00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 65-year-old woman with a history of metastatic breast cancer experiences a grand...

    Correct

    • A 65-year-old woman with a history of metastatic breast cancer experiences a grand mal seizure at home. She has been experiencing worsening headaches over the past few weeks. What is the most suitable initial management to be provided while awaiting brain imaging, considering the probable diagnosis?

      Your Answer: Dexamethasone

      Explanation:

      It is probable that this female patient has cerebral metastases and the recommended initial treatment is administering high-dose dexamethasone to alleviate cerebral edema. Additionally, anti-epileptic medication like phenytoin may be prescribed to decrease the occurrence of seizures.

      Understanding Corticosteroids and Their Side-Effects

      Corticosteroids are commonly prescribed therapies used to replace or augment the natural activity of endogenous steroids. They can be administered systemically or locally, depending on the condition being treated. However, the usage of corticosteroids is limited due to their numerous side-effects, which are more common with prolonged and systemic therapy.

      Glucocorticoid side-effects include impaired glucose regulation, increased appetite and weight gain, hirsutism, hyperlipidaemia, Cushing’s syndrome, moon face, buffalo hump, striae, osteoporosis, proximal myopathy, avascular necrosis of the femoral head, immunosuppression, increased susceptibility to severe infection, reactivation of tuberculosis, insomnia, mania, depression, psychosis, peptic ulceration, acute pancreatitis, glaucoma, cataracts, suppression of growth in children, intracranial hypertension, and neutrophilia.

      On the other hand, mineralocorticoid side-effects include fluid retention and hypertension. It is important to note that patients on long-term steroids should have their doses doubled during intercurrent illness. Longer-term systemic corticosteroids suppress the natural production of endogenous steroids, so they should not be withdrawn abruptly as this may precipitate an Addisonian crisis. The British National Formulary suggests gradual withdrawal of systemic corticosteroids if patients have received more than 40mg prednisolone daily for more than one week, received more than three weeks of treatment, or recently received repeated courses.

    • This question is part of the following fields:

      • Neurology
      10.3
      Seconds
  • Question 2 - A 14-year-old adolescent complains of recurring reactions to his nose ring. He remembers...

    Correct

    • A 14-year-old adolescent complains of recurring reactions to his nose ring. He remembers experiencing a similar reaction on his wrist when wearing a nickel bracelet. What test is used to confirm a nickel allergy?

      Your Answer: Patch test

      Explanation:

      Medical Testing Techniques

      Patch Test, Flow Cytometry, HLA Typing, Polymerase Chain Reaction, and Skin Prick Testing are all medical testing techniques used for different purposes.

      Patch Test is used to diagnose delayed type IV hypersensitivity reactions. It involves applying various test substances to the skin and examining it for any inflammatory response.

      Flow Cytometry is used to differentiate between cell populations and count the number of cells in a given sample. It works by channelling cells through a laser beam one at a time and identifying the size and granularity of the cell.

      HLA Typing is used to match patients and donors for cord blood or bone marrow transplants. It tests for proteins or markers used by the immune system to differentiate ‘self’ from ‘non-self’.

      Polymerase Chain Reaction is used to amplify a single or multiple copies of a DNA segment. It has medical uses such as functional analysis of genes, diagnosis of hereditary diseases, and detection of infectious diseases.

      Skin Prick Testing is used to diagnose type I hypersensitivity reactions, which are mediated by immunoglobulin E. It involves immediate degranulation of mast cells and the release of histamine. Examples of type I hypersensitivity reactions include allergic rhinitis, systemic anaphylaxis, and allergic asthma.

      Medical Testing Techniques for Different Purposes

    • This question is part of the following fields:

      • Immunology/Allergy
      8
      Seconds
  • Question 3 - A 38-year-old man presents to you with complaints of a persistent sensation of...

    Correct

    • A 38-year-old man presents to you with complaints of a persistent sensation of mucus in the back of his throat. He also reports a chronic cough for the past 6 months and frequently experiences bad breath, particularly in the mornings. He admits to smoking 10 cigarettes daily but otherwise feels fine. On examination, his ears appear normal, and his throat shows slight redness with no swelling of the tonsils. What is the most probable diagnosis?

      Your Answer: Postnasal drip

      Explanation:

      Nasal tumors can cause symptoms such as nosebleeds, a persistent blocked nose, blood-stained mucus draining from the nose, and a decreased sense of smell. A chronic cough in smokers, known as a smoker’s cough, is caused by damage and destruction of the protective cilia in the respiratory tract. Nasal polyps can result in symptoms such as nasal obstruction, sneezing, rhinorrhea, and a poor sense of taste and smell. If symptoms are unilateral or accompanied by bleeding, it may be a sign of a more serious condition. Nasal foreign bodies, which are commonly found in children, can include items such as peas, beads, buttons, seeds, and sweets.

      Understanding Post-Nasal Drip

      Post-nasal drip is a condition that arises when the nasal mucosa produces an excessive amount of mucus. This excess mucus then accumulates in the back of the nose or throat, leading to a chronic cough and unpleasant breath. Essentially, post-nasal drip occurs when the body produces more mucus than it can handle, resulting in a buildup that can cause discomfort and irritation. This condition can be caused by a variety of factors, including allergies, sinus infections, and even certain medications. Understanding the causes and symptoms of post-nasal drip can help individuals seek appropriate treatment and alleviate their discomfort.

    • This question is part of the following fields:

      • ENT
      111.4
      Seconds
  • Question 4 - A young patient presents with a painful red eye.
    Which of the following findings...

    Correct

    • A young patient presents with a painful red eye.
      Which of the following findings is more suggestive of acute conjunctivitis than anterior uveitis?

      Your Answer: Profuse discharge

      Explanation:

      Understanding the Symptoms of Acutely Painful Red Eye

      A red eye can be a sign of various eye conditions, including conjunctivitis, anterior uveitis, scleritis, and more. One of the most common symptoms of conjunctivitis is profuse discharge, which can cause the eyelids to stick together on waking. On the other hand, anterior uveitis can cause blurred vision, small pupil, and photophobia. Scleritis, an inflammatory disease that affects the sclera, can cause severe pain that worsens with eye movement and may radiate to the forehead or jaw. It’s essential to seek medical attention promptly if you experience any of these symptoms, as they can indicate a serious underlying condition.

    • This question is part of the following fields:

      • Ophthalmology
      10.8
      Seconds
  • Question 5 - A 32-week pregnant woman presents to the early pregnancy unit with a concern...

    Correct

    • A 32-week pregnant woman presents to the early pregnancy unit with a concern that her uterus is small for this stage of pregnancy. Upon ultrasound, she is diagnosed with oligohydramnios. What could be a potential cause of oligohydramnios?

      Your Answer: Renal agenesis

      Explanation:

      Oligohydramnios is a condition that occurs during pregnancy when there is a shortage of amniotic fluid. This can result in a smaller symphysiofundal height.

