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Question 1
Correct
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A 40-year-old male patient has been referred to the hypertension clinic by his general practitioner due to hypertension that has persisted for the past 18 months. His blood pressure readings have been consistently high, measuring around 210/140 mmHg. During the examination, a large ballotable mass is detected in the right flank. The patient's blood test results reveal elevated levels of renin at 120 pmol/L (normal range: 10-60) and aldosterone at 1215 pmol/L (normal range: 100-800). Additionally, his hemoglobin levels are high at 205 g/L (normal range: 120-170). What is the most likely cause of hypertension in this case?
Your Answer: Renin secretion by a renal cell carcinoma
Explanation:The patient likely has a renal carcinoma, which can cause hypertension through obstruction of renal arteries or secretion of renin. Other symptoms may include polycythaemia, a renal mass, and elevated levels of renin and aldosterone. Renal carcinomas typically present between 40-70 years of age and have a higher incidence in men. Other symptoms may include haematuria, flank pain, weight loss, fever, and night sweats. Rarely, non-reducing varicocele and paraneoplastic syndromes may occur.
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This question is part of the following fields:
- Nephrology
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Question 2
Correct
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A 27-year-old man is brought to the emergency department by a friend who found him confused and drowsy, with his hands over his abdomen. The patient has vomited twice on the way to the hospital and appears to be in pain. An arterial blood gas reveals the following results: pH 7.29 (normal range: 7.35-7.45), HCO3- 17 mmol/L (normal range: 22-26 mmol/L), pCO2 3kPa (normal range: 4.5-6kPa), p02 12kPa (normal range: 10-14kPa), and anion gap 20mEq/L (normal range: 10-14mEq/L). Which diagnostic test would provide the quickest indication of the patient's condition?
Your Answer: Blood glucose monitoring (BM)
Explanation:Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus, accounting for around 6% of cases. It can also occur in rare cases of extreme stress in patients with type 2 diabetes mellitus. However, mortality rates have decreased from 8% to under 1% in the past 20 years. DKA is caused by uncontrolled lipolysis, resulting in an excess of free fatty acids that are ultimately converted to ketone bodies. The most common precipitating factors of DKA are infection, missed insulin doses, and myocardial infarction. Symptoms include abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and acetone-smelling breath. Diagnostic criteria include glucose levels above 13.8 mmol/l, pH below 7.30, serum bicarbonate below 18 mmol/l, anion gap above 10, and ketonaemia.
Management of DKA involves fluid replacement, insulin, and correction of electrolyte disturbance. Most patients with DKA are depleted around 5-8 litres, and isotonic saline is used initially, even if the patient is severely acidotic. Insulin is administered through an intravenous infusion, and correction of electrolyte disturbance is necessary. Long-acting insulin should be continued, while short-acting insulin should be stopped. DKA resolution is defined as pH above 7.3, blood ketones below 0.6 mmol/L, and bicarbonate above 15.0mmol/L. Complications may occur from DKA itself or the treatment, such as gastric stasis, thromboembolism, arrhythmias, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Children and young adults are particularly vulnerable to cerebral oedema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations.
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This question is part of the following fields:
- Medicine
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Question 3
Correct
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A 72-year-old retired teacher is receiving Palliative Care for advanced carcinoma of the liver. The patient has been prescribed ondansetron to alleviate symptoms of nausea and vomiting and wants to know about the potential side-effects of the medication.
What is a typical side-effect of ondansetron?Your Answer: Constipation
Explanation:Understanding the Side Effects of Ondansetron
Ondansetron is a medication commonly used to prevent nausea and vomiting. However, like any medication, it can have side effects. It is important to be aware of these potential side effects before taking ondansetron.
Constipation is the most common side effect of ondansetron. This is because the medication is broken down through the cytochrome P450 system in the liver. Other common side effects include dizziness and headache. It is also possible for ondansetron to cause QT prolongation, which can lead to fatal heart arrhythmias. Before prescribing ondansetron, it is important to check whether patients are on other potentially QT-prolonging medications.
While ondansetron can cause constipation in some patients, it is not a direct cause of diarrhea. However, overflow constipation may present as diarrhea.
Cough is not a common side effect of ondansetron. It may cause a dry mouth, but coughing is more commonly associated with angiotensin-converting enzyme inhibitors.
Palpitations and arrhythmias associated with ondansetron are uncommon. However, constipation is a common side effect.
Rarely, ondansetron may be associated with immediate hypersensitivity reactions, such as a skin rash. It is important to be aware of these potential side effects and to speak with a healthcare provider if any concerns arise.
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This question is part of the following fields:
- Pharmacology
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Question 4
Incorrect
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A 35-year-old woman visits her GP complaining of menstrual irregularity, ‘hot flashes’, nausea, palpitations and sweating, especially at night. The GP suspects that the patient may be experiencing premature menopause.
What is a known factor that can cause premature menopause?Your Answer: Polycystic ovarian syndrome
Correct Answer: Addison’s disease
Explanation:Premature Menopause: Risk Factors and Associations
Premature menopause, also known as premature ovarian failure, is a condition where a woman’s ovaries stop functioning before the age of 40. While the exact cause is unknown, there are certain risk factors and associations that have been identified.
Addison’s Disease: Women with Addison’s disease, an autoimmune disorder that affects the adrenal glands, may have steroid cell autoantibodies that cross-react with the ovarian follicles. This can lead to premature ovarian failure and early menopause.
Multiparity: Having multiple pregnancies does not increase the risk of premature menopause.
Polycystic Ovarian Syndrome: While PCOS can cause menstrual irregularities, it is not associated with premature menopause.
Recurrent Miscarriage: Women who experience recurrent miscarriages are not at an increased risk for premature menopause.
Hyperthyroidism: Hyperthyroidism can cause menstrual disturbances, but once it is treated and the patient is euthyroid, their menstrual cycle returns to normal. It is not associated with premature menopause.
In conclusion, while the cause of premature menopause is still unknown, it is important to understand the risk factors and associations in order to identify and manage the condition.
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This question is part of the following fields:
- Gynaecology
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Question 5
Correct
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A 70-year-old man has been experiencing increasing fatigue and difficulty with mobility for the past three days. He denies any chest or abdominal pain, nausea, vomiting, sweating, or fever. The patient is known to be a private individual and can be cantankerous at times. He has no family except for a son whom he has not spoken to in 15 years. Upon arrival at his home, he is able to provide a detailed medical history.
