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  • Question 1 - A 4-year-old boy is diagnosed with retinoblastoma after his mother noticed that the...

    Incorrect

    • A 4-year-old boy is diagnosed with retinoblastoma after his mother noticed that the appearance of the child's left eye looked different to the right on photos. She had read in a magazine that this could be a dangerous sign and so reported it an optometrist.
      Which one of the following statements about retinoblastoma is correct?

      Your Answer: Is inherited as an autosomal recessive condition

      Correct Answer: Results from loss of heterozygosity of the normal Rb gene

      Explanation:

      Retinoblastoma: Understanding the Mechanisms and Risks

      Retinoblastoma is a type of cancer caused by a mutation in the Rb-1 gene, which is a tumour suppressor gene. This mutation can occur through loss of heterozygosity, where the normal Rb gene is lost in one region, but cancer only results when both copies of the normal gene are lost. While about 60% of cases are sporadic, the remaining 40% are inherited in an autosomal dominant manner, with a predisposition to non-ocular cancers such as pineal or suprasellar primitive neuroectodermal tumour. The Knudson’s two-hit hypothesis explains that in inherited cases, one genetic change is inherited from an affected parent, and the second mutation occurs after birth through somatic mutation. Understanding the mechanisms and risks of retinoblastoma is crucial for early detection and treatment.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 2 - A 28-year-old woman is admitted with an overdose. She is currently taking Antidepressants...

    Incorrect

    • A 28-year-old woman is admitted with an overdose. She is currently taking Antidepressants prescribed by her GP and painkillers for a chronic back complaint. Other past medical history of note includes hypertension. On examination she has a GCS of 7. Her pulse is 105/min regular and her BP is 85/60 mmHg. Her pupils are sluggish and dilated.
      Investigation Result Normal value
      Haemoglobin 131 g/l 115–155 g/l
      White cell count (WCC) 8.4 × 109/l 4–11 × 109/l
      Platelets 201 × 109/l 150–400 × 109/l
      Sodium (Na+) 141 mmol/l 135–145 mmol/l
      Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
      Creatinine 182 μmol/l 50–120 µmol/l
      pH 7.15 7.35–7.45
      pO2 8.1 kPa 10.5–13.5 kPa
      pCO2 5.9 kPa 4.6–6.0 kPa
      Bicarbonate 14 mmol/l 24–30 mmol/l
      Which of the following is the most likely diagnosis?

      Your Answer: Opiate overdose

      Correct Answer: Tricyclic antidepressant overdose

      Explanation:

      Drug Overdose: Symptoms and Treatment Options

      Tricyclic antidepressant overdose can cause mydriasis, tachycardia, and reduced conscious level, along with a history of overdose. It can also lead to significant acidosis, convulsions, hypothermia, and skin blisters. Cardiac monitoring is necessary as QT interval prolongation and arrhythmias are common. Airway protection, fluid resuscitation, and IV alkalisation are required to restore pH and reduce the risk of arrhythmias.

      Opiate overdose causes constricted pupils and respiratory depression. Naloxone can be used to reverse the effects of opiate toxicity.

      Diazepam overdose presents with drowsiness, confusion, hypotension, and impaired motor function. It does not cause significant acidosis. Flumazenil can be used as an antidote in extreme cases of respiratory depression.

      Serotonin reuptake inhibitor overdose requires very high doses to produce significant symptoms. Serotonin syndrome is a serious complication that can cause cognitive, autonomic, and somatic symptoms. Somatic symptoms are the most common.

      Noradrenaline reuptake inhibitor overdose is associated with vomiting, confusion, and tachycardia. It is unlikely that this drug would be prescribed for depression.

      Understanding the Symptoms and Treatment Options for Different Drug Overdoses

    • This question is part of the following fields:

      • Pharmacology
      73.9
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  • Question 3 - Samantha Masters, a 16-year-old high school student, visits the Dermatology Clinic with concerns...

    Incorrect

    • Samantha Masters, a 16-year-old high school student, visits the Dermatology Clinic with concerns about her appearance. She has been struggling with severe acne for a few years and has tried various over-the-counter treatments and antibiotics, but none have worked. She has been researching Roaccutane® (isotretinoin) and is interested in trying it. What is the most frequent side effect Samantha may encounter while taking Roaccutane®?

