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  • Question 1 - You are the surgical foundation year 1 doctor and have been bleeped by...

    Incorrect

    • You are the surgical foundation year 1 doctor and have been bleeped by the nurse on the surgical ward regarding a 66-year-old patient who had a laparotomy for large bowel obstruction 2 days ago. On attending the ward the nurse reports that she thinks the patient is becoming unconscious with a drop in respiratory rate to eight breaths per minute. You have tried to secure the patient’s airway and noted on the drug chart that patient has been using the patient controlled analgesia with morphine regularly.
      Which of the following is the next appropriate treatment?

      Your Answer: 40 µg increments of naloxone titrated to effect

      Correct Answer: 400 µg bolus of naloxone

      Explanation:

      Proper Medication Dosages and Procedures for Opioid Overdose

      Opioid overdose is a serious medical emergency that requires immediate intervention. Here are some important medication dosages and procedures to keep in mind:

      – A 400 µg bolus of naloxone should be given intravenously immediately to treat opioid toxicity. However, be aware that one bolus may not be sufficient as naloxone has a short half-life.
      – Naloxone should be prescribed in µg rather than mg.
      – Flumazenil is used in benzodiazepine overdose, not opioid overdose.
      – Naloxone should be given in bolus rather than increments of 40 µg, which is an insufficient dose.
      – Intubation and ventilation should only be attempted by trained professionals in cases of compromised airway.

      By following these guidelines, healthcare professionals can effectively treat opioid overdose and potentially save lives.

    • This question is part of the following fields:

      • Pharmacology
      29.9
      Seconds
  • Question 2 - A 63-year-old man who is receiving treatment for alcoholism presents with a week-long...

    Correct

    • A 63-year-old man who is receiving treatment for alcoholism presents with a week-long history of pins and needles in his right arm. He continues to consume over 20 units of alcohol per day and is taking disulfiram and citalopram. On examination, there are no signs of weakness, abnormal movements, or changes in tone, and his sensation is intact in all dermatomes. A blood test reveals a clinically significant result of Mg2+ 0.5 mmol/L (0.65 - 1.05). The patient is prescribed oral magnesium sulfate, and his doctor informs him of a potential side effect of the medication. What side effect is the patient likely to be warned about?

      Your Answer: Diarrhoea

      Explanation:

      Severe diarrhoea is the main side effect that limits the dosage of magnesium salts. Hypomagnesaemia can cause symptoms similar to hypokalemia, such as paraesthesia. Heavy alcohol consumption can lead to magnesium loss from tissues and increased urinary magnesium loss. Oral magnesium sulfate is the treatment for hypomagnesaemia above 0.4 mmol/L, while intravenous magnesium sulfate is used for levels below 0.4 mmol/L. Although constipation resulting from paralytic ileus is a rare side effect of oral magnesium salts, severe diarrhoea is the more common clinical presentation. Loss of appetite is not a known side effect of oral magnesium salts, and nausea is only seen in cases of magnesium salt overdose, not at therapeutic levels.

      Understanding Hypomagnesaemia: Causes, Symptoms, and Treatment

      Hypomagnesaemia is a condition characterized by low levels of magnesium in the blood. There are several causes of this condition, including the use of certain drugs such as diuretics and proton pump inhibitors, total parenteral nutrition, and chronic or acute diarrhoea. Alcohol consumption, hypokalaemia, hypercalcaemia, and metabolic disorders like Gitelman’s and Bartter’s can also lead to hypomagnesaemia. The symptoms of this condition may be similar to those of hypocalcaemia, including paraesthesia, tetany, seizures, and arrhythmias.

      When the magnesium level drops below 0.4 mmol/L or when there are symptoms of tetany, arrhythmias, or seizures, intravenous magnesium replacement is commonly given. An example regime would be 40 mmol of magnesium sulphate over 24 hours. For magnesium levels above 0.4 mmol/L, oral magnesium salts are prescribed in divided doses of 10-20 mmol per day. However, diarrhoea can occur with oral magnesium salts. It is important to note that hypomagnesaemia can exacerbate digoxin toxicity.

    • This question is part of the following fields:

      • Pharmacology
      28.3
      Seconds
  • Question 3 - A 42-year-old man presents with a one-month history of tingling sensation in his...

    Correct

    • A 42-year-old man presents with a one-month history of tingling sensation in his fingers, toes and around the mouth. Initially, the symptom only affected his fingers but has since spread and gradually worsened. He had a similar symptom a couple of years ago and was diagnosed with low calcium levels. The patient reports no muscle weakness, tremors or other neurological symptoms. He is currently taking esomeprazole for reflux symptoms. His recent blood test showed a calcium level of 2.2 mmol/L (2.1-2.6). What electrolyte abnormality could be causing this patient's presenting symptoms?

      Your Answer: Hypomagnesaemia

      Explanation:

      Hypomagnesaemia can lead to symptoms that are similar to those of hypocalcaemia, such as paresthesia, tetany, seizures, and arrhythmias. This condition can be caused by the use of proton pump inhibitors like lansoprazole and esomeprazole.

      The answer hyperkalemia is incorrect because its symptoms are often non-specific, including breathing difficulty, weakness, fatigue, palpitations, or chest pain, but not paresthesia.

      Similarly, hypermagnesaemia and hypernatremia are also incorrect answers. While hypermagnesaemia can cause weakness, confusion, nausea, vomiting, and shortness of breath, it does not lead to paresthesia. Hypernatremia, on the other hand, can cause lethargy, weakness, confusion, irritability, and seizures, but not paresthesia.

      Understanding Hypomagnesaemia: Causes, Symptoms, and Treatment

      Hypomagnesaemia is a condition characterized by low levels of magnesium in the blood. There are several causes of this condition, including the use of certain drugs such as diuretics and proton pump inhibitors, total parenteral nutrition, and chronic or acute diarrhoea. Alcohol consumption, hypokalaemia, hypercalcaemia, and metabolic disorders like Gitelman’s and Bartter’s can also lead to hypomagnesaemia. The symptoms of this condition may be similar to those of hypocalcaemia, including paraesthesia, tetany, seizures, and arrhythmias.

      When the magnesium level drops below 0.4 mmol/L or when there are symptoms of tetany, arrhythmias, or seizures, intravenous magnesium replacement is commonly given. An example regime would be 40 mmol of magnesium sulphate over 24 hours. For magnesium levels above 0.4 mmol/L, oral magnesium salts are prescribed in divided doses of 10-20 mmol per day. However, diarrhoea can occur with oral magnesium salts. It is important to note that hypomagnesaemia can exacerbate digoxin toxicity.

    • This question is part of the following fields:

      • Pharmacology
      56
      Seconds
  • Question 4 - A 55-year-old man presents with sudden onset of severe chest pain and difficulty...

