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  • Question 1 - You are resuscitating a trauma patient who is 42 years old and your...

    Correct

    • You are resuscitating a trauma patient who is 42 years old and your consultant asks you to perform a central venous catheter insertion. During your discussion, you consider which approach carries the greatest risk of pneumothorax.

      Your Answer: Subclavian

      Explanation:

      The subclavian approach for central lines carries the highest risk of pneumothorax. However, it does have advantages such as being accessible during airway control and having easily identifiable landmarks for insertion, even in obese patients. It is important to note that the carotid is not used for CVC’s.

      Further Reading:

      A central venous catheter (CVC) is a type of catheter that is inserted into a large vein in the body, typically in the neck, chest, or groin. It has several important uses, including CVP monitoring, pulmonary artery pressure monitoring, repeated blood sampling, IV access for large volumes of fluids or drugs, TPN administration, dialysis, pacing, and other procedures such as placement of IVC filters or venous stents.

      When inserting a central line, it is ideal to use ultrasound guidance to ensure accurate placement. However, there are certain contraindications to central line insertion, including infection or injury to the planned access site, coagulopathy, thrombosis or stenosis of the intended vein, a combative patient, or raised intracranial pressure for jugular venous lines.

      The most common approaches for central line insertion are the internal jugular, subclavian, femoral, and PICC (peripherally inserted central catheter) veins. The internal jugular vein is often chosen due to its proximity to the carotid artery, but variations in anatomy can occur. Ultrasound can be used to identify the vessels and guide catheter placement, with the IJV typically lying superficial and lateral to the carotid artery. Compression and Valsalva maneuvers can help distinguish between arterial and venous structures, and doppler color flow can highlight the direction of flow.

      In terms of choosing a side for central line insertion, the right side is usually preferred to avoid the risk of injury to the thoracic duct and potential chylothorax. However, the left side can also be used depending on the clinical situation.

      Femoral central lines are another option for central venous access, with the catheter being inserted into the femoral vein in the groin. Local anesthesia is typically used to establish a field block, with lidocaine being the most commonly used agent. Lidocaine works by blocking sodium channels and preventing the propagation of action potentials.

      In summary, central venous catheters have various important uses and should ideally be inserted using ultrasound guidance. There are contraindications to their insertion, and different approaches can be used depending on the clinical situation. Local anesthesia is commonly used for central line insertion, with lidocaine being the preferred agent.

    • This question is part of the following fields:

      • Resus
      11.4
      Seconds
  • Question 2 - A 45-year-old man comes in feeling extremely sick with nausea and vomiting. He...

    Correct

    • A 45-year-old man comes in feeling extremely sick with nausea and vomiting. He is suddenly disoriented and claims that everything appears to be yellow. A blood test shows that his potassium level is 6.8 mmol/l.
      Which of the following medications is most likely causing his symptoms?

      Your Answer: Digoxin

      Explanation:

      Digoxin is a medication used to treat atrial fibrillation and flutter, as well as congestive cardiac failure. It belongs to a class of drugs called cardiac glycosides. Its mechanism of action involves inhibiting the Na/K ATPase in cardiac myocytes, which leads to an increase in intracellular sodium concentration. This, in turn, indirectly increases the availability of intracellular calcium through Na/Ca exchange.

      The rise in intracellular calcium levels caused by digoxin results in a positive inotropic effect, meaning it strengthens the force of heart contractions, and a negative chronotropic effect, meaning it slows down the heart rate.

      Therapeutic plasma levels of digoxin typically range between 1.0-1.5 nmol/l. However, higher concentrations may be necessary, and the specific value can vary between different laboratories. It is important to note that the risk of toxicity significantly increases when digoxin levels exceed 2 nmol/l.

      Signs and symptoms of digoxin toxicity include nausea, vomiting, diarrhea, abdominal pain, confusion, tachyarrhythmias or bradyarrhythmias, xanthopsia (yellow-green vision), and hyperkalemia (an early sign of significant toxicity).

      Several factors can potentially contribute to digoxin toxicity. These include being elderly, having renal failure, experiencing myocardial ischemia, having hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, acidosis, or hypothyroidism.

      Additionally, there are several drugs that can increase the risk of digoxin toxicity. These include spironolactone, amiodarone, quinidine, verapamil, diltiazem, and drugs that cause hypokalemia, such as thiazide and loop diuretics.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      13.4
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  • Question 3 - A 62-year-old woman comes in with a gout flare-up after starting a new...

    Incorrect

    • A 62-year-old woman comes in with a gout flare-up after starting a new antihypertensive medication prescribed by her doctor. Which of the following antihypertensives is the LEAST likely to be the cause?

      Your Answer: Atenolol

      Correct Answer: Losartan

      Explanation:

      Thiazide diuretics, like bendroflumethiazide and hydrochlorothiazide, have the potential to raise levels of uric acid in the blood, which can worsen gout symptoms in individuals who are susceptible to the condition.

      Other medications, such as diuretics, beta-blockers, ACE inhibitors, and non-losartan ARBs, are also linked to an increased risk of gout.

      On the other hand, calcium-channel blockers like amlodipine and verapamil, as well as losartan, have been found to lower uric acid levels and are associated with a reduced risk of gout.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      20
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  • Question 4 - A 35-year-old individual goes to the emergency room feeling sick for the past...

    Correct

    • A 35-year-old individual goes to the emergency room feeling sick for the past 48 hours after moving into a new apartment. Earlier today, a boiler technician came to conduct the gas safety inspection for the landlord and advised the patient to go to the A&E department due to high carbon monoxide levels and a faulty boiler. You suspect the presence of carbon monoxide poisoning. What is the primary symptom typically associated with carbon monoxide poisoning?

      Your Answer: Headache

      Explanation:

      The primary symptom typically associated with carbon monoxide poisoning is a headache.

      Carbon monoxide (CO) is a dangerous gas that is produced by the combustion of hydrocarbon fuels and can be found in certain chemicals. It is colorless and odorless, making it difficult to detect. In England and Wales, there are approximately 60 deaths each year due to accidental CO poisoning.

      When inhaled, carbon monoxide binds to haemoglobin in the blood, forming carboxyhaemoglobin (COHb). It has a higher affinity for haemoglobin than oxygen, causing a left-shift in the oxygen dissociation curve and resulting in tissue hypoxia. This means that even though there may be a normal level of oxygen in the blood, it is less readily released to the tissues.

      The clinical features of carbon monoxide toxicity can vary depending on the severity of the poisoning. Mild or chronic poisoning may present with symptoms such as headache, nausea, vomiting, vertigo, confusion, and weakness. More severe poisoning can lead to intoxication, personality changes, breathlessness, pink skin and mucosae, hyperpyrexia, arrhythmias, seizures, blurred vision or blindness, deafness, extrapyramidal features, coma, or even death.

