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  • Question 1 - A 65-year-old man is brought to the doctors by his son. Three weeks...

    Correct

    • A 65-year-old man is brought to the doctors by his son. Three weeks ago his wife passed away from metastatic breast cancer. He reports feeling sad and tearful every day, but his son is worried because he keeps getting into arguments with him over small things and bringing up past family issues. The son also mentions that his father has mentioned hearing his wife's voice and even cooked a meal for her once. Despite this, he has started going for walks with his friends again and is determined to get his life back on track. What is the most probable diagnosis?

      Your Answer: Normal grief reaction

      Explanation:

      Grief is a natural response to the death of a loved one and does not always require medical intervention. However, understanding the potential stages of grief can help determine if a patient is experiencing a normal reaction or a more significant problem. The most common model of grief divides it into five stages: denial, anger, bargaining, depression, and acceptance. It is important to note that not all patients will experience all five stages. Atypical grief reactions are more likely to occur in women, sudden and unexpected deaths, problematic relationships before death, and lack of social support. Delayed grief, which occurs when grieving does not begin for more than two weeks, and prolonged grief, which is difficult to define but may last beyond 12 months, are features of atypical grief reactions.

    • This question is part of the following fields:

      • Psychiatry
      24.3
      Seconds
  • Question 2 - A 20-year-old man was admitted to the Emergency Department after his roommate reported...

    Incorrect

    • A 20-year-old man was admitted to the Emergency Department after his roommate reported that he was afraid that the government had implanted a radio in his brain that was telling him to kill himself. Further evaluation revealed that he had many symptoms of schizophrenia and a decision was made to treat him with clozapine. Which statement about this drug is correct?

      Your Answer: It is a D2 agonist

      Correct Answer: It is a alpha1-adrenoceptor antagonist

      Explanation:

      Understanding the Mechanism of Action of Clozapine: A Multifaceted Antipsychotic Medication

      Clozapine is an atypical antipsychotic medication used in the treatment of schizophrenia for patients who have not responded to other medications. Its mechanism of action is complex and involves antagonistic effects on dopamine D2, 5-HT2A, alpha1-adrenoceptor, and muscarinic receptors. Clozapine’s antipsychotic action is likely mediated through a combination of antagonistic effects at D2 receptors in the mesolimbic pathway and 5-HT2A receptors in the frontal cortex. D2 antagonism relieves positive symptoms while 5-HT2A antagonism alleviates negative symptoms. However, it is important to note that clozapine has a D1 antagonist action and is not a D1 agonist. Understanding the multifaceted mechanism of action of clozapine is crucial in its effective use in the treatment of schizophrenia.

    • This question is part of the following fields:

      • Pharmacology
      15.9
      Seconds
  • Question 3 - A 4-year-old child was admitted with a high fever, cervical lymph node enlargement,...

    Correct

    • A 4-year-old child was admitted with a high fever, cervical lymph node enlargement, conjunctival congestion, redness of lips and palms, and desquamation of fingertips. Upon examination, erythema of the oral cavity was observed. Blood tests showed a hemoglobin level of 110 g/l and a platelet count of 450,000. The symptoms resolved after two weeks, but during the third week, the child unexpectedly passed away. An autopsy revealed vasculitis of the coronary arteries and aneurysm formation. What is the most likely diagnosis?

      Your Answer: Kawasaki’s disease

      Explanation:

      Understanding Kawasaki’s Disease and Differential Diagnosis

      Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a multisystem disease that primarily affects children under the age of 5. It is characterized by fever, cervical adenitis, and changes in the skin and mucous membranes. While generally benign and self-limited, it can lead to coronary artery aneurysms in 25% of cases and has a case-fatality rate of 0.5-2.8%. Treatment with high-dose intravenous globulin and aspirin has been shown to be effective in reducing the prevalence of coronary artery abnormalities.

      When considering a differential diagnosis, it is important to distinguish Kawasaki disease from other conditions with similar symptoms. Scarlet fever, rheumatic fever, diphtheria, and Marfan syndrome can all present with fever and cardiovascular involvement, but each has distinct clinical features and underlying pathophysiologic mechanisms. Careful evaluation and diagnosis are essential for appropriate treatment and management.