    Correct

    • A 55-year-old man presents with sudden onset of severe chest pain and difficulty breathing. The pain started while he was eating and has been constant for the past three hours. It radiates to his back and interscapular region.

      The patient has a history of hypertension for three years, alcohol abuse, and is a heavy smoker of 30 cigarettes per day. On examination, he is cold and clammy with a heart rate of 130/min and a blood pressure of 80/40 mm Hg. JVP is normal, but breath sounds are decreased at the left lung base and a chest x-ray reveals a left pleural effusion.

      What is the most likely diagnosis?

      Your Answer: Acute aortic dissection

      Explanation:

      Acute Aortic Dissection: Symptoms, Diagnosis, and Imaging

      Acute aortic dissection is a medical emergency that causes sudden and severe chest pain. The pain is often described as tearing and may be felt in the front or back of the chest, as well as in the neck. Other symptoms and signs depend on the arteries involved and nearby organs affected. In severe cases, it can lead to hypovolemic shock and sudden death.

      A chest x-ray can show a widened mediastinum, cardiomegaly, pleural effusion, and intimal calcification separated more than 6 mm from the edge. However, aortography is the gold standard for diagnosis, which shows the origin of arteries from true or false lumen. CT scan and MRI are also commonly used for diagnosis. Transoesophageal echo (TEE) is best for the descending aorta, while transthoracic echo (TTE) is best for the ascending aorta and arch.

      In summary, acute aortic dissection is a serious condition that requires prompt diagnosis and treatment. Symptoms include sudden and severe chest pain, which may be accompanied by other signs depending on the arteries involved. Imaging techniques such as chest x-ray, aortography, CT scan, MRI, TEE, and TTE can aid in diagnosis.

    • This question is part of the following fields:

      • Cardiology
      56.6
      Seconds
  • Question 5 - A 35-year-old man presents to a psychiatrist after his wife demands he sees...

    Correct

    • A 35-year-old man presents to a psychiatrist after his wife demands he sees someone to manage his ‘endless nagging’. He has no interest in being here. He reports that his wife is always frustrating him because she simply will not do things the right way. He cites frequent eruptions over how to load the dishwasher properly and how his wife continues to load it improperly. When asked what happens if she loads it her way, the patient describes feeling frustrated that it is not loaded the right way and expressing his frustration to his wife. When asked what he hopes to get out of this visit, the patient wants to learn if there are better ways of effectively communicating the right way to do things.

      Which of the following is most likely?

      Your Answer: Obsessive-compulsive personality disorder (OCPD)

      Explanation:

      The patient’s behavior of being fixated on the right way to load a dishwasher could be indicative of either obsessive-compulsive personality disorder (OCPD) or obsessive-compulsive disorder (OCD). The key difference between the two is whether or not the individual experiences distress over their obsession. In this case, the patient does not seem to experience any distress and instead wants to control how his wife loads the dishwasher. This suggests OCPD rather than OCD. Histrionic personality disorder, antisocial personality disorder, and narcissistic personality disorder are not as applicable to this situation.

    • This question is part of the following fields:

      • Psychiatry
      44.8
      Seconds
  • Question 6 - A 22-year-old woman at 36 weeks gestation contacts her doctor seeking advice on...

    Correct

    • A 22-year-old woman at 36 weeks gestation contacts her doctor seeking advice on contraceptive options post-childbirth. She expresses interest in the contraceptive implant after a thorough discussion. The patient has no medical issues and does not intend to breastfeed. When can she start this treatment?

      Your Answer: Immediately following childbirth

      Explanation:

      It is safe to insert a contraceptive implant after childbirth. The manufacturer of the most commonly used implant in the UK, Nexplanon®, recommends waiting at least 4 weeks postpartum for breastfeeding women. While there is no evidence of harm to the mother or baby, it is not recommended to insert an implant during pregnancy due to potential complications. It may take some time for fertility to return after pregnancy.

      Implanon and Nexplanon are subdermal contraceptive implants that slowly release the progesterone hormone etonogestrel to prevent ovulation and thicken cervical mucous. Nexplanon is the newer version and has a redesigned applicator to prevent deep insertions and is radiopaque for easier location. It is highly effective with a failure rate of 0.07/100 women-years and lasts for 3 years. It does not contain estrogen, making it suitable for women with a past history of thromboembolism or migraine. It can be inserted immediately after a termination of pregnancy. However, a trained professional is needed for insertion and removal, and additional contraceptive methods are required for the first 7 days if not inserted on days 1 to 5 of a woman’s menstrual cycle.

      The main disadvantage of these implants is irregular and heavy bleeding, which can be managed with a co-prescription of the combined oral contraceptive pill. Other adverse effects include headache, nausea, and breast pain. Enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon, and women should switch to a method unaffected by enzyme-inducing drugs or use additional contraception until 28 days after stopping the treatment.

      There are also contraindications for using these implants, such as ischaemic heart disease/stroke, unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, and liver cancer. Current breast cancer is a UKMEC 4 condition, which represents an unacceptable risk if the contraceptive method is used. Overall, these implants are a highly effective and long-acting form of contraception, but they require careful consideration of the potential risks and contraindications.

    • This question is part of the following fields:

      • Gynaecology
      32.5
      Seconds
  • Question 7 - A 93-year-old man was admitted to your medical ward in Scotland a week...

    Correct

    • A 93-year-old man was admitted to your medical ward in Scotland a week ago, having developed pneumonia. He has a history of dementia, has had two previous small strokes and lives in a residential home. His dementia has been worsening for 5 years. He has difficulty remembering who the nursing home staff are. The staff report that his appetite is poor and that he has gradually lost weight over the last few months.
      He is treated with antibiotics with good effect. A week later, a swallowing assessment is performed by the speech and language therapist, which suggests a high risk of aspiration. As a result of this assessment, the care team wish to stop him taking food and drink by mouth and start intravenous (IV) fluids.
      How should you proceed next?

      Your Answer: Talk to the patient, explaining what you want to do and why, and listen to his answers

      Explanation:

      Involving Patients in Decision Making: The Importance of Communication

      Explanation: When it comes to making decisions about a patient’s care, it is crucial to involve the patient in the process. The Adults with Incapacity (Scotland) Act 2000 emphasizes that it cannot be assumed that any patient is incapable of making a decision about their care. Therefore, it is important to talk to the patient, explain what you want to do and why, and listen to their answers.

      It is also important to note that relatives are not allowed to agree or refuse management for the patient. While they can provide valuable input, the patient’s wishes and opinions should be the primary consideration.

      In the scenario of starting an IV, it is essential to speak to the patient first before proceeding. The patient’s consent should be obtained before any medical intervention is carried out.

      If there are concerns about the patient’s capacity to make decisions, it is important to assess their understanding of the information provided. This can be done by giving them the information and checking whether they understand what has been said. Written information can also be provided to supplement the conversation.

