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  • Question 1 - A 65-year-old woman comes to the clinic complaining of sudden pain in her...

    Correct

    • A 65-year-old woman comes to the clinic complaining of sudden pain in her right groin. She mentions that she had noticed a swelling in the area on and off for a few years, but it never bothered her before. She denies any nausea, vomiting, changes in bowel habits, or weight loss.

      Upon examination, the abdomen appears normal, but there is a tender and irreducible swelling below and to the side of the pubic tubercle.

      What is the probable diagnosis?

      Your Answer: Femoral hernia

      Explanation:

      Diagnosis and Treatment of Femoral Hernia

      The patient’s hernia is located in the typical position of a femoral hernia, which is below and to the side of the pubic tubercle. The patient has reported an intermittent swelling that has become irreducible. Based on these symptoms, it is likely that the femoral canal has been blocked by omentum, rather than a loop of bowel becoming trapped. Since the patient has no other concerning signs, it is safe for them to undergo hernia repair on the next available CEPOD list.

    • This question is part of the following fields:

      • Surgery
      23.6
      Seconds
  • Question 2 - A 35 year old woman presents to the Emergency Department complaining of crampy...

    Correct

    • A 35 year old woman presents to the Emergency Department complaining of crampy abdominal pain, nausea, and vomiting that started 4 hours ago. She reports not having a bowel movement for the past 3 days and cannot recall passing gas. Although she admits to heavy drinking, she has never required any medical intervention. Her medical history is unremarkable except for a laparotomy 5 years ago for appendicitis. On examination, you note a scar in the right iliac fossa. Palpation of the abdomen reveals tenderness mainly in the umbilical area with involuntary guarding. Bowel sounds are high pitched. What is the most likely cause of her symptoms?

      Your Answer: Adhesions

      Explanation:

      It is crucial to identify the symptoms and indications of bowel obstruction, as it can result in intestinal necrosis, sepsis, and multiple organ failure. Common signs and symptoms include abdominal pain, vomiting, constipation, failure to pass stool, distention, and peritonitis. It is important to gather information about risk factors from the patient’s medical history, including those mentioned above.

      Imaging for Bowel Obstruction

      Bowel obstruction is a condition that requires immediate medical attention. One of the key indications for diagnosing this condition is through imaging, particularly an abdominal film. The imaging process is done to identify whether the obstruction is in the small or large bowel.

      In small bowel obstruction, the maximum normal diameter is 35 mm, and the valvulae conniventes extend all the way across. On the other hand, in large bowel obstruction, the maximum normal diameter is 55 mm, and the haustra extend about a third of the way across.

      A CT scan is also used to diagnose small bowel obstruction. The scan shows distension of small bowel loops proximally, such as the duodenum and jejunum, with an abrupt transition to an intestinal segment of normal caliber. Additionally, a small amount of free fluid intracavity may be present.

      In summary, imaging is a crucial tool in diagnosing bowel obstruction. It helps identify the location of the obstruction and the extent of the damage. Early detection and treatment of bowel obstruction can prevent further complications and improve the patient’s prognosis.

    • This question is part of the following fields:

      • Surgery
      39.3
      Seconds
  • Question 3 - A 38-year-old woman has chronic pancreatitis. She has lost weight and has troublesome...

    Correct

    • A 38-year-old woman has chronic pancreatitis. She has lost weight and has troublesome diarrhoea. She reports that she has had diarrhoea daily and it has a strong, malodorous smell. The unintentional weight loss is 7 kg over the last year and she has had a general decrease in energy.
      Which preparation would be most suitable to decrease her diarrhoea?

      Your Answer: Pancreatin

      Explanation:

      Common Gastrointestinal Medications and Their Uses

      Pancreatin is a mixture of digestive enzymes that aid in the digestion of carbohydrates, lipids, and proteins. It is used in conditions where there is a lack of pancreatic enzyme production, such as cystic fibrosis and chronic pancreatitis. Pancreatin should be taken with meals and may cause side-effects such as nausea and hypersensitivity.

      Co-phenotrope is a combination drug that controls the consistency of faeces following ileostomy or colostomy formation and in acute diarrhoea. It is composed of diphenoxylate and atropine and may cause side-effects such as abdominal pain and lethargy.

