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"__typename": "QuestionChoice",
"answer": true,
"explanation": "HIV seroconversion illness occurs when the body develops antibodies against the human immunodeficiency virus. This can result in the manifestation of a wide range of symptoms, including fever, sore throat, maculopapular rash, malaise, arthralgia, lymphadenopathy, and oro-genital ulceration. Due to the non-specific nature of the presentation, a high index of suspicion is required. Seroconversion typically occurs in the first few weeks after infection, however, can occur up to 6 months after initial exposure. HIV diagnosis can be confirmed with antibody and antigen testing and treatment should be initiated immediately regardless of CD4 cell count.",
"id": "10000486",
"label": "a",
"name": "HIV seroconversion",
"picture": null,
"votes": 343
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Malaria is an important differential in individuals returning from endemic areas. However, it is an unlikely differential in this case. *Plasmodium falciparum* is the most common cause of malaria worldwide, and almost always presents within 3 months of exposure. Furthermore, although malaria can present with cutaneous symptoms, it would be very uncommon to present with a maculopapular rash.",
"id": "10000489",
"label": "d",
"name": "Malaria",
"picture": null,
"votes": 21
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "An important differential but unlikely in this patient's case. Although influenza is likely to present with fever, sore throat, and lymphadenopathy, influenza would be unlikely to present with a maculopapular rash. Furthermore, the history of sexual solicitation in a country of high HIV prevalence should further raise the index of suspicion.",
"id": "10000488",
"label": "c",
"name": "Influenza",
"picture": null,
"votes": 4
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gonococcal meningitis is a very rare complication of gonorrhoea infection which occurs when the infection becomes disseminated. However, this diagnosis is unlikely in this patient. This patient has presented without headache or nuchal rigidity, which are cardinal symptoms of meningitis. Therefore meningitis of any origin is unlikely in this patient.",
"id": "10000487",
"label": "b",
"name": "Gonococcal meningitis",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dengue fever is a viral infection spread by the *Aedes aegypti* mosquito. Although an important differential, it is an unlikely diagnosis here due to timing. Dengue fever typically presents with fever, rash, headache, and sometimes severe myalgia and arthralgia. However, Dengue typically presents within 2 weeks of exposure and would not present in an individual after 4 months. Dengue fever is therefore an unlikely diagnosis.",
"id": "10000490",
"label": "e",
"name": "Dengue fever",
"picture": null,
"votes": 49
}
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"question": "A 32-year-old male presents to the Emergency Department with a 3-day history of sore throat, fever, joint pain, and a new rash. On examination, you identify generalised lymphadenopathy and a maculopapular rash across his trunk. Further history reveals his only foreign travel recently was a trip to South Africa, where he admits he solicited sex work. This was, however, 4 months ago.\n\nWhich of the following is the most likely diagnosis?",
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173,459,650 | false | 49 | null | 6,495,002 | null | false | [] | null | 12,645 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hydroxychloroquine is a drug used in the treatment of systemic lupus erythematosus. It may also be used instead of chloroquine to treat malaria, however, chloroquine-based therapies are no longer recommended as the first line due to increasing levels of resistance. Instead, artemisinin-based combination therapy is recommended as a first-line treatment by the WHO.",
"id": "10000495",
"label": "e",
"name": "Hydroxychloroquine",
"picture": null,
"votes": 150
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptomatic management alone is not appropriate management for malaria. Paracetamol is recommended for use to manage fever in malaria, but additional treatment to target the parasite is recommended by the WHO.",
"id": "10000494",
"label": "d",
"name": "Symptomatic management",
"picture": null,
"votes": 18
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"explanation": "This patient is suffering from malaria. Malaria is a parasitic infection caused by *Plasmodium* parasites and transmitted by the *Anopheles* mosquito. Malaria classically presents with a high fever, headache, fatigue, myalgia/arthralgia as well as signs and symptoms of red blood cell destruction (e.g. anaemia, jaundice). Artemisinin-based combination therapy (ACT) is the treatment of choice for malaria. Chloroquine-based therapies may still be used but due to the increase in chloroquine resistance across many endemic countries, the WHO recommend the use of ACT instead.",
"id": "10000491",
"label": "a",
"name": "Artemisinin-based combination therapy",
"picture": null,
"votes": 139
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Praziquantel is the treatment of choice for schistosomiasis. Schistosomiasis is a parasitic infection that typically manifests in the genitourinary tract or intestinal tract. It most commonly presents with fever, rash, abdominal pain and urinary symptoms. Schistosomiasis would not present with trophozoites on blood film and therefore can be ruled out.",
"id": "10000493",
"label": "c",
"name": "Praziquantel",
"picture": null,
"votes": 73
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although chloroquine was previously the mainstay of malaria management, recent rises in chloroquine resistance have resulted in the WHO recommending the use of artemisinin-based combination therapy in place of chloroquine.",
"id": "10000492",
"label": "b",
"name": "Chloroquine",
"picture": null,
"votes": 99
}
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"explanation": "# Summary\n\nMalaria is caused by protozoan parasites of the Plasmodium genus, with five species affecting humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Predominantly found in tropical and subtropical regions, malaria is a significant global health concern and the most common imported tropical disease in the UK. The parasite's life cycle involves humans and female Anopheles mosquitoes, with human infection comprising liver and blood stages. Symptoms result from blood-stage parasites and can vary by species, with P. falciparum having a 7-30 day incubation period. Risk factors for severe disease include pregnancy, age extremes, and immunosuppression. Diagnosis relies on blood films and rapid diagnostic tests. Treatment depends on the species and severity, with artemisinin-based therapies commonly used. Prevention includes avoiding travel to endemic areas, mosquito bite prevention, and chemoprophylaxis. Malaria is notifiable, necessitating reporting to health authorities.\n\n\n# Definition\n\n\nMalaria is a disease caused by protozoan parasites of the Plasmodium genus. The different malaria species are:\n\n* *P. falciparum* (the most pathogenic species)\n* *P. vivax*\n* *P. ovale*\n* *P. malariae*\n* *P. knowlesi*\n\n# Epidemiology\n\nMalaria is typically found in the tropics and subtropics, and contributes to significant morbidity and mortality globally. It is the most common imported tropical disease in the UK, usually on return from travel.\n\n\n# Aetiology\n\n\nThe parasitic life cycle of malaria involves a cyclical infection of two hosts: humans and female Anopheles mosquitoes. Infection in humans occurs in two stages: the liver stage and the blood stage. The clinical signs and symptoms of the disease are due to blood-stage parasites and tend to occur at different times depending on the species. *Plasmodium falciparum* has an incubation period of 7-30 days.\n\nFollowing the bite of an infected female Anopheles mosquito, parasites, known as sporozoites, are inoculated into the human host, where they transit in the bloodstream to the liver. Sporozoites initially establish infection in hepatocytes, where they replicate and mature into hepatic schizonts. These subsequently rupture and release a form of parasite known as a merozoite into the bloodstream.\n\nMerozoites infect erythrocytes, forming trophozoites that reproduce asexually and mature into blood-stage schizonts, which also rupture, causing the further release of merozoites. Some trophozoites differentiate into male or female gametocytes, which may be ingested by their second host, the Anopheles mosquito, in subsequent blood meals. Gametocytes reproduce within the stomach of the mosquito, where they form oocysts which grow and release sporozoites, which travel to the mosquito's salivary glands to further perpetuate the cycle of further inoculation into a new human host.\n\nThe clinical manifestations of the disease are due to blood-stage parasites, which cause the accumulation of toxic substances and waste during their development in erythrocytes. Lysis of red blood cells results in the releasing these factors and potent inflammatory immune responses. The incubation period until symptoms appear tends to vary between 7 to 30 days. \n\n**Risk factors for severe disease:**\n\n- Pregnancy\n- Children\n- Elderly\n- Complex comorbidities\n- Immunosuppression\n\n# Signs & Symptoms\n\nInitial symptoms of malaria are quite non-specific. These include:\n\n* Fevers which may be cyclical, sweats and chills\n* Headache, malaise, aches & pains\n* Abdominal pain, nausea & vomiting, diarrhoea\n* Patients may have splenomegaly, jaundice, hypotension, pallor and reduced urine output\n\n\nFeatures of severe malaria relate to the disease process or complications:\n\n- Abnormal behaviour, seizures or altered consciousness suggest cerebral malaria\n- Parasitaemia >2%, severe anaemia or haemoglobinuria\n- Hypoglycaemia, metabolic acidosis, hypovolaemia\n- Temperature >39C\n- Acute respiratory distress syndrome, disseminated intravascular coagulation or shock\n- Renal impairment\n\n\n# Differential Diagnosis\n\n- Infections encountered in the UK e.g. meningitis, sepsis, pneumonia, viral illness, UTI, hepatitis, HIV\n- Non-infectious causes of fever e.g. lymphoma\n- Other travel-associated infections e.g. viral haemorrhagic fevers, enteric fever, Dengue, Rickettsia, Trypanosomiasis, Rabies\n\n\n# Investigations\n\nThick and thin blood films are the gold-standard method of diagnosing malaria. The thick film identifies the presence of parasites, and the thin film determines the species. If negative, films should be repeated.\n\nRapid diagnostic tests can also be used but do not replace the need for blood films.\n\nOther important investigations include:\n\n- FBC & film, clotting, U&E's, LFT's, glucose measurement\n- Urine dip ± culture\n- ABG if severe symptoms\n\nOther investigations to consider include blood cultures, stool culture, chest X-ray and lumbar puncture.\n\n# Management\n\nPatients with malaria usually need to be admitted to hospital as they can deteriorate very quickly. A-E assessment is required for acutely unwell patients and specialist management should be sought early, regardless.\n\nDefinitive treatment for malaria depends on the species identified and the presence of complications. First-line treatments are:\n\n- Uncomplicated falciparum: artemisinin-based combination (Artemether with lumefantrine) therapy\n- Uncomplicated non-falciparum: artemisinin-combination therapy or chloroquine\n- Severe falciparum: IV artesunate\n\nPatients will also require supportive care and antipyretics. In severe cases, ICU admission may be indicated.\n\nMalaria is a notifiable disease and all cases should be reported to the local health protection team in the first instance.\n\n**Malaria prevention**\n\nA careful risk assessment needs to be undertaken before any travel to a malaria-endemic area. Interventions to avoid infection include:\n\n- Avoidance of travel - particularly those who are at higher risk of severe infection\n- Measures to avoid mosquito bites - avoiding exposure at dusk & down, mosquito nets & screens, repellant, loose clothing\n- Chemoprophylaxis - drugs available include chloroquine, mefloquine and doxycycline, all of which have pro's and cons and, as such, should be an individualised decision\n- Education about malaria, its symptoms and seeking medical attention early. Standby emergency medication may be prescribed if the person is far from medical care.\n\n\n# NICE Guidelines\n\n[NICE CKS: malaria prophylaxis](https://cks.nice.org.uk/topics/malaria-prophylaxis/)\n\n[NICE CKS: Malaria](https://cks.nice.org.uk/topics/malaria/)\n\n# References\n\n[BNF: Malaria, treatment](https://bnf.nice.org.uk/treatment-summaries/malaria-treatment/#advice-for-travellers)\n\n[UK malaria treatment guidelines 2016](https://www.journalofinfection.com/article/S0163-4453(16)00047-5/fulltext)\n\n[British Society for Haematology guidelines for the laboratory diagnosis of malaria](https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjh.18092)\n\n[Patient.info: Malaria](https://patient.info/doctor/malaria-pro#malaria-epidemiology)",
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"question": "A 53-year-old female presents to the Emergency Department with a 3-day history of high fever, headache, arthralgia, malaise, and fatigue.\n\nThe patient returned 1 week ago from Zimbabwe where she was visiting family.\n\nExamination reveals a temperature of 39C and a full blood count reveals anaemia and thrombocytopenia. Thick and thin blood smears reveal the presence of trophozoites in the blood.\n\nWhich of the following is the best treatment for this patient?",
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"__typename": "QuestionChoice",
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"explanation": "Whilst stomach acid is HCl, H<sup>+</sup> and Cl<sup>-</sup> do not combine until inside the stomach lumen where they combine due to their differing charges. Cl<sup>-</sup> enters the stomach lumen via a Cl<sup>-</sup> channel in exchange for the HCO<sub>3</sub> <sup>-</sup> produced by the reaction CO<sub>2</sub> + H<sub>2</sub>O → H<sub>2</sub>CO<sub>3</sub> → HCO<sub>3</sub><sup>-</sup> in the gastric parietal cells (which is catalysed by carbonic anhydrase!)",
"id": "10000498",
"label": "c",
"name": "2Cl<sup>-</sup> + H<sub>2</sub>O → HCl + OH<sup>-</sup>",
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"answer": false,
"explanation": "This is the equation for the formation of calcium oxalate kidney stones, and whilst it does produce acidic H<sup>+</sup> ions, it has no link to stomach acidity.",
"id": "10000500",
"label": "e",
"name": "Ca<sup>2+</sup> + C<sub>2</sub>O<sub>4</sub>H<sub>2</sub> → CaC<sub>2</sub>O<sub>4</sub> + 2H<sup>+</sup>",
"picture": null,
"votes": 5
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This reaction is catalysed by carbonic anhydrase and is used for homeostasis in many systems, including within gastric parietal cells - causing them to secrete acidic H<sup>+</sup> into the stomach, thus decreasing the stomach pH.",
"id": "10000496",
"label": "a",
"name": "CO<sub>2</sub> + H<sub>2</sub>O → H<sub>2</sub>CO<sub>3</sub> → H<sup>+</sup>+ HCO<sup>3</sup> <sup>-</sup>",
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"votes": 112
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "H+ is produced by this reaction, so would decrease the stomach pH. However, the equation is not balanced in charge or molecules - there are two hydrogens on the left and three on the right, and the total charge on the left is 0, whilst it is +1 on the right.",
"id": "10000497",
"label": "b",
"name": "CO<sub>2</sub> + H<sub>2</sub>O→ 2H<sup>+</sup>+ HCO<sub>3</sub> <sup>-</sup>",
"picture": null,
"votes": 13
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This reaction is the reversed version of the reaction which occurs within gastric parietal cells to produce H<sup>+</sup> and decrease the stomach pH, and whilst this reaction is also catalysed by carbonic anhydrase it is a neutralising reaction, rather than an acid-producing reaction, so if anything would increase the pH.",
"id": "10000499",
"label": "d",
"name": "HCO<sub>3</sub><sup>-</sup> + H<sup>+</sup> → H<sub>2</sub>CO<sub>3</sub> → H<sub>2</sub>O + CO<sub>2</sub>",
"picture": null,
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"question": "Which of the following reactions is catalysed by the enzyme carbonic anhydrase within gastric parietal cells in order to decrease the pH of the stomach?",
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"explanation": "This epithelium is named 'pseudostratified columnar' due to the single layer of column-shaped cells appearing to be arranged in layers. The epithelium surface is also ciliated to trap dust particles, warm the airway, and secrete mucus.",
"id": "10000501",
"label": "a",
"name": "Pseudostratified ciliated columnar epithelium",
"picture": null,
"votes": 123
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"__typename": "QuestionChoice",
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"explanation": "The upper respiratory tract is lined by columnar cells (column-shaped), not squamous (flat). Additionally 'keratinised' refers to the protein keratin produced by keratinocytes in skin - hence why keratinised stratified squamous epithelium is found mainly in the skin. The upper respiratory tract epithelium is pseudo-stratified as it is exposed to less mechanical damage than areas which are protected by stratified epithelium.",
"id": "10000503",
"label": "c",
"name": "Keratinised stratified squamous epithelium",
"picture": null,
"votes": 7
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"explanation": "Whilst the cells which line the upper respiratory tract are pseudostratified, they are also ciliated and are columnar epithelial cells, not squamous epithelial cells.",
"id": "10000502",
"label": "b",
"name": "Pseudostratified squamous epithelium",
"picture": null,
"votes": 25
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"__typename": "QuestionChoice",
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"explanation": "Cuboidal cells are found in glands which secrete specialised substances, such as sweat glands. Whilst the respiratory tract does secrete small amounts of mucus, this is secreted by goblet cells which line the columnar cells of the pseudostratified ciliated columnar epithelium of the upper airway.",
"id": "10000505",
"label": "e",
"name": "Stratified cuboidal epithelium",
"picture": null,
"votes": 6
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "The upper respiratory tract is lined by columnar epithelium, not squamous, and is pseudostratified not stratified. Non-keratinised stratified squamous epithelium is found in areas such as the oesophagus.",
"id": "10000504",
"label": "d",
"name": "Non-keratinised stratified squamous epithelium",
"picture": null,
"votes": 39
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"explanation": "The 11th and 12th ribs are the last two sets of ribs in the thoracic cage and are known as the 'floating ribs'. There is no 13th rib.",
"id": "10000510",
"label": "e",
"name": "11th, 12th and 13th ribs",
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"explanation": "The clavicle is not referred to as a rib at all, and does not form part of the thoracic cage.",
"id": "10000509",
"label": "d",
"name": "The clavicle",
"picture": null,
"votes": 0
},
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"explanation": "These ribs attach directly to the sternum via the costal cartilage and are known as 'true ribs'.",
"id": "10000508",
"label": "c",
"name": "1st, 2nd, 3rd, 4th, 5th, 6th and 7th ribs",
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"explanation": "These ribs do not directly attach to the sternum, but instead attach the cartilage of the 7th ribs - and so are known as 'false ribs'.",
"id": "10000506",
"label": "a",
"name": "8th, 9th and 10th ribs",
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},
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"answer": false,
"explanation": "These ribs are the lowest two sets of ribs. They do not attach to the sternum or any other structure at all, and so are known as 'floating ribs'.",
"id": "10000507",
"label": "b",
"name": "11th and 12th ribs",
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"votes": 103
}
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"explanation": "A double mastectomy in this instance would be an aggressive surgical approach given the cancer only being Stage-1. Instead, a more breast-conserving surgery would be preferred e.g. wide local excision. Tamoxifen is used to treat ER+ breast cancer. However, it is usually reserved for pre-menopausal women so would not be appropriate for a woman of this age.",
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"label": "c",
"name": "Double mastectomy with adjuvant tamoxifen therapy",
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"explanation": "Wide local excision would be appropriate to remove the cancer. However, trastuzumab is a monoclonal antibody used to treat HER2+ breast cancer - so it would not be appropriate to give this unless the patient was known to be HER2+.",
"id": "10000515",
"label": "e",
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"explanation": "Fine needle aspiration is a method of collecting cells from tumours for diagnostic purposes, it is not usually therapeutic. Hence, it would not be appropriate given that the cancer is already diagnosed and staged. However, adjuvant anastrozole would be appropriate following an excision.",
"id": "10000514",
"label": "d",
"name": "Fine needle aspiration of the lesion with adjuvant anastrozole (@Arimidex) therapy",
"picture": null,
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"explanation": "Whilst both surgical excision and an aromatase inhibitor (e.g. Anastrozole) are the most appropriate choice for this patient, the hormone therapy should be given as an adjuvant treatment (after the surgery) rather than as a neoadjuvant treatment (before the surgery).",
"id": "10000512",
"label": "b",
"name": "Wide local excision of the lesion with neoadjuvant anastrozole (@Arimidex) therapy",
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"answer": true,
"explanation": "Excision of the cancer followed by adjuvant endocrine therapy in the form of an aromatase inhibitor (e.g. anastrozole) is the first-line treatment to reduce the risk of recurrence of ER+ breast cancer. Aromatase inhibitors such as anastrozole are also first-line in post-menopausal patients with ER+ breast cancer. Therefore, given this patient's age, this would be the most appropriate treatment.",
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"label": "a",
"name": "Wide local excision of the lesion with adjuvant anastrozole (@Arimidex) therapy",
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"explanation": "The T1 spinal nerve innervates a dermatome higher up than the umbilicus (above the nipple-line), so would not be responsible for this patient's symptoms.",
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"label": "d",
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"__typename": "QuestionChoice",
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"explanation": "Cauda Equina syndrome results due to compression of the cauda equina - a series of nerve roots which travel through the spinal canal after L2/3. The cauda equina supplies sensation, parasympathetic, and motor innervation to the lower limbs, bladder, and rectum. Therefore, compression leads to symptoms such as incontinence, saddle anaesthesia, and bilateral sciatica. Loss of sensation would not occur above the lower limbs.",
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"explanation": "Pancoast tumours are a type of lung cancer affecting the pulmonary apex. They can lead to neurological symptoms by causing pressure on the sympathetic ganglion. However, these symptoms are ptosis, anhidrosis, and miosis.",
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"label": "b",
"name": "Pancoast tumour",
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"explanation": "The diaphragm is innervated by spinal nerves C3-5, which also innervate the dermatomes of the shoulder and parts of the arm. Therefore, diaphragm irritation can present as referred cutaneous shoulder pain.",
