-
Question 1
Correct
-
A 65-year-old insurance broker with mitral stenosis is seen in the Cardiology Clinic. He reports increasing shortness of breath on exertion and general fatigue over the past six months. Additionally, he notes swelling in his feet and ankles at the end of the day. What is the first-line intervention for symptomatic mitral stenosis with a mobile undistorted mitral valve and no left atrial thrombus or mitral regurgitation?
Your Answer: Balloon valvuloplasty
Explanation:Treatment Options for Mitral Valve Disease
Mitral valve disease can be managed through various treatment options depending on the severity and type of the condition. Balloon valvuloplasty is the preferred option for symptomatic patients with mitral stenosis, while mitral valve repair is the preferred surgical management for mitral regurgitation. Aortic valve replacement is an option if the aortic valve is faulty. Mitral valve replacement with a metallic valve requires high levels of anticoagulation, and therefore repair is preferred if possible. The Blalock–Taussig shunt is a surgical method for palliation of cyanotic congenital heart disease. Mitral valve repair may be considered in patients with mitral stenosis if the valve anatomy is unsuitable for balloon valvuloplasty. However, if the patient has severe symptomatic mitral stenosis with signs of heart failure, mitral valve replacement would be the first line of treatment.
Treatment Options for Mitral Valve Disease
-
This question is part of the following fields:
- Cardiology
-
-
Question 2
Correct
-
A 35-year-old woman was brought to the Emergency Department with confusion. She has a history of manic illness. There is no evidence of alcohol or drug abuse. Upon examination, she displays mild jaundice and signs of chronic liver disease, such as spider naevi and palmar erythema. Additionally, there is a brownish ring discoloration at the limbus of the cornea.
Blood tests reveal:
Investigation Result Normal value
Bilirubin 130 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 85 IU/l 5–30 IU/l
Ferritin 100 μg/l 10–120 µg/l
What is the most likely diagnosis based on this clinical presentation?Your Answer: Wilson’s disease
Explanation:Differential diagnosis of a patient with liver disease and neurological symptoms
Wilson’s disease, haemochromatosis, alcohol-related cirrhosis, viral hepatitis, and primary sclerosing cholangitis are among the possible causes of liver disease. In the case of a patient with Kayser-Fleischer rings, the likelihood of Wilson’s disease increases, as this is a characteristic sign of copper overload due to defective incorporation of copper and caeruloplasmin. Neurological symptoms such as disinhibition, emotional lability, and chorea may also suggest Wilson’s disease, although they are not specific to it. Haemochromatosis, which is characterized by iron overload, can be ruled out if the ferritin level is normal. Alcohol-related cirrhosis is less likely if the patient denies alcohol or drug abuse, but this information may not always be reliable. Viral hepatitis is a common cause of liver disease, but in this case, there are no obvious risk factors in the history. Primary sclerosing cholangitis, which is a chronic inflammatory disease of the bile ducts, does not present with Kayser-Fleischer rings. Therefore, a careful evaluation of the patient’s clinical features, laboratory tests, and imaging studies is necessary to establish the correct diagnosis and guide the appropriate treatment.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 3
Incorrect
-
A 45-year-old patient presents with the following full blood count (FBC) result: Hb 105 g/L (130-180), RBC 4.5 ×1012/L, Hct 0.353 (0.4-0.52), MCV 75 fL (80-96), MCH 32.5 pg (28-32), Platelets 325 ×109/L (150-400), WBC 7.91 ×109/L (4-11), Neutrophils 6.15 ×109/L (1.5-7.0), Lymphocytes 1.54 ×109/L (1.5-4.0), Monocytes 0.33 ×109/L (0-0.8), Eosinophils 0.16 ×109/L (0.04-0.4), Basophils 0.08 ×109/L (0-0.1), Others 0.14 ×109/L. What would be the most appropriate initial investigation for this FBC result?
Your Answer: Endoscopy
Correct Answer: Ferritin concentration
Explanation:Interpretation of FBC Results
When analyzing a full blood count (FBC), a microcytosis with low mean corpuscular volume (MCV) and anaemia (low Hb) is indicative of iron deficiency anaemia. To confirm this, a ferritin test should be requested, followed by an investigation into the source of blood loss if iron deficiency is confirmed. If faecal occult blood is positive, an endoscopy may be necessary. On the other hand, macrocytic anaemia with elevated MCV is caused by folate and B12 deficiency, while hypothyroidism is associated with elevated MCV. While a bone marrow biopsy can also show iron deficiency, it is an invasive procedure and is not necessary in a primary care setting. Therefore, interpreting FBC results requires a thorough of the different types of anaemia and their associated causes.
-
This question is part of the following fields:
- Haematology
-
-
Question 4
Incorrect
-
A 25-year-old woman comes to her GP complaining of breathlessness, dry cough and occasional wheezing.
What investigation finding would indicate a diagnosis of asthma?Your Answer: A 150 ml or higher improvement in FEV1 following a nebulised bronchodilator
Correct Answer: Fraction exhaled nitric oxide (FeNO) 50 parts per billion (ppb)
Explanation:Diagnostic Criteria for Asthma: Key Indicators to Consider
Asthma is a chronic respiratory disease that affects millions of people worldwide. It is characterized by airway inflammation, bronchoconstriction, and increased mucous production, leading to symptoms such as wheezing, coughing, and shortness of breath. Diagnosing asthma can be challenging, as its symptoms can mimic those of other respiratory conditions. However, several key indicators can help healthcare professionals make an accurate diagnosis.
Fraction exhaled nitric oxide (FeNO) 50 parts per billion (ppb): An FeNO level > 40 ppb is indicative of asthma.
Forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC ratio) ≥ 75%: An obstructive FEV1/FVC ratio < 70% would support a diagnosis of asthma in this patient. A 10% or higher improvement in FEV1 following a nebulised bronchodilator: A 12% or higher improvement in FEV1 following a nebulised bronchodilator supports a diagnosis of asthma. A 150 ml or higher improvement in FEV1 following a nebulised bronchodilator: A 200 ml or higher improvement in FEV1 following a nebulised bronchodilator supports a diagnosis of asthma. Greater than 15% variability in peak expiratory flow rate (PEFR) on monitoring: Greater than 20% variability in PEFR on monitoring supports a diagnosis of asthma. In conclusion, healthcare professionals should consider these key indicators when diagnosing asthma. However, it is important to note that asthma is not the only cause of these indicators, and a comprehensive evaluation of the patient’s medical history, physical examination, and other diagnostic tests may be necessary to make an accurate diagnosis.
