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173,461,048 | false | 2 | null | 6,495,044 | null | false | [] | null | 13,246 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Previously known as *Pneumocystis carinii*, this yeast-like fungus is an opportunistic agent and a common cause of pneumonia in patients who have HIV.",
"id": "10003498",
"label": "c",
"name": "*Pneumocystis jirovecii*",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a Gram-negative rod-shaped bacterium associated with pneumonia. It typically causes pneumonia in patients at high risk of aspiration. Alcoholism is also a well-known risk factor.",
"id": "10003499",
"label": "d",
"name": "*Klebsiella pneumoniae*",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a gram-negative cocci that can cause ear, upper respiratory tract, and lower respiratory tract infections. It is also known as *Branhamella catarrhalis*.",
"id": "10003497",
"label": "b",
"name": "*Moraxella catarrhalis*",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has developed a community–acquired pneumonia (CAP). Other potential differentials include pulmonary embolism, acute bronchitis and acute exacerbation of COPD. However, this patient's symptoms - particularly the fever, sputum, low oxygen saturations, cough and now a cavitating lesion - point towards a diagnosis of CAP with cavitation.\n\nFurthermore, *Staphylococcus aureus* and *Streptococcus pneumoniae* are the only answer choices that are gram-positive cocci. However, of the two, *Staphylococcus aureus* is arranged in grape-like clusters or 'clumps', whereas Streptococci are arranged in chains or pairs (diplococci).",
"id": "10003496",
"label": "a",
"name": "*Staphylococcus aureus*",
"picture": null,
"votes": 268
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a Gram-positive spherical bacteria, usually found in pairs (diplococci). *Streptococcus pneumoniae* is the most common cause of community-acquired pneumonia.",
"id": "10003500",
"label": "e",
"name": "*Streptococcus pneumoniae*",
"picture": null,
"votes": 112
}
],
"comments": [],
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"name": "Pneumonia",
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"question": "A 39-year-old woman presents to A&E with a one-week history of dyspnoea and cough, bringing up increasing amounts of sputum.\n\nShe has a fever, a respiratory rate of 26 breaths per minute and is saturating 92% on room air.\n\nA chest x-ray shows a cavitating lesion in the right middle zone. Microscopy shows Gram-positive cocci.\n\nShe has not been in contact with any unwell persons nor does she have a history of tuberculosis. She is a known IV drug user.\n\nWhat is the most likely causative organism of this woman's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 524,
"typeId": 1,
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173,461,049 | false | 3 | null | 6,495,044 | null | false | [] | null | 13,247 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Despite a history of smoking and the presence of clubbing, there are no further indications of lung cancer such as red flag symptoms or extrapulmonary features. Furthermore, this patient has a dry cough, crackles, clubbing and is a 70-year-old smoker: this is a typical presentation of IPF.",
"id": "10003504",
"label": "d",
"name": "Lung carcinoma",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no risk factors for TB in this question (i.e. travel abroad, unwell contacts). Furthermore, this patient has a dry cough, crackles, clubbing and is a 70-year-old smoker: this is a typical presentation of IPF.",
"id": "10003505",
"label": "e",
"name": "Pulmonary tuberculosis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with bronchiectasis often have a chronic mucopurulent cough, exertional dyspnoea and occasionally have haemoptysis.\n\nThey can also present with an acute infective exacerbation. If this patient did have an infection, his symptomatic history would be much shorter, he would be pyrexic, and be producing purulent sputum.",
"id": "10003502",
"label": "b",
"name": "Bronchiectasis",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no indication of allergy or exposure to irritants (coal, dust, chemicals) in this question. Furthermore, this patient has a dry cough, crackles, clubbing, and is a 70-year-old smoker: this is a typical presentation of IPF.",
"id": "10003503",
"label": "c",
"name": "Extrinsic allergic alveolitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a dry cough, crackles, clubbing and is a 70-year-old smoker. This is a typical presentation of IPF.",
"id": "10003501",
"label": "a",
"name": "Idiopathic pulmonary fibrosis (IPF)",
"picture": null,
"votes": 429
}
],
"comments": [],
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"id": "3719",
"name": "Bronchiectasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
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"question": "A 70-year-old male has a seven-month history of dry cough and increasing dyspnoea. He was previously fit and well and is an occasional smoker. His temperature is 36.3°C, pulse 60 bpm and oxygen saturations are 88% on air.\n\nOn examination, there is finger clubbing and on respiratory examination, you auscultate bibasal crepitations.\n\nWhich of the following options is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 511,
"typeId": 1,
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173,461,050 | false | 4 | null | 6,495,044 | null | false | [] | null | 13,248 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The appropriate treatment is drainage to avoid empyema development. The streptococcus is sensitive to penicillin therefore a change in antibiotic or the way in which it is administered is very unlikely to yield any significant results.",
"id": "10003510",
"label": "e",
"name": "Switch benzylpenicillin to ceftriaxone",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The streptococcus is sensitive to penicillin therefore a change in antibiotics or the way in which it is administered is very unlikely to yield any significant results.",
"id": "10003508",
"label": "c",
"name": "Inject antibiotic into the effusion",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The appropriate treatment is drainage to avoid empyema development. The streptococcus is sensitive to penicillin therefore a change in antibiotic or the way in which it is administered is very unlikely to yield any significant results.",
"id": "10003509",
"label": "d",
"name": "Increase the dose of penicillin",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is because the Gram stain and low pH indicate a complex parapneumonic effusion (pleural effusion that develops next to a pneumonia). The appropriate treatment is drainage of the effusion as it is likely developing into an empyema. Streptococcus is sensitive to penicillin, therefore a change in antibiotics is very unlikely to yield any significant results.",
"id": "10003506",
"label": "a",
"name": "Drainage of the effusion",
"picture": null,
"votes": 399
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The goal of pleurodesis is to try to adhere the linings of the lung (pleura) together in order to stop further fluid or air build-up. This is achieved by inserting sterile talc into the area between the lung and the inside of the chest wall. It is indicated in recurrent pleural effusions and persistent pneumothoraces.",
"id": "10003507",
"label": "b",
"name": "Talc pleurodesis",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
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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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"question": "A 40-year-old female has a left lower lobe pneumonia. Blood cultures are positive for a penicillin-sensitive *Streptococcus pneumoniae*. She is managed with IV benzylpenicillin. She improves but on the fourth day of treatment, she becomes pyrexic and has increased dyspnoea.\n\nA chest x-ray shows a left basal effusion. Purulent fluid is aspirated and analysis of the fluid shows a pH of 6.80 (reference range 7.35 – 7.45) and Gram-positive cocci.\n\nWhat is the most appropriate next step in managing this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 493,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,051 | false | 5 | null | 6,495,044 | null | false | [] | null | 13,249 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pleural effusion is an excessive accumulation of fluid in the pleural space (between the visceral and parietal pleura). It can be detected on x-ray when ≥300 mL of fluid is present, and clinically, when ≥500 mL is present.",
"id": "10003512",
"label": "b",
"name": "≥100 mL",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pleural effusion is an excessive accumulation of fluid in the pleural space (between the visceral and parietal pleura). It can be detected on x-ray when ≥300 mL of fluid is present, and clinically, when ≥500 mL is present.",
"id": "10003514",
"label": "d",
"name": "≥400 mL",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A pleural effusion is an excessive accumulation of fluid in the pleural space (between the visceral and parietal pleura). It can be detected on x-ray when ≥300 mL of fluid is present, and clinically, when ≥500 mL is present.",
"id": "10003511",
"label": "a",
"name": "≥300 mL",
"picture": null,
"votes": 129
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pleural effusion is clinically noted when ≥500 mL is present. However, it can be noted on CXR with just 300ml.",
"id": "10003515",
"label": "e",
"name": "≥500 mL",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pleural effusion is an excessive accumulation of fluid in the pleural space (between the visceral and parietal pleura). It can be detected on x-ray when ≥300 mL of fluid is present, and clinically, when ≥500 mL is present.",
"id": "10003513",
"label": "c",
"name": "≥200 mL",
"picture": null,
"votes": 241
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4174",
"name": "Pleural effusions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "At what volume can pleural effusions be seen on a chest x-ray?",
"sbaAnswer": [
"a"
],
"totalVotes": 487,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,052 | false | 6 | null | 6,495,044 | null | false | [] | null | 13,250 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This choice would not solve this patient's respiratory acidosis, which is an immediate concern that needs to be corrected with non-invasive ventilation. Furthermore, this patient is alert and unlikely to tolerate an OP airway.\n\nBiPAP is used in patients with type II respiratory failure and pH <7.35.",
"id": "10003519",
"label": "d",
"name": "Oesopharngeal airway (OP)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Invasive ventilation is not indicated in this patient who is alert and has a raised respiratory rate. His respiratory acidosis should instead be managed less aggressively with non-invasive ventilation.\n\nBiPAP is used in patients with type II respiratory failure and pH <7.35.",
"id": "10003517",
"label": "b",
"name": "Invasive ventilation",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CPAP is commonly used in patients with type I respiratory failure.\nThis patient has type II respiratory failure with respiratory acidosis secondary to his COPD exacerbation and requires BiPAP.",
"id": "10003520",
"label": "e",
"name": "Continuous positive airway pressure (CPAP)",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient is already on 15L NRB, therefore this choice represents a step down in this patient's management, which is not appropriate given his signs and symptoms.",
"id": "10003518",
"label": "c",
"name": "Nasal high-flow oxygen",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Respiratory acidosis is an immediate concern that needs to be corrected with non-invasive ventilation (NIV). This patient is alert with a pH of less than 7.35 and is in type II respiratory failure, making NIV the optimal initial management.\n\nBiPAP is used in patients with type II respiratory failure, with two different levels of positive pressure on inspiration and expiration.",
"id": "10003516",
"label": "a",
"name": "Bilevel-positive airway pressure (BiPAP)",
"picture": null,
"votes": 336
}
],
"comments": [],
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"__typename": "Chapter",
"explanation": null,
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3902",
"name": "COPD",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 71-year-old man with known COPD presents to A&E with increasing shortness of breath. He is alert.\n\n\nHis observations are: Temp 38.0°C, pulse 101, BP 98/77mmHg, RR 31 and saturations 88% SpO2 on a 15 L non-rebreather mask (NRB).\n\n\nThe results from the patient's arterial blood gas are shown below:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.30|7.35 - 7.45|\n|PaO₂|6.9 kPa|11 - 15|\n|PaCO₂|9.3 kPa|4.6 - 6.4|\n|Bicarbonate|32 mmol/L|22 - 30|\n\n\nWhat is the most important initial management?",
"sbaAnswer": [
"a"
],
"totalVotes": 482,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,053 | false | 7 | null | 6,495,044 | null | false | [] | null | 13,251 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pancreatitis typically presents with severe epigastric pain radiating to the back. This patient has mild abdominal pain, which is likely related to his recent surgery.",
"id": "10003522",
"label": "b",
"name": "Pancreatitis",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pneumonia would present with a cough, purulent sputum and chest pain which could be pleuritic in nature.",
"id": "10003523",
"label": "c",
"name": "Pneumonia",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has had a prolonged period of immobilisation and likely has a history of atherosclerosis, given the nature of his recent surgery (carotid artery bypass). This alongside his tachypnoea and tachycardia makes pulmonary embolism the most likely diagnosis.",
"id": "10003521",
"label": "a",
"name": "Pulmonary embolism",
"picture": null,
"votes": 342
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myocardial infarction would present with severe, crushing central chest pain, which may radiate to the jaw. This choice is a reasonable differential given his recent carotid endarterectomy.",
"id": "10003524",
"label": "d",
"name": "Myocardial infarction",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The risk of stroke is around 2% following carotid endarterectomy and is higher in people who have had a stroke before the operation. However, this patient's clinical picture is more suggestive of a pulmonary embolism.",
"id": "10003525",
"label": "e",
"name": "Stroke",
"picture": null,
"votes": 0
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "4175",
"name": "Pulmonary embolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 71-year-old man has increasing breathlessness. He had a carotid artery bypass 9 days ago. He reports chest pain and mild abdominal pain. He has a past medical history of hypertension and stroke.\n\nHis observations are: Temp 37.6°C, pulse 107 bpm, BP 121/78 mmHg, RR 26, and oxygen saturations of 93% SpO2 on room air.\n\nThere are no crackles on auscultation, and he complains of some mild abdominal pain which is improving.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 480,
"typeId": 1,
"userPoint": null
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173,461,054 | false | 8 | null | 6,495,044 | null | false | [] | null | 13,252 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The transoesophageal echocardiogram is the most sensitive diagnostic test for infective endocarditis. However, the first-line imaging modality performed should be a transthoracic echocardiogram, and whilst it is an important investigation in the work-up of suspected infective endocarditis, this patient's clinical features are highly suggestive of acute sepsis. Indeed, the patient has clammy hands, is hypotensive and tachycardic, and has new onset confusion. This should ring alarm bells for sepsis and should therefore prompt you to order blood cultures before any other investigation. This can be followed by IV antibiotics and fluid resuscitation.",
"id": "10003527",
"label": "b",
"name": "Transoesophageal echocardiogram",
"picture": null,
"votes": 129
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient meets the threshold for a sepsis screen, hence blood cultures should be performed. Blood cultures are also important in the investigation of infective endocarditis, which is the most likely diagnosis in this case.",
"id": "10003526",
"label": "a",
"name": "Blood cultures",
"picture": null,
"votes": 300
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst you are unsure if the PR interval is prolonged, which could indicate infective endocarditis secondary to aortic root abscess, it would still be more appropriate to order blood cultures at this stage to investigate his sepsis.",
"id": "10003528",
"label": "c",
"name": "Repeat ECG",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a sputum culture is part of the investigative workup for suspected infective endocarditis, it would be more appropriate to order blood cultures at this stage to investigate his sepsis.",
"id": "10003530",
"label": "e",
"name": "Sputum culture",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a 'Urea and Electrolytes' blood test is part of the diagnostic workup for suspected infective endocarditis, it would be more appropriate to order blood cultures at this stage to investigate his sepsis.",
"id": "10003529",
"label": "d",
"name": "Urea and Electrolytes",
"picture": null,
"votes": 31
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "3710",
"name": "Infective Endocarditis",
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"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"dislikes": 0,
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"question": "A 51-year-old man presents to the critical care unit with new-onset confusion and chest pain. An ECG shows no ST changes or T wave inversion, but you are unsure if the PR interval is prolonged.\n\nHe is a known IV drug user and has needle track marks on his arms. His hands are clammy and have painful nodules. He also has non-tender macules on his soles. Exudative haemorrhagic retinal lesions with pale centres are seen on ophthalmoscopy. He is mildly confused.\n\nHis observations are: BP 100/75mmHg, HR 116 bpm, Temp 38.3 degrees Celsius.\n\nA urine dip shows raised protein and blood.\n\nWhat is the most appropriate next investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 474,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,055 | false | 9 | null | 6,495,044 | null | false | [] | null | 13,253 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has drug-induced pulmonary fibrosis secondary to her extensive use of methotrexate for her rheumatoid arthritis, which has caused pneumonitis and subsequent pulmonary fibrosis.",
"id": "10003531",
"label": "a",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 382
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic obstructive pulmonary disease (COPD) is characterised by an obstructive picture on spirometry. This patient has an FEV1/FVC ratio of 0.88, which is indicative of a restrictive lung pathology.",
"id": "10003532",
"label": "b",
"name": "Chronic obstructive pulmonary disease (COPD)",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Asthma is a type of obstructive lung disease characterised by paroxysmal and reversible airway bronchoconstriction. This patient has an FEV1/FVC ratio of 0.88, indicative of restrictive lung pathology.",
"id": "10003533",
"label": "c",
"name": "Asthma",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tuberculosis is transmitted via the inhalation of droplets infected with *Mycobacterium tuberculosis*. There are no risk factors here suggesting tuberculosis such as homelessness, immunosuppression or foreign travel. Furthermore, tuberculosis usually causes a productive and purulent cough, whereas this patient has a dry cough.",
"id": "10003534",
"label": "d",
"name": "Tuberculosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bronchiectasis is the permanent dilation of the bronchi and bronchioles due to chronic infection. It usually causes a productive, purulent cough with lots of sputum. This patient has a dry cough. Finally, bronchiectasis is an obstructive lung disease. This patient has an FEV1/FVC ratio of 0.73, indicative of restrictive lung pathology.",
"id": "10003535",
"label": "e",
"name": "Bronchiectasis",
"picture": null,
"votes": 6
}
],
"comments": [],
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"__typename": "Concept",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3693",
"name": "Pulmonary Fibrosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"videos": []
},
"conceptId": 3693,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "A 59-year-old female presents to A&E with a 6-week history of shortness of breath and a dry cough which she noticed 1 month ago. She has a 40-pack-year smoking history and works as a comedian.\n\nShe has a history of rheumatoid arthritis which has improved with treatment. Her spirometry results are FEV1: 2.3 and FVC: 2.6. She also has a history of hypertension and hypercholesterolaemia.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 465,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,056 | false | 10 | null | 6,495,044 | null | false | [] | null | 13,254 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Group AB blood does not have any anti-B or anti-A antibodies in the plasma, making it the universal FFP donor.\n\nFFP is used in patients with a coagulopathy who need replacement of their clotting factors. As this patient has no G&S available, she should be given the universal FFP donor, which is group AB plasma (as this plasma has no antibodies). As the patient has childbearing potential, it would be best to give her rhesus-negative blood until her rhesus group is known.",
"id": "10003536",
"label": "a",
"name": "AB RhD negative",
"picture": null,
"votes": 144
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Group O blood donors produce anti-A and anti-B antibodies in their plasma. The universal donor for FFP is group AB blood. The universal donor for red cells is group O blood.\n\nAs this patient has no G&S available, she should be given the universal FFP donor, which is group AB plasma (as this plasma has no antibodies). As the patient has childbearing potential, it would be best to give her rhesus-negative blood until her rhesus group is known.",
"id": "10003538",
"label": "c",
"name": "O RhD positive",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Group A blood donors produce anti-B antibodies in their plasma. The universal donor for FFP is group AB blood. The universal donor for red cells is group O blood.\n\nAs this patient has no G&S available she should be given the universal FFP donor, which is group AB plasma (as this plasma has no antibodies). As the patient has childbearing potential, it would be best to give her rhesus-negative blood until her rhesus group is known.",
"id": "10003540",
"label": "e",
"name": "A RhD negative",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Group O blood donors produce anti-A and anti-B antibodies in their plasma. The universal donor for FFP is group AB blood. The universal donor for red cells is group O blood.\n\nAs this patient has no G&S available, she should be given the universal FFP donor, which is group AB plasma (as this plasma has no antibodies). As the patient has childbearing potential, it would be best to give her rhesus-negative blood until her rhesus group is known.",
"id": "10003537",
"label": "b",
"name": "O RhD negative",
"picture": null,
"votes": 221
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst group AB blood is the universal donor for FFP, this patient is of reproductive age, and if available, should receive RhD-negative blood to avoid the issue of a future fetus being RhD-positive and her being RhD-negative.\n\nIf a rhesus-negative mother becomes sensitised to rhesus-positive blood, she will form anti-RhD antibodies (this is called sensitisation). This can cause anaemia, hydrops fetalis and kernicterus in a future pregnancy if the foetus' blood is RhD-positive.",
"id": "10003539",
"label": "d",
"name": "AB RhD positive",
"picture": null,
"votes": 71
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
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"id": "4176",
"name": "Transfusion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
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},
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"dislikes": 4,
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"id": "13254",
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"likes": 1,
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"question": "A 38-year-old female presents to A&E with a massive haemorrhage following a road traffic accident. A group and save (G&S) has been ordered but is not yet available.\n\nThe patient has been transfused with 6 packs of red cells and the haematologist now requires fresh frozen plasma (FFP).\n\nWhich type of FFP is most appropriate for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 457,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,057 | false | 11 | null | 6,495,044 | null | false | [] | null | 13,255 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although ivabradine can be used in the management of angina pectoris they are not known to exacerbate psoriasis.",
"id": "10003543",
"label": "c",
"name": "Ivabradine (Procoralan)",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Macrolides are the first-line medication in penicillin-allergic patients who have mild community-acquired pneumonia. However, this question is about her psoriasis, not her new respiratory symptoms.\n\nStatins are metabolised via the cytochrome P450 system. P450 inhibitors such as clarithromycin, a macrolide, can increase the risk of myalgia and rhabdomyolysis, and therefore both medications should not be co-prescribed. However, this combination is unlikely to have exacerbated this patient's psoriasis.",
"id": "10003545",
"label": "e",
"name": "Atorvastatin & Clarithromycin",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Beta-blockers are known to exacerbate psoriasis. Drugs ending -lol are typically beta blockers.\n\nTo remember the drugs which may exacerbate psoriasis, use the memory aid 'BALI':\n\n* Beta-blockers\n* Anti-malarials (e.g. chloroquine), ACE inhibitors and Alcohol\n* Lithium\n* Ibuprofen (NSAIDs) and Infliximab.",
"id": "10003541",
"label": "a",
"name": "Carvedilol",
"picture": null,
"votes": 286
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dithranol is a topical agent commonly used in the management of psoriasis. This would be beneficial for this patient.",
"id": "10003544",
"label": "d",
"name": "Dithranol (Anthralin)",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although calcium channel blockers are used in the management of angina pectoris they are not known to exacerbate psoriasis.",
"id": "10003542",
"label": "b",
"name": "Amlodipine",
"picture": null,
"votes": 62
}
],
"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": "3914",
"name": "psoriasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"question": "A 67-year-old lawyer has a productive cough which started yesterday. She has also had a flare-up of her psoriasis over the last month. Her repeat medications have recently been altered following a diagnosis of angina pectoris 2 months ago. She has a 50-pack-year smoking history and also takes sertraline for depression. She is allergic to penicillin and sulphonamides.\n\nWhich of the following drugs is most likely to be contributing to her flare-up of psoriasis?",
"sbaAnswer": [
"a"
],
"totalVotes": 454,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,058 | false | 12 | null | 6,495,044 | null | false | [] | null | 13,256 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mebendazole is used to treat threadworm infection, not scabies mites infection.",
"id": "10003547",
"label": "b",
"name": "Mebendazole",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical corticosteroids are known to exacerbate some conditions, particularly infections such as tinea and scabies.",
"id": "10003550",
"label": "e",
"name": "Hydrocortisone 5% cream",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Malathion is also an insecticide that can kill scabies mites. However, it is not used first-line to treat scabies. Malathion 0.5% lotion is used if permethrin is ineffective.",
"id": "10003548",
"label": "c",
"name": "Malathion",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ivermectin is an insecticide but is not used first-line to treat scabies. It is more commonly used to treat papulopustular rosacea and in combination with topical drugs to treat Norwegian/crusted scabies that hasn't responded to topical treatment alone.",
"id": "10003549",
"label": "d",
"name": "Ivermectin",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Permethrin 5% cream is the first-line management for the treatment of scabies. It should be applied once weekly for two doses all over the body, not including the head and face. The care home residents who have been in close contact with the worker and all members of her household should also be treated.",
"id": "10003546",
"label": "a",
"name": "Permethrin",
"picture": null,
"votes": 397
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3915",
"name": "scabies",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3915,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"likes": 1,
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"question": "A 27-year-old woman works part-time in a care home. She presents to her GP as she started itching her arms a lot over the last few days. Some of the care home residents are also complaining of similar symptoms.\n\nOn inspection, she has visible burrows on her arms.\n\nWhat is the most appropriate medical management that the GP should prescribe?",
"sbaAnswer": [
"a"
],
"totalVotes": 455,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,059 | false | 13 | null | 6,495,044 | null | false | [] | null | 13,257 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has suffered an inferior wall STEMI. This occurs when the inferior cardiac tissue receives insufficient blood flow from the right coronary artery. This can be seen as ST-segment elevation in the inferior ECG leads (II, III, aVF)",
"id": "10003551",
"label": "a",
"name": "Right coronary artery",
"picture": null,
"votes": 416
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Occlusion of the left anterior descending artery results in an anterior infarction. ECGs commonly show ST elevation in leads V1-6 and AVL. Anterior infarctions can be further classified into septal leads (V1-2), anterior leads (V3-4) and lateral leads (V5-6).",
"id": "10003554",
"label": "d",
"name": "Left anterior descending",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The left main coronary artery arises from the left coronary cusp and bifurcates into the left anterior descending (LAD) and left circumflex arteries. This causes ST elevation in aVR which is usually greater than the ST elevation in V1. Early identification is important as acute occlusion can cause rapid haemodynamic and electrical deterioration.",
"id": "10003552",
"label": "b",