    • This question is part of the following fields:

      • Paediatrics
      29.1
      Seconds
  • Question 4 - A 7-year-old boy is brought in by his father for symptoms of upper...

    Correct

    • A 7-year-old boy is brought in by his father for symptoms of upper respiratory tract infection. During examination, you observe multiple bruises on his arms with a circular pattern. Which type of bruising is more frequently associated with physical abuse in children?

      Your Answer: Humeral fracture

      Explanation:

      Whenever there is suspicion of non-accidental injury (NAI), it is important to consider the patient’s clinical history. Child abuse is commonly associated with fractures in the radial, humeral, and femoral bones. On the other hand, fractures in the distal radial, elbow, clavicular, and tibial bones are not typically linked to NAI in paediatrics.

      Recognizing Child Abuse: Signs and Symptoms

      Child abuse is a serious issue that can have long-lasting effects on a child’s physical and emotional well-being. It is important to be able to recognize the signs and symptoms of child abuse in order to intervene and protect the child. One possible indicator of abuse is when a child discloses abuse themselves. However, there are other factors that may point towards abuse, such as an inconsistent story with injuries, repeated visits to A&E departments, delayed presentation, and a frightened, withdrawn appearance known as frozen watchfulness.

      Physical presentations of child abuse can also be a sign of abuse. These may include bruising, fractures (especially metaphyseal, posterior rib fractures, or multiple fractures at different stages of healing), torn frenulum (such as from forcing a bottle into a child’s mouth), burns or scalds, failure to thrive, and sexually transmitted infections like Chlamydia, gonorrhoeae, and Trichomonas. It is important to be aware of these signs and symptoms and to report any concerns to the appropriate authorities to ensure the safety and well-being of the child.

    • This question is part of the following fields:

      • Paediatrics
      24.7
      Seconds
  • Question 5 - What is the function of delta cells in the pancreas? ...

    Incorrect

    • What is the function of delta cells in the pancreas?

      Your Answer: Produce pancreatic polypeptide

      Correct Answer: Produce somatostatin

      Explanation:

      Pancreatic Cell Functions

      The pancreas is an important organ in the body that plays a crucial role in regulating blood sugar levels. It is made up of different types of cells that produce various hormones and enzymes. Alpha cells are responsible for producing glucagon, which helps increase blood sugar levels. On the other hand, beta cells produce insulin, which helps lower blood sugar levels. Lastly, PP cells produce pancreatic polypeptide, which helps regulate pancreatic secretion and digestion.

      Aside from hormone production, the pancreas also produces enzymes that aid in digestion. Trypsinogen is one of these enzymes, which is produced in the ducts of the exocrine pancreas. It is then converted to trypsin by enzymes found in the gut mucosa. Trypsin plays a crucial role in breaking down proteins in the small intestine, allowing for better absorption of nutrients.

      In summary, the pancreas is a complex organ that performs various functions to maintain the body’s overall health. Its different types of cells work together to regulate blood sugar levels and aid in digestion.

    • This question is part of the following fields:

      • Clinical Sciences
      7.6
      Seconds
  • Question 6 - A 68-year-old male with dry age-related macular degeneration is evaluated. Regrettably, his vision...

    Incorrect

    • A 68-year-old male with dry age-related macular degeneration is evaluated. Regrettably, his vision has worsened in the last six months. He has never smoked and is currently using antioxidant supplements. What would be the most suitable course of action?

      Your Answer: Photodynamic therapy

      Correct Answer: Explain no other medical therapies currently available

      Explanation:

      Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.

      To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with antioxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.

      In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and antioxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.

    • This question is part of the following fields:

      • Ophthalmology
      20.4
      Seconds
  • Question 7 - A 6-month-old infant, one of twins born at term, presents with central cyanosis....

    Incorrect

    • A 6-month-old infant, one of twins born at term, presents with central cyanosis. What is the most probable cause?

      Your Answer: Patent ductus arteriosus (PDA)

      Correct Answer: Transposition of great arteries

      Explanation:

      Congenital Heart Diseases and their Association with Cyanosis

      Congenital heart diseases can be classified into cyanotic and acyanotic types. Coarctation of the aorta is an example of an acyanotic congenital heart disease, which is not associated with cyanosis. On the other hand, tricuspid atresia and transposition of the great arteries are both cyanotic congenital heart diseases that present in the immediate newborn period. Transposition of the great arteries is more common than tricuspid atresia and is therefore more likely to be the cause of cyanosis in newborns.