      Your Answer:

      Correct Answer: Dry skin and lips

      Explanation:

      Understanding the Side-Effects of Roaccutane®: Dry Skin and Lips

      Roaccutane® is a powerful medication used to treat severe acne when other treatments have failed. While it is highly effective, it is also associated with a range of side-effects that patients should be aware of. One of the most common side-effects is severe dry skin and lips, which can be uncomfortable and require additional moisturizing. Other potential side-effects include dryness of the eyes, mucous membranes, and scalp, as well as muscle pain and hair loss.

      It is important to note that Roaccutane® is highly teratogenic, meaning it can cause birth defects if taken during pregnancy. Women who are taking Roaccutane® should use at least two forms of contraception to prevent pregnancy. Additionally, all patients should have their liver function and lipid levels monitored before and during treatment, as Roaccutane® can cause elevated levels of both.

      While night sweats and peptic ulceration are not recognised side-effects of Roaccutane®, photosensitivity is a potential side-effect, although it is not the most common. Weight gain is also not a recognised side-effect. Patients taking Roaccutane® should be aware of these potential side-effects and discuss any concerns with their healthcare provider.

    • This question is part of the following fields:

      • Dermatology
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  • Question 4 - In a 25-year-old woman undergoing a routine physical examination for a new job,...

    Incorrect

    • In a 25-year-old woman undergoing a routine physical examination for a new job, a mid-systolic ejection murmur is discovered in the left upper sternal border. The cardiac examination reveals a significant right ventricular cardiac impulse and wide and fixed splitting of the second heart sound. An electrocardiogram (ECG) shows a right axis deviation, and a chest X-ray shows enlargement of the right ventricle and atrium. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Atrial septal defect

      Explanation:

      Cardiac Abnormalities and their Clinical Findings

      Atrial Septal Defect:
      Atrial septal defect is characterized by a prominent right ventricular cardiac impulse, a systolic ejection murmur heard best in the pulmonic area and along the left sternal border, and fixed splitting of the second heart sound. These findings are due to an abnormal left-to-right shunt through the defect, which creates a volume overload on the right side. Small atrial septal defects are usually asymptomatic.

      Pulmonary Valve Stenosis:
      Pulmonary valve stenosis causes an increased right ventricular pressure which results in right ventricular hypertrophy and pulmonary artery dilation. A crescendo–decrescendo murmur may be heard if there is a severe stenosis. Right atrial enlargement would not be present.

      Mitral Regurgitation:
      Mitral regurgitation would also present with a systolic murmur; however, left atrial enlargement would be seen before right ventricular enlargement.

      Mitral Stenosis:
      Mitral stenosis would present with an ‘opening snap’ and a diastolic murmur.

      Aortic Stenosis:
      Aortic stenosis is also associated with a systolic ejection murmur. However, the murmur is usually loudest at the right sternal border and radiates upwards to the jugular notch. Aortic stenosis is associated with left ventricular hypertrophy.

      Clinical Findings of Common Cardiac Abnormalities

    • This question is part of the following fields:

      • Cardiology
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  • Question 5 - A 60-year-old man presents with complaints of fatigue and general discomfort. He is...

    Incorrect

    • A 60-year-old man presents with complaints of fatigue and general discomfort. He is overweight and has a history of hypertension, which is currently being treated. He does not smoke and drinks very little alcohol. His blood pressure is 129/80 mmHg and his BMI is 30 kg/m2. Upon conducting fasting blood tests, the following results were obtained: glucose 8.5 mmol/L (3.0-6.0), total cholesterol 6.7 mmol/L (<5.2), triglycerides 9.3 mmol/L (0.45-1.69), HDL 1.3 mmol/L (>1.55), and LDL unable to calculate due to high triglycerides. He was diagnosed with diabetes mellitus and was referred to a dietitian and practice nurse for further management.

      Nine months later, the patient returned for a follow-up appointment. He had been taking fenofibrate 160 mg OD and metformin 1g BD for the past three months and had lost some weight, bringing his BMI down to 28 kg/m2. A repeat lipid profile was conducted and compared to the previous results. The cholesterol level had decreased from 5.4 to 3.9 (<5.2), triglycerides had decreased from 3.7 to 1.5 (0.45-1.69), HDL had decreased from 1.2 to 0.5 (1.55), and calculated LDL had increased from 2.5 to 2.72 (<3.36). The patient's low HDL level was a cause for concern.