"id": "10000518",
"label": "c",
"name": "Diaphragm irritation",
"picture": null,
"votes": 4
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "The T10 spinal nerve innervates the dermatome which covers the umbilical region. Therefore damage to the T10 spinal nerve may explain this patient's loss of sensation.",
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"label": "a",
"name": "Damage to the T10 spinal nerve",
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"explanation": "Sensory coding is a term used to describe how sensory information is encoded in memory. It does not explain how a person will react to a stimulus if they encounter it again.",
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"name": "Sensory coding",
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"label": "b",
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"label": "c",
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"id": "10000521",
"label": "a",
"name": "Classical conditioning",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Imitation and observation refers to how people learn from observing and imitating those around them.",
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"label": "d",
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"picture": null,
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"question": "A 24-year-old patient experienced nausea and vomiting following her weekly chemotherapy sessions at her local hospital. She now feels nauseous and vomits whenever she visits a hospital, despite finishing chemotherapy eight months ago.\n\nWhich of the following is this an example of?",
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"label": "b",
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"explanation": "It is expected for infants reaching milestones at a normal pace to be speaking at 18-months, and so they would have been recognising words in speech for many months by this point.",
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"label": "d",
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"__typename": "QuestionChoice",
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"explanation": "Flat muscles consist of parallel fibres within an aponeurosis. The fascicles/fibres in the deltoids are arranged obliquely, not in parallel, and so they are flat muscles.",
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"label": "e",
"name": "Flat",
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"explanation": "Whilst the deltoid muscles do have a pennate structure, with the fascicles sitting obliquely to the tendon, they have four fascicles rather than two, so are known as 'multipennate' rather than 'bipennate'.",
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"explanation": "The deltoid muscles have a multipennate structure, with many feather-like fascicles originating from various points (e.g. clavicle, acromion, and spine of scapula) which then converge and insert onto a singular central point (the deltoid tuberosity).",
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"__typename": "QuestionChoice",
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"explanation": "Circular muscles are exactly what they sound like - circular! They are concentrically arranged fascicles which increase and decrease the size of an opening. The fascicles of the deltoids are not arranged concentrically, and so the deltoids are not circular muscles.",
"id": "10000534",
"label": "d",
"name": "Circular",
"picture": null,
"votes": 16
},
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"__typename": "QuestionChoice",
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"explanation": "Deltoid muscles may appear fusiform (spindle-shaped) at first-glance. However, the arrangement of fascicles in an oblique pattern means that they are classified as pennate, and the number of fascicles means that they are 'multipennate'.",
"id": "10000532",
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"name": "Fusiform",
"picture": null,
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}
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"explanation": "The histone octamer is positively charged so that it is attracted to the negatively charged double-stranded DNA.",
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"id": "10000536",
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"explanation": "The DNA in a nucleosome is double-stranded, not single-stranded, and the core particle is a histone octamer (eight histones), not a histone pentamer (five histones).",
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"explanation": "This would explain the patient's thrombocytopenia (low platelets), and may also explain the splenomegaly. However, the symptoms would be purpura of the legs and increased bleeding. There would also be no effect on the WCC, and so increased infection rates would not be expected, and the RBC count would also remain within normal ranges.",
"id": "10000550",
"label": "e",
"name": "Immune thrombocytopenic purpura",
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"explanation": "Asthma would not lead to any of these symptoms, and we would not expect any changes on a FBC.",
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"label": "c",
"name": "Asthma",
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"explanation": "Anaemia of chronic disease is a good differential as it can cause a normocytic anaemia. However, the raised WCC and presenting symptoms are more suggestive of an underlying malignancy.",
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"label": "d",
"name": "Anaemia of chronic disease",
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"explanation": "Whilst this fits with the 'repeated chest infections' part of the patient history, it would be unlikely for pneumonia to cause symptoms such as splenomegaly and night sweats - although a general fever may be present. A two-month history is also a chronic presentation for something such as an infection. The WCC is also very high for an infection, and instead suggests a haematological cancer.",
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"label": "b",
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"__typename": "QuestionChoice",
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"explanation": "The patient's history gives red flag symptoms of cancer, such as unintentional weight loss and night sweats. Splenomegaly is a key sign of chronic lymphocytic leukaemia, and is caused by the production of malignant cells within the spleen. Enlarged lymph nodes also occur due to the proliferation of malignant cells. The repeated chest infections are due to the malignant lymphocytes being unable to fight off infection. The blood results show raised WCC due to the malignancy, low platelets (thrombocytopenia) and anaemia due to lack of space in the bone marrow for red blood cell development. The patient is also within the key age-range for this leukaemia.",
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"label": "a",
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"explanation": "*S. haemolyticus* is a coagulase-negative bacteria - so would not cause a positive coagulase test such as the one seen in test tube A.",
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"explanation": "Analgesia is a good idea considering this patient has severe pain. However, given its severity, a stronger choice may be more appropriate e.g. morphine or codeine. Also, there is little indication for fluids at this point as we do not know her blood pressure or hydration status.",
"id": "10000563",
"label": "c",
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"explanation": "Whilst this would help with the infection, it would not treat the underlying infection of the deep tissue - removal of the infection tissue via surgical debridement is needed to ensure all infection is treated.",
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"label": "b",
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"explanation": "This is the correct treatment pathway for necrotising fasciitis, which is what this patient is presenting with. Typical symptoms of necrotising fasciitis include pain which is out of proportion to clinical findings, skin discolouration, fever, and local swelling. Urgent surgical debridement is needed to remove the infected tissue to prevent the spread of the infection, and antibiotics are needed to treat the infection.",
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"explanation": "This is the treatment for an anaphylactic reaction (severe type 1 hypersensitivity reaction), which is not what this patient is presenting with. In a anaphylactic reaction, we would see airway and/or circulation compromise with a rapid onset of allergic symptoms such as wheeze and urticaria, rather than this patient's fever and severe pain which suggests an infection.",
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"label": "e",
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"__typename": "QuestionChoice",
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"explanation": "This may be indicated if this case was a suspected deep vein thrombosis, which would present with pain and swelling of the lower leg. However, the severe pain and fever are more suggestive of a significant infection- necrotising fasciitis. This requires urgent IV antibiotics and surgical debridement.",
"id": "10000564",
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"name": "Oral rivaroxaban",
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"question": "A 45-year-old woman presents with severe pain in her lower right leg. She ranks the pain a 10/10 when asked. Examination reveals minor swelling and erythema to the area as well as it being warm to the touch. She also has a fever of 39.7C.\n\nWhat is the most appropriate management of this patient?",
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"explanation": "Streptococci are gram-positive bacteria which would best be detected by a gram stain.",
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"name": "*Streptococcus pneumoniae*",
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"__typename": "QuestionChoice",
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"explanation": "PJP can be detected using a variety of stains. However, it is usually detected using the Beta-D-Glucan blood test which identifies the cell wall present in this type of fungi.",
"id": "10000568",
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"explanation": "Zeihl-Neelsen staining is used to test for TB. The sample is stained, heated and washed in an acid solution. The TB bacteria (*Mycobacterium tuberculosis*) are resistant to the acid wash and remain stained so are described as acid-fast bacilli. They appear as distinctive bright-red bacilli against a blue background.",
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"explanation": "*H. influenzae* can be tested for by gram-staining, appearing as small gram-negative coccobacilli.",
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"explanation": "This is an infection caused by inhalation of aspergillus (a common type of mould). Silver stains (e.g. a Gridley stain) are used to stain Aspergillus.",
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"name": "Aspergillus",
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"answer": false,
"explanation": "These two veins do drain into the coronary sinus. However, there are four veins in total which drain into the sinus. The additional two veins are the middle cardiac vein and the posterior cardiac vein.",
"id": "10000578",
"label": "c",
"name": "Great cardiac vein and small cardiac vein only",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The coronary sinus is a vein, and so only veins drain into it. The right and left coronary arteries arise from the ascending aorta and supply oxygenated blood to the heart.",
"id": "10000577",
"label": "b",
"name": "Right and left coronary arteries",
"picture": null,
"votes": 17
}
],
"comments": [],
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"__typename": "Concept",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3792",
"name": "Coronary blood flow",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
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"question": "Which of the following vessels drain into the coronary sinus?",
"sbaAnswer": [
"a"
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"totalVotes": 145,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,804 | false | 18 | null | 6,495,006 | null | false | [] | null | 12,663 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pancoast tumours only affect the lung apecies, and if they occur within the left lung may lead to recurrent laryngeal nerve compression - causing vocal cord paralysis, thus explaining this patient's hoarse voice.",
"id": "10000581",
"label": "a",
"name": "Left lung apex",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pancoast tumours are found exclusively within the lung apex's. However, this patient's vocal hoarseness is likely due to vocal cord paralysis due to compression of her left recurrent laryngeal nerve by a tumour on the left side.",
"id": "10000582",
"label": "b",
"name": "Right lung apex",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pancoast tumours are found in the lung apex, not the base of the lungs.",
"id": "10000583",
"label": "c",
"name": "Left lung base",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While, if left untreated, a pancoast tumour may grow to extend towards the middle lobe, it would have begun within the apex. Also, to cause vocal paralysis it would likely have occurred on the left side.",
"id": "10000585",
"label": "e",
"name": "Right middle lobe",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pancoast tumours are found in the lung apex, not in the base of the lungs.",
"id": "10000584",
"label": "d",
"name": "Right lung base",
"picture": null,
"votes": 6
}
],
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"id": "3793",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "160",
"name": "Oncology",
"typeId": 7
},
"topicId": 160,
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"question": "A 75-year-old female is diagnosed with a pancoast tumour. She also complains of having a hoarse voice over recent months.\n\nWhere is the likely location of her tumour?",
"sbaAnswer": [
"a"
],
"totalVotes": 139,
"typeId": 1,
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} | MarksheetMark |
173,459,805 | false | 19 | null | 6,495,006 | null | false | [] | null | 12,664 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The low Hb and RBC mean that the patient has anaemia. The raised MCV means that the anaemia is macrocytic (large RBCs). Given the patient's history of Crohn's disease, she likely has poor absorption of B12 and folate, thus causing a macrocytic megaloblastic anaemia. This could be confirmed by testing her serum B12 and folate levels.",
"id": "10000586",
"label": "a",
"name": "Macrocytic megaloblastic anaemia",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Microcytic anaemia means a low MCV, which indicates small RBCs. This patient has a raised MCV, indicating large RBCs, meaning they must have a macrocytic anaemia.",
"id": "10000589",
"label": "d",
"name": "Microcytic anaemia",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a raised MCV. Therefore the anaemia must be macrocytic as the RBCs are large. Normocytic anaemia refers to an anaemia with a within-range MCV.",
"id": "10000588",
"label": "c",
"name": "Normocytic anaemia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anaemia of chronic disease is a cause of microcytic or normocytic anaemia, causing a low/normal MCV. It often occurs due to cancer. As this patient has a raised MCV, indicating large RBCs, they cannot have anaemia of chronic disease.",
"id": "10000590",
"label": "e",
"name": "Anaemia of chronic disease",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The anaemia is macrocytic due to the high MCV. However, it is much more likely to be caused by a B12 or folate deficiency given the patient's history of Crohn's disease. Normoblastic anaemia is more likely in patients with histories of alcoholism or hypothyroidism. We could rule this out by testing her serum B12 and folate levels.",
"id": "10000587",
"label": "b",
"name": "Macrocytic normoblastic anaemia",
"picture": null,
"votes": 32
}
],
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"chapterId": 2693,
"demo": null,
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"id": "3794",
"name": "Iron deficiency anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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"question": "A 28-year-old female with a history of Crohn's disease presents with a month-long history of fatigue and shortness of breath.\n\n\nHer FBC is as follows:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|70 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|4.9x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|192x10<sup>9</sup>/L|150 - 400|\n|Mean Cell Volume (MCV)|113.7 fL|80 - 96|\n|Red blood cells|2.05 10<sup>12</sup>/L|3.8 - 4.8|\n\n\nWhich of the following best describes the pattern seen in the blood tests?",
"sbaAnswer": [
"a"
],
"totalVotes": 139,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,806 | false | 20 | null | 6,495,006 | null | false | [] | null | 12,665 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Unfractionated heparin is rarely used anymore due to its need to be monitored via APTT. Therefore it would not be used first-line. However, it is preferred to low molecular weight heparin in patients with reduced CrCl.",
"id": "10000594",
"label": "d",
"name": "Unfractionated heparin",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a DOAC (direct oral anticoagulant) and is an appropriate treatment for a DVT. However, it should only be used when CrCl > 30ml/min.",
"id": "10000592",
"label": "b",
"name": "Dabigatran",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Patients with suspected DVT should be managed with treatment dose rivaroxaban (or apixaban alternatively) first-line. It is a DOAC (direct oral anticoagulant), and is safe to give at a reduced dose in patients with CrCl below 30ml/min.",
"id": "10000591",
"label": "a",
"name": "Rivaroxaban",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin is an anti-platelet drug which may be used for secondary prevention of a DVT in patients who decline anticoagulant drugs. However, it would not be used first-line for this patient.",
"id": "10000595",
"label": "e",
"name": "Aspirin",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of low-molecular weight heparin, which can be used to treat DVTs. However, it is not typically used first-line for treatment, more so for thromboprophylaxis. It also cannot be used in patients with CrCl <30ml/min.",
"id": "10000593",
"label": "c",
"name": "Enoxaparin",
"picture": null,
"votes": 16
}
],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3795",
"name": "Deep Vein Thrombosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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"question": "A 74-year-old is found to have a deep-vein-thrombosis (DVT) on doppler ultrasound. His CrCl is 24ml/min and he takes 300mg OD Allopurinol for gout.\n\nWhich of the following is the most appropriate drug for the immediate treatment of his DVT?",
"sbaAnswer": [
"a"
],
"totalVotes": 140,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,807 | false | 21 | null | 6,495,006 | null | false | [] | null | 12,666 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The blood cannot be group A as the cells do not agglutinate with anti-A. It also must be Rh +'ve as the cells agglutinate with anti-D.",
"id": "10000599",
"label": "d",
"name": "Group A Rh -'ve",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The blood cells are negative for anti-A and anti-B, meaning it is type O (as they contain neither A nor B antigens, and so do not agglutinate). The cells are then positive for anti-D, meaning they do have D antigens, making the blood Rh +'ve. The reverse matching in the final two tubes confirms the O-type blood by mixing the patient's plasma with A and B RBCs, which causes a positive result as type O plasma contains both A and B antibodies.",
"id": "10000596",
"label": "a",
"name": "Group O Rh +'ve",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the reverse interpretation of the results. Remember that the antibodies are in the plasma, and the antigens are on the RBC surface.",
"id": "10000597",
"label": "b",
"name": "Group AB Rh -'ve",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The blood is group O as its cells do not agglutinate with anti-A or anti-B, and group O blood cells do not have A or B antigens. However, it is Rh +'ve as the cells agglutinate with anti-D.",
"id": "10000600",
"label": "e",
"name": "Group O Rh -'ve",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The gel card shows that the patient's blood cells do not contain B antigens as they do not agglutinate with anti-B, therefore it cannot be group B. However, it is Rh +'ve, as seen by the blood cells agglutinating with anti-D.",
"id": "10000598",
"label": "c",
"name": "Group B Rh +'ve",
"picture": null,
"votes": 4
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3796",
"name": "Blood group compatibility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
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},
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"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1682079567,
"id": "1506",
"index": 0,
"name": "Image 4.jpg",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/eq986ifl1682079617191.jpg",
"path256": "images/eq986ifl1682079617191_256.jpg",
"path512": "images/eq986ifl1682079617191_512.jpg",
"thumbhash": "pPcFF4JvhIh1ZmaSZnaEx3Za9TYZTJAC",
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
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"topicId": 157,
"updatedAt": 1708373886
}
],
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"question": "The above image shows a gel card of a patient's blood sample. Which of the following is the patient's correct blood type?\n\n[lightgallery]",
"sbaAnswer": [
"a"
],
"totalVotes": 119,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,808 | false | 22 | null | 6,495,006 | null | false | [] | null | 12,667 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The curve shifts to the right (rightward shift) to reflect the decreased affinity of Hb for O<sub>2</sub> due to CO<sub>2</sub> now taking up more of the Hb binding sites.",
"id": "10000603",
"label": "c",
"name": "No change in position or shape of the curve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would indicate the Hb having an increased affinity for O<sub>2</sub>, and as the Hb binding sites are taken up by CO<sub>2</sub> due to the increased CO<sub>2</sub> concentration, it instead has a decreased affinity and so shifts to the right.",
"id": "10000602",
"label": "b",
"name": "Leftward shift",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Only rightward or leftward shifts are seen in oxygen-haemoglobin dissociation curves, specifically a rightward shift when CO<sub>2</sub> is increased.",
"id": "10000605",
"label": "e",
"name": "Downward shift",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A hyperbolic (AKA exponential) curve is seen in myoglobin (Mb), not haemoglobin (Hb).",
"id": "10000604",
"label": "d",
"name": "The curve becomes hyperbolic in shape rather than S-shaped",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Increased CO<sub>2</sub> in the blood causes a decreased affinity of Hb for O<sub>2</sub> which then leads to the oxygen-Hb dissociation curve shifting to the right, as the Hb is less saturated with O<sub>2</sub>.",
"id": "10000601",
"label": "a",
"name": "Rightward shift",
"picture": null,
"votes": 121
}
],
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"chapterId": 2693,
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"id": "3797",
"name": "Haemoglobin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
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"topicId": 157,
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"question": "Which of the following best describes the effect of increased blood CO<sub>2</sub> on the oxygen-haemoglobin (Hb) dissociation curve?",