      It is important to note that some congenital heart diseases involve shunting of blood from the left side of the heart to the right side, leading to increased pulmonary blood flow and eventually causing cyanosis. Patent ductus arteriosus (PDA) and ventricular septal defect (VSD) are examples of such left-to-right shunts. However, these conditions are not considered cyanotic congenital heart diseases as they do not present with cyanosis in the immediate newborn period.

      In summary, the presence of cyanosis in a newborn can be indicative of a cyanotic congenital heart disease such as tricuspid atresia or transposition of the great arteries. Coarctation of the aorta is an example of an acyanotic congenital heart disease, while PDA and VSD are left-to-right shunts that do not typically present with cyanosis.

    • This question is part of the following fields:

      • Paediatrics
      22
      Seconds
  • Question 8 - A 4-year-old boy, with a history of acute lymphoblastic leukaemia (ALL), is admitted...

    Incorrect

    • A 4-year-old boy, with a history of acute lymphoblastic leukaemia (ALL), is admitted to the Paediatric Ward due to a fever of 38.9 °C at home. He received his last treatment 1 week ago. His parents report that he has been feeling well, without cough, cold, rash, or vomiting.
      Upon examination, his vital signs are stable except for a temperature of 38.4 °C. Physical examination is unremarkable. Blood tests and blood culture are taken from the portacath, revealing a haemoglobin (Hb) level of 11.5, a white cell count (WCC) of 1.1, neutrophils of 0.2, and a C-reactive protein (CRP) level of 85.
      What is the most crucial next step in managing this patient?

      Your Answer: Start oral AugmentinÂź

      Correct Answer: Start intravenous (iv) TazocinÂź

      Explanation:

      Management of Febrile Neutropenia in a Child with ALL Receiving Chemotherapy

      Febrile neutropenia is a serious complication in cancer patients, particularly those receiving chemotherapy. It is defined as neutropenia with fever or symptoms of significant sepsis. In such cases, immediate initiation of broad-spectrum intravenous antibiotics is crucial to prevent mortality.

      In this scenario, a child with acute lymphoblastic leukemia (ALL) presents with febrile neutropenia. The first step is to start intravenous TazocinÂź monotherapy, pending blood cultures and a thorough physical examination. A urine sample should also be obtained, particularly for children under the age of 5. Chest radiography is only necessary for symptomatic children.

      After 48 hours, if the child shows improvement and cultures are negative, empirical antibiotic treatment can be discontinued or switched to oral antibiotics such as AugmentinÂź. Intravenous fluids may be necessary if the child deteriorates or becomes haemodynamically unstable.

      It is also important to send urine and stool samples for microbial culture and sensitivity (MC&S) to investigate sepsis. However, initiating antibiotics should be the first priority.

      In summary, febrile neutropenia in cancer patients is a medical emergency that requires prompt initiation of broad-spectrum antibiotics. Close monitoring and appropriate investigations are necessary to ensure timely and effective management.

    • This question is part of the following fields:

      • Paediatrics
      81.8
      Seconds
  • Question 9 - A patient presents to the General Practice (GP) Clinic, seeking advice regarding driving...

    Correct

    • A patient presents to the General Practice (GP) Clinic, seeking advice regarding driving following two unprovoked seizures in 48 hours. What advice do you give the patient regarding their ability to drive their car?

      Your Answer: They must inform the DVLA and will be unfit to drive for at least six months

      Explanation:

      If an individual experiences a seizure, they must inform the DVLA. Depending on the circumstances, they may be unfit to drive for six months or up to five years if they drive a bus or lorry. It is important to note that the DVLA must always be informed of any neurological event that could affect driving ability. An assessment by a DVLA medical examiner is not conducted, but a private or NHS neurologist should evaluate the individual’s fitness to drive.

    • This question is part of the following fields:

      • Neurology
      26.5
      Seconds
  • Question 10 - A 32-year-old male patient complains of pain following a fall onto his right...

