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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct as it describes the tertiary structure of a protein.",
"id": "10005001",
"label": "a",
"name": "A three-dimensional conformation that requires the lowest amount of energy",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the quaternary structure of a protein.",
"id": "10005002",
"label": "b",
"name": "A complex made up of more than one polypeptide chain",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the secondary structure of a protein.",
"id": "10005004",
"label": "d",
"name": "An alpha helix which contains non-covalent hydrogen bonds",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the secondary structure of a protein.",
"id": "10005005",
"label": "e",
"name": "A beta-pleated sheet which contains non-covalent hydrogen bonds",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the primary structure of a protein.",
"id": "10005003",
"label": "c",
"name": "An amino acid sequence with covalent peptide bonds",
"picture": null,
"votes": 20
}
],
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"name": "Proteins and their structure",
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"question": "Which of the following statements describes the tertiary structure of a protein?",
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"a"
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173,461,901 | false | 3 | null | 6,495,069 | null | false | [] | null | 13,548 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholesterol makes the plasma membrane less fluid by stabilising interactions between neighbouring phospholipids. As a result, the outer surface of the membrane is immobilised and very small water-soluble molecules are less likely to freely move across. This reduces membrane permeability.",
"id": "10005010",
"label": "e",
"name": "Cholesterol makes the membrane more permeable",
"picture": null,
"votes": 15
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "At 37°C cholesterol stabilises interactions between neighbouring phospholipids. Cholesterol immobilises the outer surface of the membrane and reduces fluidity. Therefore, very small water-soluble molecules are less likely to freely move across.",
"id": "10005006",
"label": "a",
"name": "At 37°C cholesterol tends to make the plasma membrane less fluid",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholesterol is absent from prokaryotic cells. Cholesterol provides structural integrity to eukaryotic cells which is why animal cells do not require a cell wall.",
"id": "10005009",
"label": "d",
"name": "Cholesterol is present in the plasma membrane of eukaryotes and prokaryotes",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Phospholipids are derived from triglycerides and contain 2 fatty acid chains, glycerol and a phosphate group.\nCholesterol is a type of steroid. It is an organic molecule which contains 4 rings.\n\nCholesterol and phospholipids are both a type of lipid but they have different chemical structures, therefore, cholesterol cannot be a type of phospholipid.",
"id": "10005008",
"label": "c",
"name": "Cholesterol is a phospholipid",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "At 37°C cholesterol will stabilise interactions between neighbouring phospholipids. It immobilises the outer surface of the membrane and reduces fluidity, therefore this answer is incorrect.",
"id": "10005007",
"label": "b",
"name": "At 37°C cholesterol tends to make the plasma membrane more fluid",
"picture": null,
"votes": 65
}
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"name": "Cholesterol",
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"id": "180",
"name": "Biochemistry",
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"question": "Which one of the following is true regarding cholesterol and the plasma membrane?",
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"a"
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173,461,902 | false | 4 | null | 6,495,069 | null | false | [] | null | 13,549 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The cephalo-caudal folding of the embryo encloses the endoderm-lined cavity inside. This forms the primitive gut tube which eventually forms the digestive tract.",
"id": "10005011",
"label": "a",
"name": "Endoderm",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mesoderm separates into 3 columns: paraxial, lateral plate and intermediate mesoderm. The lateral plate mesoderm forms the visceral layer lining organs and the parietal layer lining the body wall.",
"id": "10005015",
"label": "e",
"name": "Lateral plate mesoderm",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This germ layer forms the skeletal, muscular and circulatory systems and connective tissues.",
"id": "10005013",
"label": "c",
"name": "Mesoderm",
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"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mesoderm separates into 3 columns: paraxial, lateral plate and intermediate mesoderm. Intermediate mesoderm forms urogenital structures.",
"id": "10005014",
"label": "d",
"name": "Intermediate mesoderm",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This germ layer will form the neural plate or neuroectoderm which eventually gives rise to the epidermis and nervous tissues.",
"id": "10005012",
"label": "b",
"name": "Ectoderm",
"picture": null,
"votes": 26
}
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"name": "Germ layers",
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"question": "Which germ layer will give rise to the digestive tract?",
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173,461,903 | false | 5 | null | 6,495,069 | null | false | [] | null | 13,550 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of osmosis as water is moving from an area of high concentration to an area of low concentration through a semi-permeable membrane.",
"id": "10005019",
"label": "d",
"name": "Water moves down its concentration gradient through a semi-permeable membrane with no carrier proteins involved",
"picture": null,
"votes": 13
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Glucose is transported via the uniporter protein Glut2 within the gut epithelium. Glut2 is a carrier protein transporting glucose from an area of high concentration to an area of low concentration. Therefore this is an example of facilitated diffusion.",
"id": "10005016",
"label": "a",
"name": "Glucose transported via the Glut2 transporter within the gut epithelium",
"picture": null,
"votes": 179
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxygen is an uncharged molecule which can pass through the lipid bilayer without assistance from any membrane proteins. This is an example of simple diffusion.",
"id": "10005017",
"label": "b",
"name": "Oxygen moves down its concentration gradient through the lipid bilayer with no membrane proteins involved",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of active transport as the Na+K+ATPase hydrolyses ATP to ADP and uses ENERGY to expel Na+ outside of the cell from an area of low Na+ concentration to an area of high Na+ concentration.",