During the physical examination, the patient appears pale and mildly short of breath but is oriented. His blood pressure is 130/75 mm Hg while sitting and 122/68 mmHg while standing. Crackles are heard at both lung bases, and there is an intermittent ventricular gallop. The patient has marked joint deformities in both knees and mild ankle edema. Neurological examination is normal.
Investigations reveal the following results:
- Haemoglobin: 92 g/L (115-165)
- Plasma glucose: 5.5 mmol/L (3.0-6.0)
- Urea: 6.5 mmol/L (2.5-7.5)
- Serum creatinine: 95 µmol/L (60-110)
- Sodium: 137 mmol/L (137-144)
- Potassium: 4.2 mmol/L (3.5-4.9)
- Bicarbonate: 23 mmol/L (20-28)
Despite understanding the recommendation for hospital admission, the patient adamantly refuses and requests that his son not be contacted.
What is the best course of action for this patient?Your Answer: Prescribe furosemide, 40 mg orally, and visit her again the next day
Explanation:Respectful Management of Heart Failure Related Peripheral Oedema in Primary Care
Managing heart failure related peripheral oedema in primary care requires a respectful approach towards the patient’s wishes and needs. Even if a patient is unable to perform certain tasks, it does not necessarily mean that they are incompetent. It is important to listen to their wishes and respect them accordingly. For instance, if a patient asks not to be contacted by a certain person, their request should be honored.
Physical examination is crucial in determining the cause of heart failure related peripheral oedema. In most cases, anaemia contributes to the condition. The most appropriate initial therapy for this condition is diuretics. However, it is important to closely monitor the patient’s response to the medication.
In some cases, hospitalization may be necessary. In such situations, it is important to communicate with the patient and try to win them over to this approach. Ultimately, the goal is to provide the best possible care for the patient while respecting their wishes and needs.
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This question is part of the following fields:
- Miscellaneous
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Question 6
Correct
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A 16-year-old girl visits your GP practice seeking contraception. After counseling her, you both agree that the implant would be the most suitable option. You believe that she has the ability to make this decision and give her consent for the insertion. However, during previous consultations, you have found her to lack capacity for certain decisions and have involved her parents. According to the GMC, what is necessary to proceed with the implant insertion?
Your Answer: Just the patient's consent.
Explanation:Capacity to make decisions is dependent on both time and the individual’s ability to make decisions. If the patient did not have the capacity to make a decision in the past, but currently has the capacity to do so, their consent is the only one required. It is advisable to involve parents in the decision-making process for pediatric patients, especially in cases involving contraception. However, if the patient is not convinced, the treatment can still proceed as long as they have the capacity to make the decision. If there are doubts, it is good practice to involve another healthcare team member, but if the patient is deemed capable of making the decision, their capacitous consent is sufficient according to the GMC. There is no requirement for a time gap between consultations to allow for decision-making.
Guidelines for Obtaining Consent in Children
The General Medical Council has provided guidelines for obtaining consent in children. According to these guidelines, young people who are 16 years or older can be treated as adults and are presumed to have the capacity to make decisions. However, for children under the age of 16, their ability to understand what is involved determines whether they have the capacity to decide. If a competent child refuses treatment, a person with parental responsibility or the court may authorize investigation or treatment that is in the child’s best interests.
When it comes to providing contraceptives to patients under 16 years of age, the Fraser Guidelines must be followed. These guidelines state that the young person must understand the professional’s advice, cannot be persuaded to inform their parents, is likely to begin or continue having sexual intercourse with or without contraceptive treatment, and will suffer physical or mental health consequences without contraceptive treatment. Additionally, the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.
Some doctors use the term Fraser competency when referring to contraception and Gillick competency when referring to general issues of consent in children. However, rumors that Victoria Gillick removed her permission to use her name or applied copyright have been debunked. It is important to note that in Scotland, those with parental responsibility cannot authorize procedures that a competent child has refused.
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This question is part of the following fields:
- Paediatrics
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Question 7
Incorrect
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A 59-year-old postmenopausal woman with a history of chronic hypertension and diabetes mellitus presents with mild vaginal bleeding. The bimanual pelvic examination reveals a relatively large mass on the right side of the pelvis. The patient undergoes an abdominal and pelvic computerised tomography scan with contrast injection. The scan shows multiple enlarged lymph nodes in the pelvis, along the iliac arteries. The para-aortic lymph nodes appear normal.
What is the most likely diagnosis?Your Answer: Uterine leiomyosarcoma
Correct Answer: Cervical squamous cell carcinoma
Explanation:Differentiating Gynecologic Cancers: Understanding the Symptoms and Metastasis Patterns
When a postmenopausal woman presents with vaginal bleeding, pelvic mass, and pelvic lymphadenopathy, it is important to consider the different types of gynecologic cancers that may be causing these symptoms.
Cervical squamous cell carcinoma is the most likely diagnosis in this case, as it typically metastasizes to the pelvic lymph nodes along the iliac arteries. On the other hand, endometrial carcinoma first metastasizes to the para-aortic lymph nodes, while ovarian malignancies typically spread to the para-aortic lymph nodes and are not associated with vaginal bleeding.
Uterine leiomyosarcoma, which is the most common type of sarcoma in the female pelvis, often extends beyond the uterine serosa and may metastasize to distant organs through blood vessels. However, vaginal bleeding and pelvic lymphadenopathy are not typical features of this cancer.
Cervical adenocarcinomas, which are rare and account for about 25% of cervical cancers, are associated with human papillomavirus and prolonged exposure to exogenous estrogens, but not with smoking. Their presentation and management are similar to those of squamous cancer.
Understanding the symptoms and metastasis patterns of different gynecologic cancers is crucial in making an accurate diagnosis and providing appropriate treatment.
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This question is part of the following fields:
- Gynaecology
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Question 8
Correct
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How should neuropathic pain be managed?
Your Answer: Anticonvulsants are prescribed in similar doses to the treatment of epilepsy
Explanation:Neuropathic Pain and Treatment Options
Neuropathic pain is a chronic condition that affects neuronal membrane excitability and often results in allodynia, hyperalgesia, and hyperpathia. Unlike nociceptive pain, neuropathic pain is less responsive to opioids and can be more difficult to treat. To manage this type of pain, coanalgesics such as antidepressants, anticonvulsants, and antiarrhythmics are commonly prescribed. Anticonvulsants are typically administered at similar doses and schedules as in the treatment of epilepsy. The analgesic response to mexiletine can be predicted by evaluating the improvement in pain after an intravenous lidocaine infusion. Amitriptyline, on the other hand, has a faster analgesic response than its antidepressant effect, with pain relief occurring within a week of treatment. Overall, managing neuropathic pain requires a multifaceted approach that may involve a combination of medications and other therapies.