      To help diagnose domestic carbon monoxide poisoning, there are four key questions that can be asked using the COMA acronym. These questions include asking about co-habitees and co-occupants in the house, whether symptoms improve outside of the house, the maintenance of boilers and cooking appliances, and the presence of a functioning CO alarm.

      Typical carboxyhaemoglobin levels can vary depending on whether the individual is a smoker or non-smoker. Non-smokers typically have levels below 3%, while smokers may have levels below 10%. Symptomatic individuals usually have levels between 10-30%, and severe toxicity is indicated by levels above 30%.

      When managing carbon monoxide poisoning, the first step is to administer 100% oxygen. Hyperbaric oxygen therapy may be considered for individuals with a COHb concentration of over 20% and additional risk factors such as loss of consciousness, neurological signs, myocardial ischemia or arrhythmia, or pregnancy. Other management strategies may include fluid resuscitation, sodium bicarbonate for metabolic acidosis, and mannitol for cerebral edema.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      27.5
      Seconds
  • Question 5 - A 65-year-old diabetic man presents with a gradual decrease in consciousness and confusion...

    Correct

    • A 65-year-old diabetic man presents with a gradual decrease in consciousness and confusion over the past week. He normally controls his diabetes with metformin 500 mg twice a day. He recently received treatment for a urinary tract infection from his doctor, and his family reports that he has been excessively thirsty. He has vomited multiple times today. A urine dipstick test shows a small amount of white blood cells and 1+ ketones. His arterial blood gas results are as follows:
      pH: 7.29
      pO2: 11.1 kPa
      pCO2: 4.6 kPa
      HCO3-: 22 mmol/l
      Na+: 154 mmol/l
      K+: 3.2 mmol/l
      Cl-: 100 mmol/l
      Urea: 17.6 mmol/l
      Glucose: 32 mmol/l
      What is the SINGLE most likely diagnosis?

      Your Answer: Hyperosmolar hyperglycaemic state

      Explanation:

      In an elderly patient with a history of gradual decline accompanied by high blood sugar levels, excessive thirst, and recent infection, the most likely diagnosis is hyperosmolar hyperglycemic state (HHS). This condition can be life-threatening, with a mortality rate of approximately 50%. Common symptoms include dehydration, elevated blood sugar levels, altered mental status, and electrolyte imbalances. About half of the patients with HHS also experience hypernatremia.

      To calculate the serum osmolality, the formula is 2(K+ + Na+) + urea + glucose. In this case, the serum osmolality is 364 mmol/l, indicating a high level. It is important to discontinue the use of metformin in this patient due to the risk of metformin-associated lactic acidosis (MALA). Additionally, an intravenous infusion of insulin should be initiated.

      The treatment goals for HHS are to address the underlying cause and gradually and safely:
      – Normalize the osmolality
      – Replace fluid and electrolyte losses
      – Normalize blood glucose levels

      If significant ketonaemia is present (3β-hydroxybutyrate is more than 1 mmol/L), it indicates a relative lack of insulin, and insulin should be administered immediately. However, if significant ketonaemia is not present, insulin should not be started.

      Patients with HHS are at a high risk of thromboembolism, and it is recommended to routinely administer low molecular weight heparin. In cases where the serum osmolality exceeds 350 mmol/l, full heparinization should be considered.

    • This question is part of the following fields:

      • Endocrinology
      55.8
      Seconds
  • Question 6 - A 32-year-old woman comes in seeking contraceptive advice. She is currently 48 hours...

    Incorrect

    • A 32-year-old woman comes in seeking contraceptive advice. She is currently 48 hours behind schedule in starting the first pill of her new packet. She took all of her pills consistently last month before her pill-free interval. She engaged in unprotected sexual intercourse last night and wants to know the best course of action.
      What is the MOST suitable advice to provide her?

      Your Answer: She should take the most recent missed pill, the remaining pills should be continued at the usual time and emergency contraception should be considered

      Correct Answer: She should take the most recent missed pill, the remaining pills should be continued at the usual time, but no emergency contraception is required

      Explanation:

      If you have missed one pill, which means it has been 48-72 hours since you took the last pill in your current packet or you started the first pill in a new packet 24-48 hours late, you need to take the missed pill as soon as you remember. Make sure to continue taking the remaining pills at your usual time. Emergency contraception is generally not necessary in this situation, but it may be worth considering if you have missed pills earlier in the packet or during the last week of the previous packet.

    • This question is part of the following fields:

      • Sexual Health
      36.4
      Seconds
  • Question 7 - A 68-year-old woman comes in after experiencing an episode of weakness in her...

    Incorrect

    • A 68-year-old woman comes in after experiencing an episode of weakness in her left arm and leg that resolved within a few hours. Her family has noticed a sudden increase in forgetfulness over the past week, with difficulty remembering names of people and places and struggling to find the right words for things.

      What is the SINGLE most probable diagnosis?

      Your Answer:

      Correct Answer: Vascular dementia

      Explanation:

      Vascular dementia is the second most common form of dementia, accounting for approximately 25% of all cases. It occurs when the brain is damaged due to various factors, such as major strokes, multiple smaller strokes that go unnoticed (known as multi-infarct), or chronic changes in smaller blood vessels (referred to as subcortical dementia). The term vascular cognitive impairment (VCI) is increasingly used to encompass this range of diseases.

      Unlike Alzheimer’s disease, which has a gradual and subtle onset, vascular dementia can occur suddenly and typically shows a series of stepwise increases in symptom severity. The presentation and progression of the disease can vary significantly.

      There are certain features that suggest a vascular cause of dementia. These include a history of transient ischemic attacks (TIAs) or cardiovascular disease, the presence of focal neurological abnormalities, prominent memory impairment in the early stages of the disease, early onset of gait disturbance and unsteadiness, frequent unprovoked falls in the early stages, bladder symptoms (such as incontinence) without any identifiable urological condition in the early stages, and seizures.

    • This question is part of the following fields:

      • Elderly Care / Frailty
      0
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  • Question 8 - A 65 year old female patient has been brought into the department after...

    Incorrect

    • A 65 year old female patient has been brought into the department after being hit by a car in a vehicle-pedestrian accident. The patient needs CT imaging to evaluate the complete scope of her injuries. What are the minimum monitoring requirements for transferring a critically ill patient?