    Correct

    • A 32-year-old male patient complains of pain following a fall onto his right hand while stretching backward. Upon examination, a flattened contour is observed in the right shoulder, and a small bulge is felt below the right clavicle. Additionally, a small area of anesthesia is noted over the distal attachment of the deltoid muscle. What type of injury could account for all of these examination findings?

      Your Answer: Anterior shoulder dislocation

      Explanation:

      Shoulder dislocations happen when the humeral head becomes detached from the glenoid cavity of the scapula. This is the most common type of joint dislocation, with the shoulder accounting for around half of all major joint dislocations. In particular, anterior shoulder dislocations make up over 95% of cases.

      There are many different techniques for reducing shoulders, but there is limited evidence to suggest that one is better than another. If the dislocation is recent, it may be possible to attempt reduction without any pain relief or sedation. However, some patients may require analgesia and/or sedation to ensure that the rotator cuff muscles are relaxed.

    • This question is part of the following fields:

      • Musculoskeletal
      22.9
      Seconds
  • Question 11 - A 27-year-old woman is currently in labour and giving birth to her first...

    Correct

    • A 27-year-old woman is currently in labour and giving birth to her first child on the Labour Ward. She has been in labour for a while now and has just had a vaginal delivery, with a healthy baby boy born 30 minutes ago. The midwife contacts you as the placenta has not yet been delivered, although the woman's observations are stable and there is minimal blood loss.

      What would be the most appropriate course of action to take next in managing this situation?

      Your Answer: Observe for 30 min and then initiate intramuscular (im) SyntocinonÂź and breastfeeding

      Explanation:

      Management of Retained Placenta in Obstetrics

      Retained placenta is a common complication in obstetrics that requires prompt management to prevent severe bleeding and other complications. Here are the steps involved in managing retained placenta:

      Observation and Intramuscular SyntocinonÂź and Breastfeeding
      After delivery, the clock starts, and the midwife should observe the patient for 30 minutes. If there is no bleeding, the patient can be observed for another 30 minutes while establishing IV access and crossmatching blood. During this time, im SyntocinonÂź and breastfeeding can be used to stimulate spontaneous expulsion.

      Full Obstetric Emergency Team Resuscitation
      If the patient is bleeding heavily, retained placenta is classified as an obstetric emergency, and resuscitation is necessary. IV access should be confirmed, and blood should be grouped and crossmatched.

      Commence a SyntocinonÂź Infusion
      To encourage separation of the placenta from the uterus, SyntocinonÂź is given im into the quadriceps, rather than as an infusion.

      Observation with IM SyntocinonÂź and Breastfeeding
      The patient can be observed for another 60 minutes with im SyntocinonÂź and breastfeeding to encourage spontaneous expulsion.

      Surgical Removal under General Anaesthesia
      If after an hour, the placenta is still retained, the patient should be taken to theatre for surgical removal under general anaesthesia.

    • This question is part of the following fields:

      • Obstetrics
      54.6
      Seconds
  • Question 12 - A 76-year-old male presents with a one day history of abdominal distension and...

    Correct

    • A 76-year-old male presents with a one day history of abdominal distension and vomiting.

      Upon examination, there is an irreducible lump in the right groin arising below and lateral to the pubic tubercle. A plain abdominal radiograph reveals distended loops of small bowel.

      Which of the following hernias are most likely to have caused these symptoms?

      Your Answer: Femoral

      Explanation:

      Small Bowel Obstruction and Femoral Hernias

      This patient is experiencing a small bowel obstruction, which is likely caused by an obstructed femoral hernia. The lump in the left groin that cannot be reduced arises below and lateral to the pubic tubercle, indicating a femoral hernia rather than an inguinal hernia, which would produce a lump above and medial to the pubic tubercle. Femoral hernias are the third most common type of hernia, with a higher incidence in elderly multiparous women. It is important to repair all femoral hernias, as 40% of cases are strangulated upon initial presentation. If the overlying skin becomes erythematosus, it is a sign of poor outcome. Obturator hernias are rare and typically do not present with a lump.

      Overall, it is crucial to identify the type of hernia causing a small bowel obstruction in order to provide appropriate treatment. Femoral hernias, in particular, require prompt repair to prevent strangulation and potential complications.