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This question is part of the following fields:
- Anaesthetics & ITU
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Question 9
Incorrect
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You review a 56-year-old man who has type II diabetes. He is taking metformin 2 g per day and his HbA1c is 62 mmol/mol. You consider adding sitagliptin to his regime.
Which of the following fits best with the mode of action of sitagliptin?Your Answer: It leads to an increase in activity of dipeptidyl peptidase IV (DPP-IV)
Correct Answer: It is an inhibitor of DPP-IV
Explanation:Different Mechanisms of Action for Diabetes Medications
Sitagliptin is a medication that inhibits dipeptidyl peptidase IV (DPP-IV), an enzyme responsible for breaking down glucagon-like peptide 1 (GLP-1). By inhibiting DPP-IV, sitagliptin promotes an increase in GLP-1 levels, which leads to a decrease in glucagon release and lower blood glucose levels.
On the other hand, an increase in DPP-IV activity would promote glucagon release and inhibit insulin secretion, worsening hyperglycemia. This is why sitagliptin inhibition of DPP-IV is beneficial for managing diabetes.
Pioglitazone, a thiazolidinedione medication, is a PPAR-gamma agonist. This means that it activates peroxisome proliferator-activated receptor gamma (PPAR-gamma), a protein that regulates glucose and lipid metabolism. By activating PPAR-gamma, pioglitazone increases insulin sensitivity and decreases insulin resistance, leading to lower blood glucose levels.
Glucokinase activators are a type of medication that is currently undergoing trials for the management of type II diabetes. These medications activate glucokinase, an enzyme that plays a crucial role in glucose metabolism. By activating glucokinase, these medications increase glucose uptake and utilization, leading to lower blood glucose levels.
In summary, different diabetes medications work through different mechanisms of action to manage blood glucose levels. Sitagliptin inhibits DPP-IV to increase GLP-1 levels, pioglitazone activates PPAR-gamma to increase insulin sensitivity, and glucokinase activators activate glucokinase to increase glucose uptake and utilization.
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This question is part of the following fields:
- Endocrinology
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Question 10
Correct
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An 8-year-old boy comes to the paediatric department with a 5-day history of epistaxis and mucosal bleeding during tooth brushing. He has no significant medical history except for a cold he had 3 weeks ago. Upon examination, his vital signs are normal, but he has multiple bruises and petechiae on his upper and lower limbs. The following laboratory tests were ordered: Hb 140 g/L (135-180), Platelets 33 * 109/L (150 - 400), WBC 7.3 * 109/L (4.0 - 11.0), Na+ 138 mmol/L (135 - 145), K+ 4.1 mmol/L (3.5 - 5.0), Urea 5.1 mmol/L (2.0 - 7.0), Creatinine 110 µmol/L (55 - 120). What is the most probable diagnosis?
Your Answer: Immune thrombocytopenic purpura
Explanation:When a child presents with petechiae and no fever, ITP should be considered as a possible diagnosis. ITP is an autoimmune disorder that causes thrombocytopenia without any identifiable cause. It is most commonly found in children and women and often follows a viral illness. Symptoms include mucosal bleeding, epistaxis, petechiae, and bruising.
Acute lymphoblastic leukaemia is an unlikely diagnosis in this case, as the patient’s normal haemoglobin and white cell count do not suggest malignancy.
Disseminated intravascular coagulation (DIC) is also unlikely, as there is no evidence of unregulated bleeding or thrombosis triggered by trauma, sepsis, obstetric disorders, or malignancy.
Henoch-Schönlein purpura (HSP) is another possible diagnosis, but the lack of additional symptoms and the presence of bruising and easy bleeding make ITP more likely. HSP is a form of IgA vasculitis that causes a palpable purpuric rash, abdominal pain, and arthralgia, and is commonly triggered by a viral infection. Most cases of HSP are self-limiting or resolve with symptomatic treatment.
Understanding Immune Thrombocytopenia (ITP) in Children
Immune thrombocytopenic purpura (ITP) is a condition where the immune system attacks the platelets, leading to a decrease in their count. This condition is more common in children and is usually acute, often following an infection or vaccination. The antibodies produced by the immune system target the glycoprotein IIb/IIIa or Ib-V-IX complex, causing a type II hypersensitivity reaction.
The symptoms of ITP in children include bruising, a petechial or purpuric rash, and less commonly, bleeding from the nose or gums. A full blood count is usually sufficient to diagnose ITP, and a bone marrow examination is only necessary if there are atypical features.
In most cases, ITP resolves on its own within six months, without any treatment. However, if the platelet count is very low or there is significant bleeding, treatment options such as oral or IV corticosteroids, IV immunoglobulins, or platelet transfusions may be necessary. It is also advisable to avoid activities that may result in trauma, such as team sports. Understanding ITP in children is crucial for prompt diagnosis and management of this condition.
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This question is part of the following fields:
- Paediatrics
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Question 11
Correct
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A 25-year-old woman comes to the clinic seeking family planning options that won't affect her sexual activity and can be reversed if needed. She reports experiencing irregular, painful, and heavy menstrual periods, but is in good health otherwise. The healthcare provider recommends starting the COCP as it is safe for her and may alleviate her symptoms. What other health advantages could this medication offer?
Your Answer: Decreased risk of endometrial cancer
Explanation:The combined oral contraceptive pill (COCP) is a highly effective birth control method that contains both oestrogen and progesterone. Studies have shown that the use of COCP can increase or decrease the risk of certain cancers. It has been found that the use of COCP can decrease the risk of endometrial cancer by suppressing the growth of endometrial cells. However, prolonged use of COCP has been associated with an increased risk of breast cancer, as synthetic hormones in the pill may stimulate the growth of breast cancer cells. Similarly, the use of COCP has been linked to an increased risk of cervical cancer, as it may make cervical cells more susceptible to human papillomavirus infections. It is important to note that COCP does not provide protection against sexually transmitted infections. Additionally, the use of oestrogen-containing contraception has been associated with an increased risk of strokes and ischaemic heart disease, particularly in patients with additional risk factors such as smoking and diabetes. The exact mechanism for this increased risk is not yet clear, but it may be due to increased blood pressure and/or hypercoagulation.
