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  • Question 1 - A 32-year-old pregnant woman is concerned about the risk of measles, mumps, and...

    Incorrect

    • A 32-year-old pregnant woman is concerned about the risk of measles, mumps, and rubella (MMR) infection for her unborn baby. She has never been vaccinated for MMR and is currently 14 weeks pregnant. There are no sick contacts around her.

      What is the appropriate course of action in this situation?

      Your Answer: Give her an one-off dose of MMR vaccine during her current visit

      Correct Answer: Refrain from giving her any MMR vaccination now and at any stage of her pregnancy

      Explanation:

      The MMR vaccine, which contains live attenuated virus, should not be given to women who are pregnant or trying to conceive. It is recommended that women avoid getting pregnant for at least 28 days after receiving the vaccine. If a pregnant woman is not immune to MMR, she should avoid contact with individuals who have the disease. In the event that a woman receives the MMR vaccine unintentionally during the periconception period or early pregnancy, termination of pregnancy is not necessary. This information is based on the guidelines provided by the American College of Obstetricians and Gynecologists.

      Rubella and Pregnancy: Risks, Features, Diagnosis, and Management

      Rubella, also known as German measles, is a viral infection caused by the togavirus. Thanks to the introduction of the MMR vaccine, it is now rare. However, if contracted during pregnancy, there is a risk of congenital rubella syndrome, which can cause serious harm to the fetus. It is important to note that the incubation period is 14-21 days, and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.

      The risk of damage to the fetus is highest in the first 8-10 weeks of pregnancy, with a risk as high as 90%. However, damage is rare after 16 weeks. Features of congenital rubella syndrome include sensorineural deafness, congenital cataracts, congenital heart disease (e.g. patent ductus arteriosus), growth retardation, hepatosplenomegaly, purpuric skin lesions, ‘salt and pepper’ chorioretinitis, microphthalmia, and cerebral palsy.

      If a suspected case of rubella in pregnancy arises, it should be discussed immediately with the local Health Protection Unit (HPU) as type/timing of investigations may vary. IgM antibodies are raised in women recently exposed to the virus. It should be noted that it is very difficult to distinguish rubella from parvovirus B19 clinically. Therefore, it is important to also check parvovirus B19 serology as there is a 30% risk of transplacental infection, with a 5-10% risk of fetal loss.

      If a woman is tested at any point and no immunity is demonstrated, they should be advised to keep away from people who might have rubella. Non-immune mothers should be offered the MMR vaccination in the post-natal period. However, MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.

    • This question is part of the following fields:

      • Obstetrics
      279.5
      Seconds
  • Question 2 - A 28-year-old male patient visits their GP complaining of abdominal pain and bloody...

    Incorrect

    • A 28-year-old male patient visits their GP complaining of abdominal pain and bloody diarrhoea that began six weeks ago. He has never experienced anything like this before and believes he may have lost some weight in the past three months. When asked about his family history, he mentions that his father was diagnosed with bowel cancer at the age of 30, and he remembers his grandfather having a stoma before he passed away when the patient was a child. The GP suspects bowel cancer and is concerned about a potential genetic abnormality. During colonoscopy, a large tumour is discovered in the ascending colon near the hepatic flexure, but the rest of the colonic mucosa appears normal. What is the most probable underlying genetic issue?

      Your Answer: Heterozygous Familial Adenomatous Polyposis (FAP)

      Correct Answer: Lynch Syndrome

      Explanation:

      Familial adenomatous polyposis (FAP) has a mutation in the APC gene and is characterized by over 100 colonic adenomas and a 100% cancer risk. MYH-associated polyposis has a biallelic mutation of the MYH gene and is associated with multiple colonic polyps and a 100% cancer risk by age 60. Peutz-Jeghers syndrome has a mutation in the STK11 gene and is characterized by multiple benign intestinal hamartomas and an increased risk of GI cancers. Cowden disease has a mutation in the PTEN gene and is associated with multiple intestinal hamartomas and an 89% risk of cancer at any site. HNPCC (Lynch syndrome) has germline mutations of DNA mismatch repair genes and is associated with a high risk of colorectal and endometrial cancer. Screening and management strategies vary for each syndrome.

    • This question is part of the following fields:

      • Surgery
      153.4
      Seconds
  • Question 3 - A 30-year-old man arrives at the emergency department after intentionally overdosing on 50...

    Correct

    • A 30-year-old man arrives at the emergency department after intentionally overdosing on 50 aspirin tablets at 10:15 following an argument with his partner. He has a history of anxiety, depression, and self-harm, with multiple hospital admissions due to intentional overdose. Upon examination, his temperature is 38.5ºC, heart rate is 120 bpm, blood pressure is 110/70 mmHg, and respiratory rate is 30 breaths per minute. The current time is 11:00. What is the most appropriate next step in managing this patient?

      Your Answer: Activated charcoal

      Explanation:

      Activated charcoal is a suitable treatment option for aspirin overdose within an hour of ingestion. It can adsorb the salicylate in the gastrointestinal tract, preventing its absorption. In this case, since the patient has presented within 50 minutes of the overdose, activated charcoal can be offered. Haemodialysis is not necessary at this point as the patient does not exhibit severe poisoning symptoms. IV acetylcysteine is not applicable in aspirin overdose cases as it is used for paracetamol overdose management.

      Salicylate overdose can result in a combination of respiratory alkalosis and metabolic acidosis. The initial effect of salicylates is to stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis. However, as the overdose progresses, the direct acid effects of salicylates, combined with acute renal failure, can cause metabolic acidosis. In children, metabolic acidosis tends to be more prominent. Other symptoms of salicylate overdose include tinnitus, lethargy, sweating, pyrexia, nausea/vomiting, hyperglycemia and hypoglycemia, seizures, and coma.

      The treatment for salicylate overdose involves general measures such as airway, breathing, and circulation support, as well as administering activated charcoal. Urinary alkalinization with intravenous sodium bicarbonate can help eliminate aspirin in the urine. In severe cases, hemodialysis may be necessary. Indications for hemodialysis include a serum concentration of salicylates greater than 700 mg/L, metabolic acidosis that is resistant to treatment, acute renal failure, pulmonary edema, seizures, and coma.

      It is important to note that salicylates can cause the uncoupling of oxidative phosphorylation, which leads to decreased adenosine triphosphate production, increased oxygen consumption, and increased carbon dioxide and heat production. Therefore, prompt and appropriate treatment is crucial in managing salicylate overdose.

    • This question is part of the following fields:

      • Pharmacology
      223.4
      Seconds
  • Question 4 - A 28-year-old woman presents with a 48-hour history of headache and malaise that...