    • This question is part of the following fields:

      • Surgery
      35.5
      Seconds
  • Question 13 - Sophie is a 32-year-old mother of two, who is uncertain if she wants...

    Incorrect

    • Sophie is a 32-year-old mother of two, who is uncertain if she wants to have more children. She comes to you with a history of not having a period for the past 9 months. Sophie had regular menstrual cycles for 28 months after giving birth to her last child. She has never used any hormonal birth control or undergone any surgeries. Upon examination, her abdomen and gynecological areas appear normal, and there are no signs of hyperandrogenism. A pregnancy test confirms that she is not pregnant.

      Lab results show a decrease in follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels, while prolactin, thyroid-stimulating hormone (TSH), and T4 levels are normal. A 10-day progestin challenge fails to induce a withdrawal bleed.

      What is the underlying cause of Sophie's amenorrhea?

      Your Answer: Premature ovarian failure

      Correct Answer: Hypothalamic dysfunction

      Explanation:

      Caroline’s case of secondary amenorrhoea suggests a hypothalamic cause, as indicated by low levels of gonadotrophins (FSH and LH) and oestradiol. This is different from pituitary adenoma, which often presents with panhypopituitarism and normal prolactin levels, and premature ovarian failure, which is diagnosed in women under 40 with increased FSH levels and menopausal-like symptoms. PCOS is also unlikely as there is no hyperandrogenism or other symptoms present. Hypothalamic dysfunction can be caused by excessive exercise, stress, or dieting, which should be explored in the patient’s history.

      Understanding Amenorrhoea: Causes, Investigations, and Management

      Amenorrhoea is a condition characterized by the absence of menstrual periods in women. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls without secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.

      There are various causes of amenorrhoea, including gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, Sheehan’s syndrome, Asherman’s syndrome, and thyrotoxicosis. To determine the underlying cause of amenorrhoea, initial investigations such as full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels are necessary.

      The management of amenorrhoea depends on the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause in women 40 years of age or older and treat the underlying cause accordingly. It is important to note that hypothyroidism may also cause amenorrhoea.

    • This question is part of the following fields:

      • Gynaecology
      66.9
      Seconds
  • Question 14 - A 50-year-old female with a history of rheumatoid arthritis presents to the emergency...

    Incorrect

    • A 50-year-old female with a history of rheumatoid arthritis presents to the emergency department with a painful, swollen right eye. She is compliant with her hydroxychloroquine medication and has had three arthritic flares in the past year, all of which responded well to IV steroids. The patient frequently uses artificial teardrops for foreign body sensation, but her current ocular symptoms are not improving with this treatment. What is the most probable diagnosis?

      Your Answer: Keratitis

      Correct Answer: Scleritis

      Explanation:

      Rheumatoid Arthritis and Its Effects on the Eyes

      Rheumatoid arthritis is a chronic autoimmune disease that affects various parts of the body, including the eyes. In fact, ocular manifestations of rheumatoid arthritis are quite common, with approximately 25% of patients experiencing eye problems. These eye problems can range from mild to severe and can significantly impact a patient’s quality of life.

      The most common ocular manifestation of rheumatoid arthritis is keratoconjunctivitis sicca, also known as dry eye syndrome. This condition occurs when the eyes do not produce enough tears, leading to discomfort, redness, and irritation. Other ocular manifestations of rheumatoid arthritis include episcleritis, scleritis, corneal ulceration, and keratitis. Episcleritis and scleritis both cause redness in the eyes, with scleritis also causing pain. Corneal ulceration and keratitis both affect the cornea, with corneal ulceration being a more severe condition that can lead to vision loss.

      In addition to these conditions, patients with rheumatoid arthritis may also experience iatrogenic ocular manifestations. These are side effects of medications used to treat the disease. For example, steroid use can lead to cataracts, while the use of chloroquine can cause retinopathy.

      Overall, it is important for patients with rheumatoid arthritis to be aware of the potential ocular manifestations of the disease and to seek prompt medical attention if they experience any eye-related symptoms. Early diagnosis and treatment can help prevent vision loss and improve overall quality of life.

    • This question is part of the following fields:

      • Ophthalmology
      37
      Seconds
  • Question 15 - An older woman presents with an intermittent frontal headache associated with pain around...