-
This question is part of the following fields:
- Respiratory
-
-
Question 5
Correct
-
A 25-year-old woman has undergone an artificial rupture of membranes to speed up a labor that is progressing slowly. While her partner is assisting her in changing positions for comfort, she suddenly becomes breathless and collapses from the bed. She is now unresponsive and unconscious, with a blood pressure of 82/50 mmHg and a heart rate of 134 beats per minute. What is the probable diagnosis?
Your Answer: Amniotic fluid embolism
Explanation:The sudden collapse that occurred shortly after the rupture of membranes suggests the possibility of amniotic fluid embolism. The patient’s condition is too severe to be attributed to a simple vasovagal event. While amniotic fluid emboli can indirectly cause myocardial infarctions, it is difficult to diagnose a primary myocardial infarction without any mention of preceding chest pain. Typically, occult bleeding and hypovolemic shock would develop gradually. Although postural orthostatic tachycardia syndrome is more prevalent in women of reproductive age, it would not cause the significant hypotension observed in this case.
Amniotic fluid embolism is a rare but serious complication of pregnancy that can result in a high mortality rate. It occurs when fetal cells or amniotic fluid enter the mother’s bloodstream, triggering a reaction that leads to various signs and symptoms. While several risk factors have been associated with this condition, such as maternal age and induction of labor, the exact cause remains unclear. It is believed that exposure of maternal circulation to fetal cells or amniotic fluid is necessary for the development of an amniotic fluid embolism, but the underlying pathology is not well understood.
The majority of cases of amniotic fluid embolism occur during labor, but they can also occur during a cesarean section or in the immediate postpartum period. Symptoms of this condition include chills, shivering, sweating, anxiety, and coughing, while signs may include cyanosis, hypotension, bronchospasms, tachycardia, arrhythmia, and myocardial infarction. Diagnosis is primarily clinical and based on exclusion, as there are no definitive diagnostic tests available.
Management of amniotic fluid embolism requires a multidisciplinary team and critical care unit. Treatment is mainly supportive, focusing on addressing the patient’s symptoms and stabilizing their condition. Given the high mortality rate associated with this condition, prompt recognition and management are crucial for improving outcomes.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 6
Incorrect
-
A 13-year-old boy experiences facial swelling and a red, itchy rash shortly after receiving his first dose of the HPV vaccine. Upon arrival, paramedics observe a bilateral expiratory wheeze and a blood pressure reading of 85/60 mmHg. According to the Gell and Coombs classification of hypersensitivity reactions, what type of reaction is this an example of?
Your Answer: Type II reaction
Correct Answer: Type I reaction
Explanation:Classification of Hypersensitivity Reactions
Hypersensitivity reactions are classified into four types according to the Gell and Coombs classification. Type I, also known as anaphylactic hypersensitivity, occurs when an antigen reacts with IgE bound to mast cells. This type of reaction is responsible for anaphylaxis and atopy, such as asthma, eczema, and hay fever. Type II, or cytotoxic hypersensitivity, happens when cell-bound IgG or IgM binds to an antigen on the cell surface. This type of reaction is associated with autoimmune hemolytic anemia, ITP, Goodpasture’s syndrome, and other conditions. Type III, or immune complex hypersensitivity, occurs when free antigen and antibody (IgG, IgA) combine to form immune complexes. This type of reaction is responsible for serum sickness, systemic lupus erythematosus, post-streptococcal glomerulonephritis, and extrinsic allergic alveolitis. Type IV, or delayed hypersensitivity, is T-cell mediated and is responsible for tuberculosis, graft versus host disease, allergic contact dermatitis, and other conditions.
In recent times, a fifth category has been added to the classification of hypersensitivity reactions. Type V hypersensitivity occurs when antibodies recognize and bind to cell surface receptors, either stimulating them or blocking ligand binding. This type of reaction is associated with Graves’ disease and myasthenia gravis. Understanding the different types of hypersensitivity reactions is important in diagnosing and treating various conditions. Proper identification of the type of reaction can help healthcare professionals provide appropriate treatment and management strategies.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 7
Correct
-
A woman brings her middle-aged husband to see you. She is worried about his recent forgetfulness. She also reveals that he has been experiencing hallucinations of small children playing in the house. On examination, there is nothing significant to note except for a mild resting tremor in the hands (right > left).
What is the most probable diagnosis?Your Answer: Lewy body dementia
Explanation:Differentiating Types of Dementia: Lewy Body Dementia, Korsakoff’s Dementia, Alzheimer’s Disease, Multi-Infarct Dementia, and Pick’s Disease
Lewy Body Dementia: This type of dementia is characterized by memory impairment and parkinsonism. It is caused by the build-up of Lewy bodies in the cerebral cortex and basal ganglia, resulting in a movement disorder similar to Parkinson’s disease and memory problems. Visual hallucinations are common, and symptoms often fluctuate. Treatment involves acetylcholinesterase inhibitors and levodopa, while neuroleptics are contraindicated.
Korsakoff’s Dementia: This type of dementia is typically associated with alcohol misuse. Patients tend to confabulate and make up information they cannot remember.
Alzheimer’s Disease: This is the most common type of dementia. However, visual hallucinations and resting tremor are not typical symptoms of Alzheimer’s disease.
Multi-Infarct Dementia: This type of dementia is caused by problems that interrupt blood supply to the brain, such as multiple minor and major strokes. Risk factors include hypertension, diabetes, smoking, hypercholesterolemia, and cardiovascular disease.
Pick’s Disease: Also known as fronto-temporal dementia, this type of dementia is characterized by the patient sometimes losing their inhibitions.
-
This question is part of the following fields:
- Neurology
-
-
Question 8
Correct
-
You are called to see a 27-year-old primiparous woman who has just delivered via spontaneous vaginal delivery. She had an active third stage of labour with 10 mg of Syntocinon® administered intramuscularly. The placenta was delivered ten minutes ago and appears complete. The midwife has called you, as there is a continuous small stream of fresh red blood loss. It is estimated that the patient has lost 1050 ml of blood so far. You palpate the abdomen, and you cannot feel any uterine contractions.
Observations:
Heart rate (HR) 107 bpm
Blood pressure (BP) 158/105 mmHg
Temperature 37.1 °C
Respiratory rate (RR) 18 breaths per minute
Oxygen saturations 98% on air
Which of the following is the next step in this patient’s management?Your Answer: Uterine massage and oxytocin infusion
Explanation:Management of Postpartum Hemorrhage: Conservative and Pharmacological Methods
Postpartum hemorrhage is a common complication of childbirth and can be life-threatening if not managed promptly. The causes of postpartum hemorrhage fall under four categories, known as the 4Ts: tissue problems, tone problems, trauma, and thrombin. In cases of uterine atony, which is the most common cause of postpartum hemorrhage, conservative and pharmacological methods should be employed first.