    Correct

    • A 28-year-old woman presents with a 48-hour history of headache and malaise that has worsened in the last 6 hours. She has vomited twice and recently had a sore throat. Her general practitioner has been treating her with a topical anti-fungal cream for vaginal thrush. On examination, she is photophobic and has moderate neck stiffness. The Glasgow Coma Score is 15/15, and she has no focal neurological signs. Her temperature is 38.5 °C. A computed tomography (CT) brain scan is reported as ‘Normal intracranial appearances’. A lumbar puncture is performed and CSF results are as follows: CSF protein 0.6 g/l (<0.45), cell count 98 white cells/mm3, mainly lymphocytes (<5), CSF glucose 2.8 mmol/l (2.5 – 4.4 mmol/l), and blood glucose 4.3 mmol/l (3-6 mmol/l). What is the most likely diagnosis?

      Your Answer: Acute viral meningitis

      Explanation:

      Distinguishing Acute Viral Meningitis from Other Neurological Disorders

      Acute viral meningitis is characterized by mild elevation of protein, a mainly lymphocytic cellular reaction, and a CSF: blood glucose ratio of >50%. In contrast, bacterial meningitis presents with a polymorph leukocytosis, lower relative glucose level, and more severe signs of meningism. Tuberculous meningitis typically presents subacutely with very high CSF protein and very low CSF glucose. Fungal meningitis is rare and mainly occurs in immunocompromised individuals. Guillain–Barré syndrome, an autoimmune peripheral nerve disorder causing ascending paralysis, is often triggered by a recent viral illness but presents with focal neurological signs, which are absent in viral meningitis. Accurate diagnosis is crucial for appropriate treatment and management.

    • This question is part of the following fields:

      • Neurology
      52.2
      Seconds
  • Question 5 - A patient who underwent abdominal surgery 12 hours ago now has a temperature...

    Incorrect

    • A patient who underwent abdominal surgery 12 hours ago now has a temperature of 38.2ºC. Their blood pressure is 118/78 mmHg, heart rate 68 beats per minute and respiratory rate 16 breaths/minute. The patient reports feeling pain around the incisional wound. On examination, the wound appears red and their chest is clear. What is the probable reason for the fever in this scenario?

      Your Answer: Wound infection

      Correct Answer: Physiological reaction to operation

      Explanation:

      The most likely cause of a fever developing within the first 24 hours after surgery in an otherwise healthy patient is a physiological reaction to the operation. This is due to the inflammatory response to tissue damage caused by the surgery. Other potential causes such as cellulitis, pneumonia, and pulmonary embolism are less likely due to the absence of other symptoms and vital sign changes. Cellulitis may present with red and tender wounds, but without changes in other vital signs, it is not the likely cause. Pneumonia and pulmonary embolism typically occur after 48 hours and 2-10 days respectively, and would be accompanied by changes in heart and respiratory rates, which were not observed in this patient.

      Post-operative pyrexia, or fever, can occur after surgery and can be caused by various factors. Early causes of post-op pyrexia, which typically occur within the first five days after surgery, include blood transfusion, cellulitis, urinary tract infection, and a physiological systemic inflammatory reaction that usually occurs within a day following the operation. Pulmonary atelectasis is also often listed as an early cause, but the evidence to support this link is limited. Late causes of post-op pyrexia, which occur more than five days after surgery, include venous thromboembolism, pneumonia, wound infection, and anastomotic leak.

      To remember the possible causes of post-op pyrexia, it is helpful to use the memory aid of the 4 W’s: wind, water, wound, and what did we do? (iatrogenic). This means that the causes can be related to respiratory issues (wind), urinary tract or other fluid-related problems (water), wound infections or complications (wound), or something that was done during the surgery or post-operative care (iatrogenic). It is important to identify the cause of post-op pyrexia and treat it promptly to prevent further complications. This information is based on a peer-reviewed publication available on the National Center for Biotechnology Information website.

    • This question is part of the following fields:

      • Surgery
      37
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  • Question 6 - A 56-year-old man presents to the Emergency Department with central abdominal pain. The...

    Correct

    • A 56-year-old man presents to the Emergency Department with central abdominal pain. The pain started very suddenly, is described as severe and radiates through to his back. He has a past medical history of hypertension. On examination, the patient looks unwell, with some bruising around his flanks.
      Investigation Result Normal value
      Heart rate (HR) 118 bpm 60–100 bpm
      Blood pressure (BP) 98/62 mmHg < 120/80 mmHg
      Respiratory rate (RR) 28 breaths/min 12–18 breaths/min
      Sats 95% on air 94–98%
      Temperature 36 °C 36.1–37.2 °C
      There is generalised tenderness upon palpation of the abdomen.
      Which of the following is the most likely diagnosis?

      Your Answer: Ruptured AAA

      Explanation:

      Possible Diagnoses for Abdominal Pain and Bruising

      When a patient presents with abdominal pain and bruising, it is important to consider a range of possible diagnoses. In this case, a ruptured abdominal aortic aneurysm (AAA) is the most likely explanation, given the patient’s history and examination findings. This is a serious condition with high mortality, and urgent surgical intervention is required if AAA is suspected. To avoid further complications, blood pressure should be maintained at less than 100 mmHg.

      Other potential diagnoses that should be ruled out include pancreatitis, renal artery stenosis, appendicitis, and aortic dissection. Pancreatitis can also cause abdominal pain and bruising, but the patient’s symptoms and signs suggest AAA as the primary concern. Renal artery stenosis typically presents differently and is less likely in this case. Appendicitis can cause central abdominal pain, but it is not the most likely explanation here. Aortic dissection can cause pain radiating to the back, but the location and severity of the pain in this patient do not fit with that diagnosis. Overall, prompt and accurate diagnosis is crucial for effective treatment and management of abdominal pain and bruising.

    • This question is part of the following fields:

      • Vascular
      33.9
      Seconds
  • Question 7 - A 30-year-old woman presents with a swollen second toe and wrist pain associated...

    Correct

    • A 30-year-old woman presents with a swollen second toe and wrist pain associated with a 5 month history of generalised fatigue. She has no other symptoms including no skin changes, and no previous medical history. Her mother suffers from psoriasis. She had the following blood tests as part of her investigations.

      Hb 125 g/l

      Platelets 390 * 109/l

      WBC 6.5 * 109/l

      ESR 78 mm/h

      Rheumatoid Factor Negative

      Antinuclear Antibody Negative

      What is the most likely diagnosis?

      Your Answer: Psoriatic arthritis

      Explanation:

      Although females in this age group can be affected by SLE and rheumatoid arthritis, the most probable diagnosis for this patient is psoriatic arthritis due to the presence of dactylitis and a first-degree relative with psoriasis. Furthermore, rheumatoid factor and antinuclear antibody are typically positive in rheumatoid arthritis, while antinuclear antibody is mainly positive in SLE. Gout usually targets the first metatarsophalangeal joint of the first toe.

      Psoriatic arthropathy is a type of inflammatory arthritis that is associated with psoriasis. It is classified as one of the seronegative spondyloarthropathies and is known to have a poor correlation with cutaneous psoriasis. In fact, it often precedes the development of skin lesions. This condition affects both males and females equally, with around 10-20% of patients with skin lesions developing an arthropathy.