    Incorrect

    • An older woman presents with an intermittent frontal headache associated with pain around her right eye which looks slightly red. She describes episodes occurring while she watches television in the evening, during which she sees halos around lights in the room. On examination, there is no tenderness around her temporal artery and her eye appears normal. She has normal visual acuity.
      What is the most likely diagnosis?

      Your Answer: Migraine

      Correct Answer: Closed angle glaucoma

      Explanation:

      Differential Diagnosis for a Painful Red Eye with Headache and Visual Symptoms

      When a patient presents with a painful red eye, headache, and visual symptoms, several conditions should be considered. One possible diagnosis is primary closed angle glaucoma, which can present as latent, subacute, or acute. Subacute closed angle glaucoma causes intermittent attacks with blurring of vision and halos around light sources, while acute glaucoma is more severe and requires urgent reduction in intraocular pressure. Another possible diagnosis is anterior uveitis, which presents with a persistent painful red eye and photophobia but does not cause headaches or halos in the vision.

      Migraine is also an important differential, as its symptoms can be mistaken for acute glaucoma. Tension headaches are less likely, as they are not associated with visual symptoms. Finally, giant cell arthritis should be considered, especially if the patient has symptoms of claudication such as temporal headache and jaw pain when chewing food, as well as scalp tenderness and pulseless beaded temporal arteries on examination.

      In summary, a painful red eye with headache and visual symptoms can have several possible causes, and a thorough differential diagnosis is necessary to determine the appropriate treatment.

    • This question is part of the following fields:

      • Ophthalmology
      17.9
      Seconds
  • Question 16 - A 7-year-old girl with sickle cell disease arrives at the emergency department. She...

    Incorrect

    • A 7-year-old girl with sickle cell disease arrives at the emergency department. She has been running a fever for a week and complains of nausea and loss of appetite. In the past 24 hours, she has been experiencing intense pain in her left leg. The initial treatment for a sickle crisis is administered, including oxygen, fluids, morphine, and antibiotics. However, an X-ray reveals osteomyelitis in her leg.
      What is the probable causative organism for her osteomyelitis?

      Your Answer: Group A streptococcus

      Correct Answer: Salmonella enteritidis

      Explanation:

      Salmonella osteomyelitis is a common occurrence in sickle cell patients.

      Among sickle cell patients, Salmonella is the leading cause of osteomyelitis. In contrast, Staphylococcus aureus is the most frequent cause in children. Haemophilus, Group A streptococcus, and Enterococcus are all less prevalent causes of osteomyelitis.

      Understanding Osteomyelitis: Types, Causes, and Treatment

      Osteomyelitis is a bone infection that can be classified into two types: haematogenous and non-haematogenous. Haematogenous osteomyelitis is caused by bacteria that enter the bloodstream and is usually monomicrobial. It is more common in children, with vertebral osteomyelitis being the most common form in adults. Risk factors include sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis results from the spread of infection from adjacent soft tissues or direct injury to the bone. It is often polymicrobial and more common in adults, with risk factors such as diabetic foot ulcers, pressure sores, diabetes mellitus, and peripheral arterial disease.

      Staphylococcus aureus is the most common cause of osteomyelitis, except in patients with sickle-cell anaemia where Salmonella species predominate. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%. Treatment for osteomyelitis involves a six-week course of flucloxacillin. Clindamycin is an alternative for patients who are allergic to penicillin.

      In summary, osteomyelitis is a bone infection that can be caused by bacteria entering the bloodstream or spreading from adjacent soft tissues or direct injury to the bone. It is more common in children and adults with certain risk factors. Staphylococcus aureus is the most common cause, and MRI is the preferred imaging modality for diagnosis. Treatment involves a six-week course of flucloxacillin or clindamycin for penicillin-allergic patients.

    • This question is part of the following fields:

      • Musculoskeletal
      20
      Seconds
  • Question 17 - A 14-month-old boy is seen by his doctor. He has been experiencing fever...

    Correct

    • A 14-month-old boy is seen by his doctor. He has been experiencing fever and cold symptoms for the past 2 days. Recently, he has developed a harsh cough and his parents are concerned. During the examination, the doctor observes that the child has a temperature of 38ÂșC and is experiencing inspiratory stridor, but there are no signs of intercostal recession. What is the probable diagnosis?

