-
Question 1
Incorrect
-
A 57-year-old man presents with a 4 weeks-history of productive cough, dyspnoea, and pleuritic chest pain. He has had associated lethargy, weight loss, a swinging fever and night sweats. He had a stroke two years ago.
Sputum and blood cultures are collected. After a chest x-ray revealed a fluid-filled space within an area of consolidation in his left lung, he was given IV antibiotics.
However, the patient's condition has not improved and instead appears to be worsening. What is the most appropriate next step in his management?Your Answer: Prescribe rifampicin, isoniazid, pyrazinamide, and ethambutol
Correct Answer: Arrange CT-guided percutaneous drainage
Explanation:If a lung abscess is not responding to intravenous antibiotics, percutaneous drainage should be considered as an option.
Correct: Arrange CT-guided percutaneous drainage. This is because the patient’s symptoms, such as swinging fevers, night sweats, pleuritic chest pain, dyspnoea, and cough, are consistent with a lung abscess. The chest x-ray also supports this diagnosis by showing a fluid-filled space within an area of consolidation. If IV antibiotics are not effective, percutaneous drainage can be guided by a CT scan or ultrasound. IV antibiotics may not be able to penetrate the abscess wall, which is why some patients do not respond to this treatment.
Incorrect: Arrange bronchoscopy. This is not commonly used for lung abscesses and is only indicated if an underlying tumour or foreign body is suspected. It is performed for diagnosis only, not drainage.
Incorrect: Arrange sputum cytology. Sputum cultures have already been collected, and a diagnosis of lung abscess has been established. This option could be considered later if the patient still does not respond to treatment to rule out an underlying malignancy.
Incorrect: Prescribe broad-spectrum IV antibiotics. This option is unlikely to be effective since the patient has already received IV antibiotics without success. The next step would be to manually drain the abscess.
Understanding Lung Abscess
A lung abscess is a localized infection that occurs within the lung tissue. It is commonly caused by aspiration pneumonia, which can be triggered by poor dental hygiene, reduced consciousness, or previous stroke. Other potential causes include haematogenous spread, direct extension, and bronchial obstruction. The infection is typically polymicrobial, with Staphylococcus aureus, Klebsiella pneumonia, and Pseudomonas aeruginosa being the most common monomicrobial causes.
The symptoms of lung abscess are similar to pneumonia, but they tend to develop more slowly over several weeks. Patients may experience fever, productive cough, foul-smelling sputum, chest pain, and dyspnea. Some may also have systemic features such as night sweats and weight loss, while a minority may experience haemoptysis. Physical examination may reveal dull percussion and bronchial breathing, as well as clubbing in some cases.
To diagnose lung abscess, a chest x-ray is usually performed, which shows a fluid-filled space within an area of consolidation. Sputum and blood cultures should also be obtained to identify the causative organism. Treatment typically involves intravenous antibiotics, but if the infection does not resolve, percutaneous drainage or surgical resection may be required in rare cases.
-
This question is part of the following fields:
- Respiratory Medicine
-
-
Question 2
Incorrect
-
A 30-year-old female who is being investigated for secondary amenorrhoea comes in with yellowing of the eyes. During the examination, spider naevi are observed, and the liver is tender and enlarged. The blood tests reveal the following results: Hb 11.6 g/dl, Plt 145 * 109/l, WCC 6.4 * 109/l, Albumin 33 g/l, Bilirubin 78 µmol/l, and ALT 245 iu/l. What is the most probable diagnosis?
Your Answer: Primary biliary cirrhosis
Correct Answer: Autoimmune hepatitis
Explanation:When a young female experiences both abnormal liver function tests and a lack of menstrual periods, it is highly indicative of autoimmune hepatitis.
Understanding Autoimmune Hepatitis
Autoimmune hepatitis is a condition that affects mostly young females and has an unknown cause. It is often associated with other autoimmune disorders, hypergammaglobulinaemia, and HLA B8, DR3. There are three types of autoimmune hepatitis, which are classified based on the types of circulating antibodies present. Type I affects both adults and children and is characterized by the presence of anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA). Type II affects children only and is characterized by the presence of anti-liver/kidney microsomal type 1 antibodies (LKM1). Type III affects adults in middle-age and is characterized by the presence of soluble liver-kidney antigen.
Autoimmune hepatitis may present with signs of chronic liver disease, and only 25% of cases present with acute hepatitis symptoms such as fever and jaundice. Amenorrhea is a common symptom. Diagnosis is made through the presence of ANA/SMA/LKM1 antibodies, raised IgG levels, and liver biopsy showing inflammation extending beyond the limiting plate, piecemeal necrosis, and bridging necrosis.
Management of autoimmune hepatitis involves the use of steroids and other immunosuppressants such as azathioprine. In severe cases, liver transplantation may be necessary.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 3
Incorrect
-
You are in the emergency department assessing a 68-year-old man who has arrived with a fractured femur. He is currently taking anticoagulants for his atrial fibrillation and you have been requested to reverse the anticoagulation to prepare him for surgery. Can you match the correct anticoagulant with its corresponding reversal agent?
Your Answer: Rivaroxaban - Idarucizumab
Correct Answer: Dabigatran - Idarucizumab
Explanation:Vitamin K is the antidote for warfarin.
Idarucizumab is the antidote for dabigatran.
Protamine sulfate is the antidote for heparin.Understanding Direct Oral Anticoagulants
Direct oral anticoagulants (DOACs) are medications used for various indications such as preventing stroke in non-valvular atrial fibrillation, preventing venous thromboembolism (VTE) after hip or knee surgery, and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). To be prescribed DOACs for stroke prevention in non-valvular AF, certain risk factors must be present, such as prior stroke or transient ischaemic attack, age 75 years or older, hypertension, diabetes mellitus, or heart failure.
There are four DOACs available, namely dabigatran, rivaroxaban, apixaban, and edoxaban, which differ in their mechanism of action and excretion. Dabigatran is a direct thrombin inhibitor, while rivaroxaban, apixaban, and edoxaban are direct factor Xa inhibitors. The majority of dabigatran is excreted through the kidneys, while rivaroxaban is metabolized in the liver, and apixaban and edoxaban are excreted through the feces.