      The presentation of psoriatic arthropathy can vary, with different patterns of joint involvement. The most common type is symmetric polyarthritis, which is very similar to rheumatoid arthritis and affects around 30-40% of cases. Asymmetrical oligoarthritis is another type, which typically affects the hands and feet and accounts for 20-30% of cases. Sacroiliitis, DIP joint disease, and arthritis mutilans (severe deformity of fingers/hand) are other patterns of joint involvement. Other signs of psoriatic arthropathy include psoriatic skin lesions, periarticular disease, enthesitis, tenosynovitis, dactylitis, and nail changes.

      To diagnose psoriatic arthropathy, X-rays are often used. These can reveal erosive changes and new bone formation, as well as periostitis and a pencil-in-cup appearance. Management of this condition should be done by a rheumatologist, and treatment is similar to that of rheumatoid arthritis. However, there are some differences, such as the use of monoclonal antibodies like ustekinumab and secukinumab. Mild peripheral arthritis or mild axial disease may be treated with NSAIDs alone, rather than all patients being on disease-modifying therapy as with RA. Overall, psoriatic arthropathy has a better prognosis than RA.

    • This question is part of the following fields:

      • Musculoskeletal
      72
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  • Question 8 - A neighbor has a grandchild diagnosed with tetralogy of Fallot and asks you...

    Incorrect

    • A neighbor has a grandchild diagnosed with tetralogy of Fallot and asks you about this condition.
      Which of the following is a characteristic of this condition?

      Your Answer: Atrial septal defect (ASD)

      Correct Answer: Right ventricular hypertrophy

      Explanation:

      Common Congenital Heart Defects and Acquired Valvular Defects

      Congenital heart defects are present at birth and can affect the structure and function of the heart. Tetralogy of Fallot is a common congenital heart defect that includes right ventricular hypertrophy, ventricular septal defect, right-sided outflow tract obstruction, and overriding aorta. On the other hand, patent ductus arteriosus (PDA) and atrial septal defect (ASD) are not part of the tetralogy of Fallot but are commonly occurring congenital heart defects.

      PDA is characterized by a persistent communication between the descending thoracic aorta and the pulmonary artery, while ASD is characterized by a defect in the interatrial septum, allowing shunting of blood from left to right. If left untreated, patients with a large PDA are at risk of developing Eisenmenger syndrome in later life.

      Acquired valvular defects, on the other hand, are not present at birth but develop over time. Aortic stenosis is an acquired valvular defect that results from progressive narrowing of the aortic valve area over several years. Tricuspid stenosis, which is caused by obstruction of the tricuspid valve, can be a result of several conditions, including rheumatic heart disease, congenital abnormalities, active infective endocarditis, and carcinoid tumors.

    • This question is part of the following fields:

      • Paediatrics
      13.1
      Seconds
  • Question 9 - A 70-year-old man with metastatic prostate cancer presents with bony leg pain, constipation...

    Incorrect

    • A 70-year-old man with metastatic prostate cancer presents with bony leg pain, constipation for 4 days, abdominal pain, thirst and disorientation. On examination, he is cachectic and dehydrated. He is apyrexial and haemodynamically stable. He has a past medical history of hypertension and is an ex-smoker. He has no known drug allergies. His calcium is 3.1 mmol/l and he has normal renal function.
      What is the most suitable initial management for this patient?

      Your Answer: IV pamidronate

      Correct Answer: Intravenous (iv) 0.9% normal saline

      Explanation:

      Management of Hypercalcaemia in Cancer Patients

      Hypercalcaemia is a medical emergency commonly seen in cancer patients. It presents with symptoms such as lethargy, anorexia, nausea, constipation, dehydration, polyuria, polydipsia, renal stones, confusion, and generalised aches. Other causes of hypercalcaemia include primary and tertiary hyperparathyroidism, sarcoidosis, myeloma, and vitamin D excess. The management of hypercalcaemia involves intravenous (iv) normal saline and bisphosphonates. Local protocols should be referenced for specific guidelines.

      Steroids such as dexamethasone are not recommended for patients who do not have cord compression. Furosemide may be used alongside iv fluids if the patient is at risk of fluid overload, such as in heart failure. Bisphosphonates, such as iv pamidronate, act over 48 hours by preventing bone resorption and inhibiting osteoclasts. Urgent chemotherapy is not recommended for hypercalcaemia as it does not address the underlying cause of the symptoms.

      In conclusion, hypercalcaemia in cancer patients requires prompt management with iv normal saline and bisphosphonates. Other treatment options should be considered based on the patient’s individual needs and local protocols.

    • This question is part of the following fields:

      • Clinical Biochemistry
      94.9
      Seconds
  • Question 10 - A 38-year-old man comes to the emergency department with a sudden-onset severe headache...

    Correct

    • A 38-year-old man comes to the emergency department with a sudden-onset severe headache and vomiting that started an hour ago. He has no significant medical history but is a smoker and drinks socially. The doctor suspects a subarachnoid haemorrhage and wants to perform the most appropriate first-line investigation to confirm the diagnosis.

      What is the most suitable initial test to confirm the suspected diagnosis in this patient?

      Your Answer: CT scan without contrast

      Explanation:

      Diagnostic Investigations for Subarachnoid Haemorrhage

      Subarachnoid haemorrhage (SAH) is a medical emergency that requires urgent investigation and management. The following diagnostic investigations are commonly used to diagnose and manage SAH:

      CT Scan without Contrast: This is the first line investigation for every patient suspected of having SAH. A positive scan will show a hyperdense area in the basal cisterns. If SAH is confirmed, further imaging with angiography is required to locate the bleed and treat it appropriately.

      Fundal Examination: Although fundal examination may show some abnormal findings, it is not a diagnostic investigation for SAH.

      MRI Scan: MRI scan is considered less optimal for detecting SAH due to longer study times and higher cost implications. The sensitivity of MRI in detecting SAH is thought to be equal or less sensitive to that of CT scanning.

      CT Angiogram: A CT angiogram is appropriate after acute SAH is confirmed via CT without contrast. The CT angiogram may then be used to confirm the origin of the bleed.

      Lumbar Puncture: In a small percentage of patients with SAH, CT head can be normal. A lumbar puncture should be performed in patients with suspected SAH and a normal CT of the head as long as the CT scan showed no contraindications. The lumbar puncture should ideally be delayed for 4-12 hours to diagnose xanthochromia reliably. Microscopy of the CSF is unreliable because many lumbar punctures are traumatic, and therefore red blood cells will be seen even in the absence of SAH.

      Diagnostic Investigations for Subarachnoid Haemorrhage

    • This question is part of the following fields:

      • Neurosurgery
      82.1
      Seconds
  • Question 11 - What is a true statement about gentamicin treatment? ...

    Correct

    • What is a true statement about gentamicin treatment?

      Your Answer: May produce ventilatory failure in sensitive patients

      Explanation:

      Aminoglycosides and Their Side Effects

      Aminoglycosides are a class of antibiotics that can cause oto and renal toxicity, which is why drug concentrations need to be closely monitored during treatment. These antibiotics are primarily excreted by the kidneys, so any impairment in renal function can lead to increased toxicity. Additionally, a rare side effect of aminoglycosides is ventilatory failure, which is associated with impaired neuromuscular junction conduction. Therefore, patients with myasthenia gravis should not be given aminoglycosides.