      Cholestyramine binds bile in the gastrointestinal tract, preventing its reabsorption. It is used in conditions such as hypercholesterolaemia and primary biliary cholangitis. Side-effects may include constipation and nausea.

      Loperamide is an antimotility agent used in acute diarrhoea. It may cause side-effects such as constipation and nausea.

      Psyllium, also known as ispaghula, is a bulk-forming laxative that aids in normal bowel elimination. It is mainly used as a laxative but may also be used to treat mild diarrhoea.

      Understanding Common Gastrointestinal Medications

    • This question is part of the following fields:

      • Gastroenterology
      34.8
      Seconds
  • Question 4 - In a clinical trial evaluating the efficacy of two different antiplatelet agents in...

    Correct

    • In a clinical trial evaluating the efficacy of two different antiplatelet agents in preventing stroke among elderly patients, a total of 10,000 participants were randomly assigned to receive either the standard therapy or the new therapy. The study spanned five years, during which major gastrointestinal (GI) bleeding was observed in 3% of patients in the standard therapy group and 2% of patients in the new therapy group. What is the absolute risk reduction associated with the new therapy in terms of major GI bleeds?

      Your Answer: 1%

      Explanation:

      Comparison of Antiplatelet Therapies for GI Bleed Risk

      In comparing standard antiplatelet therapy to a new therapy, it is unclear if there is a significant difference between the two groups. However, the standard therapy group has a 3% risk of gastrointestinal (GI) bleed, while the new therapy has a 2% risk. This represents a 1% absolute risk reduction and a 33% relative risk reduction. In other words, for every 100 people treated with the new drug, one major bleeding event could be averted. Further research is needed to determine the overall effectiveness and safety of the new therapy compared to standard treatment.

    • This question is part of the following fields:

      • Clinical Sciences
      16.3
      Seconds
  • Question 5 - A 27-year-old primigravid woman at 10 weeks gestation visits her midwife for a...

    Correct

    • A 27-year-old primigravid woman at 10 weeks gestation visits her midwife for a routine booking appointment. She has sickle cell anaemia. Her partner’s sickle cell status is Hb AS. Her haemoglobin is 9.2 g / dl.
      What is the likelihood of her baby having sickle cell disease?

      Your Answer: 1 in 2

      Explanation:

      Probability of Inheriting Sickle Cell Disease

      Sickle cell anaemia is an autosomal recessive condition that affects the haemoglobin in red blood cells. The probability of a baby inheriting the disease depends on the genotypes of the parents.

      If one parent has sickle cell disease (HbSS) and the other is a carrier (HbAS), the baby has a 1 in 2 chance of inheriting the disease and a 1 in 2 chance of being a carrier.

      If both parents are carriers (HbAS), the baby has a 1 in 4 chance of inheriting the disease.

      If one parent has sickle cell disease (HbSS) and the other is unaffected (HbAA), the baby will be a carrier (HbAS).

      If both parents have sickle cell disease (HbSS), the baby will inherit the disease.

      It is important for individuals to know their carrier status and to receive genetic counselling before planning a family to understand the risks of passing on genetic conditions.

    • This question is part of the following fields:

      • Genetics
      7.8
      Seconds
  • Question 6 - A mother brings her child to the pediatrician's office concerned about her child's...

    Correct

    • A mother brings her child to the pediatrician's office concerned about her child's development. Her child is 20 months old and has been slow to meet all developmental milestones. Her health visitor advised that she come to see you. You learn that the child has experienced feeding difficulties throughout her life.

      During the examination of the child, you observe that she is drooling and is making lots of slow, writhing movements of her hands and feet. The mother tells you that this is common and that her daughter struggles to hold onto objects such as toys.

      What is the probable diagnosis?

      Your Answer: Dyskinetic cerebral palsy

      Explanation:

      The child in the stem is displaying symptoms of dyskinetic cerebral palsy, which is a subtype of cerebral palsy characterized by athetoid movements and oro-motor problems. The slow writhing movements of the child’s hands and feet and difficulty in holding objects are indicative of athetoid movements, while drooling is a sign of oro-motor problems. Ataxic cerebral palsy, Duchenne’s muscular dystrophy, and hydrocephalus are incorrect diagnoses as they do not match the symptoms presented in the stem.

