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  • Question 1 - A 16-year-old female complains of an itchy eye with watery discharge on one...

    Incorrect

    • A 16-year-old female complains of an itchy eye with watery discharge on one side. She reports feeling generally healthy with no changes to her vision or fever. The patient wears contact lenses but has not had an optician appointment recently.

      During the examination, the patient displays injected conjunctiva in the affected eye, but there is no apparent redness or swelling around the eye. The application of topical fluorescein doesn't reveal any corneal staining.

      What would be the best course of action for managing this patient's condition?

      Your Answer: Topical antihistamine eye drops are the treatment of choice

      Correct Answer: Advise she should not wear contact lenses for the duration of her symptoms

      Explanation:

      It is not recommended to wear contact lenses when experiencing conjunctivitis, which is likely the case for this 15-year-old with viral conjunctivitis. While it is possible that her prescription may not be up to date, this doesn’t affect her susceptibility to infection or more severe conditions. Warm compresses are more effective for treating styes or chalazion, which present as lumps on the eyelid, rather than viral conjunctivitis. Since the fluorescein test did not show any corneal stains, there is no need for ophthalmology referral. However, if a contact lens wearer with these symptoms had staining, they would require a visit to eye casualty as this would indicate a corneal injury. While topical antihistamine eye drops may be used for allergic conjunctivitis, the unilateral nature of the presentation makes this diagnosis less likely. Topical chloramphenicol is the preferred treatment for bacterial conjunctivitis, but the watery discharge suggests viral conjunctivitis instead.

      Infective conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes that are accompanied by a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.

      In most cases, infective conjunctivitis is a self-limiting condition that resolves on its own within one to two weeks. However, patients are often offered topical antibiotic therapy, such as Chloramphenicol or topical fusidic acid. Chloramphenicol drops are given every two to three hours initially, while chloramphenicol ointment is given four times a day initially. Topical fusidic acid is an alternative and should be used for pregnant women. For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. It is important to advise patients not to share towels and to avoid wearing contact lenses during an episode of conjunctivitis. School exclusion is not necessary.

    • This question is part of the following fields:

      • Eyes And Vision
      154
      Seconds
  • Question 2 - A 37-year-old man has noticed tenderness and slight swelling in the lower half...

    Correct

    • A 37-year-old man has noticed tenderness and slight swelling in the lower half of his left testicle for the past 2 weeks. What is the most appropriate course of action to take?

      Your Answer: Testicular ultrasound

      Explanation:

      Testicular Cancer: Symptoms, Diagnosis, and Prognosis

      Testicular cancer is a type of cancer that typically affects young men in their third or fourth decade of life. The most common symptom is a painless, unilateral mass in the scrotum, but in about 20% of cases, scrotal pain may be the first symptom. Unfortunately, in about 10% of cases, a testicular tumor can be mistaken for epididymo orchitis, leading to a delay in the correct diagnosis.

      Diagnostic ultrasound is the most effective way to confirm the presence of a testicular mass and explore the contralateral testis. It has a sensitivity of almost 100% in detecting a testicular tumor and can determine whether a mass is intra- or extratesticular. Even if a testicular tumor is clinically evident, an ultrasound should still be performed as it is an inexpensive test.

      Serum tumor markers, including αfetoprotein, HCG, and LDH, are important prognostic factors and contribute to diagnosis and staging. In about half of all cases of testicular cancer, markers are increased, but there is variation between different cancers and different markers.

      In conclusion, early detection and diagnosis of testicular cancer are crucial for successful treatment and a positive prognosis. Men should be aware of the symptoms and seek medical attention if they notice any changes in their testicles.

    • This question is part of the following fields:

      • Kidney And Urology
      29.6
      Seconds
  • Question 3 - Which of the following factors is most likely to render the use of...

    Incorrect

    • Which of the following factors is most likely to render the use of the Modification of Diet in Renal Disease (MDRD) equation inappropriate for calculating an individual's eGFR, assuming the patient is 65 years old?

      Your Answer: Type 2 diabetes mellitus

      Correct Answer: Pregnancy

      Explanation:

      During pregnancy, GFR typically experiences an increase, although this may not be reflected in the eGFR.