In terms of reversal agents, idarucizumab is available for dabigatran, while andexanet alfa is available for rivaroxaban and apixaban. However, there is currently no authorized reversal agent for edoxaban, although andexanet alfa has been studied. Understanding the differences between DOACs is important for healthcare professionals to make informed decisions when prescribing these medications.
-
This question is part of the following fields:
- Pharmacology/Therapeutics
-
-
Question 4
Correct
-
A 65-year-old woman presents to the Emergency Department with a cough, fever, diarrhoea and myalgia. The cough is non-productive and has been getting gradually worse since she returned from holiday in Italy one week ago. Her daughter is concerned because over the past 24 hours she has become more drowsy and febrile. She is normally fit and well but drinks around 15 units of alcohol per week.
On examination, pulse is 80/min, blood pressure 110/70 mmHg, oxygen saturations are 95% on room air and temperature is 38.2ºC. Bilateral coarse crackles are heard in the chest.
Initial blood tests show the following:
Hb 13.8 g/dl
Platelets 300 * 109/l
WBC 14.5 * 109/l
Na+ 132 mmol/l
K+ 4.1 mmol/l
Urea 8.9 mmol/l
Creatinine 89 µmol/l
Bilirubin 11 µmol/l
ALP 35 u/l
ALT 62 u/l
A chest x-ray shows patchy consolidation in the right lower zone with an associated pleural effusion.
What is the most likely causative organism?Your Answer: Legionella pneumophila
Explanation:Legionella is often characterized by symptoms resembling the flu, such as a dry cough, confusion, and a slower than normal heart rate. Additionally, hyponatremia may be detected through blood tests. A history of recent travel abroad and the presence of pleural effusion are also indicative of Legionella.
Legionnaire’s Disease: Symptoms, Diagnosis, and Management
Legionnaire’s disease is a type of pneumonia caused by the Legionella pneumophilia bacterium, which is commonly found in water tanks. It is not transmitted from person to person. Symptoms of the disease include flu-like symptoms such as fever, dry cough, confusion, and lymphopaenia. Other features include relative bradycardia, hyponatraemia, and deranged liver function tests. Pleural effusion is seen in around 30% of patients.
Diagnosis of Legionnaire’s disease can be done through a urinary antigen test. Treatment involves the use of erythromycin or clarithromycin. Chest x-ray features of the disease are non-specific but may include patchy consolidation with a mid-to-lower zone predominance.
Compared to Mycoplasma pneumonia, Legionnaire’s disease has distinct differences in symptoms and diagnostic methods. It is important to be aware of the potential for Legionnaire’s disease in cases where water tanks or air-conditioning systems may be involved, as early diagnosis and treatment can lead to better outcomes.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 5
Correct
-
Generalised myositis is a known side effect of certain drugs. Among the options listed below, which drug is most likely to cause this side effect?
Your Answer: Simvastatin
Explanation:Muscle Effects of Common Medications
Many medications can have effects on muscles, including statins, metoclopramide, amitriptyline, cyclizine, and venlafaxine. Statins can increase the risk of muscle toxicity, especially in patients with a history of muscular disorders, high alcohol intake, renal impairment, or hypothyroidism. Metoclopramide is associated with extrapyramidal symptoms and acute dystonic reactions, but not generalised myositis. Amitriptyline and cyclizine are rarely associated with extrapyramidal symptoms and tremor, and amitriptyline may cause myalgia on drug withdrawal. Venlafaxine commonly causes hypertonia and tremor, and more rarely myoclonus, but not generalised myositis. It is important to be aware of these potential muscle effects when prescribing and monitoring these medications.
Muscle Effects of Commonly Prescribed Medications
-
This question is part of the following fields:
- Pharmacology/Therapeutics
-
-
Question 6
Correct
-
A 35-year-old gardener complains of a gradually worsening left elbow pain for the past two weeks. The pain intensifies when the elbow is straight and there is resistance during wrist extension and supination. What is the probable diagnosis?
Your Answer: Lateral epicondylitis
Explanation:The correct diagnosis is lateral epicondylitis, which is caused by repetitive arm movements. The pain is typically more severe when the wrist is extended against resistance and the elbow is straightened. This description does not match the symptoms of anterior interosseous syndrome, carpal tunnel syndrome, or medial epicondylitis.
Understanding Lateral Epicondylitis
Lateral epicondylitis, commonly known as tennis elbow, is a condition that often occurs after engaging in activities that the body is not accustomed to, such as painting or playing tennis. It is most prevalent in individuals aged 45-55 years and typically affects the dominant arm. The primary symptom of this condition is pain and tenderness localized to the lateral epicondyle. The pain is often exacerbated by wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended. Episodes of lateral epicondylitis can last between 6 months and 2 years, with patients experiencing acute pain for 6-12 weeks.
To manage lateral epicondylitis, it is essential to avoid muscle overload and engage in simple analgesia. Steroid injections and physiotherapy are also viable options for managing the condition. By understanding the symptoms and management options for lateral epicondylitis, individuals can take the necessary steps to alleviate pain and discomfort associated with this condition.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 7
Incorrect
-
A 30-year-old woman has delivered a baby boy at 40 + 2 weeks gestation. She is now 3 weeks postpartum and is exclusively breastfeeding with plans to continue for at least 6 months. What contraceptive method should she avoid due to absolute contraindication?
Your Answer: Progesterone only pill
Correct Answer: Combined contraceptive pill
Explanation:Understanding Contraception: A Basic Overview
Contraception has come a long way in the past 50 years, with the development of effective methods being one of the most significant advancements in medicine. There are various types of contraception available, including barrier methods, daily methods, and long-acting methods of reversible contraception (LARCs).
Barrier methods, such as condoms, physically block sperm from reaching the egg. While they can help protect against sexually transmitted infections (STIs), their success rate is relatively low, particularly when used by young people.
Daily methods include the combined oral contraceptive pill, which inhibits ovulation, and the progesterone-only pill, which thickens cervical mucus. However, the combined pill increases the risk of venous thromboembolism and breast and cervical cancer.