      Understanding Cerebral Palsy

      Cerebral palsy is a condition that affects movement and posture due to damage to the motor pathways in the developing brain. It is the most common cause of major motor impairment and affects 2 in 1,000 live births. The causes of cerebral palsy can be antenatal, intrapartum, or postnatal. Antenatal causes include cerebral malformation and congenital infections such as rubella, toxoplasmosis, and CMV. Intrapartum causes include birth asphyxia or trauma, while postnatal causes include intraventricular hemorrhage, meningitis, and head trauma.

      Children with cerebral palsy may exhibit abnormal tone in early infancy, delayed motor milestones, abnormal gait, and feeding difficulties. They may also have associated non-motor problems such as learning difficulties, epilepsy, squints, and hearing impairment. Cerebral palsy can be classified into spastic, dyskinetic, ataxic, or mixed types.

      Managing cerebral palsy requires a multidisciplinary approach. Treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopedic surgery, and selective dorsal rhizotomy. Anticonvulsants and analgesia may also be required. Understanding cerebral palsy and its management is crucial in providing appropriate care and support for individuals with this condition.

    • This question is part of the following fields:

      • Paediatrics
      28.2
      Seconds
  • Question 7 - A 20-year old man with suspected schizophrenia is reviewed in clinic. During the...

    Correct

    • A 20-year old man with suspected schizophrenia is reviewed in clinic. During the consultation the patient informs you that there is a plot to destroy the world and that he has been chosen as a saviour.
      Which of the following terms most appropriately describes this patient's belief?

      Your Answer: Delusion

      Explanation:

      Understanding Psychotic Symptoms: Delusions, Illusions, Perseveration, and Hallucinations

      Psychotic symptoms are not simply exaggerations of normal experiences like anxiety or depression. They include hallucinations, delusions, and thought disorder. Delusions are false beliefs that are not shared by others in a cultural group and can be characteristic of different psychiatric disorders. Persecutory delusions are the most common form in schizophrenia and delusional disorder. Schizophrenia is characterized by episodes of delusions, hallucinations, bizarre behavior, incoherent thought processes, and flat or inappropriate affect. Illusions, on the other hand, are misinterpretations of existing sensory stimuli and suggest delirium or intoxication. Perseveration is the persistent repetition of words, phrases, or simple motor behavior and can occur in delirium, dementia, or psychosis. Hallucinations are perceptions of stimuli that are not there and are less common than delusions in schizophrenia. Mood-congruent delusions are consistent with the reported or observed mood and may be markers of the severity of mood disturbance, while mood-incongruent delusions are less easily explained but are commonly associated with a worse prognosis.

    • This question is part of the following fields:

      • Psychiatry
      5.9
      Seconds
  • Question 8 - A 30-year-old is admitted to A&E with seizures. He is advised not to...

    Correct

    • A 30-year-old is admitted to A&E with seizures. He is advised not to drive. You spot him in the parking lot of a nearby grocery store, having just parked the car he was driving. He has an upcoming clinic appointment in a week.
      What is the most suitable course of action?

      Your Answer: Stop him in the car park and remind him that he shouldn't be driving

      Explanation:

      Appropriate Actions to Take When a Patient Shouldn’t Be Driving

      As a healthcare professional, it is important to ensure the safety of both your patients and the public. If you witness a patient who shouldn’t be driving, there are several appropriate actions you can take.

      Stopping the patient in the car park and reminding them that they shouldn’t be driving is the most appropriate action. This shows that you have a duty of care and are taking responsibility for the safety of the public. It is not ideal, but approaching the patient and asking why they are driving is the most sensible option.

      Reporting the patient to the DVLA is also an option if they persist in driving. However, it is the patient’s responsibility to inform the DVLA of any medical conditions that may affect their ability to drive.

      Calling the police as a first action is drastic and should only be considered if the patient is putting themselves or others in immediate danger.

      Waiting until you are next at work to address the issue may be too late. It is important to deal with the matter straight away to prevent any potential harm.

      Ignoring what you have seen is unprofessional and puts the public at risk. It is important to take action and ensure the safety of everyone involved.

    • This question is part of the following fields:

      • Ethics And Legal
      22.2
      Seconds
  • Question 9 - A 20-year-old man, who recently immigrated to the United Kingdom from Eastern Europe,...