      Oligohydramnios is a condition characterized by a decrease in the amount of amniotic fluid present in the womb. The definition of oligohydramnios varies, but it is generally considered to be present when there is less than 500ml of amniotic fluid at 32-36 weeks of gestation or an amniotic fluid index (AFI) that falls below the 5th percentile.

      There are several potential causes of oligohydramnios, including premature rupture of membranes, Potter sequence, bilateral renal agenesis with pulmonary hypoplasia, intrauterine growth restriction, post-term gestation, and pre-eclampsia. These conditions can all contribute to a reduction in the amount of amniotic fluid present in the womb, which can have significant implications for fetal development and health. It is important for healthcare providers to monitor amniotic fluid levels and identify any potential causes of oligohydramnios in order to provide appropriate care and support for both the mother and the developing fetus.

    • This question is part of the following fields:

      • Reproductive Medicine
      12.3
      Seconds
  • Question 6 - A 55-year-old woman has been diagnosed as having lung cancer.
    Which of the following...

    Correct

    • A 55-year-old woman has been diagnosed as having lung cancer.
      Which of the following statements is the most appropriate?

      Your Answer: Hypercalcaemia may occur without bone metastasis.

      Explanation:

      Paraneoplastic syndromes are a group of disorders that can occur in patients with certain types of cancer, but are not caused by metastases, infections, metabolic disorders, chemotherapy, or coagulation disorders. These syndromes can present with a variety of symptoms affecting different body systems. Some of these syndromes are specific to certain types of cancer and may be the first sign of the disease. Therefore, if a patient presents with symptoms of a paraneoplastic syndrome, it is important to consider the possibility of an underlying malignancy. While certain paraneoplastic syndromes are associated with specific types of cancer, there can be some overlap.

    • This question is part of the following fields:

      • Respiratory Medicine
      38.4
      Seconds
  • Question 7 - A 35-year-old man presents to the Emergency Department with rapid onset abdominal pain,...

    Correct

    • A 35-year-old man presents to the Emergency Department with rapid onset abdominal pain, which is worse on lying. He feels nauseous and is vomiting.
      On examination, he is tachycardic and pyrexial at 38.1°C. His abdomen is tender with marked guarding. There is bruising around his umbilicus.
      The patient reports drinking six cans of strong lager per day. He also smokes two packets of cigarettes a day. He says he was last in hospital two years ago when he was vomiting blood. He cannot remember what treatment he was given. He has no other medical history of note. He does not take any medications regularly.
      What is the most likely cause for the man’s presentation and signs?

      Your Answer: Pancreatitis with retroperitoneal haemorrhage

      Explanation:

      Differential diagnosis for a man with abdominal pain and retroperitoneal haemorrhage

      The man in question presents with classic symptoms of pancreatitis, including abdominal pain that radiates to the back and worsens on lying down, as well as nausea. However, his periumbilical bruising suggests retroperitoneal haemorrhage, which can also manifest as flank bruising. This condition may be related to his alcohol consumption, which increases the risk of both pancreatitis and coagulopathy.

      While bleeding oesophageal varices are another potential consequence of alcohol abuse, they would not explain the absence of haematemesis or malanea on this admission, nor the retroperitoneal haemorrhage. Similarly, hepatic cirrhosis and consequent coagulopathy could contribute to bleeding but would not account for the sudden onset of abdominal pain or the lack of ecchymosis elsewhere. A pancreatic abscess, which can develop as a complication of pancreatitis, would typically present with a swinging fever and a longer history of symptoms.

      Finally, a ruptured duodenal ulcer could cause upper gastrointestinal bleeding, but there is no evidence of this in the current case. The absence of reflux also makes this diagnosis less likely. Overall, the differential diagnosis for this patient includes pancreatitis with retroperitoneal haemorrhage, which may be related to alcohol use, and other conditions that do not fully fit the clinical picture.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      194.6
      Seconds
  • Question 8 - A 42-year-old woman complains of urine leakage when laughing or jumping. She has...

    Correct

    • A 42-year-old woman complains of urine leakage when laughing or jumping. She has no other urinary symptoms, and her urine dipstick test is negative.
      What is the most appropriate initial treatment option?

      Your Answer: Pelvic floor exercises

      Explanation:

      Understanding Urinary Incontinence: Types and Treatment Options

      Urinary incontinence is a common problem that affects people of all ages, but is more prevalent in elderly individuals and females. It is important to classify the type of urinary incontinence to determine the underlying cause and appropriate treatment.

      Functional incontinence occurs due to reasons other than lower urinary tract dysfunction, such as delirium, psychiatric disorders, urinary infection, or impaired mobility. Treatment is directed at the underlying cause.

      Mixed incontinence is a combination of stress incontinence and urge incontinence, characterized by mild-to-moderate urine loss with physical activities and acute urine loss without warning, respectively. Urinary frequency, urgency, and nocturia are also present.

      Overflow incontinence occurs when the bladder is overdistended and urine overflows despite the absence of detrusor contraction. Symptoms may mimic those of mixed incontinence and may suggest a cause of bladder outlet obstruction or neurological dysfunction.

      Stress incontinence is triggered by increased intra-abdominal pressure and is characterized by involuntary urine loss during coughing, laughing, and sneezing. Irritative voiding symptoms are typically absent.

      Urge incontinence is associated with an overactive bladder and is characterized by uncontrolled urine loss associated with a strong desire to void, which occurs suddenly and without warning. Patients are unable to hold back urine and experience urinary frequency, urgency, and nocturia.

      Treatment options include pelvic floor muscle training, anticholinergic medications such as oxybutynin and solifenacin, bladder retraining, and topical estrogen for postmenopausal women with vaginal atrophy. Treatment is directed at the underlying cause of urinary incontinence.

    • This question is part of the following fields:

      • Reproductive Medicine
      97.7
      Seconds
  • Question 9 - Which of the following conditions is not screened for in the blood spot...

    Correct

    • Which of the following conditions is not screened for in the blood spot screening test for infants?

      Your Answer: Galactosaemia

      Explanation:

      Neonatal Blood Spot Screening: Identifying Potential Health Risks in Newborns

      Neonatal blood spot screening, also known as the Guthrie test or heel-prick test, is a routine procedure performed on newborns between 5-9 days of life. The test involves collecting a small sample of blood from the baby’s heel and analyzing it for potential health risks. Currently, there are nine conditions that are screened for, including congenital hypothyroidism, cystic fibrosis, sickle cell disease, phenylketonuria, medium chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1), and homocystinuria (pyridoxine unresponsive) (HCU).

    • This question is part of the following fields:

      • Paediatrics
      10
      Seconds
  • Question 10 - A 32-year-old man complains of left ear pain and hearing loss for the...