      Your Answer:

      Correct Answer: ECG, oxygen saturations, blood pressure and temperature monitoring

      Explanation:

      It is crucial to continuously monitor the oxygen saturation, blood pressure, ECG, and temperature of critically ill patients during transfers. If the patient is intubated, monitoring of end-tidal CO2 is also necessary. The minimum standard monitoring requirements for any critically ill patient during transfers include ECG, oxygen saturation, blood pressure, and temperature. Additionally, if the patient is intubated, monitoring of end-tidal CO2 is mandatory. It is important to note that the guidance from ICS/FICM suggests that monitoring protocols for intra-hospital transfers should be similar to those for interhospital transfers.

      Further Reading:

      Transfer of critically ill patients in the emergency department is a common occurrence and can involve intra-hospital transfers or transfers to another hospital. However, there are several risks associated with these transfers that doctors need to be aware of and manage effectively.

      Technical risks include equipment failure or inadequate equipment, unreliable power or oxygen supply, incompatible equipment, restricted positioning, and restricted monitoring equipment. These technical issues can hinder the ability to detect and treat problems with ventilation, blood pressure control, and arrhythmias during the transfer.

      Non-technical risks involve limited personal and medical team during the transfer, isolation and lack of resources in the receiving hospital, and problems with communication and liaison between the origin and destination sites.

      Organizational risks can be mitigated by having a dedicated consultant lead for transfers who is responsible for producing guidelines, training staff, standardizing protocols, equipment, and documentation, as well as capturing data and conducting audits.

      To optimize the patient’s clinical condition before transfer, several key steps should be taken. These include ensuring a low threshold for intubation and anticipating airway and ventilation problems, securing the endotracheal tube (ETT) and verifying its position, calculating oxygen requirements and ensuring an adequate supply, monitoring for circulatory issues and inserting at least two IV accesses, providing ongoing analgesia and sedation, controlling seizures, and addressing any fractures or temperature changes.

      It is also important to have the necessary equipment and personnel for the transfer. Standard monitoring equipment should include ECG, oxygen saturation, blood pressure, temperature, and capnographic monitoring for ventilated patients. Additional monitoring may be required depending on the level of care needed by the patient.

      In terms of oxygen supply, it is standard practice to calculate the expected oxygen consumption during transfer and multiply it by two to ensure an additional supply in case of delays. The suggested oxygen supply for transfer can be calculated using the minute volume, fraction of inspired oxygen, and estimated transfer time.

      Overall, managing the risks associated with patient transfers requires careful planning, communication, and coordination to ensure the safety and well-being of critically ill patients.

    • This question is part of the following fields:

      • Basic Anaesthetics
      0
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  • Question 9 - A 45-year-old man presents with a history of feeling generally unwell and having...

    Incorrect

    • A 45-year-old man presents with a history of feeling generally unwell and having experienced fevers at home. He has a history of lung cancer for which he is currently undergoing radiation therapy. His observations are as follows: HR 92 bpm, BP 130/80, SaO2 98% on air, temperature 38.9°C. A diagnosis of neutropenic sepsis is suspected.
      Which of the following antibiotics are recommended by the current NICE guidelines for the initial empiric treatment of neutropenic sepsis?

      Your Answer:

      Correct Answer: Tazocin alone

      Explanation:

      Neutropenic sepsis is a serious condition that can occur when a person has low levels of neutrophils, which are a type of white blood cell. This condition can be life-threatening and is often caused by factors such as chemotherapy, immunosuppressive drugs, infections, bone marrow disorders, and nutritional deficiencies.

      To diagnose neutropenic sepsis, doctors look for a neutrophil count of 0.5 x 109 per litre or lower in patients undergoing cancer treatment. Additionally, patients must have a temperature higher than 38°C or show other signs and symptoms of significant sepsis.

      According to the current guidelines from the National Institute for Health and Care Excellence (NICE), the recommended initial antibiotic treatment for suspected neutropenic sepsis is monotherapy with piperacillin with tazobactam (Tazocin 4.5 g IV). It is important to note that aminoglycosides should not be used as monotherapy or in combination therapy unless there are specific patient-related or local microbiological reasons to do so.

    • This question is part of the following fields:

      • Oncological Emergencies
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  • Question 10 - You ask your consultant to review a patient you have seen with knee...

    Incorrect

    • You ask your consultant to review a patient you have seen with knee pain. Following a history and examination, the consultant makes a diagnosis of patellofemoral pain syndrome.

      Which SINGLE statement is correct regarding this diagnosis?

      Your Answer:

      Correct Answer: It affects more than one tendon

      Explanation:

      De Quervain’s tenosynovitis is a condition characterized by inflammation and thickening of the sheath that contains the tendons of the extensor pollicis brevis and abductor pollicis longus. This leads to pain on the radial side of the wrist. It is more commonly observed in women, particularly those aged between 30 and 50 years. The condition is often associated with repetitive activities that involve pinching and grasping.

      During examination, swelling and tenderness along the tendon sheath may be observed. The tendon sheath itself may also appear thickened. The most pronounced tenderness is usually felt over the tip of the radial styloid. A positive Finkelstein’s test, which involves flexing the wrist and moving it towards the ulnar side while the thumb is flexed across the palm, can help confirm the diagnosis.

      Treatment for De Quervain’s tenosynovitis involves avoiding movements that can trigger symptoms and using a thumb splint to immobilize the thumb. In cases where symptoms persist, a local corticosteroid injection or surgical decompression may be considered.

    • This question is part of the following fields:

      • Musculoskeletal (non-traumatic)
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  • Question 11 - A 45-year-old patient presents with frequent bruising and recurrent nosebleeds. She informs you...

    Incorrect

    • A 45-year-old patient presents with frequent bruising and recurrent nosebleeds. She informs you that she has a rare platelet disorder and provides you with her outpatient letter from the hematology department, which includes details about the condition. According to the letter, her disorder is attributed to decreased levels of glycoprotein IIb/IIIa.
      What is the MOST LIKELY diagnosis for this patient?

      Your Answer:

      Correct Answer: Glanzmann’s thrombasthenia

      Explanation:

      Glanzmann’s thrombasthenia is an uncommon condition affecting platelets, where they have a deficiency or abnormality in glycoprotein IIb/IIIa. This disorder leads to platelet dysfunction and can result in various complications.

    • This question is part of the following fields:

      • Haematology
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  • Question 12 - A 45-year-old man presents with severe nausea and recurrent vomiting. The vomiting episodes...

    Incorrect

    • A 45-year-old man presents with severe nausea and recurrent vomiting. The vomiting episodes occur every few weeks and are accompanied by colicky abdominal pain. However, his bowel movements are normal. He reports that the only relief he gets during these episodes is by taking hot baths. He has no significant medical history but admits to being a heavy and regular cannabis user. A complete set of blood tests and an abdominal X-ray are performed, both of which come back normal.
      What is the most probable diagnosis in this case?