    Incorrect

    • A 20-year-old man, who recently immigrated to the United Kingdom from Eastern Europe, presents to his general practitioner with a history of intermittent dizzy spells. He reports having limited exercise capacity since childhood, but this has not been investigated before. Upon examination, the patient appears slight, has a dusky blue discoloration to his lips and tongue, and has finger clubbing. A murmur is also heard. The GP refers him to a cardiologist.

      The results of a cardiac catheter study are as follows:

      Anatomical site Oxygen saturation (%) Pressure (mmHg)
      End systolic/End diastolic
      Superior vena cava 58 -
      Inferior vena cava 52 -
      Right atrium (mean) 56 10
      Right ventricle 55 105/9
      Pulmonary artery - 16/8
      Pulmonary capillary wedge pressure - 9
      Left atrium 97 -
      Left ventricle 84 108/10
      Aorta 74 110/80

      What is the most likely diagnosis?

      Your Answer: Ventricular septal defect

      Correct Answer: Fallot's tetralogy

      Explanation:

      Fallot’s Tetralogy

      Fallot’s tetralogy is a congenital heart defect that consists of four features: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an over-riding aorta. To diagnose this condition, doctors look for specific indicators. A step-down in oxygen saturation between the left atrium and left ventricle indicates a right to left shunt at the level of the ventricles, which is a sign of ventricular septal defect. Pulmonary stenosis is indicated by a significant gradient of 89 mmHg across the pulmonary valve, which is calculated by subtracting the right ventricular systolic pressure from the pulmonary artery systolic pressure. Right ventricular hypertrophy is diagnosed by high right ventricular pressures and a right to left shunt, as indicated by the oxygen saturations. Finally, an over-riding aorta is identified by a further step-down in oxygen saturation between the left ventricle and aorta. While this could also occur in cases of patent ductus arteriosus with right to left shunting, the presence of the other features of Fallot’s tetralogy makes an over-riding aorta the most likely cause of reduced oxygen saturation due to admixture of deoxygenated blood from the right ventricle entering the left heart circulation.

    • This question is part of the following fields:

      • Cardiology
      10.9
      Seconds
  • Question 10 - A 28-year-old man comes to the Emergency Department complaining of pain in his...

    Correct

    • A 28-year-old man comes to the Emergency Department complaining of pain in his left testicle that has been gradually increasing over the past 72 hours. He appears to be in discomfort but is able to walk. Upon examination, his left testicle is tender to firm palpation. His vital signs are normal, and there is no redness or swelling. His abdominal examination is unremarkable. He reports dysuria and has recently started a new sexual relationship.

      What is the most suitable course of action?

      Your Answer: Treat with ceftriaxone 500 mg intramuscular (im) plus doxycycline 100 mg twice daily for 10–14 days

      Explanation:

      Treatment Options for Epididymo-orchitis: Choosing the Right Antibiotics

      Epididymo-orchitis is a condition that causes inflammation of the epididymis and testicles. It is most commonly caused by sexually transmitted infections such as Chlamydia trachomatis or Neisseria gonorrhoeae. When treating this condition, it is important to choose the right antibiotics based on the suspected causative organism.

      In the case of a sexually transmitted infection, ceftriaxone 500 mg intramuscular (im) plus doxycycline 100 mg twice daily for 10–14 days is the recommended treatment. However, if an enteric organism is suspected, ciprofloxacin may be preferred.

      It is important to note that pain relief alone is not sufficient and empirical treatment with antibiotics is advised. Additionally, immediate involvement of a urologist is necessary to rule out testicular torsion.

      While hospital admission and intravenous antibiotics may be necessary in severe cases, stable patients with epididymo-orchitis do not require this level of intervention. By choosing the appropriate antibiotics and involving a urologist when necessary, patients can receive effective treatment for this condition.

    • This question is part of the following fields:

      • Urology
      56.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Surgery (2/2) 100%
Gastroenterology (1/1) 100%
Clinical Sciences (1/1) 100%
Genetics (1/1) 100%
Paediatrics (1/1) 100%
Psychiatry (1/1) 100%
Ethics And Legal (1/1) 100%
Cardiology (0/1) 0%
Urology (1/1) 100%
Passmed