"id": "10005018",
"label": "c",
"name": "The Na+K+ATPase transporting Na+ outside of the cell",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Carbon Dioxide is an uncharged molecule which can pass through the lipid bilayer without assistance from any membrane proteins. This is an example of simple diffusion.",
"id": "10005020",
"label": "e",
"name": "Carbon Dioxide moves down its concentration gradient through the lipid bilayer with no membrane proteins involved",
"picture": null,
"votes": 1
}
],
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"id": "4360",
"name": "Facilitated vs active diffusion",
"status": null,
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"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
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"question": "Which one of the following describes facilitated diffusion?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,461,904 | false | 6 | null | 6,495,069 | null | false | [] | null | 13,551 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The G2 checkpoint is located after the S phase of the cell cycle and not after the M phase therefore it cannot ensure that cytoplasmic division has occurred successfully.",
"id": "10005025",
"label": "e",
"name": "To ensure that cytoplasmic division has occurred successfully",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it is describing the G1 checkpoint. The G1 checkpoint is known as the restriction point, if a cell does not pass this checkpoint it enters quiescence by switching to a non-dividing state known as G0.",
"id": "10005024",
"label": "d",
"name": "To allow for the cell to exit the cell cycle and switch to a non-dividing state known as G0 if it does not pass the checkpoint",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it is describing the G1 checkpoint. The G1 checkpoint is known as the restriction point, if a cell passes this point it is usually able to continue with the cell cycle.",
"id": "10005023",
"label": "c",
"name": "Ensures that the cell is large enough to divide and that enough nutrients are available to support the daughter cells",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it is describing the metaphase checkpoint. The metaphase checkpoint ensures that the cell is in the right condition to move on.",
"id": "10005022",
"label": "b",
"name": "Ensures that all of the chromosomes are attached to the mitotic spindle by a kinetochore",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The G2 checkpoint is located after the S phase. This is to ensure that replication has been completed successfully before the cell enters the G2 phase.",
"id": "10005021",
"label": "a",
"name": "Ensures that DNA replication in the S phase has been completed successfully",
"picture": null,
"votes": 100
}
],
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"name": "Cell cycle",
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"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
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"question": "Which one of the following best describes the function of the G2 checkpoint within the cell cycle?",
"sbaAnswer": [
"a"
],
"totalVotes": 198,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,905 | false | 7 | null | 6,495,069 | null | false | [] | null | 13,552 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "p53 damage/loss will cause a loss of function mutation leading to damaged DNA and genome instability. This will result in an increased rate of mutation.",
"id": "10005029",
"label": "d",
"name": "Genome stability",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "p53 damage/loss will cause unrestrained replication of damaged DNA which will further result in genome instability and cause resistance to apoptosis as a result of mutation accumulation.",
"id": "10005026",
"label": "a",
"name": "Unrestrained replication of damaged DNA",
"picture": null,
"votes": 108
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This statement describes what would occur if p53 were functional.",
"id": "10005027",
"label": "b",
"name": "Prevents the continuation of the cell into the S phase, giving time for DNA repair",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This statement describes what would occur if p53 were functional.",
"id": "10005028",
"label": "c",
"name": "p53 induces the cell to kill itself by apoptosis if the DNA damage is too severe",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "p53 will cause sustained proliferative signalling leading to an increased rate of mutation if it is damaged/mutated.",
"id": "10005030",
"label": "e",
"name": "Unsustained proliferative signalling",
"picture": null,
"votes": 21
}
],
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"question": "There are many proteins located within the cell cycle at specific checkpoints.\n\nWhich of the following will occur if there is a damaged/non-functional p53 protein?",
"sbaAnswer": [
"a"
],
"totalVotes": 188,
"typeId": 1,
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173,461,906 | false | 8 | null | 6,495,069 | null | false | [] | null | 13,553 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cell which is can give rise to cells within a specific lineage.",
"id": "10005032",
"label": "b",
"name": "Multipotent",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cell which can only differentiate into a singular tissue.",
"id": "10005034",
"label": "d",
"name": "Unipotent",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a cell which can give rise to all embryonic and adult cell lineages.",
"id": "10005031",
"label": "a",
"name": "Totipotent",
"picture": null,
"votes": 109
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a made-up term and does not refer to the statement above.",
"id": "10005035",
"label": "e",
"name": "Wholepotent",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cell which can give rise to all of the cell types within an adult lineage.",
"id": "10005033",
"label": "c",
"name": "Pluripotent",
"picture": null,
"votes": 60
}
],
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"name": "Genetic concepts",
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"name": "Medical Genetics",
"typeId": 7
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"question": "A cell which can give rise to all embryonic and adult lineages is known as which one of the following?",
"sbaAnswer": [
"a"
],
"totalVotes": 196,
"typeId": 1,
"userPoint": null
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173,461,907 | false | 9 | null | 6,495,069 | null | false | [] | null | 13,554 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In an autosomal recessive pedigree you usually cannot follow the disease throughout the pedigree. You see horizontal transmission (siblings affected) and an equal incidence of males and females affected. Note that there may be evidence of consanguinity.",