"name": "Left main coronary artery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The obtuse marginal artery is a branch of the lateral circumflex artery and supplies the lateral wall of the left ventricle. Occlusion of this artery usually causes a lateral MI.",
"id": "10003553",
"label": "c",
"name": "Obtuse marginal artery",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The left circumflex artery supplies the lateral wall of the left ventricle and causes ST elevation in the lateral leads (I,aVL, V5-6).",
"id": "10003555",
"label": "e",
"name": "Left circumflex artery",
"picture": null,
"votes": 12
}
],
"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": "3713",
"name": "Myocardial infarction and Acute Coronary Syndrome (ACS)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3713,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13257",
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"learningPoint": null,
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"question": "A 55-year-old female presents to ED complaining of excruciating central chest pain which radiates to the jaw. Investigations are carried out to find the underlying cause.\n\nA 12-lead ECG is performed which shows ST elevation in leads II, III and aVF.\n\nWhich artery has been occluded in this myocardial infarction?",
"sbaAnswer": [
"a"
],
"totalVotes": 458,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,060 | false | 14 | null | 6,495,044 | null | false | [] | null | 13,258 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neutropenia is seen in multiple myeloma, but abnormal neutrophils do not cause myeloma.",
"id": "10003559",
"label": "d",
"name": "Neutrophils",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "B cells differentiate into plasma cells.",
"id": "10003557",
"label": "b",
"name": "B cell",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a diagnosis of multiple myeloma. There are a few clues in the history which point to multiple myeloma such as his pathological fracture (which is likely due to the lytic lesions found in his radius) and his hypercalcaemia.\n\nMultiple myeloma cells are abnormal plasma cells that build up in the bone marrow and form tumours within the bones.",
"id": "10003556",
"label": "a",
"name": "Plasma cell",
"picture": null,
"votes": 284
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Abnormal myeloblasts are commonly seen in acute myeloid leukaemia, not multiple myeloma.",
"id": "10003560",
"label": "e",
"name": "Myeloblasts",
"picture": null,
"votes": 104
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myeloma causes the impairment of T-cell function, but abnormal T-cells do not cause myeloma.",
"id": "10003558",
"label": "c",
"name": "T cell",
"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": "3923",
"name": "myeloma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3923,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13258",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 71-year-old man presents to A&E following a fall. His x-rays show a fracture in the distal 1/3 of his right radius. The radiologist also comments on osteolytic lesions in his distal radius. His fracture is managed conservatively.\n\n\nBlood tests are performed which show a haemoglobin of 140 g/L (normal range 130-170 g/L) and calcium of 2.7 mmol/L (2.2-2.6 mmol/L).\n\n\nWhich type of cell most commonly causes this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 460,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,061 | false | 15 | null | 6,495,044 | null | false | [] | null | 13,259 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no contraindications to the use of eplerenone and statins together.",
"id": "10003564",
"label": "d",
"name": "Eplerenone",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although simvastatin and ivabradine together can induce bradycardia, research has shown that there is no impact on systolic, diastolic or mean blood pressure.",
"id": "10003565",
"label": "e",
"name": "Ivabradine",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Macrolides, such as clarithromycin, should be used cautiously with statins as they can increase the risk of myopathy. Patients should be informed to look for signs of myopathy (i.e. unexplained muscle pain or tenderness, weakness or dark-coloured urine).",
"id": "10003561",
"label": "a",
"name": "Simvastatin",
"picture": null,
"votes": 265
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ACE inhibitors do not interact with statins.",
"id": "10003562",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no adverse interactions between beta-blockers and statins.",
"id": "10003563",
"label": "c",
"name": "Bisoprolol",
"picture": null,
"votes": 27
}
],
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"id": "4177",
"name": "Statins",
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"id": "134",
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"typeId": 7
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"question": "A 48-year-old woman presents to A&E with an acute history of epigastric pain, nausea and vomiting. She has a past medical history of heart failure and hyperlipidaemia. Her current medications are simvastatin, ramipril, bisoprolol, eplerenone and ivabradine. She is diagnosed with an H.pylori infection and is started on clarithromycin, amoxicillin and omeprazole.\n\nWhich of her medications are you most likely to stop during this treatment?",
"sbaAnswer": [
"a"
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"totalVotes": 459,
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173,461,062 | false | 16 | null | 6,495,044 | null | false | [] | null | 13,260 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atrial fibrillation usually presents with palpitations, dyspnoea and chest pain. Patients also have an irregularly irregular pulse. It usually doesn't cause a murmur.",
"id": "10003567",
"label": "b",
"name": "Atrial fibrillation",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Complete heart block can present similarly with syncopal episodes, however, can also cause bradycardia (30-50 bpm) and a wide pulse pressure. A mid-late blowing diastolic murmur (Rytand murmur) is occasionally heard in these patients.",
"id": "10003568",
"label": "c",
"name": "Complete heart block",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vestibular neuronitis can present with recurrent attacks of vertigo. It is important to not confuse vertigo with dizziness. Vertigo is defined as feeling as though you or your surroundings are spinning, whilst dizziness can be characterised by a range of sensations such as feeling light-headed, faint, woozy, off-balance or weak.",
"id": "10003570",
"label": "e",
"name": "Vestibular neuronitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has not reported feeling dizzy, light-headed or nauseous when standing up suddenly. Hence, postural hypotension is an unlikely diagnosis.",
"id": "10003569",
"label": "d",
"name": "Postural hypotension",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Aortic stenosis characteristically causes a mild ejection-systolic murmur which radiates to the carotids. The most common sign and best indicator of severity is a slow-rising pulse. Aortic stenosis typically presents with chest pain, dyspnoea and syncope/presyncope.",
"id": "10003566",
"label": "a",
"name": "Aortic stenosis",
"picture": null,
"votes": 427
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Doesn't Aortic regurgitation radiate to the left sternal edge and Aortic stenosis to the carotids?",
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"question": "A 50-year-old female is admitted to the hospital after an episode of collapse. She reveals that she's recently had several attacks of faintness, mostly on exertion. During these attacks, she feels lightheaded but does not have vertigo.\n\nOn examination, she has a pulse of 70 bpm which is slow rising, and a blood pressure of 110/80 mmHg. A systolic murmur can be heard at the left sternal edge.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
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173,461,063 | false | 17 | null | 6,495,044 | null | false | [] | null | 13,261 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Mitral stenosis causes a mid-diastolic murmur due to the passive flow of blood from the left atrium to the left ventricle through a stenosed mitral valve during diastole.\n\nAtrial fibrillation occurs in mitral stenosis due to increased left atrial pressure which leads to electrical remodelling and hypertrophy of the left atrium.",
"id": "10003571",
"label": "a",
"name": "Mitral stenosis",
"picture": null,
"votes": 289
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic stenosis typically causes an ejection-systolic crescendo-decrescendo murmur due to the narrowing of the aortic valve.",
"id": "10003573",
"label": "c",
"name": "Aortic stenosis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is technically possible for symptoms of hypertrophic cardiomyopathy to present this late in life, however, HCM most commonly presents in mid-life. Symptoms of HCM include exertional dyspnoea, chest pain, fatigue and exertional syncope. It also usually causes an ejection-systolic murmur.",
"id": "10003574",
"label": "d",
"name": "Hypertrophic cardiomyopathy (HCM)",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mitral regurgitation causes a pan-systolic murmur due to the retrograde flow of blood from the left ventricle into the left atrium.",
"id": "10003575",
"label": "e",
"name": "Mitral regurgitation",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic regurgitation causes an early diastolic murmur due to the backflow of blood through an inadequately closed aortic valve.",
"id": "10003572",
"label": "b",
"name": "Aortic regurgitation",
"picture": null,
"votes": 100
}
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"name": "Mitral stenosis",
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"question": "A 79-year-old female visits her GP as she has been experiencing increasing breathlessness on exertion over the last 6 months.\n\nOn examination, her pulse is 72 bpm and is irregularly irregular. Her blood pressure is 117/74 mmHg. Her GP notices a diastolic murmur on auscultation.\n\nWhat is the most likely cause of her murmur?",
"sbaAnswer": [
"a"
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173,461,064 | false | 18 | null | 6,495,044 | null | false | [] | null | 13,262 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A CTPA scan can be used to diagnose reduced LV function but is not the first-line imaging technique recommended by NICE.",
"id": "10003577",
"label": "b",
"name": "Computerised tomography pulmonary angiography (CTPA)",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "D-dimer can be used as a prognostic factor in patients with heart failure but is not used in its diagnosis.",
"id": "10003580",
"label": "e",
"name": "Serum D-dimer",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This man has developed heart failure. An echocardiogram will show poor left ventricular (LV) function and reduced ejection fraction. NT-pro-BNP is used to determine the urgency of the echocardiogram.",
"id": "10003576",
"label": "a",
"name": "Echocardiography",
"picture": null,
"votes": 333
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Coronary angiography is considered the best method for diagnosing coronary heart disease.",
"id": "10003578",
"label": "c",
"name": "Coronary angiography",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Heart failure can cause an abnormal ECG, but ECG changes are not enough to be able to diagnose heart failure.",
"id": "10003579",
"label": "d",
"name": "Electrocardiogram (ECG)",
"picture": null,
"votes": 15
}
],
"comments": [],
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"id": "3798",
"name": "Heart Failure",
"status": null,
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"name": "Cardiology",
"typeId": 7
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"question": "A 68-year-old retired electrician is currently an inpatient on the cardiology ward. He complains of worsening breathlessness that woke him up during the night. He had a myocardial infarction 4 months ago.\n\nHis pulse is 99 bpm, blood pressure is 162/101 and respiratory rate is 20 breaths/minute.\n\nAuscultation of his chest reveals bibasal crepitations and there is a dullness to percussion of both bases.\n\nHis chest x-ray shows small bilateral pleural effusions with upper lobe blood vessel diversion.\n\nWhat is the most appropriate diagnostic investigation for this man's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 453,
"typeId": 1,
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173,461,065 | false | 19 | null | 6,495,044 | null | false | [] | null | 13,263 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypertrophic obstructive cardiomyopathy is the commonest cause of sudden cardiac death in young patients. Patients with HOCM also tend to experience exertional dyspnoea and syncope. However, prolonged QT segments are not consistent with the diagnosis of HOCM. Features of HOCM include left ventricular hypertrophy, ST changes including T wave inversion, and deep Q waves.",
"id": "10003585",
"label": "e",
"name": "Hypertrophic obstructive cardiomyopathy (HOCM)",
"picture": null,
"votes": 206
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "There are congenital and acquired causes of long QT syndrome, and this patient's cousin likely has a congenital cause. In long QT syndrome, there is delayed repolarisation of the ventricles which can lead to ventricular tachycardia/torsade de pointes. These tachyarrhythmias can lead to collapse or even sudden death. Long QT syndrome is also associated with seizures and palpitations.",
"id": "10003581",
"label": "a",
"name": "Ventricular tachyarrhythmia",
"picture": null,
"votes": 226
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Complete heart block can also present with syncopal episodes, and if untreated, can lead to sudden cardiac arrest. However, most causes of heart block are acquired, not genetic. Indeed, most cases of heart block present at older ages.",
"id": "10003582",
"label": "b",
"name": "Complete heart block",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Strokes are uncommon in teenagers (the patient's cousins passed away in their teens). This patient is also not presenting with the typical features of a stroke.",
"id": "10003584",
"label": "d",
"name": "Stroke",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient does not describe any of the typical symptoms of a pulmonary embolism, such as pleuritic chest pain, dyspnoea, tachycardia and tachypnoea. Furthermore, pulmonary embolism is rare in adolescents.",
"id": "10003583",
"label": "c",
"name": "Pulmonary embolism",
"picture": null,
"votes": 2
}
],
"comments": [],
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"id": "4178",
"name": "Arrhythmias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 27-year-old female seeks advice after having a 'funny turn'. She fainted for a few minutes and then regained consciousness and has felt fine since. She mentions that two of her maternal first cousins died in their teens while swimming.\n\nAn electrocardiogram (ECG) is carried out, which shows a QTc interval of 560ms (reference <460 ms)\n\nWhat is the most likely cause of her cousins' deaths?",
"sbaAnswer": [
"a"
],
"totalVotes": 452,
"typeId": 1,
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} | MarksheetMark |
173,461,066 | false | 20 | null | 6,495,044 | null | false | [] | null | 13,264 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Renal artery stenosis is caused by atherosclerosis. It is often seen in older people and can worsen over time, often resulting in hypertension and kidney damage. This patient is too young for renal artery stenosis to be the likely diagnosis.",
"id": "10003587",
"label": "b",
"name": "Renal artery stenosis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of coarctation of the aorta. It can present in adulthood as well as in infancy. The notching of the ribs is not seen in young children but is seen in adults due to the formation of collateral vessels.",
"id": "10003586",
"label": "a",
"name": "Coarctation of the aorta",
"picture": null,
"votes": 246
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the typical presentation of Ehlers-Danlos syndrome. Common findings in Ehlers-Danlos syndrome include hyperelasticity of the skin, and hypermobility of joints which are prone to sprains, dislocation and subluxation. Rare symptoms include easy bruising and aneurysms.",
"id": "10003589",
"label": "d",
"name": "Ehlers-Danlos syndrome",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Asthma usually develops in childhood, but can also present for the first time in adults. However, this patient does not have any of the typical features of asthma.",
"id": "10003590",
"label": "e",
"name": "Asthma",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This individual is very tall, as are most patients with Marfan's syndrome. But none of the other physical findings associated with Marfan syndrome are mentioned in the history, such as ectopia lentis (upward dislocated lens), arachnodactyly, loose joints, wingspan to arm ratio >1.05, pectus excavatum or aortic dissection/dilation.",
"id": "10003588",
"label": "c",
"name": "Marfan's syndrome",
"picture": null,
"votes": 193
}
],
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"id": "4179",
"name": "Aortic coarctation",
"status": null,
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"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 25-year-old man presents to his GP complaining of shortness of breath. He is found to have a radio-femoral delay, and rib notching is noticed on a CXR. His blood pressure is raised. His pulmonary exam is normal.\n\nHis height and weight are measured and are 196cm and 92 kg respectively.\n\nWhat is the most likely diagnosis in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 454,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,067 | false | 21 | null | 6,495,044 | null | false | [] | null | 13,266 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's normal sensory examination makes a neuropathic ulcer unlikely.",
"id": "10003597",
"label": "b",
"name": "Neuropathic ulcer",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Arterial ulcers are the result of insufficient tissue perfusion secondary to atherosclerosis. This results in ischaemia and subsequent skin breakdown. This patient's ABPI of 0.68 ABPI is indicative of peripheral arterial disease which is associated with the development of arterial ulcers. Furthermore, this patient's history of myocardial infarction increases the likelihood of her having systemic atherosclerosis.",
"id": "10003596",
"label": "a",
"name": "Arterial ulcer",
"picture": null,
"votes": 349
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's ABPI, examination, and history of myocardial infarction point towards an arterial ulcer as opposed to a venous one.",
"id": "10003599",
"label": "d",
"name": "Venous ulcer",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this patient has a history of diabetes, she has no history of diabetic neuropathy or reduced sensation.",
"id": "10003600",
"label": "e",
"name": "Diabetic ulcer",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no mention of a traumatic process or injury in this patient's history.",
"id": "10003598",
"label": "c",
"name": "Traumatic ulcer",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4181",
"name": "Ulcers",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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"question": "A 57-year-old woman presents to her GP with an ulcer over her left heel. She works as a construction site manager and has a past medical history of diabetes as well as a myocardial infarction 3 years ago.\n\nOn examination, the ulcer is 3.5cm in diameter and deeply penetrating. Her sensory examination is normal, and her doppler ratio on the left is 0.68 and 0.98 on the right.\n\nWhat's the most likely mechanism of this ulcer?",
"sbaAnswer": [
"a"
],
"totalVotes": 445,
"typeId": 1,
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173,461,068 | false | 22 | null | 6,495,044 | null | false | [] | null | 13,267 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Itraconazole is an alternative treatment for dermatophyte infections. However, it is typically given orally, not topically.",
"id": "10003603",
"label": "c",
"name": "Topical itraconazole",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a fungal nail infection which can be treated with antifungal medication. Oral terbinafine is first line in the treatment of confirmed dermatophyte nail infections.",
"id": "10003601",
"label": "a",
"name": "Oral terbinafine",
"picture": null,
"votes": 341
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical nystatin can also be used to treat fungal nail infections, however, it is not used as a first-line treatment.",
"id": "10003604",
"label": "d",
"name": "Topical nystatin",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical treatment with voriconazole can be considered if the infection involves just the tip of the toenail, but this patient's infection is quite widespread.",
"id": "10003605",
"label": "e",
"name": "Topical voriconazole",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intravenous infusions of amphotericin B are used as empirical treatment for potentially life-threatening fungal infections, such as aspergillosis or cryptococcosis.",
"id": "10003602",
"label": "b",
"name": "Intravenous amphotericin B",
"picture": null,
"votes": 1
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4182",
"name": "Fungal infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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},
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"question": "A 69-year-old man presents to his GP as he is unhappy with how his toenails are growing. He is a known diabetic.\n\nOn examination, his toe web spaces are macerated. His GP notices that several of his toenails have white and yellow opaque streaks and that the end of some of his toenails have lifted up. Yellow spots are also evident in the lanula.\n\nMicroscopy and culture of nail clippings show trichophyton tonsurans.\n\nWhat is the most appropriate treatment for this gentleman's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,069 | false | 23 | null | 6,495,044 | null | false | [] | null | 13,268 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mutations in the CARD14 gene have been shown to be associated with psoriasis.",
"id": "10003607",
"label": "b",
"name": "CARD14",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anti-synthetase antibodies, particularly anti-Jo-1, are associated with a type of polymyositis that includes respiratory involvement, Raynaud's syndrome and fever. It is also associated with the cutaneous variant of polymyositis, called dermatomyositis.",
"id": "10003610",
"label": "e",
"name": "Anti-synthetase antibodies (Anti Jo-1)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HLA antigens are encoded by genes on chromosome 6. HLA-DR4 is associated with type 1 diabetes mellitus and rheumatoid arthritis.",
"id": "10003609",
"label": "d",
"name": "HLA-DR4",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HLA-DQ2 and HLA-DQ8 are important HLA antigens to remember as they are associated with coeliac disease. They are encoded by genes on chromosome 6.",
"id": "10003608",
"label": "c",
"name": "HLA-DQ2 and HLA-DQ8",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A mutation in the filaggrin gene has been implicated in up to 50% of eczema cases. FLG encodes filaggrin, a protein required for the skin to perform its role as an effective barrier. A deficiency in FLG is thought to allow antigens access through the skin where they can initiate an immune and inflammatory response.",
"id": "10003606",
"label": "a",
"name": "Filaggrin gene",
"picture": null,
"votes": 295
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3982",
"name": "Atopic Dermatitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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},
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"question": "A 3-year-old girl is brought to her GP by her mother. She complains of dryness, redness and scaling on her daughter's arms. Her daughter is constantly itching her arms. She is worried about a diagnosis of atopic eczema. The GP advises using emollients after bathing and avoiding triggers.\n\nWhich of the following options is most associated with atopic eczema?",
"sbaAnswer": [
"a"
],
"totalVotes": 440,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,070 | false | 24 | null | 6,495,044 | null | false | [] | null | 13,269 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The management of facial eczema requires the use of a low-strength steroid cream, such as hydrocortisone.",
"id": "10003611",
"label": "a",
"name": "Topical hydrocortisone",
"picture": null,
"votes": 323
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tacrolimus ointment is used to treat symptoms of eczema in patients who either can't use other steroids or haven't responded to them.",
"id": "10003615",
"label": "e",
"name": "Topical tacrolimus",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Betamethasone is a moderate-potency steroid and is too strong for this mild case of eczema. It may be used in short bursts in cases of severe eczema.",
"id": "10003612",
"label": "b",
"name": "Betamethasone (Betnovate®)",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient is already using an emollient (aqueous cream).",
"id": "10003614",
"label": "d",
"name": "Emollient ointment",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dithranol is used to treat chronic plaque psoriasis, not eczema.",
"id": "10003613",
"label": "c",
"name": "Dithranol",
"picture": null,
"votes": 0
}
],
"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": "3982",
"name": "Atopic Dermatitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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"question": "A 4-month-old girl was diagnosed with eczema two months ago.\n\nShe is currently having a non-infective flare-up on her face, despite the frequent use of aqueous cream.\n\nWhat is the most appropriate treatment?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,071 | false | 25 | null | 6,495,044 | null | false | [] | null | 13,270 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would not expect to see a raised WCC and lymphocytosis in multiple myeloma",
"id": "10003617",
"label": "b",
"name": "Multiple myeloma",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would also expect to see Reed-Sternberg cells on lymph node biopsy in HL. A normocytic anaemia may also be seen.",
"id": "10003618",
"label": "c",
"name": "Hodgkin's lymphoma (HL)",
"picture": null,
"votes": 98
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no risk factors for TB in this case such as HIV, immunosuppression or IV drug use. Symptoms of TB include weight loss, night sweats, cough +/- haemoptysis and shortness of breath.",
"id": "10003620",
"label": "e",
"name": "Tuberculosis (TB)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Chronic lymphocytic leukaemia occurs due to the proliferation of well-differentiated lymphocytes which are mostly non-functional. This leads to immunosuppression and increased infections. Lymphocytosis is commonly seen in CLL.",
"id": "10003616",
"label": "a",
"name": "Chronic lymphocytic leukaemia (CLL)",
"picture": null,
"votes": 325
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Recurrent pneumonia is commonly seen in small-cell lung cancer. You may also see other features such as shortness of breath, cough and haemoptysis. There are no signs of small cell lung cancer cells in this patient's lymph node biopsy.",
"id": "10003619",
"label": "d",
"name": "Small cell lung cancer",
"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": "4183",
"name": "Chronic lymphocytic leukaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4183,
"conditions": [],
"difficulty": 1,
"dislikes": 5,
"explanation": null,
"highlights": [],
"id": "13270",
"isLikedByMe": 0,
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"question": "A 79-year-old female has a chest infection that is slow to clear despite several courses of broad-spectrum oral antibiotics.\n\n\nHer bloods are taken which show the following results:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|126 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|38x10<sup>9</sup>/L|3.0 - 10.0|\n|Lymphocytes|32x10<sup>9</sup>/L|1.5 - 4.0|\n|Platelets|124x10<sup>9</sup>/L|150 - 400|\n\n\nA large cervical node is biopsied which under microscopy shows a sheet of mainly small lymphoid cells.\n\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 443,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,072 | false | 26 | null | 6,495,044 | null | false | [] | null | 13,271 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If this artery was affected, the patient would experience symptoms on the left as opposed to the right.",
"id": "10003622",
"label": "b",
"name": "Right middle cerebral",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Middle cerebral artery strokes are more common than anterior cerebral artery strokes. Even though left anterior cerebral artery strokes affect the right side of the body, patients typically experience sensory loss and lower limb weakness.",
"id": "10003624",
"label": "d",
"name": "Left anterior cerebral",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cerebellar strokes affect balance and coordination and there are no signs of ataxia or loss of coordination in this patient, making this option unlikely.",
"id": "10003625",
"label": "e",
"name": "Left superior cerebellar stroke",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is less likely that this artery is affected because middle cerebral artery strokes are more common. If the anterior cerebral artery was affected then the patient would have experienced contralateral (left) sensory loss and lower limb weakness. This patient has weakness and sensory loss predominantly of the right upper limb.",
"id": "10003623",
"label": "c",
"name": "Right anterior cerebral",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing sensory loss and weakness on his right side, therefore the artery that is affected is on the contralateral side (i.e. the left).\nmiddle cerebral artery strokes typically spare the leg which is the case with this patient. Anterior cerebral artery strokes, however, present with contralateral sensory loss and lower limb weakness.",
"id": "10003621",
"label": "a",
"name": "Left middle cerebral",
"picture": null,
"votes": 318
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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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,
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"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 58-year-old man with a past medical history of Type 2 diabetes and hypertension presents to A&E with a sudden loss of sensation and weakness in his right arm. On examination, the power of his right arm is 1/5 on the MRC scale and the reflexes of the right arm are absent. The power and sensation of the right leg is preserved.\n\nWhich artery is most likely to have been affected?",
"sbaAnswer": [
"a"
],