      Chronic kidney disease (CKD) is a condition where the kidneys are not functioning properly. To estimate renal function, serum creatinine levels are often used, but this may not be accurate due to differences in muscle. Therefore, formulas such as the Modification of Diet in Renal Disease (MDRD) equation are used to estimate the glomerular filtration rate (eGFR). The MDRD equation takes into account serum creatinine, age, gender, and ethnicity. However, factors such as pregnancy, muscle mass, and recent red meat consumption may affect the accuracy of the result.

      CKD can be classified based on the eGFR. Stage 1 CKD is when the eGFR is greater than 90 ml/min, but there are signs of kidney damage on other tests. If all kidney tests are normal, there is no CKD. Stage 2 CKD is when the eGFR is between 60-90 ml/min with some sign of kidney damage. Stage 3a and 3b CKD are when the eGFR is between 45-59 ml/min and 30-44 ml/min, respectively, indicating a moderate reduction in kidney function. Stage 4 CKD is when the eGFR is between 15-29 ml/min, indicating a severe reduction in kidney function. Stage 5 CKD is when the eGFR is less than 15 ml/min, indicating established kidney failure, and dialysis or a kidney transplant may be necessary. It is important to note that normal U&Es and no proteinuria are required for a diagnosis of CKD.

    • This question is part of the following fields:

      • Kidney And Urology
      378.7
      Seconds
  • Question 4 - A 20-year-old woman complains of hearing difficulties over the last six months. She...

    Incorrect

    • A 20-year-old woman complains of hearing difficulties over the last six months. She initially suspected it was due to earwax, but her hearing has not improved after ear syringing. You conduct an auditory system examination, including Rinne's and Weber's tests:

      Rinne's test: Left ear: air conduction > bone conduction
      Right ear: air conduction > bone conduction
      Weber's test: Lateralises to the left side

      What is the significance of these test results?

      Your Answer: Left conductive deafness

      Correct Answer: Right sensorineural deafness

      Explanation:

      If there is a sensorineural issue, the sound in Weber’s test will be perceived on the healthy side (left), suggesting a problem on the affected side (right).

      Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

      Rinne’s and Weber’s tests are used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test indicates that BC is better than AC, suggesting conductive deafness.

      Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking the patient which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

      The table below summarizes the interpretation of Rinne and Weber tests. A normal result indicates that AC is greater than BC bilaterally and the sound is midline. Conductive hearing loss is indicated by BC being greater than AC in the affected ear and AC being greater than BC in the unaffected ear, with the sound lateralizing to the affected ear. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, with the sound lateralizing to the unaffected ear.

      Overall, Rinne’s and Weber’s tests are useful tools for differentiating between conductive and sensorineural deafness, allowing for appropriate management and treatment.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      124.3
      Seconds
  • Question 5 - An 82-year-old woman comes in with a complaint of worsening leg cramps for...

    Incorrect

    • An 82-year-old woman comes in with a complaint of worsening leg cramps for the past six months. What is true about leg cramps?

      Your Answer:

      Correct Answer: Examination of legs in patients who complain of leg cramps tend to be normal

      Explanation:

      The use of quinine as the first line of treatment for leg cramps is not recommended due to its low success rate. Blood tests may not be necessary unless a specific cause is suspected, such as checking urea and electrolytes, thyroid function, and creatine kinase. The National Institute for Health and Care Excellence (NICE) recommends self-care measures as the initial treatment for leg cramps. Referral to secondary care is only necessary if symptoms persist or significantly affect the patient’s quality of life despite self-care measures.

      Managing Leg Cramps

      Leg cramps are a frequent occurrence, particularly in individuals over the age of 60. However, the National Institute for Health and Care Excellence (NICE) doesn’t recommend quinine as the first line of treatment due to its poor benefit-to-risk ratio. Instead, self-care measures such as stretching exercises for the calves are recommended as the initial management approach. If leg cramps persist despite these measures, quinine may be tried for a short period, but it should be discontinued if no improvement is observed. If the symptoms continue to affect the individual’s quality of life significantly, referral to secondary care is necessary.

      To summarize, leg cramps are a common problem that can be managed with self-care measures such as stretching exercises. Quinine should only be used if the symptoms persist, and referral to secondary care is necessary if the symptoms continue to affect the individual’s quality of life.

    • This question is part of the following fields:

      • Musculoskeletal Health
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  • Question 6 - A 42-year-old man visits the GP clinic with complaints of soreness, itching, and...