    Incorrect

    • A 32-year-old man complains of left ear pain and hearing loss for the past week. He is an avid swimmer. During examination, you observe pre-auricular lymph nodes on the left side. The ear is inflamed, red, and tender to touch. A small amount of yellow discharge is visible in the ear canal.
      What is the initial treatment of choice after obtaining swabs?

      Your Answer: Oral antibiotics

      Correct Answer: Topical antibiotic drops

      Explanation:

      Patients suffering from otitis media typically experience relief from symptoms within 4 days without the need for antibiotics. While antibiotics can help shorten the duration of symptoms, they come with the risk of side effects and drug resistance. Therefore, treatment is usually postponed unless symptoms persist, the patient is generally unwell, or symptoms affect both ears. In rare cases, ear syringing may be used as a secondary treatment to remove debris from the ear canal.

      Understanding Otitis Externa: Causes, Features, and Management

      Otitis externa is a common condition that often prompts patients to seek medical attention. It is characterized by ear pain, itch, and discharge, and is caused by various factors such as infection, seborrhoeic dermatitis, and contact dermatitis. Swimming is also a common trigger of otitis externa. Upon examination, the ear canal appears red, swollen, or eczematous.

      The recommended initial management of otitis externa involves the use of topical antibiotics or a combination of topical antibiotics with a steroid. However, if the tympanic membrane is perforated, aminoglycosides are traditionally not used. In cases where there is canal debris, removal may be necessary, while an ear wick may be inserted if the canal is extensively swollen. Second-line options include oral antibiotics, taking a swab inside the ear canal, and empirical use of an antifungal agent.

      It is important to note that if a patient fails to respond to topical antibiotics, referral to an ENT specialist may be necessary. Malignant otitis externa is a more serious condition that is more common in elderly diabetics. It involves the extension of infection into the bony ear canal and the soft tissues deep to the bony canal, and may require intravenous antibiotics.

      Overall, understanding the causes, features, and management of otitis externa is crucial in providing appropriate care and preventing complications.

    • This question is part of the following fields:

      • ENT
      101.8
      Seconds
  • Question 11 - What is the most frequent negative outcome encountered by females who consume the...

    Incorrect

    • What is the most frequent negative outcome encountered by females who consume the progestin-only pill?

      Your Answer: Weight gain

      Correct Answer: Irregular vaginal bleeding

      Explanation:

      Pros and Cons of the Progestogen Only Pill

      The progestogen only pill, also known as the mini-pill, is a highly effective form of contraception with a failure rate of only 1 per 100 woman years. One of its advantages is that it does not interfere with sex and its contraceptive effects are reversible upon stopping. It can also be used while breastfeeding and in situations where the combined oral contraceptive pill is contraindicated, such as in smokers over 35 years of age and women with a history of venous thromboembolic disease.

      However, the progestogen only pill also has its disadvantages. One of the most common adverse effects is irregular periods, with some users not having periods while others may experience irregular or light periods. It also does not protect against sexually transmitted infections and has an increased incidence of functional ovarian cysts. Common side-effects include breast tenderness, weight gain, acne, and headaches, although these symptoms generally subside after the first few months. Despite its drawbacks, the progestogen only pill remains a popular choice for women seeking a reliable and convenient form of contraception.

    • This question is part of the following fields:

      • Reproductive Medicine
      11.5
      Seconds
  • Question 12 - A 55-year-old woman presents with urgency and frequency. Three weeks ago she consulted...

    Incorrect

    • A 55-year-old woman presents with urgency and frequency. Three weeks ago she consulted with a colleague as she felt 'dry' during intercourse. She has been treated for urinary tract infections on multiple occasions in the past but urine culture is always negative. Her only medication is continuous hormone replacement therapy. A vaginal examination is performed which shows no evidence of vaginal atrophy and no masses are felt. An ultrasound is requested:

      Both kidneys, spleen and liver are normal size. Outline of the bladder normal. 6 cm complex ovarian cyst noted on left ovary. Right ovary and uterus normal

      What is the most appropriate next step?

      Your Answer: Trial topical oestrogen

      Correct Answer: Urgent referral to gynaecology

      Explanation:

      Investigation is necessary for any ovarian mass found in a woman who has undergone menopause.

      Ovarian enlargement is typically diagnosed through ultrasound imaging, which can determine whether the cyst is simple or complex. Simple cysts are unilocular and more likely to be benign, while complex cysts are multilocular and more likely to be malignant. Management of ovarian enlargement depends on the patient’s age and symptoms. Younger women may be treated conservatively if the cyst is small and simple, with a repeat ultrasound scheduled in 8-12 weeks. Postmenopausal women, however, should always be referred to a gynecologist for assessment, as physiological cysts are unlikely in this population. It’s important to note that ovarian cancer can present with vague symptoms, leading to delayed diagnosis.

    • This question is part of the following fields:

      • Reproductive Medicine
      104.3
      Seconds
  • Question 13 - A 55-year-old man arrives at the emergency department with complaints of abdominal pain,...

    Incorrect

    • A 55-year-old man arrives at the emergency department with complaints of abdominal pain, nausea, and vomiting. His urine and serum tests reveal elevated ketone levels, and his serum glucose level is 3 mmol/L. An ABG is conducted, and the results are as follows:
      pH 7.24
      PaO2 14.7 kPa
      PCO2 3.5 kPa
      HCO3 13 mEq/L
      What is the most probable cause of these findings?

      Your Answer: Diabetic ketoacidosis

      Correct Answer: Alcoholic ketoacidosis

      Explanation:

      If a patient is experiencing metabolic ketoacidosis with normal or low glucose levels, alcohol consumption should be considered as a possible cause. This condition is characterized by partial respiratory compensation. While diabetic ketoacidosis could also be a potential cause, a serum glucose level of 3mmol/L makes it less likely. Therefore, the patient is more likely to be suffering from alcoholic ketoacidosis. It is important to note that a hyperosmolar hyperglycemic state would present with high serum glucose levels and normal ketone levels, while a diabetic hypoglycemic episode would not typically result in elevated ketone levels or metabolic acidosis.

      Alcoholic ketoacidosis is a type of ketoacidosis that occurs in individuals who consume large amounts of alcohol regularly. This condition is not related to diabetes and is characterized by normal blood sugar levels. Alcoholics often suffer from malnutrition due to their irregular eating habits and may vomit the food they consume, leading to starvation. When the body becomes malnourished, it starts breaking down body fat, which produces ketones and leads to ketoacidosis.

      The typical symptoms of alcoholic ketoacidosis include metabolic acidosis, elevated anion gap, elevated serum ketone levels, and normal or low glucose concentration. The most effective treatment for this condition is an infusion of saline and thiamine. Thiamine is essential to prevent the development of Wernicke encephalopathy or Korsakoff psychosis. Therefore, it is crucial to provide timely and appropriate treatment to individuals suffering from alcoholic ketoacidosis to prevent further complications.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      105.6
      Seconds
  • Question 14 - A 38-year-old man visits his GP complaining of feeling generally unwell. He reports...