      In summary, effective communication with the patient is crucial in involving them in decision making about their care. The patient’s wishes and opinions should be the primary consideration, and any concerns about capacity should be assessed through communication and information sharing.

    • This question is part of the following fields:

      • Ethics And Legal
      50.7
      Seconds
  • Question 8 - A 21-year-old male comes to the emergency department with a complaint of vomiting...

    Correct

    • A 21-year-old male comes to the emergency department with a complaint of vomiting fresh blood after a 72-hour drinking binge. He denies regular alcohol abuse.

      During the examination, his pulse is found to be 92 beats per minute and his blood pressure is 146/90 mmHg.

      What is the probable diagnosis for this patient?

      Your Answer: Mallory-Weiss tear

      Explanation:

      Causes of Gastrointestinal Bleeding

      Gastrointestinal bleeding can be caused by various factors, including Mallory-Weiss tears, aortoduodenal fistula, Meckel’s diverticulum, oesophageal varices, and peptic ulcers. Mallory-Weiss tears occur in the gastro-oesophageal junction due to forceful or prolonged coughing or vomiting, often after excessive alcohol intake or epileptic convulsions. This can result in vomiting bright red blood or passing blood per rectum. Aortoduodenal fistula is caused by erosion of the duodenum into the aorta due to tumour or previous repair of the aorta with a synthetic graft. Meckel’s diverticulum, which occasionally occurs in the ileum, may contain ectopic gastric mucosa, leading to rectal bleeding. Oesophageal varices are dilated venous collaterals that result from portal hypertension in patients with liver cirrhosis. Finally, peptic ulcers are the most common cause of upper gastrointestinal bleeds, with mucosal erosions developing due to non-steroidal anti-inflammatory drugs, steroids, or prolonged alcohol abuse. Despite the potential severity of these conditions, bleeding usually stops spontaneously.

    • This question is part of the following fields:

      • Surgery
      14.6
      Seconds
  • Question 9 - You are summoned to the neonatal ward to assess a 12 hour old...

    Incorrect

    • You are summoned to the neonatal ward to assess a 12 hour old infant delivered via elective caesarian section at 38 weeks gestation. Upon reviewing the medical records, you come across the administration of maternal labetalol for hypertension. During the physical examination, you observe that the baby displays tremors and decreased muscle tone. What would be the most suitable course of action to take next?

      Your Answer: Perform full septic screen

      Correct Answer: Measure blood glucose levels

      Explanation:

      If a baby appears nervous and has low muscle tone, it could indicate neonatal hypoglycemia. It is important to check the baby’s blood glucose levels, especially if the mother has been taking labetalol. Additionally, if the mother has used opiates or illegal drugs during pregnancy, the baby may also exhibit symptoms of neonatal abstinence syndrome.

      Neonatal Hypoglycaemia: Causes, Symptoms, and Management

      Neonatal hypoglycaemia is a common condition in newborn babies, especially in the first 24 hours of life. While there is no agreed definition, a blood glucose level of less than 2.6 mmol/L is often used as a guideline. Transient hypoglycaemia is normal and usually resolves on its own, but persistent or severe hypoglycaemia may be caused by various factors such as preterm birth, maternal diabetes mellitus, IUGR, hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, or Beckwith-Wiedemann syndrome.

      Symptoms of neonatal hypoglycaemia can be autonomic, such as jitteriness, irritability, tachypnoea, and pallor, or neuroglycopenic, such as poor feeding/sucking, weak cry, drowsiness, hypotonia, and seizures. Other features may include apnoea and hypothermia. Management of neonatal hypoglycaemia depends on the severity of the condition and whether the newborn is symptomatic or not. Asymptomatic babies can be encouraged to feed normally and have their blood glucose monitored, while symptomatic or severely hypoglycaemic babies may need to be admitted to the neonatal unit and receive intravenous infusion of 10% dextrose.

    • This question is part of the following fields:

      • Paediatrics
      32.3
      Seconds
  • Question 10 - After an emergency Caesarian-section for foetal distress, the consultant obstetrician hands the paediatrician...

    Incorrect

    • After an emergency Caesarian-section for foetal distress, the consultant obstetrician hands the paediatrician a normal term female infant. You observe that the infant is apnoeic, floppy and blue in colour.

      What would be your initial step?

      Your Answer: Initiate cardiopulmonary resuscitation

      Correct Answer: Dry the neonate

      Explanation:

      According to UK resuscitation guidelines, the first step in neonatal resuscitation is to dry the baby, remove any wet towels, and note the time. Within 30 seconds, an Apgar assessment should be conducted to evaluate the baby’s tone, breathing, and heart rate. If the baby is gasping or not breathing, the airway should be opened, and 5 inflation breaths should be given within 60 seconds. If there is no increase in heart rate, chest movement should be checked. If the chest is not moving, the head position should be rechecked, and other airway maneuvers should be considered. Inflation breaths should be repeated, and a response should be looked for. If there is still no increase in heart rate, chest compressions should be started with 3 compressions to each breath. The heart rate should be reassessed every 30 seconds. If the heart rate is still slow or undetectable, venous access and drugs should be considered. Atropine and intubation are later steps in the management.

      The Apgar score is a tool used to evaluate the health of a newborn baby. It is recommended by NICE to be assessed at 1 and 5 minutes after birth, and again at 10 minutes if the initial score is low. The score is based on five factors: pulse, respiratory effort, color, muscle tone, and reflex irritability. A score of 0-3 is considered very low, 4-6 is moderate low, and 7-10 indicates that the baby is in good health. The score helps healthcare professionals quickly identify any potential issues and provide appropriate care.

    • This question is part of the following fields:

      • Paediatrics
      37.9
      Seconds
  • Question 11 - A 45-year-old obese woman presents to the emergency department with a 5-day history...

    Correct

    • A 45-year-old obese woman presents to the emergency department with a 5-day history of colicky pain in her right hypochondrium. An ultrasound scan reveals multiple stones in her gallbladder, but her common bile duct and gallbladder wall appear normal. Her blood tests show a hemoglobin level of 118 g/L (normal range for females: 115-160 g/L), platelet count of 350 * 109/L (normal range: 150-400 * 109/L), white blood cell count of 8.5 * 109/L (normal range: 4.0-11.0 * 109/L), and CRP level of 6 mg/L (normal range: < 5 mg/L). What is the best management option for this patient?

      Your Answer: Elective laparoscopic cholecystectomy

      Explanation:

      The recommended treatment for biliary colic is elective laparoscopic cholecystectomy. This outpatient procedure should be scheduled for the patient within 6 months. Emergency laparoscopic cholecystectomy is not necessary as there are no signs of acute infection. Endoscopic retrograde cholangiopancreatography (ERCP) is also not appropriate as there is no evidence of CBD stones or obstruction. Percutaneous cholecystostomy is not recommended as the patient is stable and drainage of bile is not necessary.