      Your Answer: Croup

      Explanation:

      Understanding Croup: A Respiratory Infection in Infants and Toddlers

      Croup is a type of upper respiratory tract infection that commonly affects infants and toddlers. It is characterized by a barking cough, fever, and coryzal symptoms, and is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses are the most common cause of croup. The condition typically peaks between 6 months and 3 years of age, and is more prevalent during the autumn season.

      The severity of croup can be graded based on the presence of symptoms such as stridor, cough, and respiratory distress. Mild cases may only have occasional barking cough and no audible stridor at rest, while severe cases may have frequent barking cough, prominent inspiratory stridor at rest, and marked sternal wall retractions. Children with moderate or severe croup, those under 6 months of age, or those with known upper airway abnormalities should be admitted to the hospital.

      Diagnosis of croup is usually made based on clinical presentation, but a chest x-ray may show subglottic narrowing, commonly referred to as the steeple sign. Treatment for croup typically involves a single dose of oral dexamethasone or prednisolone, regardless of severity. In emergency situations, high-flow oxygen and nebulized adrenaline may be necessary.

      Understanding croup is important for parents and healthcare providers alike, as prompt recognition and treatment can help prevent complications and improve outcomes for affected children.

    • This question is part of the following fields:

      • Paediatrics
      21.1
      Seconds
  • Question 18 - A 50-year-old male is recovering on the surgical ward two days post-open inguinal...

    Incorrect

    • A 50-year-old male is recovering on the surgical ward two days post-open inguinal hernia repair. He has no other past medical history of note.

      He has not opened his bowels or passed wind for the last 48 hours. His abdomen is diffusely distended and tender. There is no rebound tenderness. There are no bowel sounds on auscultation. He is currently nil by mouth with a nasogastric tube placed.

      His observations are as follows:
      Respiratory rate 20 breaths per minute
      Heart rate 110 beats per minute
      Blood pressure 100/60 mmHg
      Temperature 37.3ÂșC

      Which of the following investigations is most likely to identify factors which are contributing to this patient's postoperative complication?

      Your Answer: Endoscopy

      Correct Answer: U&Es

      Explanation:

      The patient is experiencing postoperative paralytic ileus, which is evident from her inability to pass gas or have a bowel movement, as well as the absence of bowel sounds during abdominal auscultation. There are several factors that could contribute to the development of an ileus after surgery, including manipulation of the bowel during the procedure, inflammation of the intra-abdominal organs, medications used during and after surgery, and intra-abdominal sepsis. It is likely that a combination of these factors is responsible for the patient’s condition.

      Although there are no signs of intra-abdominal sepsis in this patient, it is important to rule out other potential causes, such as electrolyte imbalances or underlying medical conditions. Without more information about the patient’s medical history and medication use, it is difficult to determine the exact cause of the ileus. However, it is recommended that patients with paralytic ileus receive daily monitoring of their electrolyte levels to ensure that any imbalances are promptly corrected.

      Postoperative ileus, also known as paralytic ileus, is a common complication that can occur after bowel surgery, particularly if the bowel has been extensively handled. This condition is characterized by a reduction in bowel peristalsis, which can lead to pseudo-obstruction. Symptoms of postoperative ileus include abdominal distention, bloating, pain, nausea, vomiting, inability to pass flatus, and difficulty tolerating an oral diet. It is important to check for deranged electrolytes, such as potassium, magnesium, and phosphate, as they can contribute to the development of postoperative ileus.

      The management of postoperative ileus typically involves starting with nil-by-mouth and gradually progressing to small sips of clear fluids. If vomiting occurs, a nasogastric tube may be necessary. Intravenous fluids are administered to maintain normovolaemia, and additives may be used to correct any electrolyte disturbances. In severe or prolonged cases, total parenteral nutrition may be required. It is important to monitor the patient closely and adjust the treatment plan as necessary to ensure a successful recovery.

    • This question is part of the following fields:

      • Surgery
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  • Question 19 - A newly born infant is observed to have clubfoot on both feet. What...