"sbaAnswer": [
"a"
],
"totalVotes": 145,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,809 | false | 23 | null | 6,495,006 | null | false | [] | null | 12,668 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Mitral stenosis is heard as a low-pitched 'rumbling' mid-diastolic murmur as the stenosis restricts blood flow across the mitral valve from the left atrium into the left ventricle. The first heart sound (S1) is then heard due to the large systolic force required to snap shut the thickened mitral valve. Rheumatic fever is also a very common cause of mitral stenosis, and breathlessness often occurs as a consequence due to pulmonary congestion.",
"id": "10000606",
"label": "a",
"name": "Mitral stenosis",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Breathlessness may occur due to pulmonary oedema. However, syncope and angina are also often present. Also, whilst the murmur heard in aortic regurgitation is diastolic, it is a much shorter murmur, only heard at the beginning of diastole (and also sometimes at the end of systole).",
"id": "10000608",
"label": "c",
"name": "Aortic regurgitation",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rheumatic fever is a cause of mitral regurgitation, and it may also cause breathlessness due to back pressure on the pulmonary circulation. However, the murmur heard would be a pan-systolic, high-pitched 'whistling' murmur due to high-velocity blood flow through the leaky valve.",
"id": "10000607",
"label": "b",
"name": "Mitral regurgitation",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The heart sounds heard in mitral valve prolapse are a mid-systolic 'click' as the valve prolapses back into the left atrium, sometimes followed by a late systolic murmur if blood then continues to flow into the left atrium.",
"id": "10000609",
"label": "d",
"name": "Mitral valve prolapse",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic stenosis causes an ejection-systolic crescendo-decrescendo murmur, which is often high-pitched due to the high velocity of systole. Exertional syncope is the most common symptom of aortic stenosis, and rheumatic heart disease is a cause.",
"id": "10000610",
"label": "e",
"name": "Aortic stenosis",
"picture": null,
"votes": 11
}
],
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"__typename": "Concept",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3720",
"name": "Mitral stenosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"question": "A 16-year-old male presents with occasional episodes of breathlessness. He has a past medical history of rheumatic fever from when he was 10-years-old. On auscultation, a mid-diastolic rumbling murmur is heard alongside a loud S1.\n\nWhat valvular pathology is most likely to be responsible for this murmur?",
"sbaAnswer": [
"a"
],
"totalVotes": 135,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,810 | false | 24 | null | 6,495,006 | null | false | [] | null | 12,669 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Blocking beta<sub>1</sub>-adrenoceptors would lead to a decrease in cardiac output as it would decrease ionotropism and chronotropism of the heart. However, blocking beta<sub>2</sub>-adrenoceptors would cause increased peripheral resistance and bronchoconstriction, which would be contraindicated in this asthmatic patient.",
"id": "10000613",
"label": "c",
"name": "Combined beta<sub>1</sub> and beta<sub>2</sub> antagonist",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Beta<sub>1</sub> adrenoceptors cause positive ionotropism and chronotropism of the heart. Therefore, by blocking these receptors, cardiac output is reduced and blood pressure is reduced. Beta<sub>2</sub> adrenoceptors cause vasodilation in the peripheral vessels and lungs, so increasing the effect of these receptors will decrease peripheral resistance and increase bronchodilation. Therefore, this is the best choice, as there will be no bronchoconstriction side-effects, and his blood pressure will be lowered.",
"id": "10000611",
"label": "a",
"name": "Combination beta<sub>1</sub> antagonist and beta<sub>2</sub> agonist",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Beta<sub>1</sub>-adrenoceptors are located on the heart and cause increased ionotropism and chronotropism, so blocking them would decrease cardiac output, thus reducing his blood pressure, whilst theoretically having no adverse effects on his breathing or peripheral circulation. However, as we can cause bronchodilation via beta<sub>2</sub>agonism, a beta<sub>1</sub> antagonist + beta<sub>2</sub> agonist combination would be the best choice for this patient due to his asthma.",
"id": "10000614",
"label": "d",
"name": "Selective beta<sub>1</sub> antagonist",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alpha-adrenoceptors cause vasoconstriction whilst beta<sub>2</sub>-adrenoceptors cause vasodilation of the peripheral vessels and within the lungs. Beta<sub>1</sub>-adrenoceptors cause positive ionotropism and chronotropism within the cardiac muscle. Therefore, blocking Beta<sub>1</sub>-adrenoceptors would decrease cardiac output, and blocking alpha-adrenoceptors would decrease peripheral resistance, leading to a decrease in blood pressure. However, by blocking beta<sub>2</sub>-adrenoceptors bronchoconstriction may occur which would be a contraindication given that this patient has asthma.",
"id": "10000612",
"label": "b",
"name": "Mixed alpha/beta antagonist",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alpha-adrenoceptors are not found in the heart, they are found in the periphery and smooth muscle, where they cause vasoconstriction when bound to by noradrenaline. Therefore, blocking them simply causes vasodilation of the periphery and increased blood flow to the skin and gut, with no effect on the heart.",
"id": "10000615",
"label": "e",
"name": "Selective alpha antagonist",
"picture": null,
"votes": 39
}
],
"comments": [],
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"name": "Hypertension",
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"id": "134",
"name": "Cardiology",
"typeId": 7
},
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"question": "A 50-year-old male with asthma is being treated for treatment-resistant hypertension.\n\nWhich of the following treatments is most appropriate for managing his hypertension without compromising his airways?",
"sbaAnswer": [
"a"
],
"totalVotes": 142,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,811 | false | 25 | null | 6,495,006 | null | false | [] | null | 12,670 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Both of these drugs are diuretics so would reduce the patient's fluid overload. However, ACE-inhibitors and beta-blockers are used first-line, alongside loop diuretics only for symptom control. Aldosterone antagonists are then only used if symptoms are not controlled by these three drugs and there is a reduced ejection fraction.",
"id": "10000618",
"label": "c",
"name": "Loop diuretic + Aldosterone antagonist",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "All of the above drugs act to interfere with the body's response to the low cardiac output in heart failure. ACE inhibitors (e.g. ramipril) decrease plasma fluid and cause vasodilation, both of which decrease venous pressure. Beta-blockers (e.g. bisoprolol) help protect the myocardium from overstimulation from the action of noradrenaline on beta-adrenoceptors. Additionally, diuretics (e.g. furosemide) also decrease pressure via removing fluid, which helps to relieve symptoms such as oedema and breathlessness. However, they are not necessary if the person is not having symptoms.",
"id": "10000616",
"label": "a",
"name": "ACE inhibitor + Beta blocker",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An ACE inhibitor and beta-blocker would be used first-line. However, an ARB would only be used in place of an ACE inhibitor, not as well as, and would only be used if ACE inhibitors were not tolerated. A loop diuretic e.g. furosemide would also be used to reduce fluid overload.",
"id": "10000617",
"label": "b",
"name": "ACE-inhibitor + Beta-blocker + Angiotensin Receptor Blocker",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Beta-blockers are used first-line in chronic heart disease, as they protect the myocardium from noradrenaline by blocking the beta-adrenoreceptors. They also cause some vasodilation which helps to reduce venous pressure. However, a beta-blocker alone is not enough to treat chronic heart failure. An ACE-inhibitor (e.g. ramipril) and possibly a loop diuretic (e.g. furosemide) are also needed to adequately treat a chronic heart failure patient.",
"id": "10000619",
"label": "d",
"name": "Beta-blocker alone",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ACE inhibitors, beta blockers and loop diuretics are the three drug classes typically used first-line in chronic heart failure. However, both ARBs and aldosterone antagonists are not used first-line. Aldosterone antagonists are used when symptoms are not controlled with ACE inhibitors and beta-blockers, and ARBs are used instead of ACE inhibitors if ACE inhibitors are not tolerated.",
"id": "10000620",
"label": "e",
"name": "ACE inhibitor + Beta blocker + Loop diuretic + Aldosterone antagonist + Angiotensin Receptor Blocker (ARB)",
"picture": null,
"votes": 28
}
],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3798",
"name": "Heart Failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "Which of the following combination of drugs is typically the first-line medical treatment used in chronic heart failure?",
"sbaAnswer": [
"a"
],
"totalVotes": 143,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,812 | false | 26 | null | 6,495,006 | null | false | [] | null | 12,671 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG does not show third-degree heart block. Third-degree heart block appears on an ECG as a much slower ventricular rate (30-40bpm), regular spaced QRS complexes, and mis-shaped/upside down QRS complexes with escape beats. Also, an inferior STEMI is seen on this ECG.",
"id": "10000624",
"label": "d",
"name": "Third-degree heart block",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An inferior STEMI is seen on this ECG in the ST segment elevation in leads II, III, and aVF. However, Mobitz type I second-degree heart block can also be seen as the PR interval progressively increases until a dropped QRS complex occurs and the cycle repeats.",
"id": "10000625",
"label": "e",
"name": "Inferior STEMI",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This ECG does show an inferior STEMI, as seen by the ST segment elevation in leads II, III, and aVF. However, it shows Mobitz type I second-degree heart block, not first-degree heart block. First -degree heart block would show a continuously raised PR interval with no blocked P waves, unlike this ECG which shows a progressively increasing PR interval until a P wave is blocked.",
"id": "10000623",
"label": "c",
"name": "First-degree heart block + inferior STEMI",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a second-degree heart block is seen, it is type I rather than type II. This ECG shows a progressive increase in PR interval until a dropped QRS complex occurs, which is diagnostic of type I second-degree heart block. Type II second-degree heart block is diagnosed via occasional blocked P waves which are not followed by QRS complexes. However, the PR interval remains the same. This ECG also shows an inferior STEMI.",
"id": "10000622",
"label": "b",
"name": "Mobitz type II second-degree heart block only",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An inferior STEMI can be seen due to ST elevation in leads II, III, and aVF. Mobitz type I second-degree heart block can also be seen as the PR interval progressively increases until a dropped QRS complex occurs and the cycle repeats.",
"id": "10000621",
"label": "a",
"name": "Mobitz type I second-degree heart block + inferior STEMI",
"picture": null,
"votes": 55
}
],
"comments": [],
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"id": "3799",
"name": "ECG",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
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"name": "Image 5.png",
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"id": "159",
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"topicId": 159,
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"question": "Which of the following options is the most appropriate interpretation for the above ECG?\n\n[lightgallery]",
"sbaAnswer": [
"a"
],
"totalVotes": 132,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,813 | false | 27 | null | 6,495,006 | null | false | [] | null | 12,672 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amlodipine is a calcium-channel blocker, which is the correct drug to give to this patient for the management of his hypertension. However, it should be added to the maximum dose of an ACE inhibitor, such as ramipril 10mg OD (which he already takes).",
"id": "10000627",
"label": "b",
"name": "Switch to 5mg amlodipine OD",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Amlodipine is a calcium-channel blocker, which is the second step in the hypertension treatment pathway once the first step drug is at the maximum dose. It should be added to the patients existing medication, which in this case is 10mg Ramipril.",
"id": "10000626",
"label": "a",
"name": "Add amlodipine 5mg OD",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Indapamide is a thiazide-like diuretic, which is used as the third step in the treatment of hypertension - E.g. if a patient is still hypertensive despite both an ACE inhibitor (e.g. ramipril) and a calcium channel blocker (e.g. amlodipine). In this case, the patient would continue taking their ramipril, whilst being prescribed a calcium channel blocker for a number of weeks/months before a thiazide-like diuretic would be considered.",
"id": "10000629",
"label": "d",
"name": "Add Indapamide 2.5mg OD",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bisoprolol is a beta-blocker, which may be used to treat hypertension. However, it does not form part of the usual NICE guidelines for hypertension management, and is usually only considered in patients with raised serum potassium (>4.5mmol/) - which this patient history does not mention. Therefore, following the stepwise approach of hypertension management would lead us to prescribe a calcium-channel blocker e.g. amlodipine for this patient to take as well as his regular ACE inhibitor (ramipril).",
"id": "10000630",
"label": "e",
"name": "Bisoprolol 10mg OD",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amlodipine is a calcium-channel blocker, which is the correct drug to add to this patient's existing maximum-dose ACE inhibitor (ramipril). However, indapamide is a thiazide-like diuretic and is the third step in managing hypertension, so would not be added to this patient's regime until he was established on a both maximum dose ACE inhibitor and calcium channel blocker, and had tried alternative drugs within those classes, whilst still having uncontrolled hypertension.",
"id": "10000628",
"label": "c",
"name": "Add amlodipine 5mg OD + indapamide 2.5mg OD",
"picture": null,
"votes": 3
}
],
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"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
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"question": "A 42-year-old caucasian male has a clinic blood pressure reading of 144/98 despite treatment with 10mg Ramipril OD for the past six months.\n\nWhich of the following is the most appropriate next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 132,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,814 | false | 28 | null | 6,495,006 | null | false | [] | null | 12,673 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary oedema may cause a restrictive pattern of lung function results due to decreased lung compliance (which is not fitting with this patient's obstructive results). Also, pulmonary oedema may be caused by issues such as heart failure (which this patient shows no symptoms of, other than dyspnoea). Therefore, pulmonary oedema would be low down in this patient's differential diagnoses.",
"id": "10000635",
"label": "e",
"name": "Pulmonary oedema",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Asthma is an obstructive disease, and this patient's results show an obstructive pattern (with FEV1:FVC ratio of <70%), so this would be fitting. However, the age of this patient, and her smoking history, would make COPD the more likely diagnosis. Additionally, a five-year history would be unusual for asthma. However, we would exclude this diagnosis by testing for bronchodilator reversibility - which is present in asthma and not in COPD.",
"id": "10000632",
"label": "b",
"name": "Asthma",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fibrotic lung disease is a restrictive disease, and so does not fit with the obstructive pattern of these results. In restrictive disease, we would also expect the TLC to be decreased, rather than increased as it is in this patient.",
"id": "10000633",
"label": "c",
"name": "Fibrotic lung disease",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In a healthy patient, the FEV1:FVC ratio should be >70%. However, the lung function results for this patient show an obstructive pattern as the FEV1:FVC ratio is <70% (1.50/2.47 = 0.60), meaning that less than 70% of the FVC is exhaled within the first second. COPD also causes hyperinflation of the lungs, which would explain this patient's increased TLC. Finally, her chronic history of dyspnoea and extensive smoking history, along with recurrent infections, fits with the clinical picture of COPD - making it the most likely diagnosis.",
"id": "10000631",
"label": "a",
"name": "Chronic Obstructive Pulmonary Disease (COPD)",
"picture": null,
"votes": 109
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Kyphoscoliosis is a chest wall disease which may cause restrictive lung disease. This would not be fitting with the obstructive pattern seen in this patient's results. It also would not explain the five-year history of symptoms, nor the recurrent infections.",
"id": "10000634",
"label": "d",
"name": "Kyphoscoliosis",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3800",
"name": "Chronic Obstructive Pulmonary Disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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},
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"question": "A 55-year-old female presents with a five-year history of dyspnoea and recurrent chest infections. She has smoked 20 cigarettes a day for 30 years. She undergoes lung function testing which produces the following results:\n\nFVC 2.47 (predicted: 3.15)\n\nFEV1 1.50 (predicted 1.70)\n\nTLC 5.87 (predicted 4.39)\n\nWhich of the following is her most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 139,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,815 | false | 29 | null | 6,495,006 | null | false | [] | null | 12,674 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the final step in the guidelines, and is only used when all treatments have failed to control a patient's symptoms. With this patient only being on step two of the drug treatment for asthma, it would not be appropriate to refer for specialist management.",
"id": "10000638",
"label": "c",
"name": "Refer for specialist treatments",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral steroids are only used in patients with chronically poorly-controlled asthma. This is also a hospital-directed treatment so would only occur under specialist supervision. Additionally, the next step in this patient's treatment is the initial add-on therapy of a LABA e.g. salmeterol, not altering his steroid inhaler dosage or type.",
"id": "10000640",
"label": "e",
"name": "Switch inhaled beclometasone to low-dose oral prednisolone",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Montelukast is a Leukotriene Receptor Antagonist (LTRA), which may be used as an additional controller therapy in this patient. However, the initial add-on therapy used in the current guidelines is an inhaled LABA e.g. salmeterol. If this was then found to not work, then an LTRA may be used instead.",
"id": "10000639",
"label": "d",
"name": "Add oral montelukast to his existing drug regime",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient's asthma symptoms are not being appropriately controlled with a regular inhaled corticosteroid (Beclometasone) and SABA (Salbutamol). Therefore, he should move onto the next step of treatment. The BTS/SIGN 2019 guidelines direct us to add a LABA inhaler, such as Salmeterol, to his existing inhalers - and to continue this treatment if he has a good response.",
"id": "10000636",
"label": "a",
"name": "Add a salmeterol inhaler to his existing drug regime",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "We should follow the current BTS/SIGN guidelines and first prescribe an inhaled LABA, e.g. salmeterol, in addition to his current drug regime, before making any changes to his ICS inhaler dose. Changing his beclometasone dose would only be indicated if initial add-on therapies (e.g. salmeterol) failed to control his symptoms.",
"id": "10000637",
"label": "b",
"name": "Increase the beclometasone inhaler to a high-dose inhaled corticosteroid inhaler",
"picture": null,
"votes": 43
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3725",
"name": "Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 24-year-old male, previously diagnosed with asthma, presents with repeated episodes of dyspnoea and wheezing. He uses both a salbutamol inhaler and a low-dose beclometasone inhaler one to two times daily.\n\nWhich of the following is the most appropriate next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 129,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,816 | false | 30 | null | 6,495,006 | null | false | [] | null | 12,675 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "CURB-65 is scored from 0-5. This patient scores 3 as he has a raised respiratory rate (>30/min), raised blood urea (>7 mmol/L), and is showing signs of confusion. Therefore, he scores 3 on the CURB-65 score, with C = Confusion, U = Urea, and R = Respiratory rate, all being raised. He does not score for B or 65 because his blood pressure (B) is within normal range, and he is less than 65-years-old.",
"id": "10000641",
"label": "a",
"name": "3",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient scores 3 on the CURB-65 score, due to his confusion (C), raised blood urea (U) (>7mmol/L), and raised respiratory rate (R) (>30/min). His temperature is also slightly raised at 39C, and his heart rate at 104bpm. However, these are not measured in the CURB-65 score, so would not count towards the points.",
"id": "10000645",
"label": "e",
"name": "5",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "He would score 3 on the CURB-65 score, as he has signs of confusion (C), a raised urea (U) (>7 mmol/L), and a raised respiratory rate (>30/min) (R). 1 point is given for each raised sign or positive symptom. Therefore, he has 3 points. His normal blood pressure (B), and age of less than 65-years-old would not score any points - for these to score points they must have a low BP (< 95/60) or be older than 65-years-old.",
"id": "10000642",
"label": "b",
"name": "2",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient scores 3 on the CURB-65 score, due to his confusion (C), raised blood urea (U) (>7mmol/L), and raised respiratory rate (R) (>30/min). His temperature is also slightly raised at 39C, and his heart rate at 104bpm. However, these are not measured in the CURB-65 score, so would not count towards the points.",
"id": "10000644",
"label": "d",
"name": "4",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient definitely scores on the CURB-65 score. He has signs of confusion (C), a raised blood urea (U) (>7mmol/L), and a raised respiratory rate (R) (>30/min). This gives him a score of 3.",
"id": "10000643",
"label": "c",
"name": "0",
"picture": null,
"votes": 1
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3709",
"name": "Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"question": "A 53-year-old man presents to A&E with a two-week history of productive cough. He is unsure of what day of the week it is, despite having no background of reduced cognition.\n\n\n **His observations are as follows:**\n\n\nRR 32/min\n\n\nHR 104 bpm\n\n\nBP 100/95\n\n\nTemp 39C\n\n\nHe also has a Blood Urea of 7.6mmol/L.\n\n\nWhat is his CURB-65 score?",