The initial assessment should include securing two large-bore cannulae, sending blood for urgent full blood count, group and save, clotting and crossmatch of four units of blood, and commencing intravenous fluids. Uterine massage of the fundus, as well as an oxytocin infusion, should be the first step in management. If pharmacological methods fail to arrest the bleeding, then an intrauterine balloon can be employed as second line. If this still fails, the patient should be transferred to theatre for exploration and hysterectomy if necessary.
Ergometrine is contraindicated in women with hypertension, and therefore, should not be used in patients with a raised blood pressure. Hysterectomy is a last resort in women with massive postpartum hemorrhage where mechanical and pharmacological methods have failed to stop the bleeding and the patient is haemodynamically compromised. Intrauterine balloon tamponade is an effective mechanical method to stop postpartum hemorrhage in cases where other methods have failed.
It is important to ensure that blood is available if necessary, but transfusion should not be treated lightly due to the potential for severe complications. An up-to-date hemoglobin level should be obtained, and the patient should be fluid-resuscitated and monitored before any decision for transfusion. Overall, prompt and appropriate management of postpartum hemorrhage is crucial for ensuring positive maternal outcomes.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 9
Correct
-
A 65-year-old woman undergoes a right hemicolectomy for colon cancer and four days later presents with vomiting, a distended abdomen, and absent bowel sounds. Her blood results show a CRP of 124 mg/l and a WBC count of 5.2 * 109/l. Nursing notes reveal no bowel movements since surgery. What is the probable cause of her clinical presentation?
Your Answer: Paralytic ileus
Explanation:Simple constipation is unlikely in this patient due to the presence of vomiting and absent bowel sounds, which suggests paralytic ileus, especially so soon after surgery. Additionally, constipation alone would not explain all of the patient’s symptoms and signs. As the patient underwent a right hemicolectomy, the caecum would have been removed, making caecal volvulus an unlikely diagnosis. The raised CRP is a normal response to surgery. While peritonitis is a possibility, it would typically present with severe abdominal pain, tenderness, guarding, and more significantly elevated inflammatory markers and fever. Hirschsprung’s disease, a congenital condition, is highly unlikely to present for the first time in a 67-year-old patient.
Postoperative ileus, also known as paralytic ileus, is a common complication that can occur after bowel surgery, particularly if the bowel has been extensively handled. This condition is characterized by a reduction in bowel peristalsis, which can lead to pseudo-obstruction. Symptoms of postoperative ileus include abdominal distention, bloating, pain, nausea, vomiting, inability to pass flatus, and difficulty tolerating an oral diet. It is important to check for deranged electrolytes, such as potassium, magnesium, and phosphate, as they can contribute to the development of postoperative ileus.
The management of postoperative ileus typically involves starting with nil-by-mouth and gradually progressing to small sips of clear fluids. If vomiting occurs, a nasogastric tube may be necessary. Intravenous fluids are administered to maintain normovolaemia, and additives may be used to correct any electrolyte disturbances. In severe or prolonged cases, total parenteral nutrition may be required. It is important to monitor the patient closely and adjust the treatment plan as necessary to ensure a successful recovery.
-
This question is part of the following fields:
- Surgery
-
-
Question 10
Correct
-
A 28-year-old woman presents with recurrent deep vein thrombosis and pulmonary embolisms. She has a past medical history of recurrent miscarriages. Blood results reveal a prolonged APTT.
What is the most appropriate test from the options below?Your Answer: Anti-Cardiolipin Antibody
Explanation:Antiphospholipid syndrome is a condition that can be acquired and is characterized by a higher risk of both venous and arterial thrombosis, recurrent fetal loss, and thrombocytopenia. It can occur as a primary disorder or as a secondary condition to other diseases, with systemic lupus erythematosus being the most common. One important point to remember for exams is that antiphospholipid syndrome can cause a paradoxical increase in the APTT. This is due to an ex-vivo reaction of the lupus anticoagulant autoantibodies with phospholipids involved in the coagulation cascade. Other features of this condition include livedo reticularis, pre-eclampsia, and pulmonary hypertension.
Antiphospholipid syndrome can also be associated with other autoimmune disorders, lymphoproliferative disorders, and, rarely, phenothiazines. Management of this condition is based on EULAR guidelines. Primary thromboprophylaxis involves low-dose aspirin, while secondary thromboprophylaxis depends on the type of thromboembolic event. Initial venous thromboembolic events require lifelong warfarin with a target INR of 2-3, while recurrent venous thromboembolic events require lifelong warfarin and low-dose aspirin. Arterial thrombosis should be treated with lifelong warfarin with a target INR of 2-3.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 11
Incorrect
-
A 63-year-old man comes to his doctor complaining of urinary symptoms such as difficulty starting to urinate, increased frequency of urination at night, and post-void dribbling. He also reports experiencing back pain for the past few months and has unintentionally lost some weight. During a digital rectal exam, the doctor observes a prostate with an overall rough surface and loss of the medium sulcus. The patient's prostate-specific antigen (PSA) level is within normal range. What should be the next step in investigating this patient's condition?
Your Answer: Transrectal ultrasound-guided biopsy
Correct Answer: Multiparametric MRI
Explanation:When a man presents with typical urinary symptoms of prostate cancer, such as hesitancy, nocturia, and post-void dribbling, along with back pain and unintentional weight loss, it may indicate metastatic disease. Even if the PSA level is normal, the presence of findings consistent with prostate cancer on examination warrants further assessment through the suspected cancer pathway. Nowadays, multiparametric MRI is the preferred first-line investigation for suspected prostate cancer, even if metastasis is suspected. Depending on the results, an MRI-guided biopsy may or may not be recommended. While CT chest, abdomen, and pelvis can detect metastasis, it is not the primary investigation for prostate cancer. Transrectal ultrasound-guided biopsy used to be the traditional first-line investigation for prostate cancer, but due to the risk of complications such as sepsis or long-term pain, it is no longer the preferred option. Repeating PSA levels is unnecessary in suspected prostate cancer, as a single elevated level is sufficient to warrant further investigation.
Investigation for Prostate Cancer
Prostate cancer is a common type of cancer that affects men. The traditional investigation for suspected prostate cancer was a transrectal ultrasound-guided (TRUS) biopsy. However, recent guidelines from NICE have now recommended the increasing use of multiparametric MRI as a first-line investigation. This is because TRUS biopsy can lead to complications such as sepsis, pain, fever, haematuria, and rectal bleeding.
