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"answer": false,
"explanation": "This describes Grave's disease, which is an autoimmune disease affecting the thyroid gland. In Grave's disease, autoantibodies activate TSH receptors and cause excessive thyroid hormone synthesis and secretion.",
"id": "10001996",
"label": "e",
"name": "Autoimmune activation of thyroid tissue leads to excessive thyroid hormone synthesis",
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"votes": 9
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "The Wolff-Chaikoff effect is an autoregulatory phenomenon where a high intake of iodine leads to a decrease in thyroid hormone synthesis. This occurs as a feedback mechanism to prevent the overproduction of thyroid hormones. This effect is considered to be transient.",
"id": "10001992",
"label": "a",
"name": "A decrease in thyroid hormone synthesis that occurs in response to high levels of iodine",
"picture": null,
"votes": 76
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This does not correctly describe the Wolff-Chaikoff effect: it is, in fact, the opposite of the correct description. In the Wolff-Chaikoff effect, high levels of iodine intake acutely suppress thyroid hormone production.",
"id": "10001993",
"label": "b",
"name": "An increase in thyroid hormone synthesis that occurs in response to low levels of iodine",
"picture": null,
"votes": 9
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes Hashimoto's thyroiditis, which is an autoimmune disease affecting the thyroid gland. Here, antithyroid antibodies attack the thyroid tissue, causing fibrosis and insufficient thyroid hormone production.",
"id": "10001995",
"label": "d",
"name": "Autoimmune attack of the thyroid gland causes deficient thyroid hormone production",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the Jod-Basedow phenomenon: in individuals with iodine-deficient hypothyroidism, increased iodine exposure leads to excessive thyroid hormone synthesis. This does not occur in euthyroid individuals. The Jod-Dasedow effect produces iodine-induced hyperthyroidism. In the Wolff-Chaikoff effect, we see iodine-induced hypothyroidism.",
"id": "10001994",
"label": "c",
"name": "Excessive thyroid hormone synthesis as a result of increased iodine exposure",
"picture": null,
"votes": 10
}
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"id": "3959",
"name": "Hyperthyroidism",
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"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
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"question": "Which of the following options best describes the Wolff-Chaikoff effect?",
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"a"
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173,460,602 | false | 2 | null | 6,495,030 | null | false | [] | null | 12,946 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rotavirus is a common viral cause of diarrhoea that primarily affects infants and young children, and causes severe diarrhoea and vomiting. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.",
"id": "10002000",
"label": "d",
"name": "Rotavirus",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Norovirus is a highly contagious virus that can cause stomach and intestinal inflammation and is often spread through contaminated food or water. While it is a possible cause, it is not the most common cause of infectious diarrhoea in hospitalised patients.",
"id": "10002001",
"label": "e",
"name": "Norovirus",
"picture": null,
"votes": 12
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clostridium difficile (C. difficile) is a bacterial infection that can cause diarrhoea and colitis and is the most common cause of infectious diarrhoea in hospitalised patients. C. difficile is often acquired in healthcare settings and can occur as a complication of antibiotic use.",
"id": "10001997",
"label": "a",
"name": "Clostridium difficile",
"picture": null,
"votes": 102
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Salmonella is a common cause of foodborne illness and can cause diarrhoea, fever and abdominal cramps. It is often found in undercooked meats, eggs and dairy products. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.",
"id": "10001998",
"label": "b",
"name": "Salmonella",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Escherichia coli (E.coli) is a type of bacteria that can cause diarrhoea, as well as urinary tract infections and sepsis. It is commonly found in the gastrointestinal tract and is often spread through contaminated food or water. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.",
"id": "10001999",
"label": "c",
"name": "Escherichia coli",
"picture": null,
"votes": 11
}
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"id": "3935",
"name": "Clostridium difficile",
"status": null,
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"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
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"topicId": 136,
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"question": "Which of the following microbes is the most common cause of infectious diarrhoea in hospitalised patients?",
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"a"
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173,460,603 | false | 3 | null | 6,495,030 | null | false | [] | null | 12,947 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A systematic review is a type of research methodology that involves a comprehensive and systematic analysis of multiple studies on a specific topic, using a rigorous and transparent methodology to identify, critically appraise and synthesise all relevant studies. It aims to provide a high-quality and reliable summary of the current evidence on a specific research question or topic.",
"id": "10002002",
"label": "a",
"name": "A comprehensive analysis of available evidence on a specific topic, with a clearly defined search strategy",
"picture": null,
"votes": 73
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a correct description of a systematic review. It describes a randomised controlled trial, which is a type of primary study and not a review at all.",
"id": "10002006",
"label": "e",
"name": "A study in which subjects are randomly assigned to either an intervention or control group, with outcomes subsequently measured",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes a narrative review, which looks to describe available evidence on a specific topic and synthesise a conclusion from this evidence. They often take a less formal approach compared to systematic reviews and do not usually require reporting methodology or search terms.",
"id": "10002004",
"label": "c",
"name": "A comprehensive analysis of multiple studies, which is then used to construct a narrative on a specific topic",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This description best describes a case summary, which focuses on a single patient. In contrast, a systematic review would involve multiple studies on a specific topic.",
"id": "10002003",
"label": "b",
"name": "An analysis of a single patient's medical history, providing an evidence-based discussion of the key topics within the history",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a correct description of a systematic review, as this type of review looks to synthesise all available evidence of a specific topic regardless of what the study type is. Therefore, they will typically include other study types, such as observational studies, case-control studies etc.",
"id": "10002005",
"label": "d",
"name": "A comprehensive analysis that specifically includes only randomised controlled trials",
"picture": null,
"votes": 1
}
],
"comments": [],
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"typeId": 7
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"id": "3998",
"name": "Types of Literature Review",
"status": null,
"topic": {
"__typename": "Topic",
"id": "185",
"name": "Ethics & Law",
"typeId": 7
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"topicId": 185,
"totalCards": null,
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"question": "Which of the following descriptions correctly defines a systematic review?",
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"a"
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"typeId": 1,
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173,460,604 | false | 4 | null | 6,495,030 | null | false | [] | null | 12,948 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This does not correctly describe BPPV. While otoliths do indeed dislodge from the utricle, they float around fluid-filled areas such as the semicircular canals in the inner ear. The middle ear is not involved.",
"id": "10002009",
"label": "c",
"name": "Otoliths dislodge from the utricle and float around the middle ear",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. BPPV involves otoliths dislodging from the utricle and floating around fluid-filled spaces such as the semicircular canals in the inner ear.",
"id": "10002008",
"label": "b",
"name": "Otoliths dislodge from the semi-circular canals and float around the utricle",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This description best describes the potential pathophysiology of Meniere's disease. The exact mechanisms that cause Meniere's disease are contested. It presents clinically as dizziness, vertigo, tinnitus and aural fullness.",
"id": "10002010",
"label": "d",
"name": "Excessive pressure accumulation in the endolymph",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This description best describes the pathophysiology of BPPV. BPPV is caused by the displacement of small calcium particles (otoliths) in the inner ear. These particles are normally located in the utricle within the inner ear. When they become displaced, they can move into the semicircular canals and cause abnormal signals to be sent to the brain, resulting in vertigo.",
"id": "10002007",
"label": "a",
"name": "Otoliths dislodge from the utricle and float around the semi-circular canals",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This description best describes the pathophysiology of a vestibular schwannoma. It is a benign tumour that carries a small risk of malignant transformation.",
"id": "10002011",
"label": "e",
"name": "Development of a Schwann cell-derived tumour arising from the vestibulocochlear nerve",
"picture": null,
"votes": 1
}
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"id": "3999",
"name": "Benign Paroxysmal Positional Vertigo (BPPV)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
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"topicId": 186,
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"question": "Which of these best describes the pathophysiology of Benign Paroxysmal Positional Vertigo (BPPV)?",
"sbaAnswer": [
"a"
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"totalVotes": 109,
"typeId": 1,
"userPoint": null
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173,460,605 | false | 5 | null | 6,495,030 | null | false | [] | null | 12,949 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it best describes a third-degree heart block, also known as a complete heart block. P waves and QRS complexes here are regular but have no relationship.",
"id": "10002013",
"label": "b",
"name": "A type of heart block characterised by a complete failure of an electrical impulse to reach the ventricles",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it best describes a left bundle branch block. It can indicate underlying heart diseases, such as dilated cardiomyopathy or hypertrophic cardiomyopathy.",
"id": "10002014",
"label": "c",
"name": "A type of heart block characterised by a delay or block in the bundle of His on the left side of the heart",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct as it best describes a Mobitz II heart block. This is a type of second-degree heart block where QRS complexes are either randomly or regularly (e.g. 2:1) dropped after regular P waves. There is no PR interval prolongation. It can rapidly deteriorate into 3rd-degree heart block.",
"id": "10002012",
"label": "a",
"name": "A type of heart block characterised by the presence of some P waves which are followed by QRS complexes. P waves are regular, and there is no prolongation of PR intervals",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it best describes a first-degree heart block. Here, the PR interval is simply prolonged with no dropped QRS complexes. It is the most benign heart block.",
"id": "10002015",
"label": "d",
"name": "A type of heart block characterised by prolonged PR intervals with a regular rhythm and 1:1 ratio of P waves to QRS complexes",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it best describes a Mobitz-type I heart block. This is also a type of second-degree heart block, but here there is variation in PR interval length. It is also known as Wenckebach heart block.",
"id": "10002016",
"label": "e",
"name": "A type of heart block where gradual prolongation of PR intervals is seen until a QRS complex is dropped",
"picture": null,
"votes": 34
}
],
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"id": "3699",
"name": "Heart Block",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
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"topicId": 134,
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"question": "Which of the following best describes a Mobitz II heart block?",
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"a"
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173,460,606 | false | 6 | null | 6,495,030 | null | false | [] | null | 12,950 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Psoriasis is a chronic skin condition characterised by red, scaly patches on the skin. Some patients with psoriasis may develop psoriatic arthritis. It is not a cutaneous manifestation of Crohn's disease.",
"id": "10002018",
"label": "b",
"name": "Psoriasis",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dermatitis herpetiformis is a cutaneous manifestation of Coeliac disease, not Crohn's disease. It presents as a chronic, itchy skin rash.",
"id": "10002021",
"label": "e",
"name": "Dermatitis herpetiformis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Kaposi's sarcoma is a rare disease that develops from the endothelial cells of the lymphatic system and blood vessels. It manifests in the skin as dark, discoloured patches. It is not a cutaneous manifestation of Crohn's disease.",
"id": "10002019",
"label": "c",
"name": "Kaposi's sarcoma",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Molluscum contagiosum is a viral skin infection caused by the Molluscum contagiosum virus (MCV) that results in the formation of small, round, raised, and often itchy, benign papules on the skin. While it can be seen in patients with immune-compromising conditions, is not the most likely cutaneous manifestation of Crohn's disease out of the options given.",
"id": "10002020",
"label": "d",
"name": "Molluscum contagiosum",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Erythema nodosum is a type of inflammatory skin condition characterised by tender, red and swollen nodules on the legs. It is a common cutaneous manifestation of Crohn's disease. It is therefore most likely to be seen alongside Crohn's disease.",
"id": "10002017",
"label": "a",
"name": "Erythema nodosum",
"picture": null,
"votes": 63
}
],
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"entitlement": null,
"id": "4000",
"name": "Crohn's disease",
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"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "Which of the following skin conditions is most likely to be seen in Crohn's disease?",
"sbaAnswer": [
"a"
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"totalVotes": 111,
"typeId": 1,
"userPoint": null
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173,460,607 | false | 7 | null | 6,495,030 | null | false | [] | null | 12,951 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Boerhaave's syndrome, also known as spontaneous oesophageal rupture, is a cause of oesophageal perforations. It occurs when the oesophageal ruptures due to a sudden increase in pressure, such as from vomiting or heavy lifting. It is usually seen in middle-aged or older men who have an underlying oesophageal disease or previous history of heavy alcohol consumption. They account for approximately 15% of all oesophageal perforations.",
"id": "10002024",
"label": "c",
"name": "Boerhaave's syndrome",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oesophageal malignancy can cause perforations but accounts for <1% of all perforations, therefore it is not the most common cause.",
"id": "10002025",
"label": "d",
"name": "Malignancy",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While foreign body ingestion can cause oesophageal perforations, it leads to approximately 12% of all perforations and is therefore not the most common cause.",
"id": "10002026",
"label": "e",
"name": "Foreign body ingestion",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Iatrogenic perforation refers to perforation caused by medical or surgical procedures. This can include perforations caused by endoscopic procedures such as oesophagogastroduodenoscopy (OGD), but can also refer to perforations caused by other medical or surgical procedures as well. Iatrogenic perforations are the most common cause of oesophageal perforations. They account for over 50% of all oesophageal perforations.",
"id": "10002022",
"label": "a",
"name": "Iatrogenic",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Trauma, such as a car accident or fall, can cause oesophageal perforations, but it is not the most common cause. They account for <10% of all oesophageal perforations.",
"id": "10002023",
"label": "b",
"name": "Trauma",
"picture": null,
"votes": 18
}
],
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"name": "Oesophageal perforation",
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"id": "136",
"name": "Gastroenterology",
"typeId": 7
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"topicId": 136,
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"question": "Which of the following is the most common cause of oesophageal perforation?",
"sbaAnswer": [
"a"
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173,460,608 | false | 8 | null | 6,495,030 | null | false | [] | null | 12,952 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct definition of a type I error. It occurs when a test detects a difference or effect that, in actuality, does not exist.",
"id": "10002027",
"label": "a",
"name": "A type I error is a statistical error that occurs when a test concludes that a difference or effect exists when one does not exist",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the definition of a type II error, also known as a false negative.",
"id": "10002030",
"label": "d",
"name": "A type I error is a statistical error that occurs when a test fails to detect a difference or effect that actually exists",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In statistics, precision refers to how close multiple measurements of the same quantity are to one another. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.",
"id": "10002031",
"label": "e",
"name": "A type I error is a statistical error that occurs when a test is too precise",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In statistics, sensitivity is the ability of a test to correctly identify positive cases. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.",
"id": "10002029",
"label": "c",
"name": "A type I error is a statistical error that occurs when a test is too sensitive",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In statistics, specificity refers to the ability of a test to correctly identify negative cases. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.",
"id": "10002028",
"label": "b",
"name": "A type I error is a statistical error that occurs when a test is too specific",
"picture": null,
"votes": 4
}
],
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"chapterId": 2693,
"demo": null,
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"id": "4002",
"name": "Types of Errors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "185",
"name": "Ethics & Law",
"typeId": 7
},
"topicId": 185,
"totalCards": null,
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"question": "Which of the following statements about type I errors is correct?",
"sbaAnswer": [
"a"
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"totalVotes": 95,
"typeId": 1,
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173,460,609 | false | 9 | null | 6,495,030 | null | false | [] | null | 12,953 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The typical genotype for females is XX, which means they have two copies of the X chromosome. However, Turner's syndrome is a genetic disorder that affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO.",
"id": "10002033",
"label": "b",
"name": "XX",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Turner's syndrome is a genetic disorder that affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. This genotype is caused by the complete or partial loss of one X chromosome. It presents with symptoms such as a wide or weblike neck, low-set ears, a broad chest etc.",
"id": "10002032",
"label": "a",
"name": "XO",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Triple X syndrome is a genetic disorder that affects females and is caused by an extra X chromosome, resulting in a genotype of XXX. Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. It presents with delayed development of speech and language skills, as well as motor skills. Individuals can also present with behavioural issues.",
"id": "10002036",
"label": "e",
"name": "XXX",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The typical genotype for males is XY, which means they have one X and one Y chromosome. However, Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO.",
"id": "10002034",
"label": "c",
"name": "XY",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Klinefelter syndrome is a genetic disorder that affects males and is caused by an extra X chromosome, resulting in a genotype of XXY. Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. It can present as a low sperm count and a smaller penis/testicles in males, as well as reduced libido, weak bones and reduced body hair.",
"id": "10002035",
"label": "d",
"name": "XXY",
"picture": null,
"votes": 23
}
],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4003",
"name": "Infertility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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"question": "Which of these is the correct genotype for Turner's Syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 111,
"typeId": 1,
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} | MarksheetMark |
173,460,610 | false | 10 | null | 6,495,030 | null | false | [] | null | 12,954 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Macrocytes are abnormally large red blood cells, which can be seen in vitamin B12 and folate deficiency, but not in iron deficiency anaemia.",
"id": "10002038",
"label": "b",
"name": "Macrocytes",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Target cells are most likely to be seen on a blood film in iron deficiency anaemia. Target cells are red blood cells that have a characteristic bull's-eye appearance on a blood film, caused by a decrease in the amount of haemoglobin in the cells. They are seen in iron deficiency anaemia due to a lack of iron available for the production of haemoglobin, and thus a decreased amount of haemoglobin in cells. The bull's-eye appearance is caused by a relative excess of cell membrane due to a reduced intracellular haemoglobin content (increased cell membrane area to volume ratio).",
"id": "10002037",
"label": "a",
"name": "Target cells",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sickle cells are crescent-shaped red blood cells which are seen in sickle cell anaemia. They are caused by a genetic mutation in the beta-globin gene, which leads to the formation of abnormal haemoglobin. They are not typically seen in iron deficiency anaemia.",
"id": "10002039",
"label": "c",
"name": "Sickle cells",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Keratocytes, or bite cells, are red blood cells with a bite-like defect in their membrane. They occur as a result of the phagocytosis of a Heinz body (which is made up of denatured haemoglobin), which leaves a bite-like deformity in the cell. They are not typically seen in iron deficiency anaemia.",
"id": "10002040",
"label": "d",
"name": "Keratocytes",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Schistocytes are fragmented red blood cells which can be seen in certain types of haemolytic anaemia, such as haemolytic uraemic syndrome (HUS), disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP). They are not typically seen in iron deficiency anaemia.",
"id": "10002041",
"label": "e",
"name": "Schistocytes",
"picture": null,
"votes": 24
}
],
"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": "4004",
"name": "Anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
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"question": "Which of the following cells is most likely to be seen on a blood film in iron deficiency anaemia?",
"sbaAnswer": [
"a"
],
"totalVotes": 109,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,611 | false | 11 | null | 6,495,030 | null | false | [] | null | 12,955 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Broca's area is located in the left hemisphere, hence a stroke in this area would cause right-sided weakness. Furthermore, Broca's area is associated with speech production which explains this patient's inability to form words and sentences after his stroke.",
"id": "10002042",
"label": "a",
"name": "The left frontal lobe, specifically Broca's area",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a stroke in Wernicke's area would cause right-sided weakness, Wernicke's area is associated with comprehension of speech, rather than formation of speech.",
"id": "10002044",
"label": "c",
"name": "The temporal lobe, specifically Wernicke's area",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A stroke in the left parietal lobe is more likely to cause contralateral neglect as well as a lack of awareness on the right side.",
"id": "10002043",
"label": "b",
"name": "The left parietal lobe",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A stroke in the cerebellum is more likely to cause non-specific symptoms such as headache, dizziness, nausea and vomiting.",
"id": "10002046",
"label": "e",
"name": "The cerebellum",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A stroke in the occipital lobe is more likely to cause visual disturbances, blindness or defects in the interpretation of visual information e.g. prosopagnosia ('face blindness').",
"id": "10002045",
"label": "d",
"name": "The occipital lobe",
"picture": null,
"votes": 0
}
],
"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": "3743",
"name": "Ischaemic Stroke",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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"question": "A 60-year-old patient is brought to the emergency department after experiencing sudden onset weakness on the right side of his body and difficulty forming words and sentences. He is suspected of having had a stroke.\n\nBased on the patient's symptoms, which region of the brain is most likely affected?",
"sbaAnswer": [
"a"
],
"totalVotes": 106,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,612 | false | 12 | null | 6,495,030 | null | false | [] | null | 12,956 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ptosis (eyelid droop), miosis (pupillary constriction) and anhydrosis (decreased sweating) are the main symptoms seen in Horner's syndrome, which is a neurological disorder often caused by an apical lung tumour compressing the sympathetic nervous chain.",
"id": "10002047",
"label": "a",
"name": "Ptosis, miosis and anhydrosis",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "None of these are symptoms of Horner's syndrome. Proptosis describes protruding eyeballs, mydriasis is pupillary dilatation, and hyperhidrosis is excessive sweating.",
"id": "10002049",
"label": "c",
"name": "Proptosis, mydriasis and hyperhidrosis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While ptosis (eyelid droop) and anhydrosis (decreased sweating) are symptoms of Horner's syndrome, mydriasis (pupillary dilatation) is not.",
"id": "10002048",
"label": "b",
"name": "Ptosis, mydriasis and anhydrosis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Both ptosis (eyelid droop) and miosis (pupillary constriction) are symptoms of Horner's syndrome, which occurs due to compression of the sympathetic nervous chain. However, hyperhidrosis (excessive sweating) is not associated with Horner's syndrome.",
"id": "10002050",
"label": "d",
"name": "Ptosis, miosis and hyperhidrosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Both miosis (pupillary constriction) and anhydrosis (decreased sweating) are symptoms of Horner's syndrome, which occurs due to compression of the sympathetic nervous chain. However, proptosis (protruding eyeballs) is not associated with Horner's syndrome.",