"totalVotes": 444,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,073 | false | 27 | null | 6,495,044 | null | false | [] | null | 13,272 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has a past medical history of polymyalgia rheumatica which can explain the elevated ESR, however, does not explain the pancytopenia or his current symptoms. PMR would present with shoulder and pelvic girdle stiffness, not lumbar spine pain and weight loss.",
"id": "10003628",
"label": "c",
"name": "Polymyalgia rheumatica (PMR)",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would explain the patient's lumbar spine pain, weight loss as well as the elevated ESR. However, this would not explain the pancytopenia which makes this an unlikely diagnosis.",
"id": "10003630",
"label": "e",
"name": "Discitis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The symptoms of lumbar spine pain and unintentional weight loss suggest malignancy. There is also pancytopenia and raised ESR which is classically seen in multiple myeloma. Patients are also likely to have raised calcium and signs of renal impairment.",
"id": "10003626",
"label": "a",
"name": "Multiple myeloma",
"picture": null,
"votes": 383
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a haematological cancer which can cause pancytopenia and unintentional weight loss. However, Hodgkin's lymphoma is less likely in patients of this age group than multiple myeloma.",
"id": "10003629",
"label": "d",
"name": "Hodgkin's lymphoma",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient does have a past medical history of osteoarthritis, but this would not explain the presence of pancytopenia or red-flag symptoms like weight loss.",
"id": "10003627",
"label": "b",
"name": "Osteoarthritis of the spine",
"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": "3923",
"name": "myeloma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"dislikes": 0,
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"question": "An 82-year-old man has been admitted to the acute medical unit because he has lumbar spine pain and he is worried that he has lost 5kg in the past month. He has a past medical history of osteoarthritis and polymyalgia rheumatica. Physical examination is unremarkable.\n\n\nBlood tests show:\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|115 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|2x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|100x10<sup>9</sup>/L|150 - 400|\n|Erythrocyte Sedimentation Rate (ESR)|115 mm/hr|< 20|\n\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 442,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,074 | false | 28 | null | 6,495,044 | null | false | [] | null | 13,273 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst Paget's disease commonly affects the pelvis and patients often experience bone pain, they do not typically complain of muscle weakness. Patient's with Paget's disease tend to have normal phosphate and calcium levels, and a raised ALP.",
"id": "10003634",
"label": "d",
"name": "Paget's disease",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the patient had polymyalgia rheumatica, then they would have complained of shoulder and pelvic girdle stiffness as opposed to worsening left hip pain. They would also have normal phosphate and calcium concentrations (but may have elevated ALP).",
"id": "10003635",
"label": "e",
"name": "Polymyalgia rheumatica",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst patients with osteoarthritis would also present with hip pain, they would not experience muscle weakness nor would there be any changes to their phosphate, calcium or ALP levels.",
"id": "10003633",
"label": "c",
"name": "Osteoarthritis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Polymyositis is associated with bilateral proximal muscle weakness developing over weeks to months. 5-15% of cases of polymyositis are secondary to an underlying malignancy; there are no red flag symptoms in this case. Patients who have polymyositis also tend to have a raised creatine kinase.",
"id": "10003632",
"label": "b",
"name": "Polymyositis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Osteomalacia occurs due to inadequate levels of calcium, phosphate or vitamin D. This patient has Coeliac disease which can cause malabsorption and lead to osteomalacia. The symptoms that the patient experiences are also characteristic of this - bone pain (typically lower back, pelvis and lower extremities), myalgia, and weakness of quadriceps and gluteal muscles. Low phosphate and calcium and raised ALP point to\nosteomalacia as the likely diagnosis.",
"id": "10003631",
"label": "a",
"name": "Osteomalacia",
"picture": null,
"votes": 301
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4184",
"name": "Osteomalacia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "190",
"name": "Musculoskeletal",
"typeId": 7
},
"topicId": 190,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4184,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13273",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"question": "A 75-year-old female with a past medical history of Coeliac disease presents with worsening left hip pain. There is no recent history of falls, but she states feeling unsteady and weak when walking and getting up from sitting.\n\n\nBlood tests show:\n\n\n||||\n|---------------------------|:-------:|------------------------------|\n|Calcium|1.8 mmol/L|2.2 - 2.6|\n|Phosphate|0.5 mmol/L|0.8 - 1.5|\n|Alkaline Phosphatase (ALP)|148 IU/L|25 - 115|\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 443,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,075 | false | 29 | null | 6,495,044 | null | false | [] | null | 13,274 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lateral collateral ligament tears commonly occur when there is a blow to the medial aspect of the knee, pushing it outwards (laterally), which can happen during contact sports. It also presents with inflammation and tenderness; however, it is not associated with a posterior sag or a positive posterior draw test.",
"id": "10003639",
"label": "d",
"name": "Lateral collateral ligament",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Medial collateral ligament tears occur when a lateral force or pressure pushes the knee inwards (medially), which can happen during contact sports. It also presents with inflammation and tenderness; however, it is not associated with a posterior sag or a positive posterior draw test.",
"id": "10003640",
"label": "e",
"name": "Medial collateral ligament",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Common causes of an anterior cruciate ligament tear are sudden twisting motions of the knee such as landing awkwardly whilst playing sports. On examination, patients have a positive anterior draw test as opposed to a positive posterior draw test.",
"id": "10003637",
"label": "b",
"name": "Anterior cruciate ligament",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A common cause of injury to the posterior cruciate ligament is a \"dashboard injury\", in which there is a powerful force on the knee anteriorly which causes a tear. The examination findings, in this case, are consistent with a posterior cruciate ligament injury as there is inflammation, tenderness, posterior sag and a positive posterior draw test.",
"id": "10003636",
"label": "a",
"name": "Posterior cruciate ligament",
"picture": null,
"votes": 405
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The medial meniscus is a structure within the knee joint, but it's not a ligament; it is a type of cartilage between the medial tibia and the medial femur. A medial meniscus tear would present with inflammation and pain; however, it is not associated with a posterior sag or a positive posterior draw test.",
"id": "10003638",
"label": "c",
"name": "Medial meniscus",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4185",
"name": "Cruciate ligament tears",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
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"difficulty": 1,
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"question": "A 36-year-old man presents following a car crash with knee pain. On examination, there is inflammation over the knee and it is tender on palpation anteriorly and posteriorly. There is also a posterior sag present and the posterior draw test is positive.\n\nWhich ligament is most likely to be affected?",
"sbaAnswer": [
"a"
],
"totalVotes": 444,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,076 | false | 30 | null | 6,495,044 | null | false | [] | null | 13,275 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The plantar fascia can tear or rupture when jumping or falling from a height. Patients with this injury are likely to experience sharp pain, bruising, and swelling around the heel of their foot as well their arch.",
"id": "10003642",
"label": "b",
"name": "Plantar fascia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Posterior talofibular ligament tears are also due to inversion injuries, so they would present similarly with reduced ability to weight bear, pain and tenderness laterally. However, this is less common than an\nanterior talofibular ligament tear.",
"id": "10003644",
"label": "d",
"name": "Posterior talofibular ligament",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In inversion injuries of the ankle, the most common ligament group affected is the lateral ligament complex. Within that, the most commonly damaged ligament is the anterior talofibular ligament. Patients experience pain and inflammation, just like the patient in this scenario.",
"id": "10003641",
"label": "a",
"name": "Anterior talofibular ligament",
"picture": null,
"votes": 290
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The lateral collateral ligament is part of the knee joint, not the ankle joint, so whilst a patient with a lateral collateral ligament injury would have reduced ability to weight bear, they would not have pain and tenderness of the ankle like the patient in this question.",
"id": "10003645",
"label": "e",
"name": "Lateral collateral ligament",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deltoid ligament tears are very rare and usually happen after eversion injuries or if there is direct trauma to the ankle. Patients with deltoid ligament tears similarly experience a reduced ability to weight bear, but they also have pain and swelling over the medial aspect of their ankle.",
"id": "10003643",
"label": "c",
"name": "Deltoid ligament",
"picture": null,
"votes": 31
}
],
"comments": [],
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4186",
"name": "Foot fractures",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"dislikes": 1,
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"question": "A 17-year-old male presents to A&E with a painful right foot. He states that he was playing football and landed heavily on his right foot and that it rolled inwards. On examination, he has a reduced ability to weight bear on the right foot, and there is swelling and pain, particularly over the lateral aspect of the foot.\n\nWhich ligament is most likely to be torn?",
"sbaAnswer": [
"a"
],
"totalVotes": 441,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,077 | false | 31 | null | 6,495,044 | null | false | [] | null | 13,276 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Normally, the second-line management would be to add an NSAID; however, this patient has contraindications to NSAID by way of his peptic ulcers and impaired renal function. Hence, a weak opioid such as tramadol should be opted for instead.",
"id": "10003646",
"label": "a",
"name": "Tramadol",
"picture": null,
"votes": 208
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a strong opioid which can be given to arthritis patients if they experience severe pain, but this is not the most appropriate analgesic to add at this stage because a weaker opioid has not been trialled yet.",
"id": "10003650",
"label": "e",
"name": "Morphine",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a disease-modifying antirheumatic drug (DMARD) which is commonly used in the management of rheumatoid arthritis. It has no place in the pain management of osteoarthritis.",
"id": "10003648",
"label": "c",
"name": "Methotrexate",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an NSAID which can be used to manage pain caused by osteoarthritis, but not in this patient as they have peptic ulcers and impaired kidney function.",
"id": "10003647",
"label": "b",
"name": "Diclofenac",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a tricyclic antidepressant which can be used for neuropathic pain and chronic pain associated with osteoarthritis. However, tramadol should be trialled before neuropathic agents.",
"id": "10003649",
"label": "d",
"name": "Amitriptyline",
"picture": null,
"votes": 79
}
],
"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": "3766",
"name": "Osteoarthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
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"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3766,
"conditions": [],
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"question": "A 79-year-old man presents to the GP as he has continued to have joint pain even whilst on the maximum paracetamol dose and after applying topical capsaicin. He has a past medical history of peptic ulcers and\nchronic kidney disease.\n\nWhat is the most appropriate additional analgesic?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,078 | false | 32 | null | 6,495,044 | null | false | [] | null | 13,277 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely because it is the most common hip disorder in adolescents and does not typically affect children. It would also have different X-ray findings: short displaced epiphysis and widened growth\nplate.",
"id": "10003653",
"label": "c",
"name": "Slipped upper femoral epiphysis",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Perthes disease is common in boys aged 4-8 and tends to persist for > 4 weeks which is consistent with the child in this question. The diagnosis of Perthes disease is supported by the X-ray findings of sclerosis and fragmentation of the epiphysis, which are characteristic of this disease.",
"id": "10003651",
"label": "a",
"name": "Perthes disease",
"picture": null,
"votes": 303
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient does experience pain, but there are no other signs or symptoms of osteomyelitis such as fever, erythema or swelling. The patient also does not have any risk factors for osteomyelitis as they are generally well.",
"id": "10003655",
"label": "e",
"name": "Osteomyelitis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is also a cause of a limp in children and commonly affects children aged 3-11. However, this is generally preceded by a viral infection 1-2 weeks before the development of pain and the limp. The pain and limp do not typically last for longer than 2 weeks.",
"id": "10003652",
"label": "b",
"name": "Transient synovitis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely because whilst the patient has groin pain, there is no mention of joint swelling. The patient also experiences no other systemic symptoms and is otherwise well.",
"id": "10003654",
"label": "d",
"name": "Juvenile idiopathic arthritis",
"picture": null,
"votes": 41
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3769",
"name": "Perthes disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3769,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
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"id": "13277",
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"multiAnswer": null,
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"question": "A 6-year-old boy presents to his GP with a gradual onset limp and intermittent groin pain whilst climbing the stairs. The pain has persisted for 5 weeks now. On examination, there is reduced movement of the hip joint. The patient is otherwise well.\n\nAn X-ray shows sclerosis and fragmentation of the epiphysis.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 433,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,079 | false | 33 | null | 6,495,044 | null | false | [] | null | 13,278 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mast cells can sometimes be elevated, but it is not the most common inflammatory cell type associated with asthma.",
"id": "10003659",
"label": "d",
"name": "Mast cells",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In some patients with asthma, there are elevated neutrophils, but it is not the most common inflammatory cell type associated with asthma.",
"id": "10003657",
"label": "b",
"name": "Neutrophils",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Monocytes are not commonly associated with asthma.",
"id": "10003660",
"label": "e",
"name": "Monocytes",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is having an asthma attack. The main inflammatory cell associated with this is eosinophils - this indicates that there is airway inflammation.",
"id": "10003656",
"label": "a",
"name": "Eosinophils",
"picture": null,
"votes": 343
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Basophils can sometimes be elevated in asthma, but it is not the most common inflammatory cell type associated with it.",
"id": "10003658",
"label": "c",
"name": "Basophils",
"picture": null,
"votes": 16
}
],
"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": "3725",
"name": "Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3725,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"likes": 0,
"multiAnswer": null,
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"psaSectionId": null,
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"question": "A 22-year-old female presents to A&E with a 4-hour history of chest tightness and shortness of breath. On examination, you notice she has an end-expiratory wheeze.\n\nWhich inflammatory cell is most likely to be found in her sputum?",
"sbaAnswer": [
"a"
],
"totalVotes": 441,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,080 | false | 34 | null | 6,495,044 | null | false | [] | null | 13,279 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of revascularisation which is recommended if there is severe pain that disrupts activities of daily living. It involves a blocked artery being widened by inflating a small balloon within the vessel. This patient does not require this currently as their pain is tolerable. Revascularisation is usually performed in severe disease and if other management options have not worked.",
"id": "10003663",
"label": "c",
"name": "Angioplasty",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Blood thinners are prescribed to patients with peripheral arterial disease to reduce the risk of blood clots, however, this would be prescribed after lifestyle management has been attempted.",
"id": "10003662",
"label": "b",
"name": "Prescribe clopidogrel",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lifestyle management is the best management for this patient as they are experiencing symptoms of peripheral arterial disease and have an ABPI of 0.8. They also have modifiable risk factors such as smoking and increased weight which, once managed, should reduce their symptoms.",
"id": "10003661",
"label": "a",
"name": "Provide guidance on smoking cessation and weight loss",
"picture": null,
"votes": 387
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient should be advised to modify their lifestyle by stopping smoking and reducing their weight through a healthy diet and regular exercise. Doing nothing would be a mistake as they have signs and symptoms of peripheral arterial disease: buttock and thigh pain when walking and an ABPI of 0.8.",
"id": "10003665",
"label": "e",
"name": "Do nothing",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of revascularisation which is recommended if there is severe pain that disrupts activities of daily living. It involves blood vessels being taken from another part of the body and being used to bypass the blockage in the culprit artery. This patient does not require this currently as their pain is tolerable. Revascularisation is usually performed in severe disease and if other management options have not worked.",
"id": "10003664",
"label": "d",
"name": "Artery bypass graft",
"picture": null,
"votes": 4
}
],
"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": "4187",
"name": "Peripheral arterial disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "179",
"name": "Vascular Surgery",
"typeId": 7
},
"topicId": 179,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4187,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
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"id": "13279",
"isLikedByMe": 0,
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"multiAnswer": null,
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"question": "A 62-year-old man who is overweight and a smoker presents to the GP with pain in his buttocks and thighs while walking, which is relieved by rest. He has a past medical history of diabetes and stable angina.\n\nOn examination, his lower extremities appear normal and his ABPI reading is 0.8.\n\nWhat is the most appropriate management for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 434,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,081 | false | 35 | null | 6,495,044 | null | false | [] | null | 13,280 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Surgery is generally recommended in those with a large AAA (>5.5cm) or if there is rapid expansion (increase in diameter >5mm in 6 months or >10mm in one year).",
"id": "10003668",
"label": "c",
"name": "Offer open repair surgery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "6 monthly abdominal ultrasounds are not normally performed to assess the abdominal aorta for growth.",
"id": "10003670",
"label": "e",
"name": "Offer repeat ultrasound every 6 months",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Surgery is generally recommended in those with a large AAA (>5.5cm) or if there is rapid expansion (increase in diameter >5mm over 6 months or >10mm over one year).",
"id": "10003669",
"label": "d",
"name": "Offer endovascular aneurysm repair surgery",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a medium AAA (4.5-5.4cm) and should be scanned via abdominal ultrasound every 3 months to assess for any changes in size.",
"id": "10003666",
"label": "a",
"name": "Offer repeat ultrasound every 3 months",
"picture": null,
"votes": 339
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Yearly repeat ultrasounds are offered to those with a small AAA (3-4.4cm) to assess for any changes in size.",
"id": "10003667",
"label": "b",
"name": "Offer yearly repeat ultrasound",
"picture": null,
"votes": 22
}
],
"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": "3931",
"name": "abdominal aortic aneurysms",
"status": null,
"topic": {
"__typename": "Topic",
"id": "179",
"name": "Vascular Surgery",
"typeId": 7
},
"topicId": 179,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3931,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13280",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"qaAnswer": null,
"question": "A 65-year-old man attends his national screening ultrasound scan for abdominal aortic aneurysms (AAA). He is found to have an aneurysm measuring 4.7cm.\n\nWhat is the best next course of action?",
"sbaAnswer": [
"a"
],
"totalVotes": 432,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,082 | false | 36 | null | 6,495,044 | null | false | [] | null | 13,281 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Duchenne muscular dystrophy is inherited in an X-linked recessive pattern. An example of a mitochondrial disorder is MELAS (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes).",
"id": "10003675",
"label": "e",
"name": "Mitochondrial",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Duchenne muscular dystrophy is inherited in an X-linked recessive pattern. An example of an X-linked dominant condition is Rett syndrome.",
"id": "10003672",
"label": "b",
"name": "X-linked dominant",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Duchenne muscular dystrophy is inherited in an X-linked recessive pattern. An example of an autosomal dominant disorder is Marfan syndrome.",
"id": "10003673",
"label": "c",
"name": "Autosomal dominant",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Duchenne muscular dystrophy is inherited in an X-linked recessive pattern. An example of an autosomal recessive disorder is cystic fibrosis.",
"id": "10003674",
"label": "d",
"name": "Autosomal recessive",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Duchenne muscular dystrophy is inherited in an X-linked recessive pattern which means that males are more likely to be affected by the disease than females. This is because females can be carriers if they inherit one faulty and one normal X chromosome. Males cannot be carriers: they can either have the disease or not have the disease due to only inheriting one X chromosome.",
"id": "10003671",
"label": "a",
"name": "X-linked recessive",
"picture": null,
"votes": 262
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
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"demo": null,
"entitlement": null,
"id": "4188",
"name": "Muscular dystrophy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "156",
"name": "Medical Genetics",
"typeId": 7
},
"topicId": 156,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"difficulty": 1,
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"question": "A couple presents to the genetic counselling clinic as they both have family histories of Duchenne muscular dystrophy and want to know if their future children will be affected.\n\nWhat is the inheritance pattern of Duchenne muscular dystrophy?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,083 | false | 37 | null | 6,495,044 | null | false | [] | null | 13,282 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this would also present with an acutely hot swollen joint, it is not the most important diagnosis to exclude immediately as it would not cause as much harm as undiagnosed septic arthritis. A past medical history of rheumatoid arthritis is also a risk factor for developing septic arthritis.",
"id": "10003677",
"label": "b",
"name": "A flare-up of rheumatoid arthritis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A patient that has presented with an acutely hot swollen joint that is showing signs of systemic unwellness, such as haemodynamic instability and a raised temperature, should immediately have investigations to rule out septic arthritis. This is done through a joint aspiration for microscopy, culture and sensitivity. Early diagnosis is crucial to prevent the development of sepsis and subsequent death.",
"id": "10003676",
"label": "a",
"name": "Septic arthritis",
"picture": null,
"votes": 432
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this would also present with an acutely hot swollen joint, it is not the most important diagnosis to exclude immediately as it would not cause as much harm as undiagnosed septic arthritis. Gout is also more common in older men and most commonly affects the big toe, whereas this patient is a 35-year-old woman with a swollen knee.",
"id": "10003678",
"label": "c",
"name": "Gout",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a swollen and tender knee and reduced movement. In addition, the patient would be unable to straighten the knee and may have a hypermobile patella. It is less likely to be erythematous and would likely be bruised instead. It would also not cause as many systemic symptoms as septic arthritis.",
"id": "10003680",
"label": "e",
"name": "Knee dislocation",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this would also present with an acutely hot swollen joint, it is not the most important diagnosis to exclude immediately as it would not cause as much harm as undiagnosed septic arthritis.",
"id": "10003679",
"label": "d",
"name": "Pseudogout",
"picture": null,
"votes": 2
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4189",
"name": "Septic arthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
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"question": "A 35-year-old female with a past medical history of rheumatoid arthritis presents to A&E with an erythematous, swollen, tender left knee.\n\nOn examination, it is warm and tender across the entire left knee and there is a reduced range of all movements. The examination of the right knee was unremarkable.\n\nHer basic observations show:\n\n* O2 sats - 96% on room air\n* Respiratory rate - 25 breaths per minute\n* Blood pressure - 110/75 mmHg\n* Heart rate - 130 bpm\n* Temperature - 37.9 degrees Celcius.\n\nWhat is the most important diagnosis to exclude?",
"sbaAnswer": [
"a"
],
"totalVotes": 442,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,084 | false | 38 | null | 6,495,044 | null | false | [] | null | 13,283 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The diagnosis, in this case, is ankylosing spondylitis as this young man has presented with back pain, restricted spinal movement and a positive Schober's test. This condition is also associated with a \"bamboo-spine\" appearance on X-ray. The first-line management for ankylosing spondylitis is NSAIDs. Long-term NSAID use may cause gastric problems such as peptic ulcers, hence PPIs should be co-prescribed.",
"id": "10003681",
"label": "a",
"name": "NSAID + PPI",
"picture": null,
"votes": 366
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The diagnosis, in this case, is ankylosing spondylitis as this young man has presented with back pain, restricted spinal movement and a positive Schober test. This condition is also associated with a \"bamboo-spine\" appearance on X-ray. Paracetamol has no role in the management of ankylosing spondylitis.",
"id": "10003684",
"label": "d",
"name": "Paracetamol",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The diagnosis, in this case, is ankylosing spondylitis as this young man has presented with back pain, restricted spinal movement and a positive Schober test. This condition is also associated with a \"bamboo-spine\" appearance on X-ray. Infliximab is a TNF-alpha inhibitor and is normally given if symptoms have not been controlled effectively by NSAIDs or if a patient has severe disease.",
"id": "10003685",
"label": "e",
"name": "Infliximab",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The diagnosis, in this case, is ankylosing spondylitis as this young man has presented with back pain, restricted spinal movement and a positive Schober test. This condition is also associated with a \"bamboo-spine\" appearance on X-ray. Local steroid injections can help ease the pain in ankylosing spondylitis, but cannot be injected into the spine making it unsuitable for this patient.",
"id": "10003683",
"label": "c",
"name": "Steroid injections",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The diagnosis, in this case, is ankylosing spondylitis as this young man has presented with back pain, restricted spinal movement and a positive Schober test. This condition is also associated with a \"bamboo-spine\" appearance on X-ray. Methotrexate is a disease-modifying antirheumatic drug (DMARD) and tends to be more useful in patients with enthesitis as opposed to axial symptoms. It would also not improve spinal inflammation.",
"id": "10003682",
"label": "b",
"name": "Methotrexate",
"picture": null,
"votes": 29
}
],
"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": "3911",
"name": "ankylosing spondylitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"conditions": [],
"difficulty": 1,