      Aminoglycosides are administered intravenously and cannot be taken orally because they are denatured in the digestive system. It is important to note that these antibiotics are reserved for serious infections due to their potential for toxicity. Patients receiving aminoglycosides should be closely monitored for any signs of toxicity, including hearing loss, kidney damage, and neuromuscular weakness. Overall, aminoglycosides are effective antibiotics, but their use should be carefully considered and monitored to minimize the risk of adverse effects.

    • This question is part of the following fields:

      • Pharmacology
      13.5
      Seconds
  • Question 12 - Liam is an 8-year-old boy brought in by his father with a 2...

    Incorrect

    • Liam is an 8-year-old boy brought in by his father with a 2 day history of fever and sore throat. Today he has developed a rash on his torso. He is eating and drinking well, but has not been to school for the last 2 days and has been feeling tired.

      On examination, Liam is alert, smiling and playful. He has a temperature of 37.8°C. His throat appears red with petechiae on the hard and soft palate and his tongue is covered with a white coat through which red papillae are visible. There is a blanching rash present on his trunk which is red and punctate with a rough, sandpaper-like texture.

      What is the appropriate time for Liam to return to school, given the most likely diagnosis?

      Your Answer: Once she has completed a course of antibiotics

      Correct Answer: 24 hours after commencing antibiotics

      Explanation:

      If a child has scarlet fever, they can go back to school after 24 hours of starting antibiotics. The symptoms described are typical of scarlet fever, including a strawberry tongue and a rough-textured rash with small red spots on the palate called Forchheimer spots. Charlotte doesn’t need to be hospitalized but should take a 10-day course of phenoxymethylpenicillin (penicillin V). According to NICE, the child should stay away from school, nursery, or work for at least 24 hours after starting antibiotics. It’s also important to advise parents to take measures to prevent cross-infection, such as frequent handwashing, avoiding sharing utensils and towels, and disposing of tissues promptly.

      Scarlet fever is a condition caused by erythrogenic toxins produced by Group A haemolytic streptococci, usually Streptococcus pyogenes. It is more prevalent in children aged 2-6 years, with the highest incidence at 4 years. The disease spreads through respiratory droplets or direct contact with nose and throat discharges, especially during sneezing and coughing. The incubation period is 2-4 days, and symptoms include fever, malaise, headache, nausea/vomiting, sore throat, ‘strawberry’ tongue, and a rash that appears first on the torso and spares the palms and soles. The rash has a rough ‘sandpaper’ texture and desquamation occurs later in the course of the illness, particularly around the fingers and toes.

      To diagnose scarlet fever, a throat swab is usually taken, but antibiotic treatment should be initiated immediately, rather than waiting for the results. Management involves administering oral penicillin V for ten days, while patients with a penicillin allergy should be given azithromycin. Children can return to school 24 hours after commencing antibiotics, and scarlet fever is a notifiable disease. Although usually a mild illness, scarlet fever may be complicated by otitis media, rheumatic fever, acute glomerulonephritis, or rare invasive complications such as bacteraemia, meningitis, or necrotizing fasciitis, which may present acutely with life-threatening illness.

    • This question is part of the following fields:

      • Paediatrics
      176.1
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  • Question 13 - Which of the following interventions is most likely to decrease the occurrence of...

    Correct

    • Which of the following interventions is most likely to decrease the occurrence of intra-abdominal adhesions?

      Your Answer: Use of a laparoscopic approach over open surgery

      Explanation:

      Adhesion formation can be reduced by opting for laparoscopy over traditional surgery. The use of talc-coated surgical gloves, which was a major contributor to adhesion formation, has been discontinued. The outdated Nobles plication procedure does not aid in preventing adhesion formation. While the use of an anastomotic stapling device does not directly affect adhesion development, it is important to avoid anastomotic leaks as they can lead to increased adhesion formation.

      Complications can occur in all types of surgery and require vigilance in their detection. Anticipating likely complications and appropriate avoidance can minimize their occurrence. Understanding the anatomy of a surgical field will allow appreciation of local and systemic complications that may occur. Physiological and biochemical derangements may also occur, and appropriate diagnostic modalities should be utilized. Safe and timely intervention is the guiding principle for managing complications.

    • This question is part of the following fields:

      • Surgery
      29.9
      Seconds
  • Question 14 - A 26-year-old primigravida at 32 weeks gestation presents with vaginal bleeding and severe...

    Incorrect

    • A 26-year-old primigravida at 32 weeks gestation presents with vaginal bleeding and severe abdominal pain. The abdominal pain started suddenly in the night, about 3 hours ago. It is a severe dull pain in the suprapubic region and doesn't radiate anywhere. The pain has not settled at all since onset and is not positional. She rates the pain as 10/10 in severity. She passed about 2 cupfuls of blood 1 hour previously. She reports that the bleeding has soaked through 2 sanitary pads. She also complains of back pain and is exquisitely tender on suprapubic palpation. She has not noticed any decreased foetal movements, although says that her baby is not particularly active usually. What is the most likely diagnosis?

      Your Answer: Miscarriage

      Correct Answer: Placenta abruption

      Explanation:

      Placenta abruptio is characterized by painful vaginal bleeding, while placenta praevia typically does not cause pain. In cases of placenta abruptio, the uterus may feel hard and woody to the touch due to retroplacental blood tracking into the myometrium. The absence of fetal heart rate and shock in the mother are common symptoms. Immediate resuscitation is crucial, and once stable, the baby will require urgent delivery. Postpartum hemorrhage is more likely to occur in these cases.

      Placental Abruption: Causes, Symptoms, and Risk Factors

      Placental abruption is a condition that occurs when the placenta separates from the uterine wall, leading to maternal bleeding into the space between them. Although the exact cause of this condition is unknown, certain factors have been associated with it, including proteinuric hypertension, cocaine use, multiparity, maternal trauma, and increasing maternal age. Placental abruption is not a common occurrence, affecting approximately 1 in 200 pregnancies.

      The clinical features of placental abruption include shock that is disproportionate to the visible blood loss, constant pain, a tender and tense uterus, and a normal lie and presentation of the fetus. The fetal heart may be absent or distressed, and there may be coagulation problems. It is important to be aware of other conditions that may present with similar symptoms, such as pre-eclampsia, disseminated intravascular coagulation (DIC), and anuria.

      In summary, placental abruption is a serious condition that can have significant consequences for both the mother and the fetus. Understanding the risk factors and symptoms of this condition is important for early detection and appropriate management.

    • This question is part of the following fields:

      • Obstetrics
      159.9
      Seconds
  • Question 15 - A 75-year-old man is admitted with a urinary tract infection and subsequently develops...

    Correct

    • A 75-year-old man is admitted with a urinary tract infection and subsequently develops confusion with poor concentration. He becomes restless and frightened, exhibiting abusive behavior towards staff and experiencing perceptual abnormalities. There is no significant psychiatric history. What is the most probable diagnosis?