"id": "10002051",
"label": "e",
"name": "Proptosis, miosis and anhydrosis",
"picture": null,
"votes": 0
}
],
"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": "3702",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
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},
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"psaSectionId": null,
"qaAnswer": null,
"question": "What triad of symptoms is seen in Horner's Syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 105,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,613 | false | 13 | null | 6,495,030 | null | false | [] | null | 12,957 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Colchicine is an anti-inflammatory drug that can be used to treat acute gout as well as reduce the frequency and severity of gout attacks but is not recommended for long-term use.",
"id": "10002055",
"label": "d",
"name": "Colchicine",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The first-line treatment for the chronic management of gout is allopurinol. It works by reducing the production of uric acid which helps prevent gout attacks.",
"id": "10002052",
"label": "a",
"name": "Allopurinol",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Probenecid is a medication that is used to increase uric acid excretion and can help prevent gout attacks. However, it is not the first-line treatment for the chronic management of gout.",
"id": "10002056",
"label": "e",
"name": "Probenecid",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NSAIDs, such as ibuprofen and naproxen, can be used to reduce pain and inflammation during an acute gout attack, but are not recommended for long-term use due to the risk of side effects, such as renal failure or peptic ulcers.",
"id": "10002053",
"label": "b",
"name": "Non-steroidal anti-inflammatory drugs (NSAIDs)",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Corticosteroids, such as prednisone, can also be used to reduce inflammation and pain during an acute gout attack, but are not recommended for long-term use due to the risk of side effects, such as osteoporosis.",
"id": "10002054",
"label": "c",
"name": "Corticosteroids",
"picture": null,
"votes": 4
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3768",
"name": "Gout",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
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"question": "What drug is used first line for the chronic management of gout?",
"sbaAnswer": [
"a"
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"totalVotes": 102,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,614 | false | 14 | null | 6,495,030 | null | false | [] | null | 12,958 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Chlamydia pneumoniae* is penicillin-resistant, therefore amoxicillin is not an effective antibiotic treatment.",
"id": "10002058",
"label": "b",
"name": "Amoxicillin",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Doxycycline is a tetracycline antibiotic which can be used for the treatment of *Chlamydia pneumoniae* but is not used first-line.",
"id": "10002059",
"label": "c",
"name": "Doxycycline",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ciprofloxacin is a fluoroquinolone antibiotic and can be used for the treatment of *Chlamydia pneumoniae* but is not used first-line.",
"id": "10002060",
"label": "d",
"name": "Ciprofloxacin",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clarithromycin is a macrolide antibiotic. Macrolides are effective against *Chlamydia pneumoniae*; they work by inhibiting the 50S ribosomal subunit, limiting bacterial protein synthesis.",
"id": "10002057",
"label": "a",
"name": "Clarithromycin",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rifampicin is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis. It is not typically used to treat *Chlamydia pneumoniae* infection.",
"id": "10002061",
"label": "e",
"name": "Rifampicin",
"picture": null,
"votes": 2
}
],
"comments": [],
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"chapterId": 2693,
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"id": "3709",
"name": "Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"dislikes": 0,
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"question": "A 60-year-old gentleman presents to A&E with shortness of breath and a high fever. He has been experiencing a progressively worsening cough and fatigue. He is diagnosed with pneumonia and further tests find him to be positive for *Chlamydia pneumoniae*.\n\nWhich of the following antibiotics is used first-line in the treatment of *Chlamydia pneumoniae* infection?",
"sbaAnswer": [
"a"
],
"totalVotes": 98,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,615 | false | 15 | null | 6,495,030 | null | false | [] | null | 12,959 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In DKA, pH levels are low due to the build-up of acidic ketones. Ketones are also high.",
"id": "10002063",
"label": "b",
"name": "High pH, low ketones, low bicarbonate, high glucose",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In DKA, ketone and glucose levels are high. Patients with DKA are typically very dehydrated and present with nausea, vomiting and reduced consciousness.",
"id": "10002065",
"label": "d",
"name": "Low pH, low ketones, low bicarbonate, low glucose",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In DKA, pH levels are low due to the accumulation of acidic ketones - therefore ketone levels are also high. Bicarbonate levels are low due to decreased production and increased consumption as the body tries to compensate for the low pH levels. Glucose levels are high as there is an insulin deficiency, leading to increased glucose levels in the blood which cannot enter cells to be utilised.",
"id": "10002062",
"label": "a",
"name": "Low pH, high ketones, low bicarbonate, high glucose",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In DKA, pH levels are low due to the build-up of acidic ketones. Bicarbonate is low due to increased consumption through compensatory mechanisms which try to normalise the low pH.",
"id": "10002064",
"label": "c",
"name": "Normal pH, low ketones, high bicarbonate, high glucose",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glucose levels are high in DKA, not low. pH is also low as a result of high ketones.",
"id": "10002066",
"label": "e",
"name": "Normal pH, high ketones, high bicarbonate, low glucose",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4005",
"name": "Diabetic ketoacidosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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"question": "Which of the following best describes the changes to pH, ketones, bicarbonate and glucose levels in diabetic ketoacidosis (DKA)?",
"sbaAnswer": [
"a"
],
"totalVotes": 105,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,616 | false | 16 | null | 6,495,030 | null | false | [] | null | 12,960 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Montelukast is not a corticosteroid. This description fits drugs such as beclomethasone, which can be used in asthma management.",
"id": "10002070",
"label": "d",
"name": "Montelukast is a corticosteroid that works to inhibit inflammatory cells and the release of inflammatory mediators",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the mechanism of action for montelukast. It targets CysLT1 leukotriene receptors found on eosinophils, mast cells and airway smooth muscle cells.",
"id": "10002067",
"label": "a",
"name": "Montelukast is a CysLT1 leukotriene receptor antagonist that decreases eosinophil migration, bronchoconstriction and inflammation-induced oedema",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of theophylline. Inhibition of phosphodiesterases leads to the reduced breakdown of cyclic AMP in smooth muscle cells. This is thought to result in bronchodilation and relaxed smooth muscle. Theophylline can be used to manage asthma and COPD.",
"id": "10002071",
"label": "e",
"name": "Montelukast inhibits type III and IV phosphodiesterase, which leads to bronchodilation and relaxed smooth muscle in the bronchial airways",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action for salbutamol, which is a different drug used in asthma treatment. It is more commonly used in asthma management than montelukast.",
"id": "10002068",
"label": "b",
"name": "Montelukast is a B2-receptor agonist. Once these receptors are activated, Ca2+ entry is reduced which prevents smooth muscle contraction",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of fluticasone and mometasone. Alongside targeting eosinophils and monocytes, they also target mast cells, macrophages and dendritic cells.",
"id": "10002069",
"label": "c",
"name": "Montelukast has multiple actions on different cell types - it directly decreases inflammatory cells like eosinophils and monocytes and also reduces the number of cytokines produced by these cells",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"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,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"dislikes": 0,
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"qaAnswer": null,
"question": "Montelukast can be used in the management of asthma.\n\nWhat is the mechanism of action of montelukast?",
"sbaAnswer": [
"a"
],
"totalVotes": 96,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,617 | false | 17 | null | 6,495,030 | null | false | [] | null | 12,961 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The carotid plexus is located near the carotid arteries and innervates the head and neck. It is not the location of the ganglion cells lost in achalasia.",
"id": "10002076",
"label": "e",
"name": "Carotid plexus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The adrenal plexus is located near the adrenal glands and controls the sympathetic nervous system, and is not the location of the ganglion cells lost in achalasia.",
"id": "10002075",
"label": "d",
"name": "Adrenal plexus",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The coeliac plexus is located near the coeliac artery and controls digestion, and is not the location of the ganglion cells lost in achalasia.",
"id": "10002074",
"label": "c",
"name": "Coeliac plexus",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The pathophysiology of achalasia involves inflammation of the myenteric plexus within the oesophageal with the destruction of ganglion cells. The myenteric plexus is located between the inner and outer layers of the muscularis propria.",
"id": "10002072",
"label": "a",
"name": "Myenteric plexus",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Meissner's plexus is located in the submucosal layer and regulates secretions and blood flow within the gastrointestinal tract. It is not the location of the ganglion cells lost in achalasia.",
"id": "10002073",
"label": "b",
"name": "Meissner's plexus",
"picture": null,
"votes": 25
}
],
"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": "4006",
"name": "Achalasia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4006,
"conditions": [],
"difficulty": 1,
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"explanation": null,
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"likes": 0,
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"psaSectionId": null,
"qaAnswer": null,
"question": "Achalasia is a condition characterised by the loss of ganglion cells, leading to oesophageal hypermotility.\n\nWhere are the lost ganglion cells in achalasia normally found?",
"sbaAnswer": [
"a"
],
"totalVotes": 95,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,618 | false | 18 | null | 6,495,030 | null | false | [] | null | 12,962 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes a femoral hernia. This is a rare type of hernia and may present as a lump, which can appear with coughing/straining and disappear when the patient lies down.",
"id": "10002080",
"label": "d",
"name": "A hernia that occurs when part of the small intestine protrudes through the femoral canal into the thigh",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes a rolling hiatus hernia, also known as a para-oesophageal hernia. The location of the lower oesophageal sphincter does not change n rolling hiatus hernias; instead, a portion of the stomach slides up into the chest. These are less common than sliding hiatus hernias.",
"id": "10002081",
"label": "e",
"name": "A hernia that occurs when part of the stomach protrudes into the chest through a weakened opening in the diaphragm, adjacent to the oesophagus",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This correctly describes a sliding hiatus hernia which is the most common type of hiatus hernia. In sliding hiatus hernias, the location of the lower oesophageal sphincter changes and it rises into the chest. As a result, the sphincter may not be able to close efficiently which can lead to acid reflux.",
"id": "10002077",
"label": "a",
"name": "A hernia that occurs when the stomach intermittently slides up into the chest through a weakened opening in the diaphragm",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes an umbilical hernia which does not involve the lower oesophageal sphincter at all.",
"id": "10002078",
"label": "b",
"name": "A hernia that occurs when part of the stomach protrudes through a weakness in the abdominal wall near the umbilicus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes an inguinal hernia. This may present as a lump, which can appear with coughing/straining and disappear when the patient lies down.",
"id": "10002079",
"label": "c",
"name": "A hernia that occurs when part of the intestine protrudes through the inguinal canal into the scrotum in males or labia majora in females",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4007",
"name": "Hiatus hernia management",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4007,
"conditions": [],
"difficulty": 1,
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"highlights": [],
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"psaSectionId": null,
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"question": "Which of the following best describes a sliding hiatus hernia?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,619 | false | 19 | null | 6,495,030 | null | false | [] | null | 12,963 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Background retinopathy is characterised by the presence of at least one microaneurysm. It falls under the category of non-proliferative retinopathy.",
"id": "10002083",
"label": "b",
"name": "Background retinopathy",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as acute retinal necrosis is not a stage of diabetic retinopathy at all. It is a separate condition, which may present as panuveitis and can be viral in origin.",
"id": "10002086",
"label": "e",
"name": "Acute retinal necrosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Cotton wool spots are a hallmark feature of non-proliferative retinopathy and typically appear when the disease is at a moderate stage. Indeed, one of the diagnostic criteria for moderate non-proliferative retinopathy is cotton wool spots, as well as retinal haemorrhages, hard exudates and venous beading.",
"id": "10002082",
"label": "a",
"name": "Moderate non-proliferative retinopathy",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst cotton wool spots can be seen here, this is a much more advanced stage of diabetic retinopathy (cotton wool spots would likely have been present for a long time). Proliferative diabetic retinopathy is characterised by new vessels on the optic disc and generalised neovascularisation.",
"id": "10002084",
"label": "c",
"name": "Proliferative retinopathy",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cotton wool spots are usually seen in non-proliferative retinopathy, but are most likely to first appear during the moderate stage. The diagnostic criteria for severe non-proliferative retinopathy include intraretinal haemorrhages, venous beading in two or more quadrants and multiple intraretinal microvascular abnormalities.",
"id": "10002085",
"label": "d",
"name": "Severe non-proliferative retinopathy",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3937",
"name": "Type 1 Diabetes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3937,
"conditions": [],
"difficulty": 1,
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"highlights": [],
"id": "12963",
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"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "In which stage of diabetic retinopathy are 'cotton wool spots' typically first seen?",
"sbaAnswer": [
"a"
],
"totalVotes": 92,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,620 | false | 20 | null | 6,495,030 | null | false | [] | null | 12,964 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypopituitarism is characterised by decreased production of multiple pituitary hormones, leading to symptoms such as fatigue, decreased libido, and menstrual abnormalities. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.",
"id": "10002090",
"label": "d",
"name": "Hypopituitarism",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperparathyroidism is characterised by high levels of parathyroid hormone, leading to symptoms such as osteoporosis, kidney stones, and mood changes. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.",
"id": "10002088",
"label": "b",
"name": "Hyperparathyroidism",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Cushing's disease is characterised by excessive production of cortisol, leading to clinical signs such as centripetal obesity, moon face, buffalo hump, easy bruising, and muscle weakness.",
"id": "10002087",
"label": "a",
"name": "Cushing's disease",
"picture": null,
"votes": 105
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperthyroidism is characterised by high levels of thyroid hormone, leading to symptoms such as weight loss, tachycardia and sweating. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.",
"id": "10002089",
"label": "c",
"name": "Hyperthyroidism",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Addison's disease is characterised by decreased production of adrenal hormones, leading to symptoms such as fatigue, weight loss, and low blood pressure. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.",
"id": "10002091",
"label": "e",
"name": "Addison's disease",
"picture": null,
"votes": 0
}
],
"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": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"question": "Which of the following endocrine disorders is characterised by centripetal obesity, a moon face, and a buffalo hump?",
"sbaAnswer": [
"a"
],
"totalVotes": 105,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,621 | false | 21 | null | 6,495,030 | null | false | [] | null | 12,965 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "DIC is a rare but serious condition characterised by inappropriate, systemic activation of coagulation pathways. Raised D dimer levels, reduced fibrinogen concentration, low platelet count and prolonged prothrombin time can therefore be seen. It is caused by the inappropriate activation of clotting pathways which causes widespread coagulation. In turn, this depletes coagulation factors which then results in excessive bleeding.",
"id": "10002092",
"label": "a",
"name": "Elevated D dimer levels, reduced fibrinogen concentration, low platelet count, prolonged prothrombin time",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels. A high platelet count is not typical in DIC, and prothrombin time is prolonged.",
"id": "10002096",
"label": "e",
"name": "Elevated D-dimer levels, high fibrinogen concentration, high platelet count, normal prothrombin time",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In DIC, the platelet count is typically low, not high. Furthermore, D dimer is high, and prothrombin time (PT) is prolonged due to a depletion in coagulation factors.",
"id": "10002094",
"label": "c",
"name": "Reduced D-dimer levels, reduced fibrinogen concentration, high platelet count, reduced prothrombin time",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels. A prolonged prothrombin time would also be seen due to the depletion of coagulation factors. D dimer is also raised.",
"id": "10002093",
"label": "b",
"name": "Reduced D-dimer levels, high fibrinogen concentration, low platelet count, normal prothrombin time",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels.",
"id": "10002095",
"label": "d",
"name": "Elevated D-dimer levels, high fibrinogen concentration, low platelet count, prolonged prothrombin time",
"picture": null,
"votes": 20
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3930",
"name": "disseminated intravascular coagulation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3930,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"likes": 0,
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"qaAnswer": null,
"question": "Disseminated intravascular coagulation (DIC) is a disorder of coagulation in which changes to D dimer and fibrinogen levels are seen.\n\nWhich of the following best describes the D dimer and fibrinogen profile seen in DIC?",
"sbaAnswer": [
"a"
],
"totalVotes": 90,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,622 | false | 22 | null | 6,495,030 | null | false | [] | null | 12,966 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypokalaemia is characterised by flattened/inverted T waves, QT prolongation and occasionally U waves.",
"id": "10002098",
"label": "b",
"name": "Hypokalaemia",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypercalcaemia, especially in its severe form, may present with ST-segment elevation, biphasic T waves and prominent U waves.",
"id": "10002101",
"label": "e",
"name": "Hypercalcaemia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary embolism usually presents on ECG with sinus tachycardia, but may also present with a new right bundle branch block, rightward shift of the QRS axis or an S1Q3T3 phenomenon.",
"id": "10002099",
"label": "c",
"name": "Pulmonary embolism",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypocalcaemia is more likely to present with QT interval prolongation secondary to a prolonged ST segment.",
"id": "10002100",
"label": "d",
"name": "Hypocalcaemia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Peaked T waves and signs of slow conduction, e.g. prolonged PR interval and widened QRS complexes, are all suggestive of hyperkalaemia.",
"id": "10002097",
"label": "a",
"name": "Hyperkalaemia",
"picture": null,
"votes": 86
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3934",
"name": "hyperkalaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
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"question": "A patient's ECG shows peaked T-waves, prolonged PR interval, widened QRS complexes and flattened P waves.\n\nWhich of the following abnormalities are these ECG findings consistent with?",
"sbaAnswer": [
"a"
],
"totalVotes": 98,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,623 | false | 23 | null | 6,495,030 | null | false | [] | null | 12,967 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:\n\nMAP = DP + 1/3(SP-DP)\nSV = EDV – ESV\nCO = HR x SV\nEF = SV/EDV x 100\n\nSV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate",
"id": "10002102",
"label": "a",
"name": "CO: 10.8L, EF: 56%, MAP: 107mmHg",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "None of the above is correct. It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:\n\nMAP = DP + 1/3(SP-DP)\nSV = EDV – ESV\nCO = HR x SV\nEF = SV/EDV x 100\n\nSV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate",
"id": "10002106",
"label": "e",
"name": "CO: 11.5L, EF: 67%, MAP: 93mmHg",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "None of the above is correct. It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:\n\nMAP = DP + 1/3(SP-DP)\nSV = EDV – ESV\nCO = HR x SV\nEF = SV/EDV x 100\n\nSV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate",
"id": "10002105",
"label": "d",
"name": "CO: 11.5L, EF: 62%, MAP: 103mmHg",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst EF and MAP are correct here, CO is not. Calculate cardiac output using this equation: HR x SV",
"id": "10002104",
"label": "c",
"name": "CO: 11.5L, EF: 56%, MAP: 107mmHg",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the cardiac output and MAP are correct here, the ejection fraction is not. Calculate ejection fraction using this equation: SV/EDV x 100",
"id": "10002103",
"label": "b",
"name": "CO: 10.8L, EF: 62%, MAP: 103mmHg",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4008",
"name": "Cardiac calculations",
"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 56-year-old female presents to A&E with shortness of breath, wheeze and a fever. She is suspected to have a COVID-19 infection. Further investigations are conducted.\n\nHer observations are: O2 saturation 89% on BiPAP, heart rate 78bpm, respiratory rate 22 breaths/minute, blood pressure 152/85mmHg and temperature 38.4 degrees Celsius.\n\nA Schwanz ganz catheter indicates her end-diastolic volume (EDV) to be 248 mL and end-systolic volume (ESV) to be 109 mL.\n\nWhich of the following describes her cardiac output (CO), ejection fraction (EF) and mean arterial blood pressure (MAP)?",
"sbaAnswer": [
"a"
],
"totalVotes": 87,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,624 | false | 24 | null | 6,495,030 | null | false | [] | null | 12,968 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Presence of clonus indicates an upper motor neuron lesion. It is most commonly assessed in the ankle joint through brisk dorsiflexion of the foot.",
"id": "10002108",
"label": "b",
"name": "Presence of clonus",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Flaccid tone is a sign of lower motor neuron lesions. This can be elucidated on examination - passive movement of the patient's joints will be very easy and they will feel 'floppy'.",
"id": "10002107",
"label": "a",
"name": "Flaccid tone",
"picture": null,
"votes": 88
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a sign of an upper motor neuron lesion. In a lower motor neuron lesion, reflexes will typically be reduced or absent.",
"id": "10002109",
"label": "c",
"name": "Brisk reflexes",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a sign of an upper motor neuron lesion. Flaccid tone is more commonly seen in lower motor neuron lesions.",
"id": "10002110",
"label": "d",
"name": "Spastic tone",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a sign of an upper motor neuron lesion. A positive Babinski sign is an extensor plantar response, whereby stroking the sole of the foot causes the big toe to bend upwards and the other toes to fan outward. This is normal in children under 2 years old and pathological if seen in adults.",
"id": "10002111",
"label": "e",
"name": "Positive Babinski sign",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4009",
"name": "Motor Neurone Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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},
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"question": "Which of the following is a clinical sign of a lower motor neuron lesion?",
"sbaAnswer": [
"a"
],
"totalVotes": 100,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,625 | false | 25 | null | 6,495,030 | null | false | [] | null | 12,969 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The GI tract develops from the endoderm germ layer, alongside the liver, pancreas, lung and thyroid.",
"id": "10002112",
"label": "a",
"name": "Endoderm",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The somites are paired blocks of paraxial mesoderm that flank the neural tube and notochord. They do not partake in the development of the GI tract.",
"id": "10002116",
"label": "e",
"name": "Somites",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The notochord functions as an organising centre for neurulation and mesoderm development. It does not partake in the development of the GI tract.",
"id": "10002115",
"label": "d",
"name": "Notochord",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The GI tract does not develop from the ectoderm. However, the CNS and neural crest, skin epithelia and tooth enamel all develop from the ectoderm.",
"id": "10002113",
"label": "b",
"name": "Ectoderm",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The GI tract does not develop from the mesoderm. However, the blood, muscle and gonads all develop from the mesoderm.",
"id": "10002114",
"label": "c",
"name": "Mesoderm",
"picture": null,
"votes": 32
}
],
"comments": [],
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3942",
"name": "Development of the foregut",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
"typeId": null,
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},
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"question": "During early foetal development, the different germ layers begin to develop into what will eventually become the organs of the body.\n\nWhich germ layer does the gastrointestinal tract develop from?",
"sbaAnswer": [
"a"
],
"totalVotes": 99,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,626 | false | 26 | null | 6,495,030 | null | false | [] | null | 12,970 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Progesterone is key for the maintenance of pregnancy but does not directly coordinate the maturation of organs in the late stages of foetal development.",