"id": "10005037",
"label": "b",
"name": "Autosomal recessive inheritance",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is usually shown on a pedigree by a double line drawn between two people. This suggests that two people are 'related by blood' and therefore, have a common ancestor.",
"id": "10005040",
"label": "e",
"name": "Consanguinity",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Maternal inheritance on a pedigree would show all offspring to be affected as the mothers pass on mitochondria from their egg. The sperm's mitochondria are actively expelled from the fertilised egg and therefore not passed on to offspring.",
"id": "10005038",
"label": "c",
"name": "Maternal inheritance",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An X-linked dominant pedigree will appear similar to an autosomal dominant pedigree. However, there will be an excess of affected females and no male-to-male transmission.",
"id": "10005039",
"label": "d",
"name": "X-linked dominant disease",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is because within this pedigree you see affected people in each generation. Both males and females are affected but more importantly, all forms of transmission are seen including male-to-male transmission.",
"id": "10005036",
"label": "a",
"name": "Autosomal dominant inheritance",
"picture": null,
"votes": 142
}
],
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"name": "Pedigree chart",
"status": null,
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"id": "156",
"name": "Medical Genetics",
"typeId": 7
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173,461,908 | false | 10 | null | 6,495,069 | null | false | [] | null | 13,555 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This layer is located above the stratum basale. It usually contains several layers of keratinocytes which are attached by desmosomes, hence giving a 'spine-like' appearance.",
"id": "10005042",
"label": "b",
"name": "Stratum spinosum",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This layer only exists in thick skin which has 5 layers.",
"id": "10005044",
"label": "d",
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"picture": null,
"votes": 8
},
{
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"explanation": "This layer contains basal cells which serve as stem cells for the epithelium. These cells divide and produce keratinocytes which move up through the different layers of the epidermis. Within this layer melanocytes and Merkel cells are present.",
"id": "10005041",
"label": "a",
"name": "Stratum basale",
"picture": null,
"votes": 70
},
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"__typename": "QuestionChoice",
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"explanation": "This is usually 1-3 layers thick and contains keratinocytes. Here the keratinocytes contain keratohyalin granules.",
"id": "10005043",
"label": "c",
"name": "Stratum granulosum",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the uppermost layer of the epidermis. It contains corneocytes (originally keratinocytes before moving to the final layer) which have no nuclei or cytoplasmic organelles. These are eventually desquamated (detached from the skin).",
"id": "10005045",
"label": "e",
"name": "Stratum corneum",
"picture": null,
"votes": 16
}
],
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"question": "In which layer of the epidermis are Merkel cells present?",
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173,461,909 | false | 11 | null | 6,495,069 | null | false | [] | null | 13,556 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The Hardy-Weinberg equilibrium refers to what a population looks like when it is not evolving, the population will stay the same over generations. As a result, there should be **no** preferential selection of genotypes and therefore no evolving for the equilibrium to be applied.",
"id": "10005046",
"label": "a",
"name": "No preferential selection of genotypes",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Smaller populations would be more susceptible to genetic drift (change in an allele frequency). Therefore, the populations should be as close to infinite in size to apply to this equilibrium.",
"id": "10005048",
"label": "c",
"name": "Smaller populations",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If new alleles are present this can be a strong agent of evolution. Therefore, to be applicable to the equilibrium there should be **no** new alleles present",
"id": "10005049",
"label": "d",
"name": "New alleles present",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Random mating is required for this equilibrium to hold true. This is because reproduction will then be the result of two random events so the probability of any offspring genotype will be the probability of the sperm and egg producing that genotype.",
"id": "10005047",
"label": "b",
"name": "Non-random mating",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If there is a preferential selection of genotypes, the more advantageous genotype will be reproduced and will survive in a given environment. If an allele becomes less advantageous its frequency will drop throughout generations. Therefore, there should be **no** preferential selection of genotypes for the equilibrium to be applied.",
"id": "10005050",
"label": "e",
"name": "Preferential selection of genotypes",
"picture": null,
"votes": 30
}
],
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"name": "Genetic concepts",
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"question": "In which of the following situations does the application of the Hardy-Weinberg equilibrium hold true?",
"sbaAnswer": [
"a"
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173,461,910 | false | 12 | null | 6,495,069 | null | false | [] | null | 13,557 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a splice-site mutation. If there is a change in introns then the mutation may not affect the phenotype. If the splice site becomes mutated there will be incorrect splicing of pre-messenger RNA therefore, an altered RNA sequence and altered protein will be produced.",
"id": "10005055",
"label": "e",
"name": "A mutation in a splice site produces an altered RNA sequence",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a silent mutation. The amino acid is not altered so there is no alteration in the polypeptide composition of the protein.",
"id": "10005052",
"label": "b",
"name": "A single base substitution which alters the genetic code but not the amino acid",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes a nonsense mutation. The premature termination of translation produces a truncated protein which is unlikely to carry out its normal activities.",
"id": "10005051",
"label": "a",