LARCs include implantable contraceptives and injectable contraceptives, which both inhibit ovulation and thicken cervical mucus. The implantable contraceptive lasts for three years, while the injectable contraceptive lasts for 12 weeks. The intrauterine system (IUS) and intrauterine device (IUD) are also LARCs, with the IUS preventing endometrial proliferation and thickening cervical mucus, and the IUD decreasing sperm motility and survival.
It is important to note that each method of contraception has its own set of benefits and risks, and it is essential to consult with a healthcare provider to determine the best option for individual needs and circumstances.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 8
Correct
-
A 28-year-old female patient visits her GP for a routine check-up after her initial cervical smear. She has no medical history, no family history of gynaecological cancers, and no known allergies to medications. She is currently taking the progesterone-only pill. The results of her smear test indicate:
Positive for HPV
Low-grade dyskaryosis cytology
What is the next course of action for managing this patient?Your Answer: Colposcopy referral
Explanation:If a patient’s cervical cancer screening shows a positive result for high-risk HPV (hrHPV) and cytological abnormalities, they should be referred for a colposcopy. This is because HPV increases the risk of developing cervical intraepithelial neoplasia and abnormal cytology indicates the need for further investigation. If the sample is inadequate, a repeat test should be offered in 3 months. However, there is no situation in which a patient is asked to return for a repeat test in 6 months. If the patient is hrHPV negative, they would be returned to normal recall as the NHS now follows an HPV first system. If the patient is hrHPV positive but has normal cytology, they would be invited for a repeat test in 12 months to assess for resolution of HPV or for further increased surveillance before considering a colposcopy. It would be inappropriate to reassure the patient and return them to normal recall if they are hrHPV positive and have dyskaryosis.
The cervical cancer screening program has evolved to include HPV testing, which allows for further risk stratification. A negative hrHPV result means a return to normal recall, while a positive result requires cytological examination. Abnormal cytology results lead to colposcopy, while normal cytology results require a repeat test at 12 months. Inadequate samples require a repeat within 3 months, and two consecutive inadequate samples lead to colposcopy. Treatment for CIN typically involves LLETZ or cryotherapy. Individuals who have been treated for CIN should be invited for a test of cure repeat cervical sample 6 months after treatment.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 9
Incorrect
-
A father with glucose-6-phosphate dehydrogenase deficiency seeks guidance concerning his young son. Considering the x-linked recessive pattern of inheritance for this condition, what is the likelihood that his son will also exhibit the disease?
Your Answer: Will definitely be affected
Correct Answer: No increased risk
Explanation:Conditions that are X-linked recessive do not show transmission from male to male.
Understanding X-Linked Recessive Inheritance
X-linked recessive inheritance is a genetic pattern where only males are affected, except in rare cases such as Turner’s syndrome. This type of inheritance is transmitted by heterozygote females, who are carriers of the gene mutation. Male-to-male transmission is not observed in X-linked recessive disorders. Affected males can only have unaffected sons and carrier daughters.
If a female carrier has children, each male child has a 50% chance of being affected, while each female child has a 50% chance of being a carrier. It is important to note that the possibility of an affected father having children with a heterozygous female carrier is generally rare. However, in some Afro-Caribbean communities, G6PD deficiency is relatively common, and homozygous females with clinical manifestations of the enzyme defect are observed.
In summary, X-linked recessive inheritance is a genetic pattern that affects only males and is transmitted by female carriers. Understanding this pattern is crucial in predicting the likelihood of passing on genetic disorders to future generations.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 10
Incorrect
-
A 58-year-old woman comes to the Emergency Department complaining of a painful left leg that has been getting worse for several hours. She has no other symptoms and has a medical history of asthma, hypertension, and a laparoscopic cholecystectomy 8 weeks ago.
During the examination, the left calf diameter is approximately 4 cm larger than the right calf, but there is no oedema.
What would be the most suitable initial investigation?Your Answer:
Correct Answer: Proximal leg vein ultrasound
Explanation:If the Wells score for a suspected deep vein thrombosis (DVT) is 2 or higher, a proximal leg vein ultrasound scan should be arranged within 4 hours. In this case, the patient’s Wells score is 2 due to recent major surgery within 12 weeks and a calf swelling at least 3 cm larger than the asymptomatic side. It is important to note that a CT angiogram of the leg is not appropriate for diagnosing DVT, and ultrasound is the preferred imaging modality. A CT pulmonary angiogram would only be necessary if the patient had symptoms suggestive of pulmonary embolism. A chest X-ray is not relevant in this scenario. If ultrasound is not possible within 4 hours, a D-dimer test could be performed and interim therapeutic anticoagulation given, but the initial choice is to perform an ultrasound scan as soon as possible.
NICE updated their guidelines on the investigation and management of venous thromboembolism (VTE) in 2020. The use of direct oral anticoagulants (DOACs) is recommended as first-line treatment for most people with VTE, including as interim anticoagulants before a definite diagnosis is made. Routine cancer screening is no longer recommended following a VTE diagnosis. The cornerstone of VTE management is anticoagulant therapy, with DOACs being the preferred choice. All patients should have anticoagulation for at least 3 months, with the length of anticoagulation being determined by whether the VTE was provoked or unprovoked.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 11
Incorrect
-
A 28-year-old woman has a Mirena intrauterine device inserted for birth control on day 10 of her menstrual cycle. She has not engaged in sexual activity since her last period. What is the duration required before it can be considered a reliable contraceptive method?
Your Answer:
Correct Answer: Immediately
Explanation:Contraceptives – Time to become effective (if not used on the first day of period):
Immediate: IUD
2 days: Progestin-only pill (POP)
7 days: Combined oral contraceptive (COC), injection, implant, intrauterine system (IUS)Intrauterine contraceptive devices include copper IUDs and levonorgestrel-releasing IUS. Both are over 99% effective. The IUD prevents fertilization by decreasing sperm motility, while the IUS prevents endometrial proliferation and thickens cervical mucus. Potential problems include heavier periods with IUDs and initial bleeding with the IUS. There is a small risk of uterine perforation, ectopic pregnancy, and infection. New IUS systems, such as Jaydess® and Kyleena®, have smaller frames and less levonorgestrel, resulting in lower serum levels and different rates of amenorrhea.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 12
Incorrect
-
As a GPST on a psychiatry placement, you encounter a 75-year-old patient who has been brought in by the police under Section 136. The patient is displaying confusion and aggression towards the nursing team, making it difficult to provide care. Despite attempts to offer oral medication, the patient has refused all treatment and has also declined an ECG. What is the most appropriate medication to administer in order to quickly calm this patient?