    Correct

    • A 38-year-old man visits his GP complaining of feeling generally unwell. He reports experiencing daily frontal headaches for the past three months, which have not improved with regular paracetamol. Additionally, he has noticed some unusual symptoms such as his wedding ring no longer fitting, his shoe size apparently increasing, and a small amount of milky discharge from both nipples. During examination, his blood pressure is found to be 168/96 mmHg. What is the probable diagnosis?

      Your Answer: Acromegaly

      Explanation:

      Acromegaly: Excess Growth Hormone and its Features

      Acromegaly is a condition characterized by excess growth hormone, which is usually caused by a pituitary adenoma in over 95% of cases. However, a minority of cases are caused by ectopic GHRH or GH production by tumours such as pancreatic. The condition is associated with several features, including a coarse facial appearance, spade-like hands, and an increase in shoe size. Patients may also have a large tongue, prognathism, and interdental spaces. Excessive sweating and oily skin are also common, caused by sweat gland hypertrophy.

      In addition to these physical features, patients with acromegaly may also experience symptoms of a pituitary tumour, such as hypopituitarism, headaches, and bitemporal hemianopia. Raised prolactin levels are also seen in about one-third of cases, which can lead to galactorrhoea. It is important to note that 6% of patients with acromegaly have MEN-1, a genetic disorder that affects multiple endocrine glands.

      Complications of acromegaly include hypertension, diabetes (seen in over 10% of cases), cardiomyopathy, and an increased risk of colorectal cancer. Early diagnosis and treatment of acromegaly are crucial to prevent these complications and improve patient outcomes.

    • This question is part of the following fields:

      • Endocrinology/Metabolic Disease
      30.8
      Seconds
  • Question 15 - A 15-year-old girl comes to the clinic with concerns about not having started...

    Incorrect

    • A 15-year-old girl comes to the clinic with concerns about not having started her periods yet. She is shorter than most girls her age. She has gone through adrenarche but has not yet experienced thelarche. Her mother and sister both began menstruating at age 12. The following are her blood test results:
      - FSH: 60 IU/L (normal range: 0-10)
      - LH: 40 IU/L (normal range: 0-16)
      - Oestradiol: 6.4 pmol/L (normal range: 73-407)
      - Thyroid stimulating hormone (TSH): 5.0 mU/L (normal range: 0.5-5.5)
      - Free thyroxine (T4): 12 pmol/L (normal range: 9.0-18)
      - Prolactin: 323 mIU/L (normal range: <700)

      Based on the patient's symptoms and test results, what is the most likely cause of her amenorrhoea?

      Your Answer: Asherman’s syndrome

      Correct Answer: Turner's syndrome

      Explanation:

      Understanding Turner’s Syndrome

      Turner’s syndrome is a genetic disorder that affects approximately 1 in 2,500 females. It is caused by the absence of one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. This condition is denoted as 45,XO or 45,X.

      The features of Turner’s syndrome include short stature, a shield chest with widely spaced nipples, a webbed neck, a bicuspid aortic valve (15%), coarctation of the aorta (5-10%), primary amenorrhea, cystic hygroma (often diagnosed prenatally), a high-arched palate, a short fourth metacarpal, multiple pigmented naevi, lymphoedema in neonates (especially feet), and elevated gonadotrophin levels. Hypothyroidism is much more common in Turner’s syndrome, and there is also an increased incidence of autoimmune disease (especially autoimmune thyroiditis) and Crohn’s disease.

      In summary, Turner’s syndrome is a chromosomal disorder that affects females and can cause a range of physical features and health issues. Early diagnosis and management can help individuals with Turner’s syndrome lead healthy and fulfilling lives.

    • This question is part of the following fields:

      • Paediatrics
      87.3
      Seconds
  • Question 16 - A 25-year-old woman presents to the neurology clinic with a unilateral hand tremor....

    Correct

    • A 25-year-old woman presents to the neurology clinic with a unilateral hand tremor. Her family has noticed changes in her behavior, mood, and speech over the past year. During the examination, a resting tremor is observed in her right hand, along with bradykinesia and a lack of movement. Additionally, dark circular marks are visible around her iris. The patient mentions that her uncle passed away from liver cirrhosis at the age of 42. What is the probable diagnosis?

      Your Answer: Wilson's disease

      Explanation:

      Wilson’s disease is indicated by the presence of both liver and neurological conditions, as well as the presence of Kayser-Fleischer rings and a family history of liver disease.

      Wilson’s disease is a genetic disorder that causes excessive copper buildup in the body tissues due to increased copper absorption from the small intestine and decreased hepatic copper excretion. It is an autosomal recessive disorder caused by a defect in the ATP7B gene located on chromosome 13. Symptoms usually appear between the ages of 10 and 25, with children presenting with liver disease and young adults with neurological disease. The disease is characterised by excessive copper deposition in the brain, liver, and cornea, resulting in various symptoms such as hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioural problems, Kayser-Fleischer rings, renal tubular acidosis, haemolysis, and blue nails.

      To diagnose Wilson’s disease, a slit lamp examination is conducted to check for Kayser-Fleischer rings, and blood and urine tests are performed to measure copper levels. The diagnosis is confirmed by genetic analysis of the ATP7B gene. The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. However, trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation for the treatment of Wilson’s disease.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      46.5
      Seconds
  • Question 17 - A 53-year-old man presents to his GP with vertigo and earache. He reports...

    Correct

    • A 53-year-old man presents to his GP with vertigo and earache. He reports feeling that the room is spinning over the past 2 days. On examination, there is a left facial droop, the patient is unable to lift his left eyebrow, along with a vesicular rash around the left ear, the tympanic membrane looks healthy with a preserved cone of light. His heart rate is 78 bpm, blood pressure is 134/84 mmHg and temperature is 37.2ºC. He has a past medical history of type II diabetes mellitus for which he takes metformin.

      What is the most appropriate treatment to commence?

      Your Answer: Aciclovir and prednisolone

      Explanation:

      The recommended treatment for Ramsay Hunt syndrome, which this man is presenting with, includes both oral aciclovir and corticosteroids. This syndrome is caused by a herpes zoster infection of the facial nerve and can lead to symptoms such as ear pain, vertigo, facial palsy, and a vesicular rash around the ear. While aciclovir alone would not be sufficient, using prednisolone alone is also not recommended. Instead, NICE guidance suggests using both aciclovir and prednisolone to improve outcomes and increase the chances of recovery. Flucloxacillin, an antibiotic used to treat skin infections like cellulitis, would not be appropriate in this case as the presence of a vesicular rash makes cellulitis unlikely.