      Your Answer:

      Correct Answer: Cannabinoid hyperemesis syndrome

      Explanation:

      Cannabinoid hyperemesis syndrome (CHS) is an extremely rare form of cannabinoid toxicity that occurs in chronic smokers. It is characterized by recurring episodes of severe nausea and vomiting. One distinctive feature of this syndrome is that individuals who suffer from it often find relief from their symptoms by taking hot baths or showers, and they may compulsively bathe during episodes of nausea and vomiting.

      CHS typically develops in heavy, long-term cannabis users who consume the drug multiple times a day for many years. On average, symptoms appear after about 16 years of cannabis use, although some patients may experience symptoms after as little as three years.

      In 2009, Sontineni and colleagues established criteria for diagnosing cannabinoid hyperemesis syndrome. These criteria include essential factors such as long-term cannabis use, major factors like severe nausea and vomiting that occur in a cyclic pattern over months, and resolution of symptoms after discontinuing cannabis use. Supportive criteria include compulsive hot baths with symptom relief, colicky abdominal pain, and no evidence of inflammation in the gallbladder or pancreas.

      The exact cause of CHS is not fully understood, but there are two main theories. One theory suggests that the syndrome is a result of a build-up of cannabinoids in the body, which leads to toxicity. Another theory proposes that the functionality of cannabinoid receptors in the brain, particularly in the hypothalamus, is affected, resulting in CHS.

      Most conventional anti-emetic drugs are effective in treating the vomiting phase of CHS. During acute episodes, it is important to monitor the patient’s hydration status as the combination of hot baths and prolonged vomiting can lead to cannabinoid hyperemesis acute renal failure (CHARF). This can be easily prevented and treated with intravenous fluids.

      Once the acute episode of vomiting and dehydration has been addressed, the condition can be easily cured by discontinuing cannabis consumption.

    • This question is part of the following fields:

      • Gastroenterology & Hepatology
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  • Question 13 - A 35 year old male is brought into the emergency department after collapsing...

    Incorrect

    • A 35 year old male is brought into the emergency department after collapsing at home. The patient is observed to be hypotensive and drowsy upon arrival and is promptly transferred to the resuscitation bay. The patient's spouse informs you that the patient has been feeling sick with nausea and vomiting for the past 48 hours. It is important to note that the patient has a medical history of Addison's disease. What would be the most suitable initial treatment option?

      Your Answer:

      Correct Answer: 100mg IM hydrocortisone

      Explanation:

      The first-line treatment for Addisonian (adrenal) crisis is hydrocortisone. This patient displays symptoms that indicate an Addisonian crisis, and the main components of their management involve administering hydrocortisone and providing intravenous fluids for resuscitation.

      Further Reading:

      Addison’s disease, also known as primary adrenal insufficiency or hypoadrenalism, is a rare disorder caused by the destruction of the adrenal cortex. This leads to reduced production of glucocorticoids, mineralocorticoids, and adrenal androgens. The deficiency of cortisol results in increased production of adrenocorticotropic hormone (ACTH) due to reduced negative feedback to the pituitary gland. This condition can cause metabolic disturbances such as hyperkalemia, hyponatremia, hypercalcemia, and hypoglycemia.

      The symptoms of Addison’s disease can vary but commonly include fatigue, weight loss, muscle weakness, and low blood pressure. It is more common in women and typically affects individuals between the ages of 30-50. The most common cause of primary hypoadrenalism in developed countries is autoimmune destruction of the adrenal glands. Other causes include tuberculosis, adrenal metastases, meningococcal septicaemia, HIV, and genetic disorders.

      The diagnosis of Addison’s disease is often suspected based on low cortisol levels and electrolyte abnormalities. The adrenocorticotropic hormone stimulation test is commonly used for confirmation. Other investigations may include adrenal autoantibodies, imaging scans, and genetic screening.

      Addisonian crisis is a potentially life-threatening condition that occurs when there is an acute deficiency of cortisol and aldosterone. It can be the first presentation of undiagnosed Addison’s disease. Precipitating factors of an Addisonian crisis include infection, dehydration, surgery, trauma, physiological stress, pregnancy, hypoglycemia, and acute withdrawal of long-term steroids. Symptoms of an Addisonian crisis include malaise, fatigue, nausea or vomiting, abdominal pain, fever, muscle pains, dehydration, confusion, and loss of consciousness.

      There is no fixed consensus on diagnostic criteria for an Addisonian crisis, as symptoms are non-specific. Investigations may include blood tests, blood gas analysis, and septic screens if infection is suspected. Management involves administering hydrocortisone and fluids. Hydrocortisone is given parenterally, and the dosage varies depending on the age of the patient. Fluid resuscitation with saline is necessary to correct any electrolyte disturbances and maintain blood pressure. The underlying cause of the crisis should also be identified and treated. Close monitoring of sodium levels is important to prevent complications such as osmotic demyelination syndrome.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 14 - You assess a patient with diabetes who has a past medical history of...

    Incorrect

    • You assess a patient with diabetes who has a past medical history of inadequate blood sugar control and diabetic neuropathy. What is the most prevalent form of diabetic neuropathy?

      Your Answer:

      Correct Answer: Peripheral neuropathy

      Explanation:

      The most prevalent form of neuropathy in individuals with diabetes is peripheral neuropathy. Following closely behind is diabetic amyotrophy.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 15 - A 35 year old male is brought into the emergency department after ingesting...

    Incorrect

    • A 35 year old male is brought into the emergency department after ingesting 150 paracetamol tablets in a impulsive suicide attempt. The patient is now worried about the potential liver failure and other possible injuries associated with paracetamol overdose. What other organs or systems are at risk of injury in cases of paracetamol overdose?

      Your Answer:

      Correct Answer: Renal tubule

      Explanation:

      When someone takes too much paracetamol, it can harm their liver cells and the tubules in their kidneys. This is because paracetamol produces a harmful substance called NAPQI, which is normally combined with glutathione. However, when there is too much NAPQI, it can cause damage and death to liver and kidney cells.

      Further Reading:

      Paracetamol poisoning occurs when the liver is unable to metabolize paracetamol properly, leading to the production of a toxic metabolite called N-acetyl-p-benzoquinone imine (NAPQI). Normally, NAPQI is conjugated by glutathione into a non-toxic form. However, during an overdose, the liver’s conjugation systems become overwhelmed, resulting in increased production of NAPQI and depletion of glutathione stores. This leads to the formation of covalent bonds between NAPQI and cell proteins, causing cell death in the liver and kidneys.