Your Answer:
Correct Answer: Lorazepam
Explanation:When it comes to quickly calming down patients who are exhibiting disruptive behavior, oral lorazepam is typically the first choice. According to NICE guidelines, either intramuscular lorazepam or a combination of intramuscular haloperidol and intramuscular promethazine should be used for rapid tranquilization in patients with acute behavioral disturbances. However, lorazepam is recommended for patients who have not previously taken antipsychotic medication and for those whose heart health is uncertain.
Understanding Psychosis
Psychosis is a term used to describe a person’s experience of perceiving things differently from those around them. This can manifest in various ways, including hallucinations, delusions, thought disorganization, alogia, tangentiality, clanging, and word salad. Associated features may include agitation/aggression, neurocognitive impairment, depression, and thoughts of self-harm. Psychotic symptoms can occur in a range of conditions, such as schizophrenia, depression, bipolar disorder, puerperal psychosis, brief psychotic disorder, neurological conditions, and drug use. The peak age of first-episode psychosis is around 15-30 years.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 13
Incorrect
-
A concerned parent brings her 4-month-old to your clinic with a bright red lump on their scalp that has been gradually increasing in size over the past 6 weeks. What is the probable diagnosis?
Your Answer:
Correct Answer: Capillary haemangioma
Explanation:Port wine stain and naevus flammeus are two different conditions that are often confused with each other. While they both present as red or purple birthmarks, port wine stains are caused by a malformation of blood vessels in the skin, while naevus flammeus is a type of capillary malformation.
Understanding Strawberry Naevus
Strawberry naevus, also known as capillary haemangioma, is a type of skin condition that usually develops in infants within the first month of life. It is characterized by raised, erythematous, and multilobed tumours that commonly appear on the face, scalp, and back. While it is not present at birth, it can grow rapidly and reach its peak size at around 6-9 months before regressing over the next few years. In fact, around 95% of cases resolve before the child reaches 10 years of age. However, there are potential complications that may arise, such as obstructing visual fields or airway, bleeding, ulceration, and thrombocytopaenia.
Capillary haemangiomas are more common in white infants, particularly in female and premature infants, as well as those whose mothers have undergone chorionic villous sampling. In cases where treatment is necessary, propranolol is now the preferred choice over systemic steroids. Topical beta-blockers like timolol may also be used. It is important to note that there is a deeper type of capillary haemangioma called cavernous haemangioma. Understanding the nature of strawberry naevus is crucial in managing its potential complications and providing appropriate treatment.
-
This question is part of the following fields:
- Dermatology
-
-
Question 14
Incorrect
-
A 62-year-old man presents to the clinic with a history of ischaemic heart disease and a recent diagnosis of type 2 diabetes mellitus. His HbA1c at the time of diagnosis was 7.6% (60 mmol/mol) and he was started on metformin, which was titrated up to a dose of 1g bd. His most recent blood work shows a HbA1c of 6.8% (51 mmol/mol). He has recently retired from the IT industry and has a BMI of 28 kg/m². He is currently taking atorvastatin 80 mg, aspirin 75mg, bisoprolol 2.5 mg, and ramipril 5mg. What would be the most appropriate next step?
Your Answer:
Correct Answer: Add empagliflozin
Explanation:In addition to metformin, an SGLT-2 inhibitor (such as empagliflozin) should be prescribed for this patient who has a history of cardiovascular disease.
NICE updated its guidance on the management of type 2 diabetes mellitus (T2DM) in 2022, reflecting advances in drug therapy and improved evidence regarding newer therapies such as SGLT-2 inhibitors. The first-line drug of choice remains metformin, which should be titrated up slowly to minimize gastrointestinal upset. HbA1c targets should be agreed upon with patients and checked every 3-6 months until stable, with consideration for relaxing targets on a case-by-case basis. Dietary advice includes encouraging high fiber, low glycemic index sources of carbohydrates and controlling intake of foods containing saturated fats and trans fatty acids. Blood pressure targets are the same as for patients without type 2 diabetes, and antiplatelets should not be offered unless a patient has existing cardiovascular disease. Only patients with a 10-year cardiovascular risk > 10% should be offered a statin, with atorvastatin 20mg as the first-line choice.
-
This question is part of the following fields:
- Endocrinology/Metabolic Disease
-
-
Question 15
Incorrect
-
A 45-year-old teacher is referred to the Respiratory Clinic with a 6-month history of progressive shortness of breath and dry cough. She denies fever or weight loss and there is no past medical history of note. She reports smoking 5 cigarettes a day for 3 years whilst at college but has since stopped. There are no known allergies.
On examination, her respiratory rate is 18 breaths per minute with an oxygen saturation of 94% on air. There are audible crackles at the lung bases with expiratory wheeze.
She is referred for spirometry testing:
Forced expiratory volume (FEV1): 60% predicted
Forced vital capacity (FVC): 80% predicted
What is the most likely diagnosis?Your Answer:
Correct Answer: Alpha-1 antitrypsin deficiency
Explanation:Differential Diagnosis for a Patient with Obstructive Lung Disease: Alpha-1 Antitrypsin Deficiency
Alpha-1 antitrypsin (AAT) deficiency is a genetic disorder that causes emphysematous changes in the lungs due to the loss of elasticity. This disease presents similarly to chronic obstructive pulmonary disease (COPD) with symptoms such as shortness of breath, cough, and wheeze. However, AAT deficiency typically affects young men between 30-40 years old and is exacerbated by smoking. Spirometry testing reveals an obstructive pattern of disease (FEV1/FVC < 0.7). Other potential diagnoses for obstructive lung disease include hypersensitivity pneumonitis, Kartagener’s syndrome, and idiopathic pulmonary fibrosis. However, these are less likely in this patient’s case. Hypersensitivity pneumonitis is caused by allergen exposure and presents with acute symptoms such as fever and weight loss. Kartagener’s syndrome is a genetic disease that leads to recurrent respiratory infections and bronchiectasis. Idiopathic pulmonary fibrosis is characterized by progressive fibrosis of the lung parenchyma and typically affects individuals between 50-70 years old. In contrast to AAT deficiency, spirometry testing in fibrotic disease would show a result greater than 0.7 (FEV1/FVC > 0.7).