      What is the likely cause of the patient's low HDL level?

      Your Answer:

      Correct Answer: Fibrate therapy

      Explanation:

      Fibrates and Low HDL in Diabetic Patients

      This phenomenon is not commonly seen, but it is becoming more prevalent in diabetic patients who are prescribed fibrate therapy. The cause of this occurrence is not yet understood, but it typically resolves once the fibrate medication is discontinued. Low HDL levels are now considered a crucial factor in reducing cardiovascular risk. Although low HDL is a characteristic of metabolic syndrome, it is expected to be present at the time of diagnosis and to increase with weight loss. Weight loss may also lead to an increase in HDL levels. HDL is measured independently of total cholesterol, and reducing visceral adiposity may help to increase HDL levels.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 6 - What is the most common characteristic of a patient with a deficiency in...

    Incorrect

    • What is the most common characteristic of a patient with a deficiency in vitamin C?

      Your Answer:

      Correct Answer: Perifollicular haemorrhages and hyperkeratosis

      Explanation:

      Vitamin C Deficiency and its Symptoms

      Vitamin C is primarily found in fruits and vegetables. When there is a deficiency of ascorbic acid, it can lead to a condition called scurvy. The symptoms of scurvy include inflamed and bleeding gums, impaired wound healing, and petechiae. Cutaneous findings such as follicular hyperkeratosis, perifollicular haemorrhages, ecchymoses, xerosis, leg oedema, poor wound healing, and bent or coiled body hairs are also common.

      It is important to note that cheilosis and red tongue are more indicative of vitamin B12 or iron deficiency, while diarrhoea and delusions suggest vitamin B deficiency (pellagra). Ocular muscle palsy and dementia are more likely to be caused by thiamine deficiency or Wernicke’s encephalopathy.

      Vitamin C deficiency is not uncommon among the elderly population, and it is crucial to be aware of the signs and symptoms to make a proper diagnosis. The diagnosis can be confirmed by measuring vitamin C concentrations in the white cell. By the symptoms and causes of vitamin C deficiency, individuals can take steps to prevent and treat this condition.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 7 - A 50-year-old male visits his GP complaining of bilateral sore eyes that feel...

    Incorrect

    • A 50-year-old male visits his GP complaining of bilateral sore eyes that feel gritty. He has tried using over-the-counter eye drops, but the symptoms returned the next day. During the examination, the doctor notices erythematosus eyelid margins and a small stye on the right side. The patient has no known allergies. What is the initial management that should be taken?

      Your Answer:

      Correct Answer: Hot compress and mechanical removal of debris

      Explanation:

      The patient is displaying symptoms that are typical of blepharitis, such as bilateral grittiness. This condition is caused by inflammation of the eyelid margins due to meibomian gland dysfunction, seborrhoeic dermatitis, or infection. Common symptoms include sticky eyes, erythematosus eyelid margins, and an increased risk of styes, chalazions, and secondary conjunctivitis.

      To manage blepharitis, hot compresses should be applied to soften the eyelid margin, and debris should be removed with cotton buds dipped in cooled boiled water. Artificial tears may also be used if the patient reports dry eyes.

      If the patient were suffering from allergic conjunctivitis, topical sodium cromoglycate would be appropriate. This condition would present with bilateral red eyes, itchiness, swelling, rhinitis, and clear discharge. On the other hand, if the patient had anterior uveitis, topical steroids would be indicated. This condition would present with rapid onset blurred vision, photosensitivity, floaters, eye pain, and redness in one or both eyes.

      Blepharitis is a condition where the eyelid margins become inflamed. This can be caused by dysfunction of the meibomian glands (posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (anterior blepharitis). It is more common in patients with rosacea. The meibomian glands secrete oil to prevent rapid evaporation of the tear film, so any problem affecting these glands can cause dryness and irritation of the eyes. Symptoms of blepharitis are usually bilateral and include grittiness, discomfort around the eyelid margins, sticky eyes in the morning, and redness of the eyelid margins. Styes and chalazions are also more common in patients with blepharitis, and secondary conjunctivitis may occur.

      Management of blepharitis involves softening the lid margin with hot compresses twice a day and practicing lid hygiene to remove debris from the lid margins. This can be done using cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo or sodium bicarbonate in cooled boiled water. Artificial tears may also be given for symptom relief in people with dry eyes or an abnormal tear film.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 8 - A 47-year-old patient arrives at the dialysis center for their thrice-weekly haemodialysis. They...

