain platelet levels of greater than 50 x 10 9/L for most patients, 50-75 x 10 9/L for those at high risk of bleeding, and greater than 100 x 10 9/L for surgeries at critical sites. However, if there is no active bleeding or planned invasive procedure, a threshold of 10 x 10 9/L is recommended, unless platelet transfusion is contraindicated or there are alternative treatments available for the patient’s condition.

      It is important to note that platelet transfusions should not be performed for chronic bone marrow failure, autoimmune thrombocytopenia, heparin-induced thrombocytopenia, or thrombotic thrombocytopenic purpura. These guidelines aim to provide appropriate and safe platelet transfusion practices for patients with thrombocytopenia.

    • This question is part of the following fields:

      • Haematology/Oncology
      21.4
      Seconds
  • Question 20 - A 50-year-old builder presents to the General Practitioner with pain in his right...

    Correct

    • A 50-year-old builder presents to the General Practitioner with pain in his right elbow. He reports that the pain has been worsening over the past few months and is affecting his ability to work. He has not attempted any treatment yet.

      Upon examination, there is no swelling at the right elbow joint. The elbow can be flexed and extended without pain, and there is a good range of motion. The pain is reproduced on resisted supination.

      What is the most appropriate first line diagnosis-management pairing for this patient? Choose the SINGLE most suitable option from the list below.

      Your Answer: Lateral epicondylitis – rest, non-steroidal anti-inflammatory drugs (NSAIDs)

      Explanation:

      Lateral epicondylitis is a condition that typically affects people in their fourth decade or older, and is caused by repetitive activity or minor trauma to the elbow. It is usually seen in the dominant arm and causes pain in the front of the lateral epicondyle, which can radiate down the forearm and lead to weakness of grip strength and difficulty in carrying objects. On examination, there is tenderness in the lateral epicondyle over the extensor mass, but no swelling or pain when flexing and extending the elbow. Treatment for lateral epicondylitis involves rest and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, with physiotherapy recommended if there is no response after six weeks. Corticosteroid injections may be considered, but are unlikely to affect long-term outcomes. In contrast, medial epicondylitis affects the flexor-pronator muscles at their origin on the medial epicondyle, causing pain in that area. Treatment for both conditions is similar, involving rest and NSAIDs initially, with physiotherapy if necessary. Osteoarthritis, on the other hand, presents with joint stiffness and reduced range of motion, and is not evident in this patient.

    • This question is part of the following fields:

      • Musculoskeletal
      36.1
      Seconds
  • Question 21 - A 52-year-old man visits the clinic with concerns about a gradual decline in...

    Correct

    • A 52-year-old man visits the clinic with concerns about a gradual decline in his hearing ability over the past few months. His wife urged him to seek medical attention as she noticed he was having difficulty hearing conversations and needed to turn up the volume on the TV and radio. Upon examination, otoscopy reveals no abnormalities in either ear. The Rinne's test is positive bilaterally, and the Weber test is normal. What is the most probable diagnosis?

      Your Answer: Presbycusis

      Explanation:

      Differentiating Causes of Hearing Loss: A Brief Overview

      Hearing loss can be caused by a variety of factors, including age-related changes, tumors, infections, and genetic conditions. Here are some key features to help differentiate between some of the most common causes of hearing loss:

      Presbycusis: This is age-related hearing loss that affects high-frequency sounds and is irreversible. Management includes reassurance and discussion of hearing aid options.

      Acoustic Neuroma: This is a benign tumor of the vestibulocochlear nerve that can cause unilateral tinnitus and hearing loss, as well as facial numbness and balance problems. Bilateral hearing loss without other symptoms makes this diagnosis unlikely.

      Cholesteatoma: This condition is characterized by recurrent or persistent ear discharge, conductive hearing loss, and ear discomfort. Otoscopy may reveal a deep retraction pocket or pearly white mass behind the intact tympanic membrane. This patient has sensorineural rather than conductive hearing loss.