In conclusion, AAT deficiency should be considered in the differential diagnosis for a patient presenting with obstructive lung disease, particularly in young men with a smoking history. Spirometry testing can help confirm the diagnosis.
-
This question is part of the following fields:
- Respiratory Medicine
-
-
Question 16
Incorrect
-
A 32-year-old woman visits a sexual health clinic with a concern about a lesion on her vulva that has been present for 2 weeks. She has no medical history, takes no regular medications, and has no known allergies. On examination, a single ulcer is found on the left labia majora, but the patient reports no pain and the rest of the examination is unremarkable. She has been having regular, unprotected oral and vaginal intercourse with her husband of 4 years. What is the most suitable management for the most probable diagnosis?
Your Answer:
Correct Answer: IM benzathine benzylpenicillin
Explanation:The correct treatment for primary syphilis, which is often associated with painless ulceration, is IM benzathine benzylpenicillin. This patient’s presentation of a single painless ulcer on a background of unprotected intercourse is consistent with primary syphilis, and it is important to not rule out sexually transmitted infections even if the patient has a regular partner. IM ceftriaxone, oral aciclovir, and oral azithromycin are all incorrect treatment options for primary syphilis.
Understanding Syphilis: Symptoms and Stages
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The infection progresses through three stages: primary, secondary, and tertiary. The incubation period can range from 9 to 90 days.
During the primary stage, a painless ulcer called a chancre appears at the site of sexual contact. Local lymph nodes may also become swollen, but this symptom may not be visible in women if the lesion is on the cervix.
The secondary stage occurs 6 to 10 weeks after the primary infection and is characterized by systemic symptoms such as fevers and lymphadenopathy. A rash may appear on the trunk, palms, and soles, along with buccal ulcers and painless warty lesions on the genitalia.
In the tertiary stage, granulomatous lesions called gummas may develop on the skin and bones, and there may be an ascending aortic aneurysm. Other symptoms include general paralysis of the insane, tabes dorsalis, and Argyll-Robertson pupil.
Congenital syphilis can also occur if a pregnant woman is infected. Symptoms include blunted upper incisor teeth, linear scars at the angle of the mouth, keratitis, saber shins, saddle nose, and deafness.
Understanding the symptoms and stages of syphilis is important for early detection and treatment. It is a treatable infection, but if left untreated, it can lead to serious complications.
-
This question is part of the following fields:
- Reproductive Medicine
-
-
Question 17
Incorrect
-
As a general practice doctor, you are attending to a 55-year-old man who has come in as a same-day emergency with new pain in his right leg and foot. The pain has been present for the past 48 hours and is worse at night. He reports that the pain is in the outer side of his calf and the top of his foot and toes. The patient has a medical history of osteoarthritis, gout, and hypertension, and is currently taking paracetamol, amlodipine, naproxen, allopurinol, and omeprazole.
Upon examination, there is no tenderness or joint deformity in the ankle or foot. The patient has limited movement of the ankle and experiences pain when dorsiflexing his foot. There is slightly altered sensation over the dorsum of his foot, but sensation in the rest of his leg is normal. Bilateral palpable dorsalis pedis pulses are present.
What is the most likely cause of this man's leg pain?Your Answer:
Correct Answer: L5 radiculopathy
Explanation:Nerve root pain can be identified by its distribution along the lateral calf and dorsum of the foot, as well as the presence of a neurological deficit such as sensory changes and weakness. This suggests that the L5 nerve is affected.
In contrast, joint diseases like gout and osteoarthritis typically cause pain localized to the affected joint, without any specific distribution on the foot. There is also no associated sensory loss, and movement of the joint is limited in all directions, not just dorsiflexion.
Peripheral vascular disease or deep vein thrombosis can cause symptoms throughout the entire limb, without any discernible distribution. While arterial disease may cause calf pain, it does not lateralize to the medial or lateral side of the calf. Additionally, if the foot is affected, the pain and sensory changes will be present on both the dorsum and sole.
Understanding Prolapsed Disc and its Features
A prolapsed lumbar disc is a common cause of lower back pain that can lead to neurological deficits. It is characterized by clear dermatomal leg pain, which is usually worse than the back pain. The pain is often aggravated when sitting. The features of the prolapsed disc depend on the site of compression. For instance, L3 nerve root compression can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, L4 nerve root compression can lead to sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.
The management of prolapsed disc is similar to that of other musculoskeletal lower back pain. It involves analgesia, physiotherapy, and exercises. According to NICE, the first-line treatment for back pain without sciatica symptoms is NSAIDs +/- proton pump inhibitors, rather than neuropathic analgesia. If the symptoms persist after 4-6 weeks, referral for consideration of MRI is appropriate. Understanding the features of prolapsed disc can help in the diagnosis and management of this condition.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 18
Incorrect
-
A 12-year-old boy has been under the care of the Paediatrics Team since birth and is attending the Paediatric Clinic for a follow-up appointment. His mother reports that he is struggling at school due to his learning and behavioural difficulties. He has a large jaw, hyper-extensible joints and macroorchidism.