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"question": "A 24-year-old man presents to the Rheumatology Clinic reporting back pain and stiffness that gets better throughout the day. On examination, he has reduced range of movement of his lumbar spine and a positive Schober test.\n\nWhat is the first-line management of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 440,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,085 | false | 39 | null | 6,495,044 | null | false | [] | null | 13,284 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is limited cutaneous systemic sclerosis. Anti-Ro antibodies are associated with Sjogren's syndrome.",
"id": "10003688",
"label": "c",
"name": "Anti-Ro",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is limited cutaneous systemic sclerosis. Anti-dsDNA antibodies are primarily linked to systemic lupus erythematosus.",
"id": "10003689",
"label": "d",
"name": "Anti-dsDNA",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is limited cutaneous systemic sclerosis (CREST syndrome). Anti-Scl-70 antibodies are present in diffuse cutaneous systemic sclerosis.",
"id": "10003687",
"label": "b",
"name": "Anti-Scl-70 antibodies",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The condition described here is limited cutaneous systemic sclerosis and is characterised by skin fibrosis which is limited to the hands and forearms, feet and legs, and the head and neck. CREST symptoms are present as she experiences calcinosis (small hard lumps near her fingertips), Raynaud's phenomenon (blue and red fingers according to temperature change), oesophageal dysmotility (demonstrated by her past medical history of GORD) and sclerodactyly (swollen and shiny skin over fingers). The antibody linked to limited cutaneous systemic sclerosis is anti-centromere - it is specific and present in 90% of cases.",
"id": "10003686",
"label": "a",
"name": "Anti-centromere antibodies",
"picture": null,
"votes": 267
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is limited cutaneous systemic sclerosis. Anti-Jo-1 antibodies are seen in polymyositis.",
"id": "10003690",
"label": "e",
"name": "Anti-Jo-1",
"picture": null,
"votes": 20
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3771",
"name": "Systemic sclerosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
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},
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"question": "A 42-year-old woman presents to her GP as she is concerned that her fingers turn blue when is she outside, and red and painful when she comes back inside. She has also noticed that her fingers have looked more swollen and shiny recently, and there are several small hard lumps near her fingertips. She has a past medical history of GORD.\n\nWhich antibody is most associated with this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 435,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,086 | false | 40 | null | 6,495,044 | null | false | [] | null | 13,285 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man's diagnosis is giant cell/temporal arteritis due to him experiencing scalp tenderness and headache as well as his past medical history of polymyalgia rheumatica. Encephalitis is not a complication of these conditions as they do not directly affect the brain, but they can increase the likelihood of stroke.",
"id": "10003693",
"label": "c",
"name": "Encephalitis",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man's diagnosis is giant cell/temporal arteritis due to him experiencing scalp tenderness and headache as well as his past medical history of polymyalgia rheumatica. This is treated with high-dose steroids which if taken for a prolonged period without PPI cover for gastric protection, could result in the development of gastric ulcers as a complication of treatment. However, gastric ulcers are not a complication of temporal arteritis itself.",
"id": "10003694",
"label": "d",
"name": "Gastric ulcers",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This man's diagnosis is giant cell/temporal arteritis due to him experiencing scalp tenderness and headache as well as his past medical history of polymyalgia rheumatica. It is important to treat giant cell/temporal arteritis as quickly as possible with high-dose prednisolone to prevent permanent monocular blindness.",
"id": "10003691",
"label": "a",
"name": "Permanent monocular blindness",
"picture": null,
"votes": 391
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man's diagnosis is giant cell/temporal arteritis due to him experiencing scalp tenderness and headache as well as his past medical history of polymyalgia rheumatica. Several rheumatological conditions increase the likelihood of developing septic arthritis, but giant cell/temporal arteritis and polymyalgia rheumatica do not.",
"id": "10003692",
"label": "b",
"name": "Septic arthritis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man's diagnosis is giant cell/temporal arteritis due to him experiencing scalp tenderness and headache as well as his past medical history of polymyalgia rheumatica. This is treated with high-dose steroids which if taken for a prolonged period without bisphosphonates for bone protection, could result in the development of osteoporosis as a complication of treatment. However, osteoporosis is not a complication of temporal arteritis itself.",
"id": "10003695",
"label": "e",
"name": "Osteoporosis",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3853",
"name": "Giant Cell Arteritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3853,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13285",
"isLikedByMe": null,
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"question": "A 55-year-old man with a past medical history of polymyalgia rheumatica presents to A&E with new onset scalp tenderness and a headache towards the left side of his head. Investigations show an elevated ESR.\n\nWhich complication is this gentleman's disease linked to?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,087 | false | 41 | null | 6,495,044 | null | false | [] | null | 13,286 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing transfusion-associated circulatory overload, evidenced by her shortness of breath and signs of pulmonary oedema as well as hypertension and widened pulse pressure. This is best managed by slowing the blood transfusion and concurrently giving furosemide.",
"id": "10003696",
"label": "a",
"name": "Slow transfusion + give furosemide",
"picture": null,
"votes": 157
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing transfusion-associated circulatory overload, evidenced by her shortness of breath and signs of pulmonary oedema as well as hypertension and widened pulse pressure. This answer choice would work if the patient was experiencing an allergic reaction to the transfusion.",
"id": "10003697",
"label": "b",
"name": "Stop the transfusion + give saline, adrenaline, chlorphenamine, and hydrocortisone",
"picture": null,
"votes": 180
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing transfusion-associated circulatory overload, evidenced by her shortness of breath and signs of pulmonary oedema as well as hypertension and widened pulse pressure. This answer choice would work if the patient was experiencing a febrile non-haemolytic transfusion reaction.",
"id": "10003698",
"label": "c",
"name": "Slow the transfusion + give paracetamol",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing transfusion-associated circulatory overload, evidenced by her shortness of breath and signs of pulmonary oedema as well as hypertension and widened pulse pressure. The transfusion should not be stopped; it should be slowed and a loop diuretic like furosemide should be administered to combat the symptoms of fluid overload.",
"id": "10003700",
"label": "e",
"name": "Stop the transfusion",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing transfusion-associated circulatory overload, evidenced by her shortness of breath and signs of pulmonary oedema as well as hypertension and widened pulse pressure. Whilst slowing the transfusion is correct, the patient's fluid overload should be managed using a loop diuretic. Indapamide is a thiazide-like diuretic which has no role in managing this transfusion reaction.",
"id": "10003699",
"label": "d",
"name": "Slow the transfusion + give indapamide",
"picture": null,
"votes": 14
}
],
"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": "4190",
"name": "Complications of blood transfusions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4190,
"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "13286",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 51-year-old woman experiences shortness of breath and feelings of chest tightness following the administration of 1 unit of blood.\n\nOn examination, she is tachypnoeic, tachycardic, and has an audible wheeze at her lung bases. Her blood pressure is 180/110.\n\nWhat is the best course of management for this transfusion reaction?",
"sbaAnswer": [
"a"
],
"totalVotes": 427,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,088 | false | 42 | null | 6,495,044 | null | false | [] | null | 13,287 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Iron-deficiency anaemia would also present with fatigue and a microcytic anaemia, but not with scleral icterus. They would also have other signs and symptoms such as conjunctival pallor, brittle nails and aphthous ulcers.",
"id": "10003702",
"label": "b",
"name": "Iron-deficiency anaemia",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anaemia of chronic disease can cause either a microcytic or normocytic anaemia and would explain some of this patient's symptoms such as fatigue. However, this patient does not have any chronic medical conditions.",
"id": "10003703",
"label": "c",
"name": "Anaemia of chronic disease",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient has recently immigrated from Senegal where there is increased exposure to lead-contaminated soil and dust. The symptoms and signs he is experiencing, alongside his microcytic anaemia, correlate with a diagnosis of lead poisoning.",
"id": "10003701",
"label": "a",
"name": "Lead poisoning",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an inherited condition which commonly affects those of Mediterranean, South Asian, Southeast Asian and Middle Eastern origin. The patient in this question has no significant family history and is not exhibiting any of the other features of thalassaemia like facial bone deformities or abdominal swelling/enlargement.",
"id": "10003705",
"label": "e",
"name": "Beta thalassaemia",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic alcohol abuse would result in a macrocytic anaemia. The anaemia in this case is microcytic.",
"id": "10003704",
"label": "d",
"name": "Chronic alcohol abuse",
"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": "4191",
"name": "Sideroblastic anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4191,
"conditions": [],
"difficulty": 1,
"dislikes": 2,
"explanation": null,
"highlights": [],
"id": "13287",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 35-year-old man who has recently immigrated from Senegal presents to the GP with abdominal pain, constipation, muscle pain and fatigue.\n\n\nExamination shows icteric sclera and a blood pressure reading of 150/90. He does not have any significant past medical or family history.\n\n\nInvestigations show:\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|111 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|5.0x10<sup>9</sup>/L|3.0 - 10.0|\n|Mean Cell Volume (MCV)|70 fL|80 - 96|\n\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 431,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,089 | false | 43 | null | 6,495,044 | null | false | [] | null | 13,288 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is scabies which typically presents as an itchy rash that worsens during the night and is spread through contact with other infected people. Type II hypersensitivity reactions are mediated by antibodies like IgG or IgM (e.g. blood transfusion reactions).",
"id": "10003708",
"label": "c",
"name": "Type II",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is scabies which typically presents as an itchy rash that worsens during the night and is spread through contact with other infected people. Type I hypersensitivity reactions include allergic reactions and atopic diseases like eczema or asthma.",
"id": "10003707",
"label": "b",
"name": "Type I",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is scabies which typically presents as an itchy rash that worsens during the night and is spread through contact with other infected people. Type III hypersensitivity reactions are mediated by immune complexes that are not cleared from the circulation (e.g. systemic lupus erythematosus).",
"id": "10003709",
"label": "d",
"name": "Type III",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The condition described here is scabies which typically presents as an itchy rash that worsens during the night and is spread through contact with other infected people. This makes it a delayed Type IV hypersensitivity reaction. Type IV hypersensitivity reactions are cell-mediated reactions that occur in response to contact with certain allergens.",
"id": "10003706",
"label": "a",
"name": "Type IV",
"picture": null,
"votes": 264
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is scabies which typically presents as an itchy rash that worsens during the night and is spread through contact with other infected people. Type V hypersensitivity reactions occur when an antibody targets specific receptors on a cell (e.g. Graves disease).",
"id": "10003710",
"label": "e",
"name": "Type V",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3915",
"name": "scabies",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"question": "A 27-year-old man presents to the GP with an intensely itchy rash in-between his fingers on both hands. He describes it to be very disruptive to his sleep as the itchiness is worse at night. He has no significant past medical history or family history. He lives in a hostel and recalls that several of the other tenants have been experiencing the same symptoms over the last week.\n\nWhat type of hypersensitivity reaction is he experiencing?",
"sbaAnswer": [
"a"
],
"totalVotes": 437,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,090 | false | 44 | null | 6,495,044 | null | false | [] | null | 13,289 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atopic dermatitis would present with dry skin and areas of erythematous, poorly demarcated itchy patches. It typically affects the flexural regions, such as the antecubital and popliteal fossas.",
"id": "10003714",
"label": "d",
"name": "Atopic dermatitis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing blistering of the skin which is Nikolsky sign positive and oral mucosa ulceration which points toward a diagnosis of pemphigus vulgaris. This is supported by the biopsy and immunofluorescence showing IgG auto-antibody deposits within the epidermis.",
"id": "10003711",
"label": "a",
"name": "Pemphigus Vulgaris",
"picture": null,
"votes": 354
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bullous pemphigoid would present with deep, tense blisters which are Nikolsky sign negative. There would also not be any oral mucosa involvement. The biopsy and immunofluorescence would show IgG auto-antibodies deposited on the basement membrane.",
"id": "10003712",
"label": "b",
"name": "Bullous Pemphigoid",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with chronic plaque psoriasis have symmetrical plaques on extensor surfaces (elbows and knees, scalp, lower back) which are itchy, erythematous and well-demarcated. They do not have blistering.",
"id": "10003713",
"label": "c",
"name": "Chronic plaque psoriasis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would present with pruritic papulovesicular lesions over the legs, but there is no blistering or peeling. It would be Nikolsky sign negative as well. This diagnosis is commonly linked to Coeliac disease.",
"id": "10003715",
"label": "e",
"name": "Dermatits herpetiformis",
"picture": null,
"votes": 22
}
],
"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": "3916",
"name": "pemphigus and pemphigoid",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
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"qaAnswer": null,
"question": "A 41-year-old woman presents to the Dermatology clinic with peeling blistering skin over both her legs.\n\nOn examination, the top layers of the skin seem to lift away when pressure is applied, and there are signs of oral mucosa ulceration. She has no significant past medical history or family history. A biopsy + immunofluorescence shows deposition of IgG auto-antibodies within the epidermis.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 430,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,091 | false | 45 | null | 6,495,044 | null | false | [] | null | 13,290 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Methotrexate is a disease-modifying anti-rheumatic drug (DMARD), and it is used in the management of rheumatoid arthritis. It has no role in the management of acute gout.",
"id": "10003720",
"label": "e",
"name": "Methotrexate",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Allopurinol should be commenced at a low dose at least 2 weeks following an attack of gout; it is not used in the acute setting.",
"id": "10003718",
"label": "c",
"name": "Allopurinol",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. The NSAID indomethacin is traditionally used first-line, but because this patient has CKD, NSAIDs should be avoided. Hence, colchicine is the most appropriate therapy.",
"id": "10003716",
"label": "a",
"name": "Colchicine",
"picture": null,
"votes": 351
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. The NSAID indomethacin is traditionally used first-line, but because this patient has CKD, NSAIDs should be avoided.",
"id": "10003717",
"label": "b",
"name": "Indomethacin",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Febuxostat is used if allopurinol fails or is contraindicated in the prophylactic management of gout. It is not used in the management of acute gout.",
"id": "10003719",
"label": "d",
"name": "Febuxostat",
"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": "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": 1,
"explanation": null,
"highlights": [],
"id": "13290",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 61-year-old overweight man presents to A&E with severe pain at the base of his right big toe which has been present for 2 days. He says that nothing makes it better, and even slight pressure makes it worse. He has a past medical history of hypertension and chronic kidney disease.\n\nOn examination, his right big toe is erythematous and swollen.\n\nArthrocentesis with synovial fluid analysis shows needle-shaped monosodium urate crystals with negative birefringence.\n\nWhat is the most appropriate management for this man?",
"sbaAnswer": [
"a"
],
"totalVotes": 435,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,092 | false | 46 | null | 6,495,044 | null | false | [] | null | 13,291 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Azathioprine is an immunosuppressant which can be taken safely and effectively with methotrexate.",
"id": "10003722",
"label": "b",
"name": "Azathioprine",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lamotrigine is an anticonvulsant that is safe to take whilst on methotrexate.",
"id": "10003723",
"label": "c",
"name": "Lamotrigine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haloperidol is a typical antipsychotic that is safe to take whilst on methotrexate.",
"id": "10003725",
"label": "e",
"name": "Haloperidol",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Levetiracetam is an anticonvulsant that is safe to take whilst on methotrexate.",
"id": "10003724",
"label": "d",
"name": "Levetiracetam",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Trimethoprim is an antibiotic commonly used to treat urinary tract infections. Methotrexate and trimethoprim both work by inhibiting dihydrofolate reductase. It can be dangerous to give both medications at the same time as it increases the risk of bone marrow suppression.",
"id": "10003721",
"label": "a",
"name": "Trimethoprim",
"picture": null,
"votes": 403
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3936",
"name": "Methotrexate",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3936,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13291",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 25-year-old woman with recently diagnosed rheumatoid arthritis is put on methotrexate 2.5mg weekly. She has no other medical conditions and she takes no other medication, except for folic acid.\n\nWhich of the following medications should be avoided in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 432,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,093 | false | 47 | null | 6,495,044 | null | false | [] | null | 13,292 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Transient synovitis commonly affects boys aged 3-11 and is usually preceded by a viral infection 1-2 weeks before the onset of pain and the limp.",
"id": "10003726",
"label": "a",
"name": "Transient synovitis",
"picture": null,
"votes": 371
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient synovitis commonly affects boys aged 3-11 and is usually preceded by a viral infection 1-2 weeks before the onset of pain and the limp. DDH is a condition that affects babies in the first few months. It is more common in female babies.",
"id": "10003730",
"label": "e",
"name": "Developmental dysplasia of the hip (DDH)",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient synovitis commonly affects boys aged 3-11 and is usually preceded by a viral infection 1-2 weeks before the onset of pain and the limp. Perthes disease affects children aged 4-8 and presents with a similar hip pain and limp to transient synovitis. With Perthes however, the symptoms tend to last for more than 4 weeks, whereas in transient synovitis the symptoms usually do not last for longer than 2 weeks.",
"id": "10003729",
"label": "d",
"name": "Perthes disease",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient synovitis commonly affects boys aged 3-11 and is usually preceded by a viral infection 1-2 weeks before the onset of pain and the limp. It can be difficult to distinguish between transient synovitis and early septic arthritis, but the symptoms of transient synovitis are generally milder.",
"id": "10003727",
"label": "b",
"name": "Septic arthritis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient synovitis commonly affects boys aged 3-11 and is usually preceded by a viral infection 1-2 weeks before the onset of pain and the limp. SUFE is the most common hip disorder in adolescents; many of the children who develop it are overweight. This does not correlate with this patient's history.",
"id": "10003728",
"label": "c",
"name": "Slipped upper femoral epiphyses (SUFE)",
"picture": null,
"votes": 23
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4192",
"name": "Transient synovitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4192,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13292",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 9-year-old boy presents to the GP with a painful right hip and a limp. His mother states that it started 4 days ago and that he also had a cold 2 weeks ago. He does not have a fever now.\n\nOn examination, he has pain on palpation of the right hip, but there are no other signs of inflammation.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 433,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,094 | false | 48 | null | 6,495,044 | null | false | [] | null | 13,293 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although there is currently no radiological evidence of a fracture, the history and examination findings are highly suspicious for a scaphoid fracture. Ibuprofen can be useful in managing the pain associated with this fracture, but it should also be immobilised in a cast before the patient is discharged.",
"id": "10003732",
"label": "b",
"name": "Give ibuprofen and discharge patient",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although there is currently no radiological evidence of a fracture, the history and examination findings are highly suspicious for a scaphoid fracture. Internal fixation surgery should be done if there is radiological evidence of a displaced fracture. At this current point in time, the best course of action is to cast the wrist and repeat X-rays after 10 days.",
"id": "10003733",
"label": "c",
"name": "Internal fixation surgery",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Although there is currently no radiological evidence of a fracture, the history and examination findings are highly suspicious for a scaphoid fracture. Scaphoid fractures can take some time to show up on x-rays, which is why all suspected fractures should be immobilised in a cast and have a follow-up x-ray arranged.",
"id": "10003731",
"label": "a",
"name": "Apply a cast + repeat X-ray after 10 days",
"picture": null,
"votes": 404
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although there is currently no radiological evidence of a fracture, the history and examination findings are highly suspicious for a scaphoid fracture. This means that the patient should have a cast and the x-rays should be repeated after 10 days.",
"id": "10003735",
"label": "e",
"name": "Reassure the patient and discharge",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although there is currently no radiological evidence of a fracture, the history and examination findings make this highly suspicious of a scaphoid fracture. Reduction surgery should be done if there is radiological evidence of a displaced fracture. At this current point in time, the best course of action is to cast the wrist and repeat X-rays after 10 days.",
"id": "10003734",
"label": "d",
"name": "Reduction surgery",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3865",
"name": "Scaphoid fractures",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3865,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13293",
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"likes": 0,
"multiAnswer": null,
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"question": "A 31-year-old man presents to A&E following a fall onto his left hand whilst playing football.\n\nOn examination, there is swelling on inspection around the wrist, and there is pain on palpation of the anatomical snuffbox. An x-ray is ordered which shows no evidence of a fracture.\n\nHow should this patient be managed?",
"sbaAnswer": [
"a"
],
"totalVotes": 434,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,095 | false | 49 | null | 6,495,044 | null | false | [] | null | 13,294 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm.",
"id": "10003736",
"label": "a",
"name": "Nimodipine",
"picture": null,
"votes": 172
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Amlodipine is a calcium-channel blocker like nimodipine and is used to manage hypertension. However, it is not routinely administered to prevent vasospasm in subarachnoid haemorrhages.",
"id": "10003739",
"label": "d",
"name": "Amlodipine",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Losartan is an angiotensin-II receptor blocker used to manage hypertension. This has no role in the management of subarachnoid haemorrhages.",
"id": "10003738",
"label": "c",
"name": "Losartan",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Furosemide is a loop diuretic used to manage oedema. It has no role in the management of subarachnoid haemorrhages.",
"id": "10003740",
"label": "e",
"name": "Furosemide",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classical history of a subarachnoid haemorrhage with a sudden-onset occipital headache and a risk factor of polycystic kidney disease. This should be urgently managed with surgical treatments like coiling and clipping, but patients should also be given nimodipine in the interim to prevent vasospasm. Ramipril is an ACE-inhibitor used to manage hypertension. It has no role in the management of subarachnoid haemorrhages.",
"id": "10003737",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 76
}
],
"comments": [
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"entitlement": null,
"id": "4193",
"name": "Subarachnoid haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
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"question": "A 43-year-old woman presents to A&E with a severe sudden-onset headache towards the back of her head. She has vomited once since arriving at the hospital. She has a past medical history of polycystic kidney disease.\n\nWhich medication should be given to this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 429,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,096 | false | 50 | null | 6,495,044 | null | false | [] | null | 13,295 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has no emergency contact or next of kin, and they have the right to confidentiality. Commenting on the patient's clinical status would be a breach of their confidentiality.",
"id": "10003742",
"label": "b",
"name": "The doctor cannot confirm whether they are caring for the patient but can comment on the clinical condition of the patient",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has no emergency contact or next of kin and they have the right to confidentiality. Commenting on the stability of the patient is still a breach of their confidentiality.",
"id": "10003745",
"label": "e",
"name": "The doctor cannot confirm whether they are caring for the patient, but they can comment that they have heard that the patient is stable",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has no emergency contact or next of kin, and they have the right to confidentiality. The doctor should not divulge any information to the patient's friend.",
"id": "10003743",
"label": "c",
"name": "The doctor can confirm whether they are caring for the patient and can comment that the patient is stable now",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient has no emergency contact or next of kin, and they have the right to confidentiality. Hence, the doctor should avoid providing any information to the patient's friend.",
"id": "10003741",
"label": "a",
"name": "The doctor cannot confirm whether they are caring for the patient, and cannot comment on the clinical condition of the patient",
"picture": null,
"votes": 398
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has no emergency contact or next of kin and they have the right to confidentiality. It is also a lie to say that they can be discharged tomorrow as the prognosis is still unclear.",
"id": "10003744",
"label": "d",
"name": "The doctor can confirm whether they are caring for the patient, and can comment that the patient is ready to be discharged tomorrow",
"picture": null,
"votes": 1
}
],
"comments": [],
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4194",
"name": "Disclosing in the public interest / Confidentiality",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
"topicId": 184,
"totalCards": null,
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},