Multiparametric MRI is now the first-line investigation for people with suspected clinically localised prostate cancer. The results of the MRI are reported using a 5-point Likert scale. If the Likert scale is 3 or higher, a multiparametric MRI-influenced prostate biopsy is offered. If the Likert scale is 1-2, then NICE recommends discussing with the patient the pros and cons of having a biopsy. This approach helps to reduce the risk of complications associated with TRUS biopsy and ensures that patients receive the most appropriate investigation for their condition.
-
This question is part of the following fields:
- Surgery
-
-
Question 12
Correct
-
Sophie is a 27-year-old woman who has presented to her doctor with complaints of feeling down, difficulty sleeping and frequent headaches. She reports that these symptoms occur around the same time every month and cease just before her menstrual cycle. Sophie is worried about how these symptoms are impacting her work performance but does not have any immediate plans to start a family.
What is the recommended treatment for Sophie's likely diagnosis at this point?Your Answer: Drospirenone‐containing COC taken continuously
Explanation:Premenstrual syndrome can be treated with a combination of oral contraceptives and SSRIs, along with cognitive behavioral therapy. While the copper intrauterine device is effective for long-term contraception, it does not address the hormonal changes that cause PMS symptoms. The most appropriate option for Lydia is a new-generation combined oral contraceptive pill containing drospirenone, which can alleviate her symptoms. Progesterone-only contraception is not recommended for PMS, and sodium valproate is not a recognized treatment for this condition. It is important to take the COC continuously for maximum benefit.
Understanding Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and does not occur before puberty, during pregnancy, or after menopause.
Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.
Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.
Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this common condition.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 13
Correct
-
As a member of the surgical team, you come across a patient who is a 32-year-old male diagnosed with pigmented gallstones. In which condition is this frequently observed?
Your Answer: Sickle cell anaemia
Explanation:Sickle cell disease is linked to the formation of pigmented gallstones.
The increased breakdown of red blood cells in sickle cell disease leads to the development of pigmented gallstones. These types of gallstones are mainly composed of bilirubin and are commonly seen in individuals with hemolytic anemia and liver cirrhosis. Fanconi anemia and myelodysplastic syndrome are both forms of anemia caused by a decrease in hemoglobin production, rather than increased hemolysis. On the other hand, pancreatitis and glomerulonephritis are not associated with the formation of pigmented gallstones.
Biliary colic is a condition that occurs when gallstones pass through the biliary tree. The risk factors for this condition are commonly referred to as the ‘4 F’s’, which include being overweight, female, fertile, and over the age of forty. Other risk factors include diabetes, Crohn’s disease, rapid weight loss, and certain medications. Biliary colic occurs due to an increase in cholesterol, a decrease in bile salts, and biliary stasis. The pain associated with this condition is caused by the gallbladder contracting against a stone lodged in the cystic duct. Symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Diagnosis is typically made through ultrasound. Elective laparoscopic cholecystectomy is the recommended treatment for biliary colic. However, around 15% of patients may have gallstones in the common bile duct at the time of surgery, which can result in obstructive jaundice. Other possible complications of gallstone-related disease include acute cholecystitis, ascending cholangitis, acute pancreatitis, gallstone ileus, and gallbladder cancer.
-
This question is part of the following fields:
- Surgery
-
-
Question 14
Correct
-
A 50-year-old male with type 2 diabetes presents for his annual review. Despite following a diet plan, his glycaemic control is not optimal and his most recent HbA1c is 63 mmol/mol (20-46). You decide to initiate treatment with metformin 500 mg bd. As per NICE NG28 guidelines for diabetes management, what is the recommended interval for rechecking his HbA1c after each intensification of treatment?
Your Answer: Three to six months
Explanation:HbA1c as a Tool for Glycaemic Control
The glycated haemoglobin (HbA1c) is a measure of the glucose levels in the blood over a period of time. It reflects the glycosylation of the haemoglobin molecule by glucose, and there is a strong correlation between the glycosylation of this molecule and average plasma glucose concentrations. This makes it a widely used tool in clinical practice to assess glycaemic control. Studies have also shown that HbA1c has prognostic significance in both microvascular and macrovascular risk.
The life span of a red blood cell is 120 days, and HbA1c reflects the average blood glucose levels during the half-life of the red cell, which is about 60 days. According to NICE guidelines, it is recommended to re-check HbA1c with each treatment intensification at 3/6 monthly intervals. HbA1c as a tool for glycaemic control is crucial in managing diabetes and reducing the risk of complications.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 15
Correct
-
As you explore non-pharmacological treatments for different mental health conditions during your psychiatry rotation, you come across electroconvulsive therapy (ECT). Which of the following mental health conditions can be treated and managed using ECT?
Your Answer: Catatonia
Explanation:The Use of Electroconvulsive Therapy (ECT) in Mental Health: Conditions and Recommendations
Electroconvulsive therapy (ECT) is a treatment option for certain mental health conditions. The National Institute for Health and Care Excellence (NICE) recommends ECT for severe depression, catatonia, and prolonged or severe mania, but only if the condition is potentially life-threatening and other treatments have proved ineffective. ECT involves attaching electrodes to the scalp and passing an electrical current through to induce a seizure, which is performed under general anaesthesia. The mechanism of action involved in ECT is still not fully understood, but it is thought to cause a neurotransmitter release that improves symptoms. However, ECT can have side-effects such as memory impairment, headache, confusion, and muscle pains. It is not recommended for moderate depression, post-traumatic stress disorder (PTSD), anxiety, or severe dementia.
The Use of Electroconvulsive Therapy (ECT) in Mental Health: Conditions and Recommendations
-
This question is part of the following fields:
- Psychiatry
-
-
Question 16
Correct
-
Emily is a 6-year-old overweight girl brought in by concerned parents who are worried about her loud snoring and frequent interruptions in breathing which have been getting progressively worse. Her parents have been receiving complaints from the school teachers about her disruptive and inattentive behaviour in class. On examination, Emily has a short, thick neck and mildly enlarged tonsils but no other abnormalities.
What is the next best step in management?Your Answer: Order an overnight polysomnographic study
Explanation:Childhood Obstructive Sleep Apnoea: Diagnosis and Treatment Options
Childhood obstructive sleep apnoea (OSA) is a pathological condition that requires prompt diagnosis and treatment. A polysomnographic study should be performed before booking for an operation, as adenotonsillectomy is the treatment of choice for childhood OSA.