    Incorrect

    • A 47-year-old patient arrives at the dialysis center for their thrice-weekly haemodialysis. They have end stage renal failure caused by membranous glomerulonephritis and no other health issues. The patient reports feeling fatigued but is otherwise in good health. During routine blood work, their haemoglobin level is found to be 89 g/L (115-165). If the anaemia is a result of their renal disease, what is the appropriate treatment for this patient?

      Your Answer:

      Correct Answer: Intravenous iron plus or minus parenteral erythropoietin

      Explanation:

      Patients with end stage kidney disease have poor iron absorption and lack endogenous erythropoietin, making parenteral iron replacement and erythropoietin the best management. Anaemia is common in these patients due to poor oral iron absorption and GI blood loss. Acute packed red cell transfusion is extreme and renal transplant may be an option, but the patient’s haemoglobin can be modified with increased IV iron and epo doses. Oral iron tablets are poorly absorbed and tolerated.

    • This question is part of the following fields:

      • Nephrology
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  • Question 9 - You have a telephone consultation with a 28-year-old male who wants to start...

    Incorrect

    • You have a telephone consultation with a 28-year-old male who wants to start trying to conceive. He has a history of asthma and takes salbutamol 100mcg as needed.
      Which of the following would be most important to advise?

      Your Answer:

      Correct Answer: Take folic acid 5 mg once daily from before conception until 12 weeks of pregnancy

      Explanation:

      Women who are taking antiepileptic medication and are planning to conceive should be prescribed a daily dose of 5mg folic acid instead of the standard 400mcg. This high-dose folic acid should be taken from before conception until the 12th week of pregnancy to reduce the risk of neural tube defects. It is important to refer these women to specialist care, but they should continue to use effective contraception until they have had a full assessment. Despite the medication, it is still likely that they will have a normal pregnancy and healthy baby. If trying to conceive, women should start taking folic acid as soon as possible, rather than waiting for a positive pregnancy test.

      Folic Acid: Importance, Deficiency, and Prevention

      Folic acid is a vital nutrient that is converted to tetrahydrofolate (THF) in the body. It is found in green, leafy vegetables and plays a crucial role in the transfer of 1-carbon units to essential substrates involved in the synthesis of DNA and RNA. However, certain factors such as phenytoin, methotrexate, pregnancy, and alcohol excess can cause a deficiency in folic acid. This deficiency can lead to macrocytic, megaloblastic anemia and neural tube defects.

      To prevent neural tube defects during pregnancy, it is recommended that all women take 400mcg of folic acid until the 12th week of pregnancy. Women at higher risk of conceiving a child with a neural tube defect should take 5mg of folic acid from before conception until the 12th week of pregnancy. Women are considered higher risk if they or their partner has a neural tube defect, they have had a previous pregnancy affected by a neural tube defect, or they have a family history of a neural tube defect. Additionally, women with certain medical conditions such as coeliac disease, diabetes, or thalassaemia trait, or those taking antiepileptic drugs, or who are obese (BMI of 30 kg/m2 or more) are also considered higher risk.

      In summary, folic acid is an essential nutrient that plays a crucial role in DNA and RNA synthesis. Deficiency in folic acid can lead to serious health consequences, including neural tube defects. However, taking folic acid supplements during pregnancy can prevent these defects and ensure a healthy pregnancy.

    • This question is part of the following fields:

      • Respiratory
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  • Question 10 - A 55-year-old woman presents with acute abdominal pain and a temperature of 38.5...

    Incorrect

    • A 55-year-old woman presents with acute abdominal pain and a temperature of 38.5 °C, pulse 130 bpm and blood pressure 100/70 mmHg. She does not allow any attending doctor to touch her abdomen, as she is in severe pain.
      Past records reveal that she was suffering from ulcerative colitis, for which she was on oral mesalazine and azathioprine. She has recently had diarrhoea for which she has taken loperamide.
      What is the next appropriate diagnostic test?