      Your Answer: Acute confusional state

      Explanation:

      Acute Confusional State

      Acute confusional state, also known as delirium, is a condition characterized by sudden confusion and disorientation. It is often triggered by an infection, especially in patients without prior history of psychiatric illness. This condition is common among hospitalized patients, with a prevalence rate of 20%.

      Patients with acute confusional state may exhibit symptoms such as irritability, reduced cognitive abilities, and disturbed perception, including hallucinations. They may also experience disorientation and have difficulty their surroundings.

      It is important to identify and manage acute confusional state promptly, as it can lead to complications such as falls, prolonged hospitalization, and increased mortality rates. Treatment may involve addressing the underlying cause, providing supportive care, and administering medications to manage symptoms.

      In summary, acute confusional state is a serious condition that can affect patients without prior history of psychiatric illness. Early recognition and management are crucial to prevent complications and improve outcomes.

    • This question is part of the following fields:

      • Miscellaneous
      10.7
      Seconds
  • Question 16 - What distinguishes graded potentials from action potentials? ...

    Correct

    • What distinguishes graded potentials from action potentials?

      Your Answer: Graded potentials are localised, while action potentials conduct across the entire axon

      Explanation:

      Graded Potentials vs. Action Potentials

      Graded potentials are changes in the transmembrane potential that occur mainly in the dendrites and soma of a neuron. These changes do not cause significant depolarization to spread far from the area surrounding the site of stimulation. Graded potentials may or may not lead to an action potential, depending on the magnitude of depolarization. On the other hand, action potentials exhibit a refractory phase and are not subject to either temporal or spatial summation.

      Graded potentials involve chemical, mechanical, or light-gated channels that allow for an influx of sodium ions into the cytosol. In contrast, action potentials involve only voltage-gated ion channels, specifically sodium and potassium. Graded potentials typically last from a few milliseconds to even minutes, while action potential duration ranges between 0.5 – 2 milliseconds.

      In summary, graded and action potentials are two distinct phenomena. Graded potentials are subject to modulation by both temporal and spatial summation, while action potentials are not. Graded potentials involve different types of ion channels compared to action potentials. the differences between these two types of potentials is crucial in the complex processes that occur in the nervous system.

    • This question is part of the following fields:

      • Neurology
      17.9
      Seconds
  • Question 17 - A 25-year-old professional who is working long hours develops intermittent periods of abdominal...

    Correct

    • A 25-year-old professional who is working long hours develops intermittent periods of abdominal pain and bloating. She also notices a change in bowel habit and finds that going to the restroom helps to relieve her abdominal pain.
      Which of the following drug treatments may help in the treatment of her colic and bloating symptoms?

      Your Answer: Mebeverine

      Explanation:

      Treatment Options for Irritable Bowel Syndrome (IBS)

      Irritable bowel syndrome (IBS) is a common functional bowel disorder that affects mostly young adults, with women being more commonly affected than men. The diagnosis of IBS can be established using the Rome IV criteria, which includes recurrent abdominal pain or discomfort for at least one day per week in the last three months, along with two or more of the following: improvement with defecation, onset associated with a change in frequency of stool, or onset associated with a change in form (appearance) of the stool.

      There are several treatment options available for IBS, depending on the predominant symptoms. Mebeverine, an antispasmodic, can be used to relieve colicky abdominal pain. Loperamide can be useful for patients with diarrhea-predominant IBS (IBS-D), while osmotic laxatives such as macrogols are preferred for constipation-predominant IBS (IBS-C). Cimetidine, a histamine H2 receptor antagonist, can help with acid reflux symptoms, but is unlikely to help with colic or bloating. Metoclopramide, a D2 dopamine receptor antagonist, is used as an antiemetic and prokinetic, but is not effective for colic and bloating symptoms.

      In summary, treatment options for IBS depend on the predominant symptoms and can include antispasmodics, laxatives, and acid reflux medications. It is important to consult with a healthcare provider to determine the best course of treatment for each individual patient.

    • This question is part of the following fields:

      • Gastroenterology
      15.7
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  • Question 18 - A 28-year-old woman with Crohn's disease (CD) visits her primary care physician for...

    Correct

    • A 28-year-old woman with Crohn's disease (CD) visits her primary care physician for a regular follow-up. During the examination, the doctor observes clubbing, hepatomegaly, and episcleritis, which are known signs linked with CD. What other non-intestinal symptom is commonly associated with CD?

      Your Answer: Pyoderma gangrenosum

      Explanation:

      Extra-Intestinal Manifestations and Skin Conditions Associated with Inflammatory Bowel Disease

      Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), can present with extra-intestinal manifestations, with some features being more prevalent in one than the other. Joint complications are the most common, but other manifestations include eye inflammation, joint pain and stiffness, and liver and biliary tree issues. Additionally, CD can present with skin conditions such as pyoderma gangrenosum, while UC is associated with primary sclerosing cholangitis and cholangiocarcinoma.

      Other skin conditions, such as necrobiosis lipoidica and palmar erythema, are not associated with IBD. Erythema multiforme is a drug-related skin rash, while lichen planus is a skin rash of unknown cause that is not associated with IBD. It is important for healthcare providers to be aware of these extra-intestinal manifestations and skin conditions when evaluating patients with IBD.

    • This question is part of the following fields:

      • Gastroenterology
      21.9
      Seconds
  • Question 19 - At a multidisciplinary meeting, the nutritional concerns of a 70-year-old patient on the...

    Correct

    • At a multidisciplinary meeting, the nutritional concerns of a 70-year-old patient on the oncology ward are being discussed. The patient is currently undergoing chemotherapy and radiotherapy for pancreatic cancer and has been experiencing a significant decrease in appetite and body mass index, which now sits at 17 kg/m². Nurses have reported that the patient has not been eating meals. The dietician team suggests discussing the risks and benefits of parenteral nutrition before involving the patient's family. This form of nutrition is expected to continue for the next few weeks. Which blood vessel would be suitable for administering parenteral nutrition?

      Your Answer: Subclavian vein

      Explanation:

      Total parenteral nutrition must be administered through a central vein due to its high phlebitic nature. This type of nutrition is considered full nutrition and should only be given for more than 10 days. If it is only used to supplement enteral feeding or for a short period, peripheral parenteral nutrition may be an option. The reason for using a central vein is that TPN is hypertonic to blood and has a high osmolality, which can increase the risk of phlebitis. Central veins are larger, have higher flow rates, and fewer valves than peripheral veins, making them more suitable for TPN administration. The subclavian vein is an example of a central vein that can be used for this purpose. The external jugular veins, hepatic portal vein, superior mesenteric artery, and pulmonary arteries are not appropriate for TPN administration.

      Nutrition Options for Surgical Patients

      When it comes to providing nutrition for surgical patients, there are several options available. The easiest and most common option is oral intake, which can be supplemented with calorie-rich dietary supplements. However, this may not be suitable for all patients, especially those who have undergone certain procedures.

      nasogastric feeding is another option, which involves administering feed through a fine bore nasogastric feeding tube. While this method may be safe for patients with impaired swallow, there is a risk of aspiration or misplaced tube. It is also usually contra-indicated following head injury due to the risks associated with tube insertion.