The clinical presentation of childhood OSA is non-specific but typically includes symptoms such as mouth breathing, abnormal breathing during sleep, poor sleep with frequent awakening or restlessness, nocturnal enuresis, nightmares, difficulty awakening, excessive daytime sleepiness or hyperactivity, and behavioural problems. However, parents should be reassured that snoring loudly is very normal in children his age and that his behaviour pattern will improve as he matures.
Before any intervention is undertaken, the patient should be first worked up for OSA with a polysomnographic study. While dental splints may have a small role to play in OSA, they are not the ideal treatment option. Intranasal budesonide is an option for mild to moderate OSA, but it is only a temporising measure and not a proven effective long-term treatment.
In conclusion, childhood OSA requires prompt diagnosis and treatment. Adenotonsillectomy is the treatment of choice, but a polysomnographic study should be performed before any intervention is undertaken. Parents should be reassured that snoring loudly is normal in children his age, and other treatment options such as dental splints and intranasal budesonide should be considered only after a thorough evaluation.
-
This question is part of the following fields:
- Respiratory
-
-
Question 17
Correct
-
A 50-year-old man underwent blood tests after a recent kidney stone surgery. The test results are as follows:
Corrected calcium: 3.01 mmol/L (normal range: 2.1-2.5)
Phosphate: 0.49 mmol/L (normal range: 0.80-1.4)
Alkaline phosphatase (alk phos): 166 U/L (normal range: 30-135)
Parathyroid hormone (PTH): 71 ng/L (normal range: 14-72 ng/L)
Estimated glomerular filtration rate (eGFR): >60 ml/min/1.73m2
What is the most likely reason for the high calcium level based on these results?Your Answer: Primary hyperparathyroidism
Explanation:High Serum Calcium Levels
When analyzing blood test results, a high serum calcium level in combination with a low phosphate level, high serum alkaline phosphatase (ALP), and normal glomerular filtration rate (GFR) may indicate primary hyperparathyroidism. While the parathyroid hormone (PTH) may fall within the reference range, it is considered inappropriate for the high calcium levels, as it should be suppressed as part of the negative feedback mechanism. It is important to note that a result within the reference range may still be abnormal.
Primary hyperparathyroidism is typically caused by a solitary adenoma, hyperplasia of all the parathyroid glands, multiple adenomas, or parathyroid carcinoma. Other conditions, such as vitamin D excess or bony metastases, may also cause high calcium levels, but the PTH would be suppressed if it were the primary pathology. Severe hypercalcemia can lead to dehydration, but dehydration itself would not cause such high serum calcium levels. Sclerosing cholangitis may cause elevated ALP levels of liver origin, but it would not explain the other results. the potential causes of high serum calcium levels can aid in proper diagnosis and treatment.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 18
Incorrect
-
A 27-year-old woman has been experiencing a pattern of tumultuous endings in all of her relationships. She confides in you that she seems to have a knack for choosing friends and romantic partners who ultimately reveal themselves to be awful people.
What defense mechanism is most likely at play in this patient?Your Answer: Reaction formation
Correct Answer: Splitting
Explanation:Defense Mechanisms: Understanding How We Cope
Defense mechanisms are psychological strategies that we use to protect ourselves from anxiety and emotional pain. These mechanisms are often unconscious and can be both adaptive and maladaptive. Here are some common defense mechanisms and their explanations:
Splitting: This is a common defense mechanism in borderline personality disorder. It involves seeing people as either all good or all bad, and the inability to reconcile both good and bad traits in a person.
Dissociation: This is an immature defense mechanism where one’s personal identity is temporarily modified to avoid distress. An extreme form is dissociative identity disorder.
Identification: This is when someone models the behavior of a more powerful example. An example would be a victim of child abuse becoming a child abuser in adulthood.
Sublimation: This is a mature defense mechanism where the person takes an unacceptable personality trait and uses it to drive a respectable work that does not conflict with their value system.
Reaction formation: This is an immature defense mechanism where unacceptable emotions are repressed and replaced by their exact opposite. A classic example is a man with homoerotic desires championing anti-homosexual public policy.
Understanding these defense mechanisms can help us recognize when we are using them and how they may be impacting our relationships and mental health.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 19
Incorrect
-
A 50-year-old male smoker presented with chronic dyspnoea. He used to work in the shipyard but now has a retired life with his dogs. He was under treatment as a case of COPD, but maximal therapy for COPD failed to bring him any relief. On re-evaluation, his chest X-ray showed fine reticular opacities in the lower zones. A CT scan of his thorax showed interstitial thickening, with some ground glass opacity in the upper lungs.
Pleural plaques were absent. What is the most likely diagnosis?Your Answer: Asbestosis
Correct Answer: Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)
Explanation:Differentiating Interstitial Lung Diseases: A Case Study
The patient in question presents with dyspnoea and a history of smoking. While COPD is initially suspected, the radiograph and CT findings do not support this diagnosis. Instead, the patient may be suffering from an interstitial lung disease. RB-ILD is a possibility, given the presence of pigmented macrophages in the lung. Asbestosis is also considered, but the absence of pleural plaques makes this less likely. Pneumoconiosis and histoplasmosis are ruled out based on the patient’s history and imaging results. Treatment for interstitial lung diseases can be challenging, with steroids being the primary option. However, the effectiveness of this treatment is debatable. Ultimately, a lung biopsy may be necessary for a definitive diagnosis.
-
This question is part of the following fields:
- Respiratory
-
-
Question 20
Correct
-
An infant is admitted to the neonatal intensive care unit with low Apgar scores at birth. During examination, the infant is found to have micrognathia, low set ears, overlapping fingers, and rocker-bottom feet. What is the most probable diagnosis?
Your Answer: Edward's syndrome
Explanation:A neonate is born exhibiting micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers, which are all classic signs of Edward’s syndrome. This childhood genetic syndrome is often diagnosed prenatally, but in some cases, it may not be detected until after birth when the neonate presents with low apgar scores. Unfortunately, the mortality rate for those with Edward’s syndrome is very high, and the average life expectancy is only 5-12 days. Survivors of this syndrome often experience complications affecting multiple organs. It is important to note that many genetic syndromes share similar features, making clinical diagnosis challenging without genetic testing. As such, it is essential to be familiar with the most common features of each syndrome for final medical examinations.