      Biliary colic is a condition that occurs when gallstones pass through the biliary tree. The risk factors for this condition are commonly referred to as the ‘4 F’s’, which include being overweight, female, fertile, and over the age of forty. Other risk factors include diabetes, Crohn’s disease, rapid weight loss, and certain medications. Biliary colic occurs due to an increase in cholesterol, a decrease in bile salts, and biliary stasis. The pain associated with this condition is caused by the gallbladder contracting against a stone lodged in the cystic duct. Symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Diagnosis is typically made through ultrasound. Elective laparoscopic cholecystectomy is the recommended treatment for biliary colic. However, around 15% of patients may have gallstones in the common bile duct at the time of surgery, which can result in obstructive jaundice. Other possible complications of gallstone-related disease include acute cholecystitis, ascending cholangitis, acute pancreatitis, gallstone ileus, and gallbladder cancer.

    • This question is part of the following fields:

      • Surgery
      28.4
      Seconds
  • Question 12 - A 35-year-old female patient, who smokes and is taking the combined oral contraceptive...

    Correct

    • A 35-year-old female patient, who smokes and is taking the combined oral contraceptive pill, reports experiencing pain and swelling in her right calf for the past two days. She also presents with sudden onset weakness on her right side. Upon examination, she displays a dense hemiplegia, with upper motor neuron signs and weakness in her right hand. Additionally, evidence of a deep vein thrombosis in her right calf is observed. What is the probable diagnosis?

      Your Answer: Paradoxical embolism

      Explanation:

      Possible Embolic Cerebrovascular Accident in a Patient with History of DVT and Contraceptive Pill Use

      This patient presents with symptoms suggestive of deep vein thrombosis (DVT), including calf pain and swelling, and has a history of using the combined oral contraceptive pill, which increases the risk of DVT. However, the sudden onset of right-sided hemiplegia indicates the possibility of an embolic cerebrovascular accident (CVA) caused by an embolus passing through the heart and crossing over to the systemic side of circulation via an atrial septal defect (ASD) or ventricular septal defect (VSD).

      It is important to note that pulmonary embolism would not occur in this case without an ASD. While an aneurysm or hemorrhagic stroke are possible, they are less likely given the patient’s history of DVT. A tumor would also have a more chronic symptomatology, further supporting the possibility of an embolic CVA in this patient. Further diagnostic testing and treatment are necessary to confirm and address this potential complication.

    • This question is part of the following fields:

      • Neurology
      41.8
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  • Question 13 - A pediatric hospital adopts a set of infection management practice guidelines developed within...

    Correct

    • A pediatric hospital adopts a set of infection management practice guidelines developed within the local community. If the medical staff follows these guidelines, what is the expected outcome?

      Your Answer: Stable antibiotic susceptibility patterns for bacteria

      Explanation:

      The Benefits of Guideline Use in Antibiotic Treatment

      Guideline use in antibiotic treatment has been linked to stable antibiotic susceptibility patterns in both Gram positive and Gram negative bacteria. This is thought to be due to the promotion of antimicrobial heterogeneity. Additionally, guideline use has been associated with a decrease in overall antibiotic use and a reduction in the use of inadequate treatment regimens. These factors could potentially impact the development of antibiotic resistance. The use of automated guidelines has also been shown to decrease adverse drug effects and improve antibiotic selection. Overall, the use of guidelines in antibiotic treatment can have numerous benefits for both patients and the healthcare system.

    • This question is part of the following fields:

      • Microbiology
      61.8
      Seconds
  • Question 14 - A 47-year-old man is scheduled for an elective repair of a left-sided inguinal...

    Correct

    • A 47-year-old man is scheduled for an elective repair of a left-sided inguinal hernia under general anesthesia. What advice should he be given regarding eating and drinking before the surgery?

      Your Answer: No food for 6 hours and no clear fluids for 2 hours before his operation

      Explanation:

      To minimize the risk of pulmonary aspiration of gastric contents, the Royal College of Anaesthetists advises patients to refrain from eating for at least 6 hours prior to the administration of general anesthesia. However, patients are permitted to consume clear fluids, including water, up until 2 hours before the administration of general anesthesia.

      Overview of General Anaesthetics

      General anaesthetics are drugs used to induce a state of unconsciousness in patients undergoing surgical procedures. There are two main types of general anaesthetics: inhaled and intravenous. Inhaled anaesthetics, such as isoflurane, desflurane, sevoflurane, and nitrous oxide, are administered through inhalation. These drugs work by acting on various receptors in the brain, including GABAA, glycine, NDMA, nACh, and 5-HT3 receptors. Inhaled anaesthetics can cause adverse effects such as myocardial depression, malignant hyperthermia, and hepatotoxicity.

      Intravenous anaesthetics, such as propofol, thiopental, etomidate, and ketamine, are administered through injection. These drugs work by potentiating GABAA receptors or blocking NDMA receptors. Intravenous anaesthetics can cause adverse effects such as pain on injection, hypotension, laryngospasm, myoclonus, and disorientation. However, they are often preferred over inhaled anaesthetics in cases of haemodynamic instability.

      It is important to note that the exact mechanism of action of general anaesthetics is not fully understood. Additionally, the choice of anaesthetic depends on various factors such as the patient’s medical history, the type of surgery, and the anaesthetist’s preference. Overall, general anaesthetics play a crucial role in modern medicine by allowing for safe and painless surgical procedures.

    • This question is part of the following fields:

      • Surgery
      23.1
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  • Question 15 - A 72-year-old myopic man with a history of hypertension arrives at the clinic...

    Correct

    • A 72-year-old myopic man with a history of hypertension arrives at the clinic complaining of a sudden, painless decrease in his vision. He reports a dense shadow obstructing his left eye, which began in the periphery and has advanced towards the center of his vision.

      During the examination, he can only perceive hand movements in his left eye, while his right eye has a visual acuity of 6/6. What is the probable reason for the vision loss?

      Your Answer: Retinal detachment

      Explanation:

      Retinal detachment is a condition that can cause sudden and painless loss of vision. It is characterized by a dense shadow that starts from the periphery and progresses towards the center of the visual field.

      Central retinal artery occlusion, on the other hand, is caused by a blockage of blood flow due to thromboembolism or arthritis. This condition can also cause sudden and painless loss of vision, but it does not typically present with a peripheral-to-central progression. Instead, it is characterized by an afferent pupillary defect and a cherry red spot on a pale retina.

      Central retinal vein occlusion is more common than arterial occlusion and is often seen in older patients, particularly those with glaucoma. This condition can also cause sudden and painless loss of vision, but it can affect any venous territory and is associated with severe retinal hemorrhages.

      Retinal detachment is often seen in people with myopia and can be preceded by flashes and floaters. It typically presents with a shadow in the visual field that starts from the periphery and progresses towards the center.