"id": "10002121",
"label": "e",
"name": "Progesterone",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Insulin produced by the foetus helps to facilitate the transfer of glucose from the mother's bloodstream to the foetus for its energy needs. It also stimulates glucose uptake into foetal tissues, allowing it to be used as an energy source for growth and development. However, it does not directly coordinate organ maturation in late foetal development.",
"id": "10002119",
"label": "c",
"name": "Insulin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The insulin-like growth factors have a similar action to insulin and are key for the growth and survival of the foetus. However, in late foetal development, they do not directly coordinate organ maturation.",
"id": "10002120",
"label": "d",
"name": "IGF-1",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholesterol is a key component in the synthesis of cell membranes, hormones and bile acids in a developing foetus, but does not directly coordinate organ maturation in late foetal development.",
"id": "10002118",
"label": "b",
"name": "Cholesterol",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Foetal corticosteroids are responsible for organ maturation during late foetal development. They increase in concentration towards the end of pregnancy to facilitate this.",
"id": "10002117",
"label": "a",
"name": "Corticosteroids",
"picture": null,
"votes": 20
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4010",
"name": "Foetal organ maturation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "187",
"name": "Development & Ageing",
"typeId": 7
},
"topicId": 187,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4010,
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"psaSectionId": null,
"qaAnswer": null,
"question": "Late foetal development involves the maturation of body organs.\n\nWhich substance is responsible for coordinating foetal organ maturation?",
"sbaAnswer": [
"a"
],
"totalVotes": 94,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,627 | false | 27 | null | 6,495,030 | null | false | [] | null | 12,971 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a sign of Stevens-Johnson syndrome which is a dermatological emergency with a high mortality rate. It is not a cutaneous manifestation of dermatomyositis.",
"id": "10002126",
"label": "e",
"name": "Extensive, full-thickness mucocutaneous necrosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Livedo reticularis is a vascular condition that causes a mottled, net-like pattern on the skin. It may be associated with underlying autoimmune, connective tissue or vascular diseases, but is not typically associated with dermatomyositis.",
"id": "10002124",
"label": "c",
"name": "Livedo reticularis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Dermatomyositis is an autoimmune disease that affects the muscles and skin. It is characterised by muscle weakness and skin rashes. One of the classic skin manifestations of dermatomyositis is a heliotrope rash, which is a purplish-red rash around the eyes and on the eyelids. This rash is called heliotrope because it resembles the colour of the heliotrope flower. Other skin manifestations of dermatomyositis may include Gottron's papules (small, scaly, raised patches on the knuckles and finger joints), periungual telangiectasias (spider-like blood vessels around the nail beds), and a \"shawl sign\" rash (a red, scaly rash on the upper back, shoulders, and chest).",
"id": "10002122",
"label": "a",
"name": "Heliotrope rash",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Periorbital purpura is bruising around the eyes and is often called the 'racoon sign'. It is a cutaneous manifestation of systemic amyloidosis, not dermatomyositis.",
"id": "10002125",
"label": "d",
"name": "Periorbital purpura",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Psoriasis is a different skin condition that is not typically associated with dermatomyositis. Psoriasis is characterised by scaly, red, and itchy patches on the skin.",
"id": "10002123",
"label": "b",
"name": "Psoriasis-like rash",
"picture": null,
"votes": 15
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4011",
"name": "Dermatomyositis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4011,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"isLikedByMe": null,
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"pictures": [],
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"qaAnswer": null,
"question": "Which of the following is a cutaneous manifestation of dermatomyositis?",
"sbaAnswer": [
"a"
],
"totalVotes": 87,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,628 | false | 28 | null | 6,495,030 | null | false | [] | null | 12,972 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Renal sarcomas are a rare type of renal cancer, accounting for only 1-2% of primary renal cancers. Fibrosarcomas are the most common type within this category.",
"id": "10002130",
"label": "d",
"name": "Renal sarcoma",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Wilms' tumour is a rare type of kidney cancer, originating from metanephric blastema cells found in the embryo. It therefore primarily affects children. Overall, it is very rare and makes up <5% of all renal cancer cases.",
"id": "10002129",
"label": "c",
"name": "Wilms' tumour",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transitional cell carcinoma is the second most common type of renal cancer and makes up 10% of all cases. It is a cancer of the renal pelvis and ureter and overall is rare in occurrence.",
"id": "10002128",
"label": "b",
"name": "Transitional cell carcinoma",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Renal adenomas are benign kidney tumours that are small and slow growing and are often <1cm in size. They do not fall into the category of metastatic renal tumours or cancers.",
"id": "10002131",
"label": "e",
"name": "Renal adenoma",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Adenocarcinomas, or renal cell carcinomas, make up 85% of all renal cancers. It originates in the lining of the proximal convoluted tubule and generally affects individuals aged 50-70+.",
"id": "10002127",
"label": "a",
"name": "Adenocarcinoma",
"picture": null,
"votes": 50
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4012",
"name": "Renal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4012,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12972",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "Which of the following is the most common type of renal cancer?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,629 | false | 29 | null | 6,495,030 | null | false | [] | null | 12,973 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Janeway lesions are examples of vascular phenomena which can be seen in infective endocarditis - other examples include conjunctival haemorrhages and major arterial emboli. Vascular phenomena are minor criteria under Duke's classification, not major.",
"id": "10002133",
"label": "b",
"name": "Appearance of Janeway lesions",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A history of IV drug use is a minor criterion under Duke's classification for the diagnosis of infective endocarditis, not major.",
"id": "10002136",
"label": "e",
"name": "History of IV drug use",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glomerulonephritis is an example of an immunologic phenomenon which can be seen in infective endocarditis - other examples are Osler's nodes and Roth's spots. These are minor criteria under Duke's classification, not major.",
"id": "10002135",
"label": "d",
"name": "Diagnosis of glomerulonephritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An echocardiogram positive for signs of infective endocarditis, e.g. new valvular regurgitation or vegetation, is a major criterion for the diagnosis of infective endocarditis. The other major criterion is positive blood cultures.",
"id": "10002132",
"label": "a",
"name": "Valvular vegetation seen on echocardiogram",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Infective endocarditis can lead to fevers over 38°C in patients. This is a minor criterion under Duke's classification, not a major one.",
"id": "10002134",
"label": "c",
"name": "Fever (>38°C)",
"picture": null,
"votes": 16
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3710",
"name": "Infective Endocarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"question": "Which of the following is a major feature of Duke's diagnostic criteria for infective endocarditis?",
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"a"
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173,460,630 | false | 30 | null | 6,495,030 | null | false | [] | null | 12,974 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst high white blood cell levels are seen, high glucose levels and low protein levels are not indicative of bacterial meningitis. Other causes, such as a virus, should be considered.",
"id": "10002139",
"label": "c",
"name": "High white blood cell count, high glucose level, low protein level",
"picture": null,
"votes": 17
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is possible in bacterial meningitis, it is more indicative of fungal meningitis. CSF findings are similar in fungal meningitis to bacterial meningitis, but protein levels are more likely to be normal than high. Fibrin webs are also seen in the CSF in fungal meningitis.",
"id": "10002141",
"label": "e",
"name": "High white blood cell count, low glucose level, normal protein level",
"picture": null,
"votes": 15
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"answer": false,
"explanation": "Whilst high protein levels are seen, low white blood cell count and high glucose levels are not indicative of bacterial meningitis. Other causes, such as a virus, should be considered.",
"id": "10002138",
"label": "b",
"name": "Low white blood cell count, high glucose level, high protein level",
"picture": null,
"votes": 2
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is most commonly seen on CSF analysis in meningitis. Due to an immune response to bacterial pathogens, white blood cells are raised. Bacteria require glucose to respire which causes a depletion in glucose levels in the CSF. High protein levels are also typically seen in bacterial meningitis.",
"id": "10002137",
"label": "a",
"name": "High white blood cell count, low glucose level, high protein level",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is more indicative of viral meningitis. Indeed, glucose and protein levels are more likely to be normal in viral meningitis. Monocytes, in particular, can be high in viral meningitis.",
"id": "10002140",
"label": "d",
"name": "High white blood cell count, normal glucose level, normal protein level",
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"votes": 1
}
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"name": "Meningitis",
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"name": "Neurology",
"typeId": 7
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"question": "Which of the following sets of abnormalities are most likely to be seen on cerebrospinal fluid (CSF) analysis in bacterial meningitis?",
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"a"
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173,460,631 | false | 31 | null | 6,495,030 | null | false | [] | null | 12,975 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis is a superficial disorder, limited to the colonic mucosa. Crohn's disease, on the other hand, is transmural which means that it affects all layers of the bowel.",
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"label": "c",
"name": "Transmural inflammation",
"picture": null,
"votes": 6
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classical feature of Crohn's disease, not ulcerative colitis. Due to its transmural nature, fistulae (communication between walls of different structures) can be seen in Crohn's disease.",
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"label": "d",
"name": "Tendency to form a fistula",
"picture": null,
"votes": 8
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a typical characteristic of Crohn's disease. Ulcerative colitis is limited to the colon, hence the name.",
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"label": "b",
"name": "Affects any part of the gastrointestinal tract, from mouth to anus",
"picture": null,
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ulcerative colitis is characterised by continuous inflammation of the colon, whereas Crohn's is characterised by patchy, discontinuous inflammation.",
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"label": "a",
"name": "Continuous inflammation",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis is not characterised by the presence of granulomas, versus Crohn's disease, where granulomatous inflammation is commonly seen.",
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"label": "e",
"name": "Granulomatous in nature",
"picture": null,
"votes": 13
}
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"a"
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173,460,632 | false | 32 | null | 6,495,030 | null | false | [] | null | 12,976 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.",
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"label": "c",
"name": "Chemical feasibility",
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},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "The \"Bradford Hill Criteria for Causation\" is a set of guidelines that helps to establish a causal relationship between a potential cause and an observed effect. The criteria include nine factors that help to determine whether a causal relationship exists. The first criterion is temporality, which means that the cause must precede the effect. This means that the cause must occur before the effect and not the other way around.",
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"label": "a",
"name": "Temporality",
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.",
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"label": "b",
"name": "Accessibility",
"picture": null,
"votes": 8
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.",
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"label": "e",
"name": "Accountability",
"picture": null,
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.",
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"label": "d",
"name": "Sensitivity",
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}
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173,460,633 | false | 33 | null | 6,495,030 | null | false | [] | null | 12,977 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In COPD, FEV1/FVC is reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. Given the low FEV1, this could be a mixed picture of both obstructive and restrictive disease.",
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"label": "e",
"name": "FEV1: 50% of predicted, FEV1/FVC: 95% of predicted",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This could be indicative of a restrictive lung disease where FEV1/FVC ratio is >80% due to a drop in FVC with maintained FEV1. This could be better assessed if FVC was also provided.",
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"label": "d",
"name": "FEV1: 80%, FEV1/FVC: 90% of predicted",
"picture": null,
"votes": 1
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "In COPD, FEV1 and FEV1/FVC are reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. FEV1 of 100% is also unlikely to be seen in COPD. If FVC and patient symptoms were also provided, we could assess if restrictive lung disease is a plausible differential here.",
"id": "10002153",
"label": "b",
"name": "FEV1: 100% of predicted, FEV1/FVC: 80% of predicted",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In COPD, FEV1/FVC is reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. An FEV1 of 85%, however, is possible.",
"id": "10002154",
"label": "c",
"name": "FEV1: 85% of predicted, FEV1/FVC: 90% of predicted",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "COPD is an obstructive lung disorder characterised by reduced FEV1 and FEV1/FVC ratio due to airway obstruction. In COPD, the FEV1/FVC ratio is reduced because the airways are narrowed and there is increased resistance to airflow. This results in a decrease in the amount of air that can be exhaled in the first second (FEV1) relative to the total amount of air that can be exhaled (FVC).",
"id": "10002152",
"label": "a",
"name": "FEV1: 74% of predicted, FEV1/FVC: 63% of predicted",
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"votes": 72
}
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"id": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
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"id": "132",
"name": "Respiratory",
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"question": "Spirometry is required for the diagnosis of COPD.\n\nWhich of the following sets of spirometry results is most indicative of COPD?",
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"a"
],
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"typeId": 1,
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173,460,634 | false | 34 | null | 6,495,030 | null | false | [] | null | 12,978 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst SDH can cause a severe headache, a 'thunderclap' headache is well-known as a classic red flag for a subarachnoid haemorrhage.",
"id": "10002158",
"label": "b",
"name": "Subdural haemorrhage (SDH)",
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst EDH can cause a severe headache, a 'thunderclap' headache is well-known as a classic red flag for a subarachnoid haemorrhage.",
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"label": "c",
"name": "Extradural haemorrhage (EDH)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A 'thunderclap' headache is a key red flag sign for a subarachnoid haemorrhage. It is severe, with sudden onset and takes seconds to minutes to reach maximum severity.",
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"label": "a",
"name": "Subarachnoid haemorrhage (SAH)",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst cluster headaches can be very severe, a 'thunderclap' headache is well known as a classic red flag for a subarachnoid haemorrhage. Cluster headaches are often described as unilateral pain that lasts 15-180 minutes (if untreated).",
"id": "10002161",
"label": "e",
"name": "Cluster headache",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Migraines can cause severe headaches, but 'thunderclap' suggests a very sudden onset, which is less likely to be seen in migraines.",
"id": "10002160",
"label": "d",
"name": "Migraine",
"picture": null,
"votes": 5
}
],
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"name": "Headache",
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"name": "Neurology",
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"question": "A 'thunderclap' headache is an important red flag sign for which of the following conditions?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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173,460,635 | false | 35 | null | 6,495,030 | null | false | [] | null | 12,979 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hyponatraemia is the most common electrolyte imbalance seen in hospitalised patients. Its symptoms are unspecific and include dizziness, nausea and often falls.",
"id": "10002162",
"label": "a",
"name": "Hyponatraemia",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypomagnesaemia is not the most common electrolyte imbalance seen in hospitalised patients. It is frequently seen alongside other electrolyte disorders and is associated with prolonged length of stay in hospital.",
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"label": "e",
"name": "Hypomagnesaemia",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypocalcaemia is not the most common electrolyte imbalance seen in hospitalised patients. It is more common in the intensive care unit. Depending on population demographics, a common cause can be vitamin D deficiency.",
"id": "10002164",
"label": "c",
"name": "Hypocalcaemia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypercalcaemia, whilst common, is not the most common electrolyte imbalance seen in hospitalised patients. Malignancy is the most common aetiology.",
"id": "10002165",
"label": "d",
"name": "Hypercalcaemia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypernatraemia in hospitalised patients is not the most common electrolyte imbalance seen. It is often iatrogenic and caused by increased water loss, restricted water intake, or excessive IV fluid replacement.",
"id": "10002163",
"label": "b",
"name": "Hypernatraemia",
"picture": null,
"votes": 15
}
],
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"id": "4014",
"name": "Hyponatraemia",
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"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
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"question": "Which of the following is the most common electrolyte imbalance seen in hospitalised patients?",
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"a"
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"typeId": 1,
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173,460,636 | false | 36 | null | 6,495,030 | null | false | [] | null | 12,980 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are indeed symptoms of depression but are not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of psychomotor retardation/activation can be used to aid diagnosis alongside the core symptoms.",
"id": "10002168",
"label": "b",
"name": "Psychomotor retardation or activation",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are indeed symptoms, but not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of hypersomnia/insomnia can be used to aid diagnosis alongside the core symptoms",
"id": "10002171",
"label": "e",
"name": "Hypersomnia or insomnia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is indeed a symptom of depression, but not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of suicidality can be used to aid diagnosis alongside the core symptoms.",
"id": "10002169",
"label": "c",
"name": "Suicidality",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Anhedonia, or decreased interest or pleasure, is one of the core symptoms of major depressive disorder. Either anhedonia or a diminished/irritable mood for over 2 weeks is required for diagnosis, making them the 2 core symptoms.",
"id": "10002167",
"label": "a",
"name": "Anhedonia",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is indeed a symptom of depression, but not a core criterion in the DSM-5 criteria for major depressive disorder. Feelings of guilt or worthlessness can be used to aid diagnosis alongside the core symptoms.",
"id": "10002170",
"label": "d",
"name": "Feelings of guilt or worthlessness",
"picture": null,
"votes": 7
}
],
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"id": "3971",
"name": "Depression",
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"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
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"topicId": 173,
"totalCards": null,
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"question": "Which of the following is a core criterion within the DSM-5 criteria for major depressive disorder?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,460,637 | false | 37 | null | 6,495,030 | null | false | [] | null | 12,981 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst pH would be low in a partially compensated metabolic acidosis, BE would also be low due to a metabolic cause. The partial compensation here would come from hyperventilation, leading to a reduced PaCO2.",
"id": "10002174",
"label": "c",
"name": "Partially compensated metabolic acidosis",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a low pH would be seen, BE would be low in metabolic acidosis. As there is no respiratory compensation in an uncompensated metabolic acidosis, PaCO2 would be normal.",
"id": "10002176",
"label": "e",
"name": "Uncompensated metabolic acidosis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The low pH here accompanied by high PaCO2 suggests that the high PaCO2 is causing the increased acidity. Therefore this is a respiratory acidosis. Base excess is higher than normal, suggesting that the body is trying to counteract the acidity, making this a partially compensated respiratory acidosis.",
"id": "10002172",
"label": "a",
"name": "Partially compensated respiratory acidosis",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Here, pH would be normal and BE would be low due to a metabolic cause. This would be fully compensated by a low PaCO2.",
"id": "10002175",
"label": "d",
"name": "Fully compensated metabolic acidosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this is a respiratory acidosis (given the high PaCO2 and high BE), it is not fully compensated. In a fully compensated respiratory acidosis pH would be normal.",
"id": "10002173",
"label": "b",
"name": "Fully compensated respiratory acidosis",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"demo": null,
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"id": "4015",
"name": "Causes of respiratory acidosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
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"userNote": null,
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"question": "A patient with suspected acid-base imbalance has an arterial blood gas performed. The results are as follows:\n\npH: 7.31\nPaCO2: 6.8kPa\nBase excess(BE): 3\n\nNormal ranges:\npH: 7.35-7.45\nPaCO2: 4.7-6.4kPa\nBase excess: -2 to 2\n\nWhat acid-base imbalance is this?",
"sbaAnswer": [
"a"
],
"totalVotes": 90,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,638 | false | 38 | null | 6,495,030 | null | false | [] | null | 12,982 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Positive inotropes do not increase the secretion of atrial natriuretic peptide, leading to diuresis and natriuresis. Instead, they directly increase the contractility of the heart, leading to an increase in cardiac output. This is achieved through increasing intracellular calcium concentrations.",
"id": "10002180",
"label": "d",
"name": "Positive inotropes increase the secretion of atrial natriuretic peptide, leading to diuresis and natriuresis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Positive inotropes are drugs that increase the contractility (or force of contraction) of the heart. In cardiogenic shock, the heart is unable to pump blood effectively, leading to reduced cardiac output. By increasing the contractility of the heart, positive inotropes can help to increase cardiac output and improve perfusion to vital organs. Some examples of positive inotropes include dopamine, dobutamine and milrinone.",
"id": "10002177",
"label": "a",
"name": "Positive inotropes increase the contractility of the heart by increasing intracellular calcium levels, leading to an increase in cardiac output",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Positive inotropes do not increase sympathetic tone. Instead, they increase the contractility of the heart, leading to an increase in cardiac output.",
"id": "10002179",
"label": "c",
"name": "Positive inotropes increase sympathetic tone, leading to an increase in heart rate and contractility",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Positive inotropes do not decrease the secretion of renin, leading to decreased activation of the renin-angiotensin-aldosterone system. Instead, they directly increase the contractility of the heart, leading to an increase in cardiac output. This is achieved through increasing intracellular calcium concentrations.",
"id": "10002181",
"label": "e",
"name": "Positive inotropes decrease the secretion of renin, leading to decreased activation of the renin-angiotensin-aldosterone system",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Positive inotropes do not increase the tone of the systemic vasculature. Instead, they increase the contractility of the heart, leading to an increase in cardiac output.",
"id": "10002178",
"label": "b",
"name": "Positive inotropes increase the tone of the systemic arterioles, leading to an increase in systemic vascular resistance",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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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,
"totalCards": null,
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"question": "Inotropes can be used in the treatment of cardiogenic shock in an intensive care setting.\n\nWhich of the following best describes the mechanism of action of positive inotropes?",
"sbaAnswer": [
"a"
],
"totalVotes": 88,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,639 | false | 39 | null | 6,495,030 | null | false | [] | null | 12,983 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Riboflavin (Vitamin B2) is important for overall health and helps to maintain healthy skin, eyes and nervous system. It is not the first-line treatment here.",
"id": "10002186",
"label": "e",