"sbaAnswer": [
"a"
],
"totalVotes": 120,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,817 | false | 31 | null | 6,495,006 | null | false | [] | null | 12,676 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The acronym used to help patients set objectives for lifestyle changes is 'SMART'. It works as follows: S = Specific, M= Measurable, A = Achievable, R = Relevant, and T = Time-limited.",
"id": "10000650",
"label": "e",
"name": "GOAL",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Goals set for patients should be specific (e.g. to only consume nicotine through patches and gum), measurable (e.g. to have cut down from three patches a day to one patch a day in the next month), achievable e.g. (to have quit smoking cigarettes completely in the next six months with the use of cessation therapies), relevant (e.g. to attend one monthly smoking cessation meeting), and time-limited (e.g. to be free from all nicotine in 12-months time).",
"id": "10000646",
"label": "a",
"name": "SMART",
"picture": null,
"votes": 104
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The acronym used to help patients set objectives for lifestyle changes is 'SMART'. It works as follows: S = Specific, M= Measurable, A = Achievable, R = Relevant, and T = Time-limited.",
"id": "10000648",
"label": "c",
"name": "BRAIN",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The acronym used to help patients set objectives for lifestyle changes is 'SMART'. It works as follows: S = Specific, M= Measurable, A = Achievable, R = Relevant, and T = Time-limited.",
"id": "10000649",
"label": "d",
"name": "NOW",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The acronym used to help patients set objectives for lifestyle changes is 'SMART'. It works as follows: S = Specific, M= Measurable, A = Achievable, R = Relevant, and T = Time-limited.",
"id": "10000647",
"label": "b",
"name": "HARD",
"picture": null,
"votes": 2
}
],
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"id": "3801",
"name": "Smoking cessation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
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"question": "What is the acronym used when helping patients to create objectives for lifestyle changes?",
"sbaAnswer": [
"a"
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"totalVotes": 131,
"typeId": 1,
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} | MarksheetMark |
173,459,818 | false | 32 | null | 6,495,006 | null | false | [] | null | 12,677 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct drug regime for the secondary prevention of a STEMI, it should be offered to all patients following a STEMI.",
"id": "10000651",
"label": "a",
"name": "ACE inhibitor + dual antiplatelet therapy + beta-blocker + statin",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dual antiplatelet therapy would be given but other drugs would need to be given alongside it. Examples include an ACE inhibitor, beta blocker, and statin.",
"id": "10000654",
"label": "d",
"name": "Dual antiplatelet therapy alone",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a surgery which would have been carried out in hospital to treat the initial STEMI. It would not be used as secondary prevention. Cardiac rehabilitation centres advise for further management e.g. long-term drug management and lifestyle advice.",
"id": "10000653",
"label": "c",
"name": "PCI (Percutaneous Coronary Intervention)",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate in cardiac rehab. However, medical management requires a drug regime as well as any lifestyle advice and education being given.",
"id": "10000655",
"label": "e",
"name": "Lifestyle advice and education e.g. weight loss, smoking cessation",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Omega-3 should not be offered or advised to patients to take to prevent another MI. However, if they chose to take Omega-3, then there is no evidence of harm.",
"id": "10000652",
"label": "b",
"name": "Omega-3 capsules",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3802",
"name": "Myocardial Infarction",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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},
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"question": "A 55-year-old male who suffered an ST-elevation myocardial infarction (STEMI) has been treated acutely and referred to a cardiac rehabilitation centre.\n\nWhich of the following is the most appropriate medical management for prevention of a further ischaemic event?",
"sbaAnswer": [
"a"
],
"totalVotes": 129,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,819 | false | 33 | null | 6,495,006 | null | false | [] | null | 12,678 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a low CD4 count which puts him at risk of opportunistic infections such as Pneumocystis pneumonia. He should be given prophylactic antibiotics. Dapsone can be given, but it is only used second-line if the first-line antibiotic (co-trimoxazole) is not tolerated or inappropriate. Antibiotics should also only be used until the CD4 count is >200cell/mL.",
"id": "10000660",
"label": "e",
"name": "Dapsone PO until CD4 >300 cell/mL",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a low CD4 count which puts him at risk of opportunistic infections such as Pneumocystis pneumonia. He should be given prophylactic antibiotics, and the first-line choice is co-trimoxazole. However, it should be given until his CD4 count is >200cell/mL.",
"id": "10000658",
"label": "c",
"name": "Co-trimoxazole PO until CD4 >150 cell/mL",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a low CD4 count which puts him at risk of opportunistic infections such as Pneumocystis pneumonia. He should be given prophylactic antibiotics until his CD4 count is >200cell/mL. However, the first-line antibiotic is co-trimoxazole. Dapsone would not be given unless co-trimoxazole was not appropriate or tolerated.",
"id": "10000657",
"label": "b",
"name": "Dapsone PO until CD4 >200 cell/mL",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a low CD4 count which puts him at risk of opportunistic infections such as Pneumocystis pneumonia. He should be given prophylactic antibiotics until his CD4 count is >200cell/mL, with the first-line antibiotic being co-trimoxazole.",
"id": "10000656",
"label": "a",
"name": "Co-trimoxazole PO until CD4 >200 cell/mL",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has a low CD4 count which puts him at risk of opportunistic infections such as Pneumocystis pneumonia. He should be given prophylactic antibiotics until his CD4 count is >200cell/mL. However, erythromycin would not be an appropriate antibiotic for this. Instead, co-trimoxazole would be used.",
"id": "10000659",
"label": "d",
"name": "Erythromycin PO until CD4 > 200 cell/mL",
"picture": null,
"votes": 26
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3803",
"name": "Pneumocystis pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "163",
"name": "Genitourinary medicine",
"typeId": 7
},
"topicId": 163,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
"conceptId": 3803,
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"question": "A 32-year-old male tested positive for HIV two years ago. He is taking anti-retrovirals to suppress the virus and feels generally well. His CD4 count was 105 cell/mL when last tested one week ago.\n\nGiven this result, which of the following is the most appropriate next step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 108,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,820 | false | 34 | null | 6,495,006 | null | false | [] | null | 12,679 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These are the four muscles which line the anterior abdominal wall. They work to move the trunk, and support and compress the abdominal viscera.",
"id": "10000661",
"label": "a",
"name": "External oblique, internal oblique, transversus abdominis, and rectus abdominis",
"picture": null,
"votes": 119
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These muscles line the posterior abdominal wall, and act as hip flexors. There are four muscles which line the anterior abdominal wall. These are the external oblique, internal oblique, transversus abdominis, and rectus abdominis.",
"id": "10000665",
"label": "e",
"name": "Iliacus and psoas",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are the four muscles found surrounding the posterior abdominal wall. The muscles which line the anterior abdominal wall are the external oblique, internal oblique, transversus abdominis, and rectus abdominis.",
"id": "10000662",
"label": "b",
"name": "Diaphragm, quadratus lumborum, iliacus, and psoas",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The internal oblique does line the anterior abdominal wall. However, the diaphragm surrounds the posterior abdominal wall. Additionally, there are three more muscles which line the anterior abdominal wall in addition to the internal oblique. These are the external oblique, transversus abdominis, and rectus abdominis.",
"id": "10000664",
"label": "d",
"name": "Diaphragm and internal oblique",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These muscles are a mixture of the posterior abdominal wall muscles and anterior abdominal wall muscles. There are four muscles which line the anterior abdominal wall. They are the external oblique, internal oblique, transversus abdominis, and rectus abdominis.",
"id": "10000663",
"label": "c",
"name": "Quadratus lumborum, transversus abdominis, internal oblique, and psoas",
"picture": null,
"votes": 7
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3804",
"name": "Muscle physiology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "164",
"name": "Physiology and pathology of bone",
"typeId": 7
},
"topicId": 164,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3804,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "Which of the following muscles line the anterior abdominal wall?",
"sbaAnswer": [
"a"
],
"totalVotes": 128,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,821 | false | 35 | null | 6,495,006 | null | false | [] | null | 12,680 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the action of lactoferrin which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.",
"id": "10000669",
"label": "d",
"name": "Chelation of iron to prevent microbial multiplication",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the action of alpha-amylase (AKA Ptyalin) which is an enzyme which is also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.",
"id": "10000667",
"label": "b",
"name": "Hydrolysis of alpha-1,4-glycosidic bonds in starch",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lysozyme is an enzyme present in saliva which acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.",
"id": "10000666",
"label": "a",
"name": "Hydrolysis of peptidoglycans in the cell wall of gram-negative bacteria",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the action of kallikrein which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.",
"id": "10000670",
"label": "e",
"name": "Converts plasma protein alpha-2-globulin into bradykinin",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the action of lipase which is an enzyme also found within saliva. Lysozyme acts to break down the cell walls of gram-negative bacteria via hydrolysing peptidoglycans.",
"id": "10000668",
"label": "c",
"name": "Hydrolysis of lipid triglycerides to fatty acid and diglycerides",
"picture": null,
"votes": 27
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3805",
"name": "Saliva",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3805,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12680",
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"question": "Which of the following best describes the role of the enzyme lysozyme in saliva?",
"sbaAnswer": [
"a"
],
"totalVotes": 125,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,822 | false | 36 | null | 6,495,006 | null | false | [] | null | 12,681 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the type of pancreatic juice produced via the action of the hormone secretin, which is secreted from ductal cells in the duodenum in the presence of highly acidic chyme. CCK release into the small intestine is triggered by chyme-containing fat and protein products. Once released, it then stimulates the acinar cells of the pancreas to release enzyme-rich pancreatic juice into the duodenum in order to digest the fat and protein within the chyme.",
"id": "10000672",
"label": "b",
"name": "High-volume, HCO<sub>3</sub><sup>-</sup> rich, low-enzyme pancreatic juice",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the pancreatic juice produced via the action of CCK is enzyme-rich in order to digest the protein and fat present within the chyme, it is not HCO<sub>3</sub><sup>-</sup> rich - as the chyme is not acidic and thus does not require neutralisation. HCO<sub>3</sub><sup>-</sup> rich pancreatic juice would be secreted in response to the hormone secretin.",
"id": "10000673",
"label": "c",
"name": "Low-volume, HCO<sub>3</sub><sup>-</sup> rich, enzyme-rich pancreatic juice",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "CCK release into the small intestine is triggered by chyme-containing fat and protein products. Once released, it then stimulates the acinar cells of the pancreas to release enzyme-rich pancreatic juice into the duodenum in order to digest the fat and protein within the chyme.",
"id": "10000671",
"label": "a",
"name": "Low-volume, enzyme-rich pancreatic juice",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CCK does produce enzyme-rich pancreatic juice in order to digest protein and fat in chyme with high protein and fat content. However, much lower volumes of pancreatic juice are produced in response to CCK in comparison to other triggers, such as secretin.",
"id": "10000675",
"label": "e",
"name": "High-volume, enzyme-rich pancreatic juice",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pancreatic juice should be alkaline in nature in order to neutralise acidic gastric acid. CCK causes release of low-volume, enzyme-rich pancreatic juice in order to digest protein and fat in chyme with high protein and fat content.",
"id": "10000674",
"label": "d",
"name": "H<sup>+</sup> rich, low-enzyme pancreatic juice",
"picture": null,
"votes": 7
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3806",
"name": "Pancreatic exocrine function",
"status": null,
"topic": {
"__typename": "Topic",
"id": "165",
"name": "Gastrointestinal physiology",
"typeId": 7
},
"topicId": 165,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3806,
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"difficulty": 1,
"dislikes": 0,
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"question": "What kind of pancreatic juice is produced via the action of the hormone cholecystokinin (CCK)?",
"sbaAnswer": [
"a"
],
"totalVotes": 127,
"typeId": 1,
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} | MarksheetMark |
173,459,823 | false | 37 | null | 6,495,006 | null | false | [] | null | 12,682 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a genetic test for genes which are associated with coeliac disease. It is typically reserved for children found to have a positive TTGA, and is used in such patients in place of biopsies.",
"id": "10000679",
"label": "d",
"name": "Testing for HLA-D2 and HLA-DQ8",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be used to investigate for coeliac disease, as a raised endomysial IgA does indicate coeliac disease. The test is 100% specific, but only 90% sensitive - making TTGA the preferred, first-line, test due to it's higher sensitivity.",
"id": "10000677",
"label": "b",
"name": "Endomysial IgA",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a test used to measure inflammation of the intestine, and is used to screen for inflammatory bowel disease (IBD) e.g. Crohn's Disease or Ulcerative Colitis. It may be used to screen this patient for IBD. However, it would not be diagnostic for coeliac disease.",
"id": "10000680",
"label": "e",
"name": "Faecal calprotectin",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A series of duodenal biopsies can be used to confirm a diagnosis of coeliac disease. Diagnosis is confirmed by seeing villous atrophy, crypt hyperplasia, and increased lymphocytes when a person is consuming gluten. Villous atrophy should then be seen to recover on a gluten-free diet. However, a biopsy is only carried out after initial blood tests. The first-line investigative blood test specifically for coeliac disease is TTGA.",
"id": "10000678",
"label": "c",
"name": "Duodenal biopsy via upper GI endoscopy",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the first-line investigation for coeliac disease. It is 98% sensitive and 96% specific. If positive, then further tests may be carried out to confirm the diagnosis e.g. biopsies. It should also be ordered alongside a test for total IgA because if the person has an IgA deficiency, TTGA may not be detected even if the person does have coeliac disease.",
"id": "10000676",
"label": "a",
"name": "Tissue transglutamase IgA (TTGA)",
"picture": null,
"votes": 73
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3807",
"name": "Coeliac Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
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},
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"question": "Which of the following tests would be first-line for the investigation of a patient with suspected coeliac disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 125,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,824 | false | 38 | null | 6,495,006 | null | false | [] | null | 12,683 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A FIT is offered every two years to patients in the UK between the ages of 60-74 years. It is a home testing kit which is sent to a laboratory for analysis. It works as an antibody-antigen reaction and tests for occult blood within the stool. If it is found to be positive, the patient is referred for a colonoscopy for further investigation.",
"id": "10000681",
"label": "a",
"name": "FIT (Faecal Immunochemical Test)",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Faecal calprotectin is a marker of inflammation, which is a relatively specific test for inflammatory bowel disease e.g. Crohn's disease and ulcerative colitis. It is not used to screen for bowel cancer.",
"id": "10000682",
"label": "b",
"name": "Faecal calprotectin",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A colonoscopy is the ideal screening method for bowel cancer, and is used for bowel cancer in the USA. However, it requires sedation, expertise, and is associated with a 1-2% of bowel perforation. Therefore, it is not included in the screening program in the UK.",
"id": "10000685",
"label": "e",
"name": "Colonoscopy",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "TTGA is a highly specific and sensitive test used in the diagnosis of coeliac disease. It is not used in screening for bowel cancer.",
"id": "10000683",
"label": "c",
"name": "Tissue transglutamase IgA (TTGA)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Flexible sigmoidoscopy is offered to all patients in the UK at 55-years-old. However, between the ages of 60-74 years, they receive a Faecal Immunochemical Test (FIT) every two years as part of the bowel cancer screening program.",
"id": "10000684",
"label": "d",
"name": "Flexible sigmoidoscopy",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3731",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "Which of the following is used routinely as part of the NHS bowel cancer screening program for 60- to 74-year-olds?",
"sbaAnswer": [
"a"
],
"totalVotes": 127,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,825 | false | 39 | null | 6,495,006 | null | false | [] | null | 12,684 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should never be the first diagnosis for a patient complaining of inadequate analgesia. A range of analgesia should be trialled, and a thorough drug and social history relating to opiate drug use and previous presentations to medical services should be taken prior to considering drug-seeking as a diagnosis. Also, this patient has already been diagnosed with appendicitis - so will be in considerable pain, making it completely reasonable for him to require additional analgesia.",
"id": "10000690",
"label": "e",
"name": "Drug-seeking behaviour",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Codeine is metabolised by the enzyme CYP2D6, not by CYP450. Also, this patient's lack of response to codeine would be caused by CYP2D6 polymorphism with poor metaboliser effect, not ultra-rapid metaboliser effect.",
"id": "10000688",
"label": "c",
"name": "CYP450 polymorphism with ultra-rapid metaboliser effect",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Codeine is metabolised by the enzyme CYP2D6, not by CYP450.",
"id": "10000689",
"label": "d",
"name": "CYP450 polymorphism with poor metaboliser effect",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Codeine is metabolised by the enzyme CYP2D6 in the liver, which converts codeine into morphine - its active metabolite. CYP2D6 polymorphism with ultra-rapid metaboliser effect, meaning two copies of the CYP2D6 gene with increased activity, would cause Codeine to be rapidly broken down into Morphine, leading to an exaggerated response to Codeine and possible opiate toxicity. This is the opposite to this patient's findings, meaning that he has CYP2D6 polymorphism with poor metaboliser effect, rather than an ultra-rapid effect.",
"id": "10000687",
"label": "b",
"name": "CYP2D6 polymorphism with ultra-rapid metaboliser effect",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Codeine is metabolised by the enzyme CYP2D6 in the liver, which converts codeine into morphine - its active metabolite. This patient likely has CYP2D6 polymorphism with poor metaboliser effect, meaning that he has two inactive copies of CYP2D6. This means that pain relief is inadequate with codeine as it is unable to be converted into morphine.",
"id": "10000686",
"label": "a",
"name": "CYP2D6 polymorphism with poor metaboliser effect",
"picture": null,
"votes": 22
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3808",
"name": "Cytochrome P450 enzymes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
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},
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"question": "A 32-year-old male presents with appendicitis. Whilst waiting for surgery, he is given 60mg of codeine for pain relief. One hour later, he is still complaining of the same level of pain, and says that the codeine has not helped at all.\n\nWhich of the following is the most likely explanation for this?",
"sbaAnswer": [
"a"
],
"totalVotes": 123,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,826 | false | 40 | null | 6,495,006 | null | false | [] | null | 12,685 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The splenic artery and hepatic artery are both branches of the coeliac artery. However, it is the left gastric artery, not the right gastric artery, which is the third branch of the coeliac artery.",
"id": "10000692",
"label": "b",
"name": "Right gastric artery, splenic artery, and hepatic artery",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vessel is a branch of the splenic artery, therefore does not directly arise from the coeliac artery.",
"id": "10000695",
"label": "e",
"name": "Greater pancreatic artery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The splenic artery, hepatic artery, and left gastric artery are the three main branches of the coeliac artery which arise from the abdominal aorta at T12/L1 level. These supply blood to the spleen, liver, and stomach respectively.",
"id": "10000691",
"label": "a",
"name": "Splenic artery, hepatic artery, and left gastric artery",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These two arteries arise from the abdominal aorta, alongside the coeliac artery itself.",
"id": "10000694",
"label": "d",
"name": "Superior mesenteric artery and inferior mesenteric artery",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are the three vessels which arise from the hepatic artery. The hepatic artery itself does arise from the coeliac artery.",