      Understanding Ramsay Hunt Syndrome

      Ramsay Hunt syndrome, also known as herpes zoster oticus, is a condition that occurs when the varicella zoster virus reactivates in the geniculate ganglion of the seventh cranial nerve. The first symptom of this condition is often auricular pain, followed by facial nerve palsy and a vesicular rash around the ear. Other symptoms may include vertigo and tinnitus.

      To manage Ramsay Hunt syndrome, doctors typically prescribe oral aciclovir and corticosteroids. These medications can help reduce the severity of symptoms and prevent complications.

    • This question is part of the following fields:

      • ENT
      13.7
      Seconds
  • Question 18 - A 35-year-old female comes to your clinic complaining of vomiting that has been...

    Correct

    • A 35-year-old female comes to your clinic complaining of vomiting that has been ongoing for the past day. She reports feeling nauseous at present, with her last episode of vomiting occurring just 5 minutes ago. She mentions attending a barbecue the day before and is concerned that the sausages she ate may not have been cooked thoroughly. The patient has a medical history of Addison's disease and is currently taking oral hydrocortisone and fludrocortisone.

      What advice would be most appropriate to give to this patient?

      Your Answer: Take IM hydrocortisone until her vomiting stops

      Explanation:

      If a person with Addison’s disease experiences vomiting, they should take IM hydrocortisone until the vomiting stops. This is especially important if the vomiting is caused by food poisoning from undercooked meat. IM hydrocortisone is a glucocorticoid steroid hormone that is used to manage Addison’s disease and prevent an Addisonian crisis. It is important to note that doubling the fludrocortisone dose or pausing hydrocortisone is not the correct approach in this situation. The patient requires extra hydrocortisone to prevent an Addisonian crisis, not extra fludrocortisone. While drinking plenty of fluids is generally good advice for someone who is vomiting, it is not sufficient for a person with Addison’s disease in this situation.

      Addison’s disease is a condition that requires patients to undergo both glucocorticoid and mineralocorticoid replacement therapy. This treatment usually involves taking a combination of hydrocortisone and fludrocortisone. Hydrocortisone is typically given in 2 or 3 divided doses, with patients requiring 20-30 mg per day, mostly in the first half of the day. Patient education is crucial, and it is essential to emphasize the importance of not missing glucocorticoid doses. Additionally, patients should consider wearing MedicAlert bracelets and steroid cards, and they should be provided with hydrocortisone for injection with needles and syringes to treat an adrenal crisis.

      During an intercurrent illness, it is crucial to manage the glucocorticoid dose properly. In simple terms, the glucocorticoid dose should be doubled, while the fludrocortisone dose should remain the same. The Addison’s Clinical Advisory Panel has produced guidelines that detail specific scenarios, and patients should refer to these guidelines for more information. It is essential to discuss how to adjust the glucocorticoid dose during an intercurrent illness with a healthcare professional. Proper management of Addison’s disease is crucial to ensure that patients can lead healthy and fulfilling lives.

    • This question is part of the following fields:

      • Gastroenterology/Nutrition
      36.7
      Seconds
  • Question 19 - An 80-year-old woman arrives at the emergency department with recent onset of left-sided...

    Incorrect

    • An 80-year-old woman arrives at the emergency department with recent onset of left-sided weakness. She has a medical history of atrial fibrillation and is currently taking warfarin, with an INR of 2.5 upon admission. A CT scan of her head reveals an intracerebral haemorrhage in the left basal ganglia. What steps should be taken regarding her warfarin medication?

      Your Answer: Stop the warfarin and give 5mg of vitamin K intravenously

      Correct Answer: Stop the warfarin, give 5mg of vitamin K intravenously and give prothrombin complex concentrate intravenously

      Explanation:

      In the event of major bleeding, such as an intracranial haemorrhage, it is crucial to discontinue warfarin and administer intravenous vitamin K 5mg and prothrombin complex concentrate (PCC). PCC is a solution that contains coagulation factors II, VII, IX and X, specifically designed to reverse the effects of warfarin. It is recommended over fresh frozen plasma (FFP) for warfarin reversal.

      Management of High INR in Patients Taking Warfarin

      When managing patients taking warfarin who have a high INR, the approach will depend on whether there is bleeding or not. In cases of major bleeding, warfarin should be stopped immediately and intravenous vitamin K 5mg should be given along with prothrombin complex concentrate. If this is not available, fresh frozen plasma can be used instead. For minor bleeding, warfarin should also be stopped and intravenous vitamin K 1-3mg should be given. If the INR remains high after 24 hours, the dose of vitamin K can be repeated. Warfarin can be restarted once the INR is below 5.0.

      If there is no bleeding, warfarin should be stopped and vitamin K 1-5mg can be given orally using the intravenous preparation. The dose of vitamin K can be repeated if the INR remains high after 24 hours. Warfarin can be restarted once the INR is below 5.0. In cases where the INR is between 5.0-8.0, warfarin should be stopped for minor bleeding and intravenous vitamin K 1-3mg should be given. Warfarin can be restarted once the INR is below 5.0. For patients with no bleeding and an INR between 5.0-8.0, one or two doses of warfarin can be withheld and the subsequent maintenance dose can be reduced.

      It is important to note that in cases of intracranial hemorrhage, prothrombin complex concentrate should be considered instead of fresh frozen plasma as it can take time to defrost. These guidelines are based on the recommendations of the British Committee for Standards in Haematology and the British National Formulary.

    • This question is part of the following fields:

      • Neurology
      54.8
      Seconds
  • Question 20 - A 48-year-old male patient comes to the GP clinic complaining of pain and...

    Incorrect

    • A 48-year-old male patient comes to the GP clinic complaining of pain and redness on his left upper eyelid. Upon examination, a tender papule with erythema is found at the left eyelid margin, with a small area of pus discharge. Additionally, there is slight redness of the conjunctiva. What is the probable diagnosis?

      Your Answer: Ectropion

      Correct Answer: Hordeolum externum

      Explanation:

      The individual is experiencing an infection in the glands of their external eyelid, which is classified as a type of stye known as hordeolum externum. It should be noted that a chalazion, also referred to as a meibomian cyst, typically occurs on the internal eyelid. Blepharitis, on the other hand, is characterized by inflammation of the eyelid margins and does not typically result in a lump. Ectropion refers to the outward turning of the eyelids, while acne vulgaris does not typically impact the eyelids.

      Eyelid problems are quite common and can include a variety of issues. One such issue is blepharitis, which is inflammation of the eyelid margins that can cause redness in the eye. Another problem is a stye, which is an infection of the glands in the eyelids. Chalazion, also known as Meibomian cyst, is another eyelid problem that can occur. Entropion is when the eyelids turn inward, while ectropion is when they turn outward.