"name": "Riboflavin (Vitamin B2) supplementation",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ascorbic acid (Vitamin C) is important for overall health and immune function. It is not the first-line treatment here.",
"id": "10002184",
"label": "c",
"name": "Ascorbic acid (Vitamin C) supplementation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Niacin (Vitamin B3) is important for overall health and helps to maintain healthy skin and nerves. It is not the first-line treatment here.",
"id": "10002185",
"label": "d",
"name": "Niacin (Vitamin B3) supplementation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Insulin therapy is used to manage high blood sugar levels in diabetes. It is not the first-line treatment here.",
"id": "10002183",
"label": "b",
"name": "Insulin therapy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Thiamine (Vitamin B1) is the first-line treatment for Wernicke's encephalopathy, a neuropsychiatric disorder caused by thiamine deficiency. Thiamine supplementation is given intravenously or intramuscularly to reverse the neurological symptoms of the disease.",
"id": "10002182",
"label": "a",
"name": "Thiamine (Vitamin B1) supplementation",
"picture": null,
"votes": 82
}
],
"comments": [],
"concept": {
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"__typename": "Chapter",
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"demo": null,
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"id": "4016",
"name": "Alcohol abuse",
"status": null,
"topic": {
"__typename": "Topic",
"id": "185",
"name": "Ethics & Law",
"typeId": 7
},
"topicId": 185,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"question": "Alcohol abuse can lead to Wernicke's encephalopathy.\n\nWhat is the first-line treatment for Wernicke's encephalopathy?",
"sbaAnswer": [
"a"
],
"totalVotes": 89,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,640 | false | 40 | null | 6,495,030 | null | false | [] | null | 12,984 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes the mechanism of action of SGLT2 inhibitors such as dapagliflozin. SGLT2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 in the renal proximal convoluted tubule. This reduces glucose reabsorption and increases urinary glucose excretion.",
"id": "10002191",
"label": "e",
"name": "Reduction of glucose reabsorption by the kidneys and increased urinary glucose excretion",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes the mechanism of action of alpha-glucosidase inhibitors such as acarbose.",
"id": "10002189",
"label": "c",
"name": "Slowing of gastric emptying and decreasing carbohydrate absorption",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes the mechanism of action of DPP4-inhibitors such as sitagliptin. Inhibition of the DPP4 enzyme reduces incretin metabolism. Incretins can help stimulate insulin production and reduce glucagon production by the liver, therefore increasing incretin levels by blocking their breakdown is an effective type 2 diabetes treatment.",
"id": "10002190",
"label": "d",
"name": "Inhibition of DPP4, leading to stimulation of insulin production and improved satiety",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes the mechanism of action of metformin, which is a biguanide used commonly in the treatment of type 2 diabetes.",
"id": "10002188",
"label": "b",
"name": "Activation of AMPK in hepatocyte mitochondria which inhibits ATP production and leads to reduced gluconeogenesis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Gliclazide is a sulphonylurea which can be used in the treatment of type 2 diabetes. Sulphonylureas work by binding to SUR1 receptors on ATP-sensitive potassium channels (on beta cells in the pancreas) and stimulating insulin vesicle exocytosis.",
"id": "10002187",
"label": "a",
"name": "Inhibition of the ATP-sensitive potassium channel on pancreatic beta cells, leading to increased insulin secretion",
"picture": null,
"votes": 55
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3761",
"name": "Type 2 Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3761,
"conditions": [],
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"question": "Which of the following best describes the mechanism of action of gliclazide?",
"sbaAnswer": [
"a"
],
"totalVotes": 92,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,641 | false | 41 | null | 6,495,030 | null | false | [] | null | 12,985 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "GABAergic neurons in the globus pallidus play a role in regulating movement and are not primarily affected in Parkinson's disease.",
"id": "10002194",
"label": "c",
"name": "GABAergic neurons in the globus pallidus",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholinergic neurons in the basal forebrain play a role in regulating attention and arousal and are not typically affected in Parkinson's disease",
"id": "10002196",
"label": "e",
"name": "Cholinergic neurons in the basal forebrain",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Dopaminergic neurons in the substantia nigra play a key role in regulating movement and are the primary type of neurons affected in Parkinson's disease. This leads to a reduction in dopamine levels in the brain.",
"id": "10002192",
"label": "a",
"name": "Dopaminergic neurons in the substantia nigra",
"picture": null,
"votes": 94
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholinergic neurons in the nucleus accumbens play a role in regulating pleasure and reward. They are not typically affected by Parkinson's disease.",
"id": "10002195",
"label": "d",
"name": "Cholinergic neurons in the nucleus accumbens",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pyramidal neurons are involved in the regulation of voluntary muscle movement and are found in the cerebral cortex. They do not typically undergo degeneration in Parkinson's disease.",
"id": "10002193",
"label": "b",
"name": "Pyramidal neurons",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3747",
"name": "Parkinson's Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
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"question": "Which of the following neurons primarily undergo degeneration in Parkinson's disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 95,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,642 | false | 42 | null | 6,495,030 | null | false | [] | null | 12,986 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes a transient ischaemic attack or TIA. This involves a temporary reduction in blood flow to the brain, usually as a result of atherosclerosis.",
"id": "10002201",
"label": "e",
"name": "Rapidly developing focal disturbance of brain function which can resolve within 24 hours",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes an intercerebral haemorrhage which occurs due to a bleed within the brain parenchyma. It can occur spontaneously in poorly controlled hypertension and can have fatal effects.",
"id": "10002200",
"label": "d",
"name": "Can occur spontaneously in cases of uncontrolled hypertension. It is a subtype of stroke and can have sudden clinical effects",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes an extradural haemorrhage which is an acute bleed which accumulates between the dura mater and the inner surface of the skull. It is typically a high-pressure arterial bleed and hence leads to immediate clinical effects.",
"id": "10002198",
"label": "b",
"name": "Typically caused by traumatic incidents with immediate clinical effects. Damage usually occurs to arteries",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A subdural haemorrhage is a brain bleed that accumulates within the space between the dura mater and arachnoid mater. It is typically a venous bleed that is low pressure and therefore can lead to delayed clinical effects. For example, a patient may appear well after a head injury but may become unconscious after several hours have passed.",
"id": "10002197",
"label": "a",
"name": "Typically caused by traumatic incidents with delayed clinical effects. Damage usually occurs to veins",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This best describes a subarachnoid haemorrhage which occurs in the subarachnoid space. It is often caused by burst aneurysms and presents clinically as a 'thunderclap headache' which is sudden and severe.",
"id": "10002199",
"label": "c",
"name": "Typically occurs due to ruptured aneurysms and can be seen often at the Circle of Willis",
"picture": null,
"votes": 4
}
],
"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": "4017",
"name": "Subdural haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"qaAnswer": null,
"question": "Which of the following best describes a subdural haemorrhage?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,643 | false | 43 | null | 6,495,030 | null | false | [] | null | 12,987 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium, potassium and chloride ions in the loop of Henle. This leads to increased delivery of these ions to the distal tubule, which results in increased excretion of electrolytes (and by extension water) in the urine.",
"id": "10002202",
"label": "a",
"name": "Blocks the reabsorption of sodium, potassium and chloride ions in the loop of Henle",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of thiazide diuretics, not furosemide.",
"id": "10002204",
"label": "c",
"name": "Inhibits the sodium/chloride co-transporter in the distal convoluted tubule",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of carbonic anhydrase inhibitors, not furosemide.",
"id": "10002205",
"label": "d",
"name": "Inhibition of bicarbonate resorption primarily in the proximal tubule",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of potassium-sparing diuretics, not furosemide.",
"id": "10002203",
"label": "b",
"name": "Increases the excretion of sodium and water whilst preventing the loss of potassium in the urine",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of osmotic diuretics, not furosemide.",
"id": "10002206",
"label": "e",
"name": "Inhibition of water reabsorption in the proximal convoluted tubule, loop of Henle and collecting duct",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4018",
"name": "Furosemide",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
"conceptId": 4018,
"conditions": [],
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"question": "Which of the following best describes the mechanism of action of furosemide?",
"sbaAnswer": [
"a"
],
"totalVotes": 92,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,644 | false | 44 | null | 6,495,030 | null | false | [] | null | 12,988 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This better describes the disease distribution of rheumatoid arthritis. Osteoarthritis typically affects the distal interphalangeal joints of the hands, or the knee and hip joints.",
"id": "10002211",
"label": "e",
"name": "Metacarpophalangeal and proximal interphalangeal joints are most affected",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically a feature of rheumatoid arthritis which causes pain and stiffness in joints for prolonged periods of time, particularly in the morning. In osteoarthritis, morning stiffness usually subsides within an hour of waking.",
"id": "10002209",
"label": "c",
"name": "Morning stiffness lasting more than one hour",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Typically, patients with osteoarthritis experience pain that worsens with increased usage. Conversely, the usage of affected joints in rheumatoid arthritis can actually improve pain symptoms.",
"id": "10002207",
"label": "a",
"name": "Joint pain that worsens with usage",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically a feature of rheumatoid arthritis which affects joints on both sides of the body.",
"id": "10002208",
"label": "b",
"name": "Symmetrical joint involvement",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a diagnostic criterion for rheumatoid arthritis but is not a feature of osteoarthritis.",
"id": "10002210",
"label": "d",
"name": "Positive rheumatoid factor",
"picture": null,
"votes": 0
}
],
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"id": "3976",
"name": "Osteoarthritis",
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"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
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"question": "Which of the following options is most likely to be a feature of osteoarthritis?",
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"a"
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173,460,645 | false | 45 | null | 6,495,030 | null | false | [] | null | 12,989 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE guidelines recommend a proton pump inhibitor such as lansoprazole and two antibacterials, not just one as suggested here. Amoxicillin should be added here as long as the patient is not allergic to penicillin.",
"id": "10002214",
"label": "c",
"name": "Lansoprazole and clarithromycin for 7 days",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE guidelines recommend a proton pump inhibitor such as lansoprazole and two antibacterials, not just one as suggested here. Clarithromycin or metronidazole, for example, could be added to the amoxicillin in this answer choice.",
"id": "10002213",
"label": "b",
"name": "Lansoprazole and amoxicillin for 7 days",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE guidelines suggest triple therapy with a proton pump inhibitor (PPI) and two antibacterials for the treatment of H. Pylori infection. Lansoprazole and amoxicillin can be used, however, 7 days is the recommended treatment course. Furthermore, ranitidine is an H2-receptor antagonist, which would not be used alongside a PPI.",
"id": "10002215",
"label": "d",
"name": "Lansoprazole, ranitidine and amoxicillin for 14 days",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "First-line treatment for H. Pylori usually involves a 7-day triple-therapy regimen involving a proton pump inhibitor (lansoprazole here) and two antibacterials - amoxicillin and clarithromycin.",
"id": "10002212",
"label": "a",
"name": "Lansoprazole, amoxicillin and clarithromycin for 7 days",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the drugs suggested here are all correct, NICE guidelines recommend 7 days of treatment for H. Pylori infection, not 14.\n\n**Need to edit the last five questions**",
"id": "10002216",
"label": "e",
"name": "Lansoprazole, amoxicillin and clarithromycin for 14 days",
"picture": null,
"votes": 31
}
],
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"id": "4019",
"name": "H. Pylori",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
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"question": "Which of the following treatment regimens are used first-line in the treatment of H.\n\nPylori infection?",
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"a"
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173,460,646 | false | 46 | null | 6,495,030 | null | false | [] | null | 12,990 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Mitral regurgitation is the only valvular defect here that can cause a pan-systolic murmur. The murmur occurs due to the backflow of blood through the mitral valve during systole.",
"id": "10002217",
"label": "a",
"name": "Mitral regurgitation",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mitral valve prolapse is a condition in which the mitral valve does not close properly and produces a specific type of murmur called a mid-systolic click-murmur. It is not known to cause a pan-systolic murmur.",
"id": "10002221",
"label": "e",
"name": "Mitral valve prolapse",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic stenosis is a valvular defect that causes a crescendo-decrescendo systolic murmur, also known as an ejection systolic murmur. It does not cause a pan-systolic murmur.",
"id": "10002218",
"label": "b",
"name": "Aortic stenosis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mitral stenosis is a valvular defect that causes a mid-systolic murmur, not a pan-systolic murmur.",
"id": "10002220",
"label": "d",
"name": "Mitral stenosis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tricuspid stenosis is a valvular defect that causes a mid-diastolic murmur at the left lower sternal border.",
"id": "10002219",
"label": "c",
"name": "Tricuspid stenosis",
"picture": null,
"votes": 3
}
],
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"id": "4020",
"name": "Mitral Regurgitation",
"status": null,
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"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
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"a"
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173,460,647 | false | 47 | null | 6,495,030 | null | false | [] | null | 12,991 | {
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it describes a third-degree heart block, also known as complete heart block. P waves and QRS complexes are regular in complete heart block but have no relationship to each other.",
"id": "10002223",
"label": "b",
"name": "With a type of heart block characterised by a complete failure of the electrical impulse to reach the ventricles",
"picture": null,
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{
"__typename": "QuestionChoice",
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"explanation": "This is incorrect as it best describes a Mobitz-type I heart block. This is also a type of second-degree heart block, but here there is variation in PR interval length. It is also known as Wenckebach heart block.\n\n**Please may you rewrite the incorrect answer choices for this question. The question asks for presentations of partial 21-hydroxylase deficiencies but 4 out of the 5 answer choices are on types of heart block. Hence it is too obvious what the correct answer is.**",
"id": "10002226",
"label": "e",
"name": "A type of heart block where gradual prolongation of PR intervals is seen until a QRS complex is dropped",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, as it best describes a first-degree heart block. Here, the PR interval is simply prolonged with no dropped QRS complexes. It is the most benign heart block.",
"id": "10002225",
"label": "d",
"name": "A type of heart block characterised by prolonged PR intervals with a regular rhythm and 1:1 ratio of P waves to QRS complexes",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it best describes a left bundle branch block. It can indicate underlying heart disease, including dilated cardiomyopathy or hypertrophic cardiomyopathy.",
"id": "10002224",
"label": "c",
"name": "A type of heart block characterised by a delay or block in the bundle of His on the left side of the heart",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A patient with partial 21-hydroxylase deficiency has insufficient aldosterone and cortisol due to the reduced conversion of progesterone to 11-deoxycorticosterone and 17-hydroxyprogesterone in the 21-hydroxylase pathway. Overall, this results in reduced aldosterone and cortisol, but there is still enough for survival as it is only a partial deficiency. Furthermore, there is an increase in adrenal testosterone. This is because pre-cursors of aldosterone and cortisol build up in the adrenal glands and are converted to androgens. This results in hirsutism and virilisation in females.",
"id": "10002222",
"label": "a",
"name": "Deficient aldosterone and cortisol but enough to get by. Clinical presentation may include hirsutism and virilisation",
"picture": null,
"votes": 75
}
],
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"id": "3835",
"name": "Adrenal insufficiency and Addison's Disease",
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"id": "133",
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"typeId": 5
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"a"
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173,460,648 | false | 48 | null | 6,495,030 | null | false | [] | null | 12,992 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angiotensin II does not play a direct role in regulating blood glucose levels.",
"id": "10002228",
"label": "b",
"name": "Glucose homeostasis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angiotensin II is responsible for maintaining blood pressure and stimulating aldosterone secretion. Parathyroid hormone is important in calcium homeostasis.",
"id": "10002229",
"label": "c",
"name": "Regulating calcium reabsorption in the kidneys",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angiotensin II promotes water retention, not excretion, by the kidneys.",
"id": "10002231",
"label": "e",
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"picture": null,
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{
"__typename": "QuestionChoice",
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"explanation": "Angiotensin II is a hormone that is part of the renin-angiotensin-aldosterone system (RAAS) and is primarily responsible for increasing blood pressure and stimulating the secretion of aldosterone. When the body detects a decrease in blood pressure or blood volume, the kidney releases renin which converts angiotensinogen into angiotensin I. Angiotensin-converting enzyme (ACE) then converts angiotensin I into angiotensin II which causes vasoconstriction, increased sodium reabsorption, and increased water retention in the kidneys.",
"id": "10002227",
"label": "a",
"name": "Maintaining blood pressure",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angiotensin II is not involved in this process. RAnaemia, ischaemic stress and high altitude can all promote erythropoiesis in the bone marrow. Erythropoiesis is stimulated by erythropoietin.",
"id": "10002230",
"label": "d",
"name": "Stimulating erythropoiesis in the bone marrow",
"picture": null,
"votes": 0
}
],
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"id": "4021",
"name": "Renin-angiotensin-aldosterone system",
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"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
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"question": "What is the primary function of angiotensin II in the body?",
"sbaAnswer": [
"a"
],
"totalVotes": 95,
"typeId": 1,
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173,460,649 | false | 49 | null | 6,495,030 | null | false | [] | null | 12,993 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IL-6 is produced by a variety of cells, including T cells, B cells, macrophages, and fibroblasts, and is involved in a wide range of immune and inflammatory responses. IL-6 stimulates the production of acute-phase proteins by the liver and is involved in the differentiation of T cells and the activation of B cells.",
"id": "10002235",
"label": "d",
"name": "IL-6",
"picture": null,
"votes": 21
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "IL-5 is mainly produced by Th2 cells and is involved in the growth and differentiation of eosinophils, a type of white blood cell that is involved in the immune response to parasites and allergic reactions.",
"id": "10002234",
"label": "c",
"name": "IL-5",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IL-10 is mainly produced by regulatory T-cells and activated macrophages and is involved in downregulating immune responses. IL-10 has anti-inflammatory effects and is involved in inhibiting the production of pro-inflammatory cytokines and the activation of macrophages and dendritic cells.",
"id": "10002236",
"label": "e",
"name": "IL-10",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "IL-11, or interleukin-11, is the interleukin most significantly involved in the attachment phase of implantation. It is released by endometrial cells into the uterine fluid.",
"id": "10002232",
"label": "a",
"name": "IL-11",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IL-4 is mainly produced by T-helper 2 (Th2) cells and mast cells and is involved in stimulating the production of immunoglobulin E (IgE) by B cells, promoting the differentiation of Th2 cells, and inhibiting the differentiation of Th1 cells. IL-4 also has a role in regulating immune responses to parasites.",
"id": "10002233",
"label": "b",
"name": "IL-4",
"picture": null,
"votes": 15
}
],
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"id": "4022",
"name": "Implantation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "187",
"name": "Development & Ageing",
"typeId": 7
},
"topicId": 187,
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"question": "The attachment phase is the first stage of implantation. In this stage, the outer trophoblast cells come into contact with the uterine surface epithelial cells.\n\nWhich interleukin is most significantly involved in the attachment phase of implantation?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
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173,460,650 | false | 50 | null | 6,495,030 | null | false | [] | null | 12,994 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lamotrigine blocks voltage-gated Na+ channels. This prevents the depolarisation of glutamatergic neurones and reduces glutamate neurotoxicity.",
"id": "10002237",
"label": "a",
"name": "It blocks voltage-gated Na+ channels, preventing Na+ influx",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of sodium valproate. Through this mechanism, it increases GABA concentrations in synapses and prolongs GABA action within synapses.",
"id": "10002238",
"label": "b",
"name": "It inhibits GABA transaminase, preventing the breakdown of GABA",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of an SSRI, or selective serotonin reuptake inhibitor. This is not an anti-epileptic drug and is instead used in the treatment of depression.",
"id": "10002241",
"label": "e",
"name": "It inhibits the reuptake of serotonin, thereby increasing serotonin activity",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of diazepam. Here, increased chloride ion influx is associated with the hyperpolarisation of excitatory neurones.",
"id": "10002239",
"label": "c",
"name": "It increases chloride ion influx in response to GABA binding at the GABA A receptor",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of levetiracetam. Levetiracetam inhibits this protein and prevents vesicle exocytosis. A reduction in glutamate secretion reduces glutamate excitotoxicity.",
"id": "10002240",
"label": "d",
"name": "It inhibits the synaptic vesicle protein SV2A",
"picture": null,
"votes": 4
}
],
"comments": [],
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"demo": null,
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"id": "4023",
"name": "Pharmacokinetics of anti-epileptics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
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"topicId": 172,
"totalCards": null,
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"question": "What is the mechanism of action of lamotrigine?",
"sbaAnswer": [
"a"
],
"totalVotes": 88,
"typeId": 1,
"userPoint": null
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173,460,691 | false | 1 | null | 6,495,033 | null | false | [] | null | 12,995 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although glycogenolysis (breakdown of glycogen into glucose molecules) is a function of glucagon, glycogenesis (formation of glycogen from glucose molecules) is a function of insulin.",
"id": "10002244",
"label": "c",
"name": "Glycogenolysis and glycogenesis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Glucagon is a peptide hormone secreted by alpha cells in the pancreas. One of the key functions of glucagon is to increase the concentration of glucose in the blood. The two main methods through which this is achieved are glycogenolysis (breakdown of glycogen into glucose molecules) and gluconeogenesis (conversion of amino acids into glucose).",
"id": "10002242",
"label": "a",
"name": "Glycogenolysis and gluconeogenesis",
"picture": null,
"votes": 326
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glycogenesis (formation of glycogen from glucose molecules) and lipogenesis (formation of triglycerides) are both functions of the hormone insulin.",
"id": "10002243",
"label": "b",
"name": "Glycogenesis and lipogenesis",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although glycogenolysis (breakdown of glycogen into glucose molecules) is a function of glucagon, lipogenesis (formation of triglycerides) is a function of insulin.",
"id": "10002246",
"label": "e",
"name": "Glycogenolysis and lipogenesis",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although gluconeogenesis (conversion of amino acids into glucose molecules) is a function of glucagon, glycogenesis (formation of glycogen from glucose molecules) is a function of insulin.",
"id": "10002245",
"label": "d",
"name": "Glycogenesis and gluconeogenesis",
"picture": null,
"votes": 66
}
],
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"id": "4024",
"name": "Hormonal control of glucose metabolism",
"status": null,
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"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
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"topicId": 167,
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"question": "Which of the following are functions of glucagon in the control of blood glucose?",
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"a"