Pros and Cons of the Combined Oral Contraceptive Pill
The combined oral contraceptive pill is a highly effective method of birth control with a failure rate of less than 1 per 100 woman years. It does not interfere with sexual activity and its contraceptive effects are reversible upon stopping. Additionally, it can make periods regular, lighter, and less painful, and may reduce the risk of ovarian, endometrial, and colorectal cancer. It may also protect against pelvic inflammatory disease, ovarian cysts, benign breast disease, and acne vulgaris.
However, there are also some disadvantages to the combined oral contraceptive pill. One of the main issues is that people may forget to take it, which can reduce its effectiveness. It also offers no protection against sexually transmitted infections. There is an increased risk of venous thromboembolic disease, breast and cervical cancer, stroke, and ischaemic heart disease, especially in smokers. Temporary side-effects such as headache, nausea, and breast tenderness may also be experienced.
It is important to weigh the pros and cons of the combined oral contraceptive pill before deciding if it is the right method of birth control for you. While some users report weight gain while taking the pill, a Cochrane review did not support a causal relationship. Overall, the combined oral contraceptive pill can be an effective and convenient method of birth control, but it is important to discuss any concerns or potential risks with a healthcare provider.
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This question is part of the following fields:
- Gynaecology
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Question 12
Correct
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A 7-year-old girl is brought to the pediatrician's office by her father. She has been experiencing nighttime itching around her bottom and has mentioned to her father that she has seen small white strands moving in her stool. She is not constipated and is generally healthy. No one else in the household has reported similar symptoms. The girl lives with her father and her two-year-old brother.
What should be the next course of action?Your Answer: Mebendazole and hygiene measures for the patient and his parents, as his sister is too young
Explanation:It is recommended to treat asymptomatic household contacts of patients with threadworms, even if they show no symptoms. In the case of this boy with threadworms, the appropriate course of action would be to administer Mebendazole and advise on hygiene measures for both the patient and his parents. It is not necessary to send a sample to the laboratory for confirmation as empirical treatment is recommended. Advising on hygiene and fluid intake alone would not be sufficient to treat the infection. It is important to note that Mebendazole should not be given to children under six months old, so treating the patient’s three-month-old sister is not appropriate. Permethrin is not a suitable treatment for threadworms as it is used to treat scabies.
Threadworm Infestation in Children
Threadworm infestation, caused by Enterobius vermicularis or pinworms, is a common occurrence among children in the UK. The infestation happens when eggs present in the environment are ingested. In most cases, threadworm infestation is asymptomatic, but some possible symptoms include perianal itching, especially at night, and vulval symptoms in girls. Diagnosis can be made by applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically, and this approach is supported in the CKS guidelines.
The CKS recommends a combination of anthelmintic with hygiene measures for all members of the household. Mebendazole is the first-line treatment for children over six months old, and a single dose is given unless the infestation persists. It is essential to treat all members of the household to prevent re-infection. Proper hygiene measures, such as washing hands regularly, keeping fingernails short, and washing clothes and bedding at high temperatures, can also help prevent the spread of threadworm infestation.
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This question is part of the following fields:
- Paediatrics
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Question 13
Incorrect
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A 25-year-old male patient complains of recurring headaches on the left side accompanied by lacrimation, ptosis, and miosis on the same side. The duration of each episode is less than two hours. What is the probable diagnosis?
Your Answer:
Correct Answer: Cluster headache
Explanation:Cluster Headaches
Cluster headaches are a type of headache that affects the neurovascular system. These headaches are characterized by severe pain that is usually felt on one side of the head, specifically in the temple and periorbital region. Along with the pain, individuals may experience ipsilateral lacrimation, nasal congestion, conjunctival injection, miosis, ptosis, and lid oedema. The duration of each headache is brief, lasting only a few moments to two hours. The term cluster refers to the grouping of headaches that occur over a period of several weeks.
In summary, cluster headaches are a debilitating type of headache that can cause significant discomfort and disruption to daily life. the symptoms and duration of these headaches can help individuals seek appropriate treatment and management strategies.
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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A 22-year-old male patient complains of inadequate pubertal development. Upon examination, he has small testes on both sides, scanty pubic and facial hair, long arms and legs, and large hands and feet. What is the probable karyotype?
Your Answer:
Correct Answer: 47, XXY
Explanation:Klinefelter Syndrome and its Cytogenetic Studies
Klinefelter syndrome is a genetic disorder that affects males. It is characterized by the presence of an extra X chromosome, resulting in a karyotype of 47,XXY in 80-90% of cases. However, about 10% of patients have mosaicism, which can include various karyotypes such as 46,XY/47,XXY, 46,XY/48,XXXY, and 47,XXY/48,XXXY. Other variants include 48,XXYY, 48,XXXY, 49,XXXYY, and 49,XXXXY.
Compared to a normal male with a karyotype of 46,XY and Turner’s syndrome with a karyotype of 45,X, individuals with Klinefelter syndrome may exhibit physical and medical features such as delayed speech and language skills, learning disabilities, and increased height. However, most males with 47,XYY syndrome, which is a variant of Klinefelter syndrome, have normal sexual development and are able to conceive children.
In summary, Klinefelter syndrome is a genetic disorder that affects males and is characterized by an extra X chromosome. Cytogenetic studies have shown various karyotypes, including mosaicism and other variants. While individuals with Klinefelter syndrome may exhibit certain physical and medical features, most males with 47,XYY syndrome have normal sexual development and fertility.
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This question is part of the following fields:
- Clinical Sciences
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Question 15
Incorrect
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A 50-year-old woman arrives at the emergency department with severe pain in her right upper quadrant, along with a fever, rapid heart rate, and fast breathing. What is the most probable diagnosis for her condition?
Your Answer:
Correct Answer: Acute cholecystitis
Explanation:Distinguishing between acute cholecystitis and biliary colic can be done by observing the patient’s overall health. Those with cholecystitis are typically unwell, while those with biliary colic are not. A common challenge for students is differentiating between these conditions and acute cholangitis. In the case of acute cholecystitis, the patient will experience pain and systemic illness, whereas jaundice is a common symptom of cholangitis. Additionally, Murphy’s positive sign, which is pain during palpation of the right upper quadrant while inhaling, is a typical sign of acute cholecystitis. Treatment for acute cholecystitis involves IV antibiotics and laparoscopic cholecystectomy.