      Styes can come in different forms, such as external or internal. An external stye is an infection of the glands that produce sebum or sweat, while an internal stye is an infection of the Meibomian glands. Treatment for styes typically involves hot compresses and pain relief, with topical antibiotics only being recommended if there is also conjunctivitis present. A chalazion, on the other hand, is a painless lump that can form in the eyelid due to a retention cyst of the Meibomian gland. While most cases will resolve on their own, some may require surgical drainage.

    • This question is part of the following fields:

      • Ophthalmology
      38.9
      Seconds
  • Question 21 - A 62-year-old woman is referred to the medical team from the orthopaedic ward....

    Incorrect

    • A 62-year-old woman is referred to the medical team from the orthopaedic ward. She underwent a right total-hip replacement six days ago. She is known to have mild COPD and is on regular inhaled steroids and a short-acting b2 agonist. She now complains of left-sided chest pain and is also dyspnoeic. Your clinical diagnosis is pulmonary embolism (PE).
      Which of the following is usually NOT a feature of PE in this patient?

      Your Answer: New-onset atrial fibrillation

      Correct Answer: Bradycardia

      Explanation:

      Symptoms and Signs of Pulmonary Embolism

      Pulmonary embolism (PE) is a serious condition that can be life-threatening. It is important to recognize the symptoms and signs of PE to ensure prompt diagnosis and treatment. Here are some of the common symptoms and signs of PE:

      Dyspnoea: This is the most common symptom of PE, present in about 75% of patients. Dyspnoea can occur at rest or on exertion.

      Tachypnoea: This is defined as a respiratory rate of more than 20 breaths per minute and is present in about 55% of patients with PE.

      Tachycardia: This is present in about 25% of cases of PE. It is important to note that a transition from tachycardia to bradycardia may suggest the development of right ventricular strain and potentially cardiogenic shock.

      New-onset atrial fibrillation: This is a less common feature of PE, occurring in less than 10% of cases. Atrial flutter, atrial fibrillation, and premature beats should alert the doctor to possible right-heart strain.

      Bradycardia: This is not a classic feature of PE. However, if a patient with PE transitions from tachycardia to bradycardia, it may suggest the development of right ventricular strain and potentially cardiogenic shock.

      In summary, dyspnoea, tachypnoea, tachycardia, and new-onset atrial fibrillation are some of the common symptoms and signs of PE. It is important to have a high level of suspicion for PE, especially in high-risk patients, to ensure prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Respiratory Medicine
      19.1
      Seconds
  • Question 22 - What is the most prevalent form of multiple sclerosis? ...

    Incorrect

    • What is the most prevalent form of multiple sclerosis?

      Your Answer: Progressive-relapsing disease

      Correct Answer: Relapsing-remitting disease

      Explanation:

      Understanding Multiple Sclerosis

      Multiple sclerosis is a chronic autoimmune disorder that affects the central nervous system, causing demyelination. It is more common in women and typically diagnosed in individuals aged 20-40 years. Interestingly, it is much more prevalent in higher latitudes, with a five-fold increase compared to tropical regions. Genetics play a role in the development of multiple sclerosis, with a 30% concordance rate in monozygotic twins and a 2% concordance rate in dizygotic twins.

      There are several subtypes of multiple sclerosis, including relapsing-remitting disease, which is the most common form and accounts for around 85% of patients. This subtype is characterized by acute attacks followed by periods of remission. Secondary progressive disease describes relapsing-remitting patients who have deteriorated and developed neurological signs and symptoms between relapses. Gait and bladder disorders are commonly seen in this subtype, and around 65% of patients with relapsing-remitting disease go on to develop secondary progressive disease within 15 years of diagnosis. Finally, primary progressive disease accounts for 10% of patients and is characterized by progressive deterioration from onset, which is more common in older individuals. Understanding the different subtypes of multiple sclerosis is crucial for proper diagnosis and management of the disease.

    • This question is part of the following fields:

      • Neurology
      17
      Seconds
  • Question 23 - A 67-year-old male visits his primary care clinic complaining of progressive dyspnea on...

    Correct

    • A 67-year-old male visits his primary care clinic complaining of progressive dyspnea on exertion and a dry cough. He has a smoking history of 35 pack-years. He denies chest pain, weight loss, or hemoptysis. In the past, he was prescribed bronchodilators for COPD, but they did not alleviate his symptoms.

      During the examination, the physician detects fine crackles at the lung bases bilaterally, and the patient has significant finger clubbing. The physician orders a chest X-ray, pulmonary function tests, and refers him urgently to a respiratory clinic.

      What pulmonary function test pattern would you expect to see based on the most likely underlying diagnosis?

      Your Answer: FEV1:FVC normal or increased, TLCO reduced

      Explanation:

      In cases of IPF, the TLCO (gas transfer test) is reduced, indicating a restrictive lung disease that results in a reduced FEV1 and reduced FVC. This leads to a normal or increased FEV1:FVC ratio, which is a distinguishing factor from obstructive lung diseases like COPD or asthma. Therefore, the correct statement is that in IPF, the FEV1:FVC ratio is normal or increased, while the TLCO is reduced.

      Understanding Idiopathic Pulmonary Fibrosis

      Idiopathic pulmonary fibrosis (IPF) is a chronic lung condition that causes progressive fibrosis of the interstitium of the lungs. Unlike other causes of lung fibrosis, IPF has no underlying cause. It is typically seen in patients aged 50-70 years and is more common in men.

      The symptoms of IPF include progressive exertional dyspnoea, dry cough, clubbing, and bibasal fine end-inspiratory crepitations on auscultation. Diagnosis is made through spirometry, impaired gas exchange tests, and imaging such as chest x-rays and high-resolution CT scans.

      Management of IPF includes pulmonary rehabilitation, but very few medications have been shown to be effective. Some evidence suggests that pirfenidone, an antifibrotic agent, may be useful in selected patients. Many patients will eventually require supplementary oxygen and a lung transplant.

      The prognosis for IPF is poor, with an average life expectancy of around 3-4 years. CT scans can show advanced pulmonary fibrosis, including honeycombing. While there is no cure for IPF, early diagnosis and management can help improve quality of life and potentially prolong survival.

    • This question is part of the following fields:

      • Respiratory Medicine
      37.3
      Seconds
  • Question 24 - An 80-year-old man comes to the clinic with painless, symmetrical swellings in his...

    Correct

    • An 80-year-old man comes to the clinic with painless, symmetrical swellings in his neck. He reports no other symptoms. Laboratory tests show a haemoglobin level of 10.0 g/dl and a white cell count of 23 × 109/l. A blood film reveals smear cells, with more than 60% of the cells being small mature lymphocytes. What is the probable diagnosis?