      Ménière’s Disease: This condition typically presents with fluctuating hearing loss, vertigo, and tinnitus. Aural fullness may also be present. This patient does not have all the symptoms to meet the criteria for this diagnosis.

      Otosclerosis: This is a form of conductive hearing loss that typically occurs in early adulthood and may be accompanied by tinnitus and transient vertigo. Sensorineural hearing loss in an older patient makes this diagnosis unlikely.

    • This question is part of the following fields:

      • ENT
      14
      Seconds
  • Question 22 - A 32-year-old female with a history of alcoholic liver disease presents with frank...

    Incorrect

    • A 32-year-old female with a history of alcoholic liver disease presents with frank haematemesis. She had been discharged just two months ago after receiving treatment for bleeding oesophageal varices. What is the most suitable course of action to take while waiting for endoscopy after resuscitation?

      Your Answer: Propranolol

      Correct Answer: Terlipressin

      Explanation:

      Variceal haemorrhage is a serious condition that requires prompt management. The initial treatment involves resuscitation of the patient before endoscopy. Correcting clotting with FFP and vitamin K is important, as is the use of vasoactive agents such as terlipressin or octreotide. Prophylactic IV antibiotics are also recommended to reduce mortality in patients with liver cirrhosis. Endoscopic variceal band ligation is the preferred method of treatment, and the use of a Sengstaken-Blakemore tube or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) may be necessary if bleeding cannot be controlled. Propranolol and EVL are effective in preventing rebleeding and mortality, and are recommended by NICE guidelines. Proton pump inhibitor cover is given to prevent EVL-induced ulceration.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      18
      Seconds
  • Question 23 - Which of the following side-effects is more prevalent with atypical rather than conventional...

    Correct

    • Which of the following side-effects is more prevalent with atypical rather than conventional antipsychotics?

      Your Answer: Weight gain

      Explanation:

      Weight gain is a common side effect of atypical antipsychotics.

      Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These medications have the advantage of significantly reducing extrapyramidal side-effects. However, they can also cause adverse effects such as weight gain, hyperprolactinaemia, and in the case of clozapine, agranulocytosis. The Medicines and Healthcare products Regulatory Agency has issued warnings about the increased risk of stroke and venous thromboembolism when antipsychotics are used in elderly patients. Examples of atypical antipsychotics include clozapine, olanzapine, risperidone, quetiapine, amisulpride, and aripiprazole.

      Clozapine, one of the first atypical antipsychotics, carries a significant risk of agranulocytosis and requires full blood count monitoring during treatment. Therefore, it should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Adverse effects of clozapine include agranulocytosis, neutropaenia, reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.

    • This question is part of the following fields:

      • Psychiatry
      9.8
      Seconds
  • Question 24 - Which one of the following pathological changes favours ulcerative colitis (UC) over Crohn...

    Correct

    • Which one of the following pathological changes favours ulcerative colitis (UC) over Crohn disease in elderly patients?

      Your Answer: Crypt abscesses

      Explanation:

      Differences between Crohn’s Disease and Ulcerative Colitis

      Crohn’s disease and ulcerative colitis are both types of inflammatory bowel disease, but they differ in several aspects. One of the main differences is the presence of granulomas. While a lack of granulomas does not rule out Crohn’s disease, it is a far more likely option if they are present. Granulomas are not present in ulcerative colitis.

      Another difference is the layers of the bowel affected. Crohn’s disease affects all layers of the bowel, known as transmural disease, whereas ulcerative colitis is confined to the mucosa with occasional submucosa inflammation. Only Crohn’s disease has muscularis and serosa involvement. Additionally, Crohn’s disease can affect anything from the mouth to the anus, whereas ulcerative colitis is limited to colonic lesions.

      Skip lesions, or areas of discontinuity of the inflammatory process, are characteristic of Crohn’s disease. When skip lesions are present, this is suggestive of Crohn’s disease. Ulcerative colitis is a continuous disease, whereas Crohn’s disease can be present in multiple areas of the bowel with sharply demarcated areas.