Which of the following is the most likely syndrome?Your Answer:
Correct Answer: Fragile X syndrome
Explanation:Genetic Conditions and Their Phenotypic Features
Fragile X Syndrome, Down Syndrome, Edwards Syndrome, Noonan Syndrome, and Pierre-Robin Syndrome are genetic conditions that have distinct phenotypic features. Fragile X Syndrome is an X-linked form of learning disability and autism that mainly presents after puberty. Down Syndrome is characterized by brachycephaly, prominent epicanthal folds, and small nose and mouth with protruding tongue, among others, and is usually diagnosed at birth. Edwards Syndrome has a life expectancy of days to weeks and is characterized by neonatal hypotonia, apnea, and seizures. Noonan Syndrome is inherited in an autosomal-dominant pattern and is characterized by distinctive facial features, congenital heart defects, and skeletal malformations. Pierre-Robin Syndrome results in facial abnormalities, respiratory and feeding difficulties, and cleft palate. Understanding the phenotypic features of these genetic conditions is crucial for early diagnosis and management.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 19
Incorrect
-
A 32-year-old woman presents to her General Practitioner with a 4-day history of abdominal cramps and watery diarrhoea. Her symptoms started two days after she ate a salad from a restaurant.
Which of the following is the most likely causative organism?Your Answer:
Correct Answer: Campylobacter jejuni
Explanation:Campylobacter jejuni is a prevalent cause of bacterial food poisoning in the UK, typically transmitted through contaminated food or drink. Symptoms usually appear 2-5 days after exposure and may include abdominal cramps, diarrhea (which may or may not be bloody), nausea, vomiting, and fever. While symptoms are usually mild and self-limiting, severe cases or immunocompromised patients may require antibiotic treatment. Bacillus cereus and Clostridium perfringens are less likely causes of food poisoning due to their short incubation periods and milder symptoms. Rotavirus is a common cause of viral gastroenteritis in children, but adults are rarely affected due to immunity. Staphylococcus aureus can also cause food poisoning, with symptoms appearing 2-6 hours after ingestion and including nausea, vomiting, and abdominal pain.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 20
Incorrect
-
A 42-year-old woman is found to have breast cancer. She has no significant medical history, is premenopausal, and has no family history of breast or ovarian cancer. The cancer is in its early stages and she undergoes a wide-local excision followed by whole-breast radiotherapy. The pathology report reveals that the tumour is positive for oestrogen receptors but negative for HER2. What is the most probable adjuvant treatment that she will be recommended?
Your Answer:
Correct Answer: Tamoxifen
Explanation:The use of Tamoxifen is limited to pre-menopausal women, and there is a continuing discussion regarding the duration of therapy, whether it should be for 5 years or more.
Breast cancer management varies depending on the stage of the cancer, type of tumor, and patient’s medical history. Treatment options may include surgery, radiotherapy, hormone therapy, biological therapy, and chemotherapy. Surgery is typically the first option for most patients, except for elderly patients with metastatic disease who may benefit more from hormonal therapy. Prior to surgery, an axillary ultrasound is recommended for patients without palpable axillary lymphadenopathy, while those with clinically palpable lymphadenopathy require axillary node clearance. The type of surgery offered depends on various factors, such as tumor size, location, and type. Breast reconstruction is also an option for patients who have undergone a mastectomy.
Radiotherapy is recommended after a wide-local excision to reduce the risk of recurrence, while mastectomy patients may receive radiotherapy for T3-T4 tumors or those with four or more positive axillary nodes. Hormonal therapy is offered if tumors are positive for hormone receptors, with tamoxifen being used in pre- and peri-menopausal women and aromatase inhibitors like anastrozole in post-menopausal women. Tamoxifen may increase the risk of endometrial cancer, venous thromboembolism, and menopausal symptoms. Biological therapy, such as trastuzumab, is used for HER2-positive tumors but cannot be used in patients with a history of heart disorders. Chemotherapy may be used before or after surgery, depending on the stage of the tumor and the presence of axillary node disease. FEC-D is commonly used in the latter case.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 21
Incorrect
-
A 30-year-old man comes to the clinic with complaints of painful urination and left knee pain. He had experienced a severe episode of diarrhea three weeks ago. What is the probable diagnosis?
Your Answer:
Correct Answer: Reactive arthritis
Explanation:Reactive arthritis is characterized by the presence of urethritis, arthritis, and conjunctivitis, and this patient exhibits two of these classic symptoms.
Understanding Reactive Arthritis: Symptoms and Features
Reactive arthritis is a type of seronegative spondyloarthropathy that is associated with HLA-B27. It was previously known as Reiter’s syndrome, which was characterized by a triad of urethritis, conjunctivitis, and arthritis following a dysenteric illness during World War II. However, later studies revealed that patients could also develop symptoms after a sexually transmitted infection, now referred to as sexually acquired reactive arthritis (SARA).
Reactive arthritis is defined as an arthritis that develops after an infection, but the organism cannot be recovered from the joint. The symptoms typically develop within four weeks of the initial infection and last for around 4-6 months. Approximately 25% of patients experience recurrent episodes, while 10% develop chronic disease. The arthritis is usually an asymmetrical oligoarthritis of the lower limbs, and patients may also experience dactylitis.
Other symptoms of reactive arthritis include urethritis, conjunctivitis (seen in 10-30% of patients), and anterior uveitis. Skin symptoms may also occur, such as circinate balanitis (painless vesicles on the coronal margin of the prepuce) and keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles). A helpful mnemonic to remember the symptoms of reactive arthritis is Can’t see, pee, or climb a tree.
In conclusion, understanding the symptoms and features of reactive arthritis is crucial for early diagnosis and treatment. While the condition can be recurrent or chronic, prompt management can help alleviate symptoms and improve quality of life for affected individuals.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 22
Incorrect
-
An 80-year-old man presents with right-sided facial droop, dysphasia, and right-sided hemianopia. He has a medical history of gout, recurrent UTIs, dementia, and diabetes mellitus. A CT head is unremarkable, and an MRI head reveals a left-sided infarct. Which of the patient's pre-existing conditions elevate his chances of experiencing an ischemic stroke?
Your Answer:
Correct Answer: Diabetes mellitus
Explanation:The following factors increase the risk of ischaemic stroke: age, hypertension, smoking, hyperlipidaemia, diabetes mellitus, and atrial fibrillation. However, gout, recurrent UTIs, and dementia do not have an impact on stroke risk. Taking aspirin can lower the risk of stroke.