    Incorrect

    • A 42-year-old man visits the GP clinic with complaints of soreness, itching, and bleeding from the foreskin. Upon examination, there is evidence of skin fissuring and tightening of the foreskin. What is the probable diagnosis, and what treatment is recommended?

      Your Answer:

      Correct Answer: Lichen sclerosis

      Explanation:

      Common Penile Conditions

      Lichen sclerosis, also known as balanitis xerotica obliterans, is a skin condition that causes inflammation and scarring of the foreskin. It can be itchy and painful, but potent steroid ointments can help reduce inflammation and the need for surgery. However, if left untreated, it may lead to penile squamous cell carcinoma, which presents as an irregular ulceration or nodule.

      Peyronie’s disease is a condition that causes an increased curvature of the penis, but its cause is unknown. On the other hand, phimosis is the inability to retract the foreskin covering the glans of the penis, which may be congenital or due to scarring from another medical condition such as lichen sclerosis. Lastly, priapism is a persistent and often painful erection of the penis.

    • This question is part of the following fields:

      • Kidney And Urology
      0
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  • Question 7 - A 70-year-old male presents with bilateral paraesthesia in the radial aspects of both...

    Incorrect

    • A 70-year-old male presents with bilateral paraesthesia in the radial aspects of both hands, over the thumbs and first fingers, as well as paraesthesia in the lateral aspects of both forearms and lower limb spasticity. His HBA1c level is 46 mmol/mol and nerve conduction studies and EMG show evidence of denervation. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Degenerative cervical myelopathy

      Explanation:

      The patient’s muscle twitches are likely fibrillations, indicating dysfunction in the lower motor neurons. The neurophysiology report confirms denervation. The patient’s symptoms are mainly in the C6 dermatome distribution on both sides, which is not likely to be caused by median nerve compression at the elbow, given the patient’s age. The patient is probably suffering from degenerative cervical myelopathy, which can take more than two years to diagnose. Symptoms of this condition include pain and stiffness in the neck and limbs, loss of function, and sphincter disturbance. Neurological examination can reveal lower motor neuron signs at the level of the lesion and upper motor neuron signs below. The other answer options are unlikely for various reasons.

      Degenerative cervical myelopathy (DCM) is a condition that has several risk factors, including smoking, genetics, and certain occupations that expose individuals to high axial loading. The symptoms of DCM can vary in severity and may include pain, loss of motor function, loss of sensory function, and loss of autonomic function. Early symptoms may be subtle and difficult to detect, but as the condition progresses, symptoms may worsen or new symptoms may appear. An MRI of the cervical spine is the gold standard test for diagnosing cervical myelopathy. All patients with DCM should be urgently referred to specialist spinal services for assessment and treatment. Decompressive surgery is currently the only effective treatment for DCM, and early treatment offers the best chance of a full recovery. Physiotherapy should only be initiated by specialist services to prevent further spinal cord damage.

    • This question is part of the following fields:

      • Neurology
      0
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  • Question 8 - A syringe driver is ordered for a patient who is in the final...

    Incorrect

    • A syringe driver is ordered for a patient who is in the final stages of metastatic breast cancer. Which of the following medications is not compatible with dexamethasone, metoclopramide, and midazolam?

      Your Answer:

      Correct Answer: Cyclizine

      Explanation:

      Several drugs are incompatible with cyclizine when used in syringe drivers.

      When a patient in palliative care is unable to take oral medication due to various reasons such as nausea, dysphagia, intestinal obstruction, weakness or coma, a syringe driver should be considered. In the UK, there are two main types of syringe drivers: Graseby MS16A (blue) and Graseby MS26 (green). The delivery rate for the former is given in mm per hour, while the latter is given in mm per 24 hours.

      Most drugs are compatible with water for injection, but for certain drugs such as granisetron, ketamine, ketorolac, octreotide, and ondansetron, sodium chloride 0.9% is recommended. Commonly used drugs for various symptoms include cyclizine, levomepromazine, haloperidol, metoclopramide for nausea and vomiting, hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide for respiratory secretions/bowel colic, midazolam, haloperidol, levomepromazine for agitation/restlessness, and diamorphine as the preferred opioid for pain.