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"question": "A 25-year-old patient is currently receiving treatment for a pulmonary embolism in the hospital. The patient is stable, but the prognosis is unclear. The patient has no emergency contacts or documented next of kin.\n\nThe patient's friend approaches the doctor managing the patient and asks if she is caring for the patient and whether she can explain how the patient is doing now.\n\nWhat is the most appropriate action?",
"sbaAnswer": [
"a"
],
"totalVotes": 424,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,168 | false | 1 | null | 6,495,048 | null | false | [] | null | 13,296 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antidiuretic hormone (ADH) is also released upon stimulation by angiotensin II, however, it does not directly stimulate aldosterone release. ADH is released from the posterior pituitary and acts to increase water reabsorption from the collecting duct.",
"id": "10003748",
"label": "c",
"name": "Increased ADH levels",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Parathyroid hormone (PTH) levels are not increased in hypovolaemia. PTH is involved in calcium homeostasis. The most common cause of primary hyperparathyroidism is an adenoma of the parathyroid glands.",
"id": "10003747",
"label": "b",
"name": "Increased PTH levels",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst increased renin levels indirectly cause increased aldosterone production via the renin-angiotensin-aldosterone system by converting angiotensinogen to angiotensin I, it is angiotensin II that directly acts on the adrenal cortex to increase aldosterone production. The question specifies that the answer should be a direct trigger.",
"id": "10003750",
"label": "e",
"name": "Increased renin levels",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adrenocorticotropic hormone (ACTH) is released from the anterior pituitary. It stimulates the zona fasciculata of the adrenal cortex to produce glucocorticoids. Whilst increased ACTH levels have a very minimal role in increasing aldosterone secretion, decreased ACTH levels do not.",
"id": "10003749",
"label": "d",
"name": "Decreased ACTH levels",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In response to hypovolaemia, the juxtaglomerular cells of the kidney secrete renin. Renin acts to convert angiotensinogen (a hormone produced by the liver) to angiotensin I. Angiotensin I in turn is converted by angiotensin-converting enzyme (ACE) to angiotensin II. Angiotensin II acts on the zona glomerulosa of the adrenal cortex to increase aldosterone release.",
"id": "10003746",
"label": "a",
"name": "Increased angiotensin II levels",
"picture": null,
"votes": 533
}
],
"comments": [],
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3896",
"name": "Actions of aldosterone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
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},
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"question": "A 54-year-old man is brought to the Emergency Department following a serious road traffic collision. He has lost a significant amount of blood and the major haemorrhage protocol is activated.\n\nAs part of the physiological response to hypovolaemia, the renin-angiotensin-aldosterone system is activated.\n\nWhich of the following is a direct trigger for aldosterone release?",
"sbaAnswer": [
"a"
],
"totalVotes": 675,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,169 | false | 2 | null | 6,495,048 | null | false | [] | null | 13,297 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adenosine is the first-line drug therapy for SVT, the patient has a history of asthma so adenosine is contraindicated. The question also specifies that she was given a calcium channel blocker.",
"id": "10003752",
"label": "b",
"name": "Adenosine",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst amlodipine is a calcium channel blocker, it is non-rate limiting so would not be useful in treating SVT. Amlodipine is primarily used in the treatment of hypertension in patients over 55 or of Black African or African-Caribbean family origin.",
"id": "10003753",
"label": "c",
"name": "Amlodipine",
"picture": null,
"votes": 250
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and has no anti-arrhythmic effect. It is mainly used as an antihypertensive or post-myocardial infarction.",
"id": "10003754",
"label": "d",
"name": "Lisinopril",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Verapamil is a rate-limiting calcium channel blocker and can be given to treat SVT.\n\nSVTs often resolve spontaneously or with reflex vagal stimulation i.e. the Valsalva manoeuvre (such as blowing into a syringe) or carotid sinus massage. If these are ineffective, the patient can be given adenosine or verapamil (verapamil is given if adenosine is ineffective or contraindicated). In this question the patient has a history of asthma, so adenosine is contraindicated.",
"id": "10003751",
"label": "a",
"name": "Verapamil",
"picture": null,
"votes": 309
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bisoprolol is a beta blocker, not a calcium channel blocker. Whilst beta blockers reduce the heart rate, they are not indicated for the acute management of SVT. Beta-blockers should also be avoided in patients with asthma as they can cause airway narrowing and precipitate an asthma attack.",
"id": "10003755",
"label": "e",
"name": "Bisoprolol",
"picture": null,
"votes": 36
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4195",
"name": "Class IV anti-arrythmics: Calcium-channel blockers",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
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"explanation": null,
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"question": "A 64-year-old female with a history of asthma presents to the Emergency Department with palpitations and lightheadedness. She describes previously experiencing episodes of her heart racing which then spontaneously resolved. An ECG is performed, and she receives a diagnosis of supraventricular tachycardia (SVT). The doctor encourages her to blow into a syringe but this is ineffective. She is given a calcium channel blocker as part of her acute management.\n\nWhich of the following drugs is she most likely to have been given?",
"sbaAnswer": [
"a"
],
"totalVotes": 640,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,170 | false | 3 | null | 6,495,048 | null | false | [] | null | 13,298 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with the signs and symptoms of heart failure including orthopnoea, reduced exercise tolerance, dyspnoea, raised JVP and ankle oedema. Her doctor would have prescribed her a loop diuretic such as furosemide for symptomatic relief of heart failure. Loop diuretics block the Na+/K+/2Cl- co-transporter in the loop of Henle. This prevents the reabsorption of salt and water and causes a diuresis effect.",
"id": "10003756",
"label": "a",
"name": "Loop of Henle",
"picture": null,
"votes": 455
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the proximal convoluted tubule. Carbonic anhydrase inhibitors such as acetazolamide can act on the proximal convoluted tubule and have a weak diuretic action, however, are not routinely used for heart failure management.",
"id": "10003757",
"label": "b",
"name": "Proximal convoluted tubule",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient will have been given a loop diuretic such as furosemide for symptomatic relief of their heart failure, which acts on the Loop of Henle, not the distal convoluted tubule. Potassium-sparing diuretics such as aldosterone antagonists (such as spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be used in heart failure but is not given purely for symptomatic relief.",
"id": "10003759",
"label": "d",
"name": "Distal convoluted tubule",
"picture": null,
"votes": 91
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The efferent arteriole is not part of the nephron and therefore cannot be the correct answer. The efferent arteriole is targeted by ACE inhibitors and ARBs which cause vasodilation. This can be useful to target in proteinuric diseases such as diabetic nephropathy.",
"id": "10003760",
"label": "e",
"name": "Efferent arteriole",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient would have been given a loop diuretic such as furosemide for symptomatic relief of her heart failure - furosemide acts on the Loop of Henle, not the collecting duct. Potassium-sparing diuretics such as aldosterone antagonists (e.g. spironolactone) act on the late distal convoluted tubule and early collecting duct. Spironolactone can be indicated in heart failure but is not given for symptomatic relief.",
"id": "10003758",
"label": "c",
"name": "Collecting duct",
"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": "4196",
"name": "Salt transport in loop of Henle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"dislikes": 0,
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"question": "A 74-year-old female is referred by her GP to the cardiology clinic. She complains of being no longer able to climb the stairs at home. When questioned, she states she uses 4 pillows in bed at night. On examination, she is dyspnoeic with a raised JVP and ankle oedema. The cardiology registrar starts her on medication for symptomatic relief.\n\nWhere on the nephron is this medication most likely to act?",
"sbaAnswer": [
"a"
],
"totalVotes": 623,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,171 | false | 4 | null | 6,495,048 | null | false | [] | null | 13,299 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Salbutamol is a beta-2 agonist, and one of its most characteristic adverse effects is tremor of the hands. This man presents with a strong history of asthma and is likely to have regularly used salbutamol for symptomatic relief during exacerbations. This makes salbutamol the most likely answer.",
"id": "10003761",
"label": "a",
"name": "Salbutamol",
"picture": null,
"votes": 568
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IV hydrocortisone is often given as part of the acute management of severe asthma. However, hydrocortisone is not associated with a hand tremor.",
"id": "10003764",
"label": "d",
"name": "Hydrocortisone",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Magnesium sulfate can be used to treat severe asthma exacerbations as it acts as a bronchodilator. However, magnesium sulfate is not associated with a hand tremor.",
"id": "10003765",
"label": "e",
"name": "Magnesium sulfate",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amiodarone can be associated with tremor of the hands, however, considering the asthma history (and lack of cardiac history) in this patient, it is not the most likely cause.",
"id": "10003762",
"label": "b",
"name": "Amiodarone",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is likely to be on an inhaled corticosteroid such as beclometasone as a preventer for his asthma. However, beclomethasone is not associated with a hand tremor.",
"id": "10003763",
"label": "c",
"name": "Beclometasone",
"picture": null,
"votes": 22
}
],
"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": "4197",
"name": "Side effects of asthma medications",
"status": null,
"topic": {
"__typename": "Topic",
"id": "189",
"name": "Respiratory Pharmacology",
"typeId": 7
},
"topicId": 189,
"totalCards": null,
"typeId": null,
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},
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"question": "A 30-year-old male attends his GP after noticing a tremor in his hands. He was diagnosed with asthma as a child and experienced frequent exacerbations, some of which required hospitalisation.\n\nWhich medication is the most likely cause of his symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 612,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,172 | false | 5 | null | 6,495,048 | null | false | [] | null | 13,300 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bronchiectasis is caused by the permanent dilatation of the bronchi and bronchioles due to chronic infection. It is not associated with an increased transfer factor.",
"id": "10003768",
"label": "c",
"name": "Bronchiectasis",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Transfer factor is a measure of how well the lungs can take up oxygen - it is measured indirectly by measuring the uptake of carbon monoxide by the lungs. In pulmonary haemorrhages, there is leakage of red blood cells into the alveolar space. These red blood cells, despite not being in the pulmonary vessels, are still able to carry oxygen (and carbon monoxide), which results in an increased transfer factor.",
"id": "10003766",
"label": "a",
"name": "Pulmonary haemorrhage",
"picture": null,
"votes": 229
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pneumonia is associated with the presence of fluid and blood in the alveoli. This increases the diffusion gradient for gases, thus resulting in a decreased transfer factor.",
"id": "10003770",
"label": "e",
"name": "Pneumonia",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "COPD is characterised by both chronic bronchitis and emphysema. Emphysema is associated with the destruction of elastin fibres and alveoli, which results in a reduced surface area for gas exchange, and thus a decreased transfer factor.",
"id": "10003769",
"label": "d",
"name": "COPD",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary fibrosis is characterised by increased interstitial collagen deposition which makes it harder for oxygen (and carbon monoxide) to be taken up by the lungs. This results in a decreased transfer factor.",
"id": "10003767",
"label": "b",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 145
}
],
"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": "4198",
"name": "Gaseous exchange and transport",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "13300",
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"likes": 0,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 37-year-old female is referred for further pulmonary investigations after experiencing dyspnoea.\n\nWhich of the following is associated with an increased transfer factor?",
"sbaAnswer": [
"a"
],
"totalVotes": 600,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,173 | false | 6 | null | 6,495,048 | null | false | [] | null | 13,301 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type 1 pneumocytes are the primary cells involved in gas exchange in the epithelium of the alveoli. They are not involved in surfactant production.",
"id": "10003772",
"label": "b",
"name": "Type 1 pneumocyte",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Goblet cells are mostly found in the epithelia of the respiratory and gastrointestinal tracts and they secrete mucous, not surfactant.",
"id": "10003774",
"label": "d",
"name": "Goblet cell",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Surfactant is produced by Type 2 pneumocytes. The main function of surfactant is to reduce the surface tension across the alveoli, preventing their collapse. Type 2 pneumocytes develop their ability to secrete surfactant late in foetal development, so premature infants can have surfactant deficiency resulting in respiratory distress syndrome.",
"id": "10003771",
"label": "a",
"name": "Type 2 pneumocyte",
"picture": null,
"votes": 525
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clara cells are found in the bronchioles and serve to protect the bronchiolar epithelium. They also secrete a solution similar to surfactant to maintain a moist surface and reduce surface tension.",
"id": "10003773",
"label": "c",
"name": "Clara cell",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chief cells are found in the stomach and secrete pepsinogen which breaks down proteins. They have no role in surfactant production.",
"id": "10003775",
"label": "e",
"name": "Chief cell",
"picture": null,
"votes": 3
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4199",
"name": "Surfactant",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
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"question": "A baby is born in the neonatal unit at 25 weeks gestation. The paediatrician notes that the baby is breathing very fast, and subsequently diagnoses them with neonatal respiratory distress syndrome due to a deficiency of surfactant.\n\nWhich of the following cells is responsible for surfactant production?",
"sbaAnswer": [
"a"
],
"totalVotes": 597,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,174 | false | 7 | null | 6,495,048 | null | false | [] | null | 13,302 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The occipital lobe is the smallest lobe of the brain and is found posteriorly. The main role of the occipital lobe is visual processing.",
"id": "10003780",
"label": "e",
"name": "Occipital lobe",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pituitary gland is located at the base of the brain. The anterior pituitary responds to hormones released from the hypothalamus to release trophic hormones such as thyroid stimulating hormone (TSH). These hormones are released into the blood and target other endocrine glands in the body, such as the thyroid gland. The posterior pituitary releases ADH and oxytocin.",
"id": "10003777",
"label": "b",
"name": "Pituitary gland",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The key role of the hypothalamus is to maintain homeostasis in the body, regulating parameters such as temperature and thirst. It is not involved in the respiratory drive.",
"id": "10003778",
"label": "c",
"name": "Hypothalamus",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The respiratory centre is located in the medulla, which is a part of the brain stem. Here, there are central chemoreceptors that detect raised CO2 through an increase in H+ ion concentration. When the central chemoreceptors in the medulla detect an increased H+ ion concentration, they signal to the Dorsal Respiratory Group (DRG) which in turn increases firing to the Ventral Respiratory Group (VRG). The VRG fires impulses at an increased frequency to the diaphragm via the phrenic nerve, increasing the respiratory rate to \"blow off\" excess CO2.",
"id": "10003776",
"label": "a",
"name": "Medulla",
"picture": null,
"votes": 480
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The frontal lobes are the largest lobes of the brain. They are important for movement and complex behaviours such as judgement, morality, emotion and personality.",
"id": "10003779",
"label": "d",
"name": "Frontal lobe",
"picture": null,
"votes": 9
}
],
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"id": "4200",
"name": "Neural control of respiration",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
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"question": "A 67-year-old female presents to A&E with an exacerbation of COPD.\n\nAn ABG is carried out which shows a raised PCO2 and reduced PO2.\n\nWhich of the following parts of the brain detects raised carbon dioxide levels and stimulates an increase in respiratory rate?",
"sbaAnswer": [
"a"
],
"totalVotes": 591,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,175 | false | 8 | null | 6,495,048 | null | false | [] | null | 13,303 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoprogenitor cells do not produce the bone extracellular matrix. Osteoprogenitor cells give rise to osteoblasts, which form bone tissue. Osteoblasts can further mature into osteocytes, which maintain bone tissue.",
"id": "10003784",
"label": "d",
"name": "Osteoprogenitor cell",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An osteon is also called a Haversion system. It is the structural and functional unit of compact bone. It consists of Type 1 collagen fibres arranged in concentric lamellae around a Haversian canal which contains blood vessels and nerves.",
"id": "10003785",
"label": "e",
"name": "Osteon",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoclasts are responsible for the resorption of bone, not the formation of bone. They do this by releasing enzymes such as collagenases. Osteoclasts are large multinucleated cells, derived from monocytes.",
"id": "10003782",
"label": "b",
"name": "Osteoclast",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoid is not a cell but is an unmineralised bone produced by osteoblasts. Osteoid consists of Type 1 collagen and a glycosaminoglycan gel which contains glycoproteins that bind calcium.",
"id": "10003783",
"label": "c",
"name": "Osteoid",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Osteoblasts produce osteoid and release matrix vesicles. Osteoid consists of Type 1 collagen and a glycosaminoglycan gel which contains glycoproteins that bind calcium. Matrix vesicles contain enzymes such as alkaline phosphatase which increase local concentrations of calcium.",
"id": "10003781",
"label": "a",
"name": "Osteoblast",
"picture": null,
"votes": 437
}
],
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"id": "4201",
"name": "Osteoblasts",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
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"question": "A 52-year-old male attends fracture clinic after fracturing his wrist. When questioned, he admits to having an 8-month history of pain in his bones prior to this recent fracture. The consultant orders further investigations and he is noted to have a raised alkaline phosphatase and changes to the bone on x-ray.\n\nHe is diagnosed with Paget's disease of bone. This condition is associated with increased bone resorption, formation, and remodelling.\n\nWhich of the following is responsible for producing bone extracellular matrix?",
"sbaAnswer": [
"a"
],
"totalVotes": 589,
"typeId": 1,
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173,461,176 | false | 9 | null | 6,495,048 | null | false | [] | null | 13,304 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The soft palate and cheeks are lined with stratified squamous non-keratinising epithelium. This epithelia type is often found at entrances and exits of the body, for example, the oesophagus, vagina and anal canal inferior to the pectinate line.",
"id": "10003786",
"label": "a",
"name": "Soft palate",
"picture": null,
"votes": 341
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The skin has a stratified squamous keratinising epithelium. This allows it to withstand constant abrasion and desiccation.",
"id": "10003787",
"label": "b",
"name": "Skin",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The small intestine typically has simple columnar epithelial tissue. This tissue type is most often associated with absorption and secretion.",
"id": "10003788",
"label": "c",
"name": "Small intestine",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The bladder is lined with transitional cell epithelium. This epithelium is unique to the ureters and urinary bladder. Transitional cell epithelium changes between stretched (when the bladder is full) and relaxed (when the bladder is empty) states.",
"id": "10003790",
"label": "e",
"name": "Bladder",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trachea is lined with pseudostratified ciliated columnar epithelium. This epithelium extends to the bronchi, where it is replaced with a simple columnar epithelium in the bronchioles.",
"id": "10003789",
"label": "d",
"name": "Trachea",
"picture": null,
"votes": 84
}
],
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"id": "4202",
"name": "Epithelia",
"status": null,
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"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
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"question": "A pathologist is reviewing slides. They identify the tissue they are looking at as stratified squamous non-keratinising epithelial tissue.\n\nWhich of the following is the most likely place the specimen was taken from?",
"sbaAnswer": [
"a"
],
"totalVotes": 586,
"typeId": 1,
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173,461,177 | false | 10 | null | 6,495,048 | null | false | [] | null | 13,305 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Transitional epithelium, also known as urothelium, is unique to the urinary tract. Over 90% of bladder cancers are transitional cell carcinomas.",
"id": "10003791",
"label": "a",
"name": "Transitional epithelium",
"picture": null,
"votes": 476
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stratified squamous epithelia have a protective function, for example in the epidermis of the skin. It is not found in the bladder.",
"id": "10003794",
"label": "d",
"name": "Stratified squamous epithelium",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudostratified columnar epithelium is a variant of simple columnar. The cells are tightly packed together, squeezing the nuclei off-centre and giving the appearance of many layers. This epithelium is found in parts of the respiratory tract (trachea and bronchi) and parts of the male reproductive tract (vas deferens and epididymis).",
"id": "10003795",
"label": "e",
"name": "Pseudostratified columnar epithelium",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Simple squamous epithelia are generally found where there is a need for passive diffusion of fluids or gases, such as the alveoli of the lungs. The fact that the epithelium is one cell thick aids the movement of fluids or gases.",
"id": "10003792",
"label": "b",
"name": "Simple squamous epithelium",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Simple cuboidal epithelia are generally found lining small ducts and tubules and may have excretory, secretory or absorptive functions, for example in the proximal convoluted tubule of the nephron.",
"id": "10003793",
"label": "c",
"name": "Simple cuboidal epithelium",
"picture": null,
"votes": 24
}
],
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"id": "4203",
"name": "Types of Tissue",
"status": null,
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"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
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"question": "A 72-year-old retired factory worker attends a urology clinic after experiencing frank haematuria. They undergo cystoscopy and a biopsy is taken. They are subsequently diagnosed with bladder cancer.\n\nWhich of the following epithelia line the bladder?",
"sbaAnswer": [
"a"
],
"totalVotes": 583,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,178 | false | 11 | null | 6,495,048 | null | false | [] | null | 13,306 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "DNA is double-stranded, whereas RNA is single-stranded.",
"id": "10003798",
"label": "c",
"name": "Double-stranded",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "RNA does contain guanine, but so does DNA. Therefore containing guanine is not a characteristic unique to RNA.",
"id": "10003800",
"label": "e",
"name": "Contains guanine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deoxyribose sugar is found in DNA. Ribose is the sugar in RNA.",
"id": "10003797",
"label": "b",
"name": "Contains deoxyribose sugar",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "RNA does not contain thymine. Thymine is found in DNA.",
"id": "10003799",
"label": "d",
"name": "Contains thymine",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. RNA contains uracil. This is different to DNA, which contains thymine instead.",
"id": "10003796",
"label": "a",
"name": "Contains uracil",
"picture": null,
"votes": 564
}
],
"comments": [],
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"__typename": "Chapter",
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"entitlement": null,
"id": "3889",
"name": "Translation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
"totalCards": null,
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"userChapter": null,
"userNote": null,
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},
"conceptId": 3889,
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"dislikes": 0,
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"question": "A 27-year-old male presents to the GP after feeling generally unwell with fever, muscle aches and fatigue. He admits to being an IV drug user.\n\nOn examination, he appears jaundiced. The GP orders a PCR assay for Hepatitis C Virus (HCV) RNA.\n\nWhich of the following is a characteristic unique to RNA?",
"sbaAnswer": [
"a"
],
"totalVotes": 576,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,179 | false | 12 | null | 6,495,048 | null | false | [] | null | 13,307 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "All proteins start with AUG, which codes for the amino acid methionine.",
"id": "10003801",
"label": "a",
"name": "AUG (adenine, uracil, guanine)",
"picture": null,
"votes": 409
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "UAG codes for a stop codon, not a start codon.",
"id": "10003804",
"label": "d",
"name": "UGA (uracil, guanine, adenine)",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "UAG codes for a stop codon, not a start codon.",
"id": "10003802",
"label": "b",
"name": "UAG (uracil, adenine, guanine)",
"picture": null,
"votes": 111
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "UGG does not code for a start codon. UGG codes for the amino acid tryptophan.",
"id": "10003803",
"label": "c",
"name": "UGG (uracil, guanine, guanine)",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "UAG codes for a stop codon, not a start codon.",
"id": "10003805",
"label": "e",
"name": "UAA (uracil, guanine, adenine)",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"name": "Translation",
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"name": "Structure and Function of Cells",
"typeId": 7
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"dislikes": 0,
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"question": "A 14-year-old boy attends the Emergency Department with widespread swelling, most notably around his eyes. Nephrotic syndrome is suspected and urinalysis is carried out. It demonstrates proteinuria.\n\nWhich of the following is the start codon that every protein begins with?",
"sbaAnswer": [
"a"
],
"totalVotes": 575,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,180 | false | 13 | null | 6,495,048 | null | false | [] | null | 13,308 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intermediate filaments produce a network of fibres inside cells that provide tensile strength, allowing cells to resist external forces such as stretching. They also strengthen cell contact via desmosomes.",
"id": "10003807",
"label": "b",
"name": "Intermediate filament",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Actin microfilaments are found near the cell surface and regulate the cell cortex (cell shape) and cell movement (such as cell crawling, phagocytosis and cell division) using ATP.",
"id": "10003808",
"label": "c",
"name": "Actin microfilament",
"picture": null,
"votes": 133
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Microtubules have several functions including facilitating cell division, anchoring cell organelles, and facilitating intracellular transport. Microtubules also form cilia and flagella to assist in cell locomotion. Kartagener's Syndrome is an autosomal recessive condition in which cilia are defective. This results in increased bronchial infections and male infertility due to poor sperm motility.",
"id": "10003806",
"label": "a",
"name": "Microtubule",
"picture": null,
"votes": 329
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nuclear lamin is a nuclear intermediate filament protein found inside the cell's nucleus. It provides attachment sites for DNA (as chromatin).",
"id": "10003809",
"label": "d",
"name": "Nuclear lamin",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Centrosomes anchor microtubules near the cell's nucleus. Microtubules anchored to the centrosome can grow and shrink independently - this is known as dynamic instability.",