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173,460,692 | false | 2 | null | 6,495,033 | null | false | [] | null | 12,996 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Oxytocin is a peptide hormone produced by the hypothalamus and secreted into the blood by the posterior pituitary gland. Oxytocin plays a role in social bonding, reproduction and the stimulation of contractions during labour.",
"id": "10002247",
"label": "a",
"name": "Oxytocin",
"picture": null,
"votes": 328
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Follicle-stimulating hormone is secreted by the gonadotropic cells of the anterior pituitary gland. FSH plays a role in growth, pubertal development and the regulation of the menstrual cycle.",
"id": "10002248",
"label": "b",
"name": "Follicle-Stimulating Hormone (FSH)",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prolactin is secreted by lactotrophs in the anterior pituitary gland. Prolactin plays a role in the development of mammary glands within breast tissue, as well as milk production.",
"id": "10002249",
"label": "c",
"name": "Prolactin",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cortisol is a hormone secreted by the zona fasciculata of the adrenal glands, rather than the posterior pituitary gland. Cortisol plays a role in the regulation of the stress response, as well as metabolism.",
"id": "10002251",
"label": "e",
"name": "Cortisol",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Somatotropin (also known as growth hormone) is secreted by the anterior lobe of the pituitary gland. Somatotropin plays a role in height determination, muscle health and bone structure.",
"id": "10002250",
"label": "d",
"name": "Somatotropin",
"picture": null,
"votes": 7
}
],
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"id": "3960",
"name": "Hormones of the posterior pituitary gland",
"status": null,
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"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
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"question": "Which of the following hormones is secreted into the blood by the posterior pituitary gland?",
"sbaAnswer": [
"a"
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"totalVotes": 438,
"typeId": 1,
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173,460,693 | false | 3 | null | 6,495,033 | null | false | [] | null | 12,997 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anti-CCP is an antibody commonly measured to diagnose rheumatoid arthritis. Whilst rheumatoid arthritis sometimes presents with fatigue, it is commonly associated with pain in the small joints and does not usually involve symptoms of increased thirst or areas of hyperpigmentation.",
"id": "10002256",
"label": "e",
"name": "Anti-cyclic citrullinated peptide (anti-CCP)",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The dexamethasone suppression test is used to diagnose Cushing's syndrome, rather than Addison's disease. Cushing's syndrome classically presents with central obesity, abdominal striae and easy bruising.",
"id": "10002253",
"label": "b",
"name": "Dexamethasone suppression test",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although Addison's disease may result in a derangement of electrolytes with hyponatraemia and hyperkalaemia, these electrolyte changes are not specific enough for diagnosis. Instead, the short synacthen test offers a more definitive method of measuring adrenal function and diagnosing Addison's disease.",
"id": "10002255",
"label": "d",
"name": "Urea and electrolytes",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While tiredness and fatigue may be seen in hypothyroidism, the regions of hyperpigmentation and symptom of increased thirst are highly suggestive of Addison's disease. This condition requires a short synacthen test to measure adrenal function, rather than measuring thyroid function.",
"id": "10002254",
"label": "c",
"name": "Thyroid function tests",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of Addison's disease, particularly demonstrated by the areas of hyperpigmentation seen over the buccal mucosa. Addison's disease is a condition in which there is hyposecretion of hormones from the adrenal glands. The gold standard investigation for Addison's disease is the short synacthen test in which synthetic adrenocorticotropic hormone (ACTH) is administered to a patient, and their serum cortisol level is measured afterwards to determine whether their adrenal glands are responding appropriately.",
"id": "10002252",
"label": "a",
"name": "Short synacthen test",
"picture": null,
"votes": 271
}
],
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"id": "3835",
"name": "Adrenal insufficiency and Addison's Disease",
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"id": "133",
"name": "Endocrinology",
"typeId": 5
},
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"question": "A 43-year-old female presents to General Practice with symptoms of fatigue, weakness and increased thirst which have developed over the past 4 months. She mentions that her mood has also been quite low recently, and she is eating a bit less than usual. On examination, she is found to have areas of hyperpigmentation, particularly noticeable over the buccal mucosa.\n\nGiven the most likely diagnosis, what is the gold standard investigation for this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 421,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,694 | false | 4 | null | 6,495,033 | null | false | [] | null | 12,998 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of hypothyroidism, particularly demonstrated by her cold sensitivity and weight gain. The most common cause of hypothyroidism in developed countries is Hashimoto's thyroiditis, which is an autoimmune disease whereby autoantibodies are produced against normal thyroid cells. The main investigations for this condition are thyroid function tests, which classically reveal raised thyroid stimulating hormone (TSH) levels and reduced triiodothyronine/thyroxine (T3/T4) levels.",
"id": "10002257",
"label": "a",
"name": "Hashimoto's thyroiditis",
"picture": null,
"votes": 325
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Toxic multinodular goitre would present with symptoms of hyperthyroidism (weight loss, heat sensitivity, anxiety), as opposed to symptoms of hypothyroidism.",
"id": "10002260",
"label": "d",
"name": "Toxic multinodular goitre",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Graves' disease is the most common cause of hyperthyroidism in developed countries, as opposed to hypothyroidism. This would classically present with weight loss, heat sensitivity and anxiety.",
"id": "10002258",
"label": "b",
"name": "Graves' disease",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroid adenomas commonly present with symptoms of hyperthyroidism (weight loss, heat sensitivity, anxiety), as opposed to symptoms of hypothyroidism. Additionally, thyroid adenomas are usually associated with a non-uniform swelling of the thyroid gland.",
"id": "10002261",
"label": "e",
"name": "Solitary thyroid adenoma",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "De Quervain's thyroiditis commonly presents within a shorter timeframe, usually following a viral infection. Additionally, the condition is usually associated with a painful swelling of the thyroid gland.",
"id": "10002259",
"label": "c",
"name": "De Quervain's thyroiditis",
"picture": null,
"votes": 17
}
],
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"id": "3765",
"name": "Hypothyroidism",
"status": null,
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"id": "133",
"name": "Endocrinology",
"typeId": 5
},
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"question": "A 31-year-old female presents to General Practice with symptoms of fatigue, weakness and cold sensitivity which have developed over the past 4 months. She also mentions that she has gained a significant amount of weight over this time despite eating the same balanced diet. Examination reveals a uniform, non-tender swelling of the thyroid gland.\n\nWhat is the most likely diagnosis for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 416,
"typeId": 1,
"userPoint": null
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173,460,695 | false | 5 | null | 6,495,033 | null | false | [] | null | 12,999 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Follicle-stimulating hormone (FSH) is produced by the anterior pituitary gland, as opposed to the corpus luteum.",
"id": "10002266",
"label": "e",
"name": "Secretion of follicle-stimulating hormone (FSH)",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the corpus luteum may secrete some inhibin A, its primary function is the secretion of progesterone.",
"id": "10002264",
"label": "c",
"name": "Secretion of inhibin A",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The corpus luteum is a group of cells which arise from the remaining follicle after a maturing ovum is released. The main function of the corpus luteum is to secrete progesterone, thereby allowing the uterine wall to become more receptive to a fertilised egg. If pregnancy occurs, the corpus luteum continues secreting progesterone (and other hormones) until approximately week 12 of the pregnancy. If pregnancy does not occur, the corpus luteum breaks down and no longer secretes progesterone.",
"id": "10002262",
"label": "a",
"name": "Secretion of progesterone",
"picture": null,
"votes": 269
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the corpus luteum may secrete some oestrogen, its primary function is the secretion of progesterone.",
"id": "10002263",
"label": "b",
"name": "Secretion of oestrogen",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If pregnancy occurs, the production of human chorionic gonadotrophin (hCG) signals to the corpus luteum to continue secreting progesterone. However, hCG is not produced by the corpus luteum itself.",
"id": "10002265",
"label": "d",
"name": "Secretion of human chorionic gonadotrophin (hCG)",
"picture": null,
"votes": 47
}
],
"comments": [],
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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,
"userNote": null,
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},
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"question": "What is the primary function of the corpus luteum during the menstrual cycle?",
"sbaAnswer": [
"a"
],
"totalVotes": 413,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,696 | false | 6 | null | 6,495,033 | null | false | [] | null | 13,000 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although hypothyroidism may also present with weight gain and irregular periods, the presence of hirsutism points towards a diagnosis of PCOS. Whilst PCOS may sometimes be associated with some derangement in thyroid hormones, serum androgen levels are more specific in confirming the diagnosis.",
"id": "10002270",
"label": "d",
"name": "Thyroid function tests",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms of polycystic ovarian syndrome (PCOS). In PCOS, the follicles which contain maturing eggs are often unable to release an egg, leading to irregular periods and potential infertility. PCOS is associated with high levels of serum androgens (e.g. testosterone), which can lead to hirsutism. Diagnosis of PCOS can be difficult but is often based on measuring serum androgen levels, measuring FSH/LH levels, and performing a transvaginal ultrasound scan to assess the ovaries for the presence of multiple follicles.",
"id": "10002267",
"label": "a",
"name": "Serum androgen levels",
"picture": null,
"votes": 253
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst PCOS may be associated with some derangement in insulin levels, serum androgen levels would be more specific in confirming the diagnosis.",
"id": "10002271",
"label": "e",
"name": "Serum insulin levels",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum hCG levels may be useful for assessing whether a patient is pregnant. However, the presence of hirsutism, as well as the history of infertility, makes a diagnosis of PCOS more likely.",
"id": "10002268",
"label": "b",
"name": "Serum human chorionic gonadotrophin (hCG) levels",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transvaginal ultrasound scans (rather than CT scans) are used to assess the ovaries for multiple follicles in PCOS.",
"id": "10002269",
"label": "c",
"name": "CT scan of ovaries",
"picture": null,
"votes": 125
}
],
"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": "4025",
"name": "PCOS",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4025,
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13000",
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"multiAnswer": null,
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"question": "A 34-year-old female presents to General Practice with irregular periods, weight gain and difficulty conceiving despite trying for over one year. On examination, she is noted to have excessive hair growth around her face and upper back.\n\nWhich of the following investigations would be most useful in confirming this woman's diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 410,
"typeId": 1,
"userPoint": null
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173,460,697 | false | 7 | null | 6,495,033 | null | false | [] | null | 13,001 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Edward's syndrome is a condition in which there is an extra copy of chromosome 18. It classically presents with low birth weight, micrognathia, low-set ears, and rocker-bottom feet, along with abnormal organ development. There is currently no known association between lithium use in pregnancy and Edward's syndrome development in newborns.",
"id": "10002276",
"label": "e",
"name": "Edward's syndrome",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Retinoblastoma is a type of retinal cancer which can often be picked up on newborn examinations if there is an absent red reflex. There is currently no association between lithium use in pregnancy and retinoblastoma development.",
"id": "10002274",
"label": "c",
"name": "Retinoblastoma",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although some studies suggest an association between lithium usage in pregnancy and increased birth weight (macrosomia), there is currently no association between lithium and decreased birth weight (microsomia).",
"id": "10002273",
"label": "b",
"name": "Microsomia",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lithium use during pregnancy has been associated with the development of cardiac malformations (e.g. Ebstein's anomaly) in infants. Women taking lithium during pregnancy should have their serum lithium levels measured regularly, as well as regular thyroid and renal function tests.",
"id": "10002272",
"label": "a",
"name": "Cardiac malformations",
"picture": null,
"votes": 301
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Down's syndrome is a condition in which there is an extra copy of chromosome 21. It typically results in physical changes, such as microcephaly, a flattened face, slanted eyes, and a single palmar crease. There may also be mild to moderate intellectual disability. There is currently no known association between lithium use in pregnancy and Down's syndrome development in newborns.",
"id": "10002275",
"label": "d",
"name": "Down's syndrome",
"picture": null,
"votes": 26
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4026",
"name": "Lithium and pregnancy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
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"question": "Which of the following is a potential complication to a baby if a mother is taking lithium during her pregnancy?",
"sbaAnswer": [
"a"
],
"totalVotes": 404,
"typeId": 1,
"userPoint": null
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173,460,698 | false | 8 | null | 6,495,033 | null | false | [] | null | 13,002 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Delivery of the placenta would be part of the third stage of labour, as opposed to the first stage.",
"id": "10002278",
"label": "b",
"name": "Active contractions forcing delivery of the placenta",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mild, irregular contractions are usually seen in the passive first stage of labour, as opposed to the active first stage in which the contractions are stronger and more regular.",
"id": "10002281",
"label": "e",
"name": "Mild, irregular contractions",
"picture": null,
"votes": 128
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The mucus plug is responsible for blocking the cervical opening during pregnancy. As the cervix begins to open, the mucus plug may appear as clear pink or bloody discharge from the vagina. This usually occurs during the passive first stage of labour, as opposed to the active first stage.",
"id": "10002280",
"label": "d",
"name": "Presence of the mucus plug",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The active first stage of labour involves the cervix dilating from roughly 6 centimetres to 10 centimetres at a rate of approximately 1 centimetre per hour. This is often associated with strong and regular contractions.",
"id": "10002277",
"label": "a",
"name": "Cervical dilatation of 7 centimetres",
"picture": null,
"votes": 215
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Delivery of the baby would be part of the second stage of labour, as opposed to the first stage.",
"id": "10002279",
"label": "c",
"name": "Active contractions forcing the delivery of the baby",
"picture": null,
"votes": 33
}
],
"comments": [],
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"__typename": "Chapter",
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"typeId": 7
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"demo": null,
"entitlement": null,
"id": "4027",
"name": "First stage of labour",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
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},
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"highlights": [],
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"question": "Which of the following would be part of the active first stage of labour?",
"sbaAnswer": [
"a"
],
"totalVotes": 403,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,699 | false | 9 | null | 6,495,033 | null | false | [] | null | 13,003 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bipolar disorder is a condition characterised by phases of elevated mood (mania/hypomania) and phases of depression. Given that this patient has no previous psychiatric history, and that her symptoms started soon after childbirth, a diagnosis of postpartum psychosis is more likely than bipolar disorder.",
"id": "10002285",
"label": "d",
"name": "Bipolar disorder",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Postnatal post-traumatic stress disorder (PTSD) is occasionally seen after particularly traumatic births, such as prolonged labour or emergency deliveries. This can lead to mothers re-experiencing flashbacks of the traumatic birth process, as well as symptoms of postnatal depression. However, postnatal PTSD rarely leads to hallucinations or psychosis, unlike postpartum psychosis.",
"id": "10002286",
"label": "e",
"name": "Postnatal post-traumatic stress disorder",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Baby blues are typically characterised by irritability, mood changes and anxiety in the first week following childbirth. However, it does not present with hallucinations or delusions.",
"id": "10002284",
"label": "c",
"name": "Baby blues",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Postpartum psychosis is a serious mental health illness which can develop in mothers usually within the first 2 weeks after giving birth. It is characterised by hallucinations, delusions, confusion and spontaneous changes in mood. It is important to recognise and treat postpartum psychosis as soon as possible, as there may be a risk to both the mother and the child.",
"id": "10002282",
"label": "a",
"name": "Postpartum psychosis",
"picture": null,
"votes": 387
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Postnatal depression is another condition which may develop in parents following the birth of a child. It is typically characterised by persistent low mood, anhedonia, lack of energy and difficulty sleeping in the weeks or months following labour.",
"id": "10002283",
"label": "b",
"name": "Postnatal depression",
"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": "4028",
"name": "Postpartum psychosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"difficulty": 1,
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"question": "A 30-year-old female on the obstetrics ward is feeling confused after giving birth nearly a week ago. She complains of hearing the other patients on the ward talking about her behind her back, even though all of them deny this. She also accuses the nursing staff of attempting to steal her child. The patient has no previous psychiatric history.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 399,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,700 | false | 10 | null | 6,495,033 | null | false | [] | null | 13,004 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In general, the mesoderm is responsible for giving rise to cardiac muscle cells, smooth muscle cells, red blood cells and urogenital structures.",
"id": "10002289",
"label": "c",
"name": "Mesoderm",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In general, the endoderm is responsible for giving rise to cells of the gastrointestinal tract, respiratory tract, urinary tract and endocrine organs.",
"id": "10002288",
"label": "b",
"name": "Endoderm",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The morula is not a layer of the epiblast. Instead, the morula is the name given to the compacted layer of 8-16 cells formed after a zygote has divided multiple times.",
"id": "10002291",
"label": "e",
"name": "Morula",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "During embryonic development, the epiblast differentiates into three primary germ layers: the ectoderm, mesoderm and endoderm. In general, the ectoderm is responsible for giving rise to neural tissue, epithelial tissue and pigment cells.",
"id": "10002287",
"label": "a",
"name": "Ectoderm",
"picture": null,
"votes": 275
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The hypoblast is not a part of the epiblast. It is responsible for giving rise to the yolk sac, which in turn gives rise to the chorion.",
"id": "10002290",
"label": "d",
"name": "Hypoblast",
"picture": null,
"votes": 8
}
],
"comments": [],
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4029",
"name": "Gastrulation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"question": "During embryonic development, which layer of the epiblast is responsible for producing cells of the skin and nervous system?",
"sbaAnswer": [
"a"
],
"totalVotes": 404,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,701 | false | 11 | null | 6,495,033 | null | false | [] | null | 13,005 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While the dosage is correct in this instance, folic acid should be commenced approximately 4 weeks before planning to become pregnant, rather than waiting for a positive pregnancy test result.",
"id": "10002294",
"label": "c",
"name": "Start taking 5 milligrams of folic acid every day after a positive pregnancy test result",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Folic acid should be commenced approximately 4 weeks before planning to become pregnant, rather than waiting for a positive pregnancy test result. Additionally, this patient requires 5 milligrams of folic acid as she has type 2 diabetes.",
"id": "10002295",
"label": "d",
"name": "Start taking 400 micrograms of folic acid every day after a positive pregnancy test result",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "As this patient has type 2 diabetes, a future child may have a slightly higher risk of developing a neural tube defect. For this reason, 5 milligrams of folic acid (as opposed to 400 micrograms normally), is recommended to be taken from 4 weeks before pregnancy, up until the 12th week of pregnancy.",
"id": "10002292",
"label": "a",
"name": "Take 5 milligrams of folic acid 4 weeks before planning to become pregnant, up until 12 weeks of pregnancy",
"picture": null,
"votes": 192
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In most cases, 400 micrograms of folic acid is recommended to be taken in the weeks before pregnancy, up until the 12th week of pregnancy. However, as this patient has type 2 diabetes, a higher dose of 5 milligrams is recommended to reduce the risk of neural tube defects.",
"id": "10002293",
"label": "b",
"name": "Take 400 micrograms of folic acid 4 weeks before planning to become pregnant, up until 12 weeks of pregnancy",
"picture": null,
"votes": 147
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Folic acid should be recommended in all pregnancies to reduce the risk of neural tube defects in newborns.",
"id": "10002296",
"label": "e",
"name": "No folic acid required",
"picture": null,
"votes": 1
}
],
"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": "4030",
"name": "Fertility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"question": "A 38-year-old female with type 2 diabetes presents to the fertility clinic as she wishes to become pregnant again. She mentions that her previous pregnancy was normal, apart from the baby being born with a larger birth weight than normal.\n\nWhat advice should be given regarding folic acid intake for the mother?",
"sbaAnswer": [
"a"
],
"totalVotes": 399,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,702 | false | 12 | null | 6,495,033 | null | false | [] | null | 13,006 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Menarche refers to the start of the first menstrual period in females, usually occurring at approximately 11-12 years of age.",
"id": "10002301",
"label": "e",
"name": "Menarche",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adrenarche refers to the onset of androgen-dependent body changes, including the development of pubic hair, body odour and acne. Although it may be a sign of puberty, it is usually preceded by an increase in testicular volume in males.",
"id": "10002299",
"label": "c",
"name": "Adrenarche",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pubarche refers to the first development of pubic hair. Although it may be a sign of puberty, it is usually preceded by an increase in testicular volume in males.",
"id": "10002300",
"label": "d",
"name": "Pubarche",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thelarche (the development of breast buds) is the first sign of puberty in females, as opposed to the first sign of puberty in males.",
"id": "10002298",
"label": "b",
"name": "Thelarche",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In males, the first sign of puberty is the enlargement of the scrotum and testes, with testicular volume increasing to greater than 3 millilitres. In females, the first sign of puberty is the development of breast buds (thelarche).",
"id": "10002297",
"label": "a",
"name": "Testicular volume increases to greater than 3 millilitres",
"picture": null,
"votes": 250
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
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"demo": null,
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"id": "4031",
"name": "Tanner staging of puberty",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
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},
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"question": "Which of the following options is usually the first sign of puberty in males?",
"sbaAnswer": [
"a"
],
"totalVotes": 395,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,703 | false | 13 | null | 6,495,033 | null | false | [] | null | 13,007 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of acute coronary syndrome (ACS). As no regions of ST-elevation are seen on the ECG, this man is likely experiencing a non-ST-elevation myocardial infarction (NSTEMI). The most widely used scoring system for NSTEMIs is the GRACE score which takes into account the patient's age, heart rate/blood pressure, cardiac function, renal function, ECG findings and troponin levels to calculate the predicted 6-month mortality. If the GRACE score is greater than 3% (or if the patient is haemodynamically unstable), percutaneous coronary intervention should be the mainstay treatment. If the GRACE score is less than 3%, conservative management may be trialled, usually with ticagrelor in the first instance.",
"id": "10002302",
"label": "a",
"name": "GRACE score",
"picture": null,
"votes": 255
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The CHA₂DS₂-VASc score is used to calculate the stroke risk in patients with atrial fibrillation. It is not useful in calculating the risk of 6-month mortality in patients with NSTEMIs.",
"id": "10002304",
"label": "c",
"name": "CHA₂DS₂-VASc score",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Duke criteria are a set of clinical criteria used to calculate the probability of a patient having infective endocarditis.",
"id": "10002306",
"label": "e",
"name": "Duke criteria",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The HAS-BLED score is used to calculate the one-year risk of major bleeding in patients with atrial fibrillation who are taking anticoagulant therapy.",