      Naso jejunal feeding is a safer alternative as it avoids the risk of feed pooling in the stomach and aspiration. However, the insertion of the feeding tube is more technically complicated and is easiest if done intra-operatively. This method is safe to use following oesophagogastric surgery.

      Feeding jejunostomy is a surgically sited feeding tube that may be used for long-term feeding. It has a low risk of aspiration and is thus safe for long-term feeding following upper GI surgery. However, there is a risk of tube displacement and peritubal leakage immediately following insertion, which carries a risk of peritonitis.

      Percutaneous endoscopic gastrostomy is a combined endoscopic and percutaneous tube insertion method. However, it may not be technically possible in patients who cannot undergo successful endoscopy. Risks associated with this method include aspiration and leakage at the insertion site.

      Finally, total parenteral nutrition is the definitive option for patients in whom enteral feeding is contra-indicated. However, individualised prescribing and monitoring are needed, and it should be administered via a central vein as it is strongly phlebitic. Long-term use is associated with fatty liver and deranged LFTs.

      In summary, there are several nutrition options available for surgical patients, each with its own benefits and risks. The choice of method will depend on the patient’s individual needs and circumstances.

    • This question is part of the following fields:

      • Surgery
      77.2
      Seconds
  • Question 20 - A 16-year-old girl informs you during her appointment that her cousin was recently...

    Correct

    • A 16-year-old girl informs you during her appointment that her cousin was recently diagnosed with Bell's palsy and she has some inquiries about it. Which cranial nerve is primarily impacted by Bell's palsy?

      Your Answer: Cranial nerve VII

      Explanation:

      Overview of Cranial Nerves and Their Functions in Eye and Facial Movement

      Cranial nerves play a crucial role in eye and facial movement. Cranial nerve VII, also known as the facial nerve, is affected in Bell’s palsy, causing a lower motor neuron VIIth nerve palsy that affects one side of the face. Cranial nerve IV, or the trochlear nerve, supplies the superior oblique muscle of the eye, and injury to this nerve causes vertical diplopia. Cranial nerve III, or the oculomotor nerve, supplies several muscles that control eye movement and the levator palpebrae superioris. Cranial nerve V, or the trigeminal nerve, provides sensation in the face and controls the muscles of mastication. Finally, cranial nerve VI, or the abducens nerve, supplies the lateral rectus muscle and lesions of this nerve cause lateral diplopia. Understanding the functions of these cranial nerves is essential in diagnosing and treating conditions that affect eye and facial movement.

    • This question is part of the following fields:

      • Neurology
      18.1
      Seconds
  • Question 21 - A 25-year-old woman presents to the GP with a three-day history of vaginal...

    Incorrect

    • A 25-year-old woman presents to the GP with a three-day history of vaginal itching and thick, non-odorous white discharge. She had a similar complaint four months ago but has no other medical history. The patient is married and sexually active with her husband, and her menstrual cycle is regular, following a 28-day cycle. Vaginal pH testing shows a value of 4.3. What further tests should be conducted before initiating treatment?

      Your Answer: High vaginal swab

      Correct Answer: None needed, the diagnosis is clinical

      Explanation:

      The diagnosis of vaginal candidiasis does not require a high vaginal swab if the symptoms are highly suggestive. In fact, the diagnosis can be made clinically based on the patient’s symptoms. For example, if a patient presents with thickened, white discharge that resembles cottage cheese and vaginal itching, along with a normal vaginal pH, it is very likely that they have vaginal candidiasis. It is important to note that glycated haemoglobin (HbA1c) is not necessary for diagnosis unless the patient has recurrent episodes of vaginal candidiasis, which may indicate diabetes mellitus. Additionally, a midstream urine sample is not useful in diagnosing vaginal candidiasis and should only be used if a sexually-transmitted infection is suspected.

      Vaginal candidiasis, also known as thrush, is a common condition that many women can diagnose and treat themselves. Candida albicans is responsible for about 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain factors such as diabetes mellitus, antibiotics, steroids, pregnancy, and HIV can increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, itching, vulval erythema, fissuring, and satellite lesions. A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy, with oral fluconazole 150 mg as a single dose being the first-line treatment according to NICE Clinical Knowledge Summaries. If there are vulval symptoms, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments. Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and a high vaginal swab for microscopy and culture should be performed to confirm the diagnosis. A blood glucose test may be necessary to exclude diabetes, and differential diagnoses such as lichen sclerosus should be ruled out. An induction-maintenance regime involving oral fluconazole may be considered. Induction involves taking oral fluconazole every three days for three doses, while maintenance involves taking oral fluconazole weekly for six months.

    • This question is part of the following fields:

      • Gynaecology
      64.6
      Seconds
  • Question 22 - A 67-year-old man with end-stage renal disease due to adult polycystic kidney disease...

    Correct

    • A 67-year-old man with end-stage renal disease due to adult polycystic kidney disease complained of worsening lower back and sacral pain for the past 5 months. He looked emaciated and had lost a significant amount of weight. Despite taking regular paracetamol, his pain was excruciating. He is currently awaiting additional tests.
      What analgesics would be more effective in managing his pain?

      Your Answer: Oxycodone

      Explanation:

      Patients with moderate to end-stage renal failure can safely use oxycodone as it is primarily metabolized in the liver. However, NSAIDs such as naproxen should be avoided as they can lead to acute renal failure, interstitial nephritis (especially with ibuprofen and naproxen), volume overload, and worsening hypertension due to sodium retention caused by the inhibition of prostaglandin, which affects sodium excretion.

      Prescribing for Patients with Renal Failure

      When it comes to prescribing medication for patients with renal failure, it is important to be aware of which drugs to avoid and which ones require dose adjustment. Antibiotics such as tetracycline and nitrofurantoin should be avoided, as well as NSAIDs, lithium, and metformin. These drugs can potentially harm the kidneys or accumulate in the body, leading to toxicity.

      On the other hand, some drugs can be used with dose adjustment. Antibiotics like penicillins, cephalosporins, vancomycin, gentamicin, and streptomycin, as well as medications like digoxin, atenolol, methotrexate, sulphonylureas, furosemide, and opioids, may require a lower dose in patients with chronic kidney disease. It is important to monitor these patients closely and adjust the dose as needed.

      Finally, there are some drugs that are relatively safe to use in patients with renal failure. Antibiotics like erythromycin and rifampicin, as well as medications like diazepam and warfarin, can sometimes be used at normal doses depending on the degree of chronic kidney disease. However, it is still important to monitor these patients closely and adjust the dose if necessary.

      In summary, prescribing medication for patients with renal failure requires careful consideration of the potential risks and benefits of each drug. By avoiding certain drugs, adjusting doses of others, and monitoring patients closely, healthcare providers can help ensure the safety and effectiveness of treatment.