    Correct

    • A newly born infant is observed to have clubfoot on both feet. What is the preferred treatment for this condition?

      Your Answer: Manipulation and progressive casting starting soon after birth

      Explanation:

      Talipes Equinovarus: A Common Foot Deformity in Newborns

      Talipes equinovarus, also known as club foot, is a foot deformity characterized by an inward turning and plantar flexed foot. It is a common condition that affects 1 in 1,000 newborns, with a higher incidence in males. In about 50% of cases, the deformity is present in both feet. While the cause of talipes equinovarus is often unknown, it can be associated with conditions such as spina bifida, cerebral palsy, and oligohydramnios.

      Diagnosis of talipes equinovarus is typically made during the newborn exam, and imaging is not usually necessary. The deformity is not passively correctable, and the diagnosis is based on clinical examination.

      In recent years, there has been a shift towards conservative management of talipes equinovarus, with the Ponseti method being the preferred approach. This method involves manipulation and progressive casting of the foot, starting soon after birth. The deformity is usually corrected within 6-10 weeks, and an Achilles tenotomy may be required in some cases. Night-time braces are then used until the child is 4 years old to prevent relapse, which occurs in about 15% of cases.

      Overall, talipes equinovarus is a common foot deformity in newborns that can be effectively managed with conservative methods such as the Ponseti method.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 20 - A 36-year-old woman has given birth to her first child and was given...

    Incorrect

    • A 36-year-old woman has given birth to her first child and was given a dose of intramuscular syntocinon before the placenta was delivered. During the wait for the placenta, she experiences a blood loss of 400ml. Even after the placenta is delivered, the bleeding continues and she loses an additional 500ml of blood. The medical team initiates the necessary resuscitation measures and the major haemorrhage protocol. The cause of the bleeding is identified as uterine atony, and the patient is given boluses of syntocinon, ergometrine, and carboprost. However, the bleeding persists. What is the most appropriate next step?

      Your Answer: Hysterectomy

      Correct Answer: Intra-uterine Bakri catheter

      Explanation:

      The correct first-line surgical intervention for postpartum haemorrhage is an intra-uterine Bakri catheter. This device is used to tamponade the bleeding caused by uterine atony, which is a failure of the uterine myometrium cells to contract. Hysterectomy is not the first option as it is a last resort and will make the patient infertile. Lying the patient on her left lateral side is not relevant for a woman who has already delivered her baby. Ligation of the internal iliac artery may be used, but it is not the next most appropriate step as it may lead to ischaemic complications. Intra-uterine balloon tamponade is the first-line surgical intervention if other measures fail.

      Understanding Postpartum Haemorrhage

      Postpartum haemorrhage (PPH) is a condition where a woman experiences blood loss of more than 500 ml after giving birth vaginally. It can be classified as primary or secondary. Primary PPH occurs within 24 hours after delivery and is caused by the 4 Ts: tone, trauma, tissue, and thrombin. The most common cause is uterine atony. Risk factors for primary PPH include previous PPH, prolonged labour, pre-eclampsia, increased maternal age, emergency Caesarean section, and placenta praevia.

      In managing PPH, it is important to involve senior staff immediately and follow the ABC approach. This includes two peripheral cannulae, lying the woman flat, blood tests, and commencing a warmed crystalloid infusion. Mechanical interventions such as rubbing up the fundus and catheterisation are also done. Medical interventions include IV oxytocin, ergometrine, carboprost, and misoprostol. Surgical options such as intrauterine balloon tamponade, B-Lynch suture, ligation of uterine arteries, and hysterectomy may be considered if medical options fail to control the bleeding.

      Secondary PPH occurs between 24 hours to 6 weeks after delivery and is typically due to retained placental tissue or endometritis. It is important to understand the causes and risk factors of PPH to prevent and manage this life-threatening emergency effectively.

    • This question is part of the following fields:

      • Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Psychiatry (1/1) 100%
Pharmacology (0/1) 0%
Paediatrics (3/5) 60%
Clinical Sciences (0/1) 0%
Ophthalmology (0/3) 0%
Neurology (1/1) 100%
Musculoskeletal (2/3) 67%
Obstetrics (1/2) 50%
Surgery (1/2) 50%
Gynaecology (0/1) 0%
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