"name": "A termination codon is created: UAA, UAG, UGA resulting in premature termination of translation",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a frameshift mutation. An insertion or deletion of a nucleotide that is not a multiple of three will change each amino acid sequence downstream. A new stop codon will be formulated thus causing a shortened altered protein to be expressed.",
"id": "10005054",
"label": "d",
"name": "An insertion or deletion of base pairs that produce a stop codon downstream",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a missense mutation. If the amino acid which is coded for is chemically dissimilar to the amino acid that should be there, the structure and function of the protein will be altered. If the amino acid is chemically similar there could be conservation of the biological activity of the protein.",
"id": "10005053",
"label": "c",
"name": "A single base substitution which codes for a different amino acid",
"picture": null,
"votes": 20
}
],
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"name": "Genetic concepts",
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"typeId": 7
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"question": "Which one of the following describes a nonsense mutation?",
"sbaAnswer": [
"a"
],
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173,461,911 | false | 13 | null | 6,495,069 | null | false | [] | null | 13,558 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This occurs in 1 in 1000 male births. In this syndrome, the male is born with an extra X chromosome. This predisposes to infertility, poor development of secondary sexual characteristics and being very tall.",
"id": "10005060",
"label": "e",
"name": "Klinefelter's syndrome",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is trisomy 13.\nThis occurs in 1 in 5000 births. It causes multiple malformations: affecting midline structures. There is incomplete lobation of the brain, cleft lip and congenital heart disease.",
"id": "10005058",
"label": "c",
"name": "Patau syndrome",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is trisomy 21.\nIn this syndrome, the baby is born with an extra copy of chromosome 21. This causes intellectual disability and abnormalities such as upslanted palpebral fissures and a flat nasal bridge.",
"id": "10005057",
"label": "b",
"name": "Down's syndrome",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This occurs in 1 in 3000 births. This condition causes multiple malformations, especially in the heart and kidneys and is not compatible with life.\n\nNB Trisomy refers to an extra copy of a chromosome within the nucleus. This often leads to developmental disorders.",
"id": "10005056",
"label": "a",
"name": "Edward's syndrome",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a condition where a female is born with one of her X chromosomes missing. This characteristically causes short stature, failure of the ovaries to develop and heart defects.",
"id": "10005059",
"label": "d",
"name": "Turner's syndrome",
"picture": null,
"votes": 28
}
],
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"name": "Trisomy Disorders",
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"typeId": 7
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"question": "Which of the following is the syndrome associated with trisomy 18?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,461,912 | false | 14 | null | 6,495,069 | null | false | [] | null | 13,559 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is when a cell produces a signal such as a hormone that acts on intracellular receptors within the cell.",
"id": "10005064",
"label": "d",
"name": "Intracrine signalling",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is when a cell produces a signal which will act on the cell surface and induce changes within neighbouring cells that are physically in contact with the one releasing the signal.",
"id": "10005063",
"label": "c",
"name": "Juxtacrine signalling",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of cell signalling where signals e.g. hormones are released and travel within the bloodstream to act on distant target cells.",
"id": "10005065",
"label": "e",
"name": "Endocrine signalling",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The definition for this is the one mentioned in the question.",
"id": "10005061",
"label": "a",
"name": "Paracrine signalling",
"picture": null,
"votes": 136
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is when a cell produces a signal which will act on the cell surface and induce changes in itself.",
"id": "10005062",
"label": "b",
"name": "Autocrine signalling",
"picture": null,
"votes": 11
}
],
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"id": "4365",
"name": "Types of cell signalling",
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"name": "General pharmacological concepts",
"typeId": 7
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"question": "The following description describes which type of signalling: a cell which produces a signal that will act on and induce changes in nearby cells'?",
"sbaAnswer": [
"a"
],
"totalVotes": 191,
"typeId": 1,
"userPoint": null
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173,461,913 | false | 15 | null | 6,495,069 | null | false | [] | null | 13,560 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Cholera toxin works at Gs receptors inhibiting GTPase to prevent GTP hydrolysis. This leads to constant activation of adenylyl cyclase and elevated cAMP levels thus causing excess secretion of water. This results in diarrhoea and possible death if untreated.",
"id": "10005066",
"label": "a",
"name": "Cholera toxin works at Gs receptors causing increased cAMP levels",
"picture": null,
"votes": 78
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholera toxin works at Gs receptors inhibiting GTPase to prevent GTP hydrolysis. This leads to constant activation of adenylyl cyclase and elevated cAMP levels thus causing excess secretion of water. This results in diarrhoea and possible death if untreated.",
"id": "10005067",
"label": "b",
"name": "Cholera toxin works at Gs receptors causing decreased cAMP levels",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholera toxin works at Gs receptors inhibiting GTPase to prevent GTP hydrolysis. This leads to constant activation of adenylyl cyclase and elevated cAMP levels thus causing excess secretion of water. This results in diarrhoea and possible death if untreated.",
"id": "10005070",
"label": "e",
"name": "Cholera toxin works at Gs receptors causing decreased secretion of water in the gastrointestinal tract",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholera toxin works at Gs receptors inhibiting GTPase to prevent GTP hydrolysis. This leads to constant activation of adenylyl cyclase and elevated cAMP levels thus causing excess secretion of water. This results in diarrhoea and possible death if untreated.\nThis specific statement refers to the pertussis toxin.",
"id": "10005068",
"label": "c",