      Optic neuritis can also cause sudden visual loss, but this is usually temporary and is often accompanied by painful eye movement.

      Vitreous hemorrhage, on the other hand, causes a dark spot in the visual field where the hemorrhage is located, rather than a shadow that progresses towards the center.

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

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

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

    • This question is part of the following fields:

      • Ophthalmology
      33.3
      Seconds
  • Question 16 - A 68-year-old woman was admitted to hospital seven days ago with moderate symptoms...

    Correct

    • A 68-year-old woman was admitted to hospital seven days ago with moderate symptoms of community-acquired pneumonia and was treated with amoxicillin. She has developed a fever, maculopapular skin rash and haematuria over the last two days. You suspect that her new symptoms may be due to acute tubulointerstitial nephritis caused by a reaction to the amoxicillin she was given.
      Which of the following investigations would provide a definitive diagnosis?

      Your Answer: Kidney biopsy

      Explanation:

      Investigations for Tubulointerstitial Nephritis

      Tubulointerstitial nephritis is a condition that affects the kidneys and can lead to renal failure if left untreated. There are several investigations that can be done to help diagnose this condition.

      Kidney Biopsy: This is the most definitive investigation for tubulointerstitial nephritis. It involves taking a small sample of kidney tissue for examination under a microscope. This is usually only done if other tests have been inconclusive or if the diagnosis is unclear.

      Full Blood Count: This test can help identify the presence of eosinophilia, which is often seen in cases of tubulointerstitial nephritis. However, the absence of eosinophilia does not rule out the condition.

      Kidney Ultrasound: This test can help rule out other conditions such as chronic renal failure, hydronephrosis, or renal calculi. In cases of tubulointerstitial nephritis, the kidneys may appear enlarged and echogenic due to inflammation.

      Serum Urea and Electrolytes: This test measures the levels of urea and creatinine in the blood, which can be elevated in cases of tubulointerstitial nephritis.

      Urinalysis: This test can detect the presence of low-grade proteinuria, white blood cell casts, and sterile pyuria, which are all indicative of tubulointerstitial nephritis. However, it is not a definitive diagnostic tool.

      In conclusion, a combination of these investigations can help diagnose tubulointerstitial nephritis and guide appropriate treatment.

    • This question is part of the following fields:

      • Renal
      49.1
      Seconds
  • Question 17 - A 55-year-old diabetic man experiences a gradual burning and tingling sensation in his...

    Incorrect

    • A 55-year-old diabetic man experiences a gradual burning and tingling sensation in his right hand. He observes that his symptoms are more severe at night, frequently waking him up, and can only be alleviated by hanging his arm outside of the bed. Which nerve compression is likely responsible for this man's symptoms?

      Your Answer: Ulnar nerve

      Correct Answer: Median nerve

      Explanation:

      Understanding Nerve Compression: Symptoms and Special Tests

      Nerve compression can cause a range of symptoms, from pain and weakness to numbness and tingling. Here are some key things to know about nerve compression and how it affects different nerves in the body.

      The Median Nerve: Carpal Tunnel Syndrome

      The median nerve runs through the carpal tunnel, and compression of this nerve can cause pain, paraesthesiae, and weakness in the distribution of the median nerve. Carpal tunnel syndrome is a common condition that can be caused by pregnancy, diabetes, and other factors. Special tests to detect carpal tunnel syndrome include TINel’s sign, Phalen’s test, and motor assessment.

      The Radial Nerve: Hand and Arm Pain

      Compression of the radial nerve can lead to pain in the back of your hand, near your thumb, and you may not be able to straighten your arm.

      The Lateral Cutaneous Nerve: Reduced Sensation

      Compression of the lateral cutaneous nerve can lead to reduced sensation on the lateral aspect of the forearm.

      The Ulnar Nerve: Numbness and Tingling

      Compression of the ulnar nerve can lead to numbness and tingling in the fifth finger and half of the fourth finger.

      The Medial Cutaneous Nerve: Elbow and Forearm Pain

      Compression of the medial cutaneous nerve can lead to pain at the elbow and forearm.

      By understanding the symptoms and special tests associated with nerve compression, you can better identify and manage these conditions.

    • This question is part of the following fields:

      • Orthopaedics
      34.9
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  • Question 18 - A 52-year-old woman comes to the postmenopausal bleeding clinic complaining of continuous vaginal...

    Correct

    • A 52-year-old woman comes to the postmenopausal bleeding clinic complaining of continuous vaginal bleeding for the past 2 weeks. What would be your initial investigation in the clinic?

      Your Answer: Trans-vaginal ultrasound

      Explanation:

      TVUS is the recommended initial investigation for PMB, unless there are contraindications. This is because it provides the most accurate measurement of endometrial thickness, which is crucial in determining if the bleeding is due to endometrial cancer.

      Understanding Postmenopausal Bleeding

      Postmenopausal bleeding refers to vaginal bleeding that occurs after a woman has gone 12 months without a menstrual period. While most cases do not involve cancer, it is important to rule out this possibility in all women. The most common cause of postmenopausal bleeding is vaginal atrophy, which occurs due to a reduction in estrogen following menopause. Other causes include hormone replacement therapy, endometrial hyperplasia, endometrial cancer, cervical cancer, ovarian cancer, and vaginal cancer.

      To investigate postmenopausal bleeding, women over the age of 55 should undergo an ultrasound within two weeks to check for endometrial cancer. If referred on a cancer pathway, a transvaginal ultrasound is the preferred method of investigation. Treatment options depend on the underlying cause of the bleeding. For vaginal atrophy, topical estrogen and lifestyle changes can help alleviate symptoms, while HRT may also be used. If the bleeding is due to a specific type of HRT, switching to a different preparation may be helpful. In cases of endometrial hyperplasia, dilation and curettage may be necessary to remove excess tissue.

      Overall, it is important for women experiencing postmenopausal bleeding to seek medical attention and undergo appropriate testing to rule out any serious underlying conditions.

    • This question is part of the following fields:

      • Gynaecology
      24.4
      Seconds
  • Question 19 - A 51-year-old male presents with painful colour changes of his hands precipitated by...

    Incorrect

    • A 51-year-old male presents with painful colour changes of his hands precipitated by cold. He also reports difficulty swallowing and has noticed tightness of his skin especially on his face and his fingers.

      What is the most appropriate test from the options below?

      Your Answer: Anti-dsDNA antibody

      Correct Answer: Anti-centromere antibody

      Explanation:

      The symptoms indicate the possibility of scleroderma, and a detection of anti-centromere antibody can aid in confirming the diagnosis.

      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
      25.6
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  • Question 20 - A 56-year-old patient with a history of alcoholism is admitted to the emergency...