Understanding Stroke: A Basic Overview
Stroke is a significant cause of morbidity and mortality, with over 150,000 cases reported annually in the UK alone. It is the fourth leading cause of death in the country, killing twice as many women as breast cancer each year. However, the prevention and treatment of strokes have undergone significant changes in the past decade. What was once considered an untreatable condition is now viewed as a brain attack that requires emergency assessment to determine if patients can benefit from new treatments such as thrombolysis.
A stroke, also known as a cerebrovascular accident (CVA), occurs when there is a sudden interruption in the vascular supply of the brain. This interruption can lead to irreversible damage as neural tissue is entirely dependent on aerobic metabolism. There are two main types of strokes: ischaemic and haemorrhagic. Ischaemic strokes occur when there is a blockage in the blood vessel that stops blood flow, while haemorrhagic strokes happen when a blood vessel bursts, leading to a reduction in blood flow.
Symptoms of a stroke include motor weakness, speech problems, swallowing difficulties, visual field defects, and balance problems. The Oxford Stroke Classification is a formal system used to classify strokes based on initial symptoms. Patients with suspected stroke require emergency neuroimaging to determine if they are suitable for thrombolytic therapy to treat early ischaemic strokes. If the stroke is haemorrhagic, neurosurgical consultation should be considered for advice on further management.
In conclusion, understanding the basics of stroke is crucial in identifying and managing the condition. Early intervention and treatment can significantly improve outcomes for patients.
-
This question is part of the following fields:
- Neurology
-
-
Question 23
Incorrect
-
You are clerking a 26-year-old in the emergency department. He reports experiencing painful prolonged erection of the penis for the third time. What could be the probable cause of his recurrent presentations?
Your Answer:
Correct Answer: Sickle cell disease
Explanation:Recurrent priapism is a common occurrence in individuals with sickle cell disease, while alcohol and drug abuse may also lead to this condition. Balanitis, on the other hand, is an inflammation that affects the head of the penis and is not associated with priapism. Paraphimosis, however, can be caused by the inability to retract the foreskin.
Sickle-cell anaemia is a genetic disorder that occurs when abnormal haemoglobin, known as HbS, is produced due to an autosomal recessive condition. This condition is more common in individuals of African descent, as the heterozygous condition provides some protection against malaria. About 10% of UK Afro-Caribbean’s are carriers of HbS, and they only experience symptoms if they are severely hypoxic. Homozygotes tend to develop symptoms between 4-6 months when the abnormal HbSS molecules replace fetal haemoglobin.
The pathophysiology of sickle-cell anaemia involves the substitution of the polar amino acid glutamate with the non-polar valine in each of the two beta chains (codon 6) of haemoglobin. This substitution decreases the water solubility of deoxy-Hb, causing HbS molecules to polymerise and sickle RBCs in the deoxygenated state. HbAS patients sickle at p02 2.5 – 4 kPa, while HbSS patients sickle at p02 5 – 6 kPa. Sickle cells are fragile and haemolyse, blocking small blood vessels and causing infarction.
The definitive diagnosis of sickle-cell anaemia is through haemoglobin electrophoresis.
-
This question is part of the following fields:
- Renal Medicine/Urology
-
-
Question 24
Incorrect
-
A 50-year-old man arrives at the emergency department complaining of severe chest pain that radiates to his left arm, accompanied by nausea and sweating. His ECG reveals widespread ST depression with T wave inversion, and his blood tests show a haemoglobin level of 75g/L. What is the appropriate treatment for his anaemia?
Your Answer:
Correct Answer: Transfusion of packed red cells
Explanation:For patients with ACS, the recommended transfusion threshold is a haemoglobin level of 80 g/L. In this case, the patient is presenting with symptoms of ACS and his ECG confirms this. However, his haemoglobin level is below the threshold, indicating severe anaemia. Therefore, an immediate transfusion is necessary to alleviate the anaemia. Anaemia can exacerbate ischaemia in ACS, leading to increased strain on the heart and reduced oxygen supply. The guidelines suggest aiming for a haemoglobin concentration of 80-100 g/L after transfusion. Oral or IV iron would not provide immediate relief, and IV Hartmann’s solution is not a suitable treatment for anaemia and would not address the underlying issue. This highlights the importance of prompt and appropriate treatment for patients with ACS. This information is based on the NICE guideline [NG24].
Guidelines for Red Blood Cell Transfusion
In 2015, NICE released guidelines for the use of blood products, specifically red blood cells. These guidelines recommend different transfusion thresholds for patients with and without acute coronary syndrome (ACS). For patients without ACS, the transfusion threshold is 70 g/L, while for those with ACS, it is 80 g/L. The target hemoglobin level after transfusion is 70-90 g/L for patients without ACS and 80-100 g/L for those with ACS. It is important to note that these thresholds should not be used for patients with ongoing major hemorrhage or those who require regular blood transfusions for chronic anemia.
When administering red blood cells, it is crucial to store them at 4°C prior to infusion. In non-urgent scenarios, a unit of RBC is typically transfused over a period of 90-120 minutes. By following these guidelines, healthcare professionals can ensure that red blood cell transfusions are administered safely and effectively.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 25
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:
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
-
-
Question 26
Incorrect
-
A 42-year-old woman presented with swelling in her feet and mentioned that she uses two pillows while sleeping. What is the most suitable initial investigation?
Your Answer:
Correct Answer: Plasma NT-proBNP
Explanation:Diagnostic Tests for Suspected Heart Failure
When a patient presents with symptoms of peripheral edema and orthopnea, heart failure is a likely diagnosis. To confirm this, NICE guidelines recommend using N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an initial investigation. A level below 400 ng/litre makes heart failure unlikely, while levels between 400 and 2,000 ng/litre require referral for specialist assessment within 6 weeks. Levels above 2,000 ng/litre require referral within 2 weeks. An echocardiogram should be performed to quantify ventricular function if the ECG and NT-proBNP are abnormal. Blood cultures can also be useful for detecting systemic infection or endocarditis. An exercise tolerance test is more appropriate for suspected coronary artery disease. Finally, rheumatoid factor is a non-specific test for autoimmune conditions.