"id": "10003810",
"label": "e",
"name": "Centrosome",
"picture": null,
"votes": 13
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"demo": null,
"entitlement": null,
"id": "4204",
"name": "Globular and Fibrous proteins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
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"question": "A 30-year-old male presents to his GP complaining of recurrent bronchial infections. He also mentions that his partner and himself have been struggling to conceive.\n\nThe GP refers him for further investigations and he is subsequently diagnosed with Kartagener's Syndrome. This condition affects the cilia in the respiratory tract and the flagella of sperm.\n\nWhich type of cytoskeleton filament is responsible for the movement of cilia and flagella?",
"sbaAnswer": [
"a"
],
"totalVotes": 571,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,181 | false | 14 | null | 6,495,048 | null | false | [] | null | 13,309 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Airborne transmission involves particles with a diameter smaller than 5µm. These particles can be carried large distances in the air in aerosol form. Microorganisms that spread via airborne transmission are very difficult to control as special ventilation systems are required. Airborne transmission is also referred to as aerosol transmission.",
"id": "10003814",
"label": "d",
"name": "Airborne",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Malaria is spread by vector transmission. Vector transmission involves animals transporting a pathogen to a susceptible host. In malaria, the female Anopheles mosquito can spread malaria to humans through bites.",
"id": "10003811",
"label": "a",
"name": "Vector",
"picture": null,
"votes": 490
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the route of malaria transmission. Contact transmission can be either direct or indirect. Direct contact involves pathogens being transferred by direct physical contact, such as touch and sex. Indirect contact involves the transfer of pathogens via an object, e.g. someone sneezing onto a surface that someone else touches.",
"id": "10003812",
"label": "b",
"name": "Contact",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Droplet transmission involves particles with a diameter larger than 5µm travelling less than 2m. These can come from the respiratory tract, for example, when coughing or sneezing.",
"id": "10003813",
"label": "c",
"name": "Droplet",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vertical transmission refers to infections passing down from mothers to children. Examples of diseases that can be transmitted via vertical transmission include hepatitis B and HIV.",
"id": "10003815",
"label": "e",
"name": "Vertical",
"picture": null,
"votes": 6
}
],
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"id": "3775",
"name": "Malaria",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
},
"topicId": 148,
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"question": "A 41-year-old female presents to her GP with a 1-week history of fever 1 after returning from central Africa. A thick and thin blood smear is carried out and the patient is diagnosed with malaria.\n\nWhich of the following is the route of malaria transmission?",
"sbaAnswer": [
"a"
],
"totalVotes": 571,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,182 | false | 15 | null | 6,495,048 | null | false | [] | null | 13,310 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Mitosis is used for the growth and repair of cells. This differs from meiosis, which is used for producing gametes for sexual reproduction.",
"id": "10003816",
"label": "a",
"name": "Used for growth and repair",
"picture": null,
"votes": 509
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Mitosis produces two daughter cells per cycle. Meiosis involves the creation of four daughter cells per cycle.",
"id": "10003818",
"label": "c",
"name": "Four daughter cells per cycle",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Mitosis involves one cell division, creating two daughter cells. Meiosis involves two cell divisions, creating four daughter cells.",
"id": "10003817",
"label": "b",
"name": "Involves two cell divisions",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Mitosis produces two daughter cells that are genetically identical per cycle. Meiosis on the other hand creates genetically unique daughter cells.",
"id": "10003819",
"label": "d",
"name": "Daughter cells are genetically different",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Mitosis occurs in somatic cells, whereas meiosis occurs in germline cells (eggs in females and sperm in males) and is used in sexual reproduction.",
"id": "10003820",
"label": "e",
"name": "Occurs in germline cells",
"picture": null,
"votes": 14
}
],
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"id": "4205",
"name": "Mitosis and meiosis",
"status": null,
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"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
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"question": "An 82-year-old man attends his GP with weight loss, fatigue, and rectal bleeding. The GP refers him for further investigations and he is diagnosed with colorectal cancer.\n\nCancer can be caused by uncontrolled mitosis and cells dividing out of control.\n\nWhich of the following is a feature of mitosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 571,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,183 | false | 16 | null | 6,495,048 | null | false | [] | null | 13,311 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type Two collagen is usually found in cartilage, not bone. This can be remembered by using the memory aid \"carTWOlage\". However, fibrocartilage contains Type One collagen fibres.",
"id": "10003822",
"label": "b",
"name": "Type Two",
"picture": null,
"votes": 121
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type Three collagen is found in reticular fibres. These are thin fibres that form a delicate net-like framework in the liver, spleen, lymph nodes and other locations where blood and lymph are filtered.",
"id": "10003823",
"label": "c",
"name": "Type Three",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type Four collagen is the main collagenous component of basement membranes. This can be remembered through the memory aid \"Type Four is on the floor\".",
"id": "10003824",
"label": "d",
"name": "Type Four",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Type Five collagen is a fibrillar collagen and is essential for the fibrillation of Types One and Three collagen. Classical Ehlers-Danlos Syndrome is associated with mutations in Type Five collagen.",
"id": "10003825",
"label": "e",
"name": "Type Five",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Type One collagen is found in bone. This can be remembered by using the memory aid \"bONE\".",
"id": "10003821",
"label": "a",
"name": "Type One",
"picture": null,
"votes": 326
}
],
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"id": "3882",
"name": "Collagen",
"status": null,
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"__typename": "Topic",
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"name": "Structure and Function of Cells",
"typeId": 7
},
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"question": "A 23-year-old male is admitted from the Emergency Department after a motorcycle crash. The x-ray shows he has fractured his right femur.\n\nWhich of the following types of collagen is found in bone?",
"sbaAnswer": [
"a"
],
"totalVotes": 563,
"typeId": 1,
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} | MarksheetMark |
173,461,184 | false | 17 | null | 6,495,048 | null | false | [] | null | 13,312 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hyaline cartilage makes up the costal cartilage. Hyaline cartilage is also found elsewhere, for example in the articular surfaces of bones, the trachea and bronchi, and the nasal cavity and nose. Hyaline cartilage functions to provide stiff (but somewhat flexible support) and reduce friction between bony surfaces.",
"id": "10003826",
"label": "a",
"name": "Hyaline",
"picture": null,
"votes": 337
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spongy is a type of bone, not cartilage. Spongy bone is organised into trabeculae which are formed of longitudinal layers of lamellae. These surround red marrow spaces.",
"id": "10003830",
"label": "e",
"name": "Spongy",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Elastic cartilage is not found in costal cartilage. Elastic cartilage allows for flexibility and is found in places such as the epiglottis and the pinna of the external ear.",
"id": "10003827",
"label": "b",
"name": "Elastic",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fibrocartilage is not found in the costal cartilages. Fibrocartilage acts to resist compression, prevent bone-to-bone contact and reduce relative movement. It is found in the intervertebral discs, tendon insertions, pubic symphysis and menisci of the knee joint.",
"id": "10003828",
"label": "c",
"name": "Fibrocartilage",
"picture": null,
"votes": 168
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reticular fibres are not a type of cartilage. These are thin fibres that form a delicate net-like framework in the liver, spleen, lymph nodes and other locations where blood and lymph are filtered.",
"id": "10003829",
"label": "d",
"name": "Reticular",
"picture": null,
"votes": 11
}
],
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"id": "4203",
"name": "Types of Tissue",
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"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
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"question": "A 70-year-old woman presents to the GP with a 6-month history of dull localised chest pain which is tender on palpation. The GP suspects costochondritis.\n\nWhich of the following types of cartilage make up the costal cartilage?",
"sbaAnswer": [
"a"
],
"totalVotes": 566,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,185 | false | 18 | null | 6,495,048 | null | false | [] | null | 13,313 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Methionine (Met) is not involved in PKU.",
"id": "10003835",
"label": "e",
"name": "Methionine",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is phenylketonuria (PKU). Tyrosine (Tyr) is an incorrect answer. Tyrosine is the amino acid that phenylalanine is normally converted to by phenylalanine hydroxylase. This is reduced or absent in PKU. In PKU, tyrosine often needs supplementation as less is produced.",
"id": "10003832",
"label": "b",
"name": "Tyrosine",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Proline (Pro) is not involved in PKU.",
"id": "10003834",
"label": "d",
"name": "Proline",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The condition described here is phenylketonuria (PKU), which is associated with high phenylalanine levels. Cysteine (Cys) is not involved in PKU.",
"id": "10003833",
"label": "c",
"name": "Cysteine",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The condition described here is phenylketonuria (PKU). This is an autosomal recessive condition, and the main issue is the accumulation of the amino acid phenylalanine which is toxic to the brain. The three-letter code for phenylalanine is Phe.",
"id": "10003831",
"label": "a",
"name": "Phenylalanine",
"picture": null,
"votes": 450
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "4206",
"name": "Amino acids",
"status": null,
"topic": {
"__typename": "Topic",
"id": "180",
"name": "Biochemistry",
"typeId": 7
},
"topicId": 180,
"totalCards": null,
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"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
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"dislikes": 0,
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"question": "A 5-day-old infant receives a heel prick test. The test comes back positive for an inherited metabolic disease.\n\nThe paediatrician informs the parents that, if left untreated, the infant may suffer from developmental delay, seizures, motor deficits and psychiatric issues amongst other consequences. The paediatrician also informs the parents that the child will have to follow a lifelong restrictive diet.\n\nWhich of the following amino acids is high in this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 559,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,186 | false | 19 | null | 6,495,048 | null | false | [] | null | 13,314 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Skeletal muscle is striated, with smooth muscle being non-striated. This is because smooth muscle contains thick and thin filaments that do not arrange into sarcomeres.",
"id": "10003838",
"label": "c",
"name": "Non-striated appearance",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Smooth muscle consists of spindle-shaped cells, not skeletal muscle.",
"id": "10003839",
"label": "d",
"name": "Spindle-shaped cells",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Peripherally located nuclei are one of the key features of skeletal muscle.",
"id": "10003836",
"label": "a",
"name": "Peripherally located nuclei",
"picture": null,
"votes": 366
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of cardiac muscle, not skeletal muscle. Cardiac muscle has intercalated discs. They are important in cardiac muscle as they provide mechanical strength to hold the myocytes together (the heart is constantly beating) and facilitate rapid communication between cells, allowing them to contract in a wave-like pattern.",
"id": "10003840",
"label": "e",
"name": "Presence of intercalated discs",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Branched cells are found in cardiac muscle, not skeletal muscle. The branching of the cardiac myocytes allows for the faster spread of the wave of depolarization.",
"id": "10003837",
"label": "b",
"name": "Branched cells",
"picture": null,
"votes": 28
}
],
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"__typename": "Concept",
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"id": "4207",
"name": "Muscle histology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "183",
"name": "Physiology & Pathology of Bone",
"typeId": 7
},
"topicId": 183,
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"question": "A 34-year-old female presents to her GP with a purple rash on her eyelids and scaly patches on her knuckles. She also complains of muscle pain and weakness.\n\nA diagnosis of dermatomyositis is suspected. To confirm the diagnosis, a biopsy is taken from her biceps muscle.\n\nWhich of the following histological features will the pathologist look for when he is reviewing the biopsy sample to confirm he is looking at skeletal muscle?",
"sbaAnswer": [
"a"
],
"totalVotes": 556,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,187 | false | 20 | null | 6,495,048 | null | false | [] | null | 13,315 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In high calcium conditions, calcium binds to troponin (on tropomyosin) and the positions of troponin and tropomyosin on actin are altered, making the binding sites available for myosin to attach to.",
"id": "10003841",
"label": "a",
"name": "Troponin",
"picture": null,
"votes": 373
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tropomyosin proteins block myosin binding sites on the actin filament (in low calcium conditions). On tropomyosin proteins, there are troponin complexes and it is these that bind calcium.",
"id": "10003842",
"label": "b",
"name": "Tropomyosin",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Actin (and myosin) are contractile proteins found in every cell. However, they are found in much higher quantities in muscle cells. During muscle contraction, the myosin head attaches to the myosin-binding site on actin, forming a cross-bridge. The myosin head then pivots from a 90-degree to a 45-degree angle, and actin slides past myosin.",
"id": "10003844",
"label": "d",
"name": "Actin",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myosin (and actin) are contractile proteins found in every cell. However, they are found in much higher quantities in muscle cells. During muscle contraction, the myosin head attaches to the myosin-binding site on actin, forming a cross-bridge. The myosin head then pivots from a 90-degree to a 45-degree angle, and actin slides past myosin.",
"id": "10003843",
"label": "c",
"name": "Myosin",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myofibrils are bundles of myofilaments (actin and myosin). Bundles of myofibrils make up a muscle fibre. Myofibrils do not bind calcium.",
"id": "10003845",
"label": "e",
"name": "Myofibril",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "3966",
"name": "Muscle physiology",
"status": null,
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"__typename": "Topic",
"id": "183",
"name": "Physiology & Pathology of Bone",
"typeId": 7
},
"topicId": 183,
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"question": "A 27-year-old athlete presents to their General Practitioner with pain in the anterior aspect of their thigh, which is worse on movement. The GP suspects a muscle strain.\n\nDuring muscle contraction, what does calcium bind to?",
"sbaAnswer": [
"a"
],
"totalVotes": 561,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,188 | false | 21 | null | 6,495,048 | null | false | [] | null | 13,316 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum alkaline phosphatase is normal in osteoporosis, and therefore cannot be used for diagnosis. If elevated, it could indicate other conditions such as osteomalacia or Paget's Disease of the Bone.",
"id": "10003848",
"label": "c",
"name": "Serum alkaline phosphatase",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "DEXA scans are the gold standard investigation to measure bone density. A T-score of ≤-2.5 indicates osteoporosis.",
"id": "10003846",
"label": "a",
"name": "DEXA scan",
"picture": null,
"votes": 528
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An X-ray may reveal osteopenia and/or fractures but does not diagnose osteoporosis. X-rays can be used to justify the need for DEXA scans when osteopenia is detected coincidentally.",
"id": "10003849",
"label": "d",
"name": "Wrist x-ray",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum calcium levels are normal in osteoporosis. Hypocalcaemia could indicate osteomalacia, whilst hypercalcaemia could indicate hyperparathyroidism or malignancy.",
"id": "10003850",
"label": "e",
"name": "Serum calcium",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An MRI of the spine has no role in the diagnosis of osteoporosis. The investigation of choice is a DEXA scan.",
"id": "10003847",
"label": "b",
"name": "MRI spine",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4208",
"name": "Osteoporosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
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"question": "An 89-year-old female is admitted to the orthopaedic ward after falling from standing height and fracturing her wrist.\n\nWhich of the following investigations is best for diagnosing osteoporosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 556,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,189 | false | 22 | null | 6,495,048 | null | false | [] | null | 13,317 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The FRAX score is used to evaluate fracture risk. It estimates the probability of a fracture occurring within the next 10 years.",
"id": "10003851",
"label": "a",
"name": "FRAX",
"picture": null,
"votes": 495
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CURB-65 is used to estimate mortality in patients with community-acquired pneumonia. It is useful in predicting outcomes and deciding whether to give inpatient or outpatient treatment.",
"id": "10003855",
"label": "e",
"name": "CURB-65",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Gleason Score is used for staging prostate cancer based on biopsy findings. The greater the Gleason Score, the more poorly differentiated the tumour and the worse the prognosis.",
"id": "10003853",
"label": "c",
"name": "Gleason Score",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "DAS28 is used in patients with rheumatoid arthritis and indicates how active a patient’s rheumatoid arthritis is currently.",
"id": "10003852",
"label": "b",
"name": "DAS28",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "QRISK 3 is used to predict cardiovascular risk. It gives a percentage which indicates the likelihood of a person developing a heart attack or stroke over the next 10 years.",
"id": "10003854",
"label": "d",
"name": "QRISK 3",
"picture": null,
"votes": 14
}
],
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"id": "4208",
"name": "Osteoporosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
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"topicId": 154,
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"question": "An 82-year-old female is admitted to the geriatric ward following a fall at home.\n\nWhich of the following is the best tool for predicting fracture risk?",
"sbaAnswer": [
"a"
],
"totalVotes": 548,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,190 | false | 23 | null | 6,495,048 | null | false | [] | null | 13,318 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The correct order is initial phase, soft callus, bony callus and then remodelling. The initial phase is immediately after the fracture when blood leaks from blood vessels which have been damaged by the break. Blood which has leaked from these vessels forms a haemorrhagic swelling (haematoma). A soft callus is formed within the first few weeks, and there is also formation of granulation tissue, immature cartilaginous matrix and immature new bone. In weeks 3 to 4, the bony callus is formed - this is new bone produced by osteoblasts. New cartilage is also transformed into bone via a process of endochondral ossification. The final phase is bone remodelling.",
"id": "10003856",
"label": "a",
"name": "Initial phase, soft callus, bony callus, remodelling",
"picture": null,
"votes": 391
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct order is initial phase, soft callus, bony callus and then remodelling. The initial phase is immediately after the fracture when blood leaks from blood vessels which have been damaged by the break. Blood which has leaked from these vessels forms a haemorrhagic swelling (haematoma). A soft callus is formed within the first few weeks, and there is also formation of granulation tissue, immature cartilaginous matrix and immature new bone. In weeks 3 to 4, the bony callus is formed - this is new bone produced by osteoblasts. New cartilage is also transformed into bone via a process of endochondral ossification. The final phase is bone remodelling.",
"id": "10003858",
"label": "c",
"name": "Initial phase, remodelling, soft callus, bony callus",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct order is initial phase, soft callus, bony callus and then remodelling. The initial phase is immediately after the fracture when blood leaks from blood vessels which have been damaged by the break. Blood which has leaked from these vessels forms a haemorrhagic swelling (haematoma). A soft callus is formed within the first few weeks, and there is also formation of granulation tissue, immature cartilaginous matrix and immature new bone. In weeks 3 to 4, the bony callus is formed - this is new bone produced by osteoblasts. New cartilage is also transformed into bone via a process of endochondral ossification. The final phase is bone remodelling.",
"id": "10003857",
"label": "b",
"name": "Initial phase, soft callus, remodelling, bony callus",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct order is initial phase, soft callus, bony callus and then remodelling. The initial phase is immediately after the fracture when blood leaks from blood vessels which have been damaged by the break. Blood which has leaked from these vessels forms a haemorrhagic swelling (haematoma). A soft callus is formed within the first few weeks, and there is also formation of granulation tissue, immature cartilaginous matrix and immature new bone. In weeks 3 to 4, the bony callus is formed - this is new bone produced by osteoblasts. New cartilage is also transformed into bone via a process of endochondral ossification. The final phase is bone remodelling.",
"id": "10003860",
"label": "e",
"name": "Initial phase, bony callus, soft callus, remodelling",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct order is initial phase, soft callus, bony callus and then remodelling. The initial phase is immediately after the fracture when blood leaks from blood vessels which have been damaged by the break. Blood which has leaked from these vessels forms a haemorrhagic swelling (haematoma). A soft callus is formed within the first few weeks, and there is also formation of granulation tissue, immature cartilaginous matrix and immature new bone. In weeks 3 to 4, the bony callus is formed - this is new bone produced by osteoblasts. New cartilage is also transformed into bone via a process of endochondral ossification. The final phase is bone remodelling.",
"id": "10003859",
"label": "d",
"name": "Initial phase, remodelling, bony callus, soft callus",
"picture": null,
"votes": 5
}
],
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4209",
"name": "Fracture Healing",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
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"question": "A 34-year-old male sustains a broken femur in a rugby match.\n\nWhich of the following is the correct sequence of events in fracture healing?",
"sbaAnswer": [
"a"
],
"totalVotes": 550,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,191 | false | 24 | null | 6,495,048 | null | false | [] | null | 13,319 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prescribing opioid analgesia should not be the GP's first step. First-line pharmacological management of knee osteoarthritis should be a topical non-steroidal anti-inflammatory drug (NSAID). Paracetamol or weak opioids should not be routinely offered (except for when they are used infrequently for short-term pain relief or all other treatments are ineffective or unsuitable). Strong opioids should not be offered.",
"id": "10003863",
"label": "c",
"name": "Prescribe opioid analgesia",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acupuncture should not be recommended in patients with osteoarthritis. The GP's first steps should be to encourage exercise and weight loss.",
"id": "10003865",
"label": "e",
"name": "Advise acupuncture",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "For all patients with osteoarthritis, therapeutic exercise should be recommended. It is important to advise patients that exercise may initially cause pain or discomfort, but there will be long-term benefits. For patients that are overweight or obese, weight loss should also be advised.",
"id": "10003861",
"label": "a",
"name": "Encourage weight loss and exercise",
"picture": null,
"votes": 430
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Referral for knee replacement should only be considered if the joint symptoms are having a significant impact on quality of life and non-surgical management is either ineffective or unsuitable. It should not be the GP's first step.",
"id": "10003862",
"label": "b",
"name": "Refer for knee replacement",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rest is not recommended for osteoarthritis. The GP's first steps should be to encourage exercise and weight loss.",
"id": "10003864",
"label": "d",
"name": "Encourage rest",
"picture": null,
"votes": 64
}
],
"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": "3766",
"name": "Osteoarthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
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"typeId": null,
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"question": "A 74-year-old overweight male presents to the GP with chronic pain in his left knee. An x-ray is obtained and it shows signs of osteoarthritis.\n\nWhich of the following is the GP’s most likely first step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 550,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,192 | false | 25 | null | 6,495,048 | null | false | [] | null | 13,320 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A fracture in the proximal part of the humerus is most likely to damage the axillary nerve. The axillary nerve provides cutaneous innervation to the \"regimental patch\" area of the arm.",
"id": "10003866",
"label": "a",
"name": "Axillary",
"picture": null,
"votes": 494
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The median nerve is most likely to be damaged in a fracture of the distal part of the humerus, not the proximal.",
"id": "10003867",
"label": "b",
"name": "Median",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The radial nerve is most likely to be damaged in a fracture of the middle part of the humerus, not proximal. In \"Saturday Night Palsy\", the radial nerve is injured from prolonged direct pressure on the medial arm, commonly from hanging one's arm off a chair.",
"id": "10003870",
"label": "e",
"name": "Radial",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The common fibular nerve is located in the lower limb, not the upper limb. Damage to the common fibular nerve most often occurs in fractures of the neck of fibula or from plaster casts that have been left on too long, or fitted too tight.",
"id": "10003869",
"label": "d",
"name": "Common fibular",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The femoral nerve is located in the lower limb, not the upper limb. The femoral nerve innervates the anterior thigh muscles.",
"id": "10003868",
"label": "c",
"name": "Femoral",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "4119",
"name": "Axillary nerve injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
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"question": "A 17-year-old female falls off her horse, landing on the proximal part of her arm.\n\nShe attends ED and on examination, she has no sensation over the \"regimental patch\" area of her arm.\n\nWhich of the following nerves is most likely to be damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 549,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,193 | false | 26 | null | 6,495,048 | null | false | [] | null | 13,321 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteochondroma is a benign bone tumour, not malignant. It often presents in male patients under the age of 25. It is often asymptomatic and may only present after a fracture or the development of mobility problems.",
"id": "10003874",
"label": "d",
"name": "Osteochondroma",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chondrosarcoma is a malignant tumour of cartilage, not bone. It most commonly affects the axial skeleton and typically presents in middle age.",
"id": "10003872",
"label": "b",
"name": "Chondrosarcoma",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Enchondroma is a benign bone tumour, not malignant. It is a cartilage-forming tumour that develops in the medullary cavity of bone.",
"id": "10003873",
"label": "c",
"name": "Enchondroma",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoma is a benign bone tumour, not malignant. It causes a surface \"overgrowth\" of bone and most commonly presents on the skull.",
"id": "10003875",
"label": "e",