"id": "10002305",
"label": "d",
"name": "HAS-BLED score",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Wells score is used to calculate the clinical probability of a patient having a pulmonary embolism. A pulmonary embolism would classically present with pleuritic chest pain, tachycardia and a history of recent physical inactivity. There may also be S1Q3T3 changes on an ECG, meaning a large S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III.",
"id": "10002303",
"label": "b",
"name": "Wells score",
"picture": null,
"votes": 26
}
],
"comments": [],
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},
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"demo": null,
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"id": "3802",
"name": "Myocardial Infarction",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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},
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"difficulty": 1,
"dislikes": 0,
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"id": "13007",
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"question": "A 72-year-old male presents to the Emergency Department with acute onset central crushing chest pain radiating to the left shoulder. He has a past medical history of hypertension, type 2 diabetes and hypercholesterolaemia.\n\nThe patient's observations are currently as follows: heart rate 83 bpm regular, blood pressure 138/78 mmHg, respiratory rate 18 breaths/minute, SpO2 95% on air, temperature 37.5 degrees Celsius.\n\nAn ECG is performed which reveals no regions of ST-elevation, although there is some T-wave inversion seen in leads I and avL.\n\nGiven the most likely diagnosis, which of the following scoring systems should be used to help determine the management plan?",
"sbaAnswer": [
"a"
],
"totalVotes": 391,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,704 | false | 14 | null | 6,495,033 | null | false | [] | null | 13,008 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Indapamide is an example of a thiazide-like diuretic. These diuretics are generally indicated as second or third-line treatments for hypertension if previous medications have proven to be ineffective at sufficiently reducing blood pressure.",
"id": "10002309",
"label": "c",
"name": "Indapamide",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Candesartan is an example of an angiotensin receptor blocker (ARB). This (or an ACE inhibitor) would be the recommended first-line treatment option for patients under 55 years of age and of non-Afro-Caribbean origin.",
"id": "10002310",
"label": "d",
"name": "Candesartan",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "As this patient is over the age of 55, a calcium channel blocker is indicated as the first-line treatment for his essential hypertension. Amlodipine is an example of a dihydropyridine calcium channel blocker.",
"id": "10002307",
"label": "a",
"name": "Amlodipine",
"picture": null,
"votes": 305
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an ACE inhibitor and would be the recommended first-line treatment option if the patient was under 55 years of age and of non-Afro-Caribbean origin.",
"id": "10002308",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spironolactone is an aldosterone antagonist which is considered in later stages of hypertension if other medications have proven to be ineffective at sufficiently reducing blood pressure.",
"id": "10002311",
"label": "e",
"name": "Spironolactone",
"picture": null,
"votes": 0
}
],
"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": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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},
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"dislikes": 0,
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"id": "13008",
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"question": "A 58-year-old caucasian male presents to General Practice following a recent diagnosis of hypertension. Ambulatory blood pressure monitoring (ABPM) reveals a blood pressure of 158/94 mmHg. The patient has no other past medical history and is currently not taking any medication.\n\nWhich of the following antihypertensive medications should be offered first-line in this case?",
"sbaAnswer": [
"a"
],
"totalVotes": 395,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,705 | false | 15 | null | 6,495,033 | null | false | [] | null | 13,009 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac tamponade characteristically presents with a triad of hypotension, muffled heart sounds and a raised JVP. Additionally, the ECG would typically show electrical alternans (variation in the height of QRS complexes).",
"id": "10002315",
"label": "d",
"name": "Cardiac tamponade",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms suggestive of Dressler syndrome, particularly given the history of myocardial infarction 3 weeks ago. Dressler's syndrome is a type of pericarditis which is thought to be immune-mediated, whereby antibodies are produced against damaged cardiomyocytes. This results in inflammation and symptoms of chest pain.",
"id": "10002312",
"label": "a",
"name": "Dressler syndrome",
"picture": null,
"votes": 269
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a ventricular septal defect is a potential complication following myocardial infarction, it usually presents as acute heart failure with a pan-systolic murmur.",
"id": "10002316",
"label": "e",
"name": "Ventricular septal defect",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Infective endocarditis would classically present with a fever and the presence of a new murmur on cardiovascular examination.",
"id": "10002313",
"label": "b",
"name": "Infective endocarditis",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although it is possible for patients to experience another myocardial infarction following a previous one, the ECG shows widespread ST-elevation (as opposed to ST-elevation in specific leads), which is more suggestive of Dressler syndrome.",
"id": "10002314",
"label": "c",
"name": "Myocardial infarction",
"picture": null,
"votes": 53
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3708",
"name": "Pericarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"userNote": null,
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},
"conceptId": 3708,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13009",
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"likes": 1,
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"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1682080538,
"id": "1510",
"index": 0,
"name": "Pericarditis10.jpeg",
"overlayPath": null,
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"path": "images/2zx8ymby1682080564436.jpg",
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"thumbhash": "IzgGA4AneHh/h4eIDXykgDY=",
"topic": {
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"id": "134",
"name": "Cardiology",
"typeId": 7
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"topicId": 134,
"updatedAt": 1708373886
}
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"question": "A 67-year-old male presents to the Emergency Department complaining of chest pain. He recently suffered a myocardial infarction 3 weeks ago and had previously been well until today. He has a past medical history of hypertension and hypercholesterolaemia. His current medications include aspirin, clopidogrel, ramipril, bisoprolol and atorvastatin.\n\nThe patient's observations are as follows: heart rate 78 bpm regular, blood pressure 135/78 mmHg, respiratory rate 16 breaths/minute, SpO2 97% on air, temperature 37.6 degrees Celsius. Cardiovascular examination reveals normal I and II heart sounds, with no added sounds.\n\nAn ECG is conducted and is shown below:\n\n[lightgallery]\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 384,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,706 | false | 16 | null | 6,495,033 | null | false | [] | null | 13,010 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transcatheter aortic valve insertion is one of the definitive management options for patients presenting with aortic stenosis. This would classically present with an ejection systolic murmur, dyspnoea on exertion, as well as angina symptoms.",
"id": "10002319",
"label": "c",
"name": "Transcatheter aortic valve insertion (TAVI)",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms suggestive of cardiac tamponade, particularly given the triad of muffled heart sounds, raised JVP and hypotension. Cardiac tamponade involves blood (or other fluid) accumulating in the pericardial space leading to reduced ventricular filling and reduced cardiac output. The emergency management for cardiac tamponade is pericardiocentesis, in which a needle is inserted into the pericardial space under ultrasound guidance to drain the excess fluid.",
"id": "10002317",
"label": "a",
"name": "Pericardiocentesis",
"picture": null,
"votes": 295
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Balloon angioplasty involves a balloon being used to stretch open a narrowed coronary artery. This may be performed to improve coronary blood flow in patients with severe angina.",
"id": "10002320",
"label": "d",
"name": "Balloon angioplasty",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Percutaneous coronary intervention would be the definitive management for ST-elevation myocardial infarction (STEMI), as opposed to cardiac tamponade.",
"id": "10002318",
"label": "b",
"name": "Percutaneous coronary intervention (PCI)",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An endovascular aneurysm repair is a treatment option for abdominal aortic aneurysms (AAA), as opposed to cardiac tamponade. AAAs would typically present with hypotension, severe abdominal pain and a pulsatile abdominal mass.",
"id": "10002321",
"label": "e",
"name": "Endovascular aneurysm repair (EVAR)",
"picture": null,
"votes": 9
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4032",
"name": "Emergency Management of Cardiac Tamponade",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "A 64-year-old male presents to the Emergency Department complaining of severe chest pain. He has a past medical history of myocardial infarction, hypertension and hypercholesterolaemia. His current medications include aspirin, clopidogrel, ramipril, bisoprolol and atorvastatin.\n\nThe patient's observations are as follows: heart rate 112 bpm regular, blood pressure 88/62 mmHg, respiratory rate 18 breaths/minute, SpO2 94% on air, temperature 37.6 degrees Celsius. Cardiovascular examination reveals muffled heart sounds and raised jugular venous pressure (JVP).\n\nGiven the most likely diagnosis, what is the definitive emergency management for this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 385,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,707 | false | 17 | null | 6,495,033 | null | false | [] | null | 13,011 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism.",
"id": "10002324",
"label": "c",
"name": "Oral warfarin for 3 months",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms suggestive of pulmonary embolism, particularly given her pleuritic chest pain, the recent long-haul flight and concurrent COCP use. A pulmonary embolism involves a blood clot (usually from a deep vein thrombosis) clogging up an artery in the lungs, resulting in impeded blood flow. The mainstay management of a pulmonary embolism with an obvious trigger (in this case, the history of recent travel) is to offer a direct oral anticoagulant (DOAC), such as oral apixaban, for 3 months.",
"id": "10002322",
"label": "a",
"name": "Oral apixaban for 3 months",
"picture": null,
"votes": 215
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although oral apixaban is the mainstay treatment for pulmonary emboli, it should only be offered for 3 months as this patient had a provoked pulmonary embolism (triggered by her recent air travel). However, if there was no obvious trigger behind her pulmonary embolus, oral apixaban would need to be given for 6 months.",
"id": "10002323",
"label": "b",
"name": "Oral apixaban for 6 months",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism.",
"id": "10002325",
"label": "d",
"name": "Oral warfarin for 6 months",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism, rather than low molecular weight heparin.",
"id": "10002326",
"label": "e",
"name": "Subcutaneous low molecular weight heparin for 6 months",
"picture": null,
"votes": 32
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3724",
"name": "Pulmonary Embolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"question": "A 34-year-old female presents to the Emergency Department complaining of chest pain which is worse when breathing in. She recently travelled abroad and mentions that her left leg felt quite sore when she arrived back in the UK. The patient has no relevant past medical history and is currently taking the combined oral contraceptive pill (COCP) for contraception.\n\nThe patient's observations are as follows: heart rate 112 bpm regular, blood pressure 130/92 mmHg, respiratory rate 21 breaths/minute, SpO2 96% on air, temperature 37.6 degrees Celsius. Respiratory examination appears normal.\n\nGiven the most likely diagnosis, what is the most appropriate treatment option for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 384,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,708 | false | 18 | null | 6,495,033 | null | false | [] | null | 13,012 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adding a long-acting beta-agonist would be a later management step if his asthma symptoms did not improve. A low-dose inhaled corticosteroid should be trialled before this.",
"id": "10002329",
"label": "c",
"name": "Add a long-acting beta-agonist",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs of worsening asthma. According to British Thoracic Society guidelines, the next best medical management, in this case, would be to add an inhaled corticosteroid medication alongside his salbutamol inhaler.",
"id": "10002327",
"label": "a",
"name": "Add low-dose inhaled corticosteroid",
"picture": null,
"votes": 332
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient is already on salbutamol when required, there is likely to be no additional effect of adding another short-acting beta agonist. Instead, a low-dose inhaled corticosteroid should be trialled to see if symptoms improve.",
"id": "10002331",
"label": "e",
"name": "Add a short-acting beta agonist",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adding an LTRA medication would be the third step in the management of uncontrolled asthma. A low-dose inhaled corticosteroid should be trialled before this to see if it improves symptoms.",
"id": "10002328",
"label": "b",
"name": "Add a leukotriene receptor antagonist (LTRA)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Theophylline is a bronchodilator which is used in later stages of asthma, as opposed to low-dose inhaled corticosteroids which are usually used second-line.",
"id": "10002330",
"label": "d",
"name": "Add theophylline",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4033",
"name": "Treatment options for asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "189",
"name": "Respiratory Pharmacology",
"typeId": 7
},
"topicId": 189,
"totalCards": null,
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},
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"question": "A 15-year-old male presents to the respiratory clinic with worsening symptoms of asthma. He mentions that he often feels breathless, especially in cold weather or when about to fall asleep at night. He has found that he is taking his salbutamol inhaler more often than usual. Aside from asthma, his past medical history includes eczema and hay fever. He is currently taking no other medications apart from salbutamol when required.\n\nWhat is the next best step in the medical management of this patient's asthma?",
"sbaAnswer": [
"a"
],
"totalVotes": 383,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,709 | false | 19 | null | 6,495,033 | null | false | [] | null | 13,013 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the FEV1 is reduced and the FVC is increased, the FEV1:FVC ratio would be expected to be < 0.7, as opposed to > 0.7.",
"id": "10002334",
"label": "c",
"name": "Reduced FEV1, increased FVC, FEV1:FVC ratio > 0.7",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The FEV1 is reduced in COPD due to inflammation of the airways, rather than being increased.",
"id": "10002336",
"label": "e",
"name": "Increased FEV1, increased FVC, FEV1:FVC ratio < 0.7",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The FEV1 is reduced in COPD due to inflammation of the airways, resulting in a decreased FEV1:FVC ratio.",
"id": "10002335",
"label": "d",
"name": "Increased FEV1, reduced FVC, FEV1:FVC ratio > 0.7",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms of chronic obstructive pulmonary disorder (COPD), as characterised by his extensive smoking history. As COPD is an obstructive respiratory condition, it results in a reduced forced expiratory volume (FEV1) as the airway inflammation allows less air to be exhaled in one second. However, the forced vital capacity (FVC) remains normal, which leads to a reduced FEV1:FVC ratio.",
"id": "10002332",
"label": "a",
"name": "Reduced FEV1, normal FVC, FEV1:FVC ratio < 0.7",
"picture": null,
"votes": 292
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These spirometry results are more likely to be seen in restrictive respiratory conditions, as opposed to COPD.",
"id": "10002333",
"label": "b",
"name": "Reduced FEV1, reduced FVC, FEV1:FVC ratio > 0.7",
"picture": null,
"votes": 47
}
],
"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": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"question": "A 68-year-old male presents to the respiratory clinic with symptoms of breathlessness and a persistent cough. He mentions that his breathlessness is usually apparent on exertion, but he does feel quite breathless at night as well. The patient has a past medical history of type 2 diabetes and hypercholesterolaemia, for which he takes metformin and atorvastatin respectively. He has a smoking history of 25 cigarettes per day for approximately 40 years.\n\nGiven the most likely diagnosis, what would be the most likely spirometry findings in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 381,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,710 | false | 20 | null | 6,495,033 | null | false | [] | null | 13,014 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Given the low FEV1 and reduced FEV1:FVC ratio, this patient is presenting with an obstructive lung disease picture. The history of recurrent respiratory infections and lack of extensive smoking history leads more towards a diagnosis of bronchiectasis. This is a condition in which the airways widen, leading to the accumulation of mucus which can result in breathlessness, cough and infections.",
"id": "10002337",
"label": "a",
"name": "Bronchiectasis",
"picture": null,
"votes": 165
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sarcoidosis is a restrictive lung disorder, as opposed to an obstructive lung disorder. It would therefore classically present with a FEV1:FVC ratio > 0.7.",
"id": "10002340",
"label": "d",
"name": "Sarcoidosis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary fibrosis is a restrictive lung disorder, as opposed to an obstructive lung disorder. It would therefore classically present with a FEV1:FVC ratio > 0.7.",
"id": "10002339",
"label": "c",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "COPD would typically present with a more extensive smoking history. Additionally, the spirometry results would not show the same level of reversibility after bronchodilator use in COPD.",
"id": "10002338",
"label": "b",
"name": "Chronic obstructive pulmonary disorder (COPD)",
"picture": null,
"votes": 186
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Asbestosis is a restrictive lung disorder, as opposed to an obstructive lung disorder. It would therefore classically present with a FEV1:FVC ratio > 0.7.",
"id": "10002341",
"label": "e",
"name": "Asbestosis",
"picture": null,
"votes": 4
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3726",
"name": "Spirometry",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
"conceptId": 3726,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13014",
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"question": "A 50-year-old male presents to the respiratory clinic with symptoms of breathlessness and a persistent cough. His past medical history includes recurrent respiratory infections, but he takes no regular medications. He started smoking 10 cigarettes per day 2 years ago.\n\nSpirometry is conducted for the patient and the results are shown below:\n\nForced expiratory volume (FEV1) pre-bronchodilator = 3.0 litres\n\nForced expiratory volume (FEV1) post-bronchodilator = 3.4 litres\n\nForced vital capacity = 4.8 litres\n\nInitial FEV1:FVC ratio = 0.63\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 380,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,711 | false | 21 | null | 6,495,033 | null | false | [] | null | 13,015 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst hypoglycaemia may be a cause for collapse, the patient's bradypnea and pinpoint pupils are more suggestive of an opioid overdose.",
"id": "10002345",
"label": "d",
"name": "Intramuscular glucagon",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intravenous flumazenil is used to reverse benzodiazepine overdoses, rather than opioid overdoses.",
"id": "10002346",
"label": "e",
"name": "Intravenous flumazenil",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intramuscular adrenaline should be administered in patients presenting with signs of anaphylactic shock, as opposed to signs of opioid overdose.",
"id": "10002344",
"label": "c",
"name": "Intramuscular adrenaline",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs characteristic of an opioid overdose, especially given the bradypnea and pinpoint pupils. The definitive management for opioid toxicity is to administer intramuscular (or intranasal) naloxone to reverse the effects of the opiates.",
"id": "10002342",
"label": "a",
"name": "Intramuscular naloxone",
"picture": null,
"votes": 311
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intravenous atropine can be considered in patients presenting with severe bradycardia, as opposed to opioid overdoses.",
"id": "10002343",
"label": "b",
"name": "Intravenous atropine",
"picture": null,
"votes": 15
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4034",
"name": "Opioid toxicity",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "13015",
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"question": "A 34-year-old male is found unconscious outside of the hospital. He has a normal pulse rate of 98 bpm but appears to be breathing very slowly (respiratory rate 6 breaths/minute). He is also noticed to have pinpoint pupils.\n\nGiven the most likely diagnosis, which treatment should be offered first-line to this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 382,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,712 | false | 22 | null | 6,495,033 | null | false | [] | null | 13,016 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute interstitial nephritis would typically present with a fever or a rash alongside signs of acute kidney injury. Additionally, brown granular casts are quite specific for acute tubular necrosis.",
"id": "10002348",
"label": "b",
"name": "Acute interstitial nephritis",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst renal artery stenosis may lead to pre-renal acute kidney injury, the presence of brown granular casts in the urine is more suggestive of acute tubular necrosis secondary to gentamicin use.",
"id": "10002351",
"label": "e",
"name": "Renal artery stenosis",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst ureteric obstruction may lead to post-renal acute kidney injury, the presence of brown granular casts in the urine is more suggestive of acute tubular necrosis secondary to gentamicin use.",
"id": "10002350",
"label": "d",
"name": "Ureteric obstruction",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute glomerulonephritis would classically present with protein or blood in the urine alongside other signs of acute kidney injury (e.g. peripheral oedema). The presence of brown granular casts in the urine is more specific for acute tubular necrosis.",
"id": "10002349",
"label": "c",
"name": "Acute glomerulonephritis",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs characteristic of acute kidney injury, given the rise in serum creatinine over a short period of time. This is most likely to have been triggered by gentamicin, which can be nephrotoxic. The presence of brown granular casts in the urine indicates that this is most likely to be acute tubular necrosis, as opposed to other causes of acute kidney injury.",
"id": "10002347",
"label": "a",
"name": "Acute tubular necrosis",
"picture": null,
"votes": 269
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"name": "Acute Kidney Injury",
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"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
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"question": "An 84-year-old female is admitted to the hospital with signs and symptoms of sepsis. She has a past medical history of hypertension and hypercholesterolaemia for which she is taking amlodipine, candesartan and atorvastatin. She is started on IV 0.9% sodium chloride and IV gentamicin for sepsis. Two days after being admitted, the patient's serum creatinine rises from 82 micromol/l to 170 micromol/l (normal range 60-120 micromol/L). Her urine is examined under microscopy and is found to contain brown granular casts.\n\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 378,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,713 | false | 23 | null | 6,495,033 | null | false | [] | null | 13,017 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Naproxen is another NSAID medication and could further impair this patient's renal function. It is better to stop ibuprofen entirely than to switch it to naproxen.",
"id": "10002355",
"label": "d",
"name": "Switch ibuprofen to naproxen",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs characteristic of an acute kidney injury (AKI), given the rise in serum creatinine over a short period of time, as well as the oliguria. One of the key steps in managing acute kidney injury is to stop any nephrotoxic medications. Non-steroidal anti-inflammatory agents like ibuprofen can contribute towards AKIs and should therefore be stopped in this patient.",
"id": "10002352",
"label": "a",
"name": "Stop ibuprofen",
"picture": null,
"votes": 259
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statins are less likely to be nephrotoxic and therefore are not usually stopped in acute kidney injury.",
"id": "10002353",
"label": "b",
"name": "Stop atorvastatin",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dialysis would be considered in refractory cases of acute kidney injury where other treatment options have failed. The first step in this scenario is to stop any nephrotoxic medications.",
"id": "10002354",
"label": "c",
"name": "Start dialysis",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statins are less likely to be nephrotoxic and therefore are not usually stopped in acute kidney injury.",
"id": "10002356",
"label": "e",
"name": "Switch atorvastatin to ezetimibe",
"picture": null,
"votes": 21
}
],
"comments": [],
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"name": "Acute Kidney Injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
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"question": "A 76-year-old male is admitted to the hospital following a fractured neck of femur. He has a past medical history of osteoarthritis and hypercholesterolaemia for which he is taking ibuprofen and atorvastatin. Two days after being admitted, the patient's serum creatinine rises from 74 micromol/l to 165 micromol/l (normal range 60-120 micromol/l). He also develops peripheral oedema and is passing less urine than usual.\n\n\nWhich of the following management steps should be considered first?",
"sbaAnswer": [
"a"
],
"totalVotes": 377,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,714 | false | 24 | null | 6,495,033 | null | false | [] | null | 13,018 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs characteristic of a right-sided ischaemic stroke, which is confirmed by the region of hypodensity present on the CT scan. If a patient presents within 4.5 hours of stroke symptom onset, IV alteplase should be started as soon as possible for thrombolysis, assuming there are no contraindications.",
"id": "10002357",
"label": "a",
"name": "Intravenous alteplase",
"picture": null,
"votes": 220
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "For ischaemic strokes, intravenous alteplase is the preferred agent for thrombolysis, rather than intravenous apixaban. Apixaban also only comes in oral form.",
"id": "10002359",
"label": "c",
"name": "Intravenous apixaban",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a mechanical thrombectomy may be considered in patients presenting late with ischaemic stroke, this patient has presented within the 4.5-hour threshold and is therefore a candidate for IV alteplase thrombolysis first.",