      In terms of histology, both diseases show intense infiltration of the mucosa and submucosa with neutrophils and lymphoid aggregates. However, in fulminant cases of ulcerative colitis, the muscularis propria may be affected. On the other hand, the histologic characteristic pattern of inflammation in Crohn’s disease is transmural involvement of the bowel wall by lymphoid infiltrates that contain non-caseating granulomas.

      Therefore, it is important to differentiate between Crohn’s disease and ulcerative colitis to provide appropriate treatment. Endoscopy must be performed if ulcerative colitis is suspected.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      6.5
      Seconds
  • Question 25 - A 38-year-old woman visits her GP complaining of difficulty with fine movements in...

    Correct

    • A 38-year-old woman visits her GP complaining of difficulty with fine movements in her hands. She reports that her hands become pale and numb when exposed to cold temperatures. Upon examination, the GP observes thickening and tightening of the skin over the patient's hands. What other symptom would indicate a possible diagnosis of limited systemic sclerosis?

      Your Answer: Heartburn

      Explanation:

      CREST syndrome is a subtype of limited systemic sclerosis that includes calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, and telangiectasia. If a patient experiences heartburn, it may indicate oesophageal dysmotility, which is a feature of CREST syndrome. However, dry eyes are a symptom of Sjogren’s syndrome, which is a separate condition. Hypertension is a complication of diffuse systemic sclerosis, which affects the proximal limbs and trunk and can lead to renal crisis and respiratory involvement. Oliguria is a symptom of renal crisis, which is a complication of diffuse systemic sclerosis.

      Understanding Systemic Sclerosis

      Systemic sclerosis is a condition that affects the skin and other connective tissues, but its cause is unknown. It is more common in females, with three patterns of the disease. Limited cutaneous systemic sclerosis is characterised by Raynaud’s as the first sign, affecting the face and distal limbs, and associated with anti-centromere antibodies. CREST syndrome is a subtype of limited systemic sclerosis that includes Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, and Telangiectasia. Diffuse cutaneous systemic sclerosis affects the trunk and proximal limbs, associated with scl-70 antibodies, and has a poor prognosis. Respiratory involvement is the most common cause of death, with interstitial lung disease and pulmonary arterial hypertension being the primary complications. Renal disease and hypertension are also possible complications, and patients with renal disease should be started on an ACE inhibitor. Scleroderma without internal organ involvement is characterised by tightening and fibrosis of the skin, manifesting as plaques or linear. Antibodies such as ANA, RF, anti-scl-70, and anti-centromere are associated with different types of systemic sclerosis.

    • This question is part of the following fields:

      • Musculoskeletal
      14
      Seconds
  • Question 26 - A 45-year-old woman presents to the Emergency Department with a 2-week history of...

    Correct

    • A 45-year-old woman presents to the Emergency Department with a 2-week history of dull pain under her tongue while eating. This resolves after she finishes eating and has been gradually getting worse. Over the previous three days, this was also accompanied by swelling of the floor of her mouth. She is afebrile and all of her parameters are stable.
      Which of the following is the first-line investigation that needs to be done?

      Your Answer: X-ray sialogram

      Explanation:

      Investigating Salivary Gland Stones: Imaging and Laboratory Tests

      Salivary gland stones, or sialolithiasis, can cause pain and swelling in the affected gland, especially during eating or chewing. Diagnosis is usually based on clinical examination, but imaging may be necessary in cases of diagnostic uncertainty or suspected secondary infection. X-ray sialography is the traditional first-line investigation, as it is cheap and highly sensitive. Ultrasound and more advanced techniques like magnetic resonance sialography and CT sialography may also be used, but X-ray sialography remains the preferred option. Laboratory tests like amylase levels and blood cultures are not typically used in the diagnosis of sialolithiasis, unless there is a suspicion of acute pancreatitis or secondary infection, respectively.