      Your Answer: Chronic lymphocytic leukaemia (CLL)

      Explanation:

      Differentiating Leukaemia and Lymphoma: Characteristics and Symptoms

      Leukaemia and lymphoma are both types of blood cancer, but they have distinct characteristics and symptoms. In this context, we will discuss the characteristics and symptoms of chronic lymphocytic leukaemia (CLL), acute lymphoblastic leukaemia (ALL), chronic myeloid leukaemia (CML), Hodgkin’s lymphoma (HL), and multiple myeloma (MM).

      CLL is the most common leukaemia in adults, characterized by peripheral blood lymphocytosis and uncontrolled proliferation of B cell lymphocytes in the bone marrow, lymph nodes, and splenomegaly. Patients are often asymptomatic, and CLL is often picked up incidentally.

      ALL is a common leukaemia of children aged 2–5 years and is very rare in adults.

      CML tends to present with more systemic, B symptoms in a slightly younger age group. A classic symptom is a massive hepatosplenomegaly. Blood film would show PMNs, basophils, and myelocytes.

      HL is a possibility in this age group; however, the question asks for the ‘most likely’ diagnosis, which would be CLL as it is more common in this age group and the western world. Further investigation would be used to confirm the diagnosis.

      MM is the uncontrolled proliferation of plasma cells and does not present in the way described above. Bone pain, hypercalcaemia, renal failure, and neutropenia are common presentations.

    • This question is part of the following fields:

      • Haematology/Oncology
      12.6
      Seconds
  • Question 25 - A 35-year-old woman comes to the clinic with patchy hair loss on her...

    Incorrect

    • A 35-year-old woman comes to the clinic with patchy hair loss on her scalp, which is well-defined. The hair loss is affecting approximately 25% of her scalp, and she is experiencing significant emotional distress. The doctor suspects alopecia areata. What would be an appropriate course of action for management?

      Your Answer: Topical ketoconazole + referral to dermatologist

      Correct Answer: Topical corticosteroid + referral to dermatologist

      Explanation:

      In this clinical scenario, the patient presents with well-defined patchy hair loss on the scalp, which is characteristic of alopecia areata. This autoimmune condition can lead to significant psychological distress, making effective management crucial. The most appropriate management strategy involves the use of topical corticosteroids, which are anti-inflammatory agents that can help reduce the immune response in the affected areas, promoting hair regrowth.

      Additionally, referring the patient to a dermatologist is advisable for further evaluation and potential advanced treatment options, especially if the condition is extensive or does not respond to initial therapy. Other options presented are less suitable for this case. For instance, topical 5-fluorouracil (5-FU) is primarily used for actinic keratosis and superficial basal cell carcinoma, not for alopecia areata. An autoimmune screen may be considered in certain cases, but it is not routinely necessary for alopecia areata unless there are other clinical indications. Topical ketoconazole is an antifungal treatment and is not indicated for alopecia areata.

      Key Takeaways: – Alopecia areata is an autoimmune condition that can cause significant emotional distress. – Topical corticosteroids are effective in managing localized alopecia areata. – Referral to a dermatologist is important for comprehensive care and management options. – Other treatments like 5-FU and ketoconazole are not appropriate for this condition.

    • This question is part of the following fields:

      • Dermatology
      19.3
      Seconds
  • Question 26 - You are evaluating a 67-year-old patient in the renal clinic who has been...

    Incorrect

    • You are evaluating a 67-year-old patient in the renal clinic who has been undergoing haemodialysis for chronic kidney disease for the last 6 years. What is the leading cause of mortality in this patient population?

      Your Answer: Dilated cardiomyopathy

      Correct Answer: Ischaemic heart disease

      Explanation:

      Causes of Chronic Kidney Disease

      Chronic kidney disease is a condition that affects the kidneys, causing them to gradually lose their ability to function properly. There are several common causes of this condition, including diabetic nephropathy, chronic glomerulonephritis, chronic pyelonephritis, hypertension, and adult polycystic kidney disease.

      Diabetic nephropathy is a complication of diabetes that occurs when high blood sugar levels damage the small blood vessels in the kidneys. Chronic glomerulonephritis is a condition in which the glomeruli, the tiny filters in the kidneys, become inflamed and damaged over time. Chronic pyelonephritis is a type of kidney infection that can cause scarring and damage to the kidneys. Hypertension, or high blood pressure, can also damage the kidneys over time. Finally, adult polycystic kidney disease is an inherited condition in which cysts form in the kidneys, causing them to enlarge and lose function.

      It is important to identify the underlying cause of chronic kidney disease in order to properly manage the condition and prevent further damage to the kidneys. Treatment may involve medications, lifestyle changes, and in some cases, dialysis or kidney transplant.

    • This question is part of the following fields:

      • Renal Medicine/Urology
      9.6
      Seconds
  • Question 27 - An older woman with advanced breast cancer has been discharged from the hospital...

    Incorrect

    • An older woman with advanced breast cancer has been discharged from the hospital for palliative care at home. She was prescribed oral morphine at a dose of 10mg four times a day to manage her pain from bony metastases. This dosage was effective in controlling her pain.

      However, the patient's condition has worsened, and she is now experiencing difficulty swallowing, making it impossible to take the medication orally. The GP has recommended converting the morphine to a subcutaneous injection, which will be administered by the district nurses.

      What is the appropriate subcutaneous morphine dose for this patient?

      Your Answer: 2.5mg four times daily

      Correct Answer: 5mg four times daily

      Explanation:

      To convert from oral to subcutaneous morphine, divide the oral dose by two. In this case, the recommended subcutaneous morphine dose is 5mg four times daily, which is equivalent to 10mg of oral morphine four times daily. As the patient’s pain is currently well controlled, there is no need to adjust the analgesia dose.

      Palliative care prescribing for pain is guided by NICE and SIGN guidelines. NICE recommends starting treatment with regular oral modified-release or immediate-release morphine, with immediate-release morphine for breakthrough pain. Laxatives should be prescribed for all patients initiating strong opioids, and antiemetics should be offered if nausea persists. Drowsiness is usually transient, but if it persists, the dose should be adjusted. SIGN advises that the breakthrough dose of morphine is one-sixth the daily dose, and all patients receiving opioids should be prescribed a laxative. Opioids should be used with caution in patients with chronic kidney disease, and oxycodone is preferred to morphine in patients with mild-moderate renal impairment. Metastatic bone pain may respond to strong opioids, bisphosphonates, or radiotherapy, and all patients should be considered for referral to a clinical oncologist for further treatment. When increasing the dose of opioids, the next dose should be increased by 30-50%. Conversion factors between opioids are also provided. Opioid side-effects are usually transient, such as nausea and drowsiness, but constipation can persist. In addition to strong opioids, bisphosphonates, and radiotherapy, denosumab may be used to treat metastatic bone pain.