"name": "Cholera toxin works at Gi receptors causing increased cAMP levels",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cholera toxin works at Gs receptors inhibiting GTPase to prevent GTP hydrolysis. This leads to constant activation of adenylyl cyclase and elevated cAMP levels thus causing excess secretion of water. This results in diarrhoea and possible death if untreated.",
"id": "10005069",
"label": "d",
"name": "Cholera toxin works at Gi receptors causing decreased cAMP levels",
"picture": null,
"votes": 23
}
],
"comments": [],
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"name": "Cholera",
"status": null,
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"id": "194",
"name": "Infectious Diseases",
"typeId": 7
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"topicId": 194,
"totalCards": null,
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"question": "Which one of the following is correct regarding the pharmacology of cholera toxin?",
"sbaAnswer": [
"a"
],
"totalVotes": 151,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,914 | false | 16 | null | 6,495,069 | null | false | [] | null | 13,561 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is produced by the ANTERIOR pituitary and is released throughout life. Its release is stimulated by hypoglycaemia, exercise and sleep.",
"id": "10005074",
"label": "d",
"name": "Growth hormone (GH)",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is produced by the ANTERIOR pituitary and acts on the adrenal gland to release glucocorticoids and weak androgens.",
"id": "10005073",
"label": "c",
"name": "Adrenocorticotrophic hormone (ACTH)",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is produced by the ANTERIOR pituitary and stimulates the release of T4 from the thyroid. This usually controls metabolism.",
"id": "10005072",
"label": "b",
"name": "Thyroid-stimulating hormone (TSH)",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is produced by the ANTERIOR pituitary. In males, FSH/LH promotes the production of sperm and testosterone. In females, FSH/LH promotes the production of oestrogens, stimulation, maturation and release of egg follicles.",
"id": "10005075",
"label": "e",
"name": "LH/FSH (Luteinising hormone/ Follicle stimulating hormone)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is released by the posterior pituitary to determine the rate of free water excretion. If there is more ADH released there will be increased water retention and decreased urine output.",
"id": "10005071",
"label": "a",
"name": "Anti-diuretic hormone (ADH)",
"picture": null,
"votes": 135
}
],
"comments": [],
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"__typename": "Chapter",
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"demo": null,
"entitlement": null,
"id": "3960",
"name": "Hormones of the posterior pituitary gland",
"status": null,
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"id": "167",
"name": "Endocrine physiology",
"typeId": 7
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"topicId": 167,
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"question": "Which of the following is a hormone released by the posterior pituitary gland?",
"sbaAnswer": [
"a"
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"totalVotes": 191,
"typeId": 1,
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173,461,915 | false | 17 | null | 6,495,069 | null | false | [] | null | 13,562 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "High FSH/LH levels in the blood will prevent GnRH release from the hypothalamus. This will in turn stop the release of FSH/LH from the anterior pituitary and is therefore an example of negative feedback.",
"id": "10005080",
"label": "e",
"name": "Relationship between FSH/LH levels and GnRH release from the hypothalamus",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is an example of positive feedback because the release of oxytocin from the posterior pituitary gland during labour causes more release of oxytocin.",
"id": "10005076",
"label": "a",
"name": "Releasing oxytocin from the posterior pituitary gland during labour",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "High growth hormone levels in the blood will prevent GHRH release from the hypothalamus. This will in turn stop the release of GH from the anterior pituitary and is therefore an example of negative feedback.",
"id": "10005079",
"label": "d",
"name": "Relationship between growth hormone levels and GHRH release from the hypothalamus",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "High glucocorticoid levels in the blood will prevent CRH release from the hypothalamus. This will in turn stop the release of ACTH from the anterior pituitary and is therefore an example of negative feedback.",
"id": "10005078",
"label": "c",
"name": "Relationship between glucocorticoid levels and CRH release from the hypothalamus",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "High thyroxine levels in the blood will prevent TRH release from the hypothalamus. This will in turn stop the release of TSH from the anterior pituitary and is therefore an example of negative feedback.",
"id": "10005077",
"label": "b",
"name": "Relationship between thyroxine levels and TRH release from the hypothalamus",
"picture": null,
"votes": 11
}
],
"comments": [],
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"__typename": "Concept",
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"name": "Oxytocin",
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"name": "Endocrine physiology",
"typeId": 7
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"question": "Which of the following describes an example of positive feedback?",
"sbaAnswer": [
"a"
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"totalVotes": 175,
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173,461,916 | false | 18 | null | 6,495,069 | null | false | [] | null | 13,563 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This description refers to desensitisation.\n\nDesensitisation will reduce the response to a specific agonist.",
"id": "10005084",
"label": "d",
"name": "Prolonged/repeated exposure to agonists reduces the response",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the therapeutic window. A therapeutic window lies between the toxic concentration and the effective concentration of a drug. It is a range of values which describe a suitable dosage plasma concentration of the drug.",
"id": "10005085",
"label": "e",
"name": "Range of dosages between the effective and toxic concentration of a drug",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Low potency will mean that more drug is required to produce an effect, whereas high potency will mean that less drug is required to produce an effect. Most drugs are highly potent thus requiring low doses to produce an effect.",
"id": "10005081",
"label": "a",
"name": "This is the amount of drug required to produce an effect",
"picture": null,
"votes": 108