Acute cholecystitis is a condition where the gallbladder becomes inflamed. This is usually caused by gallstones, which are present in 90% of cases. The remaining 10% of cases are known as acalculous cholecystitis and are typically seen in severely ill patients who are hospitalized. The pathophysiology of acute cholecystitis is multifactorial and can be caused by gallbladder stasis, hypoperfusion, and infection. In immunosuppressed patients, it may develop due to Cryptosporidium or cytomegalovirus. This condition is associated with high morbidity and mortality rates.
The main symptom of acute cholecystitis is right upper quadrant pain, which may radiate to the right shoulder. Patients may also experience fever and signs of systemic upset. Murphy’s sign, which is inspiratory arrest upon palpation of the right upper quadrant, may be present. Liver function tests are typically normal, but deranged LFTs may indicate Mirizzi syndrome, which is caused by a gallstone impacted in the distal cystic duct, causing extrinsic compression of the common bile duct.
Ultrasound is the first-line investigation for acute cholecystitis. If the diagnosis remains unclear, cholescintigraphy (HIDA scan) may be used. In this test, technetium-labelled HIDA is injected IV and taken up selectively by hepatocytes and excreted into bile. In acute cholecystitis, there is cystic duct obstruction, and the gallbladder will not be visualized.
The treatment for acute cholecystitis involves intravenous antibiotics and cholecystectomy. NICE now recommends early laparoscopic cholecystectomy, within 1 week of diagnosis. Previously, surgery was delayed for several weeks until the inflammation had subsided. Pregnant women should also proceed to early laparoscopic cholecystectomy to reduce the chances of maternal-fetal complications.
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This question is part of the following fields:
- Surgery
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Question 16
Incorrect
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A 42-year-old woman complains of fatigue after experiencing flu-like symptoms two weeks ago. Upon examination, she has a smooth, small goiter and a pulse rate of 68 bpm. Her lab results show a Free T4 level of 9.3 pmol/L (normal range: 9.8-23.1) and a TSH level of 49.3 mU/L (normal range: 0.35-5.50). What additional test would you perform to confirm the diagnosis?
Your Answer:
Correct Answer: Thyroid peroxidase (TPO) antibodies
Explanation:Diagnosis and Management of Primary Hypothyroidism
The patient’s test results indicate a case of primary hypothyroidism, characterized by low levels of thyroxine (T4) and elevated thyroid-stimulating hormone (TSH). The most likely cause of this condition is Hashimoto’s thyroiditis, which is often accompanied by the presence of thyroid peroxidase antibodies. While the patient has a goitre, it appears to be smooth and non-threatening, so a thyroid ultrasound is not necessary. Additionally, a radio-iodine uptake scan is unlikely to show significant uptake and is therefore not recommended. Positive TSH receptor antibodies are typically associated with Graves’ disease, which is not the likely diagnosis in this case. For further information on Hashimoto’s thyroiditis, patients can refer to Patient.info.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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A 4-year-old girl is under your review for idiopathic constipation treatment with Movicol Paediatric Plain. Despite her mother increasing the dose, there has been no improvement. The child is in good health and abdominal examination is unremarkable. What would be the most suitable course of action to take next?
Your Answer:
Correct Answer: Add senna
Explanation:Understanding and Managing Constipation in Children
Constipation is a common problem in children, with the frequency of bowel movements decreasing as they age. The National Institute for Health and Care Excellence (NICE) has provided guidelines for the diagnosis and management of constipation in children. A diagnosis of constipation is suggested by two or more symptoms, including infrequent bowel movements, hard stools, and associated distress or pain. Most cases of constipation in children are idiopathic, but other causes such as dehydration, low-fiber diet, and medication use should be considered and excluded.
If a diagnosis of constipation is made, NICE recommends assessing for faecal impaction before starting treatment. Treatment for faecal impaction involves using polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) as the first-line treatment, with the addition of a stimulant laxative if necessary. Maintenance therapy involves a similar regime, with adjustments to the starting dose and the addition of other laxatives if necessary.
It is important to note that dietary interventions alone are not recommended as first-line treatment, although ensuring adequate fluid and fiber intake is important. Regular toileting and non-punitive behavioral interventions should also be considered. For infants, extra water, gentle abdominal massage, and bicycling the legs can be helpful for constipation. If these measures are not effective, lactulose can be added.
In summary, constipation in children can be managed effectively with a combination of medication, dietary adjustments, and behavioral interventions. It is important to follow NICE guidelines and consider the individual needs of each child.
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This question is part of the following fields:
- Paediatrics
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Question 18
Incorrect
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A 50-year-old man with type II diabetes, is having his annual diabetes review. During this review it is noticed that the man has a heart rate between 38–48 beats/min. On questioning, he mentions that he has noticed occasional palpitations, but otherwise has been asymptomatic.
An ECG is performed, which shows that on every fourth beat there is a non-conducted P-wave (a P-wave without QRS complex). Otherwise there are no other abnormalities and the PR interval is constant.
What is the most likely diagnosis?Your Answer:
Correct Answer: Second degree heart block – Mobitz type II
Explanation:Understanding Different Types of Heart Blocks on an ECG
An electrocardiogram (ECG) is a diagnostic tool used to monitor the electrical activity of the heart. It can help identify different types of heart blocks, which occur when the electrical signals that control the heartbeat are disrupted. Here are some common types of heart blocks and how they appear on an ECG:
Second Degree Heart Block – Mobitz Type II
This type of heart block is characterized by a regular non-conducted P-wave on the ECG. It may also show a widened QRS, indicating that the block is in the bundle branches of Purkinje fibers. If a patient is symptomatic with Mobitz type II heart block, permanent pacing is required to prevent progression to third degree heart block.Third Degree Heart Block
An ECG of a third degree heart block would show dissociated P-waves and QRS-waves. This means that the atria and ventricles are not communicating properly, and the heart may beat very slowly or irregularly.Atrial Flutter
Atrial flutter on an ECG would typically show a saw-toothed baseline. This occurs when the atria are beating too quickly and not in sync with the ventricles.Ectopic Beats
Ectopic beats are premature heartbeats that occur outside of the normal rhythm. They would not result in regular non-conducted P-waves on an ECG.Second Degree Heart Block – Mobitz Type I
Mobitz type I heart block would typically show progressive lengthening of the PR interval over several complexes, before a non-conducted P-wave would occur. This type of heart block is usually not as serious as Mobitz type II, but may still require monitoring and treatment. -
This question is part of the following fields:
- Cardiology
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Question 19
Incorrect
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A 29-year-old woman arrives at the Emergency Department, worried about her pregnancy. She is currently 32 weeks pregnant and has not experienced any complications. However, during a shopping trip a few hours ago, she felt a sudden rush of fluid from her vagina and noticed that her underwear was wet.