      Symptoms of paracetamol poisoning may not appear for the first 24 hours or may include abdominal symptoms such as nausea and vomiting. After 24 hours, hepatic necrosis may develop, leading to elevated liver enzymes, right upper quadrant pain, and jaundice. Other complications can include encephalopathy, oliguria, hypoglycemia, renal failure, and lactic acidosis.

      The management of paracetamol overdose depends on the timing and amount of ingestion. Activated charcoal may be given if the patient presents within 1 hour of ingesting a significant amount of paracetamol. N-acetylcysteine (NAC) is used to increase hepatic glutathione production and is given to patients who meet specific criteria. Blood tests are taken to assess paracetamol levels, liver function, and other parameters. Referral to a medical or liver unit may be necessary, and psychiatric follow-up should be considered for deliberate overdoses.

      In cases of staggered ingestion, all patients should be treated with NAC without delay. Blood tests are also taken, and if certain criteria are met, NAC can be discontinued. Adverse reactions to NAC are common and may include anaphylactoid reactions, rash, hypotension, and nausea. Treatment for adverse reactions involves medications such as chlorpheniramine and salbutamol, and the infusion may be stopped if necessary.

      The prognosis for paracetamol poisoning can be poor, especially in cases of severe liver injury. Fulminant liver failure may occur, and liver transplant may be necessary. Poor prognostic indicators include low arterial pH, prolonged prothrombin time, high plasma creatinine, and hepatic encephalopathy.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
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  • Question 16 - A 60-year-old woman comes in with a red, hot, swollen great toe. The...

    Incorrect

    • A 60-year-old woman comes in with a red, hot, swollen great toe. The diagnosis is acute gout. You decide to start her on a non-steroidal anti-inflammatory drug (NSAID). Her husband was recently diagnosed with a peptic ulcer after an endoscopy, and she is worried about the potential side effects of NSAIDs.
      Which of the following NSAIDs has the lowest occurrence of side effects?

      Your Answer:

      Correct Answer: Ibuprofen

      Explanation:

      The differences in anti-inflammatory activity among NSAIDs are minimal, but there is significant variation in how individuals respond to and tolerate these drugs. Approximately 60% of patients will experience a positive response to any NSAID, and those who do not respond to one may find relief with another. Pain relief typically begins shortly after taking the first dose, and a full analgesic effect is usually achieved within a week. However, it may take up to 3 weeks to see an anti-inflammatory effect, which may not be easily assessed. If desired results are not achieved within these timeframes, it is recommended to try a different NSAID.

      NSAIDs work by reducing the production of prostaglandins through the inhibition of the enzyme cyclo-oxygenase. Different NSAIDs vary in their selectivity for inhibiting different types of cyclo-oxygenase. Selective inhibition of cyclo-oxygenase-2 is associated with a lower risk of gastrointestinal intolerance. Other factors also play a role in susceptibility to gastrointestinal effects, so the choice of NSAID should consider the incidence of gastrointestinal and other side effects.

      Ibuprofen, a propionic acid derivative, possesses anti-inflammatory, analgesic, and antipyretic properties. It generally has fewer side effects compared to other non-selective NSAIDs, but its anti-inflammatory properties are weaker. For rheumatoid arthritis, doses of 1.6 to 2.4 g daily are required, and it may not be suitable for conditions where inflammation is prominent, such as acute gout.

      Naproxen is often a preferred choice due to its combination of good efficacy and low incidence of side effects. However, it does have a higher occurrence of side effects compared to ibuprofen.

      Ketoprofen and diclofenac have similar anti-inflammatory properties to ibuprofen but are associated with more side effects.

      Indometacin has an action that is equal to or superior to naproxen, but it also has a high incidence of side effects, including headache, dizziness, and gastrointestinal disturbances.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
      0
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  • Question 17 - A 45-year-old man presents with a history of gradually worsening left-sided hearing loss...

    Incorrect

    • A 45-year-old man presents with a history of gradually worsening left-sided hearing loss and tinnitus. He also reports occasional episodes of dizziness. During the examination, his hearing is significantly reduced in the left ear, and the Weber's test shows lateralization to the right. Additionally, he experiences tingling sensations on the left side of his face and has decreased sensation on that side. The rest of his cranial nerve examination appears normal.

      What is the SINGLE most probable diagnosis?

      Your Answer:

      Correct Answer: Vestibular schwannoma

      Explanation:

      This patient has come in with a past medical history of hearing loss and ringing in the ears on the right side, along with a nerve problem in the right trigeminal nerve. These symptoms are consistent with a growth in the cerebellopontine angle, such as a vestibular schwannoma (also known as an acoustic neuroma).

      A vestibular schwannoma typically affects the 5th and 8th cranial nerves and is known to present with the following symptoms:

      – Gradually worsening hearing loss on one side
      – Numbness and tingling in the face
      – Ringing in the ears
      – Dizziness

      In some cases, the patient may also have a history of headaches, and in rare instances, the 7th, 9th, and 10th cranial nerves may be affected.

      It is recommended that this patient be referred to an ear, nose, and throat specialist or a neurosurgeon for further evaluation, which may include an MRI scan. The main treatment options for vestibular schwannoma include surgery, radiotherapy, and stereotactic radiosurgery.

    • This question is part of the following fields:

      • Ear, Nose & Throat
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  • Question 18 - You review a 65-year-old woman who is on the clinical decision unit (CDU)...

    Incorrect

    • You review a 65-year-old woman who is on the clinical decision unit (CDU) following a fall. Her son is present, and he is concerned about recent problems she has had with memory loss. He is very worried that she may be showing signs of developing dementia.

      Which of the following is the most prevalent type of dementia?

      Your Answer:

      Correct Answer: Alzheimer’s disease

      Explanation:

      Alzheimer’s disease is the most prevalent type of dementia, making up around 55-60% of all cases. In the UK, the occurrence of Alzheimer’s disease is approximately 5 per 1000 person-years, and the likelihood of developing it increases with age.

    • This question is part of the following fields:

      • Elderly Care / Frailty
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  • Question 19 - A 32-year-old woman is given a medication for a medical ailment during the...

    Incorrect

    • A 32-year-old woman is given a medication for a medical ailment during the first trimester of her pregnancy. As a result, the newborn experiences nasal hypoplasia, bone stippling, and bilateral optic atrophy.
      Which of the listed drugs is the probable culprit for these abnormalities?