"id": "10000693",
"label": "c",
"name": "Gastroduodenal artery, right hepatic artery, and left hepatic artery",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3809",
"name": "Structure and physiology of blood vessels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3809,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"psaSectionId": null,
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"question": "Which of the following blood vessels are the direct branches of the coeliac artery?",
"sbaAnswer": [
"a"
],
"totalVotes": 127,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,827 | false | 41 | null | 6,495,006 | null | false | [] | null | 12,686 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The common bile duct transports bile from the gallbladder. It fuses with the pancreatic duct to form the ampulla of Vater which then passes through the sphincter of Oddi and into the duodenum. If there is a high concentration of fatty food in the duodenum, the sphincter of Oddi may relax to allow bile (and pancreatic juice) to pass through the ampulla of Vater into the duodenum to emulsify fats.",
"id": "10000700",
"label": "e",
"name": "Common bile duct",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The duct of Santorini is an accessory duct from the main pancreatic duct (Wirsung duct). It exits into the duodenum around 2cm superiorly to the ampulla of Vater. This usually acts only as a safety feature for if the Wirsung duct is unable to drain pancreatic juice, and is usually largely non-functioning.",
"id": "10000698",
"label": "c",
"name": "Duct of Santorini",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The sphincter of Oddi is a muscular valve which surrounds the exit of the common bile duct and pancreatic duct, which join to create the Ampulla of Vater which exits into the duodenum. When fatty foods move into the duodenum, bile and pancreatic juices are needed to digest them. Therefore, the sphincter of Oddi relaxes to allow bile and pancreatic juice to enter the duodenum via the ampulla of Vater.",
"id": "10000696",
"label": "a",
"name": "Sphincter of Oddi",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ampulla of Vater is the point where the bile duct and pancreatic duct join and pass into the duodenum. It is surrounded by the sphincter of Oddi, which relaxes to allow bile and pancreatic juice to pass into the duodenum when fatty food is present. The ampulla of Vater itself does not relax or contract, and is controlled by the Sphincter of Oddi.",
"id": "10000697",
"label": "b",
"name": "Ampulla of Vater",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Wirsung duct is the main pancreatic duct. It joins with the common bile duct to create the ampulla of Vater which allows bile and pancreatic juice to flow into the duodenum. However, the flow of bile into the duodenum when fatty food is present in the duodenum is controlled by the sphincter of Oddi - which the ampulla of Vater flows through.",
"id": "10000699",
"label": "d",
"name": "Wirsung duct",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3810",
"name": "Gallstone Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"question": "Which of the following relaxes in response to the presence of fatty food within the duodenum?",
"sbaAnswer": [
"a"
],
"totalVotes": 126,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,828 | false | 42 | null | 6,495,006 | null | false | [] | null | 12,687 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis B leads to damage to the hepatocytes - thus causing a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results, alongside right upper quadrant pain, jaundice and pale stool, are consistent with biliary obstruction. Considering her age and gender, gallstones are the most likely cause of this obstructive picture.",
"id": "10000702",
"label": "b",
"name": "Hepatitis B",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The LFTs of this patient show an obstructive pattern, with raised GGT and ALP, alongside a lesser rise in ALT. Additionally, the right upper quadrant pain is consistent with biliary obstruction - which would also explain her jaundice. The presence of pale stools in her history also means that the cause of this obstruction is likely post-hepatic. Gallstones are the most common cause of biliary obstruction, and are post-hepatic. As she has no red flags for metastases, gallstones are the most likely diagnosis.",
"id": "10000701",
"label": "a",
"name": "Gallstones",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alcoholic hepatitis would lead to hepatocellular disease and cause a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results (alongside right upper quadrant pain, jaundice and pale stool) are consistent with biliary obstruction. Considering her age and gender, gallstones is the most likely cause of this obstructive picture.",
"id": "10000703",
"label": "c",
"name": "Alcoholic hepatitis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary sclerosing cholangitis may produce an obstructive LFT picture as it causes obstruction to the flow of bile out of the liver. It would also present with obstructive jaundice and right upper quadrant pain, and may cause pale stools. It is a differential diagnosis for this patient, and should be excluded via imaging. However, gallstones are by far the most common cause of biliary obstruction, especially in women around the age of 40 years. Therefore, gallstones are the most likely diagnosis.",
"id": "10000705",
"label": "e",
"name": "Primary Sclerosing Cholangitis",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gilberts Syndrome is an inherited, pre-hepatic, cause of jaundice that causes an isolated rise in bilirubin. This would not explain any of this patient's other symptoms e.g. pale stools and right upper quadrant pain. It also does not explain the derangement of any of her other LFTs.",
"id": "10000704",
"label": "d",
"name": "Gilberts Syndrome",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3810",
"name": "Gallstone Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
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"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1682079567,
"id": "1508",
"index": 0,
"name": "Image 6.png",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/d8hy4anl1682079658352.jpg",
"path256": "images/d8hy4anl1682079658352_256.jpg",
"path512": "images/d8hy4anl1682079658352_512.jpg",
"thumbhash": "NOcFE4JmZniAiAh3h3BwCAc=",
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"id": "135",
"name": "General surgery",
"typeId": 7
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"updatedAt": 1708373886
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"question": "A 36-year-old female presents with right upper quadrant pain and jaundice. From her history, you find out that her stool has also been pale in recent weeks. Her LFT results are shown below.\n\n[lightgallery]\n\nWhich of the following is her most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 123,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,829 | false | 43 | null | 6,495,006 | null | false | [] | null | 12,688 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). The dose is divided by the plasma concentration, not multiplied. Also, it is 'volume' of distribution, so the units are 'L' not 'mg'.",
"id": "10000709",
"label": "d",
"name": "250mg",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct calculation has been carried out here, as the volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). However, given it is 'volume' of distribution, the units are 'L' not 'mg'.",
"id": "10000708",
"label": "c",
"name": "2.5mg",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L).",
"id": "10000706",
"label": "a",
"name": "2.5L",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L).",
"id": "10000710",
"label": "e",
"name": "15L",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The volume of distribution is the theoretical volume which would be needed to contain a dose of a drug in order to keep it at the same concentration as the required plasma concentration. Midazolam must reach 10mg/L within the plasma, and the dose being given is 25mg. Therefore, Vd = 25 /10 = 2.5 because Vd = Dose (mg) / Plasma concentration (mg/L). The dose is divided by the plasma concentration, not multiplied.",
"id": "10000707",
"label": "b",
"name": "250L",
"picture": null,
"votes": 4
}
],
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"id": "3811",
"name": "Apparent volume of distribution",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
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"question": "A patient is prescribed 25mg of Midazolam. It must reach a plasma concentration of 10mg/L for it to take effect.\n\nWhat is the volume of distribution (Vd) for this dose of Midazolam?",
"sbaAnswer": [
"a"
],
"totalVotes": 123,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,830 | false | 44 | null | 6,495,006 | null | false | [] | null | 12,689 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Noradrenaline (and adrenaline) are produced in the medulla of the suprarenal glands, not the cortex. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone",
"id": "10000713",
"label": "c",
"name": "Noradrenaline",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adrenaline is produced by the medulla of the suprarenal glands, not the cortex. Noradrenaline is also produced here. The suprarenal gland cortices produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone.",
"id": "10000712",
"label": "b",
"name": "Adrenaline",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Insulin is secreted by the beta cells of the pancreas, not by the suprarenal glands. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone",
"id": "10000714",
"label": "d",
"name": "Insulin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glucagon is secreted by the alpha cells of the pancreas, not by the suprarenal glands. The cortices of the suprarenal glands produce adrenal corticosteroids e.g. cortisol and aldosterone, and sex hormones e.g. progesterone.",
"id": "10000715",
"label": "e",
"name": "Glucagon",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The cortex of the suprarenal glands produces corticosteroids e.g. aldosterone and cortisol, and sex hormones e.g. progesterone.",
"id": "10000711",
"label": "a",
"name": "Aldosterone",
"picture": null,
"votes": 89
}
],
"comments": [],
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"id": "3812",
"name": "Adrenal cortical hormones",
"status": null,
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"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
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"question": "Which of the following hormones is secreted by the cortex of the suprarenal (AKA adrenal) glands?",
"sbaAnswer": [
"a"
],
"totalVotes": 130,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,831 | false | 45 | null | 6,495,006 | null | false | [] | null | 12,690 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.",
"id": "10000716",
"label": "a",
"name": "10 mmHg",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.",
"id": "10000717",
"label": "b",
"name": "80 mmHg",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.",
"id": "10000720",
"label": "e",
"name": "18 mmHg",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.",
"id": "10000718",
"label": "c",
"name": "30 mmHg",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Net filtration pressure is the total pressure which drives fluid out of the capillary. The pressure within the glomerular capillary is hydrostatic pressure driving fluid out of the capillary. The plasma protein pressure is osmotic pressure into the capillary. The pressure within the Bowman's capsule is hydrostatic pressure into the capillary. Therefore, net filtration pressure = 45 - (25 +10), meaning net filtration pressure = 10mmHg.",
"id": "10000719",
"label": "d",
"name": "205 mmHg",
"picture": null,
"votes": 1
}
],
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"id": "3813",
"name": "Glomerular permeability",
"status": null,
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"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
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"question": "During glomerular filtration, the pressure within the glomerular capillary is 45mmHg, the plasma protein pressure is 25mmHg, and the pressure within the Bowman's capsule is 10mmHg. Calculate the net filtration pressure.\n\n",
"sbaAnswer": [
"a"
],
"totalVotes": 120,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,832 | false | 46 | null | 6,495,006 | null | false | [] | null | 12,691 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Modification of urine does occur via the movement of ions within the distal tubule, it occurs via the following mechanism: Na<sup>+</sup> and Cl<sup>-</sup> are actively reabsorbed from the tubular fluid in exchange for K<sup>+</sup> and H<sup>+</sup> which are secreted into the tubular fluid.",
"id": "10000725",
"label": "e",
"name": "There is no movement of ions within the distal tubule",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is switched around, the correct exchange of ions is: Na<sup>+</sup> and Cl<sup>-</sup> are actively reabsorbed from the distal tubule, in exchange for K<sup>+</sup> and H<sup>+</sup> which are secreted into the tubule.",
"id": "10000723",
"label": "c",
"name": "Na<sup>+</sup>and Cl<sup>-</sup> are secreted from the tubular fluid in exchange for K<sup>+</sup> and H<sup>+</sup>, which are actively reabsorbed into the tubular fluid",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is Cl<sup>-</sup> which is actively reabsorbed from the tubular fluid alongside Na<sup>+</sup> in exchange for K<sup>+</sup> and H<sup>+</sup>, not Ca<sup>2+</sup>.",
"id": "10000724",
"label": "d",
"name": "Ca<sup>2+</sup> and Na<sup>+</sup> are actively reabsorbed from the tubular fluid in exchange for K<sup>+</sup> and H<sup>+</sup>, which are secreted into the tubular fluid",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The distal tubule performs modification of urine prior to the final modification in the collecting duct. Na<sup>+</sup> and Cl<sup>-</sup> are exchanged for K<sup>+</sup> or H<sup>+</sup> throughout the distal tubule.",
"id": "10000721",
"label": "a",
"name": "Na<sup>+</sup> and Cl<sup>-</sup> are actively reabsorbed from the tubular fluid in exchange for K<sup>+</sup> and H<sup>+</sup>, which are secreted into the tubular fluid",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The distal tubule performs modification of urine prior to the final modification in the collecting duct. However, the correct exchange of ions is the following: Na<sup>+</sup> and Cl<sup>-</sup> are exchanged for K<sup>+</sup> or H<sup>+</sup> throughout the distal tubule.",
"id": "10000722",
"label": "b",
"name": "K<sup>+</sup> and Cl<sup>-</sup> are actively reabsorbed from the tubular fluid in exchange for Na<sup>+</sup> and H<sup>+</sup>, which are secreted into the tubular fluid",
"picture": null,
"votes": 15
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
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"demo": null,
"entitlement": null,
"id": "3814",
"name": "Nephron Structure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
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"question": "Which of the following options best describes what happens in the distal tubule of the nephron during urine formation?",
"sbaAnswer": [
"a"
],
"totalVotes": 123,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,833 | false | 47 | null | 6,495,006 | null | false | [] | null | 12,692 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This mechanism would lead to an increase in Na<sup>+</sup> reabsorption, and so would cause decreased water excretion (diuresis). Instead, thiazide-diuretics act in the distal tubule to inhibit the apical Na<sup>+</sup>/Cl<sup>-</sup>co-transporter. This leads to less Na<sup>+</sup> reabsorption from the tubule, thus leading to moderately increased Na<sup>+</sup> excretion with increased water excretion. This is diuresis.",
"id": "10000727",
"label": "b",
"name": "Activates the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter in the distal tubule",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Thiazide diuretics act in the distal tubule to inhibit the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter. This leads to less Na<sup>+</sup> reabsorption, thus leading to moderately increased Na<sup>+</sup> excretion with increased water excretion. This is diuresis.",
"id": "10000726",
"label": "a",
"name": "Inhibits the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter in the distal tubule",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of certain K<sup>+</sup>-sparing diuretics (e.g. spironolactone) which antagonise aldosterone receptors to then reduce Na<sup>+</sup> channel formation. This means that less Na<sup>+</sup> can be reabsorbed from the tubule - therefore causing greater Na<sup>+</sup> and water excretion. Meanwhile, thiazide-diuretics act in the distal tubule to inhibit the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter. This leads to less Na<sup>+</sup> reabsorption from the tubule, thus leading to moderately increased Na<sup>+</sup> excretion with increased water excretion. This is diuresis.",
"id": "10000728",
"label": "c",
"name": "Aldosterone receptor antagonist",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the action of the weak K<sup>+</sup> sparing diuretics triamterene and amiloride. This mechanism leads to the inhibition of Na<sup>+</sup> reabsorption and decrease of K<sup>+</sup> excretion. Meanwhile, thiazide-diuretics act in the distal tubule to inhibit the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter. This leads to less Na<sup>+</sup> reabsorption from the tubule, thus leading to moderately increased Na<sup>+</sup> excretion with increased water excretion. This is diuresis.",
"id": "10000729",
"label": "d",
"name": "Blocks the luminal Na<sup>+</sup> channel in the distal tubule",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of carbonic anhydrase Inhibitors e.g. acetazolamide, which are early examples of weak diuretics, and are not often used for diuresis. Thiazide-diuretics, however, act in the distal tubule and inhibit the apical Na<sup>+</sup>/Cl<sup>-</sup> co-transporter. This leads to less Na<sup>+</sup> reabsorption from the tubule, thus leading to moderately increased Na<sup>+</sup> excretion with increased water excretion. This is diuresis.",
"id": "10000730",
"label": "e",
"name": "Blocks NaHCO<sub>3</sub> reabsorption in the proximal tubule",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3815",
"name": "Thiazide diuretics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "Which of the following options best describes the mechanism of action of thiazide diuretics?",
"sbaAnswer": [
"a"
],
"totalVotes": 132,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,834 | false | 48 | null | 6,495,006 | null | false | [] | null | 12,693 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Given this patient's past medical history and symptoms, he is likely experiencing a panic attack which would lead to hyperventilation. This would result in him exhaling excessive CO~2~, thus causing decreased CO~2~, which would cause his pH to increase into an alkalosis. This would be seen via a raised pH and decreased PaCO~2~.",
"id": "10000731",
"label": "a",
"name": "Respiratory alkalosis",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given this patient's past medical history and symptoms, it is unlikely that the cause of his symptoms is metabolic. Instead, he is most likely to be experiencing a panic attack which is causing hyperventilation and leading to exhalation of excessive CO~2~. This decreased CO~2~ would push his pH to increase into an alkalosis, not an acidosis, giving him a respiratory alkalosis overall.",
"id": "10000732",
"label": "b",
"name": "Metabolic acidosis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given this patient's past medical history and symptoms, it is likely that the cause of his symptoms is respiratory - specifically a panic attack causing hyperventilation and leading to exhalation of excessive CO~2~. However, this decreased CO~2~ would push his pH to increase into an alkalosis, not an acidosis, giving him a respiratory alkalosis overall.",
"id": "10000733",
"label": "c",
"name": "Respiratory acidosis",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given this patient's past medical history and symptoms, it is unlikely that the cause of his symptoms is metabolic. Instead, he is most likely to be experiencing a panic attack which is causing hyperventilation and leading to exhalation of excessive CO~2~. This decreased CO~2~ would push his pH to increase into an alkalosis, giving him a respiratory alkalosis overall.",
"id": "10000735",
"label": "e",
"name": "Mixed respiratory and metabolic alkalosis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given this patient's past medical history and symptoms, it is unlikely that the cause of his symptoms is metabolic. Instead, he is most likely to be experiencing a panic attack which is causing hyperventilation and leading to exhalation of excessive CO~2~. This decreased CO~2~ would push his pH to increase into an alkalosis, giving him a respiratory alkalosis overall.",
"id": "10000734",
"label": "d",
"name": "Metabolic alkalosis",
"picture": null,
"votes": 5
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "3816",
"name": "Respiratory alkalosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
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"question": "A 20-year-old male with a known anxiety disorder presents with shortness of breath and the feeling of pins and needles in his fingers. A venous blood gas (VBG) is carried out.\n\nGiven his likely diagnosis, what is the VBG most likely to show?",
"sbaAnswer": [
"a"
],
"totalVotes": 130,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,835 | false | 49 | null | 6,495,006 | null | false | [] | null | 12,694 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The raised creatinine is most likely to have occurred over the last week as she was previously well. Additionally, the fall in urine output for more than eight hours also indicates an AKI. There is no past medical history to indicate a diabetic or drug cause. One week of diarrhoea and nausea indicates possible gastroenteritis causing dehydration, resulting in AKI.",
"id": "10000736",
"label": "a",
"name": "Acute Kidney Injury (AKI) secondary to gastroenteritis",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "T2DM is more likely than T1DM given this patient's age. However, this would usually lead to CKD (chronic kidney injury), which would not fit with the one-week history of this patient's symptoms. Instead, a more acute cause e.g. gastroenteritis causing dehydration and AKI is more likely.",
"id": "10000739",
"label": "d",
"name": "Type 2 Diabetes Mellitus (T2DM)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CKD is unlikely given the length of time of the symptoms and the fact that this patient was previously well. The signs of clinical dehydration, and hypotension, both indicate that this patient has lost substantial amounts of fluid due to her diarrhoea - which given the one-week history, likely has an infective cause. This means the most likely diagnosis is AKI secondary to gastroenteritis.",
"id": "10000737",
"label": "b",
"name": "Chronic Kidney Disease (CKD)",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "T1DM is unlikely given the age of this patient, as we would have expected this to have already been diagnosed in childhood, or early adulthood at the latest. Dehydration due to gastroenteritis, causing an AKI is much more likely.",
"id": "10000738",
"label": "c",
"name": "Type 1 Diabetes Mellitus (T1DM)",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst sepsis is a risk for this patient given her likely infection, it is not possible to say if she is septic without further investigations (blood cultures etc.). However, it is possible to say that she is suffering with an AKI. This is likely due to gastroenteritis given her one-week history of gastrointestinal symptoms.",
"id": "10000740",
"label": "e",
"name": "Sepsis",
"picture": null,
"votes": 2
}
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"id": "3817",
"name": "Management of AKI",