The triage nurse has already taken her vital signs, which are all within normal limits.
What is the initial test that should be performed based on the probable diagnosis?Your Answer:
Correct Answer: Speculum examination
Explanation:Preterm prelabour rupture of the membranes (PPROM) is a condition that occurs in approximately 2% of pregnancies, but it is responsible for around 40% of preterm deliveries. This condition can lead to various complications, including prematurity, infection, and pulmonary hypoplasia in the fetus, as well as chorioamnionitis in the mother. To confirm PPROM, a sterile speculum examination should be performed to check for pooling of amniotic fluid in the posterior vaginal vault. However, digital examination should be avoided due to the risk of infection. If pooling of fluid is not observed, testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor binding protein-1 is recommended. Ultrasound may also be useful to show oligohydramnios.
The management of PPROM involves admission and regular observations to ensure that chorioamnionitis is not developing. Oral erythromycin should be given for ten days, and antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome. Delivery should be considered at 34 weeks of gestation, but there is a trade-off between an increased risk of maternal chorioamnionitis and a decreased risk of respiratory distress syndrome as the pregnancy progresses. PPROM is a serious condition that requires prompt diagnosis and management to minimize the risk of complications for both the mother and the fetus.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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An 83-year-old woman visits her GP complaining of generalised weakness that has been ongoing for a month. She mentions having difficulty standing up after sitting down. She also reports noticing a red rash on her chest, but denies any itching. Her medical history is unremarkable except for hypertension that is well-controlled.
During the physical examination, the doctor observes dry hands with linear cracks and violaceous papules on both knuckles. The patient also has a distinct purple rash around each eyelid. What is the most specific antibody for the probable diagnosis?Your Answer:
Correct Answer: Anti-Jo-1 antibody
Explanation:The most specific autoantibody associated with dermatomyositis is anti-Jo-1. This is consistent with the patient’s symptoms, which include proximal myopathy, Gottron’s papules, mechanic’s hands, and a heliotrope rash. Anti-Ro antibody, anti-Smith antibody, and antinuclear antibody are not specific to dermatomyositis and are associated with other rheumatological conditions.
Dermatomyositis is a condition that causes inflammation and muscle weakness, as well as distinct skin lesions. It can occur on its own or be associated with other connective tissue disorders or underlying cancers, particularly ovarian, breast, and lung cancer. Screening for cancer is often done after a diagnosis of dermatomyositis. Polymyositis is a variant of the disease that does not have prominent skin manifestations.
The skin features of dermatomyositis include a photosensitive macular rash on the back and shoulders, a heliotrope rash around the eyes, roughened red papules on the fingers’ extensor surfaces (known as Gottron’s papules), extremely dry and scaly hands with linear cracks on the fingers’ palmar and lateral aspects (known as mechanic’s hands), and nail fold capillary dilation. Other symptoms may include proximal muscle weakness with tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease (such as fibrosing alveolitis or organizing pneumonia), dysphagia, and dysphonia.
Investigations for dermatomyositis typically involve testing for ANA antibodies, which are positive in around 80% of patients. Approximately 30% of patients have antibodies to aminoacyl-tRNA synthetases, including antibodies against histidine-tRNA ligase (also called Jo-1), antibodies to signal recognition particle (SRP), and anti-Mi-2 antibodies.
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This question is part of the following fields:
- Musculoskeletal
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Question 21
Incorrect
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A 65-year-old patient is receiving medical treatment for primary open-angle glaucoma and experiences side effects of increased eyelash length, iris, and periocular pigmentation. What medication class is responsible for these effects?
Your Answer:
Correct Answer: Prostaglandin analogues
Explanation:Prostaglandin analogues can cause hyperaemia, increased eyelash growth, periocular skin pigmentation, and increased iris pigmentation as side effects. On the other hand, beta-blockers have the potential to exacerbate asthma and heart block, unlike the other options mentioned.
Glaucoma is a condition where the optic nerve is damaged due to increased pressure in the eye. Primary open-angle glaucoma is a type where the iris is clear of the trabecular meshwork, which is responsible for draining aqueous humour from the eye. This results in increased resistance to outflow and raised intraocular pressure. The condition affects 0.5% of people over 40 years old and increases with age. Genetics also play a role, with first-degree relatives having a 16% chance of developing the disease. Symptoms are usually absent, and diagnosis is made through routine eye examinations. Investigations include visual field tests, tonometry, and slit lamp examinations. Treatment involves eye drops to lower intraocular pressure, with prostaglandin analogues being the first line of treatment. Surgery may be considered in refractory cases. Regular reassessment is necessary to monitor progression and prevent visual field loss.
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This question is part of the following fields:
- Ophthalmology
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Question 22
Incorrect
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A 84-year-old woman visits her GP with a complaint of persistent, heightened vaginal discharge. She reports that this has been going on for approximately a month and the odor is so unpleasant that she needs to change pads every 2 hours. During the examination, her abdomen is soft and painless. There is a small amount of fecal matter on the pad. A digital rectal examination reveals normal perianal sensation and an empty rectal vault. What is the probable cause of her symptom?
Your Answer:
Correct Answer: Diverticular disease
Explanation:The woman’s symptoms of diverticulitis and passing of faeces or flatus through the vaginal passage suggest the presence of a colovaginal fistula, which is a complication of diverticular disease. This abnormal connection between the colon and vagina can occur during or after episodes of diverticulitis, leading to continuous leakage of faecal matter through the vagina. This condition can be diagnosed even in the absence of active infection or inflammation. Digital rectal examination will not reveal any findings as diverticulosis does not occur in the rectum. Age-related faecal incontinence is not a valid explanation as it is not a normal part of ageing and always has an underlying cause. Bacterial vaginosis and cauda equina syndrome are not relevant to this case.
Understanding Diverticulitis
Diverticulitis is a condition where an outpouching of the intestinal mucosa becomes infected. This outpouching is called a diverticulum and the presence of these pouches is known as diverticulosis. Diverticula are common and are thought to be caused by increased pressure in the colon. They usually occur in the sigmoid colon and are more prevalent in Westerners over the age of 60. While only a quarter of people with diverticulosis experience symptoms, 75% of those who do will have an episode of diverticulitis.