      Your Answer:

      Correct Answer: Warfarin

      Explanation:

      During the first trimester of pregnancy, the use of warfarin can lead to a condition known as fetal warfarin syndrome. This condition is characterized by nasal hypoplasia, bone stippling, bilateral optic atrophy, and intellectual disability in the baby. However, if warfarin is taken during the second or third trimester, it can cause optic atrophy, cataracts, microcephaly, microphthalmia, intellectual disability, and both fetal and maternal hemorrhage.

      There are several other drugs that can have adverse effects during pregnancy. For example, ACE inhibitors like ramipril can cause hypoperfusion, renal failure, and the oligohydramnios sequence if taken during the second and third trimesters. Aminoglycosides such as gentamicin can lead to ototoxicity and deafness in the baby. High doses of aspirin can result in first trimester abortions, delayed onset labor, premature closure of the fetal ductus arteriosus, and fetal kernicterus. However, low doses of aspirin (e.g. 75 mg) do not pose significant risks.

      Benzodiazepines like diazepam, when taken late in pregnancy, can cause respiratory depression and a neonatal withdrawal syndrome. Calcium-channel blockers, if taken during the first trimester, can cause phalangeal abnormalities, while their use in the second and third trimesters can lead to fetal growth retardation. Carbamazepine can result in hemorrhagic disease of the newborn and neural tube defects. Chloramphenicol can cause gray baby syndrome. Corticosteroids, if taken during the first trimester, may cause orofacial clefts.

      Danazol, if taken during the first trimester, can cause masculinization of the female fetuses genitals. Finasteride should not be handled by pregnant women as crushed or broken tablets can be absorbed through the skin and affect male sex organ development. Haloperidol, if taken during the first trimester, may cause limb malformations, while its use in the third trimester increases the risk of extrapyramidal symptoms in the newborn.

      Heparin can lead to maternal bleeding and thrombocytopenia. Isoniazid can cause maternal liver damage and neuropathy and seizures in the baby. Isotretinoin carries a high risk of teratogenicity, including multiple congenital malformations and spontaneous abortion.

    • This question is part of the following fields:

      • Pharmacology & Poisoning
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  • Question 20 - A 2-month-old baby girl is brought in by her parents with projectile vomiting....

    Incorrect

    • A 2-month-old baby girl is brought in by her parents with projectile vomiting. She is vomiting approximately every 45 minutes after each feed but remains hungry. On examination, she appears dehydrated, and you can palpate a small mass in the upper abdomen.

      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Infantile hypertrophic pyloric stenosis

      Explanation:

      Infantile hypertrophic pyloric stenosis is a condition characterized by the thickening and enlargement of the smooth muscle in the antrum of the stomach, leading to the narrowing of the pyloric canal. This narrowing can easily cause obstruction. It is a relatively common condition, occurring in about 1 in 500 live births, and is more frequently seen in males than females, with a ratio of 4 to 1. It is most commonly observed in first-born male children, although it can rarely occur in adults as well.

      The main symptom of infantile hypertrophic pyloric stenosis is vomiting, which typically begins between 2 to 8 weeks of age. The vomit is usually non-bilious and forcefully expelled. It tends to occur around 30 to 60 minutes after feeding, leaving the baby hungry despite the vomiting. In some cases, there may be blood in the vomit. Other clinical features include persistent hunger, dehydration, weight loss, and constipation. An enlarged pylorus, often described as olive-shaped, can be felt in the right upper quadrant or epigastric in approximately 95% of cases. This is most noticeable at the beginning of a feed.

      The typical acid-base disturbance seen in this condition is hypochloremic metabolic alkalosis. This occurs due to the loss of hydrogen and chloride ions in the vomit, as well as decreased secretion of pancreatic bicarbonate. The increased bicarbonate ions in the distal tubule of the kidney lead to the production of alkaline urine. Hyponatremia and hypokalemia are also commonly present.

      Ultrasound scanning is the preferred diagnostic tool for infantile hypertrophic pyloric stenosis, as it is reliable and easy to perform. It has replaced barium studies as the investigation of choice.

      Initial management involves fluid resuscitation, which should be tailored to the weight and degree of dehydration. Any electrolyte imbalances should also be corrected.

      The definitive treatment for this condition is surgical intervention, with the Ramstedt pyloromyotomy being the procedure of choice. Laparoscopic pyloromyotomy is also an effective alternative if suitable facilities are available. The prognosis for infants with this condition is excellent, as long as there is no delay in diagnosis and treatment initiation.

    • This question is part of the following fields:

      • Neonatal Emergencies
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  • Question 21 - A 30-year-old man comes in with a cough and wheezing.
    What ONE clinical...

    Incorrect

    • A 30-year-old man comes in with a cough and wheezing.
      What ONE clinical feature would indicate a potential diagnosis of severe asthma?

      Your Answer:

      Correct Answer: Normal PaCO2

      Explanation:

      Asthma can be categorized into three levels of severity: moderate exacerbation, acute severe asthma, and life-threatening asthma.

      Moderate exacerbation is characterized by an increase in symptoms and a peak expiratory flow rate (PEFR) that is between 50-75% of the best or predicted value. There are no signs of acute severe asthma present.

      Acute severe asthma is indicated by a PEFR that is between 33-50% of the best or predicted value. Additionally, the respiratory rate is higher than 25 breaths per minute and the heart rate is higher than 110 beats per minute. People experiencing acute severe asthma may have difficulty completing sentences in one breath.

      Life-threatening asthma is the most severe level and requires immediate medical attention. It is identified by a PEFR that is less than 33% of the best or predicted value. Oxygen saturations are below 92% when breathing regular air. The PaCO2 levels are within the normal range of 4.6-6.0 KPa, but the PaO2 levels are below 8 KPa. Other symptoms include a silent chest, cyanosis, feeble respiratory effort, bradycardia, arrhythmia, hypotension, and signs of exhaustion, confusion, or coma.

      It is important to recognize the severity of asthma symptoms in order to provide appropriate medical care and intervention.

    • This question is part of the following fields:

      • Respiratory
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  • Question 22 - A 14-year-old girl with a background of mental health issues is brought to...

    Incorrect

    • A 14-year-old girl with a background of mental health issues is brought to the Emergency Department by law enforcement. She is currently being restrained and needs immediate sedation.
      According to the NICE guidelines for short-term management of violent and aggressive patients, what should be the first-line choice for rapid sedation in this patient?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      Rapid tranquillisation involves administering medication through injection (typically into the muscle) when oral medication is not feasible or appropriate and immediate sedation is necessary. The current guidelines from NICE regarding the short-term management of violent and aggressive patients recommend the use of intramuscular lorazepam for rapid tranquillisation in children and young individuals. The dosage should be adjusted based on their age and weight. If there is only a partial response to intramuscular lorazepam, the dosage should be assessed according to the child or young person’s age and weight, and an additional dose may be considered.