"id": "10002361",
"label": "e",
"name": "Mechanical thrombectomy",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "For ischaemic strokes, intravenous alteplase is the preferred agent for thrombolysis, rather than intravenous warfarin.",
"id": "10002358",
"label": "b",
"name": "Intravenous warfarin",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Blood pressure control is a part of the management of haemorrhagic strokes, as opposed to ischaemic strokes.",
"id": "10002360",
"label": "d",
"name": "Intravenous bisoprolol",
"picture": null,
"votes": 13
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3743",
"name": "Ischaemic Stroke",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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"question": "A 77-year-old male presents to A&E with left-sided hemiparesis, left-sided facial paralysis and slurred speech which started 3 hours ago. He has a past medical history of hypertension and type 2 diabetes for which he is taking amlodipine and metformin. A CT scan is performed which reveals a region of hypodensity over the right frontal lobe.\n\nGiven the most likely diagnosis, which of the following treatment options is most likely to be considered?",
"sbaAnswer": [
"a"
],
"totalVotes": 375,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,715 | false | 25 | null | 6,495,033 | null | false | [] | null | 13,019 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Listeria monocytogenes* commonly causes meningitis in infants aged between 0-3 months and occasionally in adults older than 60 years of age.",
"id": "10002365",
"label": "d",
"name": "*Listeria monocytogenes*",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Escherichia coli* typically causes meningitis in infants aged between 0-3 months, as opposed to children beyond the age of 1 year.",
"id": "10002364",
"label": "c",
"name": "*Escherichia coli*",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of meningitis, given the triad of fever, headache and neck stiffness. The most likely causative organism of meningitis between the ages of 3 months to 6 years is *Neisseria meningitidis*, which is a gram-negative diplococci bacterium.",
"id": "10002362",
"label": "a",
"name": "*Neisseria meningitidis*",
"picture": null,
"votes": 321
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although *Haemophilus influenzae* can lead to meningitis in children between 3 months and 1 year of age, *Neisseria meningitidis* is far more common in this age range.",
"id": "10002366",
"label": "e",
"name": "*Haemophilus influenzae*",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Group B streptococcus* is the most common cause of bacterial meningitis in neonates, rather than in children beyond the age of 1 year.",
"id": "10002363",
"label": "b",
"name": "*Group B streptococcus*",
"picture": null,
"votes": 31
}
],
"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": "3751",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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},
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"question": "A 5-year-old male child presents to A&E with a headache and neck stiffness. His temperature is measured to be 39.1 degrees Celsius.\n\nGiven the most likely diagnosis, which of the following organisms is most likely to be present?",
"sbaAnswer": [
"a"
],
"totalVotes": 385,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,716 | false | 26 | null | 6,495,033 | null | false | [] | null | 13,020 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "100 micrograms of intramuscular adrenaline may be considered for anaphylaxis in individuals less than 6 months of age.",
"id": "10002370",
"label": "d",
"name": "100 micrograms of intramuscular adrenaline",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intravenous adrenaline should only be considered if no improvement is seen after 2 doses of intramuscular adrenaline. Expert help should be sought before starting IV adrenaline infusions for anaphylaxis.",
"id": "10002371",
"label": "e",
"name": "250 micrograms of intravenous adrenaline",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of anaphylaxis, as demonstrated by the stridor and urticarial rash which started shortly after an external stimulus. The first-line treatment for individuals above the age of 12 years with anaphylaxis is to administer 500 micrograms of intramuscular adrenaline, usually via an EpiPen. Adrenaline can be repeated every 5 minutes, but expert help should be sought if symptoms do not improve after 2 doses.",
"id": "10002367",
"label": "a",
"name": "500 micrograms of intramuscular adrenaline",
"picture": null,
"votes": 174
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "300 micrograms of intramuscular adrenaline would be the first-line treatment for anaphylaxis in individuals between 6-12 years of age.",
"id": "10002368",
"label": "b",
"name": "300 micrograms of intramuscular adrenaline",
"picture": null,
"votes": 113
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "150 micrograms of intramuscular adrenaline would be the first-line treatment for anaphylaxis in individuals between 6 months and 6 years of age.",
"id": "10002369",
"label": "c",
"name": "150 micrograms of intramuscular adrenaline",
"picture": null,
"votes": 42
}
],
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"demo": null,
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"id": "3945",
"name": "Emergency Management of Anaphylaxis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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},
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"question": "A 14-year-old male is assessed by an ambulance team. He has stridor, wheeze, and a widespread urticarial rash. His mother states that his symptoms started after he was stung by a wasp.\n\nGiven the most likely diagnosis, which treatment option should be offered first?",
"sbaAnswer": [
"a"
],
"totalVotes": 377,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,717 | false | 27 | null | 6,495,033 | null | false | [] | null | 13,021 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypovolaemic shock would typically present with a history of trauma or blood loss, as opposed to a worsening pneumonia.",
"id": "10002373",
"label": "b",
"name": "Hypovolaemic shock",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although anaphylactic shock is a type of distributive shock, it would typically present with sudden onset stridor, wheezing and an urticarial rash.",
"id": "10002375",
"label": "d",
"name": "Anaphylactic shock",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has signs and symptoms characteristic of sepsis, as demonstrated by the fever, hypotension and tachycardia. Sepsis is a form of distributive shock, whereby systemic vasodilation leads to inadequate tissue perfusion and associated end-organ damage.",
"id": "10002372",
"label": "a",
"name": "Distributive shock",
"picture": null,
"votes": 137
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although neurogenic shock is a type of distributive shock, it is usually secondary to a spinal cord transection. This would typically present with bradycardia and hypotension, rather than tachycardia.",
"id": "10002376",
"label": "e",
"name": "Neurogenic shock",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiogenic shock would typically present with a weak pulse, hypotension and tachypnea on a background of myocardial ischaemia.",
"id": "10002374",
"label": "c",
"name": "Cardiogenic shock",
"picture": null,
"votes": 49
}
],
"comments": [],
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"typeId": 7
},
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"demo": null,
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"id": "4035",
"name": "Sepsis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
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},
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"dislikes": 0,
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"question": "A 75-year-old male on the respiratory ward develops shortness of breath and fever. He was initially diagnosed with pneumonia and started on IV amoxicillin, but his symptoms are continuing to worsen.\n\nThe patient's observations are currently as follows: heart rate 112 bpm regular, blood pressure 88/54 mmHg, respiratory rate 26 breaths/minute, SpO2 94% on 15-litre oxygen, temperature 39.1 degrees Celsius.\n\nWhich type of shock does this patient have?",
"sbaAnswer": [
"a"
],
"totalVotes": 373,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,718 | false | 28 | null | 6,495,033 | null | false | [] | null | 13,022 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of gout. Whilst both NSAIDs and colchicine may be considered first-line in gout, this patient has a history of peptic ulcer disease which could worsen through NSAID use. Therefore, colchicine should be trialled first.",
"id": "10002377",
"label": "a",
"name": "Colchicine",
"picture": null,
"votes": 213
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ibuprofen is an NSAID which could potentially cause/worsen peptic ulcers given the patient's history of peptic ulcer disease.",
"id": "10002378",
"label": "b",
"name": "Ibuprofen",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Naproxen is an NSAID which could potentially cause/worsen peptic ulcers, given the patient's history of peptic ulcer disease.",
"id": "10002379",
"label": "c",
"name": "Naproxen",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although allopurinol is used as a urate-lowering therapy after gout, it should not be started until 2 weeks after an acute attack.",
"id": "10002380",
"label": "d",
"name": "Allopurinol",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral steroids may be considered in patients with gout if NSAIDs and colchicine are both contraindicated. However, in this case, there are no contraindications to colchicine use.",
"id": "10002381",
"label": "e",
"name": "Prednisolone",
"picture": null,
"votes": 43
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3768",
"name": "Gout",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3768,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13022",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "A 65-year-old male presents to General Practice with a painful swelling of the first metatarsophalangeal joint. The patient mentions that this started yesterday and has become very painful, limiting the movement of the joint. He has a past medical history of peptic ulcer disease but does not currently take any medication. He does not have any allergies.\n\nWhich of the following medications should be considered first in the acute management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 378,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,719 | false | 29 | null | 6,495,033 | null | false | [] | null | 13,023 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Plain x-ray of the sacroiliac joints is the preferred method for diagnosing ankylosing spondylitis, as opposed to ultrasound scans which may not provide enough detail.",
"id": "10002385",
"label": "d",
"name": "Ultrasound of sacroiliac joints",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "MRI spine may be considered in patients with suspected ankylosing spondylitis who show no signs of the disease on plain x-ray of the sacroiliac joints.",
"id": "10002384",
"label": "c",
"name": "MRI spine",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs and symptoms characteristic of ankylosing spondylitis, given his back pain of insidious onset. A plain x-ray of the sacroiliac joints is the first imaging modality that should be performed to confirm the diagnosis. Signs of ankylosing spondylitis on x-ray include sacroiliitis, subchondral erosions, sclerosis, squaring of the lumbar vertebrae and syndesmophytes.",
"id": "10002382",
"label": "a",
"name": "Plain x-ray of sacroiliac joints",
"picture": null,
"votes": 227
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to NICE guidelines, there is currently no role for CT scans in the diagnosis of ankylosing spondylitis.",
"id": "10002386",
"label": "e",
"name": "Non-contrast CT scan of sacroiliac joints",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to NICE guidelines, there is currently no role for CT scans in the diagnosis of ankylosing spondylitis.",
"id": "10002383",
"label": "b",
"name": "Contrast CT scan of sacroiliac joints",
"picture": null,
"votes": 48
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3911",
"name": "ankylosing spondylitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
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"question": "A 28-year-old male presents to General Practice with worsening back pain and tiredness. His symptoms started a few months ago and appear to be worst in the morning, often improving with exercise.\n\nWhich of the following investigations should be considered first-line to confirm the most likely diagnosis?",
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173,460,720 | false | 30 | null | 6,495,033 | null | false | [] | null | 13,024 | {
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{
"__typename": "QuestionChoice",
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"explanation": "Sjogren's syndrome is an autoimmune disorder which is typically characterised by dry eyes and dry mouth.",
"id": "10002391",
"label": "e",
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"explanation": "Osteoarthritis usually affects large weight-bearing joints (hip/knee), as opposed to smaller joints in the hands. Additionally, osteoarthritis typically presents with unilateral symptoms which are worst at the end of the day.",
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"label": "b",
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"explanation": "Psoriatic arthritis typically presents with joint pain associated with skin changes and/or nail pitting.",
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"votes": 4
},
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"explanation": "This patient is presenting with signs and symptoms characteristic of rheumatoid arthritis, given the bilateral swelling of the small joints in her hands. Rheumatoid arthritis is an autoimmune disorder where autoantibodies (e.g. anti-cyclic citrullinated peptides) are produced against cells surrounding the joints.",
"id": "10002387",
"label": "a",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 345
},
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"explanation": "Reactive arthritis usually involves joint pain which presents following an infection.",
"id": "10002390",
"label": "d",
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"picture": null,
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"question": "A 57-year-old female presents to General Practice with swollen, painful joints in the fingers and wrists of both hands. She mentions that her symptoms started a few months ago, and are usually worst in the morning. There do not appear to be any skin changes around the affected joints.\n\nWhat is the most likely diagnosis?",
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173,460,721 | false | 31 | null | 6,495,033 | null | false | [] | null | 13,025 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst ANA can be used to assist in the diagnosis of lupus, it has a high sensitivity, rather than a high specificity.",
"id": "10002393",
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"picture": null,
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"explanation": "This patient is presenting with signs and symptoms characteristic of systemic lupus erythematosus (SLE), given the generalised systemic symptoms and the presence of a butterfly rash. One of the most specific investigations for SLE is the anti-dsDNA test which can be used to help confirm the diagnosis.",
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"label": "a",
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"__typename": "QuestionChoice",
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"explanation": "ESR may be used as an inflammatory marker to monitor the progression of lupus. However, it is not used as a specific investigation to confirm the initial diagnosis.",
"id": "10002396",
"label": "e",
"name": "Erythrocyte sedimentation rate (ESR)",
"picture": null,
"votes": 15
},
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"explanation": "Whilst rheumatoid factor may be positive in lupus, it is not a very specific investigation for the condition.",
"id": "10002394",
"label": "c",
"name": "Rheumatoid factor",
"picture": null,
"votes": 13
},
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"__typename": "QuestionChoice",
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"explanation": "Anti-CCP is a specific investigation for the diagnosis of rheumatoid arthritis, as opposed to lupus.",
"id": "10002395",
"label": "d",
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"picture": null,
"votes": 26
}
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"question": "A 30-year-old female presents with generalised fatigue, recurrent mouth ulcers and joint pains. On examination, she is noted to have a red rash on her face which spares the nasolabial folds.\n\nWhich of the following investigations is most specific at confirming the most likely diagnosis?",
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173,460,722 | false | 32 | null | 6,495,033 | null | false | [] | null | 13,026 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "In asymptomatic patients with a raised HbA1c level, a repeat test should be conducted before commencing treatment.",
"id": "10002398",
"label": "b",
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"__typename": "QuestionChoice",
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"explanation": "Although the patient is currently asymptomatic, a repeat HbA1c test is still warranted to check for the development of type 2 diabetes.",
"id": "10002399",
"label": "c",
"name": "No further management required",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "In asymptomatic patients with a raised HbA1c level, a repeat test should be conducted before commencing treatment.",
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"label": "d",
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"explanation": "In asymptomatic patients with a raised HbA1c level, a repeat test should be conducted before commencing treatment. Additionally, insulin therapy is usually considered much later in the management of type 2 diabetes.",
"id": "10002401",
"label": "e",
"name": "Start insulin",
"picture": null,
"votes": 2
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with a raised HbA1c level without any symptoms of diabetes. According to NICE guidelines, a repeat HbA1c test should be conducted in all patients with an incidentally raised HbA1c before commencing any treatment.",
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"label": "a",
"name": "Repeat HbA1c test",
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}
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"question": "A 64-year-old male presents to General Practice for a routine health check. As part of his routine investigations, a glycated haemoglobin (HbA1c) test is conducted and found to be elevated at 54 mmol/L (normal range 20-42 mmol/L). The patient is currently asymptomatic and does not have any other medical conditions.\n\n\nWhat should be the next step in the management of this patient?",
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"a"
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173,460,723 | false | 33 | null | 6,495,033 | null | false | [] | null | 13,027 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst sulfonylureas, such as gliclazide, may be considered in the management of type 2 diabetes, metformin is usually started before them.",
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"votes": 7
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"__typename": "QuestionChoice",
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"explanation": "As this patient is symptomatic and his symptoms have not improved with lifestyle changes alone, it is important to commence medical therapy.",
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"label": "e",
"name": "No further management required",
"picture": null,
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst insulin therapy may be considered in the later stages of type 2 diabetes, metformin is the recommended first-line medication after initial diagnosis.",
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"label": "d",
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"__typename": "QuestionChoice",
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"label": "a",
"name": "Start metformin",
"picture": null,
"votes": 349
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As the patient's HbA1c levels have been raised on 2 occasions, it is important to start medical therapy, rather than repeating the test again.",
"id": "10002404",
"label": "c",
"name": "Repeat HbA1c after 3 months",
"picture": null,
"votes": 7
}
],
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"comment": "The patient is symptomatic with polyuria and polydipsia - is that not an indication to provide them with sulphonylurea until their BG is controlled? Or is it because that's in the past and it's safe to assume the patient is no longer 'symptomatic' ",
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"question": "A 68-year-old male presents to General Practice with symptoms of tiredness, increased thirst and frequent urination. A glycated haemoglobin (HbA1c) test is found to be elevated at 54 mmol/L (normal range 20-42 mmol/L). The patient is advised to make lifestyle changes, but a repeat HbA1c measured 3 months later remains elevated at 56 mmol/L.\n\n\nWhat should be the next step in the management of this patient?",
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173,460,724 | false | 34 | null | 6,495,033 | null | false | [] | null | 13,028 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Crohn's disease is associated with an increase in goblet cells, as opposed to a decrease.",
"id": "10002410",
"label": "d",
"name": "Loss of goblet cells",
"picture": null,
"votes": 31
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Based on the symptoms and initial investigations, this patient likely has Crohn's disease. The presence of mouth ulcers and skip lesions on colonoscopy lean more towards Crohn's disease, as opposed to ulcerative colitis. Some of the key histological changes in Crohn's disease include granulomas, goblet cells, and inflammation in all layers from the mucosa to the serosa.",
"id": "10002407",
"label": "a",
"name": "Granulomas",
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"votes": 208
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In Crohn's disease, inflammation can affect any layer of the gastrointestinal tract, from the mucosa to the serosa.",
"id": "10002409",
"label": "c",
"name": "No inflammation beyond the submucosal layer",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Crypt abscesses are classically seen in patients with ulcerative colitis, as opposed to Crohn's disease.",
"id": "10002411",
"label": "e",
"name": "Crypt abscesses",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudopolyps are classically seen in patients with ulcerative colitis, as opposed to Crohn's disease.",
"id": "10002408",
"label": "b",
"name": "Pseudopolyps",
"picture": null,
"votes": 24
}
],
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"question": "A 28-year-old male presents with frequent diarrhoea, lethargy, and recurrent mouth ulcers. His symptoms started a few months ago, and are occasionally accompanied by abdominal pain. After initial investigations, a colonoscopy is performed, which reveals inflammatory changes with skip lesions. A colonic biopsy is also taken.\n\nWhich of the following features is most likely to be seen on histology?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,460,725 | false | 35 | null | 6,495,033 | null | false | [] | null | 13,029 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis may result in pseudopolyps, as opposed to polyps.",
"id": "10002416",
"label": "e",
"name": "Polyps",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is likely to be presenting with ulcerative colitis due to the presence of bloody diarrhoea and rectal inflammation with no skip lesions. Some of the key histological changes in ulcerative colitis include crypt abscesses, pseudopolyps, depletion of goblet cells, and inflammation affecting only the mucosal and submucosal layers.",
"id": "10002412",
"label": "a",
"name": "Crypt abscesses",
"picture": null,
"votes": 225
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis typically results in increased neutrophilic infiltration.",
"id": "10002415",
"label": "d",
"name": "Reduced neutrophilic infiltration",
"picture": null,
"votes": 9
},
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"__typename": "QuestionChoice",
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"explanation": "Granulomas are classically seen in patients with Crohn's disease, as opposed to ulcerative colitis.",
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"label": "b",
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"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis typically presents with a depletion in goblet cells, rather than an increase in goblet cells.",
"id": "10002414",
"label": "c",
"name": "Increased goblet cells",
"picture": null,
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}
],
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"name": "Ulcerative Colitis",
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"question": "A 22-year-old female presents with bloody diarrhoea, lethargy, and weight loss. Her symptoms started a few months ago. After initial investigations, a colonoscopy is performed which reveals inflammatory changes affecting only the mucosal and submucosal layers of the rectum. There are no skip lesions present. A colonic biopsy is also taken.\n\nWhich of the following features is most likely to be seen on histology?",
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"a"
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173,460,726 | false | 36 | null | 6,495,033 | null | false | [] | null | 13,030 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Negative HBsAg, negative anti-HBc, and negative anti-HBs would suggest susceptibility to hepatitis B infection.",
"id": "10002421",
"label": "e",
"name": "Unvaccinated and has no previous hepatitis B infection",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hepatitis B surface antigen (HBsAg) is a marker of acute or chronic hepatitis B infection. As HBsAg is negative in this case, there is no active infection present. Additionally, the hepatitis B core antibody (anti-HBc) is only IgG positive if there is a resolved infection or a chronic infection. There cannot be a chronic infection (as HBsAg is negative), meaning that a resolved infection is the most likely interpretation.",
"id": "10002417",
"label": "a",
"name": "Previous hepatitis B infection",
"picture": null,
"votes": 228
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute hepatitis B infection would typically show positive HBsAg, IgM positive anti-HBc, and negative anti-HBs.",
"id": "10002419",
"label": "c",
"name": "Acute hepatitis B infection",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A hepatitis B vaccination with no active infection would show a negative HBsAg, negative anti-HBc, and a positive anti-HBs.",
"id": "10002418",
"label": "b",
"name": "Previous hepatitis B vaccination",
"picture": null,
"votes": 78
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic hepatitis B infection would typically show positive HBsAg, IgG positive anti-HBc, and negative anti-HBs.",
"id": "10002420",
"label": "d",
"name": "Chronic hepatitis B infection",
"picture": null,
"votes": 43
}
],
"comments": [],
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"entitlement": null,
"id": "4038",
"name": "Hepatitis viruses",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
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"question": "A 44-year-old male undergoes hepatitis B serology testing. His results are shown below:\n\nTest | Result\n---------- | ----------\nHepatitis B surface antigen (HBsAg) | Negative\nHepatitis B surface antibody (Anti-HBs) | Positive\nHepatitis B core antibody (Anti-HBc) | IgG Positive\n\nWhat is the most likely interpretation of these findings?",
"sbaAnswer": [
"a"
],
"totalVotes": 373,
"typeId": 1,
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} | MarksheetMark |
173,460,727 | false | 37 | null | 6,495,033 | null | false | [] | null | 13,031 | {
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"explanation": "Whilst alpha-1 antitrypsin deficiency is a known risk factor for the development of hepatocellular carcinoma, it is not as common as hepatitis B infections.",
"id": "10002424",
"label": "c",
"name": "Alpha-1 antitrypsin deficiency",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst primary biliary cirrhosis is a known risk factor for the development of hepatocellular carcinoma, hepatitis B is the more common cause worldwide.",