      Your Answer:

      Correct Answer: Erect X-ray of the abdomen

      Explanation:

      Diagnostic Tests for Suspected Toxic Megacolon in a Patient with Ulcerative Colitis

      When a patient with ulcerative colitis (UC) presents with fever and severe abdominal pain after taking anti-diarrhoeal agents, toxic megacolon should be considered as a potential complication. This rare but life-threatening condition can be precipitated by electrolyte disturbances, antimotility agents, opiates, barium enema studies, and colonoscopies during acute UC episodes. To diagnose toxic megacolon, a straight X-ray of the abdomen is necessary to show colonic dilation with a diameter greater than 6 cm and loss of haustrations, which is typically found in the transverse colon. Perforation and peritonitis are also possible complications, which can be detected by an erect chest X-ray. Regular clinical examination is crucial since patients with toxic megacolon may not exhibit signs of peritonitis after perforation due to steroid use. While blood tests for serum electrolytes, C-reactive protein (CRP), and antineutrophil cytoplasmic antibodies (ANCA) may be useful in diagnosing UC, they are not specific to toxic megacolon. Azathioprine toxicity is also unlikely in this case, as it typically presents with bone marrow suppression and is only a concern when used concurrently with allopurinol or in patients lacking TPMT activity.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - A 2-day-old male is brought to the neonatal unit due to bilious vomiting...

    Incorrect

    • A 2-day-old male is brought to the neonatal unit due to bilious vomiting and decreased feeding. He was delivered without complications at 32 weeks gestation. An abdominal X-ray reveals intramural gas, prompting the cessation of oral feeding and initiation of broad-spectrum antibiotics. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Necrotising enterocolitis

      Explanation:

      Necrotising enterocolitis can be identified by the presence of pneumatosis intestinalis on an abdominal X-ray.

      Understanding Necrotising Enterocolitis

      Necrotising enterocolitis is a serious condition that is responsible for a significant number of premature infant deaths. The condition is characterized by symptoms such as feeding intolerance, abdominal distension, and bloody stools. If left untreated, these symptoms can quickly progress to more severe symptoms such as abdominal discolouration, perforation, and peritonitis.

      To diagnose necrotising enterocolitis, doctors often use abdominal x-rays. These x-rays can reveal a number of important indicators of the condition, including dilated bowel loops, bowel wall oedema, and intramural gas. Other signs that may be visible on an x-ray include portal venous gas, pneumoperitoneum resulting from perforation, and air both inside and outside of the bowel wall. In some cases, an x-ray may also reveal air outlining the falciform ligament, which is known as the football sign.

      Overall, understanding the symptoms and diagnostic indicators of necrotising enterocolitis is crucial for early detection and treatment of this serious condition. By working closely with healthcare professionals and following recommended screening protocols, parents and caregivers can help ensure the best possible outcomes for premature infants at risk for this condition.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 12 - A 56-year-old man visits your clinic with a complaint of altered bowel habit...

    Incorrect

    • A 56-year-old man visits your clinic with a complaint of altered bowel habit for the past 4 weeks. He also reports per rectal bleeding mixed with his stool, tenesmus after defecation, and a weight loss of 6 kilos in the last 8 weeks. Upon performing a PR examination, you detect a mass on the rectum's posterior wall, approximately 10 cm from the anal verge. The mass is irregular and measures 9 cm in diameter. You suspect rectal cancer and order an urgent suspected cancer review and colonoscopy. If your suspicions are correct, what is the most probable diagnosis?

      Your Answer:

      Correct Answer: Adenocarcinoma

      Explanation:

      Understanding Colorectal Cancer

      Colorectal cancer is a prevalent type of cancer in the UK, ranking third in terms of frequency and second in terms of mortality rates. Every year, approximately 150,000 new cases are diagnosed, and 50,000 people die from the disease. The cancer can occur in different parts of the colon, with the rectum being the most common location, accounting for 40% of cases. The sigmoid colon follows closely, with 30% of cases, while the descending colon has only 5%. The transverse colon has 10% of cases, and the ascending colon and caecum have 15%. Understanding the location of the cancer is crucial in determining the appropriate treatment and management plan. With early detection and proper medical care, the prognosis for colorectal cancer can be improved.

    • This question is part of the following fields:

      • Surgery
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  • Question 13 - A 75-year-old male has been diagnosed with rectal carcinoma and is scheduled for...

    Incorrect

    • A 75-year-old male has been diagnosed with rectal carcinoma and is scheduled for a lower anterior resection with the goal of restoring intestinal continuity. What type of stoma would be most suitable?