      For more information, please refer to the NICE guidance on violence and aggression: short-term management in mental health, health, and community settings.

    • This question is part of the following fields:

      • Mental Health
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  • Question 23 - A 45-year-old woman comes in with a painful sore on the bottom of...

    Incorrect

    • A 45-year-old woman comes in with a painful sore on the bottom of her right foot. She has a history of diabetes and high blood pressure and takes metformin, ramipril, and aspirin. She has no known allergies to medications. The sore is located on the front part of the foot, next to the big toe.
      Which nerve provides sensory innervation to the area where the sore is located?

      Your Answer:

      Correct Answer: Medial plantar nerve

      Explanation:

      The tibial nerve has three main sensory branches that provide sensory function. These branches include the medial plantar nerve, which supplies the skin on the medial sole and the medial three and a half toes. The lateral plantar nerve supplies the skin on the lateral sole and the lateral one and a half toes. Lastly, the medial calcaneal branches of the tibial nerve supply the skin over the heel. Overall, these branches play a crucial role in providing sensory supply to the sole of the foot.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 24 - A 32-year-old patient with asthma is transferred to the resuscitation area of your...

    Incorrect

    • A 32-year-old patient with asthma is transferred to the resuscitation area of your Emergency Department due to a worsening of their symptoms. Your consultant administers an initial dose of IV aminophylline, and the patient's symptoms start to improve. Your consultant requests that you monitor the patient's theophylline levels after a suitable period of time.
      What is the recommended therapeutic range for theophylline in plasma?

      Your Answer:

      Correct Answer: 10-20 mg/litre

      Explanation:

      In order to achieve satisfactory bronchodilation, most individuals require a plasma theophylline concentration of 10-20 mg/litre (55-110 micromol/litre). However, it is possible for a lower concentration to still be effective. Adverse effects can occur within the range of 10-20 mg/litre, and their frequency and severity increase when concentrations exceed 20 mg/litre.

      To measure plasma theophylline concentration, a blood sample should be taken five days after starting oral treatment and at least three days after any dose adjustment. For modified-release preparations, the blood sample should typically be taken 4-6 hours after an oral dose (specific sampling times may vary, so it is advisable to consult local guidelines). If aminophylline is administered intravenously, a blood sample should be taken 4-6 hours after initiating treatment.

    • This question is part of the following fields:

      • Respiratory
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  • Question 25 - A 68-year-old man with asthma has been experiencing persistent diarrhea for the past...

    Incorrect

    • A 68-year-old man with asthma has been experiencing persistent diarrhea for the past week. A stool sample has been sent for analysis, which has cultured Salmonella enteritidis. He currently takes a daily maintenance dose of prednisolone for control of his asthma.
      Which of the following antibacterial agents would be most suitable to prescribe in this situation?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      The current recommendations by NICE and the BNF for non-typhoid salmonella enteritis suggest that ciprofloxacin should be used as the first-line treatment if necessary. Alternatively, cefotaxime can be considered as a suitable alternative. It is important to note that cases of salmonella enteritis often resolve on their own without treatment and are frequently self-limiting. Therefore, the BNF advises against treatment unless there is a risk of developing invasive infection. This includes individuals who are immunocompromised, have haemoglobinopathy, or are children under 6 months old. However, in the case of an elderly patient who is regularly taking corticosteroids, treatment would be recommended.

    • This question is part of the following fields:

      • Gastroenterology & Hepatology
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  • Question 26 - A 35 year old accountant presents to the emergency department with a 3...

    Incorrect

    • A 35 year old accountant presents to the emergency department with a 3 day history of diarrhea, stomach cramps, and occasional vomiting. After evaluating the patient, you inform them that they are likely experiencing viral gastroenteritis and provide instructions for self-care at home. The patient inquires about when it would be appropriate for them to return to work.

      Your Answer:

      Correct Answer: Do NOT attend work or other institutional/social settings until at least 48 hours after the last episode of diarrhoea or vomiting.

      Explanation:

      Individuals who have gastroenteritis should be instructed to refrain from going to work or participating in social activities until at least 48 hours have passed since their last episode of diarrhea or vomiting.

      Further Reading:

      Gastroenteritis is a transient disorder characterized by the sudden onset of diarrhea, with or without vomiting. It is caused by enteric infections with viruses, bacteria, or parasites. The most common viral causes of gastroenteritis in adults include norovirus, rotavirus, and adenovirus. Bacterial pathogens such as Campylobacter jejuni and coli, Escherichia coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Salmonella typhi and paratyphi, and Shigella dysenteriae, flexneri, boydii, and sonnei can also cause gastroenteritis. Parasites such as Cryptosporidium, Entamoeba histolytica, and Giardia intestinalis or Giardia lamblia can also lead to diarrhea.

      Diagnosis of gastroenteritis is usually based on clinical symptoms, and investigations are not required in many cases. However, stool culture may be indicated in certain situations, such as when the patient is systemically unwell or immunocompromised, has acute painful diarrhea or blood in the stool suggesting dysentery, has recently taken antibiotics or acid-suppressing medications, or has not resolved diarrhea by day 7 or has recurrent diarrhea.

      Management of gastroenteritis in adults typically involves advice on oral rehydration. Intravenous rehydration and more intensive treatment may be necessary for patients who are systemically unwell, exhibit severe dehydration, or have intractable vomiting or high-output diarrhea. Antibiotics are not routinely required unless a specific organism is identified that requires treatment. Antidiarrheal drugs, antiemetics, and probiotics are not routinely recommended.

      Complications of gastroenteritis can occur, particularly in young children, the elderly, pregnant women, and immunocompromised individuals. These complications include dehydration, electrolyte disturbance, acute kidney injury, haemorrhagic colitis, haemolytic uraemic syndrome, reactive arthritis, Reiter’s syndrome, aortitis, osteomyelitis, sepsis, toxic megacolon, pancreatitis, sclerosing cholangitis, liver cirrhosis, weight loss, chronic diarrhea, irritable bowel syndrome, inflammatory bowel disease, acquired lactose intolerance, Guillain-Barré syndrome, meningitis, invasive entamoeba infection, and liver abscesses.

    • This question is part of the following fields:

      • Gastroenterology & Hepatology
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  • Question 27 - A 68-year-old man is brought into the Emergency Department by his wife. He...

    Incorrect

    • A 68-year-old man is brought into the Emergency Department by his wife. He has been experiencing excessive watery diarrhea for the past nine days and feels extremely weak.

      What type of acid-base imbalance would you anticipate in a patient with severe and prolonged diarrhea?