    Incorrect

    • A 56-year-old patient with a history of alcoholism is admitted to the emergency department after experiencing acute haematemesis. During emergency endoscopy, bleeding oesophageal varices are discovered and treated with banding. The patient's hospital stay is uneventful, and they are ready for discharge after 10 days. What medication would be the most appropriate prophylactic agent to prevent the patient from experiencing further variceal bleeding?

      Your Answer: Nifedipine

      Correct Answer: Propranolol

      Explanation:

      Portal Hypertension and Varices in Alcoholic Cirrhosis

      The portal vein is responsible for carrying blood from the gut and spleen to the liver. In cases of alcoholic cirrhosis, this flow can become obstructed, leading to increased pressure and the need for blood to find alternative routes. This often results in the development of porto-systemic collaterals, with the gastro-oesophageal junction being the most common site. As a result, patients with alcoholic cirrhosis often present with varices, which are superficial and prone to rupture, causing acute and massive haematemesis.

      To prevent rebleeding and reduce portal pressures, beta blockers such as propranolol have been found to be the most effective treatment for portal hypertension. Propranolol is licensed for this purpose and can help manage the complications associated with varices in alcoholic cirrhosis.

    • This question is part of the following fields:

      • Gastroenterology
      50.5
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  • Question 21 - A 16-year-old female patient arrives at the Emergency Department after overdosing on medication...

    Incorrect

    • A 16-year-old female patient arrives at the Emergency Department after overdosing on medication found in her home. She currently has a Glasgow Coma Scale (GCS) score of 15/15 but is hesitant to disclose what she ingested. According to her mother, it may have been acetazolamide, a carbonic anhydrase inhibitor. As part of her evaluation, a venous blood gas is obtained.
      If the patient's mother is correct, what biochemical abnormality would you anticipate?

      Your Answer: Metabolic acidosis with an increased anion gap

      Correct Answer: Metabolic acidosis with a normal anion gap

      Explanation:

      Metabolic acidosis can occur with a normal anion gap, which is caused by the loss of bicarbonate ions. This can be due to factors such as diarrhoea, renal failure, or the use of carbonic anhydrase inhibitors. On the other hand, metabolic alkalosis is characterized by an increase in bicarbonate ions, which can be caused by antacid overdose, vomiting, or hyperaldosteronism. Metabolic acidosis with an increased anion gap is caused by the production of excess acid or impaired bicarbonate production, and can be due to factors such as diabetic ketoacidosis or methanol ingestion. Respiratory acidosis occurs when there is alveolar hypoventilation, which can be caused by conditions such as chronic obstructive pulmonary disease or drug use. Respiratory alkalosis, on the other hand, occurs when there is alveolar overventilation and hypocapnia, which can be caused by factors such as panic disorder or high altitude.

    • This question is part of the following fields:

      • Pharmacology
      50.1
      Seconds
  • Question 22 - A 29-year-old Caucasian man presents with a 3-month history of diarrhoea, fatigue, and...

    Incorrect

    • A 29-year-old Caucasian man presents with a 3-month history of diarrhoea, fatigue, and weight loss. He denies any history of alcohol or drug abuse. He frequently travels to southern India for work. Laboratory tests show mixed macrocytic anaemia with low levels of serum folate and vitamin B12. Stool examination is negative for ova and parasites. A small bowel biopsy reveals predominant mononuclear infiltration and villous destruction throughout the small intestine. What intervention is most likely to improve his symptoms?

      Your Answer: Gluten-free diet

      Correct Answer: Broad spectrum antibiotics like tetracycline and folate

      Explanation:

      Treatment Options for Tropical Sprue: Broad Spectrum Antibiotics and Folate Supplementation

      Tropical sprue is a condition commonly seen in individuals visiting or residing in tropical countries, particularly in southern India. It is characterized by chronic diarrhea, weight loss, and deficiencies in vitamin B12 and folate. Stool examination typically shows no evidence of ova and parasites, while small intestinal biopsy reveals mononuclear cell infiltration and less villous atrophy throughout the intestine.

      The recommended treatment for tropical sprue involves the use of broad-spectrum antibiotics, such as tetracyclines, along with folate supplementation. This approach has been shown to effectively reverse the changes in the small intestine associated with the condition.

      Other treatment options, such as antihelminthic drugs, are not effective in treating tropical sprue. Similarly, pancreatic enzyme replacement is not indicated in this condition.

      It is important to note that tropical sprue should not be confused with coeliac disease, which is treated with a gluten-free diet. In coeliac disease, small intestinal biopsy typically shows severe villous atrophy and mononuclear cell infiltration in the proximal portion of the small bowel.

      Finally, double-strength trimethoprim and sulfamethoxazole is used in the treatment of Whipple’s disease, which is characterized by PAS-positive macrophages in the lamina propria of the small intestine.

    • This question is part of the following fields:

      • Gastroenterology
      41.2
      Seconds
  • Question 23 - A 65-year-old female visits her doctor complaining of annular papulosquamous lesions on sun-exposed...

    Incorrect

    • A 65-year-old female visits her doctor complaining of annular papulosquamous lesions on sun-exposed areas that appeared two weeks ago. She was diagnosed with primary tuberculosis four months ago and is currently undergoing treatment with rifampicin and isoniazid. What antibodies are expected to be present in this patient?

      Your Answer: Anti-double stranded DNA antibodies

      Correct Answer: Anti-histone antibodies

      Explanation:

      The presence of anti-histone antibodies is associated with drug-induced lupus, which is the most likely cause of the symmetrical annular papulosquamous lesions on sun-exposed areas in this patient who is currently taking isoniazid. Anti-Ro antibodies are not relevant as they are commonly associated with Sjogren’s syndrome, while anti-centromere antibodies are associated with limited systemic sclerosis. Anti-double stranded DNA antibodies are associated with systemic lupus erythematosus, which is less likely in this patient given her age and clinical presentation.

      Understanding Drug-Induced Lupus

      Drug-induced lupus is a condition that shares some similarities with systemic lupus erythematosus, but not all of its typical features are present. Unlike SLE, renal and nervous system involvement is rare in drug-induced lupus. The good news is that this condition usually resolves once the drug causing it is discontinued.

      The most common symptoms of drug-induced lupus include joint pain, muscle pain, skin rashes (such as the malar rash), and pulmonary issues like pleurisy. In terms of laboratory findings, patients with drug-induced lupus typically test positive for ANA (antinuclear antibodies) but negative for dsDNA (double-stranded DNA) antibodies. Anti-histone antibodies are found in 80-90% of cases, while anti-Ro and anti-Smith antibodies are only present in around 5% of cases.

      The most common drugs that can cause drug-induced lupus are procainamide and hydralazine. Other less common culprits include isoniazid, minocycline, and phenytoin.

    • This question is part of the following fields:

      • Musculoskeletal
      30.4
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  • Question 24 - A 60-year-old male smoker with severe rheumatoid arthritis comes to the clinic complaining...