Risk factors for diverticulitis include age, lack of dietary fiber, obesity, and a sedentary lifestyle. Patients with diverticular disease may experience intermittent abdominal pain, bloating, and changes in bowel habits. Those with acute diverticulitis may experience severe abdominal pain, nausea, vomiting, changes in bowel habits, and urinary symptoms. Complications may include colovesical or colovaginal fistulas.
Signs of diverticulitis include low-grade fever, tachycardia, tender lower left quadrant of the abdomen, and possibly a palpable mass. Imaging tests such as an erect CXR, AXR, and CT scans can help diagnose diverticulitis. Treatment may involve oral antibiotics, a liquid diet, and analgesia for mild cases. Severe cases may require hospitalization for IV antibiotics. Colonoscopy should be avoided initially due to the risk of perforation.
Overall, understanding the symptoms, risk factors, and signs of diverticulitis can help with early diagnosis and treatment. Proper management can help prevent complications and improve outcomes for patients.
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This question is part of the following fields:
- Surgery
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Question 23
Incorrect
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A 31-year-old woman presents to her general practitioner 7 days after giving birth to her first child. The patient has been complaining of feeling ‘down’ for the last 4 or 5 days. She also describes being tearful and tired. She denies loss of interest in her hobbies, difficulty concentrating, guilt, change in appetite, sluggishness and suicidal thoughts. She also denies hallucination.
Which of the following statements concerning this patient’s likely condition is most accurate?Your Answer:
Correct Answer: Her condition will probably improve within 10–14 days following birth
Explanation:Understanding Postpartum Mood Disorders: Symptoms and Treatment Options
Postpartum mood disorders are a common occurrence among women after giving birth. There are three main types of postpartum mood disorders: postpartum blues, postpartum depression, and postpartum psychosis.
Postpartum blues is the mildest form and affects at least 50% of women. Symptoms include fatigue, tearfulness, and a depressed mood that develops 2-3 days after giving birth. This condition usually resolves without treatment within 10-14 days following birth.
Postpartum depression is a more serious condition that affects about 10% of women. Patients present with at least 2 weeks of depressed mood that begins within 4 weeks of delivery. They also suffer from five of the following symptoms: change in sleep, loss of interest, guilt, decreased energy, difficulty concentrating, sluggishness, and suicidal ideation. Treatment options include antidepressants and psychotherapy.
Postpartum psychosis is the rarest form, with an incidence rate of about 0.1%. It is characterized by hallucinations and delusions, and patients may feel suicidal or homicidal, especially towards the newborn. This condition can last 1 month or more and often requires hospitalization with anti-psychotic treatment.
It is important to note that there is no time limit on diagnosing these conditions. If you or someone you know is experiencing symptoms of a postpartum mood disorder, seek medical attention immediately. With proper treatment, these conditions can be managed effectively, and the patient can make a full recovery.
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This question is part of the following fields:
- Psychiatry
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Question 24
Incorrect
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A 48-year-old woman is seen in rheumatology clinic for her rheumatoid arthritis. Despite trying various medications, she has not experienced much relief from her symptoms. The rheumatologist decides to prescribe hydroxychloroquine for her.
What are the potential adverse effects that the patient should be informed about?Your Answer:
Correct Answer: Retinopathy
Explanation:Hydroxychloroquine is known to have a severe and permanent side effect on the retina, known as ‘bull’s eye retinopathy’, which can result in significant visual loss. Recent studies suggest that this side effect is more common than previously thought, and the Royal College of Ophthalmologists recommends regular monitoring. While hydroxychloroquine may also cause keratopathy, this is considered less harmful. The other ocular effects listed as options are not associated with hydroxychloroquine.
Long-term steroid use is known to cause cataracts and open-angle glaucoma.
While case reports have linked bisphosphonates to scleritis and uveitis, there is limited data on this association. However, these conditions are commonly associated with rheumatological and inflammatory disorders.Hydroxychloroquine: Uses and Adverse Effects
Hydroxychloroquine is a medication commonly used in the treatment of rheumatoid arthritis and systemic/discoid lupus erythematosus. It is similar to chloroquine, which is used to treat certain types of malaria. However, hydroxychloroquine has been found to cause bull’s eye retinopathy, which can result in severe and permanent visual loss. Recent data suggests that this adverse effect is more common than previously thought, and the most recent guidelines recommend baseline ophthalmological examination and annual screening, including colour retinal photography and spectral domain optical coherence tomography scanning of the macula. Despite this risk, hydroxychloroquine may still be used in pregnant women if needed. Patients taking this medication should be asked about visual symptoms and have their visual acuity monitored annually using a standard reading chart.
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Incorrect
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A 47-year-old man is prescribed haloperidol, a first-generation antipsychotic, for an acute psychotic episode. He had previously been on olanzapine, a second-generation antipsychotic, but discontinued it due to adverse reactions. What adverse effect is he more prone to encounter with this new medication in comparison to olanzapine?
Your Answer:
Correct Answer: Torticollis
Explanation:Antipsychotic medications can cause acute dystonic reactions, which are more frequently seen with first-generation antipsychotics like haloperidol. These reactions may include dysarthria, torticollis, opisthotonus, and oculogyric crises. Atypical antipsychotics are more likely to cause diabetes mellitus and dyslipidemia, while neither typical nor atypical antipsychotics are commonly associated with osteoporosis.
Antipsychotics are a group of drugs used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. They are associated with extrapyramidal side-effects and hyperprolactinaemia, which are less common with atypical antipsychotics.
Extrapyramidal side-effects (EPSEs) are common with typical antipsychotics and include Parkinsonism, acute dystonia, sustained muscle contraction, akathisia, and tardive dyskinesia. The latter is a late onset of choreoathetoid movements that may be irreversible and occur in 40% of patients. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients, including an increased risk of stroke and venous thromboembolism. Other side-effects include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval.
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This question is part of the following fields:
- Psychiatry
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Question 26
Incorrect
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A 15-year-old girl presents with a six-month history of fatigue, lethargy, and abdominal discomfort with constipation. Despite denying depression, her academic performance has declined. On examination, she appears pale and thin with a blood pressure of 110/60 mmHg. Her laboratory results show low potassium levels, high bicarbonate levels, and a slightly elevated ESR. A chest X-ray is normal. Based on these findings, what is the most probable underlying diagnosis?