      Your Answer:

      Correct Answer: Normal anion gap metabolic acidosis

      Explanation:

      The following provides a summary of common causes for different acid-base disorders.

      Respiratory alkalosis can be caused by hyperventilation, such as during periods of anxiety. It can also be a result of conditions like pulmonary embolism, CNS disorders (such as stroke or encephalitis), altitude, pregnancy, or the early stages of aspirin overdose.

      Respiratory acidosis, on the other hand, is often associated with chronic obstructive pulmonary disease (COPD), life-threatening asthma, pulmonary edema, sedative drug overdose (such as opiates or benzodiazepines), neuromuscular disease, obesity, or other respiratory conditions.

      Metabolic alkalosis can occur due to vomiting, potassium depletion (often caused by diuretic usage), Cushing’s syndrome, or Conn’s syndrome.

      Metabolic acidosis with a raised anion gap can be caused by lactic acidosis (such as in cases of hypoxemia, shock, sepsis, or infarction), ketoacidosis (such as in diabetes, starvation, or alcohol excess), renal failure, or poisoning (such as in late stages of aspirin overdose, methanol or ethylene glycol ingestion).

      Lastly, metabolic acidosis with a normal anion gap can be a result of conditions like diarrhea, ammonium chloride ingestion, or adrenal insufficiency.

    • This question is part of the following fields:

      • Gastroenterology & Hepatology
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  • Question 28 - A 42 year old man is brought into the emergency department after a...

    Incorrect

    • A 42 year old man is brought into the emergency department after a car accident. He has significant bruising on the right side of his chest. You suspect he may have a hemothorax. When would thoracotomy be considered as a treatment option?

      Your Answer:

      Correct Answer: Prompt drainage of ≥1500 ml of blood following chest drain insertion

      Explanation:

      Thoracotomy is recommended when there is a need for prompt drainage of at least 1500 ml of blood following the insertion of a chest drain. Additionally, it is indicated when there is a continuous blood loss of more than 200 ml per hour for a period of 2-4 hours or when there is a persistent requirement for blood transfusion.

      Further Reading:

      Haemothorax is the accumulation of blood in the pleural cavity of the chest, usually resulting from chest trauma. It can be difficult to differentiate from other causes of pleural effusion on a chest X-ray. Massive haemothorax refers to a large volume of blood in the pleural space, which can impair physiological function by causing blood loss, reducing lung volume for gas exchange, and compressing thoracic structures such as the heart and IVC.

      The management of haemothorax involves replacing lost blood volume and decompressing the chest. This is done through supplemental oxygen, IV access and cross-matching blood, IV fluid therapy, and the insertion of a chest tube. The chest tube is connected to an underwater seal and helps drain the fluid, pus, air, or blood from the pleural space. In cases where there is prompt drainage of a large amount of blood, ongoing significant blood loss, or the need for blood transfusion, thoracotomy and ligation of bleeding thoracic vessels may be necessary. It is important to have two IV accesses prior to inserting the chest drain to prevent a drop in blood pressure.

      In summary, haemothorax is the accumulation of blood in the pleural cavity due to chest trauma. Managing haemothorax involves replacing lost blood volume and decompressing the chest through various interventions, including the insertion of a chest tube. Prompt intervention may be required in cases of significant blood loss or ongoing need for blood transfusion.

    • This question is part of the following fields:

      • Trauma
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  • Question 29 - You are asked to evaluate a 7-year-old girl who is feeling unwell in...

    Incorrect

    • You are asked to evaluate a 7-year-old girl who is feeling unwell in the Pediatric Emergency Department. Upon reviewing her urea & electrolytes, you observe that her potassium level is elevated at 6.7 mmol/l. An ECG is conducted, which reveals normal sinus rhythm. A nebulizer treatment with salbutamol is administered, and shortly after, an arterial blood gas is performed. The child's pH is 7.41, but her potassium level remains unchanged.
      As per the APLS guidelines, which medication should be utilized next?

      Your Answer:

      Correct Answer: Insulin and glucose infusion

      Explanation:

      Hyperkalaemia is when the level of potassium in the blood is higher than 5.5 mmol/l. It can be categorized as mild, moderate, or severe depending on the specific potassium levels. Mild hyperkalaemia is between 5.5-5.9 mmol/l, moderate hyperkalaemia is between 6.0-6.4 mmol/l, and severe hyperkalaemia is above 6.5 mmol/l. The most common cause of hyperkalaemia in renal failure, which can be acute or chronic. Other causes include acidosis, adrenal insufficiency, cell lysis, and excessive potassium intake.

      Calcium is used to counteract the harmful effects of hyperkalaemia on the heart by stabilizing the cardiac cell membrane and preventing abnormal depolarization. It works quickly, usually within 15 minutes, but its effects are not long-lasting. Calcium is considered a first-line treatment for arrhythmias and significant ECG abnormalities caused by hyperkalaemia, such as widening of the QRS interval, loss of the P wave, and cardiac arrhythmias. However, arrhythmias are rare at potassium levels below 7.5 mmol/l.

      It’s important to note that calcium does not lower the serum potassium level. Therefore, it should be used in conjunction with other therapies that actually help reduce potassium levels, such as insulin and salbutamol. If the pH is measured to be above 7.35 and the potassium level remains high despite nebulized salbutamol, the APLS guidelines recommend the administration of an insulin and glucose infusion.

    • This question is part of the following fields:

      • Nephrology
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  • Question 30 - A middle-aged man who lives alone is brought in by ambulance; he is...

    Incorrect

    • A middle-aged man who lives alone is brought in by ambulance; he is drowsy, vomiting and complaining of a headache. There is currently a summer heatwave, and you suspect a diagnosis of heat stroke.

      What is the threshold temperature used in the definition of heat stroke?

      Your Answer:

      Correct Answer: Above 40.6°C

      Explanation:

      Heat stroke is a condition characterized by a systemic inflammatory response, where the core body temperature rises above 40.6°C. It is accompanied by alterations in mental state and varying degrees of organ dysfunction.

      There are two types of heat stroke. The first is classic non-exertional heat stroke, which occurs when individuals are exposed to high environmental temperatures. This form of heat stroke is commonly seen in elderly patients during heat waves.

      The second type is exertional heat stroke, which occurs during intense physical activity in hot weather conditions. This form of heat stroke is often observed in endurance athletes who participate in strenuous exercise in high temperatures.

    • This question is part of the following fields:

      • Environmental Emergencies
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SESSION STATS - PERFORMANCE PER SPECIALTY

Resus (1/1) 100%
Pharmacology & Poisoning (2/3) 67%
Endocrinology (1/1) 100%
Sexual Health (0/1) 0%
Passmed