    • This question is part of the following fields:

      • Pharmacology
      258.1
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  • Question 23 - A 61-year-old electrician presents with a 4-month history of cough and weight loss....

    Correct

    • A 61-year-old electrician presents with a 4-month history of cough and weight loss. On further questioning, the patient reports experiencing some episodes of haemoptysis. He has a long-standing history of hypothyroidism, which is well managed with thyroxine 100 µg daily. The patient smokes ten cigarettes a day and has no other significant medical history. Blood tests and an X-ray are carried out, which reveal possible signs of asbestosis. A CT scan is ordered to investigate further.
      What is the typical CT scan finding of asbestosis in the lung?

      Your Answer: Honeycombing of the lung with parenchymal bands and pleural plaques

      Explanation:

      Differentiating Lung Diseases: Radiological Findings

      Asbestosis is a lung disease characterized by interstitial pneumonitis and fibrosis, resulting in honeycombing of the lungs with parenchymal bands and pleural plaques. Smoking can accelerate its presentation. On a chest X-ray, bilateral reticulonodular opacities in the lower zones are observed, while a CT scan shows increased interlobular septae, parenchymal bands, and honeycombing. Silicosis, on the other hand, presents with irregular linear shadows and hilar lymphadenopathy, which can progress to PMF with compensatory emphysema. Tuberculosis is characterized by cavitation of upper zones, while pneumoconiosis shows parenchymal nodules and lower zone emphysema. Proper diagnosis is crucial in determining the appropriate treatment and management of these lung diseases.

    • This question is part of the following fields:

      • Respiratory
      49.7
      Seconds
  • Question 24 - A 63-year-old man presents to his general practitioner with stiffness in his muscles,...

    Incorrect

    • A 63-year-old man presents to his general practitioner with stiffness in his muscles, difficulty initiating movements such as getting up from a chair, slow movements and hand shaking, which started 5 weeks ago. He has a medical history of schizophrenia and has had good compliance with his medication for the past 3 months. He is taking haloperidol. On examination, his temperature is 37.5 °C, blood pressure 120/81 mmHg and pulse 98 bpm. On examination, there is decreased facial expression, pill-rolling tremor, cogwheel rigidity and festinating gait.
      Which of the following terms describes the symptoms of this patient?

      Your Answer: Tardive dyskinesia

      Correct Answer: Bradykinesia

      Explanation:

      Common Neurological Side Effects of Medications

      Medications can sometimes cause neurological side effects that mimic symptoms of neurological disorders. One such side effect is called pseudo-parkinsonism, which is characterized by bradykinesia or slowness in movements. This can be caused by typical and atypical antipsychotic medication, anti-emetics like metoclopramide, and some calcium channel blockers like cinnarizine.

      Another side effect is acute dystonia, which is the sudden and sustained contraction of muscles in any part of the body, usually following the administration of a neuroleptic agent. Akathisia is another symptom associated with antipsychotic use, which is characterized by restlessness and the inability to remain motionless.

      Tardive dyskinesia is a neurological side effect that is characterized by involuntary muscle movements, usually affecting the tongue, lips, trunk, and extremities. This is seen in patients who are on long-term anti-dopaminergic medication such as antipsychotic medication (both typical and atypical), some antidepressants, metoclopramide, prochlorperazine, carbamazepine, phenytoin, and others.

      Finally, neuroleptic malignant syndrome is a life-threatening condition associated with the use of antipsychotic medication. It is characterized by hyperthermia, muscle rigidity, changes in level of consciousness, and autonomic instability. Management is supportive, and symptoms generally resolve within 1-2 weeks.

      Understanding the Neurological Side Effects of Medications

    • This question is part of the following fields:

      • Psychiatry
      94.3
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  • Question 25 - A 70-year-old man undergoing chemo-radiotherapy treatment for prostate cancer complains of poor appetite...

    Correct

    • A 70-year-old man undergoing chemo-radiotherapy treatment for prostate cancer complains of poor appetite and nausea secondary to his treatment. He is finding it difficult to cope with his illness and has become depressed.
      Which of the following may be the most suitable appetite stimulant for him?

      Your Answer: Mirtazapine

      Explanation:

      Medications for Appetite Stimulation and Mood Improvement in a Patient with Anorexia

      Mirtazapine is an antidepressant that can also stimulate appetite, making it a suitable option for a patient with anorexia who needs both mood improvement and increased food intake. Dexamethasone can also be used to boost appetite in the short term. However, metoclopramide is not effective for mood improvement and would require dual therapy with another medication. Megestrol, a progestin, is indicated for anorexia, cachexia, or significant weight loss, but it does not address mood issues. Trazodone, on the other hand, is an antidepressant but may not be the first choice for a patient with anorexia as it can cause weight loss and anorexia as side effects.

    • This question is part of the following fields:

      • Oncology
      35
      Seconds
  • Question 26 - A 55-year-old woman is scheduled for a routine blood pressure check. As she...

    Correct

    • A 55-year-old woman is scheduled for a routine blood pressure check. As she waits in the reception area, she suddenly experiences severe breathlessness with stridor. She had mentioned to someone else in the room that she was stung by an insect on her way to the clinic. Based on your assessment, you determine that she is having an anaphylactic reaction to the sting. What would be the appropriate dose and route of administration for adrenaline in this scenario?

      Your Answer: Intramuscular 1:1000 (500 micrograms)

      Explanation:

      Recommended Injection Route for Anaphylactic Reactions

      Anaphylactic reactions require immediate treatment, and one of the most effective ways to administer medication is through injection. The recommended route of injection is intramuscular, which involves injecting the medication into the muscle tissue. While the subcutaneous route can also be used, it is not as effective as the intramuscular route. In some cases, intravenous adrenaline 1:10000 may be used, but only under the supervision of a specialist. It is important to follow the guidelines provided by the Resuscitation Council (UK) for the emergency treatment of anaphylactic reactions. By administering medication through the recommended injection route, healthcare providers can effectively manage anaphylactic reactions and potentially save lives.

    • This question is part of the following fields:

      • Emergency Medicine
      10.2
      Seconds
  • Question 27 - A 20-year-old male patient arrives at the emergency department following a fall from...

    Incorrect

    • A 20-year-old male patient arrives at the emergency department following a fall from his skateboard, where he landed on his outstretched right hand. On examination, the patient reports experiencing considerable pain and tenderness between the extensor pollicis longus and extensor pollicis brevis tendons of his right hand. An X-ray is conducted, but no abnormalities are detected.
      What is the best initial approach to managing this injury?

      Your Answer: Immobilise using Futuro splint or standard below-elbow backslab for 4 weeks

      Correct Answer: Immobilise using Futuro splint or standard below-elbow backslab before specialist review

      Explanation:

      For non-displaced or minimally displaced scaphoid fractures (less than 0.5mm), immobilization for 6 weeks is sufficient for union. However, since these fractures can lead to avascular necrosis and other long-term complications, it is crucial to seek specialized medical attention. It is unnecessary to immobilize the elbow with a standard above-elbow backslab for suspected scaphoid fractures.