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"question": "A 60-year-old female presents with a one-week history of diarrhoea and nausea, and a two-day history of reduced urine output. On examination, she is clinically dehydrated and has a BP of 84/60. She is normally well with no past medical history. Her blood results are as follows:\n\n\n||||\n|---------------------------|:-------:|--------------------|\n|Sodium|151 mmol/L|135 - 145|\n|Potassium|6.2 mmol/L|3.5 - 5.3|\n|Urea|28 mmol/L|2.5 - 7.8|\n|Creatinine|660 µmol/L|60 - 120|\n|Fasting Glucose|6.2 mmol/L|<6.1|\n\n\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
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"totalVotes": 121,
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173,459,927 | false | 1 | null | 6,495,011 | null | false | [] | null | 12,696 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Subarachnoid haemorrhage is associated with sudden onset \"thunderclap\" headache after the rupture of an artery or berry aneurysm in the cerebral arterial circle (circle of Willis). It can be associated with age, trauma, hypertension and connective tissue disorders such as Marfan's or Elhers Dhanlos Syndrome.",
"id": "10000748",
"label": "c",
"name": "Within the subarachnoid space",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intraparenchymal/intracerebral haemorrhage occurs with rupture to the cerebral veins which causes sudden onset neurological deficits. It is often associated with hypertension.",
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"label": "d",
"name": "Within the brain parenchyma",
"picture": null,
"votes": 4
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"__typename": "QuestionChoice",
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"explanation": "Subdural haemorrhage often presents with a slow gradual deterioration. It can be after trauma and is associated with risk factors such as age, alcoholism, and hypertension.",
"id": "10000747",
"label": "b",
"name": "Between the dura mater and arachnoid mater",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dense connective tissue lacerations to the scalp will cause profuse bleeding from this area. They may require suturing or glue to prevent bleeding.",
"id": "10000750",
"label": "e",
"name": "Within the dense connective tissue of the scalp",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Trauma to the pterion region of the skull can rupture the middle meningeal artery (MMA), which will cause an extradural haemorrhage above the dura mater and beneath the skull.",
"id": "10000746",
"label": "a",
"name": "Between the skull and dura mater",
"picture": null,
"votes": 137
}
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"id": "3819",
"name": "Haemorrhagic stroke",
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"question": "A 20-year-old female presents to the emergency department after being hit with a cricket ball on the side of her head 20 minutes ago. She reports worsening vomiting, headache, and confusion. A CT scan is performed and shows a haemorrhage.\n\nWhere is this haemorrhage most likely to be located?",
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"a"
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"totalVotes": 211,
"typeId": 1,
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173,459,928 | false | 2 | null | 6,495,011 | null | false | [] | null | 12,697 | {
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"__typename": "QuestionChoice",
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"explanation": "This is required in early-phase LTP before late-phase LTP occurs. Activation of NMDA receptors allows calcium influx. NMDA receptors are activated once a post-synaptic neuron is already depolarised.",
"id": "10000753",
"label": "c",
"name": "Activation of NMDA receptors in the post-synaptic neuron",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nitric oxide diffuses into the presynaptic terminal to cause more glutamate to be released.",
"id": "10000755",
"label": "e",
"name": "Nitric oxide signalling",
"picture": null,
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{
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"explanation": "This is required in early-phase LTP before late-phase LTP occurs. These changes result in more excitatory post-synaptic potentials (EPSPs), enhanching neuron depolarisation.",
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"label": "b",
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"picture": null,
"votes": 38
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"answer": false,
"explanation": "This is required in early-phase LTP before late-phase LTP occurs. Calcium entry activates CaMKII, which can now insert and phosphorylate AMPA receptors.",
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"label": "d",
"name": "Calcium ion entry through NMDA receptors",
"picture": null,
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"answer": true,
"explanation": "This question is asking specifically about the late phase of LTP in the post-synaptic neuron.\n\nCalcium-activated signal transduction activates new protein synthesis, recruiting new proteins to the synapse to cause morphological changes. These changes last for hours, days and months in late-phase LTP. Early phase LTP lasts minutes to an hour and is explained through the other options.",
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"label": "a",
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"picture": null,
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}
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"question": "What changes occur in the post-synaptic neuron in order to sustain late-phase long-term potentiation (LTP)?",
"sbaAnswer": [
"a"
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173,459,929 | false | 3 | null | 6,495,011 | null | false | [] | null | 12,698 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
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"explanation": "Tyrosine is used to synthesise various neurotransmitters, such as dopamine, adrenaline, and noradrenaline.",
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"label": "b",
"name": "Tyrosine",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Serotonin is synthesised from tryptophan.",
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"label": "a",
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},
{
"__typename": "QuestionChoice",
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"explanation": "Glutamate and GABA are both synthesised from Glutamine.",
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{
"__typename": "QuestionChoice",
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"explanation": "Nitric oxide is synthesised from arginine. Nitric oxide is a retrograde neurotransmitter (travels from the pre-synaptic neuron to act on the pre-synaptic neuron).",
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"label": "c",
"name": "Arginine",
"picture": null,
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"__typename": "QuestionChoice",
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"explanation": "At NMDA receptors, glycine is required for NMDA receptor activation. Glycine is also an inhibitory neurotransmitter in the spinal cord.",
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"question": "Serotonin is synthesised from which amino acid?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,459,930 | false | 4 | null | 6,495,011 | null | false | [] | null | 12,699 | {
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"__typename": "QuestionChoice",
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"explanation": "As the neuron returns back to resting potential, K+ is actively transported out (not in) through the Na+/K+ ATPase.",
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"label": "c",
"name": "K+ in",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "Action potentials open voltage-gated calcium channels at the axon terminal. This allows Ca2+ to diffuse in, which causes vesicle fusion at the synapse and neurotransmitter release.",
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"explanation": "K+ diffuses out of the neuron during repolarization, making the membrane potential more negative.",
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"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
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"explanation": "As the neuron returns back to resting potential, Na+ is actively transported through the Na+/K+ ATPase.",
"id": "10000764",
"label": "d",
"name": "Na+ out",
"picture": null,
"votes": 13
}
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"question": "During an action potential, movement of which ion is responsible for repolarisation?",
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"a"
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173,459,931 | false | 5 | null | 6,495,011 | null | false | [] | null | 12,700 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
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"explanation": "The cortex sends excitatory signals to the striatum in both direct and indirect pathways. The striatum sends signals to either globus pallidus internal or external.",
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"label": "b",
"name": "Excitatory to the striatum",
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},
{
"__typename": "QuestionChoice",
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"explanation": "The thalamus sends excitatory signals to the cortex in both pathways.",
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},
{
"__typename": "QuestionChoice",
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"explanation": "The globus pallidus internus sends inhibitory signals to the thalamus in both pathways.",
"id": "10000768",
"label": "c",
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"picture": null,
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},
{
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"explanation": "This is part of the indirect pathway. The subthalamic nucleus sends excitatory signals to here.",
"id": "10000770",
"label": "e",
"name": "Excitatory to the globus pallidus internal",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is part of the indirect pathway to withhold movement.",
"id": "10000766",
"label": "a",
"name": "Inhibitory to the subthalamic nucleus",
"picture": null,
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}
],
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"question": "Which signal is sent from the globus pallidus external in the basal ganglia, and to where?",
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"a"
],
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173,459,932 | false | 6 | null | 6,495,011 | null | false | [] | null | 12,701 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vagus nerve (CN X) has many functions in the body, but does not provide sensation to the tongue.",
"id": "10000774",
"label": "d",
"name": "Vagus nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
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"explanation": "The glossopharyngeal nerve (CN IX) innervates the posterior one-third of the tongue for taste and sensation.",
"id": "10000772",
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"name": "Glossopharyngeal nerve",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
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"explanation": "The lingual nerve is a branch of the mandibular nerve (CN V3). It provides sensation to the anterior two-thirds of the tongue.",
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"label": "e",
"name": "Lingual nerve",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "The hypoglossal nerve (CN XII) innervates all the muscles of the tongue, apart from palatoglossus.",
"id": "10000773",
"label": "c",
"name": "Hypoglossal nerve",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "The facial nerve (CN VII) innervates taste in the anterior two-thirds of the tongue. The tongue's innervation can be divided between the anterior two-thirds and the posterior one-third. Different cranial nerves provide either taste (special sense) or general sensation in these regions.",
"id": "10000771",
"label": "a",
"name": "Facial nerve",
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}
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"question": "What cranial nerve is responsible for transmitting sour sense to the brain when the tip of the tongue licks a lemon?",
"sbaAnswer": [
"a"
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173,459,933 | false | 7 | null | 6,495,011 | null | false | [] | null | 12,702 | {
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"__typename": "QuestionChoice",
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"explanation": "Monoamine oxidase inhibitors (MAO-Is) are part of the treatment of Parkinson's disease. They reduce the breakdown of monoamine neurotransmitters (such as dopamine).",
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"label": "b",
"name": "Monoamine oxidase inhibitors",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "This is a recent non-drug treatment for Parkinson's disease. There are different targets in the brain depending on the symptoms experienced.",
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"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "Anticholinergics were the first-line drug treatment for Parkinson's disease in the past. They help treat tremor, but have many side effects, such as cognitive decline.",
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"name": "Anticholinergics",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "Entacapone is an additional treatment with levodopa. It reduces the peripheral metabolism of L-dopa, increasing efficacy. However, it worsens side effects.",
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"name": "Entacapone",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Parkison's disease involves the destruction of dopaminergic neurons in the substantia nigra, reducing dopamine transmission in the brain. Levodopa aims to replace dopamine and is the gold-standard treatment in Parkinson's disease.",
"id": "10000776",
"label": "a",
"name": "Levodopa",
"picture": null,
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}
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173,459,934 | false | 8 | null | 6,495,011 | null | false | [] | null | 12,703 | {
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"__typename": "QuestionChoice",
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"id": "10000783",
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"id": "10000781",
"label": "a",
"name": "C fibres",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These fibres are myelinated and have a large diameter. They are involved in light touch and proprioception.",
"id": "10000782",
"label": "b",
"name": "A alpha fibres",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These fibres are myelinated and have a large diameter. They are involved in light touch and proprioception.",
"id": "10000784",
"label": "d",
"name": "A beta",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Efferent nerve fibres exit the spinal cord and travel to effector sites (e.g. skeletal muscle). They do not perceive pain.",
"id": "10000785",
"label": "e",
"name": "Efferent nerve fibres",
"picture": null,
"votes": 2
}
],
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"id": "3825",
"name": "Pain sensation",
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"question": "Pain described as a \"dull ache\" is transmitted through which nerve fibre?",
"sbaAnswer": [
"a"
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"totalVotes": 171,
"typeId": 1,
"userPoint": null
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173,459,935 | false | 9 | null | 6,495,011 | null | false | [] | null | 12,704 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Satellite cells perform the same role as astrocytes, but instead work in the PNS.",
"id": "10000790",
"label": "e",
"name": "Satellite cell",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Astrocytes support neuronal development and influence the blood-brain barrier in the CNS.",
"id": "10000788",
"label": "c",
"name": "Astrocyte",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These produce and maintain myelin in the PNS. One axon is wrapped per Schwann cell.",
"id": "10000786",
"label": "a",
"name": "Schwann cell",
"picture": null,
"votes": 153
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Microglia are immune cells in the CNS. They engulf microbes and debris and, like other immune cells, originate from the mesoderm.",
"id": "10000789",
"label": "d",
"name": "Microglial cell",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These produce and maintain myelin, but in the central nervous system (CNS) instead. One oligodendrocyte myelinates multiple axons from different neurons, unlike Schwann cells.",
"id": "10000787",
"label": "b",
"name": "Oligodendrocyte",
"picture": null,
"votes": 15
}
],
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"question": "Which glial cell is responsible for myelinating neurons in the peripheral nervous system (PNS)?",
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"a"
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173,459,936 | false | 10 | null | 6,495,011 | null | false | [] | null | 12,705 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atonic seizures occur suddenly with the muslces losing tone and becoming limp.",
"id": "10000795",
"label": "e",
"name": "Atonic",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Absence seizures are short and abrupt. They can happen multiple times a day, and patients report memory loss during their seizures.",
"id": "10000793",
"label": "c",
"name": "Absence",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the commonest form of primary generalized epilepsy. It starts in childhood and features early-morning jerks.",
"id": "10000794",
"label": "d",
"name": "Juvenile myoclonic epilepsy",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Focal onset seizures start in one region of the brain. In this case, the sensory symptoms suggest they start in the temporal lobe (the most common lobe for focal onset seizures). Focal seizures may spread to the whole brain, becoming a secondary generalized seizure. However, this patient does not describe this.",
"id": "10000791",
"label": "a",
"name": "Focal onset",
"picture": null,
"votes": 111
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These seizures happen with sudden onset as electrical dischargers spread over the whole brain. Patients experience continuous muscle spasm (tonic phase), rhythmic jerking (clonic phase), and drowsiness/ confusion/ pain/ headache afterwards (post-ictal phase).",
"id": "10000792",
"label": "b",
"name": "Primary generalized",
"picture": null,
"votes": 24
}
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"name": "Epilepsy",
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"typeId": 7
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"question": "A patient with epilepsy describes their seizures. They can happen at any time of day. During their seizures, they have visual hallucinations, are often scared, and experience deja vu.\n\nWhich type of seizure is this?",
"sbaAnswer": [
"a"
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"totalVotes": 170,
"typeId": 1,
"userPoint": null
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173,459,937 | false | 11 | null | 6,495,011 | null | false | [] | null | 12,706 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients in a coma are unresponsive to external stimuli and do not show basic reflexes. Coma is often reversible. However, it may progress to vegetative states, minimally conscious states, or even death.",
"id": "10000800",
"label": "e",
"name": "Coma",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "As this patient is unresponsive but shows arousal in his sleep-wake cycle, he is in a vegetative state. These patients are unresponsive and do not show voluntary responses to their environment. Reflexes are variably preserved.",
"id": "10000796",
"label": "a",
"name": "Continuing vegetative state",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is similar to a vegetative state. However, some higher cortical function remains, such as movement to command, reaching, or visual tracking.",
"id": "10000799",
"label": "d",
"name": "Minimally conscious state",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is irreversible damage to the brainstem. As such, no reflexes are present.",
"id": "10000798",
"label": "c",
"name": "Brainstem death",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients are conscious (arousable and aware), but cannot respond. Their vertical eye movements are often present. They do not have any reflexes due to damage to the pons in the brain.",
"id": "10000797",
"label": "b",
"name": "Locked-in syndrome",
"picture": null,
"votes": 70
}
],
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"question": "A 35-year-old male had a traumatic brain injury three weeks ago. He is still unresponsive to voice and pain. However, he does have pupillary reflexes, as well as a sleep/wake cycle.\n\nHow can his state of consciousness best be described?",
"sbaAnswer": [
"a"
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173,459,938 | false | 12 | null | 6,495,011 | null | false | [] | null | 12,707 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "D2 (dopamine) receptors are inhibitory. D2 activation in the striatum inhibits the indirect pathway, leading to promoting movement. Antipsychotics antagonise D2 receptors. With long-term use, the brain adapts by upregulating more receptors to the synapse. This upregulation of D2 is irreversible. This results in promotion of movement, and movement disorders called tardive dyskinesia.",
"id": "10000801",
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"name": "D2",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "GABA a receptors are inhibitory ionotropic receptors. Antipsychotics may affect GABA and its receptors, but this is not their primary mechanism of action.",
"id": "10000805",
"label": "e",
"name": "GABA a",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Typical (newer) antipsychotics affect various serotonin receptors. However, serotonin is not involved in movement.",
"id": "10000802",
"label": "b",
"name": "5-HT2a",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reduction of NMDA receptors has a role in the development of schizophrenia. Antipsychotics do not directly affect NMDA receptors.",
"id": "10000804",
"label": "d",
"name": "NMDA",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Muscarinic receptors M1, M3, and M5 are found in smooth muscles and glands. Antagonism of these receptors causes hypersalivation in patients on certain antipsychotics (such as clozapine).",
"id": "10000803",
"label": "c",
"name": "M3",
"picture": null,
"votes": 1
}
],
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"name": "Side effects of antipsychotics",
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"question": "Long-term antipsychotic use can cause movement disorders such as tardive dyskinesia.\n\nUpregulation of which receptor is responsible for this?",
"sbaAnswer": [
"a"
],
"totalVotes": 166,
"typeId": 1,
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173,459,939 | false | 13 | null | 6,495,011 | null | false | [] | null | 12,708 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Naloxone antagonises opioid receptors, reversing the effects of any opioids in someone's body.",
"id": "10000806",
"label": "a",
"name": "Naloxone",
"picture": null,
"votes": 156
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Methadone is another opioid given to someone addicted to opioids (such as heroin) to help them stop taking street opioids.",
"id": "10000808",
"label": "c",
"name": "Methadone",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Flumazenil is used to treat benzodiazepine overdose.",
"id": "10000807",
"label": "b",
"name": "Flumazenil",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Buprenorphine is another opioid given to someone addicted to opioids (such as heroin) to help them stop taking street opioids.",
"id": "10000809",
"label": "d",