"name": "Osteoma",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Osteosarcoma is the most common primary malignant bone tumour. It is seen mainly in children and adolescents, with the mean age of diagnosis being 15. Pain that is worse at night is a feature of osteosarcoma.",
"id": "10003871",
"label": "a",
"name": "Osteosarcoma",
"picture": null,
"votes": 380
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
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"id": "4210",
"name": "Bone malignancies",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
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"question": "A 15-year-old female presents to her GP with persistent pain around her knee that is worse at night. The GP suspects a malignant bone condition.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 539,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,194 | false | 27 | null | 6,495,048 | null | false | [] | null | 13,322 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diamorphine is a strong opioid, not a simple analgesic.",
"id": "10003880",
"label": "e",
"name": "Diamorphine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Codeine is a weak opioid, not a simple analgesic. Codeine is converted in the liver to morphine.",
"id": "10003877",
"label": "b",
"name": "Codeine",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Morphine is a strong opioid, not a simple analgesic.",
"id": "10003879",
"label": "d",
"name": "Morphine",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tramadol is a weak opioid, not a simple analgesic.",
"id": "10003878",
"label": "c",
"name": "Tramadol",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Paracetamol is a simple analgesic and an anti-pyretic. Its exact mechanism of action remains unclear. It is most commonly used for mild to moderate pain without inflammation.",
"id": "10003876",
"label": "a",
"name": "Paracetamol",
"picture": null,
"votes": 524
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4211",
"name": "Paracetamol",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
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},
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"question": "An 18-year-old male presents to the GP after spraining his ankle. The GP recommends taking some simple analgesia.\n\nWhich of the following is an example of a simple analgesic?",
"sbaAnswer": [
"a"
],
"totalVotes": 546,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,195 | false | 28 | null | 6,495,048 | null | false | [] | null | 13,323 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This diagnosis is not the most likely considering the history given. There is no mention of a fever or purulent sputum.",
"id": "10003883",
"label": "c",
"name": "Pneumonia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most likely diagnosis considering the patient's history and the obstructive findings on spirometry (FEV1/FVC ratio <0.7).",
"id": "10003881",
"label": "a",
"name": "COPD",
"picture": null,
"votes": 500
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this patient is high risk for lung malignancy, there are no red flags mentioned in the history, such as weight loss or haemoptysis.",
"id": "10003884",
"label": "d",
"name": "Lung malignancy",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst asthma can present with exertional dyspnoea and wheeze, it is more associated with a dry cough. Furthermore, there is no mention in the history of symptom variability. The significant smoking history makes COPD more likely.",
"id": "10003882",
"label": "b",
"name": "Asthma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary fibrosis typically presents with a dry cough and persistent, progressive dyspnoea that is worse on exertion. Pulmonary fibrosis is also associated with a restrictive profile on spirometry (reduced FVC, normal FEV1/FVC), not obstructive.",
"id": "10003885",
"label": "e",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 25
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"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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"question": "A 67-year-old man attends a respiratory outpatient clinic with long-term exertional dyspnoea, wheeze and a chronic productive cough. He is calculated to have a 40-pack-year smoking history. He undergoes spirometry testing: his FEV1/FVC ratio is 0.5.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 548,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,196 | false | 29 | null | 6,495,048 | null | false | [] | null | 13,324 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).",
"id": "10003887",
"label": "b",
"name": "500ml",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).",
"id": "10003888",
"label": "c",
"name": "3L",
"picture": null,
"votes": 118
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).",
"id": "10003889",
"label": "d",
"name": "10L",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).",
"id": "10003886",
"label": "a",
"name": "6L",
"picture": null,
"votes": 397
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).",
"id": "10003890",
"label": "e",
"name": "1L",
"picture": null,
"votes": 19
}
],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
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"id": "4212",
"name": "Lung volumes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
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"question": "A 72-year-old man with a 37-pack-year smoking history presents to his GP with a troublesome cough and dyspnoea that is worse on exertion.\n\nThe GP suspects COPD and arranges for further tests, including a chest x-ray.\n\nThe chest x-ray shows hyperinflated lungs.\n\nWhich of the following is the normal total lung capacity in healthy individuals?",
"sbaAnswer": [
"a"
],
"totalVotes": 549,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,197 | false | 30 | null | 6,495,048 | null | false | [] | null | 13,325 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metabolic acidosis is characterised by an increase in the concentration of H+, with an associated decrease in bicarbonate. This can be caused by a gain of acid, or loss of bicarbonate. The anion gap is important in differentiating between these two causes. A high anion gap is associated with a gain of acid (such as in renal failure, diabetic ketoacidosis or lactic acidosis) whilst a normal/reduced anion gap is associated with loss of bicarbonate (such as severe diarrhoea or renal tubular acidosis).",
"id": "10003893",
"label": "c",
"name": "Metabolic acidosis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A mixed respiratory and metabolic acidosis would have a reduced pH, high CO2 and low bicarbonate. This can be caused by cardiac arrest or multi-organ failure.",
"id": "10003895",
"label": "e",
"name": "Mixed respiratory and metabolic acidosis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metabolic alkalosis is caused by an increase in bicarbonate intake (eg excessive antacid use) or a loss of acid from the body (eg severe vomiting). This causes a rise in pH and an alkalosis.",
"id": "10003894",
"label": "d",
"name": "Metabolic alkalosis",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Respiratory alkalosis is most commonly seen in panic attacks. Hyperventilation causes CO2 to be blown off which results in a decrease in the concentration of H+ ions in the blood, and therefore an increase in pH above normal limits.",
"id": "10003891",
"label": "a",
"name": "Respiratory alkalosis",
"picture": null,
"votes": 431
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Respiratory acidosis results from failure of the respiratory system, causing a decrease in respiratory rate or a decrease in respiratory volume. This results in increased retention of CO2 and an increase in the concentration of H+ ions and subsequent acidosis. This can be caused by chronic respiratory conditions such as COPD.",
"id": "10003892",
"label": "b",
"name": "Respiratory acidosis",
"picture": null,
"votes": 91
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4213",
"name": "Respiratory alkalosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
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"question": "A 54-year-old female attends the Emergency Department after experiencing a panic attack 1 hour ago. Her respiratory rate is currently 28 breaths per minute.\n\nWhat is the most likely acid-base finding?",
"sbaAnswer": [
"a"
],
"totalVotes": 551,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,198 | false | 31 | null | 6,495,048 | null | false | [] | null | 13,326 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The biggest factor contributing to airway resistance is airway diameter, with narrower airways typically having greater airway resistance. The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.",
"id": "10003896",
"label": "a",
"name": "Trachea",
"picture": null,
"votes": 238
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.",
"id": "10003900",
"label": "e",
"name": "Segmental bronchi",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.",
"id": "10003898",
"label": "c",
"name": "Alveoli",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea. Most airway diseases affect the bronchioles first, and as bronchioles don't contribute much towards airway resistance, their resistance can increase a lot before the total resistance of the respiratory tract is affected.",
"id": "10003897",
"label": "b",
"name": "Bronchioles",
"picture": null,
"votes": 141
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.",
"id": "10003899",
"label": "d",
"name": "Alveolar ducts",
"picture": null,
"votes": 33
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
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"demo": null,
"entitlement": null,
"id": "4214",
"name": "Sites of airway resistance",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
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"question": "A 32-year-old male attends the Emergency Department with a severe asthma exacerbation. He is dyspnoeic and wheezy and unable to complete full sentences.\n\nWhich of the following parts of the respiratory tract provides the most total resistance to airflow?",
"sbaAnswer": [
"a"
],
"totalVotes": 549,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,199 | false | 32 | null | 6,495,048 | null | false | [] | null | 13,327 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and hyperkalaemia, not hypokalaemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as loop diuretics (eg furosemide) can cause hypokalaemia.",
"id": "10003902",
"label": "b",
"name": "Hypokalaemia",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and hyperkalaemia, not hypocalcaemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as bisphosphonates and denosumab (both of which are used to treat osteoporosis) can cause hypocalcaemia.",
"id": "10003905",
"label": "e",
"name": "Hypocalcaemia",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and hyperkalaemia, not hyponatraemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as diuretics (especially thiazide diuretics) and carbamazepine (an anti-epileptic) can cause hyponatraemia.",
"id": "10003903",
"label": "c",
"name": "Hyponatraemia",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Lisinopril is an ACE inhibitor and hyperkalaemia is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water.",
"id": "10003901",
"label": "a",
"name": "Hyperkalaemia",
"picture": null,
"votes": 358
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and hyperkalaemia, not hypernatraemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as NSAIDs can cause hypernatraemia.",
"id": "10003904",
"label": "d",
"name": "Hypernatraemia",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4215",
"name": "ACE inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
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"question": "A 45-year-old man attends his General Practitioner for a follow-up after wearing an ambulatory blood pressure monitor to provide an accurate measurement of his blood pressure. His daytime average blood pressure is 145/95. He is started on Lisinopril.\n\nWhich of the following electrolyte disturbances is he most likely to develop on this medication?",
"sbaAnswer": [
"a"
],
"totalVotes": 549,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,200 | false | 33 | null | 6,495,048 | null | false | [] | null | 13,328 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spironolactone is an aldosterone antagonist and can be added as a 4th-line agent for hypertension management, along with an ACE inhibitor or Angiotensin II receptor blocker, a calcium channel blocker and a thiazide-like diuretic. This can only be done if the blood potassium is ≤4.5mmol/L as spironolactone is a potassium-sparing agent. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.",
"id": "10003910",
"label": "e",
"name": "Spironolactone",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Candesartan is an Angiotensin II Receptor Blocker (ARB) and is only used as a first-line antihypertensive treatment (along with ACE inhibitors, but not together) in patients with Type 2 diabetes, or those who are under 55 and not from a Black African or African-Carribean family origin. For the patient in this question, the first line antihypertensive is a calcium channel blocker such as amlodipine.",
"id": "10003908",
"label": "c",
"name": "Candesartan",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Indapamide is a thiazide-like diuretic and can be used second or third-line in hypertension management. It can be added to an ACE inhibitor or Angiotensin II receptor blocker, or a calcium channel blocker as second-line management. For third-line management, it is used in conjunction with either an ACE inhibitor or Angiotensin II receptor blocker, as well as a calcium channel blocker. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.",
"id": "10003909",
"label": "d",
"name": "Indapamide",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is an ACE inhibitor and is only used as a first-line antihypertensive treatment (along with Angiotensin II receptor blockers, but not together) in patients with type 2 diabetes or those who are under 55 and not from a Black African or African-Carribean family origin. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.",
"id": "10003907",
"label": "b",
"name": "Lisinopril",
"picture": null,
"votes": 137
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Amlodipine is a calcium-channel blocker, and this class of medications is used first-line for hypertension in patients aged over 55, or from a Black African or African-Carribean family origin (provided they do not have Type 2 diabetes). ACE inhibitors, angiotensin II receptor blockers or thiazide-like diuretics can be added to the calcium-channel blocker as second-line management.",
"id": "10003906",
"label": "a",
"name": "Amlodipine",
"picture": null,
"votes": 378
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "4215",
"name": "ACE inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
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"question": "A 60-year-old male attends his GP and is found to have stage 2 hypertension. He does not have diabetes.\n\nWhich of the following is the first-line anti-hypertensive medication for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 546,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,201 | false | 34 | null | 6,495,048 | null | false | [] | null | 13,329 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Patients under the age of 16 should not be given aspirin due to the risk of Reye's syndrome, a poorly understood neurological condition. Kawasaki disease, however, is one exception when aspirin can be given to children.",
"id": "10003911",
"label": "a",
"name": "Patients aged under 16",
"picture": null,
"votes": 384
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with diabetes can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.",
"id": "10003912",
"label": "b",
"name": "Patients with diabetes",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with anaemia can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.",
"id": "10003915",
"label": "e",
"name": "Patients with anaemia",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients on beta blockers can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.",
"id": "10003913",
"label": "c",
"name": "Patients on beta blockers",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although aspirin is cautioned in elderly patients, it is not contraindicated. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.",
"id": "10003914",
"label": "d",
"name": "Patients aged over 85",
"picture": null,
"votes": 22
}
],
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
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"id": "4216",
"name": "Aspirin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "A 54-year-old man is brought to the Emergency Department by ambulance with central crushing chest pain. His ECG shows ST-segment elevation. He is given 300mg aspirin.\n\nIn which of the following groups of patients is aspirin contraindicated?",
"sbaAnswer": [
"a"
],
"totalVotes": 544,
"typeId": 1,
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} | MarksheetMark |
173,461,202 | false | 35 | null | 6,495,048 | null | false | [] | null | 13,330 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient presents with symptoms consistent with rhabdomyolysis after starting a statin post-myocardial infarction. Rhabdomyolysis is a rare side effect of statins, such as simvastatin. If muscular symptoms are severe, treatment should be discontinued.",
"id": "10003916",
"label": "a",
"name": "Simvastatin",
"picture": null,
"votes": 353
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clopidogrel is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.",
"id": "10003920",
"label": "e",
"name": "Clopidogrel",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lisinopril is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.",
"id": "10003917",
"label": "b",
"name": "Lisinopril",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.",
"id": "10003919",
"label": "d",
"name": "Aspirin",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bisoprolol is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.",
"id": "10003918",
"label": "c",
"name": "Bisoprolol",
"picture": null,
"votes": 29
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "ACEi should also be stopped in the presence of AKI",
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"demo": null,
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"id": "4116",
"name": "Statins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "A 54-year-old woman is on the cardiology ward after suffering from a recent myocardial infarction. A week later she complains of severe muscle aches throughout her body. She also notes her urine is cola-coloured.\n\nWhich of the following drugs should be stopped?",
"sbaAnswer": [
"a"
],
"totalVotes": 548,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,203 | false | 36 | null | 6,495,048 | null | false | [] | null | 13,331 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. The mechanism of action of warfarin, an anticoagulant, is inhibiting vitamin K epoxide reductase. This prevents the regeneration of reduced Vitamin K which is needed for clotting factor synthesis.",
"id": "10003924",
"label": "d",
"name": "Vitamin K epoxide reductase inhibitor",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Aspirin inhibits the COX-1 enzyme. This prevents the conversion of arachidonic acid to prostaglandins. Prostaglandins produced by COX-1 are involved in platelet aggregation. Hence, aspirin reduces platelet aggregation.",
"id": "10003921",
"label": "a",
"name": "COX-1 inhibitor",
"picture": null,
"votes": 491
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. However, another anti-platelet agent, dipyridamole, achieves part of its anti-platelet effect by inhibiting phosphodiesterase. This increases cAMP levels, causing vasodilation and inhibiting platelet activation and aggregation.",
"id": "10003923",
"label": "c",
"name": "Phosphodiesterase inhibitor",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. Other anti-platelets, such as clopidogrel and ticagrelor, are P2Y12 receptor antagonists, preventing ADP-mediated platelet aggregation.",
"id": "10003922",
"label": "b",
"name": "P2Y12 receptor antagonist",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. The mechanism of action of dabigatran, a DOAC, is directly inhibiting thrombin IIa.",
"id": "10003925",
"label": "e",
"name": "Direct Thrombin IIa inhibitor",
"picture": null,
"votes": 14
}
],
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"name": "Aspirin",
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"id": "169",
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"question": "A 72-year-old female is admitted to the stroke ward after having an ischaemic stroke. She receives thrombolysis and 24 hours later and is started on 300mg aspirin for 14 days.\n\nWhat is the mechanism of action of aspirin?",
"sbaAnswer": [
"a"
],
"totalVotes": 548,
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} | MarksheetMark |
173,461,204 | false | 37 | null | 6,495,048 | null | false | [] | null | 13,332 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ticagrelor is associated with causing breathlessness, not prasugrel. Prasugrel is also an anti-platelet agent and can be used alongside aspirin in patients undergoing percutaneous coronary intervention (PCI).",
"id": "10003927",
"label": "b",
"name": "Prasugrel",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ticagrelor is associated with causing breathlessness, not simvastatin. Simvastatin is a statin and can be used for the secondary prevention of myocardial infarctions along with other drugs. Statins reduce cholesterol in the blood.",
"id": "10003930",
"label": "e",
"name": "Simvastatin",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ticagrelor is associated with causing breathlessness, not bisoprolol. Bisoprolol is a beta-blocker and can be used for the secondary prevention of myocardial infarctions along with other drugs.",
"id": "10003929",
"label": "d",
"name": "Bisoprolol",
"picture": null,
"votes": 228
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ticagrelor is associated with causing breathlessness, not lisinopril. Lisinopril is an ACE inhibitor and can be used for the secondary prevention of myocardial infarctions along with other drugs.",
"id": "10003928",
"label": "c",
"name": "Lisinopril",
"picture": null,
"votes": 75
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ticagrelor is an anti-platelet agent and breathlessness is a common side effect associated with it due to the impaired clearance of adenosine. Adenosine can stimulate sensory nerve fibres in the lungs, causing the sensation of breathlessness.",
"id": "10003926",
"label": "a",
"name": "Ticagrelor",
"picture": null,
"votes": 179
}
],
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"id": "4217",
"name": "Ticagrelor",
"status": null,
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"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
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"question": "A 42-year-old man is admitted to the Coronary Care Unit after experiencing central crushing chest pain. His ECG showed ST elevation.\n\nHe received percutaneous coronary intervention and was started on secondary prevention medications. He soon complains of breathlessness.\n\nWhich of the following drugs is the most likely cause of his breathlessness?",
"sbaAnswer": [
"a"
],
"totalVotes": 541,
"typeId": 1,
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} | MarksheetMark |
173,461,205 | false | 38 | null | 6,495,048 | null | false | [] | null | 13,333 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Arterioles contribute the most to vascular resistance. Veins have a very low resistance to flow due to their ability to distend.",
"id": "10003934",
"label": "d",
"name": "Vein",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Arterioles contribute the most to vascular resistance. Muscular arteries are distributing vessels. In comparison to elastic arteries, the tunica media in muscular arteries is smaller (less elastic tissue).",
"id": "10003935",
"label": "e",
"name": "Muscular artery",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Arterioles contribute the most to vascular resistance. Metarterioles are also capable of increasing their resistance to blood flowing into capillaries, but their effect is not as significant as arterioles.",
"id": "10003933",
"label": "c",
"name": "Metarterioles",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Arterioles contribute the most to vascular resistance. Elastic arteries are conducting vessels, such as the aorta and other large vessels. The aorta has minimal resistance to flow compared to the arterioles.",
"id": "10003932",
"label": "b",
"name": "Elastic artery",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Arterioles provide the most vascular resistance as they have abundant sympathetic nerve endings which can cause the smooth muscle to contract or relax.",
"id": "10003931",
"label": "a",
"name": "Arteriole",
"picture": null,
"votes": 338
}
],
"comments": [],
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"__typename": "Chapter",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3809",
"name": "Structure and physiology of blood vessels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
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"question": "A 65-year-old female attends her General Practitioner after being diagnosed with stage 1 hypertension. Her GP discusses lifestyle changes the patient could make to help manage her condition.\n\nWhich of the following blood vessels contribute the most towards vascular resistance?",
"sbaAnswer": [
"a"
],
"totalVotes": 549,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,206 | false | 39 | null | 6,495,048 | null | false | [] | null | 13,334 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).",
"id": "10003940",
"label": "e",
"name": "Stroke volume x total peripheral resistance",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Mean arterial pressure can be calculated by cardiac output x total peripheral resistance.",
"id": "10003939",
"label": "d",
"name": "Heart rate x mean arterial pressure",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest.",
"id": "10003937",
"label": "b",
"name": "Heart rate x total peripheral resistance",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Mean arterial pressure can be calculated by cardiac output x total peripheral resistance. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).",
"id": "10003938",
"label": "c",
"name": "Stroke volume x mean arterial pressure",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). Normal cardiac output is 5-6 L/min at rest. Stroke volume is the volume of blood pumped out of the left ventricle with each contraction. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).",
"id": "10003936",
"label": "a",
"name": "Heart rate x stroke volume",
"picture": null,
"votes": 511
}
],
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"chapterId": 2693,
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"entitlement": null,
"id": "4218",
"name": "Cardiac Volumes and Arterial Pressure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
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"question": "A 72-year-old female attends her GP with symptoms of breathlessness on exertion. She also complains of waking up in the middle of the night gasping for breath. On examination, she has a raised JVP and her ankles have pitting oedema.\n\nShe is referred for echocardiography to assess her left ventricular function.\n\nWhich of the following describes how to calculate cardiac output?",
"sbaAnswer": [
"a"
],
"totalVotes": 543,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,207 | false | 40 | null | 6,495,048 | null | false | [] | null | 13,335 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Increased stimulation of the baroreceptors in the aortic arch and carotid bodies results in the increased firing of the afferent nerve fibres from the baroreceptors. These fibres synapse in the cardiac vasomotor centre of the medulla resulting in an increase in parasympathetic and a decrease in sympathetic stimulation to the heart, thereby reducing blood pressure.",
"id": "10003945",
"label": "e",
"name": "Increased baroreceptor stimulation",
"picture": null,
"votes": 106
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Decreased total peripheral resistance means that the blood vessels are less constricted, and will therefore cause a fall in blood pressure.",
"id": "10003944",
"label": "d",
"name": "Decreased total peripheral resistance",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sympathetic stimulation increases cardiac contractility, increasing cardiac output and blood pressure. Therefore a decrease in sympathetic stimulation will cause a fall in blood pressure.",
"id": "10003942",
"label": "b",
"name": "Decreased sympathetic stimulation to the heart",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Increased cardiac output results in increased stimulation of the baroreceptors in the aortic arch and carotid bodies. This results in the increased firing of the afferent nerve fibres from the baroreceptors. These fibres synapse in the cardiac vasomotor centre of the medulla and cause an increase in parasympathetic and a decrease in sympathetic stimulation to the heart, thus reducing blood pressure.",
"id": "10003943",
"label": "c",
"name": "Increased cardiac output",
"picture": null,
"votes": 252
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with postural hypotension. The vagus nerve provides parasympathetic stimulation to the heart, reducing blood pressure. Therefore decreased vagal tone will cause a compensatory increase in blood pressure.",
"id": "10003941",
"label": "a",
"name": "Decreased vagal tone",
"picture": null,
"votes": 132
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
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"entitlement": null,
"id": "4219",
"name": "Baroreceptor reflex",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
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"topicId": 159,
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"question": "A 92-year-old woman attends her GP after experiencing syncopal episodes when standing up from a seated or lying position. The GP checks her seated and standing blood pressure and finds there is a systolic drop of 35mmHg.\n\nWhich of the following will cause a rise in blood pressure?",
"sbaAnswer": [
"a"
],
"totalVotes": 545,
"typeId": 1,
"userPoint": null
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173,461,208 | false | 41 | null | 6,495,048 | null | false | [] | null | 13,336 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of ezetimibe, another cholesterol-lowering drug. Ezetimibe works by blocking the NPC1L1 protein, stopping the absorption of cholesterol across the gut wall. The first line cholesterol-lowering drug is a statin. This drug class works by inhibiting the HMG-CoA reductase enzyme. This decreases the synthesis of cholesterol causing an upregulation in LDL receptor expression which moves more LDL into cells and thus lowers the level of circulating LDL.",
"id": "10003947",
"label": "b",