Childhood syndromes are a group of medical conditions that affect children and are characterized by a set of common features. Patau syndrome, also known as trisomy 13, is a syndrome that is characterized by microcephaly, small eyes, cleft lip/palate, polydactyly, and scalp lesions. Edward’s syndrome, also known as trisomy 18, is characterized by micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers. Fragile X syndrome is characterized by learning difficulties, macrocephaly, long face, large ears, and macro-orchidism. Noonan syndrome is characterized by a webbed neck, pectus excavatum, short stature, and pulmonary stenosis. Pierre-Robin syndrome is characterized by micrognathia, posterior displacement of the tongue, and cleft palate. Prader-Willi syndrome is characterized by hypotonia, hypogonadism, and obesity. William’s syndrome is characterized by short stature, learning difficulties, friendly, extrovert personality, and transient neonatal hypercalcaemia. Cri du chat syndrome, also known as chromosome 5p deletion syndrome, is characterized by a characteristic cry, feeding difficulties and poor weight gain, learning difficulties, microcephaly and micrognathism, and hypertelorism. It is important to note that Treacher-Collins syndrome is similar to Pierre-Robin syndrome, but it is autosomal dominant and usually has a family history of similar problems.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 21
Correct
-
A 48-year-old Nigerian patient presents with a 3-month history of jaundiced sclera, weight loss, and pale stools. Suspected malignancy is being worked up, and a pancreatic protocol CT reveals a low attenuating mass within the pancreatic body and neck, distension of the pancreatic duct within the pancreatic tail, and non-opacification of the portal confluence. Peritoneal nodular thickening and masses are also noted, along with a right hepatic lobe focal lesion in the arterial phase. After MDT discussion, it is determined that the extent of the disease is unresectable. What is the most appropriate management option for this patient?
Your Answer: Biliary stenting
Explanation:Biliary stenting is the preferred treatment for patients with malignant distal obstructive jaundice caused by unresectable pancreatic carcinoma. Although it does not provide a cure, it can alleviate symptoms and reduce short-term morbidity and mortality. Percutaneous biliary drainage via transhepatic route may be considered if biliary stenting fails, but it is not the first option. However, due to the complexity of the procedure and the presence of peritoneal seeding and liver metastases, it requires careful consideration before being performed.
A choledochoduodenostomy is an anastomosis between the common bile duct (CBD) and jejunum, which is used to relieve biliary obstruction distal to the junction of the hepatic duct and the cystic duct. Although it is indicated for chronic pancreatitis, it is not recommended for many patients with pancreatic head malignancies because the tumours can prevent proper repositioning of the duodenum, leading to a tension-filled surgical anastomosis that can cause bile leakage. As the patient has unresectable pancreatic cancer, this procedure is not appropriate.
The CT report shows a significant pancreatic malignancy with metastases in the right liver lobe and peritoneum, making pancreaticoduodenectomy or pancreatic resection inappropriate options.
Jaundice can present in various surgical situations, and liver function tests can help classify whether the jaundice is pre hepatic, hepatic, or post hepatic. Different diagnoses have typical features and pathogenesis, and ultrasound is the most commonly used first-line test. Relief of jaundice is important, even if surgery is planned, and management depends on the underlying cause. Patients with unrelieved jaundice have a higher risk of complications and death. Treatment options include stenting, surgery, and antibiotics.
-
This question is part of the following fields:
- Surgery
-
-
Question 22
Incorrect
-
Over the last 150 years, the life expectancy of people in all countries throughout the world has continued to increase. What is the estimated maximum lifespan for a human being?
Your Answer: 111-120 years
Correct Answer: 131-140 years
Explanation:The Limits of Human Lifespan
Life Expectancy and Maximum Lifespan
Life expectancy has been increasing steadily in both developing and developed countries. In fact, it is estimated that 50% of baby girls born in the UK at the turn of the millennium will live to be over 100 years old. This is a remarkable achievement, but it is important to note that it is not the same as the maximum human lifespan.
The Ceiling of Human Lifespan
Despite the advances in medicine and technology, the maximum human lifespan has remained unchanged for over 500 years. It is believed that this is due to a combination of genetic programming and environmental factors. Scientists estimate that the maximum human lifespan is around 140 years old. While there have been a few individuals who have lived beyond this age, they are extremely rare.
The Possibility of Immortality
If the ceiling of human lifespan could be broken, it would have significant implications for the concept of immortality. While it may not be possible to achieve true immortality, an increase in lifespan to hundreds of years would be a significant step forward. However, it is important to remember that we are still far from achieving this goal.
Conclusion
Life expectancy is increasing, but the maximum human lifespan remains unchanged. While it is possible that we may one day break through the ceiling of human lifespan, we are not there yet. In the meantime, we should focus on improving the quality of life for those who are living longer and finding ways to prevent age-related diseases.
-
This question is part of the following fields:
- Statistics
-
-
Question 23
Correct
-
An 18-year-old girl visits her GP with worries about not having started her menstrual cycle yet. Apart from that, she feels healthy. During the examination, she appears to be of average height and has developed breasts, but has minimal pubic hair growth. The doctor can feel two lumps in her groin area upon examination of her abdomen. Her external genitalia seem normal. What is the probable diagnosis?
Your Answer: Androgen insensitivity syndrome
Explanation:The patient’s presentation is consistent with androgen insensitivity, which is a genetic condition where individuals with XY chromosomes have female physical characteristics due to a lack of testosterone receptors in their tissues. This disorder is X-linked and often results in undescended testes. Congenital adrenal hyperplasia is unlikely as it typically causes early puberty and virilization, while Kallmann syndrome does not explain the presence of groin masses. Polycystic ovarian syndrome usually results in secondary amenorrhea or oligomenorrhea and is accompanied by other symptoms such as acne and hirsutism. Turner’s syndrome, which causes primary amenorrhea, is characterized by short stature, webbed neck, heart defects, and abnormal breast development, and does not involve undescended testes.
Disorders of sex hormones can have various effects on the body, as shown in the table below. Primary hypogonadism, also known as Klinefelter’s syndrome, is characterized by high levels of LH and low levels of testosterone. Patients with this disorder often have small, firm testes, lack secondary sexual characteristics, and are infertile. They may also experience gynaecomastia and have an increased risk of breast cancer. Diagnosis is made through chromosomal analysis.
Hypogonadotrophic hypogonadism, or Kallmann syndrome, is another cause of delayed puberty. It is typically inherited as an X-linked recessive trait and is caused by the failure of GnRH-secreting neurons to migrate to the hypothalamus. Patients with Kallmann syndrome may have hypogonadism, cryptorchidism, and anosmia. Sex hormone levels are low, and LH and FSH levels are inappropriately low or normal. Cleft lip/palate and visual/hearing defects may also be present.