      When mixing drugs, diamorphine is compatible with most other drugs used, including dexamethasone, haloperidol, hyoscine butylbromide, hyoscine hydrobromide, levomepromazine, metoclopramide, and midazolam. However, cyclizine may precipitate with diamorphine when given at higher doses, and it is incompatible with a number of drugs such as clonidine, dexamethasone, hyoscine butylbromide (occasional), ketamine, ketorolac, metoclopramide, midazolam, octreotide, and sodium chloride 0.9%.

    • This question is part of the following fields:

      • End Of Life
      0
      Seconds
  • Question 9 - In a study examining mortality outcomes after bariatric surgery, it was found that...

    Incorrect

    • In a study examining mortality outcomes after bariatric surgery, it was found that obese patients with type II diabetes had a lower 10-year mortality rate (RR = 0.65) compared to obese patients without diabetes (RR = 0.90). However, the study did not show a statistically significant difference between the two groups. If bariatric surgery does indeed decrease mortality more in patients with diabetes, what has this study demonstrated?

      Your Answer:

      Correct Answer: A type II error

      Explanation:

      Understanding Type II Errors in Statistical Studies

      A type II error occurs when a study fails to reject a false null hypothesis, also known as a false negative. In the context of a study comparing the impact of bariatric surgery on mortality rates for diabetics versus non-diabetics, if the surgery does indeed have a significantly greater impact on mortality rates for diabetics but the study fails to detect this, it would be an example of a type II error.

      To reduce the risk of type II errors, the power of a study can be increased by, for example, increasing the sample size. It is important to note that a type II error is different from a type I error, which occurs when a true null hypothesis is incorrectly rejected (false positive).

      Other potential biases in a study include selection bias, where subjects are not chosen randomly or representatively, and misclassification bias, where subjects are wrongly assigned to a classification. However, there is no indication of these biases in the given study. Ultimately, understanding and minimizing the risk of type II errors is crucial for ensuring accurate and reliable statistical results.

    • This question is part of the following fields:

      • Population Health
      0
      Seconds
  • Question 10 - A 63-year-old woman complains of abdominal discomfort, bloating, and a change in bowel...

    Incorrect

    • A 63-year-old woman complains of abdominal discomfort, bloating, and a change in bowel habit with looser, more frequent stools. She has been experiencing these symptoms since her husband passed away 3 months ago. Her daughter believes she may have irritable bowel syndrome and is seeking treatment. What is the recommended course of action for managing her symptoms?

      Your Answer:

      Correct Answer: 2 week referral to secondary care

      Explanation:

      This woman has exhibited a concerning symptom of experiencing loose stools for over 6 weeks, which is a red flag indicator. Given her age of over 60 years, it is important to discuss the potential of an underlying cancer and refer her to secondary care for further testing within 2 weeks to rule out the possibility of bowel cancer.

      Colorectal cancer referral guidelines were updated by NICE in 2015. Patients who are 40 years or older with unexplained weight loss and abdominal pain, those who are 50 years or older with unexplained rectal bleeding, and those who are 60 years or older with iron deficiency anaemia or a change in bowel habit should be referred urgently to colorectal services for investigation. Additionally, patients with positive results for occult blood in their faeces should also be referred urgently.

      An urgent referral should be considered if there is a rectal or abdominal mass, an unexplained anal mass or anal ulceration, or if patients under 50 years old have rectal bleeding and any of the following unexplained symptoms or findings: abdominal pain, change in bowel habit, weight loss, or iron deficiency anaemia.

      The NHS offers a national screening programme for colorectal cancer every two years to all men and women aged 60 to 74 years in England and 50 to 74 years in Scotland. Patients aged over 74 years may request screening. Eligible patients are sent Faecal Immunochemical Test (FIT) tests through the post. FIT is a type of faecal occult blood test that uses antibodies to detect and quantify the amount of human blood in a single stool sample. Patients with abnormal results are offered a colonoscopy.

      The FIT test is also recommended for patients with new symptoms who do not meet the 2-week criteria listed above. For example, patients who are 50 years or older with unexplained abdominal pain or weight loss, those under 60 years old with changes in their bowel habit or iron deficiency anaemia, and those who are 60 years or older who have anaemia even in the absence of iron deficiency.

    • This question is part of the following fields:

      • Gastroenterology
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Eyes And Vision (0/1) 0%
Kidney And Urology (1/2) 50%
Ear, Nose And Throat, Speech And Hearing (0/1) 0%
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