      Your Answer:

      Correct Answer: Loop ileostomy

      Explanation:

      The loop ileostomy is a technique used to redirect the flow of bowel contents away from a distal anastomosis, typically in cases of rectal cancer. When the ileostomy is reversed, it allows for the restoration of bowel continuity and can greatly enhance the patient’s quality of life.

      Abdominal stomas are created during various abdominal procedures to bring the lumen or contents of organs onto the skin. Typically, this involves the bowel, but other organs may also be diverted if necessary. The type and method of construction of the stoma will depend on the contents of the bowel. Small bowel stomas should be spouted to prevent irritant contents from coming into contact with the skin, while colonic stomas do not require spouting. Proper siting of the stoma is crucial to reduce the risk of leakage and subsequent maceration of the surrounding skin. The type and location of the stoma will vary depending on the purpose, such as defunctioning the colon or providing feeding access. Overall, abdominal stomas are a necessary medical intervention that requires careful consideration and planning.

    • This question is part of the following fields:

      • Surgery
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  • Question 14 - A 42-year-old man is brought to the Emergency Department (ED) after being involved...

    Incorrect

    • A 42-year-old man is brought to the Emergency Department (ED) after being involved in a motor vehicle accident, in which he was thrown from a motorcycle. In the ED, the patient is unresponsive. Neurological examination shows intact pupillary and corneal reflexes, but the rest of the examination cannot be completed. Thirty minutes later, computerised tomography (CT) reveals uncal herniation of the right temporal lobe, and the patient is rushed to surgery.
      What physical examination finding change is most consistent with this patient's presentation?

      Your Answer:

      Correct Answer: Right pupillary dilation

      Explanation:

      Understanding Pupillary Dilation in Head Trauma Patients

      Head trauma patients are at risk of decompensating quickly due to cerebral edema causing intracranial pressure to rise. This can lead to herniation of the temporal lobe towards the tentorium cerebelli, resulting in pressure being transmitted to the brainstem. One of the consequences of uncal herniation of the temporal lobe is the compression of the ipsilateral oculomotor nerve, which contains both somatic efferent and visceral efferent components. Dysfunction of the visceral efferent component can cause pupillary dilation, or a ‘blown pupil’, on the affected side.

      It is important to note that left pupillary dilation is unlikely in this scenario as it would only occur if pressure was transmitted to the contralateral midbrain. Similarly, right pupillary constriction would only occur with activation, not compromise, of the visceral efferent component. Deviation of the pupil medially would be caused by injury to cranial nerve VI, while injury to the left oculomotor nerve would cause a ‘down and out’ injury, resulting in depression and abduction of the left pupil. However, these scenarios are less likely in the case of a right-sided temporal lobe herniation.

      In summary, understanding pupillary dilation in head trauma patients can provide valuable insights into the severity and location of the injury, allowing for prompt and appropriate medical intervention.

    • This question is part of the following fields:

      • Neurosurgery
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  • Question 15 - A 56-year-old male presents with a history of a sore area on his...

    Incorrect

    • A 56-year-old male presents with a history of a sore area on his tongue, which has failed to heal for over three months and is becoming increasingly bothersome. The patient is otherwise well, with a history of mild osteoarthritis of the knees, but nil else of note. He is a builder, and smokes 30 cigarettes a day for the past 30 years. He drinks around 30 units of alcohol a week.
      Following examination, the patient is referred urgently as a case of suspected cancer of the tongue.
      Which one of the following statements is correct about tongue cancer?

      Your Answer:

      Correct Answer: It may be associated with human papillomavirus (HPV)

      Explanation:

      Myth-busting: Tongue Cancer Risk Factors

      Tongue cancer is a rare form of oral carcinoma, accounting for only 2% of overall cancers. While it can be associated with human papillomavirus (HPV), there are several misconceptions about its risk factors. Contrary to popular belief, smoking and alcohol are known risk factors, while coconut ingestion is not. Betel nut ingestion, on the other hand, is associated with an increased risk of tongue cancer. It is important to note that tongue cancer usually metastasises to the upper cervical and submandibular nodes, not the lower cervical nodes. However, early detection and treatment with a combination of surgery and chemoradiotherapy can often lead to a cure.

    • This question is part of the following fields:

      • Oncology
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  • Question 16 - A 25-year-old patient visits the antenatal clinic after her 20-week scan reveals a...