Androgen insensitivity syndrome is an X-linked recessive condition that causes end-organ resistance to testosterone, resulting in genotypically male children (46XY) having a female phenotype. Complete androgen insensitivity syndrome is the new term for testicular feminisation syndrome. Patients with this disorder may experience primary amenorrhoea, undescended testes causing groin swellings, and breast development due to the conversion of testosterone to oestradiol. Diagnosis is made through a buccal smear or chromosomal analysis to reveal a 46XY genotype. Management includes counseling to raise the child as female, bilateral orchidectomy due to an increased risk of testicular cancer from undescended testes, and oestrogen therapy.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 24
Correct
-
Which patient has an elevated PTH level that is indicative of primary hyperparathyroidism?
Patient A:
Adjusted calcium - 2.3 mmol/L
Phosphate - 0.9 mmol/L
PTH - 8.09 pmol/L
Urea - 7.8 mmol/L
Creatinine - 132 μmol/L
Albumin - 36 g/L
Patient B:
Adjusted calcium - 2.9 mmol/L
Phosphate - 0.5 mmol/L
PTH - 7.2 pmol/L
Urea - 5 mmol/L
Creatinine - 140 μmol/L
Albumin - 38 g/L
Patient C:
Adjusted calcium - 2.0 mmol/L
Phosphate - 2.8 mmol/L
PTH - 12.53 pmol/L
Urea - 32.8 mmol/L
Creatinine - 540 μmol/L
Albumin - 28 g/L
Patient D:
Adjusted calcium - 2.5 mmol/L
Phosphate - 1.6 mmol/L
PTH - 2.05 pmol/L
Urea - 32.8 mmol/L
Creatinine - 190 μmol/L
Albumin - 40 g/L
Patient E:
Adjusted calcium - 2.2 mmol/L
Phosphate - 0.7 mmol/L
PTH - 5.88 pmol/L
Urea - 4.6 mmol/L
Creatinine - 81 μmol/L
Albumin - 18 g/LYour Answer: Patient B
Explanation:Primary Hyperparathyroidism and its Complications
Primary hyperparathyroidism is a condition where the parathyroid glands produce too much parathyroid hormone (PTH), leading to elevated calcium levels and low serum phosphate. This condition can go undiagnosed for years, with an incidental finding of elevated calcium often being the first clue. However, complications can arise from longstanding primary hyperparathyroidism, including osteoporosis, renal calculi, and renal calcification.
Osteoporosis occurs due to increased bone resorption under the influence of high levels of PTH. Renal calculi are also a common complication, as high levels of phosphate excretion and calcium availability can lead to the development of calcium phosphate renal stones. Additionally, calcium deposition in the renal parenchyma can cause renal impairment, which can develop gradually over time.
Patients with longstanding primary hyperparathyroidism are at risk of impaired renal function, which is less common in patients with chronic kidney disease of other causes. While both conditions may have elevated PTH levels, hypocalcaemia is more common in chronic kidney disease due to impaired hydroxylation of vitamin D. the complications of primary hyperparathyroidism is crucial for early diagnosis and management of this condition.
-
This question is part of the following fields:
- Nephrology
-
-
Question 25
Correct
-
A 32-year-old white man presents to his doctor with concerns about fatigue and changes to his tongue. He reports no other symptoms.
The patient has been following a strict vegan diet for the past six years and has a history of Crohn's disease. He is currently receiving immunomodulation therapy for his condition. His vital signs are within normal limits.
Upon examination of his mouth, a beefy-red tongue is observed. His neurological exam is unremarkable.
What is the most suitable course of treatment for this patient?Your Answer: Vitamin B12 supplementation
Explanation:Supplementation Options for Nutrient Deficiencies: A Clinical Overview
Vitamin B12 Supplementation for Deficiency
Vitamin B12 is a crucial nutrient involved in the production of red blood cells. Its deficiency can cause various clinical presentations, including glossitis, jaundice, depression, psychosis, and neurological findings like subacute combined degeneration of the spinal cord. The deficiency is commonly seen in strict vegans and patients with diseases affecting the terminal ileum. Management depends on the cause, and oral supplementation is recommended for dietary causes, while intramuscular injections are indicated for malabsorption.
Folate Supplementation for Deficiency
Folate deficiency is typically seen in patients with alcoholism and those taking anti-folate medications. However, the clinical findings of folate deficiency are different from those of vitamin B12 deficiency. Patients with folate deficiency may present with fatigue, weakness, and pallor.
Magnesium Supplementation for Hypomagnesaemia
Hypomagnesaemia is commonly seen in patients with severe diarrhoea, diuretic use, alcoholism, or long-term proton pump inhibitor use. The clinical presentation of hypomagnesaemia is variable but classically involves ataxia, paraesthesia, seizures, and tetany. Management involves magnesium replacement.
Oral Steroids for Acute Exacerbations of Crohn’s Disease
Oral steroids are indicated in patients suffering from acute exacerbations of Crohn’s disease, which typically presents with abdominal pain, diarrhoea, fatigue, and fevers.
Vitamin D Supplementation for Deficiency
Vitamin D deficiency is typically seen in patients with dark skin, fatigue, bone pain, weakness, and osteoporosis. Supplementation is recommended for patients with vitamin D deficiency.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 26
Incorrect
-
A 75-year-old left-handed man with permanent atrial fibrillation comes to the clinic complaining of difficulty finding words and weakness in his right arm and leg. The symptoms appeared suddenly and have persisted for 24 hours. He reports no changes in his vision.
What is the probable diagnosis?Your Answer: Lacunar syndrome stroke (LACS)
Correct Answer: Partial anterior circulation syndrome stroke (PACS)
Explanation:Understanding Different Types of Strokes: PACS, TACS, TIA, POCS, and LACS
Strokes can be classified into different types based on the location and severity of the brain damage. Here are some key features of five common types of strokes:
Partial anterior circulation syndrome stroke (PACS): This type of stroke affects a part of the brain’s anterior circulation, which supplies blood to the front of the brain. Symptoms may include motor and speech deficits, but not hemianopia (loss of vision in one half of the visual field).
Total anterior circulation syndrome stroke (TACS): This type of stroke affects the entire anterior circulation, leading to a combination of motor deficit, speech deficit, and hemianopia.
Transient ischaemic attack (TIA): This is a temporary episode of neurological symptoms caused by a brief interruption of blood flow to the brain. Symptoms typically last no longer than 24 hours.
Posterior circulation syndrome stroke (POCS): This type of stroke affects the posterior circulation, which supplies blood to the back of the brain. Symptoms may include brainstem symptoms and signs arising from cranial nerve lesions, cerebellar signs, or ipsilateral motor/sensory deficits.
Lacunar syndrome stroke (LACS): This type of stroke is caused by a small infarct (tissue damage) in the deep brain structures, such as the internal capsule. Symptoms may include isolated motor or sensory deficits.