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This refers to efficacy. If a drug has maximal efficacy it will bind to all of the available receptors and produce a maximal response, Competition will affect the efficacy of a drug.",
"id": "10005083",
"label": "c",
"name": "Maximum response achievable by application of a drug",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This refers to affinity. Usually, a potent drug will have a high affinity.",
"id": "10005082",
"label": "b",
"name": "Strength of drug-receptor interaction",
"picture": null,
"votes": 33
}
],
"comments": [],
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"name": "Pharmacological terms",
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"name": "General pharmacological concepts",
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"question": "Which of the following definitions describes the potency of a drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 185,
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173,461,917 | false | 19 | null | 6,495,069 | null | false | [] | null | 13,564 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes what occurs when there is no agonist/neutral antagonist.\nThere is no response except for some negligible spontaneous channel opening.",
"id": "10005089",
"label": "d",
"name": "When there is no agonist bound and there is no response",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes an irreversible antagonist. This binds at the same site as an agonist and decreases the maximal response to agonists by inactivating and degrading receptors. This decreases the number of available receptors.",
"id": "10005090",
"label": "e",
"name": "A structure which binds irreversibly at an agonist site to decrease the maximal response to agonists",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a full, high-efficacy agonist.",
"id": "10005087",
"label": "b",
"name": "An agonist which when bound to a receptor opens the channel. These receptors are capable of a maximal response",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes a partial, low-efficacy agonist.",
"id": "10005086",
"label": "a",
"name": "An agonist which when bound to a receptor doesn't open a channel as readily. These receptors are not capable of maximal response",
"picture": null,
"votes": 137
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes an inverse agonist.",
"id": "10005088",
"label": "c",
"name": "An agonist which when bound to a receptor makes the channels less likely to open",
"picture": null,
"votes": 11
}
],
"comments": [],
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"__typename": "Concept",
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"id": "4369",
"name": "Types of agonists",
"status": null,
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"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
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"question": "Which one of the following describes a partial low-efficacy agonist?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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173,461,918 | false | 20 | null | 6,495,069 | null | false | [] | null | 13,565 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a competitive antagonist which blocks the receptor site for catecholamines. This is often used to control the heart rhythm and also has a mortality benefit when used after a heart attack.",
"id": "10005093",
"label": "c",
"name": "Propranolol at beta-adrenoceptors",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is an allosteric antagonist. This binds reversibly at a distant site from the agonist and causes a conformational change to the receptor. This prevents an agonist from binding to its active site and causing an effect.",
"id": "10005091",
"label": "a",
"name": "Beta-carbolines at GABA(A) receptor",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a competitive antagonist. It blocks the muscarinic acetylcholine (ACh) receptor to prevent activation of the parasympathetic nervous system.",
"id": "10005092",
"label": "b",
"name": "Atropine at muscarinic receptors",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a competitive antagonist. It is a PDE5 inhibitor which inhibits the degradation of cGMP and allows for vasodilatation of the vessels to occur.",
"id": "10005094",
"label": "d",
"name": "Sildenafil at phosphodiesterase-5 (PDE5)",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a competitive antagonist at the benzodiazepine site of the GABA(A) receptor. It is utilised to reverse a benzodiazepine overdose.",
"id": "10005095",
"label": "e",
"name": "Flumazenil acting at the GABA(A) receptor",
"picture": null,
"votes": 40
}
],
"comments": [],
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"__typename": "Concept",
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"demo": null,
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"id": "4370",
"name": "Allosteric inhibition",
"status": null,
"topic": {
"__typename": "Topic",
"id": "180",
"name": "Biochemistry",
"typeId": 7
},
"topicId": 180,
"totalCards": null,
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"question": "Which one of the following is an example of an allosteric antagonist?",
"sbaAnswer": [
"a"
],
"totalVotes": 149,
"typeId": 1,
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173,461,919 | false | 21 | null | 6,495,069 | null | false | [] | null | 13,566 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The urine analysis will detect glucose and ketones. In those with type 1 diabetes, the glucose will be excreted in the urine. A patient may present with diabetic ketoacidosis (DKA) and in this instance, urinary ketones will also be raised. It is useful in diabetic emergencies, but not in routine monitoring of glycaemic control.",
"id": "10005097",
"label": "b",
"name": "Urine analysis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "When blood glucose is taken randomly, it should not exceed 11.1 mmol/L. If it does, this is indicative of diabetes. Random blood glucose values are used to monitor glucose levels multiple times a day in Type 1 Diabetes but does not indicate long term glycaemic control.",
"id": "10005099",
"label": "d",
"name": "Random blood glucose values",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "When blood glucose is taken after fasting it should not exceed 7.0 mmol/L. If it does, this is indicative of diabetes. It does not indicate long term glycaemic control.",
"id": "10005100",
"label": "e",
"name": "Fasting blood glucose",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This value reflects ambient circulating glucose (glycation of Hb) for the last 2-3 months and is used routinely to monitor glycaemic control.",
"id": "10005096",
"label": "a",
"name": "HbA1c",
"picture": null,
"votes": 122
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the gold standard for diagnosis of diabetes mellitus. The patient's fasting glucose is measured and the patient is given a 75g glucose drink. After 2 hours, the blood glucose is measured again. These values are compared to those of a healthy patient. It is not used for routine monitoring.",