    • This question is part of the following fields:

      • ENT
      17.2
      Seconds
  • Question 27 - A 56-year-old woman presents to the emergency department complaining of right upper quadrant...

    Correct

    • A 56-year-old woman presents to the emergency department complaining of right upper quadrant pain and rigors that have been ongoing for 2 days. She had previously seen her GP 6 months ago for biliary colic and was referred for an elective cholecystectomy. Upon examination, her blood work reveals elevated levels of WCC, CRP, and bilirubin. Based on these findings, what is the most probable diagnosis?

      Your Answer: Ascending cholangitis

      Explanation:

      If a patient with a history of gallstones experiences RUQ pain along with elevated inflammatory markers, it is more likely to be acute cholecystitis or cholangitis rather than biliary colic. The presence of fever and abnormal LFTs suggests ascending cholangitis, as opposed to cholecystitis, which is indicated by Charcot’s triad of RUQ pain, fever, and jaundice. Acute pancreatitis is unlikely if amylase levels are normal, and the sudden onset of symptoms makes malignancy, particularly cholangiocarcinoma, less probable.

      Understanding Ascending Cholangitis

      Ascending cholangitis is a bacterial infection that affects the biliary tree, with E. coli being the most common culprit. This condition is often associated with gallstones, which can predispose individuals to the infection. Patients with ascending cholangitis may present with Charcot’s triad, which includes fever, right upper quadrant pain, and jaundice. However, this triad is only present in 20-50% of cases. Other common symptoms include hypotension and confusion. In severe cases, Reynolds’ pentad may be observed, which includes the additional symptoms of hypotension and confusion.

      To diagnose ascending cholangitis, ultrasound is typically used as a first-line investigation to look for bile duct dilation and stones. Raised inflammatory markers may also be observed. Treatment involves intravenous antibiotics and endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction.

      Overall, ascending cholangitis is a serious condition that requires prompt diagnosis and treatment. Understanding the symptoms and risk factors associated with this condition can help individuals seek medical attention early and improve their chances of a successful recovery.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      11.7
      Seconds
  • Question 28 - A 48-year-old man comes to the General Practitioner complaining of feeling dizzy and...

    Correct

    • A 48-year-old man comes to the General Practitioner complaining of feeling dizzy and experiencing shortness of breath during physical activity. He has a bicuspid aortic valve and is waiting for valve replacement surgery.
      Which of the following murmurs would be the most likely to occur in this patient?

      Your Answer: Ejection systolic murmur loudest over the 2nd intercostal space, right sternal edge

      Explanation:

      Differentiating Heart Murmurs Based on Location and Type

      Heart murmurs are abnormal sounds heard during a heartbeat and can indicate various cardiac conditions. The location and type of murmur can help differentiate between different conditions.

      Ejection systolic murmur loudest over the 2nd intercostal space, right sternal edge: This is typical for aortic stenosis, which is more likely to occur in a bicuspid aortic valve. The murmur may radiate to the carotids. Pulmonary stenosis, hypertrophic obstructive cardiomyopathy, and atrial septal defect can also cause this type of murmur, but the location would be different.

      Ejection systolic murmur loudest over the 2nd intercostal space, left sternal edge: This location is typical for pulmonary stenosis, not aortic stenosis. The patient’s history indicates symptomatic aortic stenosis, making this finding inconsistent.

      Early diastolic murmur loudest over the 3rd intercostal space, left sternal edge: This type and location of murmur is typical for aortic regurgitation, not aortic stenosis. The location is Erb’s point, where S1 and S2 should both be heard.

      Mid-diastolic murmur loudest over the apex: This type and location of murmur is typical for mitral stenosis, not aortic stenosis. The apex is the mitral area, located at the 5th intercostal space in the midclavicular line.

      Pansystolic murmur loudest over the apex: This type and location of murmur is typical for mitral regurgitation, not aortic stenosis. The apex is the mitral area, located at the 5th intercostal space in the midclavicular line.