"name": "Buprenorphine",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amitriptyline is a tricyclic antidepressant used primarily to treat neuropathic pain. It is not the first-line treatment in depression as an overdose can be fatal.",
"id": "10000810",
"label": "e",
"name": "Amitriptyline",
"picture": null,
"votes": 4
}
],
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"name": "Heroin withdrawal",
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"typeId": 5
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"question": "What medication is used during an opioid overdose?",
"sbaAnswer": [
"a"
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"totalVotes": 174,
"typeId": 1,
"userPoint": null
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173,459,940 | false | 14 | null | 6,495,011 | null | false | [] | null | 12,709 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Benzodiazepines, such as diazepam, have good immediate effects in anxiety. However, patients develop tolerance. Withdrawal from these drugs causes anxiety, and they can be addictive.",
"id": "10000812",
"label": "b",
"name": "Diazepam",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lithium is the gold-standard treatment in bipolar, not GAD.",
"id": "10000814",
"label": "d",
"name": "Lithium",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing symptoms suggestive of generalized anxiety disorder (GAD). Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment in patients with GAD. Patients with anxiety should be offered therapy in conjunction with medication, such as cognitive behavioural therapy (CBT). Therapy and medication together have been shown to have the largest benefit in many mental health disorders.",
"id": "10000811",
"label": "a",
"name": "Fluoxetine",
"picture": null,
"votes": 105
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Buspirone can be used in the treatment of GAD, but is not a first-line treatment.",
"id": "10000813",
"label": "c",
"name": "Buspirone",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Risperidone is an atypical antipsychotic. These are rarely used in treating anxiety alone.",
"id": "10000815",
"label": "e",
"name": "Risperidone",
"picture": null,
"votes": 10
}
],
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"name": "Anxiety, Obsessions and Stress Reactions",
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"typeId": 5
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"question": "A 17-year-old female presents to the GP for the first time with a three-month history saying she feels worried all time, and has sensitivity to noise, poor concentration, and restlessness. She describes headaches, sickness, and stomach aches that come and go throughout the day.\n\nWhich first-line medication can be offered?",
"sbaAnswer": [
"a"
],
"totalVotes": 164,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,941 | false | 15 | null | 6,495,011 | null | false | [] | null | 12,710 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient may develop sepsis if her infection is untreated but, in the context of hyperosmolar hyperglycaemic state, thrombosis is the most common cause of mortality.",
"id": "10000818",
"label": "c",
"name": "Sepsis",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient's history is suggestive of hyperosmolar hyperglycaemic state (HHS). HHS presents with a slow onset of increasing thirst (polydipsia) and urination (polyuria). Patients with HHS are at high risk of thromboembolic events, such as myocardial infarction or stroke. It is important to anticoagulate them to prevent this.",
"id": "10000816",
"label": "a",
"name": "Thrombosis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The history of underlying Type 2 diabetes, polyuria and polydypsia is suggestive of hyperosmolar hyperglycaemic state (HHS). This patient could likely develop an acute kidney injury (AKI) in her current presentation because of her urinary tract infection. Patients with HHS are often profoundly dehydrated, also contributing to AKI. However, the most common cause of mortality in patients with HHS is thrombosis.",
"id": "10000817",
"label": "b",
"name": "Acute kidney injury",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with HHS may go into heart failure. This is because dehydration contributes to renal failure, which may progress to shock, then cardiovascular collapse. However, this is not the leading cause of mortality.",
"id": "10000819",
"label": "d",
"name": "Heart failure",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with Type 2 diabetes can develop DKAs. However, this is much rarer than HHS and would have a more acute presentation. In HHS, the leading cause of mortality is thrombosis.",
"id": "10000820",
"label": "e",
"name": "Diabetic ketoacidosis",
"picture": null,
"votes": 49
}
],
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"id": "3831",
"name": "Type 2 Diabetes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
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"question": "A 52-year-old female comes to the emergency department with a two-month history of passing lots of urine and feeling thirsty, as well as being more confused than normal. Over the past three days, she has had pain while urinating and offensive smelling urine. She has a past medical history of Type 2 Diabetes.\n\nWhat is the leading cause of mortality in patients who develop the complication most likely seen in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 169,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,942 | false | 16 | null | 6,495,011 | null | false | [] | null | 12,711 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "High calcium in the blood should feedback to the parathyroids to stop producing PTH. As this feedback is not happening and PTH is excessively released, there must something causing this hyperparathyroidism. This is commonly caused by a parathyroid adenoma, but there may be secondary or tertiary hyperparathyroidism causing this.",
"id": "10000824",
"label": "d",
"name": "Hypercalcaemia and raised parathyroid hormone",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypercalcaemia in the blood will suppress PTH. Non-parathyroid malignancies or vitamin D excess may cause this finding.",
"id": "10000822",
"label": "b",
"name": "Hypercalcaemia and reduced parathyroid hormone",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Normocalcaemia may be found in vitamin D deficiency. However, this can only be the case if there is enough PTH to raise the calcium to normal.",
"id": "10000825",
"label": "e",
"name": "Normocalcaemia and normal parathyroid hormone",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Vitamin D is needed to absorb calcium from the diet. Without it, calcium in the blood is reduced. The parathyroid glands will sense this and release PTH into the bloodstream.",
"id": "10000821",
"label": "a",
"name": "Hypocalcaemia and raised parathyroid hormone",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reduced calcium in the blood is sensed by the parathyroids, which should release PTH to increase calcium in the blood. However, because PTH is not being released in this finding, there must be an issue with the parathyroid. This could be due to a primary hypoparathyroidism from DiGeorge syndrome or post-thyroid surgery, for example.",
"id": "10000823",
"label": "c",
"name": "Hypocalcaemia and reduced parathyroid hormone",
"picture": null,
"votes": 19
}
],
"comments": [],
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"demo": null,
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"id": "3832",
"name": "Vitamin D",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
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"question": "A 35-year-old male comes to the GP with tiredness and bone aches.\n\nWhich blood results would support a diagnosis of vitamin D deficiency?",
"sbaAnswer": [
"a"
],
"totalVotes": 169,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,943 | false | 17 | null | 6,495,011 | null | false | [] | null | 12,712 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of ALS and B12 deficiency are similar. Both cause progressive muscle weakness and loss of reflexes. However, ALS weakness and loss of tendon reflexes are usually asymmetric. In ALS, people may have speech and swallowing difficulties but the mind remains in tact as ALS does not affect upper motor neurons.",
"id": "10000828",
"label": "c",
"name": "Amylotrophic lateral sclerosis (ALS)",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetic neuropathy is a similar presentation to B12 deficiency as they are both length-dependent neuropathies (i.e. longest neurons in the legs are affected first). However, diabetic neuropathy is more likely to happen in people who do not control their diabetes as well as this patient does (indicated by the stable HbA1c). Fine touch is the first sense to go in diabetic neuropathy.",
"id": "10000827",
"label": "b",
"name": "Diabetic neuropathy",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sciatica is asymmetrical and only affects one side of the lower limb. However, like B12 deficiency, there are reduced reflexes. Sensory loss in sciatica has a \"saddle distribution\" around the perineal area.",
"id": "10000830",
"label": "e",
"name": "Sciatica",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Chronic metformin use can cause B12 deficiency. B12 deficiency will manifest with cognitive symptoms such as fatigue, brain fog, or depression. There may also be symmetrical muscle weakness that mainly affects the lower limbs, as well as loss of reflexes or pins and needles.",
"id": "10000826",
"label": "a",
"name": "B12 deficiency",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of MS and B12 deficiency are similar. Both conditions can cause cognitive dysfunction, sensory disturbance, and progressive muscle weakness. However, B12 deficiency affects both sides of the body equally and is more pronounced in the legs. Also, MS may be more predominant on one side of the body than the other.",
"id": "10000829",
"label": "d",
"name": "Multiple sclerosis (MS)",
"picture": null,
"votes": 31
}
],
"comments": [],
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"id": "3831",
"name": "Type 2 Diabetes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
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"question": "A 47-year-old female has a two-month history of worsening weakness in her legs, which is affecting her walking. She also reports feeling more tired and down than usual. She has a past medical history of well-controlled type 2 diabetes mellitus with metformin, which developed after giving birth 10 years ago. Her HbA1c has remained in the normal range over the years. On examination, there is mild sensory loss to the lower limbs and bilateral loss of ankle reflex.\n\nWhat is the most likely cause of her weakness?",
"sbaAnswer": [
"a"
],
"totalVotes": 165,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,944 | false | 18 | null | 6,495,011 | null | false | [] | null | 12,713 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The optic tract is after the optic chiasm, which is where visual information crosses over. The optic tract carries visual information from either the left or right side only. The most common cause is stroke, which damages one side of the brain. If the right side of the brain is damaged, the left visual field will be affected (i.e. contralaterally). This visual field finding is called contralateral homonymous hemianopia.",
"id": "10000831",
"label": "a",
"name": "Optic tract",
"picture": null,
"votes": 102
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The optic radiations carry information from one-quarter of each eye to the visual cortex. Damage will cause contralateral quadrantopia.",
"id": "10000832",
"label": "b",
"name": "Optic radiation",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Damage to an area of the visual cortex will cause scotoma in both eyes. This is where patchy visual loss occurs in the same visual fields from both eyes.",
"id": "10000835",
"label": "e",
"name": "Occipital cortex",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The optic nerve carries information from one eye. Damage to one optic nerve will cause blindness in one eye. This is known as monocular vision loss.",
"id": "10000834",
"label": "d",
"name": "Optic nerve",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The optic chiasm is where information from the outer visual field crosses over. Compression of the optic chiasm will cause a visual field defect affecting the outer visual fields of both eyes. The visual field defect is called bitemporal hemianopia. Often, a pituitary tumour below will compress the chiasm, causing this presentation.",
"id": "10000833",
"label": "c",
"name": "Optic chiasm",
"picture": null,
"votes": 26
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3833",
"name": "Visual pathway anatomy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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{
"__typename": "Picture",
"caption": null,
"createdAt": 1682079734,
"id": "1509",
"index": 0,
"name": "Left Homonymous Hemianopia.jpeg",
"overlayPath": null,
"overlayPath256": null,
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"thumbhash": "LggSA4CK/XCHh8h3AAAAAAA=",
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"id": "152",
"name": "Neuroscience",
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"topicId": 152,
"updatedAt": 1708373886
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"question": "A 63-year-old woman comes in with visual problems. The results of her visual field test are shown. Damage to which part of the visual pathway has caused this visual field defect?\n\n[lightgallery]",
"sbaAnswer": [
"a"
],
"totalVotes": 163,
"typeId": 1,
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173,459,945 | false | 19 | null | 6,495,011 | null | false | [] | null | 12,714 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These antibodies are more likely to be present in primary hyperthyroidism caused by Graves disease. Hypothyroidism is more likely to detect anti-thyroid peroxidase antibodies. However, some patients will not have this autoantibody even if they have primary hypothyroidism.",
"id": "10000839",
"label": "d",
"name": "Presence of thyroid-stimulating hormone receptor antibodies",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reduced TSH and reduced fT4 suggest there is a problem higher up in the thyroid axis, in the hypothalamus or pituitary, that has caused reduced fT4. This is consistent with secondary hypothyroidism.",
"id": "10000840",
"label": "e",
"name": "Reduced thyroid-stimulating hormone, reduced fT4",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Reduced fT4 is responsible for the symptoms of hypothyroidism. Lack of negative feedback on the pituitary gland releases TSH into circulation. Thyroid-stimulating hormone (TSH) is the best biomarker for thyroid status.",
"id": "10000836",
"label": "a",
"name": "Raised thyroid-stimulating hormone and reduced free T4",
"picture": null,
"votes": 126
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Raised fT4 will cause symptoms of hyperthyroidism (sweating, agitation, tachycardia, weight loss). This will feedback to the pituitary gland to release less TSH. fT3 is used to diagnose hyperthyroidism, as well as TSH and fT4.",
"id": "10000837",
"label": "b",
"name": "Reduced thyroid-stimulating hormone, and raised free T4 and T3",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In primary hypothyroidism, both of these hormones would be raised due to the lack of negative feedback provided by reduced levels of fT4.",
"id": "10000838",
"label": "c",
"name": "Reduced thyrotropin-releasing hormone and raised thyroid-stimulating hormone",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3834",
"name": "Thyroid Axis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
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},
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"question": "A patient presents to the GP with fatigue, weight gain and cold intolerance. The GP tests their thyroid status for the first time.\n\nWhich test results indicate primary hypothyroidism?",
"sbaAnswer": [
"a"
],
"totalVotes": 160,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,946 | false | 20 | null | 6,495,011 | null | false | [] | null | 12,715 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Steroids should in fact be doubled during illness to support the body in mounting a stress response. If steroids are being stopped, they should be weaned down slowly under guidance, but this should not be done during illness.",
"id": "10000843",
"label": "c",
"name": "Slowly wean down the steroids throughout the illness",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "People who take steroid replacement therapy should aim to mimic what happens in the body when physiologically stressed by doubling their usual dose.",
"id": "10000844",
"label": "d",
"name": "No changes necessary",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "When ill, physiologically there are more endogenous steroids released into our circulation. Patients with Addison's disease do not have functioning adrenal glands. This means they may not mount an adequate \"stress response\" that happens when healthy people become ill. Because of this, they should double their steroid dose until they feel better.",
"id": "10000841",
"label": "a",
"name": "Double steroid dose",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients should never reduce their steroid dose without special guidance as they may go into an adrenal crisis.",
"id": "10000845",
"label": "e",
"name": "Half steroid dose",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients who take long-term steroids, for example in Addison's disease, must never abruptly stop taking their steroids. They may go into an adrenal crisis due to the lack of cortisol. This can be fatal.",
"id": "10000842",
"label": "b",
"name": "Stop taking steroids",
"picture": null,
"votes": 10
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3835",
"name": "Adrenal insufficiency and Addison's Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
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"question": "A 17-year-old with Addison's disease is unwell with the flu.\n\nWhat change to their usual medications should they make?",
"sbaAnswer": [
"a"
],
"totalVotes": 159,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,947 | false | 21 | null | 6,495,011 | null | false | [] | null | 12,716 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pituitary tumours can cause a variety of symptoms, but the symptoms this patient is experiencing are more typical of phaeochromacytoma. Symptoms of pituitary tumours may include visual changes (bitemporal hemianopia), headache, or nausea. Pituitary tumours are associated with MEN1, not MEN2A.",
"id": "10000850",
"label": "e",
"name": "Pituitary gland",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "MEN2A does increase the risk of medullary thyroid cancer. However, the symptoms described here are more typical of phaeochromacytoma.",
"id": "10000848",
"label": "c",
"name": "Thyroid gland",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has symptoms classic of phaeochromacytoma: spells of palpitations, headache, and anxiety. The tumour arises from the adrenal medulla, which makes catecholamines. These hormones are responsible for the symptoms experienced. Symptoms may be constant, or come and go in \"spells\". MEN is a genetic condition that predisposes people to multiple endocrine neoplasia (MEN). In MEN2A, people are at increased risk of parathyroid hyperplasia, medullary C cell carcinoma, and phaeohromacytoma.",
"id": "10000846",
"label": "a",
"name": "Adrenal medulla",
"picture": null,
"votes": 108
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms from pancreatic tumours can be hard to spot, but include jaundice, stool changes, and indigestion. Pancreatic tumours are associated with MEN1, not MEN2A.",
"id": "10000849",
"label": "d",
"name": "Pancreas",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Parathyroid hyperplasia is a feature of MEN2A. However, hyperparathyroidism would cause calcium release from bones, which may cause problems such as bone fracture, abdominal pain, kidney stones, or psychiatric changes (bones, groans, stones, moans).",
"id": "10000847",
"label": "b",
"name": "Parathyroid gland",
"picture": null,
"votes": 5
}
],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3836",
"name": "Phaeochromacytoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
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"question": "A patient with a family history of MEN2A has developed spells of palpitations, headaches, and anxiety. An endocrine tumour is suspected.\n\nFrom where has the tumour arisen?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,948 | false | 22 | null | 6,495,011 | null | false | [] | null | 12,717 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Missed miscarriages are diagnosed incidentally (e.g. on a dating scan) and do not have any symptoms. This may happen when an embryo never develops or stops developing early (anembryonic pregnancy).",
"id": "10000855",
"label": "e",
"name": "Missed",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In an inevitable miscarriage, there is bleeding and/or pain. On examination, the cervical os is open as the miscarriage is ongoing or about to begin.",
"id": "10000851",
"label": "a",
"name": "Inevitable",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An incomplete miscarriage will have the same symptoms as an inevitable miscarriage (pain/bleeding and open os). However, in incomplete miscarriage, some tissue has been expelled from the uterus.",
"id": "10000853",
"label": "c",
"name": "Incomplete",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is pain and/or bleeding in a threatened miscarriage, yet the intrauterine pregnancy is still present and the cervical os remains closed.",
"id": "10000852",
"label": "b",
"name": "Threatened",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In complete miscarriage, no tissue remains and the cervical os will be closed.",
"id": "10000854",
"label": "d",
"name": "Complete",
"picture": null,
"votes": 6
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3837",
"name": "Miscarriage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
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"question": "A 24-year-old woman in her first-trimester of pregnancy presents to the emergency department with pain and bleeding. On examination, the cervical os is open. There is no evidence of foetal tissue having passed.\n\nWhat type of miscarriage does this describe?",
"sbaAnswer": [
"a"
],
"totalVotes": 153,
"typeId": 1,
"userPoint": null
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173,459,949 | false | 23 | null | 6,495,011 | null | false | [] | null | 12,718 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dermoid cysts are sacs that contain fluid or semi-solid material. Fusion of ectoderm may trap some elements underneath, meaning they continue to grow as a cyst. They are commonly found above the eyebrow (dermoid angular cysts).",
"id": "10000858",
"label": "c",
"name": "Dermoid cyst",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haemangioma is a common benign vascular neoplasm often found on the face, scalp, chest or back. They tend to disappear with time. However, an operation may be needed if it is around the eye.",
"id": "10000857",
"label": "b",
"name": "Haemangioma",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroglossal cysts will present with a lump near the hyoid bone that moves on swallowing. They develop when the thyroglossal duct from the caecum of the tongue to the thyroid does not close properly, leaving fluid (cyst).",
"id": "10000859",
"label": "d",
"name": "Thyroglossal cyst",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Also known as lymphangioma, these are fluid-filled sacs (cysts) that develop as a result of the lymphatic system. They are commonly found around the neck and armpit.",
"id": "10000860",
"label": "e",
"name": "Cystic hygroma",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ranula may be present in up to 1% of neonates. It is a cyst in the floor of the mouth that occurs due to blockage of a salivary gland. They are usually blue, dome-shaped and fluctuant.",