    Incorrect

    • A 25-year-old patient visits the antenatal clinic after her 20-week scan reveals a low-lying placenta. She is concerned about what this means and if any action needs to be taken. This is her first pregnancy, and she has not experienced any complications thus far. She has no known medical conditions and does not take any regular medications. The patient mentions that her mother had a placenta-related issue that resulted in significant bleeding, and she is worried that the same may happen to her. What steps would you take to assist this patient?

      Your Answer:

      Correct Answer: Rescan at 32 weeks

      Explanation:

      In the event that a low-lying placenta is detected during the 20-week scan, it is recommended to undergo a follow-up scan at 32 weeks for further evaluation.

      Management and Prognosis of Placenta Praevia

      Placenta praevia is a condition where the placenta is located wholly or partially in the lower uterine segment. If a low-lying placenta is detected at the 20-week scan, a rescan is recommended at 32 weeks. There is no need to limit activity or intercourse unless there is bleeding. If the placenta is still present at 32 weeks and is grade I/II, then a scan every two weeks is recommended. A final ultrasound at 36-37 weeks is necessary to determine the method of delivery. For grades III/IV, an elective caesarean section is recommended between 37-38 weeks. However, if the placenta is grade I, a trial of vaginal delivery may be offered. If a woman with known placenta praevia goes into labour before the elective caesarean section, an emergency caesarean section should be performed due to the risk of post-partum haemorrhage.

      In cases where placenta praevia is accompanied by bleeding, the woman should be admitted and an ABC approach should be taken to stabilise her. If stabilisation is not possible, an emergency caesarean section should be performed. If the woman is in labour or has reached term, an emergency caesarean section is also necessary.

      The prognosis for placenta praevia has improved significantly, and death is now extremely rare. The major cause of death in women with placenta praevia is post-partum haemorrhage.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 17 - Which one of the following statements regarding lidocaine is accurate? ...

    Incorrect

    • Which one of the following statements regarding lidocaine is accurate?

      Your Answer:

      Correct Answer: Preparations mixed with adrenaline should not be used for minor surgery involving the finger

      Explanation:

      Minor Surgery: Local Anaesthetic and Suture Material

      Minor surgery often requires the use of local anaesthetic (LA) to numb the area being operated on. Lidocaine is the most commonly used LA due to its fast-acting properties and short duration of anaesthesia. The maximum safe dose of lidocaine is 3 mg/kg, with the recommended dose being 200mg (or 500 mg if mixed with adrenaline) for a 66 kg patient. This equates to 20 ml of 1% solution or 10 ml of 2% solution. Lidocaine mixed with adrenaline can also help reduce blood loss by constricting blood vessels, but should not be used near extremities to avoid the risk of ischaemia.

      Suture material is also an important consideration in minor surgery. Non-absorbable sutures, such as silk, Prolene, and Ethilon, need to be removed after 7-14 days depending on the location of the wound. Absorbable sutures, such as Vicryl, Dexon, and PDS, dissolve on their own after 7-10 days. The removal times for non-absorbable sutures vary depending on the area of the body, with the face requiring removal after 3-5 days, the scalp, limbs, and chest after 7-10 days, and the hand, foot, and back after 10-14 days. Proper use of LA and suture material can help ensure a successful and safe minor surgery procedure.

    • This question is part of the following fields:

      • Surgery
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  • Question 18 - A 72-year-old man presents to the emergency department after a fall resulting in...

    Incorrect

    • A 72-year-old man presents to the emergency department after a fall resulting in a fracture of his distal 1/3 right femur. The radiologist noted v-shaped osteolytic lesions on his femur. Due to his age and the stability of the fracture, conservative management is chosen. His blood test results are as follows: haemoglobin 142 g/L (135-180), calcium 2.6 mmol/L (2.2 - 2.6), phosphate 0.9 mmol/L (0.74 - 1.4), alkaline phosphatase 418 u/L (30 - 100), and parathyroid hormone 52 pg/mL (10-55). The patient has a medical history of chronic kidney disease and diabetes. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Paget's disease

      Explanation:

      The correct diagnosis for the patient’s condition is Paget’s disease of the bone, which commonly affects the skull, spine/pelvis, and long bones of the lower extremities. This is evidenced by the patient’s distal 2/3 femur fracture with osteolytic lesions and elevated ALP levels. Myeloma, osteomalacia, and osteoporosis are incorrect diagnoses as they do not match the patient’s symptoms and blood test results.