"id": "10002426",
"label": "e",
"name": "Primary biliary cirrhosis",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst haemochromatosis is a known risk factor for the development of hepatocellular carcinoma, it is not as common as hepatitis B infections.",
"id": "10002423",
"label": "b",
"name": "Haemochromatosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "One of the most important complications of hepatitis B or hepatitis C infections is the development of chronic hepatitis. This chronic inflammation of the liver can eventually lead to hepatocellular carcinoma, especially if the condition is left untreated. Chronic hepatitis B infection is currently the most common cause of hepatocellular carcinoma worldwide.",
"id": "10002422",
"label": "a",
"name": "Chronic hepatitis B",
"picture": null,
"votes": 213
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst non-alcoholic fatty liver disease is a known risk factor for the development of hepatocellular carcinoma, hepatitis B is the more common cause worldwide.",
"id": "10002425",
"label": "d",
"name": "Non-alcoholic fatty liver disease",
"picture": null,
"votes": 100
}
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"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anaemia of chronic disease would typically present with a normocytic anaemia, as opposed to a macrocytic anaemia.",
"id": "10002431",
"label": "e",
"name": "Anaemia of chronic disease",
"picture": null,
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"explanation": "Thalassaemia would typically present with a microcytic anaemia, as opposed to a macrocytic anaemia.",
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"label": "d",
"name": "Thalassaemia",
"picture": null,
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"explanation": "This patient is presenting with signs and symptoms characteristic of vitamin B12 deficiency anaemia, corroborated by the macrocytic anaemia seen on the full blood count. Aside from the typical features of anaemia (e.g. fatigue/shortness of breath), B12 deficiency may also lead to neurological symptoms, such as loss of proprioception or vibration sensation. This is known as subacute combined degeneration of the cord.",
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"label": "a",
"name": "Vitamin B12 deficiency anaemia",
"picture": null,
"votes": 256
},
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"explanation": "Iron deficiency anaemia would typically present with a microcytic anaemia, as opposed to a macrocytic anaemia.",
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"label": "b",
"name": "Iron deficiency anaemia",
"picture": null,
"votes": 73
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aplastic anaemia would typically present with a normocytic anaemia, as opposed to a macrocytic anaemia.",
"id": "10002429",
"label": "c",
"name": "Aplastic anaemia",
"picture": null,
"votes": 24
}
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"question": "A 29-year-old female presents to General Practice with symptoms of fatigue, weakness and mild shortness of breath which have been present for the past 3 months. She also mentions that she has started to feel slightly unsteady on her feet. She has no previous medical history, and only takes the combined oral contraceptive pill. A full blood count is conducted and the results are shown below:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|90 g/L|(M) 130 - 170, (F) 115 - 155|\n|Mean Cell Volume (MCV)|112 fL|80 - 96|\n|White Cell Count|5.0x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|300x10<sup>9</sup>/L|150 - 400|\n|Neutrophils|3.5x10<sup>9</sup>/L|2.0 - 7.5|\n|Lymphocytes|1.5x10<sup>9</sup>/L|1.5 - 4.0|\n\n\nWhat is the most likely diagnosis?",
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173,460,729 | false | 39 | null | 6,495,033 | null | false | [] | null | 13,033 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glutamate is the main excitatory neurotransmitter in the CNS, as opposed to the main inhibitory neurotransmitter.",
"id": "10002433",
"label": "b",
"name": "Glutamate",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
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"explanation": "Noradrenaline is an excitatory neurotransmitter in the CNS, as opposed to an inhibitory neurotransmitter.",
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"label": "e",
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"__typename": "QuestionChoice",
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"explanation": "Whilst serotonin is also an inhibitory neurotransmitter, GABA is the main inhibitory neurotransmitter in the CNS.",
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"label": "d",
"name": "Dopamine",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
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"explanation": "The main inhibitory neurotransmitter in the CNS is gamma-aminobutyric acid (GABA). GABA is a naturally occurring amino acid which reduces neuronal excitability throughout the central nervous system.",
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"label": "a",
"name": "Gamma-aminobutyric acid",
"picture": null,
"votes": 254
}
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173,460,730 | false | 40 | null | 6,495,033 | null | false | [] | null | 13,034 | {
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"__typename": "QuestionChoice",
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"explanation": "Whilst rigidity is classically identified as a hallmark feature of Parkinson's disease, muscle wasting is not. Parkinson's patients may occasionally develop hallucinations as well, but this is usually at later stages of the disease.",
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"label": "d",
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"__typename": "QuestionChoice",
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"explanation": "Muscle wasting, tongue fasciculations, and slurred speech may be signs of motor neurone disease, as opposed to Parkinson's disease.",
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"explanation": "Ataxia, action tremor, and reduced coordination may occur in cerebellar disease. Notably, Parkinson's disease is associated with a resting tremor, whereas cerebellar disease usually involves an intention tremor which worsens with movement.",
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"label": "c",
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"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Parkinson's disease is a neurodegenerative condition caused by the loss of dopaminergic neurones in the substantia nigra of the brain. The reduced levels of dopamine usually result in initial motor symptoms: bradykinesia (slow movements), a unilateral resting tremor, and increased cogwheel rigidity.",
"id": "10002437",
"label": "a",
"name": "Bradykinesia, resting tremor, rigidity",
"picture": null,
"votes": 343
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a resting tremor is a hallmark feature of Parkinson's disease, ataxia and brisk reflexes are not.",
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"label": "e",
"name": "Ataxia, brisk reflexes, resting tremor",
"picture": null,
"votes": 12
}
],
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"question": "Which of the following options correctly identifies the 3 cardinal features of Parkinson's disease?",
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"a"
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173,460,731 | false | 41 | null | 6,495,033 | null | false | [] | null | 13,035 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the thalamus can be affected in some cases of Parkinson's disease, the basal ganglia is the area which is most predominantly affected.",
"id": "10002445",
"label": "d",
"name": "Thalamus",
"picture": null,
"votes": 10
},
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"__typename": "QuestionChoice",
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"explanation": "The hippocampus is one of the first regions damaged in Alzheimer's disease, as opposed to Parkinson's disease.",
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"picture": null,
"votes": 18
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"__typename": "QuestionChoice",
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"explanation": "Parkinson's disease is a neurodegenerative condition caused by the loss of dopaminergic neurones in the substantia nigra of the brain. The substantia nigra consists is a group of cells in the basal ganglia which usually secretes dopamine, enabling the control of movement and coordination.",
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"label": "a",
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"votes": 287
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"__typename": "QuestionChoice",
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"explanation": "The diencephalon consists of the epithalamus, thalamus, hypothalamus, ventral thalamus, and third ventricle structures of the brain. Whilst some of these structures can be affected in Parkinson's disease, the basal ganglia is the area which is most predominantly affected.",
"id": "10002446",
"label": "e",
"name": "Diencephalon",
"picture": null,
"votes": 10
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst there are multi-synaptic loops between the basal ganglia and cerebellum to aid with balance/coordination, it is the basal ganglia which is predominantly affected in Parkinson's disease.",
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"name": "Cerebellum",
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"question": "Which region of the brain is predominantly affected by Parkinson's disease?",
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173,460,732 | false | 42 | null | 6,495,033 | null | false | [] | null | 13,036 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tolcapone is an example of a catechol-O-methyl transferase inhibitor. This is often offered as an adjunct to other medications in the later stages of Parkinson's disease.",
"id": "10002449",
"label": "c",
"name": "Tolcapone",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Procyclidine is an example of an antimuscarinic medication which is often used to treat drug-induced parkinsonism, as opposed to idiopathic Parkinson's disease.",
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"label": "e",
"name": "Procyclidine",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
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"explanation": "Bromocriptine is an example of a dopamine agonist. These may be offered as an adjunct to levodopa if symptoms of Parkinson's disease worsen.",
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"label": "d",
"name": "Bromocriptine",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In cases of Parkinson's disease where motor symptoms are interfering with a patient's quality of life, levodopa should be the first-line medication offered. Levodopa is a precursor molecule to dopamine, which enables more dopamine to be formed, thereby assisting with the motor symptoms of Parkinson's disease. Levodopa is often combined with carbidopa (which reduces the peripheral breakdown of dopamine) to reduce the side effects of the medication.",
"id": "10002447",
"label": "a",
"name": "Levodopa",
"picture": null,
"votes": 337
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Selegiline is an example of a monoamine oxidase B (MAO-B) inhibitor. This is often offered as an adjunct to other medications in the later stages of Parkinson's disease.",
"id": "10002448",
"label": "b",
"name": "Selegiline",
"picture": null,
"votes": 4
}
],
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"question": "A 74-year-old male presents to the neurology clinic after a recent diagnosis of Parkinson's disease with symptoms of worsening tremor at rest. He is finding it more difficult to move around the house, and his motor symptoms are beginning to interfere with his activities of daily living. His past medical history includes hypertension, for which he takes amlodipine and losartan.\n\nWhat is the most likely first-line medical therapy for this patient?",
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"a"
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173,460,733 | false | 43 | null | 6,495,033 | null | false | [] | null | 13,037 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Periarticular erosions are commonly seen in the late stages of rheumatoid arthritis, as opposed to osteoarthritis.",
"id": "10002454",
"label": "c",
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"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Subluxation refers to the partial dislocation of a joint. It is usually seen in the late stages of rheumatoid arthritis, as opposed to osteoarthritis.",
"id": "10002455",
"label": "d",
"name": "Subluxation",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Juxta-articular osteoporosis is more commonly seen in rheumatoid arthritis, as opposed to osteoarthritis. This would typically present with bilateral joint pain in small joints, which is worse in the morning.",
"id": "10002453",
"label": "b",
"name": "Juxta-articular osteoporosis",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mixed lytic and sclerotic lesions may be seen in Paget's disease of the bone, as opposed to osteoarthritis.",
"id": "10002456",
"label": "e",
"name": "Mixed lytic and sclerotic lesions",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with symptoms suggestive of osteoarthritis, given the unilateral joint pain in large joints which is worse at the end of the day. The key osteoarthritic changes on x-ray are loss of joint space, osteophytes, subchondral cysts, and subchondral sclerosis.",
"id": "10002452",
"label": "a",
"name": "Osteophytes at the joint margin",
"picture": null,
"votes": 260
}
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"name": "Osteoarthritis",
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"typeId": 7
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"question": "A 75-year-old female presents to general practice with worsening joint pain, predominantly affecting her right knee and right hip. She finds that her symptoms are usually worst at the end of the day. The GP orders an x-ray of the affected joints.\n\nGiven the most likely diagnosis, which of the following changes are most likely to be seen on an x-ray?",
"sbaAnswer": [
"a"
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"totalVotes": 376,
"typeId": 1,
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173,460,734 | false | 44 | null | 6,495,033 | null | false | [] | null | 13,038 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Denosumab is a monoclonal antibody which inhibits the maturation of osteoclasts. It may be considered in the later stages of osteoporosis management.",
"id": "10002458",
"label": "b",
"name": "Start denosumab",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient is older than 75 years of age, bisphosphonate treatment can be commenced without the need for a DEXA scan.",
"id": "10002460",
"label": "d",
"name": "Perform a DEXA scan before starting treatment",
"picture": null,
"votes": 163
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "As this patient is above the age of 75 years, any fragility fractures which occur should be attributed to underlying osteoporosis. The first-line therapy for this is an oral bisphosphonate (e.g. alendronic acid), which should help to reduce the risk of further fractures by inhibiting osteoclast activity.",
"id": "10002457",
"label": "a",
"name": "Start oral alendronic acid",
"picture": null,
"votes": 191
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Raloxifene is a selective oestrogen receptor modulator which helps to reduce the risk of vertebral fractures. It may be considered in some cases of osteoporosis, however, bisphosphonates are still the first-line medical management.",
"id": "10002461",
"label": "e",
"name": "Start raloxifene",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
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"explanation": "Although hormone replacement therapy may be considered in the later stages of osteoporosis, bisphosphonates are the first-line medical therapy.",
"id": "10002459",
"label": "c",
"name": "Start hormone replacement therapy",
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}
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"question": "An 80-year-old female on the geriatric ward is recovering from a fragility fracture which occurred 3 days ago. She has a past medical history of hypertension and COPD, for which she takes amlodipine, ramipril and salbutamol.\n\nWhich of the following options should be considered next in the management of this patient?",
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"a"
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173,460,735 | false | 45 | null | 6,495,033 | null | false | [] | null | 13,039 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The two main pathophysiological changes which occur in Alzheimer's disease are the build-up of beta-amyloid plaques and the development of neurofibrillary tangles. As a result of these changes, there is a reduction in the neuronal connections within the brain, which leads to symptoms of dementia.",
"id": "10002462",
"label": "a",
"name": "Formation of neurofibrillary tangles",
"picture": null,
"votes": 254
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Autoimmune demyelination of neurones is more commonly seen in multiple sclerosis, as opposed to Alzheimer's disease.",
"id": "10002466",
"label": "e",
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"picture": null,
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"__typename": "QuestionChoice",
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"explanation": "Loss of dopaminergic neurones in the substantia nigra occurs in Parkinson's disease, as opposed to Alzheimer's disease.",
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"label": "b",
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although deposition of alpha-synuclein may be seen in some cases of Alzheimer's disease, it is more commonly seen in Lewy body dementia and Parkinson's disease.",
"id": "10002465",
"label": "d",
"name": "Deposition of alpha-synuclein",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Loss of brainstem motor nuclei occurs in motor neurone disease, as opposed to Alzheimer's disease.",
"id": "10002464",
"label": "c",
"name": "Loss of brainstem motor nuclei",
"picture": null,
"votes": 3
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"question": "Which of the following pathophysiological changes are most likely to be seen in Alzheimer's disease?",
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173,460,736 | false | 46 | null | 6,495,033 | null | false | [] | null | 13,040 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is currently no indication for steroid medications in the medical management of Alzheimer's disease.",
"id": "10002471",
"label": "e",
"name": "Prednisolone",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Riluzole is a medication option available for the treatment of motor neurone disease, as opposed to Alzheimer's disease. This would typically present with muscle wasting, fasciculations, and difficulties with mobility.",
"id": "10002470",
"label": "d",
"name": "Riluzole",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Levodopa is usually the first-line medication for Parkinson's disease, as opposed to Alzheimer's disease. This would classically present with bradykinesia, resting tremor and increased rigidity.",
"id": "10002469",
"label": "c",
"name": "Levodopa",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with symptoms of Alzheimer's disease, corroborated by the cerebral atrophy seen on the CT scan. Donepezil is an acetylcholinesterase inhibitor which is usually used first-line to improve symptoms in mild-moderate Alzheimer's disease.",
"id": "10002467",
"label": "a",
"name": "Donepezil",
"picture": null,
"votes": 251
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Memantine is an NMDA receptor antagonist which is typically used in the later stages of Alzheimer's disease, or if acetylcholinesterase inhibitors are not deemed suitable for first-line management.",
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"label": "b",
"name": "Memantine",
"picture": null,
"votes": 57
}
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"name": "Alzheimer's disease",
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"a"
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173,460,737 | false | 47 | null | 6,495,033 | null | false | [] | null | 13,041 | {
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"__typename": "QuestionChoice",
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"explanation": "Marfan syndrome is a genetic connective tissue disorder which usually occurs due to a mutation in the fibrillin-1 gene. There is currently no known link between Marfan syndrome and the development of Alzheimer's disease.",
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"label": "c",
"name": "Marfan syndrome",
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"__typename": "QuestionChoice",
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"label": "d",
"name": "Motor neurone disease",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mutations in the LRRK 2 gene are more commonly seen in Parkinson's disease, as opposed to Alzheimer's disease.",
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"label": "b",
"name": "Mutation in LRRK 2 gene",
"picture": null,
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Current research indicates that Alzheimer's disease is far more common in females than males.",
"id": "10002476",
"label": "e",
"name": "Male sex",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Down's syndrome is an important risk factor in the development of Alzheimer's disease, with around 30% of Down's syndrome individuals developing dementia by their 50s. One of the reasons for this is that chromosome 21 carries the amyloid precursor protein (APP) gene, which codes for amyloid protein development and deposition. In Down's syndrome, the extra chromosome 21 can result in excessive amyloid protein formation, leading to Alzheimer's disease.",
"id": "10002472",
"label": "a",
"name": "Down's syndrome",
"picture": null,
"votes": 256
}
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"name": "Alzheimer's disease",
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"question": "Which of the following options is a risk factor for the development of Alzheimer's disease?",
"sbaAnswer": [
"a"
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"totalVotes": 374,
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173,460,738 | false | 48 | null | 6,495,033 | null | false | [] | null | 13,042 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with symptoms of Lewy body dementia, demonstrated by progressive cognitive impairment, hallucinations, and more recent Parkinsonian changes.",
"id": "10002477",
"label": "a",
"name": "Lewy body dementia",
"picture": null,
"votes": 331
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vascular dementia would typically present with a shorter history of cognitive impairment, usually following a stroke.",
"id": "10002478",
"label": "b",
"name": "Vascular dementia",
"picture": null,
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Multiple sclerosis typically presents with episodes of fatigue, numbness, muscle weakness and vision problems. Although it can present at any age, it usually occurs in females between 20-40 years of age.",
"id": "10002481",
"label": "e",
"name": "Multiple sclerosis",
"picture": null,
"votes": 3
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst there is some overlap between Alzheimer's disease and Lewy body dementia, the recent development of a resting tremor (Parkinsonian sign) is more suggestive of Lewy body dementia.",
"id": "10002480",
"label": "d",
"name": "Alzheimer's disease",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Frontotemporal dementia would typically present with extreme changes in personality, difficulties with language, and cognitive impairment.",
"id": "10002479",
"label": "c",
"name": "Frontotemporal dementia",
"picture": null,
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}
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"name": "Dementia with Lewy bodies",
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"question": "A 72-year-old male presents to neurology with worsening attention, reduced executive function, and some visual hallucinations. His wife mentions that these symptoms have been worsening over the past year. She also notices that he has recently started to develop a resting tremor in his left hand.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 375,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,739 | false | 49 | null | 6,495,033 | null | false | [] | null | 13,043 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with signs of postural hypotension, as demonstrated by the > 20 mmHg drop in systolic blood pressure when switching from a lying to a standing position. Many factors can increase the risk of postural hypotension, including diuretics, antihypertensives, antidepressants, and Parkinson's medications. In this case, the beta-blocker (bisoprolol) may be a likely precipitating factor for this patient's symptoms, and a change in dosage should be considered.",
"id": "10002482",
"label": "a",
"name": "Lower bisoprolol dose",
"picture": null,
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is currently no association between atorvastatin and the development of postural hypotension.",
"id": "10002484",
"label": "c",
"name": "Lower atorvastatin dose",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is currently no association between prasugrel use and the development of postural hypotension.",
"id": "10002486",
"label": "e",
"name": "Lower prasugrel dose",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is currently no association between aspirin use and the development of postural hypotension.",
"id": "10002485",
"label": "d",
"name": "Lower aspirin dose",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is currently no association between metformin and the development of postural hypotension.",
"id": "10002483",
"label": "b",
"name": "Lower metformin dose",
"picture": null,
"votes": 16
}
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"question": "An 82-year-old male presents to orthopaedics with a fracture following a recent fall. His wife mentions that he has recently been having more falls than usual, and is beginning to struggle with his activities of daily living. He has a past medical history of type 2 diabetes and a previous myocardial infarction. His current medications include metformin, gliclazide, losartan, bisoprolol, aspirin, prasugrel and atorvastatin. The blood pressure for this patient is measured:\n\nLying blood pressure: 144/82 mmHg\n\nStanding blood pressure: 106/70 mmHg\n\nGiven the most likely diagnosis, which of the following options should be considered in the management of this patient?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,460,740 | false | 50 | null | 6,495,033 | null | false | [] | null | 13,044 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient health questionnaire (PHQ-9) score can be used to screen patients for major depressive disorder, as opposed to delirium.",
"id": "10002490",
"label": "d",
"name": "PHQ-9 score",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The GAD-7 score screens patients for generalised anxiety disorder, as opposed to delirium.",
"id": "10002489",
"label": "c",
"name": "GAD-7 score",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The 4AT score is a useful screening tool for assessing whether a patient may have delirium, with a score of more than 4 out of 12 suggesting delirium. The score takes into account the alertness, memory and attention of the patient, as well as whether their symptoms fluctuate throughout the day.",
"id": "10002487",
"label": "a",
"name": "4AT score",
"picture": null,
"votes": 191
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The MMSE may be used as a screening tool for Alzheimer's disease or other types of dementia, as opposed to delirium.",
"id": "10002488",
"label": "b",
"name": "Mini-mental state examination (MMSE)",
"picture": null,
"votes": 133
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The disease activity score (DAS28) is used to assess the severity of rheumatoid arthritis symptoms, as opposed to delirium.",
"id": "10002491",
"label": "e",
"name": "DAS28 score",
"picture": null,
"votes": 28
}
],
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"name": "Delirium",
"status": null,
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"name": "Geriatrics",
"typeId": 7
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"question": "Which of the following scoring systems can be used as a screening tool for assessing delirium in a patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 377,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
Subsets and Splits