"id": "10005098",
"label": "c",
"name": "Oral glucose tolerance test",
"picture": null,
"votes": 2
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4058",
"name": "Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
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"topicId": 167,
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"question": "Which one of the following tests is most appropriate to monitor long term glycaemic control in diabetes mellitus?",
"sbaAnswer": [
"a"
],
"totalVotes": 174,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,920 | false | 22 | null | 6,495,069 | null | false | [] | null | 13,567 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This value reflects ambient circulating glucose (glycation of Hb) for the last 2-3 months. It is useful for those with suspected type 2 diabetes.",
"id": "10005102",
"label": "b",
"name": "HbA1c",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this test basal TSH levels are determined before giving an IV bolus of TRH. TSH levels are measured once again and compared to the baseline.\n\nIf there is an increase in TSH this means that the cause of the hypothyroidism is the hypothalamus (tertiary hypothyroidism). If there is no TSH increase or a slight increase this is indicative of the anterior pituitary not secreting TSH. This test would be used if there is normal TSH but low thyroid output.",
"id": "10005104",
"label": "d",
"name": "TRH stimulation test",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "When given dexamethasone, ACTH is downregulated and endogenous cortisol should be suppressed.\n\nThis patient likely has Cushing's syndrome, as there is a glucocorticoid excess, cortisol secretion would be autonomous and not responsive to feedback. Therefore cortisol levels will remain high and the test will be positive.",
"id": "10005101",
"label": "a",
"name": "Dexamethasone suppression test (DST)",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a test where exogenous ACTH is given and there should be high cortisol in response to this.\n\nIn Addison's disease there is decreased mineralocorticoid and glucocorticoid synthesis. Despite receiving exogenous ACTH there will be low plasma cortisol.",
"id": "10005103",
"label": "c",
"name": "Short synacthen test",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the gold standard for the diagnosis of diabetes. The patient's fasting glucose is measured and the patient is given a 75g glucose drink. After 2 hours, the blood glucose is measured again. These values are then compared to those of a healthy patient.",
"id": "10005105",
"label": "e",
"name": "Oral glucose tolerance test (OGTT)",
"picture": null,
"votes": 16
}
],
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"__typename": "Chapter",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
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"question": "A 45-year-old female patient has presented to her GP with complaints of amenorrhea.\n\nUpon examination, she has central obesity and purple striae, which one of the following tests would you conduct to diagnose the patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 162,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,921 | false | 23 | null | 6,495,069 | null | false | [] | null | 13,568 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There will be increased calcium reabsorption from the kidneys and intestines as the body wants to prevent calcium loss.",
"id": "10005110",
"label": "e",
"name": "Decreased calcium reabsorption",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There will be decreased urinary calcium as the body wants to prevent calcium loss.",
"id": "10005108",
"label": "c",
"name": "Increased urinary calcium",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Osteoclasts are stimulated via osteoblast-released cytokines. This causes increased calcium release from bone.",
"id": "10005106",
"label": "a",
"name": "Increased bone resorption",
"picture": null,
"votes": 115
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In response to hypocalcemia, PTH will be increased. This leads to increased calcium reabsorption in the renal distal tubule, increased intestinal calcium reabsorption and increased bone resorption.",
"id": "10005107",
"label": "b",
"name": "Decreased PTH (Parathyroid hormone) secretion",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There will be increased urinary phosphate.\n\nPhosphorus and calcium have an inverse relationship. As phosphorus increases, calcium will decrease because phosphorus binds to free calcium in the blood. Therefore, losing more phosphorus should increase calcium levels.",
"id": "10005109",
"label": "d",
"name": "Decreased urinary phosphate",
"picture": null,
"votes": 19
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4371",
"name": "Calcium levels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
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"question": "Which one of the following effects occurs within the body when someone is hypocalcaemic?",
"sbaAnswer": [
"a"
],
"totalVotes": 180,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,922 | false | 24 | null | 6,495,069 | null | false | [] | null | 13,569 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a loss of the nasal field in the left eye and the temporal field of the right eye. This would result in a right homonymous hemianopia where the right visual field in each eye is lost.",
"id": "10005114",
"label": "d",
"name": "Left optic tract",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a loss of the temporal field in the left eye and the nasal field of the right eye. This would result in a left homonymous hemianopia where the left visual field in each eye is lost.",
"id": "10005115",
"label": "e",
"name": "Right optic tract",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a total loss of vision in the right eye **not** bitemporal hemianopia",
"id": "10005113",
"label": "c",
"name": "Right optic nerve",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a total loss of vision in the left eye **not** bitemporal hemianopia",
"id": "10005112",
"label": "b",
"name": "Left optic nerve",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A pituitary tumour will compress the optic chiasm. This will lead to impaired peripheral vision in the temporal halves of the visual field.",
"id": "10005111",
"label": "a",
"name": "The optic chiasm",
"picture": null,
"votes": 123
}
],
"comments": [],
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"__typename": "Chapter",
"explanation": null,
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"id": "4372",
"name": "Visual field loss",
"status": null,
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"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