"name": "Inhibits absorption of cholesterol across the gut wall",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of fibrates, another group of cholesterol-lowering drugs. Activation of the PPARα transcription factor by fibrates increases the transcription of genes for lipoprotein lipase, apo-A1 and apo-A5. The first line cholesterol-lowering drug is a statin. This drug class works by inhibiting the HMG-CoA reductase enzyme. This decreases the synthesis of cholesterol causing an upregulation in LDL receptor expression which moves more LDL into cells and thus lowers the level of circulating LDL.",
"id": "10003948",
"label": "c",
"name": "Activates nuclear transcription factor PPARα",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of PCSK-9 inhibitors, such as alirocumab. These are monoclonal antibodies against the PCSK-9 protein on the LDL receptor. Normally PCSK-9 breaks down the LDL receptor; inhibiting PCSK-9 allows LDL receptors to be reused by the cell, thus increasing the uptake of LDL from the blood. The first line cholesterol-lowering drug is a statin. This drug class works by inhibiting the HMG-CoA reductase enzyme. This decreases the synthesis of cholesterol causing an upregulation in LDL receptor expression which moves more LDL into cells and thus lowers the level of circulating LDL.",
"id": "10003949",
"label": "d",
"name": "Inhibits PCSK-9 protein",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The first-line cholesterol-lowering drug is a statin. This drug class works by inhibiting the HMG-CoA reductase enzyme. This decreases the synthesis of cholesterol causing an upregulation in LDL receptor expression which moves more LDL into cells and thus lowers the level of circulating LDL.",
"id": "10003946",
"label": "a",
"name": "Inhibits HMG-CoA reductase",
"picture": null,
"votes": 484
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of bempedoic acid, another cholesterol-lowering medication. The first line cholesterol-lowering drug is a statin. This drug class works by inhibiting the HMG-CoA reductase enzyme. This decreases the synthesis of cholesterol causing an upregulation in LDL receptor expression which moves more LDL into cells and thus lowers the level of circulating LDL.",
"id": "10003950",
"label": "e",
"name": "Inhibits cholesterol synthesis in the liver",
"picture": null,
"votes": 18
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "4116",
"name": "Statins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "A 33-year-old attends her GP after she noticed a white ring on the outer edge of her cornea. When questioned, she tells the GP her father died aged 42 from a \"heart problem\". The GP suspects familial hypercholesterolaemia and refers her to the lipid clinic. The GP starts the patient on some medication while waiting for the appointment.\n\nWhat is the mechanism of action of the first-line cholesterol-lowering medication?",
"sbaAnswer": [
"a"
],
"totalVotes": 542,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,209 | false | 42 | null | 6,495,048 | null | false | [] | null | 13,337 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has iron-deficiency anaemia due to chronic blood loss from her heavy periods. This causes a microcytic hypochromic picture on the blood film. This means the red blood cells are smaller and paler than normal due to lower levels of haemoglobin.",
"id": "10003955",
"label": "e",
"name": "Microcytic hyperchromic anaemia",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Macrocytic hyperchromic anaemia is seen in vitamin B12 and folate deficiency. This patient has iron-deficiency anaemia due to chronic blood loss from her heavy periods. This causes a microcytic hypochromic picture on the blood film. This means the red blood cells are smaller and paler than normal due to lower levels of haemoglobin.",
"id": "10003952",
"label": "b",
"name": "Macrocytic hyperchromic anaemia",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has iron-deficiency anaemia due to chronic blood loss from her heavy periods. This causes a microcytic hypochromic picture on the blood film. This means the red blood cells are smaller and paler than normal due to lower levels of haemoglobin.",
"id": "10003951",
"label": "a",
"name": "Microcytic hypochromic anaemia",
"picture": null,
"votes": 306
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Normocytic normochromic anaemia is seen in haemorrhage or acutely in haemolytic anaemias. This patient has iron-deficiency anaemia due to chronic blood loss from her heavy periods. This causes a microcytic hypochromic picture on the blood film. This means the red blood cells are smaller and paler than normal due to lower levels of haemoglobin.",
"id": "10003953",
"label": "c",
"name": "Normocytic normochromic anaemia",
"picture": null,
"votes": 167
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Macrocytic normochromic blood films are seen in conditions such as aplastic anaemia. This patient has iron-deficiency anaemia due to chronic blood loss from her heavy periods. This causes a microcytic hypochromic picture on the blood film. This means the red blood cells are smaller and paler than normal due to lower levels of haemoglobin.",
"id": "10003954",
"label": "d",
"name": "Macrocytic normochromic anaemia",
"picture": null,
"votes": 18
}
],
"comments": [],
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"demo": null,
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"id": "3794",
"name": "Iron deficiency anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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"question": "A 34-year-old female attends her GP complaining of being tired all the time. On further questioning, she also admits to experiencing light-headedness and exertional dyspnoea. She also states she has been having heavy periods for the last year.\n\nThe GP orders further tests, including a blood film.\n\nWhat is the blood film most likely to show?",
"sbaAnswer": [
"a"
],
"totalVotes": 538,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,210 | false | 43 | null | 6,495,048 | null | false | [] | null | 13,338 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This history is suggestive of a haemolytic anaemia. we would expect to see corresponding blood film changes such as the presence of schistocytes (red blood cell fragments), spherocytes (in hereditary spherocytosis), bite cells and Heinz bodies (in G6PD deficiency).",
"id": "10003960",
"label": "e",
"name": "Normal blood film",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This history is suggestive of a haemolytic anaemia. In haemolytic anaemias the haptoglobin is low. Haptoglobin is a plasma protein that binds to free haemoglobin and then is removed from the body. It is low in haemolytic anaemias as red blood cell breakdown results in the release of lots of free haemoglobin which haptoglobin can bind to.",
"id": "10003956",
"label": "a",
"name": "Low haptoglobin",
"picture": null,
"votes": 257
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This history is suggestive of a haemolytic anaemia. Reticulocytes are immature red blood cells and would be increased in haemolytic anaemias as a compensatory mechanism for the increased red blood cell breakdown.",
"id": "10003959",
"label": "d",
"name": "Reduced reticulocytes",
"picture": null,
"votes": 136
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This history is suggestive of a haemolytic anaemia. Bilirubin is a breakdown product of haem and would be raised in a haemolytic anaemia, not lowered. It is the increased level of bilirubin that is responsible for the yellow skin pigmentation in this patient (jaundice).",
"id": "10003958",
"label": "c",
"name": "Low bilirubin",
"picture": null,
"votes": 98
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This history is suggestive of a haemolytic anaemia. Lactate dehydrogenase (LDH) would be expected to be raised in a haemolytic anaemia. LDH is present in red cells and haemolysis causes its release into the plasma.",
"id": "10003957",
"label": "b",
"name": "Low LDH",
"picture": null,
"votes": 31
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4220",
"name": "Haemolytic anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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},
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"question": "A 6-year-old male presents to the paediatric haematology team with his mother.\n\nOn examination, the child has a yellow colouring to his skin. The mother states that this has happened before, and the child is becoming increasingly lethargic and irritable.\n\nThe haematologist orders further tests.\n\nWhich of the following is the most likely test result for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 540,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,211 | false | 44 | null | 6,495,048 | null | false | [] | null | 13,339 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute haemolytic reactions occur within 24 hours of transfusion due to ABO incompatibility and normally present with a triad of symptoms: fever, flank pain, and red or brown urine. Further investigations would show a raised bilirubin and LDH, and an acute fall in haemoglobin.",
"id": "10003965",
"label": "e",
"name": "Acute haemolytic reaction",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst renal biopsies can be carried out to investigate the cause of nephrotic syndrome, the patient's pattern of symptoms is not in keeping with nephrotic syndrome. Nephrotic syndrome is associated with hypoalbuminaemia (and fluid overload) and massive proteinuria.",
"id": "10003963",
"label": "c",
"name": "Nephrotic syndrome",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pattern of symptoms following blood transfusion are more in keeping with a diagnosis of transfusion-associated acute lung injury.",
"id": "10003962",
"label": "b",
"name": "Heart failure",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "TRALI causes acute pulmonary oedema within 6 hours of transfusion. It is caused by antibodies in the donor blood reacting with the patient’s white blood cells (neutrophils and monocytes) or pulmonary endothelium, causing inflammatory cells to be sequestered in the lungs. This results in the leakage of plasma into the alveolar spaces and acute respiratory distress.",
"id": "10003961",
"label": "a",
"name": "Transfusion-associated acute lung injury (TRALI)",
"picture": null,
"votes": 315
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "TACO can also present within 6 hours of transfusion, but it is associated with hypertension, not hypotension, and is generally in older patients. It also does not present with a high temperature.",
"id": "10003964",
"label": "d",
"name": "Transfusion-associated circulatory overload (TACO)",
"picture": null,
"votes": 127
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4190",
"name": "Complications of blood transfusions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4190,
"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13339",
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"question": "A 32-year-old man receives a blood transfusion after experiencing bleeding following a renal biopsy. 4 hours later he develops rapid onset dyspnoea and tachypnoea. His blood pressure is 95/65 and his temperature is 37.8°C.\n\nAn ABG is carried out and shows a normal LDH.\n\nWhich of the following is the most likely cause of his symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 534,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,212 | false | 45 | null | 6,495,048 | null | false | [] | null | 13,340 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As the patient is a female of childbearing age, she should receive O- blood to ensure she will not form anti-D antibodies against Rhesus factor which could cause problems in future pregnancies.",
"id": "10003970",
"label": "e",
"name": "A-",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As the patient is a female of childbearing age, she should receive O- blood to ensure she will not form anti-D antibodies against Rhesus factor which could cause problems in future pregnancies.",
"id": "10003968",
"label": "c",
"name": "AB-",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As the patient is a female of childbearing age, she should receive O- blood to ensure she will not form anti-D antibodies against Rhesus factor which could cause problems in future pregnancies.",
"id": "10003969",
"label": "d",
"name": "O+",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's blood group is unknown and blood is urgently required so O- blood should be given. As the patient is a female of childbearing age, she shouldn't be given O+ blood as she will form anti-D antibodies against Rhesus factor and this has the potential to cause problems in future pregnancies. AB+ is the blood group that is a universal recipient.",
"id": "10003967",
"label": "b",
"name": "AB+",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "O- blood has no ABO and RhD antigens on the surface of the red blood cells, so is safe for all patients to receive.",
"id": "10003966",
"label": "a",
"name": "O-",
"picture": null,
"votes": 508
}
],
"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": "3796",
"name": "Blood group compatibility",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3796,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13340",
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"question": "A 27-year-old female is brought to the Emergency Department after being involved in a road traffic collision. On arrival, she is noted to be hypotensive and has lost a lot of blood. The major haemorrhage protocol is activated. No blood has been crossmatched.\n\nWhich of the following groups of blood is safe to give to this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 542,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,213 | false | 46 | null | 6,495,048 | null | false | [] | null | 13,341 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Enoxaparin is an anticoagulant and is given to patients to reduce the risk of them developing DVTs in hospital. This means enoxaparin treatment cannot be a contributing factor to this patient developing a DVT. Considering the history given, immobility following surgery is the most likely contributing factor to his DVT.",
"id": "10003973",
"label": "c",
"name": "Enoxaparin treatment",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst smoking can contribute to endothelial damage - a part of Virchow's triad for thrombus formation - the history given in this situation makes immobility following surgery the most likely contributing factor to him developing a DVT.",
"id": "10003975",
"label": "e",
"name": "Smoking",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst long-haul flights can result in the development of DVTs due to stasis of blood flow, there is nothing in this patient's history that would suggest he has been on any recent long-haul flights. Considering the history given, immobility following surgery is the most likely contributing factor to his DVT.",
"id": "10003972",
"label": "b",
"name": "Recent long-haul flight",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst atherosclerosis can contribute to endothelial damage - a part of Virchow's triad for thrombus formation - the history given in this situation makes immobility following surgery the most likely contributing factor to him developing a DVT.",
"id": "10003974",
"label": "d",
"name": "Atherosclerosis",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with a DVT 5 days post-operation and is likely to have been moving less due to his poorly controlled pain, making immobility the most likely contributing factor to his DVT. Stasis of blood is part of Virchow's triad for thrombus formation.",
"id": "10003971",
"label": "a",
"name": "Immobility",
"picture": null,
"votes": 432
}
],
"comments": [],
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"__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": "4221",
"name": "Virchow’s triad",
"status": null,
"topic": {
"__typename": "Topic",
"id": "193",
"name": "Haematological Science",
"typeId": 7
},
"topicId": 193,
"totalCards": null,
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"question": "A 72-year-old man is on a surgical ward recovering from a Hartmann's procedure 5 days ago. His pain post-op has been poorly controlled. He now complains of a swollen and tender left leg. On examination, it is erythematous and a 5cm difference in circumference is noted from the right leg.\n\nHe receives an ultrasound scan which confirms the diagnosis of a deep vein thrombosis (DVT).\n\nWhich of the following factors is most likely to have contributed to the development of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 545,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,214 | false | 47 | null | 6,495,048 | null | false | [] | null | 13,342 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Erythropoietin (EPO) is a hormone produced by the kidney in response to hypoxia. It stimulates the red bone marrow to increase erythropoiesis, increasing red blood cell production. The spleen functions to sequester and destroy worn-out red blood cells. The spleen also has an important role in immune function by detecting and responding to blood-borne antigens.",
"id": "10003978",
"label": "c",
"name": "Spleen",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Erythropoietin (EPO) is a hormone produced by the kidney in response to hypoxia. It stimulates the red bone marrow to increase erythropoiesis, increasing red blood cell production.",
"id": "10003976",
"label": "a",
"name": "Kidney",
"picture": null,
"votes": 430
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Erythropoietin (EPO) is a hormone produced by the kidney in response to hypoxia. It stimulates the red bone marrow to increase erythropoiesis, increasing red blood cell production. The red bone marrow also contains stem cells that can differentiate to form white blood cells and platelets.",
"id": "10003977",
"label": "b",
"name": "Red bone marrow",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Erythropoietin (EPO) is a hormone produced by the kidney in response to hypoxia. It stimulates the red bone marrow to increase erythropoiesis, increasing red blood cell production. The liver has many functions including being a glucose and fat buffer, as well as protein and drug metabolism.",
"id": "10003979",
"label": "d",
"name": "Liver",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Erythropoietin (EPO) is a hormone produced by the kidney in response to hypoxia. It stimulates the red bone marrow to increase erythropoiesis, increasing red blood cell production. The thyroid's primary function is to produce thyroid hormone in the form of T4 (mainly) and T3.",
"id": "10003980",
"label": "e",
"name": "Thyroid",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4222",
"name": "Renal erythropoietin secretion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "193",
"name": "Haematological Science",
"typeId": 7
},
"topicId": 193,
"totalCards": null,
"typeId": null,
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"difficulty": 1,
"dislikes": 0,
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"question": "A 72-year-old man attends his GP for an annual review. He has a past medical history of severe COPD, diagnosed 25 years ago. The GP orders routine blood tests and they come back showing an erythrocytosis. The GP suspects this has occurred secondary to chronic hypoxia from his COPD.\n\nHypoxia stimulates erythropoietin production, which in turn stimulates the red bone marrow to increase erythropoiesis.\n\nWhere is erythropoietin produced?",
"sbaAnswer": [
"a"
],
"totalVotes": 546,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,215 | false | 48 | null | 6,495,048 | null | false | [] | null | 13,343 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "D-dimer is a highly sensitive but non-specific marker of clotting. This test is useful for ruling out DVTs and PEs, but not confirming the diagnosis. According to the Wells' Score, this patient has a high risk of having a pulmonary embolism, and as such a d-dimer test is not recommended. Furthermore, d-dimer is elevated in pregnancy, and would not provide a meaningful result in this patient.",
"id": "10003982",
"label": "b",
"name": "D-Dimer",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. If the compression duplex ultrasound was negative or the woman did not have features of DVT, then a CT pulmonary angiogram or V/Q scan could be considered. A V/Q scan is a ventilation-perfusion scan, and it looks at the blood and air supply to the lungs. In pregnant women, V/Q scanning is associated with a mildly increased risk of childhood cancer, and a lower risk of maternal breast cancer compared to CT pulmonary angiogram. This is why it is not used first line for diagnosis of PE in pregnant women who also show features of DVT. However, the absolute risk for both these scans is very low.",
"id": "10003983",
"label": "c",
"name": "V/Q scan",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. If the compression duplex ultrasound was negative, then a CT pulmonary angiogram or VQ scan could be considered. A CT pulmonary angiogram looks at the blood vessels from the heart to the lungs and can identify any blockages. As CT scans use radiation, this poses risks to the foetus, however, the absolute risks are very small.",
"id": "10003984",
"label": "d",
"name": "CT pulmonary angiogram",
"picture": null,
"votes": 274
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. Fibrinogen is a protein that is essential for clot formation. It is most often requested after a patient has prolonged or unexplained bleeding, not clots. However, it can also be used to help diagnose disseminated intravascular coagulation (DIC).",
"id": "10003985",
"label": "e",
"name": "Fibrinogen levels",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In pregnant women with suspected pulmonary embolism (PE) who also have symptoms and signs of deep vein thrombosis (DVT), compression duplex ultrasound should be performed. This is due to the risks of radiation exposure to the foetus in CTPA and VQ scans. The management would also be the same for both DVT and PE.",
"id": "10003981",
"label": "a",
"name": "Compression duplex ultrasound",
"picture": null,
"votes": 121
}
],
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"id": "4223",
"name": "Virchow's Triad",
"status": null,
"topic": {
"__typename": "Topic",
"id": "193",
"name": "Haematological Science",
"typeId": 7
},
"topicId": 193,
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"question": "A 32-year-old pregnant female attends the Emergency Department with shortness of breath, pleuritic chest pain and haemoptysis. She is also complaining of a swollen left leg that is warm to touch. Pitting oedema is present. A chest x-ray and ECG have been performed.\n\nConsidering the most likely diagnosis, what is the next best investigation to carry out?",
"sbaAnswer": [
"a"
],
"totalVotes": 540,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,216 | false | 49 | null | 6,495,048 | null | false | [] | null | 13,344 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Marfan's Syndrome is a connective tissue disorder that is associated with an increased risk of aortic dissections. It occurs as a result of a point mutation in the fibrillin gene, preventing the normal deposition of elastin in the extracellular matrix. Other significant risk factors for aortic dissection are hypertension and valvular heart disease.",
"id": "10003986",
"label": "a",
"name": "Marfan's Syndrome",
"picture": null,
"votes": 420
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis in this patient is aortic dissection. The main risk factors for this condition are hypertension, connective tissue disease, e.g. Marfan's syndrome, and valvular heart disease. Some studies have suggested that diabetes is actually a protective factor against aortic dissection.",
"id": "10003987",
"label": "b",
"name": "Diabetes",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis in this patient is aortic dissection. The main risk factors for this condition are hypertension (not hypotension), connective tissue disease, e.g. Marfan's syndrome, and valvular heart disease.",
"id": "10003988",
"label": "c",
"name": "Hypotension",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Normally the aortic valve is tricuspid, with a bicuspid aortic valve being a congenital heart defect. The most likely diagnosis in this patient is aortic dissection. The main risk factors for this condition are hypertension (not hypotension), connective tissue disease, e.g. Marfan's syndrome, and valvular heart disease (such as a bicuspid aortic valve).",
"id": "10003989",
"label": "d",
"name": "Tricuspid aortic valve",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis in this patient is aortic dissection. The main risk factors for this condition are hypertension (not hypotension), connective tissue disease, e.g. Marfan's syndrome, and valvular heart disease. Aortic dissections usually present in men over the age of 50.",
"id": "10003990",
"label": "e",
"name": "Younger age",
"picture": null,
"votes": 3
}
],
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},
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"id": "3707",
"name": "Aortic Dissection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
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"question": "A 63-year-old male presents to the Emergency Department with acute onset severe chest pain that radiates to the back. He describes it as a \"tearing\" pain. His blood pressure is 96/62 and his heart rate is 109. The chest x-ray shows a widened mediastinum. An urgent CT aortogram is ordered.\n\nConsidering the most likely diagnosis, which of the following is a risk factor for this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 546,
"typeId": 1,
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} | MarksheetMark |
173,461,217 | false | 50 | null | 6,495,048 | null | false | [] | null | 13,345 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac tamponade is associated with Beck's triad: hypotension, muffled heart sounds and a raised JVP. It occurs when there is an accumulation of fluid or blood in the pericardial cavity. This compresses the heart, preventing diastolic filling and thus reducing cardiac output. Causes of symmetrically reduced chest expansion include pulmonary fibrosis, whereas pneumothorax, pneumonia and pleural effusions all cause asymmetrical reduced chest expansion.",
"id": "10003994",
"label": "d",
"name": "Reduced chest expansion",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac tamponade is associated with Beck's triad: hypotension, muffled heart sounds and a raised JVP. It occurs when there is an accumulation of fluid or blood in the pericardial cavity. This compresses the heart, preventing diastolic filling and thus reducing cardiac output.",
"id": "10003992",
"label": "b",
"name": "Hypertension",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac tamponade is associated with Beck's triad: hypotension, muffled heart sounds and a raised JVP. It occurs when there is an accumulation of fluid or blood in the pericardial cavity. This compresses the heart, preventing diastolic filling and thus reducing cardiac output. No observable JVP is a normal examination finding.",
"id": "10003993",
"label": "c",
"name": "No observable JVP",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Cardiac tamponade occurs when there is an accumulation of fluid or blood in the pericardial cavity. This compresses the heart, preventing diastolic filling and thus reducing cardiac output. Cardiac tamponade is associated with Beck's triad: hypotension, muffled heart sounds and a raised JVP.",
"id": "10003991",
"label": "a",
"name": "Muffled heart sounds",
"picture": null,
"votes": 423
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiac tamponade is associated with Beck's triad: hypotension, muffled heart sounds and a raised JVP. It occurs when there is an accumulation of fluid or blood in the pericardial cavity. This compresses the heart, preventing diastolic filling and thus reducing cardiac output. A deviated trachea can be seen in many conditions, most notably in tension pneumothoraces.",
"id": "10003995",
"label": "e",
"name": "Deviated trachea",
"picture": null,
"votes": 34
}
],
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},
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"id": "3696",
"name": "Cardiac Tamponade",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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},
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"question": "A 19-year-old female is brought to the Emergency Department by ambulance after suffering a stab wound to the chest. She has lost a significant amount of blood and is tachycardic and dyspnoeic. The clinician treating her suspects cardiac tamponade and an echocardiogram confirms the diagnosis.\n\nWhich of the following signs is the clinician most likely to see in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 543,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,363 | false | 1 | null | 6,495,054 | null | false | [] | null | 13,346 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is where the apex of the heart is located, which is made up of the left ventricle, insertion of a chest drain here would have life-threatening consequences.",
"id": "10003998",
"label": "c",
"name": "Left Fifth intercostal space at the mid-clavicular line",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This area is the recommended site for an emergency tracheotomy in airway management but is not used for chest drain insertion.",
"id": "10003999",
"label": "d",
"name": "Between the cricoid cartilage and sternal notch",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The triangle of safety is used as an anatomical guide for chest drain insertion when managing injuries to the thoracic cavity. These structures form its borders and this location is deemed to pose the least risk of injury to blood vessels, muscle, breast tissue and internal organs.",
"id": "10003996",
"label": "a",
"name": "Between the anterior border of the latissimus dorsi, lateral border of the pectoralis major, apex below the axilla, and horizontal level of the nipple",
"picture": null,
"votes": 113
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is where the apex of the lungs extends to superiorly. You do not insert a chest drain into the apex of the lung.",
"id": "10004000",
"label": "e",
"name": "3 cm above the medial third of the clavicle",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These structures form the border of the anterior triangle of the neck which houses important anatomical contents of the neck but is not related to chest drain insertion.",
"id": "10003997",
"label": "b",
"name": "Between the midline of the neck, the anterior border of the sternocleidomastoid muscle and the inferior border of the mandible",
"picture": null,
"votes": 20
}
],
"comments": [],
"concept": {
"__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": "3899",
"name": "Pneumothorax",
"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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"question": "A 42-year-old female is admitted to A&E after a road traffic accident. She is found to have a tension pneumothorax and a chest tube must be inserted in the triangle of safety.\n\nWhich of the following describes the triangle of safety?",
"sbaAnswer": [
"a"
],
"totalVotes": 144,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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