      Understanding Scaphoid Fractures

      A scaphoid fracture is a type of wrist fracture that typically occurs when a person falls onto an outstretched hand or during contact sports. It is important to recognize this type of fracture due to the unusual blood supply of the scaphoid bone. Interruption of the blood supply can lead to avascular necrosis, which is a serious complication. Patients with scaphoid fractures typically present with pain along the radial aspect of the wrist and loss of grip or pinch strength. Clinical examination is highly sensitive and specific when certain signs are present, such as tenderness over the anatomical snuffbox and pain on telescoping of the thumb.

      Plain film radiographs should be requested, including scaphoid views, but the sensitivity in the first week of injury is only 80%. A CT scan may be requested in the context of ongoing clinical suspicion or planning operative management, while MRI is considered the definite investigation to confirm or exclude a diagnosis. Initial management involves immobilization with a splint or backslab and referral to orthopaedics. Orthopaedic management depends on the patient and type of fracture, with undisplaced fractures of the scaphoid waist typically treated with a cast for 6-8 weeks. Displaced scaphoid waist fractures require surgical fixation, as do proximal scaphoid pole fractures. Complications of scaphoid fractures include non-union, which can lead to pain and early osteoarthritis, and avascular necrosis.

    • This question is part of the following fields:

      • Musculoskeletal
      98.6
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  • Question 28 - A 34-year-old man and his wife have been struggling to conceive for the...

    Correct

    • A 34-year-old man and his wife have been struggling to conceive for the past decade. During his examination, you notice that he is tall and thin with bilateral gynaecomastia. Your colleague has conducted some initial tests, and one of them has come back indicating elevated levels of urinary gonadotrophins. What is the probable diagnosis?

      Your Answer: Klinefelter's syndrome

      Explanation:

      Genetic Disorders and Andropause

      Gaucher’s and Marfan syndrome are genetic disorders that do not cause infertility. Noonan’s syndrome, on the other hand, is associated with short stature. Klinefelter’s syndrome is a sex chromosome disorder that affects males, with a prevalence of 1 in 400 to 1 in 600 births. This disorder is characterized by the presence of an extra X chromosome, resulting in a karyotype of 47 XXY, XXXYY, or XXYY.

      Andropause is a term used to describe the gradual decrease in serum testosterone concentration that occurs with age. However, this condition typically does not occur until after the age of 50. It is important to note that while these conditions may have some similarities, they are distinct and require different approaches to diagnosis and treatment. Proper diagnosis and management of these conditions can help individuals lead healthy and fulfilling lives.

    • This question is part of the following fields:

      • Clinical Sciences
      57.7
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  • Question 29 - A 4-year-old child is brought to your office by their mother, complaining of...

    Incorrect

    • A 4-year-old child is brought to your office by their mother, complaining of diarrhoea that has been ongoing for a few months. The mother reports that the diarrhoea does not have a foul smell but sometimes contains undigested food. The child does not experience any abdominal pain or bloating. Upon measuring their height and weight, it is found to be appropriate for their age. What is the most probable diagnosis?

      Your Answer: Lactose intolerance

      Correct Answer: Toddler's diarrhoea

      Explanation:

      Toddler’s diarrhoea is a harmless condition that does not cause any issues for the child. It occurs due to the rapid movement of food through their digestive system and may contain undigested food particles. No treatment is necessary. However, it is advisable to monitor the child’s growth by tracking their height and weight to rule out any serious underlying conditions such as coeliac disease, which may cause the child to drop centiles on the growth chart. Gastroenteritis is unlikely to persist for several months, and it is probable that other members of the household would also be affected.

      Understanding Diarrhoea in Children

      Diarrhoea is a common condition in children that can be caused by various factors. One of the most common causes is gastroenteritis, which is often accompanied by fever and vomiting for the first two days. The main risk associated with this condition is severe dehydration, which can be life-threatening if left untreated. The most common cause of gastroenteritis is rotavirus, and the diarrhoea may last up to a week. The treatment for this condition is rehydration.

      Chronic diarrhoea is another type of diarrhoea that can affect infants and toddlers. In the developed world, the most common cause of chronic diarrhoea in infants is cow’s’ milk intolerance. Toddler diarrhoea, on the other hand, is characterized by stools that vary in consistency and often contain undigested food. Other causes of chronic diarrhoea in children include coeliac disease and post-gastroenteritis lactose intolerance.

    • This question is part of the following fields:

      • Paediatrics
      113.9
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  • Question 30 - You are asked to give a presentation to a group of third-year medical...

    Incorrect

    • You are asked to give a presentation to a group of third-year medical students about the different types of dementia and how they may present.
      Which of the following is characteristic of frontotemporal dementia?

      Your Answer: Rapid progressive loss of memory and cognitive abilities

      Correct Answer: Confabulation and repetition

      Explanation:

      Understanding Fronto-Temporal Dementia: Symptoms and Features

      Fronto-temporal dementia is a complex disorder that affects both the frontal and temporal lobes of the brain. Its diagnosis can be challenging, especially in the early stages of the disease. To better understand this condition, it is helpful to examine its symptoms and features based on the affected brain regions.

      Frontal lobe dysfunction is characterized by changes in personality and behavior, such as loss of tact and concern for others, disinhibition, emotional instability, distractibility, impulsivity, and fixed attitudes. However, some patients may exhibit opposite behaviors and become increasingly withdrawn.

      Temporal lobe dysfunction, on the other hand, affects speech and language abilities, leading to dysphasia, confabulation, repetition, and difficulty finding words and names (semantic dementia).

      Other features of fronto-temporal dementia include earlier onset (typically between 40-60 years old), slow and insidious progression, relatively preserved memory in the early stages, and loss of executive function as the disease advances. Unlike Alzheimer’s disease, hallucinations, paranoia, and delusions are rare, and personality and mood remain largely unaffected.

      It is important to note that fronto-temporal dementia can present differently in late onset cases (70-80 years old) and does not typically involve bradykinesia, a hallmark symptom of Parkinson’s disease. Rapid progressive loss of memory and cognitive abilities is also not typical of fronto-temporal dementia, as the disease tends to progress slowly over time.

      In summary, understanding the symptoms and features of fronto-temporal dementia can aid in its early detection and management.

    • This question is part of the following fields:

      • Neurology
      22.4
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SESSION STATS - PERFORMANCE PER SPECIALTY

Obstetrics (0/2) 0%
Surgery (2/4) 50%
Pharmacology (3/3) 100%
Neurology (3/4) 75%
Vascular (1/1) 100%
Musculoskeletal (1/2) 50%
Paediatrics (0/3) 0%
Clinical Biochemistry (0/1) 0%
Neurosurgery (1/1) 100%
Miscellaneous (1/1) 100%
Gastroenterology (2/2) 100%
Gynaecology (0/1) 0%
Respiratory (1/1) 100%
Psychiatry (0/1) 0%
Oncology (1/1) 100%
Emergency Medicine (1/1) 100%
Clinical Sciences (1/1) 100%
Passmed