      Understanding Paget’s Disease of the Bone

      Paget’s disease of the bone is a condition characterized by increased and uncontrolled bone turnover. It is believed to be caused by excessive osteoclastic resorption followed by increased osteoblastic activity. Although it is a common condition, affecting 5% of the UK population, only 1 in 20 patients experience symptoms. The most commonly affected areas are the skull, spine/pelvis, and long bones of the lower extremities. Predisposing factors include increasing age, male sex, northern latitude, and family history.

      Symptoms of Paget’s disease include bone pain, particularly in the pelvis, lumbar spine, and femur. The stereotypical presentation is an older male with bone pain and an isolated raised alkaline phosphatase (ALP). Classical, untreated features include bowing of the tibia and bossing of the skull. Diagnosis is made through blood tests, which show raised ALP, and x-rays, which reveal osteolysis in early disease and mixed lytic/sclerotic lesions later.

      Treatment is indicated for patients experiencing bone pain, skull or long bone deformity, fracture, or periarticular Paget’s. Bisphosphonates, either oral risedronate or IV zoledronate, are the preferred treatment. Calcitonin is less commonly used now. Complications of Paget’s disease include deafness, bone sarcoma (1% if affected for > 10 years), fractures, skull thickening, and high-output cardiac failure.

      Overall, understanding Paget’s disease of the bone is important for early diagnosis and management of symptoms and complications.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 19 - A 42-year-old woman complains of abdominal pain and heavy menstrual bleeding for the...

    Incorrect

    • A 42-year-old woman complains of abdominal pain and heavy menstrual bleeding for the past 6 months. Upon examination, the abdomen is not tender, but the uterus feels enlarged. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Fibroids

      Explanation:

      Understanding Uterine Fibroids

      Uterine fibroids are non-cancerous growths that develop in the uterus. They are more common in black women and are thought to occur in around 20% of white women in their later reproductive years. Fibroids are usually asymptomatic, but they can cause menorrhagia, which can lead to iron-deficiency anaemia. Other symptoms include lower abdominal pain, bloating, and urinary symptoms. Fibroids may also cause subfertility.

      Diagnosis is usually made through transvaginal ultrasound. Asymptomatic fibroids do not require treatment, but periodic monitoring is recommended. Menorrhagia secondary to fibroids can be managed with various treatments, including the levonorgestrel intrauterine system, NSAIDs, tranexamic acid, and hormonal therapies.

      Medical treatment to shrink or remove fibroids may include GnRH agonists or ulipristal acetate, although the latter is not currently recommended due to concerns about liver toxicity. Surgical options include myomectomy, hysteroscopic endometrial ablation, hysterectomy, and uterine artery embolization.

      Fibroids generally regress after menopause, but complications such as subfertility and iron-deficiency anaemia can occur. Red degeneration, which is haemorrhage into the tumour, is a common complication during pregnancy.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 20 - A 28-year-old male with type 1 diabetes is instructed to collect his urine...

    Incorrect

    • A 28-year-old male with type 1 diabetes is instructed to collect his urine for 24 hours. What level of urine albumin concentration indicates the presence of microalbuminuria?

      Your Answer:

      Correct Answer: 50 mg/day

      Explanation:

      Microalbuminuria and Proteinuria

      Microalbuminuria is a condition where the urine albumin excretion ranges from 30-300 mg per 24 hours. If the concentration exceeds 300 mg/24 hours, it signifies albuminuria, and if it exceeds 3.5 g/24 hours, it signifies overt proteinuria. Microalbuminuria is not only an early indicator of renal involvement but also a sign of increased cardiovascular risk, with a twofold risk above the already increased risk in diabetic patients. The albumin:creatinine ratio is a useful surrogate of the total albumin excretion, and it is measured using the first morning urine sample where possible. An albumin:creatinine ratio of ≥2.5 mg/mmol (men) or 3.5 mg/mmol (women) indicates microalbuminuria, while a ratio of ≥30 mg/mmol indicates proteinuria. these conditions is crucial in managing and preventing complications associated with renal and cardiovascular diseases.

    • This question is part of the following fields:

      • Endocrinology
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