Your Answer:
Correct Answer: Anorexia nervosa
Explanation:Anorexia Nervosa and Electrolyte Imbalances
Anorexia nervosa is a possible diagnosis for a patient with low sodium and potassium levels, especially if vomiting is present. Interestingly, despite the severe weight loss associated with anorexia nervosa, albumin levels tend to remain normal. However, if albumin levels are reduced, other causes such as sepsis should be considered. Addison’s disease and Conn’s syndrome are also conditions that can cause electrolyte imbalances, but their clinical presentations differ from that of anorexia nervosa. Cushing’s disease, on the other hand, is not a likely diagnosis in this case. It is important to consider the underlying cause of electrolyte imbalances in order to provide appropriate treatment.
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This question is part of the following fields:
- Clinical Sciences
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Question 27
Incorrect
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A 65-year-old man comes to the Emergency Department with severe abdominal pain and haematemesis. Following initial resuscitation, an urgent CT scan shows a perforated duodenal ulcer. The surgical team schedules an emergency laparotomy, and he is transferred to the operating room. Due to his non-fasted state, the anaesthetist intends to perform a rapid sequence induction (RSI) using a depolarising muscle relaxant to minimize airway obstruction.
What is the appropriate drug to use in this situation?Your Answer:
Correct Answer: Suxamethonium
Explanation:Suxamethonium belongs to the category of depolarising muscle relaxants, which is one of the two main categories of muscle relaxants used in anaesthesia. The other category is non-depolarising muscle relaxants. Therefore, suxamethonium is the correct answer out of the given options. Rocuronium, mivacurium, and pancuronium are all examples of non-depolarising muscle relaxants and are incorrect options. Sugammadex is used for reversing neuromuscular blockade caused by rocuronium and vecuronium and is also an incorrect answer.
Muscle relaxants are drugs that can be used to induce paralysis in patients undergoing surgery or other medical procedures. Suxamethonium is a type of muscle relaxant that works by inhibiting the action of acetylcholine at the neuromuscular junction. It is broken down by plasma cholinesterase and acetylcholinesterase and has the fastest onset and shortest duration of action of all muscle relaxants. However, it can cause adverse effects such as hyperkalaemia, malignant hyperthermia, and lack of acetylcholinesterase.
Atracurium is another type of muscle relaxant that is a non-depolarising neuromuscular blocking drug. It usually has a duration of action of 30-45 minutes and may cause generalised histamine release on administration, which can produce facial flushing, tachycardia, and hypotension. Unlike suxamethonium, atracurium is not excreted by the liver or kidney but is broken down in tissues by hydrolysis. Its effects can be reversed by neostigmine.
Vecuronium is also a non-depolarising neuromuscular blocking drug that has a duration of action of approximately 30-40 minutes. Its effects may be prolonged in patients with organ dysfunction as it is degraded by the liver and kidney. Similarly, its effects can be reversed by neostigmine.
Pancuronium is a non-depolarising neuromuscular blocker that has an onset of action of approximately 2-3 minutes and a duration of action of up to 2 hours. Its effects may be partially reversed with drugs such as neostigmine. Overall, muscle relaxants are important drugs in medical practice, but their use requires careful consideration of their potential adverse effects and appropriate monitoring of patients.
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This question is part of the following fields:
- Surgery
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Question 28
Incorrect
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A 35-year-old man with a past medical history of internal hemorrhoids presents with a recent exacerbation of symptoms. He reports having to manually reduce his piles after bowel movements. What grade of hemorrhoids is he experiencing?
Your Answer:
Correct Answer: Grade III
Explanation:Understanding Haemorrhoids
Haemorrhoids are a normal part of the anatomy that contribute to anal continence. They are mucosal vascular cushions found in specific areas of the anal canal. However, when they become enlarged, congested, and symptomatic, they are considered haemorrhoids. The most common symptom is painless rectal bleeding, but pruritus and pain may also occur. There are two types of haemorrhoids: external, which originate below the dentate line and are prone to thrombosis, and internal, which originate above the dentate line and do not generally cause pain. Internal haemorrhoids are graded based on their prolapse and reducibility. Management includes softening stools through dietary changes, topical treatments, outpatient procedures like rubber band ligation, and surgery for large, symptomatic haemorrhoids. Acutely thrombosed external haemorrhoids may require excision if the patient presents within 72 hours, but otherwise can be managed with stool softeners, ice packs, and analgesia.
Overall, understanding haemorrhoids and their management is important for individuals experiencing symptoms and healthcare professionals providing care.
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This question is part of the following fields:
- Surgery
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Question 29
Incorrect
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Which of the following does not result in feeding challenges during the neonatal phase?
Your Answer:
Correct Answer: Physiological jaundice
Explanation:Feeding Difficulty and Physiological Jaundice
Feeding difficulty is a common problem among infants, but it is not associated with physiological jaundice. Physiological jaundice is a benign condition that is short-lived and does not generally cause any symptoms. This means that it is not related to feeding difficulties that infants may experience.
It is important for parents to be aware of the signs of feeding difficulty in their infants, such as difficulty latching, poor weight gain, and excessive crying during feeding. These symptoms may indicate an underlying medical condition that requires prompt attention. On the other hand, physiological jaundice is a normal occurrence in many newborns and typically resolves on its own without any treatment.
In summary, while feeding difficulty is a common problem among infants, it is not associated with physiological jaundice. Parents should be aware of the signs of feeding difficulty and seek medical attention if necessary, but they can rest assured that physiological jaundice is a benign condition that does not generally cause any symptoms.
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This question is part of the following fields:
- Paediatrics
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Question 30
Incorrect
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A 50-year-old construction worker presents with a haematemesis.
His wife provides a history that he has consumed approximately six cans of beer per day together with liberal quantities of whiskey for many years. He has attempted to quit drinking in the past but was unsuccessful.
Upon examination, he appears distressed and disoriented. His pulse is 110 beats per minute and blood pressure is 112/80 mmHg. He has several spider naevi over his chest. Abdominal examination reveals a distended abdomen with ascites.
What would be your next course of action for this patient?Your Answer:
Correct Answer: Endoscopy
Explanation:Possible Causes of Haematemesis in a Patient with Alcohol Abuse
When a patient with a history of alcohol abuse presents with symptoms of chronic liver disease and sudden haematemesis, the possibility of bleeding oesophageal varices should be considered as the primary diagnosis. However, other potential causes such as peptic ulceration or haemorrhagic gastritis should also be taken into account. To determine the exact cause of the bleeding, an urgent endoscopy should be requested. This procedure will allow for a thorough examination of the gastrointestinal tract and enable the medical team to identify the source of the bleeding. Prompt diagnosis and treatment are crucial in managing this potentially life-threatening condition.
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This question is part of the following fields:
- Gastroenterology
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