      Overall, the guidelines recommend starting with regular oral morphine and adjusting the dose as needed. Laxatives should be prescribed to prevent constipation, and antiemetics may be needed for nausea. Opioids should be used with caution in patients with chronic kidney disease, and oxycodone is preferred in patients with mild-moderate renal impairment. Metastatic bone pain may respond to strong opioids, bisphosphonates, or radiotherapy, and referral to a clinical oncologist should be considered. Conversion factors between opioids are provided, and the next dose should be increased by 30-50% when adjusting the dose. Opioid side-effects are usually transient, but constipation can persist. Denosumab may also be used to treat metastatic bone pain.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      29.4
      Seconds
  • Question 28 - A 42-year-old male complains of difficulty breathing after experiencing flu-like symptoms for a...

    Correct

    • A 42-year-old male complains of difficulty breathing after experiencing flu-like symptoms for a week. He has a dry cough and no chest discomfort. A chest x-ray reveals bilateral consolidation, and he has red rashes on his limbs and torso. Which test is most likely to provide a definitive diagnosis?

      Your Answer: Serology for Mycoplasma

      Explanation:

      A diagnosis of Mycoplasma can be made based on symptoms such as flu-like symptoms, bilateral consolidation, and erythema multiforme. The most suitable diagnostic test for this condition is Mycoplasma serology.

      Mycoplasma pneumoniae: A Cause of Atypical Pneumonia

      Mycoplasma pneumoniae is a type of bacteria that causes atypical pneumonia, which is more common in younger patients. This disease is associated with various complications such as erythema multiforme and cold autoimmune haemolytic anaemia. Epidemics of Mycoplasma pneumoniae typically occur every four years. It is important to recognize atypical pneumonia because it may not respond to penicillins or cephalosporins due to the bacteria lacking a peptidoglycan cell wall.

      The disease usually has a gradual onset and is preceded by flu-like symptoms, followed by a dry cough. X-rays may show bilateral consolidation. Complications may include cold agglutinins, erythema multiforme, erythema nodosum, meningoencephalitis, Guillain-Barre syndrome, bullous myringitis, pericarditis/myocarditis, and gastrointestinal and renal problems.

      Diagnosis is generally made through Mycoplasma serology and a positive cold agglutination test. Management involves the use of doxycycline or a macrolide such as erythromycin or clarithromycin.

      In comparison to Legionella pneumonia, which is caused by a different type of bacteria, Mycoplasma pneumoniae has a more gradual onset and is associated with different complications. It is important to differentiate between the two types of pneumonia to ensure appropriate treatment.

    • This question is part of the following fields:

      • Infectious Diseases
      28.2
      Seconds
  • Question 29 - A 65-year-old man presents to the emergency department with severe chest pain that...

    Correct

    • A 65-year-old man presents to the emergency department with severe chest pain that started an hour ago and is radiating to his left arm. He has a history of type two diabetes and has smoked 50 packs of cigarettes in his lifetime. An ECG shows ST-elevation in leads V2-4, indicating a STEMI. As the healthcare provider, you decide to initiate treatment and give the patient 300mg of aspirin orally. What is the mechanism of action of this medication?

      Your Answer: Non-reversible COX 1 and 2 inhibitor

      Explanation:

      Aspirin irreversibly inhibits both COX 1 and COX 2, preventing the conversion of arachidonic acid into prostaglandin, prostacyclin, and thromboxane. Thromboxane A2 is responsible for platelet aggregation and vasoconstriction. In cases of acute coronary syndrome, high doses of aspirin are administered to prevent the enlargement of the coronary thrombus.

      The Mechanism and Guidelines for Aspirin Use in Cardiovascular Disease

      Aspirin is a medication that works by blocking the action of cyclooxygenase-1 and 2, which are responsible for the synthesis of prostaglandin, prostacyclin, and thromboxane. By inhibiting the formation of thromboxane A2 in platelets, aspirin reduces their ability to aggregate, making it a widely used medication in cardiovascular disease. However, recent trials have cast doubt on the use of aspirin in primary prevention of cardiovascular disease, leading to changes in guidelines. Aspirin is now recommended as a first-line treatment for patients with ischaemic heart disease, but it should not be used in children under 16 due to the risk of Reye’s syndrome. The medication can also potentiate the effects of oral hypoglycaemics, warfarin, and steroids.

      The Medicines and Healthcare products Regulatory Agency (MHRA) issued a drug safety update in January 2010, reminding prescribers that aspirin is not licensed for primary prevention. NICE now recommends clopidogrel as a first-line treatment following an ischaemic stroke and for peripheral arterial disease. However, the situation is more complex for TIAs, with recent Royal College of Physician (RCP) guidelines supporting the use of clopidogrel, while older NICE guidelines still recommend aspirin + dipyridamole – a position the RCP state is ‘illogical’. Despite these changes, aspirin remains an important medication in the treatment of cardiovascular disease, and its use should be carefully considered based on individual patient needs and risk factors.

    • This question is part of the following fields:

      • Pharmacology/Therapeutics
      34.1
      Seconds
  • Question 30 - A 6-year-old girl is diagnosed with haemolytic uraemic syndrome (HUS), after a recent...

    Incorrect

    • A 6-year-old girl is diagnosed with haemolytic uraemic syndrome (HUS), after a recent Salmonella infection. She is admitted to the hospital and blood tests demonstrate a platelet count of 85 × 109/l as well as a haemoglobin of 9 g/dl. She is maintaining good oral intake and her observations are normal.
      What would be the next most appropriate step in this patient’s management?

      Your Answer: Transfusion of red blood cells and platelets

      Correct Answer: Supportive treatment with intravenous fluids

      Explanation:

      Treatment Options for Haemolytic Uraemic Syndrome

      Haemolytic uraemic syndrome (HUS) is a condition that can lead to acute renal failure and even chronic renal failure if left untreated. The main treatment for HUS is supportive care, which often involves intravenous fluids to prevent renal damage and decline in renal function. Oral rehydration medications may be useful for patients with ongoing diarrhoea, but intravenous fluids are preferred for inpatients. Intravenous immunoglobulins are not used in the acute treatment of HUS, and transfusion of red blood cells and platelets is only necessary if the patient’s levels are significantly low. Intravenous steroids are not a viable treatment option for HUS.

    • This question is part of the following fields:

      • Renal Medicine/Urology
      40.7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (1/3) 33%
Immunology/Allergy (1/1) 100%
ENT (2/3) 67%
Ophthalmology (1/2) 50%
Reproductive Medicine (2/4) 50%
Respiratory Medicine (2/3) 67%
Gastroenterology/Nutrition (3/3) 100%
Paediatrics (1/2) 50%
Endocrinology/Metabolic Disease (1/2) 50%
Haematology/Oncology (1/1) 100%
Dermatology (0/1) 0%
Renal Medicine/Urology (0/2) 0%
Pharmacology/Therapeutics (1/2) 50%
Infectious Diseases (1/1) 100%
Passmed