    Correct

    • A 60-year-old male smoker with severe rheumatoid arthritis comes to the clinic complaining of a dry cough and increasing difficulty in breathing over the past few months. During the examination, he appears to be mildly cyanosed and has end inspiratory crepitations. A chest x-ray reveals widespread reticulonodular changes. What is the most probable diagnosis?

      Your Answer: Rheumatoid lung

      Explanation:

      Diagnosis and Differential Diagnosis of Pulmonary Fibrosis

      Pulmonary fibrosis is suspected in a patient with a history and examination features that suggest the condition. Rheumatoid lung is a common cause of pulmonary fibrosis, especially in severe rheumatoid disease and smokers. The reported changes on the chest X-ray are consistent with the diagnosis. However, to diagnose respiratory failure, a blood gas result is necessary.

      On the other hand, bronchial asthma is characterized by reversible airways obstruction, which leads to fluctuation of symptoms and wheezing on auscultation. The history of the patient is not consistent with chronic obstructive pulmonary disease (COPD). Pneumonia, on the other hand, is suggested by infective symptoms, pyrexia, and consolidation on CXR.

      In summary, the diagnosis of pulmonary fibrosis requires a thorough history and examination, as well as imaging studies. Differential diagnosis should include other conditions that present with similar symptoms and signs, such as bronchial asthma, COPD, and pneumonia.

    • This question is part of the following fields:

      • Respiratory
      70.4
      Seconds
  • Question 25 - A 67-year-old woman is brought to the Emergency Department after she slipped on...

    Incorrect

    • A 67-year-old woman is brought to the Emergency Department after she slipped on a wet kitchen floor and fell onto her outstretched hand. Her X-ray shows a fracture within 2.5 cm of the distal radius, with dorsal displacement of the distal segment and avulsion of the ulnar styloid.
      What is the diagnosis?

      Your Answer: Smith’s fracture

      Correct Answer: Colles’ fracture

      Explanation:

      Common Fractures of the Wrist: Colles’, Smith’s, Barton’s, and Chauffeur’s Fractures

      Fractures of the wrist are common injuries, with the most frequent being the Colles’ fracture. This type of fracture occurs within 2.5 cm of the wrist and is often seen in elderly women who suffer a fall onto an outstretched hand. The Colles’ fracture is characterized by dorsal displacement of the distal fragment, radial displacement of the hand, radial shortening due to impaction, and avulsion of the ulnar styloid. Treatment involves assessing the patient’s neurovascular status, followed by reduction and fixation of the fracture with a Colles’ plaster.

      Another type of wrist fracture is the Smith’s fracture, which is a reverse Colles’ fracture with ventral displacement of the distal fragment. This injury often results from a fall onto the back of the hand. A Barton’s fracture is an intra-articular fracture of the distal radius with associated dorsal or volar subluxation of the distal fragment, similar to a Colles’ or reverse Colles’ fracture. Finally, a Chauffeur’s fracture is an intra-articular fracture of the radial styloid process.

      In conclusion, wrist fractures are common injuries that can be classified into different types based on their location and displacement. Proper assessment and treatment are essential for optimal recovery and function of the affected wrist.

    • This question is part of the following fields:

      • Orthopaedics
      29.6
      Seconds
  • Question 26 - A 14-year-old boy comes to the GP complaining of left groin pain and...

    Incorrect

    • A 14-year-old boy comes to the GP complaining of left groin pain and a limp that has been gradually developing over the past 5 weeks. He has no medical or family history and his right leg is unaffected. Upon examination, there is a noticeable decrease in internal rotation of the left leg, but no swelling or warmth around the joints. The patient's vital signs are normal, and his height is in the 50th percentile while his weight is in the 95th percentile. What is the most probable diagnosis?

      Your Answer: Transient synovitis

      Correct Answer: Slipped capital femoral epiphysis

      Explanation:

      Slipped capital femoral epiphysis is more likely to occur in obese boys aged 10-15, as obesity is a risk factor for this condition. It is caused by a weakness in the proximal femoral growth plate, which can also be due to endocrine disorders or rapid growth. Loss of internal rotation of the affected leg is a common finding during examination. Perthes’ disease can also cause groin pain, but it typically affects children aged 4 to 8 years old. Being male and having a lower socioeconomic status are also risk factors for this condition. Septic arthritis is unlikely in this case as the child’s vital signs are normal, and it usually presents with a hot and swollen joint and systemic illness. Developmental dysplasia of the hip is usually detected during routine hip examinations in the first year of life, using Barlow/Ortolani tests and assessing hip abduction.

      Slipped Capital Femoral Epiphysis: A Rare Hip Condition in Children

      Slipped capital femoral epiphysis, also known as slipped upper femoral epiphysis, is a rare hip condition that primarily affects children between the ages of 10 and 15. It is more commonly seen in obese boys. This condition is characterized by the displacement of the femoral head epiphysis postero-inferiorly, which may present acutely following trauma or with chronic, persistent symptoms.

      The most common symptoms of slipped capital femoral epiphysis include hip, groin, medial thigh, or knee pain and loss of internal rotation of the leg in flexion. In some cases, a bilateral slip may occur. Diagnostic imaging, such as AP and lateral (typically frog-leg) views, can confirm the diagnosis.

      The management of slipped capital femoral epiphysis typically involves internal fixation, which involves placing a single cannulated screw in the center of the epiphysis. However, if left untreated, this condition can lead to complications such as osteoarthritis, avascular necrosis of the femoral head, chondrolysis, and leg length discrepancy.

      In summary, slipped capital femoral epiphysis is a rare hip condition that primarily affects children, especially obese boys. It is characterized by the displacement of the femoral head epiphysis postero-inferiorly and can present with various symptoms. Early diagnosis and management are crucial to prevent complications.

    • This question is part of the following fields:

      • Paediatrics
      42.3
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  • Question 27 - A 65-year-old man presents to clinic with a three month history of worsening...

    Correct

    • A 65-year-old man presents to clinic with a three month history of worsening lower urinary tract symptoms and nocturnal enuresis. Upon examination, he has a painless distended bladder and a smoothly enlarged prostate on digital rectal examination. Bladder scan reveals 1.5L residual and ultrasound kidney, ureter, bladder (US KUB) shows bilateral hydronephrosis. His blood results are as follows:
      Na+ 136 mmol/L (135 - 145)
      K+ 4.5 mmol/L (3.5 - 5.0)
      Bicarbonate 28 mmol/L (22 - 29)
      Urea 6.5 mmol/L (2.0 - 7.0)
      Creatinine 310 µmol/L (55 - 120)
      What is the most likely diagnosis?