"id": "10000856",
"label": "a",
"name": "Ranula",
"picture": null,
"votes": 37
}
],
"comments": [],
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"demo": null,
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"id": "3838",
"name": "Head and neck neoplasia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "138",
"name": "Ear, Nose & Throat",
"typeId": 7
},
"topicId": 138,
"totalCards": null,
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"question": "A baby is born and is found to have a swelling at the floor of their mouth under the tongue. It is blue in colour and fluctuant when examined.\n\nWhat is the likely pathology?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
"userPoint": null
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173,459,950 | false | 24 | null | 6,495,011 | null | false | [] | null | 12,719 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The copper IUD is the most effective emergency contraception. It works up to 5 days after unprotected intercourse. Ulipristal is a hormonal option that is licensed for unprotected intercourse up to five days ago.",
"id": "10000861",
"label": "a",
"name": "Copper intra-uterine device",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most effective method of contraception. However, it does not work as emergency contraception.",
"id": "10000865",
"label": "e",
"name": "Progesterone-only implant",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a good hormonal emergency contraception. However, because this patient had unprotected intercourse more than 72 hours ago, this is not a suitable option.",
"id": "10000864",
"label": "d",
"name": "Levonorgestrel",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Methotrexate is used to treat ectopic pregnancies as it acts to slow nucleic acid synthesis, interfering with DNA synthesis and cell growth. It is not contraception.",
"id": "10000862",
"label": "b",
"name": "Methotrexate",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Misoprostol is used in inducing labour, and management of miscarriages and terminations. It is not contraception.",
"id": "10000863",
"label": "c",
"name": "Misoprostol",
"picture": null,
"votes": 21
}
],
"comments": [],
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"id": "3839",
"name": "Emergency contraception",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"question": "A 32-year-old requires emergency contraception after unprotected intercourse four days ago.\n\nWhat treatment is available for them?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
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173,459,951 | false | 25 | null | 6,495,011 | null | false | [] | null | 12,720 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Spina bifida is a neural tube defect that occurs when the posterior neural tube does not close fully. There are two types, occulta (hidden), or cystica (when the meninges project out).",
"id": "10000866",
"label": "a",
"name": "Posterior neural tube",
"picture": null,
"votes": 149
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anencephaly is a fatal neural tube defect that causes degeneration of the forebrain and skull.",
"id": "10000867",
"label": "b",
"name": "Anterior neuropore",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The amniotic sac should enclose the foetus during pregnancy.",
"id": "10000870",
"label": "e",
"name": "Amniotic sac",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "When the foramen ovale in the heart remains open, this is known as a patent foramen ovale. Blood may flow between the atria. Most people do not experience complications from this.",
"id": "10000868",
"label": "c",
"name": "Foramen ovale",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Failure of palate fusion can lead to a cleft palate.",
"id": "10000869",
"label": "d",
"name": "Palate",
"picture": null,
"votes": 0
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3840",
"name": "Spina Bifida",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
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},
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"question": "Ultrasound of a 12-week pregnant woman reveals that the foetus has a protrusion of tissue from the spine.\n\nFailure to close of which embryological structure results in this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
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173,459,952 | false | 26 | null | 6,495,011 | null | false | [] | null | 12,721 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lactobacilli are the most abundant bacteria in the vagina. They use glycogen as their substrate and make lactic acid, lowering the pH of the vagina. However, acid exposure drives metaplasia, not the presence of bacteria.",
"id": "10000873",
"label": "c",
"name": "Bacteria",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Progesterone's role is to promote gestation (hence its name). It does this in many ways, such as thickening the lining of the uterus. At the cervix, it keeps mucus thick, keeping the contents of the uterus present.",
"id": "10000874",
"label": "d",
"name": "Progesterone",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glycogen is shed from squamous epithelial cells and provides a substrate for anaerobic organisms (such as lactobacilli) to use.",
"id": "10000875",
"label": "e",
"name": "Glycogen",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "During puberty, the cervix is exposed to acid. At the transformation zone, columnar epithelial cells are exposed to acid. They start to change to squamous epithelial cells. This physiological metaplasia occurs as squamous cells are more resistant to acidic environments than columnar epithelium.",
"id": "10000871",
"label": "a",
"name": "Acid",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oestrogen is first needed to stimulate the maturation of the squamous cells. This happens before cell metaplasia can occur.",
"id": "10000872",
"label": "b",
"name": "Oestrogen",
"picture": null,
"votes": 88
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3841",
"name": "Menstrual cycle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"question": "During puberty, changes to the cervix occur.\n\nWhich of the following is responsible for actively causing cell change at the transformation zone?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,953 | false | 27 | null | 6,495,011 | null | false | [] | null | 12,722 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are fast-growing tumours that tend to spread to other body parts, such as bones, lymph nodes, lungs, and brain - causing symptoms in these areas. They are also associated with haemorrhage and are usually present in mixed germ cell tumours. They will raise HCG as well.",
"id": "10000879",
"label": "d",
"name": "Choriocarcinoma",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Embryonal carcinoma is present in 40% of testicular tumours, but are often components of mixed cell tumours. However, as well as raised AFP, embryonal carcinoma will have raised human chorionic gonadotropin (HCG) too.",
"id": "10000878",
"label": "c",
"name": "Embryonal carcinoma",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pure teratomas of the testicle are rare, but are often components of mixed germ cell tumours. Teratomas of the testicle are always malignant. Teratomas of the ovary, however, are benign.",
"id": "10000880",
"label": "e",
"name": "Teratoma",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Seminomas are much more slow-growing and spreading than non-seminomatous germ cell tumours (the other answers all fall into this category of testicular cancer). They may cause a raised LDH.",
"id": "10000877",
"label": "b",
"name": "Seminoma",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This the most common form of testicular cancer in children, and is rarer in adults. They cause a raised AFP.",
"id": "10000876",
"label": "a",
"name": "Yolk sac carcinoma",
"picture": null,
"votes": 54
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3842",
"name": "Testicular Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
"typeId": null,
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},
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"question": "A 15-year-old presents to the GP with a painless swelling on one of his testicles for the past four months. Blood tests reveal raised tumour marker alpha-fetoprotein (AFP). Other testicular tumour markers are normal.\n\nWhat is the most likely type of testicular tumour present?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,954 | false | 28 | null | 6,495,011 | null | false | [] | null | 12,723 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The anterior division of the internal iliac artery supplies most of the pelvis. However, it does not supply the gonads.",
"id": "10000884",
"label": "d",
"name": "Anterior division of the internal iliac artery",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The internal pudendal is a branch off the anterior division of the internal iliac artery. It supplies the external genitalia.",
"id": "10000885",
"label": "e",
"name": "Internal pudendal",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The external iliac artery eventually becomes the femoral artery. Before this, it has two branches: inferior epigastric and deep circumflex arteries.",
"id": "10000882",
"label": "b",
"name": "External iliac artery",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The posterior division of the internal iliac artery has three branches: iliolumbar, lateral sacral, and superior gluteal.",
"id": "10000883",
"label": "c",
"name": "Posterior division of the internal iliac artery",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In embryological development, the gonads (ovaries and testes) start above the pelvis in the abdomen. This is where their blood supply starts. As they develop and descend into the pelvis, they bring this artery down with them. Other arteries in the pelvis that do not branch from the iliac arteries are the median sacral artery (a branch from the abdominal aorta) and superior rectal artery (a branch from inferior mesenteric artery).",
"id": "10000881",
"label": "a",
"name": "Aorta",
"picture": null,
"votes": 64
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
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"id": "3843",
"name": "Ovarian cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
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"question": "The ovaries receive blood supply from the ovarian artery.\n\nThe ovarian artery is a branch of what larger artery?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,955 | false | 29 | null | 6,495,011 | null | false | [] | null | 12,724 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Because she is between 40-42 and has never had IVF before, one cycle of IVF should be followed as long as tests show that her ovaries respond normally to fertility drugs. Doctors should discuss the risks of fertility treatment if over 40.",
"id": "10000887",
"label": "b",
"name": "A 41-year-old woman who has never had IVF before",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "He should be offered two cycles of IVF. If transgender men stop taking testosterone for four months, they have similar egg yields to cisgender women.",
"id": "10000888",
"label": "c",
"name": "A 38-year-old transgender man taking testosterone who has used cycles of intrauterine insemination, and has had one previous cycle of IVF",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She should not be offered any more IVF because she is over 42.",
"id": "10000890",
"label": "e",
"name": "A 43-year-old woman who has had one cycle of IVF before",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She should not be offered any more cycles of IVF as she already had three cycles. This is because the chances of having a baby fall with the number of unsuccessful cycles of IVF.",
"id": "10000889",
"label": "d",
"name": "A 37-year-old woman who has had three previous cycles of IVF",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This woman should be offered three cycles of IVF. This is because she is under 40 and has been trying to get pregnant through regular unprotected sexual intercourse for a total of two years. Three cycles of IVF can also be offered if someone is under 40, has used artificial insemination to conceive and has not become pregnant after 12 cycles (with at least six of these cycles should have used intrauterine insemination).",
"id": "10000886",
"label": "a",
"name": "A 39-year-old woman who has used 12 cycles of intrauterine insemination",
"picture": null,
"votes": 64
}
],
"comments": [],
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"name": "Infertility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
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"question": "All of the five people below have been having regular unprotected intercourse for two years with the aim to conceive.\n\nAccording to NICE guidelines, who will be offered the most cycles of in vitro fertilisation (IVF) from the cases below?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
"userPoint": null
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173,459,956 | false | 30 | null | 6,495,011 | null | false | [] | null | 12,725 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ovarian torsion presents with acute abdominal pain with nausea and vomiting. There will be signs of tachycardia and pyrexia due to ischaemia. Infarction to the ovary has occurred at the time of surgery, but salpingo-oophorectomy is the usual treatment.",
"id": "10000891",
"label": "a",
"name": "Ovarian torsion",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ectopic pregnancies may present with pain, bleeding, or missed period. It is an important differential to rule out with a pregnancy test.",
"id": "10000895",
"label": "e",
"name": "Ectopic pregnancy",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ovarian rupture may present similarly to this, however, symptoms depend on amount and character of cyst contents that are released. It is unlikely to be this as, if the cyst had ruptured, it would not be palpable. If symptoms are mild, conservative management is an option, but patients should be monitored for signs of peritonitis.",
"id": "10000893",
"label": "c",
"name": "Rupture",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fibroids are not found in the ovary, but in and around the uterus. The most common symptom is vaginal bleeding after menopause.",
"id": "10000894",
"label": "d",
"name": "Fibroid",
"picture": null,
"votes": 19
},
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"explanation": "NSAIDs are one of the options for treating acute flare of gout.",
"id": "10000932",
"label": "b",
"name": "Naproxen",
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Colchicine is one of the options for treating acute flare of gout.",
"id": "10000933",
"label": "c",
"name": "Colchicine",
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Allopurinol can be started after an acute flare of gout. It works to reduce urate as urate crystals are responsible for gout. It is important to take this as people may get chronic arthritis from gout and it prevents adverse cardiovascular risks.",
"id": "10000931",
"label": "a",
"name": "Allopurinol",
"picture": null,
"votes": 119
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Methotrexate is a medication used to treat rheumatoid arthritis.",
"id": "10000935",
"label": "e",
"name": "Methotrexate",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A short dose of oral steroids is one of the options for treating acute flare of gout.",
"id": "10000934",
"label": "d",
"name": "Prednisolone",
"picture": null,
"votes": 14
}
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"question": "A 56-year-old man comes to the GP with a first flare of gout. After the patient is treated for the flare, the GP mentions starting a long-term medication to reduce the incidence of gout in the future.\n\nWhich medication is the GP referring to?",
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"a"
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173,459,965 | false | 39 | null | 6,495,011 | null | false | [] | null | 12,734 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "If patients are not treated immediately with high-dose steroids, they may become permanently blind.",
"id": "10000936",
"label": "a",
"name": "Blindness",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be a long-term complication of steroid treatment, but not GCA itself.",
"id": "10000937",
"label": "b",
"name": "Osteoporosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "GCA may mimic malignancy at first, as both have systemic symptoms of fever, weight loss, and fatigue.",
"id": "10000938",
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"explanation": "AKI can be a complication of small vessel vasculitis. GCA is a large vessel vasculitis.",
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"label": "e",
"name": "Acute kidney injury",
"picture": null,
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "GCA is a large vessel vasculitis. Other arteries vasculitis may affect include the aorta. However, this may be a late-stage complication of GCA, not immediate.",
"id": "10000939",
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"name": "Aortic aneurysm",
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}
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173,459,966 | false | 40 | null | 6,495,011 | null | false | [] | null | 12,735 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Somatic hypermutation in lymph nodes adds further diversity to the already rearranged VDJ segments. The enzyme AID does this by introducing point mutations to the variable region of the antibody.",
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This process happens by B cells to produce more antibodies with an increased affinity to a specific antigen.",
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"explanation": "This process generates the different isotypes of antibodies (eg IgG, IgA, IgE). It happens by changing the constant region of an antibody.",
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173,459,967 | false | 41 | null | 6,495,011 | null | false | [] | null | 12,736 | {
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"__typename": "QuestionChoice",
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"explanation": "OsteoClasts Cut bone, breaking it down. They are active in the constant process of bone remodelling.",
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"label": "b",
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173,459,968 | false | 42 | null | 6,495,011 | null | false | [] | null | 12,737 | {
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"__typename": "QuestionChoice",
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"picture": null,
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"__typename": "QuestionChoice",
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"__typename": "QuestionChoice",
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"__typename": "QuestionChoice",
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"label": "d",
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"picture": null,
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"__typename": "QuestionChoice",
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173,459,969 | false | 43 | null | 6,495,011 | null | false | [] | null | 12,738 | {
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"__typename": "QuestionChoice",
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"label": "d",
"name": "Inguinal ligament",
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{
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},
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"__typename": "QuestionChoice",
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},
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"__typename": "QuestionChoice",
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"picture": null,
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}
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"question": "A trans-aortic valve implantation (TAVI) is a procedure that requires the insertion of a catheter into the femoral artery of the groin.\n\nWhat structure is immediately lateral to the femoral artery?",
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173,459,970 | false | 44 | null | 6,495,011 | null | false | [] | null | 12,739 | {
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{
"__typename": "QuestionChoice",
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"explanation": "This muscle is innervated by the median nerve.",
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},
{
"__typename": "QuestionChoice",
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"votes": 17
},
{
"__typename": "QuestionChoice",
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"explanation": "The interossei muscles (both dorsal and ventral) are innervated by the ulnar nerve. In carpal tunnel syndrome, the median nerve is compressed. This leads to weakness of the LOAF muscles (which are the other options in this question).",
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"picture": null,
"votes": 76
},
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"label": "b",
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"picture": null,
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},
{
"__typename": "QuestionChoice",
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}
],
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173,459,971 | false | 45 | null | 6,495,011 | null | false | [] | null | 12,740 | {
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{
"__typename": "QuestionChoice",
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"picture": null,
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"picture": null,
"votes": 27
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"__typename": "QuestionChoice",
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"explanation": "This monoclonal antibody targets CD20 on B cells. It may be used to treat MG, but is not first-line.",
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"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Acetylcholine esterase (AChE) inhibitors are usually the first-line treatment. MG is caused by a reduction in nicotinic receptors, which use acetylcholine (ACh) as the ligand to activate them. AChE breaks down acetylcholine (ACh). Treatment aims to increase ACh in the synapse, which can be done using pyridostigmine (a AChE).",
"id": "10000966",
"label": "a",
"name": "Pyridostigmine",
"picture": null,
"votes": 105
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This treats malignant hyperthermia, which is caused by a reaction to some inhaled anaesthetics.",
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"label": "c",
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"picture": null,
"votes": 0
}
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"name": "Myasthenia Gravis",
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"question": "Which of the following medications is typically used first-line in myasthenia gravis (MG)?",
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173,459,972 | false | 46 | null | 6,495,011 | null | false | [] | null | 12,741 | {
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{
"__typename": "QuestionChoice",
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"explanation": "SERCA working too hard is part of the pathophysiology of this process. However, it is not mutated in patients with malignant hyperthermia.",
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"label": "b",
"name": "SERCA",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
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"explanation": "Mutation to dystrophin gene is X-linked and can cause Duchenne muscular dystrophy.",
"id": "10000974",
"label": "d",
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"picture": null,
"votes": 10
},
{
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"explanation": "Nicotinic receptors are responsible for muscle contraction at the neuromuscular junction.",
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Subsets and Splits