    • This question is part of the following fields:

      • Cardiovascular
      41.7
      Seconds
  • Question 29 - A 32-year-old woman presents to her General Practitioner with a 4-week history of...

    Correct

    • A 32-year-old woman presents to her General Practitioner with a 4-week history of diarrhoea, opening her bowels up to 2–3 times per day. She also complains of intermittent bloating and abdominal pain mostly prior to opening her bowels. There is no history of fever or vomiting and she has no past medical history of note. She returned from Thailand two weeks ago.
      Stool microscopy: trophozoites and cysts are seen.
      Given the likely diagnosis, what is the recommended management for this patient?
      Select the SINGLE most appropriate management from the list below.

      Your Answer: Metronidazole

      Explanation:

      Antibiotics for Diarrhoeal Illnesses: Understanding the Appropriate Treatment

      Giardiasis is a diarrhoeal illness caused by the protozoa Giardia lamblia, which is spread through contaminated food, water or faeces. The disease can last up to six weeks and presents with symptoms such as abdominal bloating, flatulence or malabsorption. Metronidazole is the preferred treatment for giardiasis due to its effectiveness and improved compliance.

      Doxycycline is used to treat cholera, a severe disease that causes watery diarrhoea and dehydration. However, the chronic duration of symptoms and presence of parasitic organisms make cholera unlikely.

      Ciprofloxacin is used to treat urinary-tract infections and some diarrhoeal illnesses such as cholera and Campylobacter jejuni infections. However, Campylobacter is usually self-limiting and has a much shorter duration of illness, making it an unlikely diagnosis.

      Clindamycin is not classically used to treat giardiasis and should be used with caution due to the increased risk of developing antibiotic-associated colitis and opportunistic infections such as Clostridium difficile.

      Co-amoxiclav may be used to treat intra-abdominal infections such as biliary sepsis, but it is not indicated for giardiasis.

      In summary, understanding the appropriate use of antibiotics for diarrhoeal illnesses is crucial in providing effective treatment and avoiding unnecessary risks.

    • This question is part of the following fields:

      • Immunology/Allergy
      18.3
      Seconds
  • Question 30 - A 9-year-old girl comes to the clinic with a one-month history of unusual...

    Correct

    • A 9-year-old girl comes to the clinic with a one-month history of unusual facial movements noticed by her father. Her father reports that he first noticed her having twitching of left eye and face as well as drooling of saliva. This happens about twice a week, always at night. Each episode lasts for 1-2 minutes and after each episode, the girl is unable to speak properly for around 5 minutes. The girl is aware of these occurrences but reports unable to control them. The father reports that his daughter is otherwise normal with normal development.
      What is the diagnosis?

      Your Answer: Benign rolandic epilepsy

      Explanation:

      Benign rolandic epilepsy is identified by the occurrence of partial seizures during the night.

      The child displays typical indications of benign rolandic epilepsy, which is distinguished by partial seizures that occur during the night. Reflex anoxic seizures are caused by anoxia and typically manifest as syncope and subsequent convulsions in very young children. Panayiotopoulos syndrome is characterised by seizures, often prolonged, with predominantly autonomic symptoms such as nausea and retching. Idiopathic childhood occipital epilepsy of Gastaut is mainly characterised by visual hallucinations. Night terrors are a sleep disorder that causes feelings of dread or terror, typically during REM sleep.

      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
      20.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

ENT (3/3) 100%
Musculoskeletal (3/3) 100%
Haematology/Oncology (3/3) 100%
Gastroenterology/Nutrition (3/4) 75%
Reproductive Medicine (1/3) 33%
Renal Medicine/Urology (1/1) 100%
Endocrinology/Metabolic Disease (1/1) 100%
Paediatrics (2/2) 100%
Ophthalmology (1/1) 100%
Genetics (1/1) 100%
Cardiovascular (2/3) 67%
Neurology (1/1) 100%
Psychiatry (1/2) 50%
Infectious Diseases (0/1) 0%
Immunology/Allergy (1/1) 100%
Passmed