      Your Answer: Chronic high pressure urinary retention

      Explanation:

      Chronic urinary retention is considered high pressure if it leads to impaired renal function or hydronephrosis. A painless distended bladder containing over 1 L of urine is a common symptom of chronic urinary retention, usually caused by bladder outflow obstruction. In this case, the patient’s elevated creatinine levels (290) and bilateral hydronephrosis visible on US KUB indicate high pressure chronic retention. Low pressure chronic urinary retention, on the other hand, does not cause hydronephrosis or renal impairment. Acute urinary retention typically presents with supra-pubic tenderness and a palpable bladder, but does not usually result in a painless distended bladder. Catheterisation typically drains less than 1 L of urine. Given the patient’s painless distended bladder and 1.2L urine volume, acute urinary retention is unlikely.

      Understanding Chronic Urinary Retention

      Chronic urinary retention is a condition that develops gradually and is usually painless. It can be classified into two types: high pressure retention and low pressure retention. High pressure retention is often caused by bladder outflow obstruction and can lead to impaired renal function and bilateral hydronephrosis. On the other hand, low pressure retention does not affect renal function and does not cause hydronephrosis.

      When chronic urinary retention is diagnosed, catheterisation may be necessary to relieve the pressure in the bladder. However, this can lead to decompression haematuria, which is a common side effect. This occurs due to the rapid decrease in pressure in the bladder and usually does not require further treatment.

    • This question is part of the following fields:

      • Surgery
      44.7
      Seconds
  • Question 28 - What is considered an unacceptable risk (UKMEC4) when prescribing the COCP for women...

    Incorrect

    • What is considered an unacceptable risk (UKMEC4) when prescribing the COCP for women under the age of 18?

      Your Answer: Family history of pulmonary embolism in a first degree relative aged <45 years old

      Correct Answer: Breastfeeding and 4 weeks postpartum

      Explanation:

      The UK Medical Eligibility Criteria (UKMEC) offer guidance on the contraindications for using contraception, including the combined oral contraceptive pill (COCP). The UKMEC categorizes the use of COCP as follows: no restriction (UKMEC1), advantages outweigh disadvantages (UKMEC2), disadvantages outweigh advantages (UKMEC3), and unacceptable risk (UKMEC4).

      According to UKMEC3, COCP use may have more disadvantages than advantages for individuals who are over 35 years old and smoke less than 15 cigarettes per day, have a BMI over 35, experience migraines without aura, have a family history of deep vein thrombosis or pulmonary embolism in a first-degree relative under 45 years old, have controlled hypertension, are immobile (e.g., use a wheelchair), or are breastfeeding and between 6 weeks to 6 months postpartum.

      On the other hand, UKMEC4 indicates that COCP use poses an unacceptable risk for individuals who are over 35 years old and smoke more than 15 cigarettes per day, experience migraines with aura, have a personal history of deep vein thrombosis or pulmonary embolism, have a personal history of stroke or ischemic heart disease, have uncontrolled hypertension, have breast cancer, have recently undergone major surgery with prolonged immobilization, or are breastfeeding and less than 6 weeks postpartum.

      Source: FSRH UKMEC for contraceptive use.

      The decision to prescribe the combined oral contraceptive pill is now based on the UK Medical Eligibility Criteria (UKMEC), which categorizes potential contraindications and cautions on a four-point scale. UKMEC 1 indicates no restrictions for use, while UKMEC 2 suggests that the benefits outweigh the risks. UKMEC 3 indicates that the disadvantages may outweigh the advantages, and UKMEC 4 represents an unacceptable health risk. Examples of UKMEC 3 conditions include controlled hypertension, a family history of thromboembolic disease in first-degree relatives under 45 years old, and current gallbladder disease. Examples of UKMEC 4 conditions include a history of thromboembolic disease or thrombogenic mutation, breast cancer, and uncontrolled hypertension. Diabetes mellitus diagnosed over 20 years ago is classified as UKMEC 3 or 4 depending on severity. In 2016, Breastfeeding between 6 weeks and 6 months postpartum was changed from UKMEC 3 to UKMEC 2.

    • This question is part of the following fields:

      • Gynaecology
      28.4
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  • Question 29 - A 9-year-old girl presents to the Emergency department with a three day history...

    Correct

    • A 9-year-old girl presents to the Emergency department with a three day history of limping. She has been experiencing illness recently. Upon examination, she has no fever and shows discomfort when moving her hip. What is the probable diagnosis?

      Your Answer: Transient synovitis

      Explanation:

      Transient Synovitis in Childhood: the Causes and Diagnosis

      Transient synovitis is a prevalent cause of hip pain in children, but it is crucial to rule out other more severe causes before diagnosing it. The exact cause of this condition is still unknown, but it is believed to be associated with viral infections, allergic reactions, or trauma.

      Transient synovitis is a self-limiting condition that typically resolves within a few days to weeks. However, it is essential to differentiate it from other conditions that may require urgent medical attention, such as septic arthritis or Legg-Calve-Perthes disease. Therefore, a thorough medical history, physical examination, and imaging studies are necessary to make an accurate diagnosis.

      In conclusion, transient synovitis is a common cause of hip pain in childhood, but it is crucial to exclude other more serious conditions before diagnosing it. Parents should seek medical attention if their child experiences hip pain, limping, or difficulty walking to ensure prompt and appropriate treatment.

    • This question is part of the following fields:

      • Paediatrics
      9.7
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  • Question 30 - A 65-year-old patient visits the clinic with symptoms of diarrhoea and a stool...

    Correct

    • A 65-year-old patient visits the clinic with symptoms of diarrhoea and a stool culture is ordered. The microbiology laboratory at the nearby hospital sends you the results. Can you identify which of the following is not a part of the normal flora found in the large bowel and faecal matter?

      Your Answer: Shigella spp

      Explanation:

      Shigella and Other Pathogenic Organisms in the Colon

      Shigella is a bacterium that attaches itself to the lining of the colon and can lead to dysentery. While other organisms may also be present in the colon, they typically do not cause harm unless antibiotic therapy is administered. In such cases, these organisms may grow uncontrollably and become pathogenic, resulting in conditions such as antibiotic-associated colitis. Therefore, it is important to monitor the presence of these organisms in the colon and use antibiotics judiciously to prevent the development of harmful infections.

    • This question is part of the following fields:

      • Clinical Sciences
      27.8
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SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology (2/4) 50%
Cardiology (1/1) 100%
Psychiatry (1/1) 100%
Gynaecology (2/3) 67%
Ethics And Legal (1/1) 100%
Surgery (4/4) 100%
Paediatrics (1/4) 25%
Neurology (1/1) 100%
Microbiology (1/1) 100%
Ophthalmology (1/1) 100%
Renal (1/1) 100%
Orthopaedics (0/2) 0%
Musculoskeletal (0/2) 0%
Gastroenterology (0/2) 0%
Respiratory (1/1) 100%
Clinical Sciences (1/1) 100%
Passmed