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 27
Incorrect
-
You are an F2 treating an 8 year-old patient with acute epiglottitis in the emergency department. Which is the most appropriate initial management?
Your Answer:
Correct Answer: Call for an anaesthetist
Explanation:Acute epiglottitis is a medical emergency that requires prompt management to prevent airway obstruction. It is caused by inflammation of the epiglottis and is most common in children. Symptoms include fever, sore throat, difficulty swallowing, and respiratory distress. The most severe cases can lead to complete airway obstruction, which can be fatal.
The most important initial step in management is to call for an anaesthetist to intubate the child. Attempting to administer treatment via a facemask or examining the child’s throat can cause distress and increase the risk of complete airway obstruction. The anaesthetist should be present during any examination or treatment to ensure the safety of the child.
In summary, acute epiglottitis is a medical emergency that requires prompt management to prevent airway obstruction. Calling for an anaesthetist to intubate the child is the most important initial step in management. Any examination or treatment should be done with the anaesthetist present to ensure the safety of the child.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 28
Incorrect
-
A 50-year-old woman comes to the clinic complaining of an itchy papular rash on her palms and forearms. The rash has white lines visible across its surface and scratching has worsened it. Additionally, she has noticed thinning of her nails with longitudinal ridges visible. What is the most appropriate first-line treatment?
Your Answer:
Correct Answer: Potent topical steroids
Explanation:The primary treatment for lichen planus is potent topical steroids. Emollients are not effective for this condition, and oral steroids may only be necessary in severe or resistant cases. Calcipotriol, a synthetic vitamin D derivative, is used for psoriasis and not lichen planus. Fusidic acid is an antibiotic used for staphylococcal skin infections, such as impetigo, and is not indicated for lichen planus.
Understanding Lichen Planus
Lichen planus is a skin condition that is believed to be caused by an immune response, although the exact cause is unknown. It is characterized by an itchy, papular rash that typically appears on the palms, soles, genitalia, and flexor surfaces of the arms. The rash often has a polygonal shape and a distinctive white-lines pattern on the surface, known as Wickham’s striae. In some cases, new skin lesions may appear at the site of trauma, a phenomenon known as the Koebner phenomenon.
Oral involvement is common in around 50% of patients, with a white-lace pattern often appearing on the buccal mucosa. Nail changes may also occur, including thinning of the nail plate and longitudinal ridging. Lichenoid drug eruptions can be caused by certain medications, such as gold, quinine, and thiazides.
The main treatment for lichen planus is potent topical steroids. For oral lichen planus, benzydamine mouthwash or spray is recommended. In more extensive cases, oral steroids or immunosuppression may be necessary.
-
This question is part of the following fields:
- Dermatology
-
-
Question 29
Incorrect
-
A 72-year-old woman comes to the emergency department with a blocked stoma bag. She had surgery for bowel cancer recently, which involved removing a section of her bowel. The stoma bag is situated in the upper left quadrant of her abdomen. The bag is entirely empty, and you can see that the proximal part of the resected bowel is flush with the skin. Her abdomen is swollen, and you can hear tinkling bowel sounds. What kind of stoma does this patient have?
Your Answer:
Correct Answer: End colostomy
Explanation:The correct type of stoma in this case is an end colostomy. This is because the stoma is flush to the skin, indicating that the large bowel contents are not irritant. To differentiate between a colostomy and a small intestine stoma, one can look at the location and output. Ileostomies are typically located on the right iliac fossa and have spouted output, while colostomies are usually on the left iliac fossa and have flush output. An end ileostomy is used after complete colon excision or when an ileocolic anastomosis is not planned, and it would have spouted output. A loop ileostomy involves taking a loop of the ileum and bringing it up to the skin, and it is used to defunction the colon and can be reversed. It would also have spouted output. A loop jejunostomy is used as a high output stoma and would also have spouted output. A percutaneous jejunostomy involves a feeding tube directly inserted into the jejunum and would not have a stoma bag.
Abdominal stomas are created during various abdominal procedures to bring the lumen or contents of organs onto the skin. Typically, this involves the bowel, but other organs may also be diverted if necessary. The type and method of construction of the stoma will depend on the contents of the bowel. Small bowel stomas should be spouted to prevent irritant contents from coming into contact with the skin, while colonic stomas do not require spouting. Proper siting of the stoma is crucial to reduce the risk of leakage and subsequent maceration of the surrounding skin. The type and location of the stoma will vary depending on the purpose, such as defunctioning the colon or providing feeding access. Overall, abdominal stomas are a necessary medical intervention that requires careful consideration and planning.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 30
Incorrect
-
A 26-year-old female patient arrives with a sudden onset of pain at the back of her ankle while jogging, accompanied by a cracking sound. Which medication from the following list could have played a role in causing this injury?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:The patient is displaying typical symptoms of a ruptured Achilles tendon, which can be caused by ciprofloxacin. Tendon damage is a known potential side effect of quinolone antibiotics, and it seems to be a rare reaction that can occur after just 8 days of treatment.
Understanding Quinolones: Antibiotics that Inhibit DNA Synthesis
Quinolones are a type of antibiotics that are known for their bactericidal properties. They work by inhibiting DNA synthesis, which makes them effective in treating bacterial infections. Some examples of quinolones include ciprofloxacin and levofloxacin.
The mechanism of action of quinolones involves inhibiting topoisomerase II (DNA gyrase) and topoisomerase IV. However, bacteria can develop resistance to quinolones through mutations to DNA gyrase or by using efflux pumps that reduce the concentration of quinolones inside the cell.
While quinolones are generally safe, they can have adverse effects. For instance, they can lower the seizure threshold in patients with epilepsy and cause tendon damage, including rupture, especially in patients taking steroids. Additionally, animal models have shown that quinolones can damage cartilage, which is why they are generally avoided in children. Quinolones can also lengthen the QT interval, which can be dangerous for patients with heart conditions.
Quinolones should be avoided in pregnant or breastfeeding women and in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Overall, understanding the mechanism of action, mechanism of resistance, adverse effects, and contraindications of quinolones is important for their safe and effective use in treating bacterial infections.
-
This question is part of the following fields:
- Pharmacology/Therapeutics
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Mins)