Understanding the different types of strokes can help healthcare professionals diagnose and treat patients more effectively. If you or someone you know experiences any symptoms of a stroke, seek medical attention immediately.
-
This question is part of the following fields:
- Neurology
-
-
Question 27
Correct
-
A 70-year-old woman falls on her outstretched hand and is brought to the Emergency Department with a painful and deformed wrist that looks like a dinner fork. A radiograph shows a dorsally displaced, dorsally angulated fracture of the distal radius. Neurological examination is unremarkable. Her past medical history includes osteoporosis, type II diabetes mellitus and ischaemic heart disease.
What is the most suitable course of action for managing this fracture?Your Answer: Closed reduction and below-elbow backslab (half cast)
Explanation:Treatment Options for Distal Radial Fracture in an Elderly Patient
Distal radial fractures, commonly known as Colles’ fractures, are often seen in elderly patients with poor bone quality. There are several treatment options available for this type of fracture, but the choice of treatment depends on various factors, including the patient’s age, overall health, and the severity of the fracture.
Closed Reduction and Below-Elbow Backslab (Half Cast)
This is the most common treatment option for distal radial fractures. The fracture can be reduced with closed manipulation following a haematoma block, and then immobilized with a below-elbow backslab (half cast).Skeletal Traction
Skeletal traction is not practical for distal radial fractures as it can cause stiffness in the limb.Open Reduction and Internal Fixation
While open reduction and internal fixation can provide the most anatomical reduction, it comes with risks that may outweigh the benefits, especially in elderly patients with poor bone quality and co-morbidities.Intramedullary Rod
An intramedullary rod is rarely used for upper limb fractures.Closed Reduction and Above-Elbow Backslab (Half Cast)
Although an above-elbow backslab can stabilize the joint above and below the fracture, it is not recommended as it can cause stiffness and difficulty in regaining full use after removal.In conclusion, the treatment of distal radial fractures in elderly patients should be carefully considered, taking into account the patient’s overall health and the severity of the fracture. Closed reduction and below-elbow backslab (half cast) is the most common treatment option, while other options should be considered on a case-by-case basis.
-
This question is part of the following fields:
- Orthopaedics
-
-
Question 28
Correct
-
A 26-year-old male patient arrives at the Emergency department complaining of mild left testicular pain and dysuria that has been going on for six days. During the examination, the patient's scrotum is inflamed, and the epididymis is the most tender area. The patient has a temperature of 37.9°C, and the urine dipstick test came back negative. The cremasteric reflex is present.
What is the most appropriate management plan for the underlying cause of this patient's symptoms?Your Answer: Doxycycline 100 mg bd for 10 days (or single dose 1g azithromycin) plus IM ceftriaxone
Explanation:Acute Epididymitis and its Treatment
Acute epididymitis is a condition characterized by the inflammation of the epididymis, which causes pain and swelling in the testicles over several days. It is most commonly caused by sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae in patients under 35 years old. In contrast, urinary coliforms are the most common cause in children and men over 35 years old.
To treat acute epididymitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae, a combination of antibiotics is required. A course of doxycycline or a single dose of azithromycin can cover chlamydia, while ceftriaxone can cover Neisseria, which can be resistant to other antibiotics. It is important to note that single agents do not cover both infections.
Symptomatic relief can be achieved through the use of anti-inflammatory drugs and scrotal support, but they do not treat the underlying cause. It is crucial to seek medical attention promptly to prevent complications and ensure proper treatment.
In summary, acute epididymitis is a painful condition that requires a combination of antibiotics to treat the underlying infection. Prompt medical attention and proper treatment are essential to prevent complications and achieve symptomatic relief.
-
This question is part of the following fields:
- Surgery
-
-
Question 29
Correct
-
A 50-year-old lady with known chronic obstructive pulmonary disease (COPD) is admitted to the Respiratory Ward with shortness of breath, cough and wheeze. On examination, she appears unwell and short of breath, and there is an audible wheeze. Her respiratory rate is 30 breaths per minute, pulse rate 92 bpm and oxygen saturations 90% on room air. She reports that she is able to leave the house but that she has to stop for breath after walking approximately 100 m. What grade on the MODIFIED MRC dyspnoea scale would this patient be recorded as having?
Your Answer: 3
Explanation:Managing COPD: Non-Pharmacological, Pharmacological, and Surgical Approaches
Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects the airways and is often caused by smoking. Symptoms include coughing, wheezing, and shortness of breath. While there is no cure for COPD, there are various management strategies that can help improve symptoms and quality of life.
Non-pharmacological approaches include quitting smoking, losing weight if necessary, and participating in physiotherapy and pulmonary rehabilitation to improve lung function and exercise capacity. Pharmacological treatment includes the use of bronchodilators and inhaled corticosteroids, as well as oral prednisolone and antibiotics during exacerbations. Diuretics may also be necessary for patients with cor pulmonale and edema. Long-term oxygen therapy can help manage persistent hypoxia.
Surgical options for COPD include heart and lung transplantation. The modified MRC dyspnoea scale can be used to assess the degree of breathlessness and guide treatment decisions. The BODE index, which includes the mMRC dyspnoea scale, is a composite marker of disease severity that takes into account the systemic nature of COPD.
Overall, managing COPD requires a comprehensive approach that addresses both the physical and systemic aspects of the disease. With proper management, patients can improve their symptoms and quality of life.
-
This question is part of the following fields:
- Respiratory
-
-
Question 30
Correct
-
A 30-year-old woman visits an Infertility clinic with a complaint of irregular periods and difficulty conceiving for the past 2 years. During the examination, she is found to be obese (BMI 32) and hirsute. Mildly elevated androgen levels are also observed.
What is the probable reason for her condition?Your Answer: Polycystic ovarian syndrome
Explanation:The patient in question is showing signs of polycystic ovarian syndrome, which is characterized by elevated androgen levels, obesity, and hirsutism. Diagnosis requires meeting two of the following three criteria: polycystic ovaries, oligo-ovulation or anovulation, and clinical and/or biochemical signs of hyperandrogenism. Blood tests may show raised LH and free testosterone levels, and it is important to rule out other potential causes and assess for insulin resistance/diabetes and lipid levels. Hypothyroidism, anorexia nervosa, Turner syndrome, and prolactinoma are all potential causes of subfertility, but they do not present with the same symptoms as polycystic ovarian syndrome.
-
This question is part of the following fields:
- Gynaecology
-
5
Correct
2
Incorrect
0
:
00
:
9
Session Time
00
:
8
Average Question Time (
Secs)