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"question": "A patient has presented to the GP with complaints of vision disturbance, particularly double vision. Upon examination, it is found that the patient has bitemporal hemianopia.\n\nWhich part of the optic pathway is most likely affected?",
"sbaAnswer": [
"a"
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"totalVotes": 150,
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173,461,923 | false | 25 | null | 6,495,069 | null | false | [] | null | 13,570 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the total fertility rate.",
"id": "10005118",
"label": "c",
"name": "The average number of children that a woman would bear if they experience the age-specific fertility rates at that point in time",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct as it describes birth rate.",
"id": "10005116",
"label": "a",
"name": "The number of live births per 1000 of the population",
"picture": null,
"votes": 137
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes prevalence.",
"id": "10005119",
"label": "d",
"name": "The proportion of people in a population who have a particular disease at a specific point in time",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the general fertility rate.",
"id": "10005117",
"label": "b",
"name": "Number of live births per 1000 women aged 15-44",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes incidence.",
"id": "10005120",
"label": "e",
"name": "Number of new cases over a period of time in a population",
"picture": null,
"votes": 6
}
],
"comments": [],
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"question": "Which one of the following descriptions defines the birth rate?",
"sbaAnswer": [
"a"
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"totalVotes": 165,
"typeId": 1,
"userPoint": null
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173,461,924 | false | 26 | null | 6,495,069 | null | false | [] | null | 13,571 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the artefact theory, not the social selection theory.",
"id": "10005122",
"label": "b",
"name": "Observed associations between health and socioeconomic deprivation are not genuine but exist due to methods of measuring health and deprivation",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the behavioural/cultural theory, not the social selection theory.",
"id": "10005123",
"label": "c",
"name": "Those in deprived areas are more likely to smoke, eat poor diets and not exercise",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the psychosocial theory, not the social selection theory.",
"id": "10005124",
"label": "d",
"name": "The stress of working in a poorly paid, low-status job with little autonomy causes biological changes within the body",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the material theory, not the social selection theory.",
"id": "10005125",
"label": "e",
"name": "Poor health is a direct effect of poverty",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct as it describes the social selection theory.",
"id": "10005121",
"label": "a",
"name": "Health determines socio-economic status rather than socio-economic status causing poor health",
"picture": null,
"votes": 31
}
],
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"question": "Which one of the following describes the social selection theory regarding the association of health and socioeconomic deprivation?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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173,461,925 | false | 27 | null | 6,495,069 | null | false | [] | null | 13,572 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the health belief model.",
"id": "10005130",
"label": "e",
"name": "This is a model which helps to explain and predict health behaviours such as a person's readiness to take health action",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the biomedical model.",
"id": "10005128",
"label": "c",
"name": "This model focuses on the physical processes (pathology, biochemistry and physiology) of disease. It looks for single-factor causes rather than contributory factors like genetics/alcoholism/smoking",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the biopsychosocial model.",
"id": "10005129",
"label": "d",
"name": "This is a model which takes a holistic approach and looks at all levels of disease, not just single-factor causes. It does not focus exclusively on illness as it looks at the continuum between health and illness",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes Kleinmann's model of healthcare systems. It shows who is consulted when someone's health begins to deteriorate.",
"id": "10005126",
"label": "a",
"name": "This is a model relating to why patients consult. It includes a professional, folk and popular sector",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is known as the germ theory.",
"id": "10005127",
"label": "b",
"name": "This model suggests that each disease has a single specific cause, and all research and interventions are targeted at this causal agent",
"picture": null,
"votes": 6
}
],
"comments": [],
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"__typename": "Concept",
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"name": "Models of medicine",
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"name": "Medicine in society",
"typeId": 7
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"question": "Which one of the following describes Kleinmann’s model of healthcare systems?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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173,461,926 | false | 28 | null | 6,495,069 | null | false | [] | null | 13,573 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cognitive sign of stress as conscious intellectual activity is affected.",
"id": "10005133",
"label": "c",
"name": "Poor concentration and memory",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a biochemical sign of stress, endorphin levels will be altered.",
"id": "10005132",
"label": "b",
"name": "Alteration of endorphin levels",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an emotional sign of stress.",
"id": "10005134",
"label": "d",
"name": "Mood swings and irritability",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a physiological sign of stress. Other signs may include rapid shallow breathing and digestive problems.",
"id": "10005135",
"label": "e",
"name": "High blood pressure",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Stress can lead to behavioural changes such as drinking more alcohol and smoking as a method of coping.",
"id": "10005131",
"label": "a",
"name": "Increased alcohol intake",
"picture": null,
"votes": 58
}
],
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"name": "Medicine in society",
"typeId": 7
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"question": "Which one of the following is a behavioural sign of stress?",
"sbaAnswer": [
"a"
],
"totalVotes": 177,
"typeId": 1,
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173,461,927 | false | 29 | null | 6,495,069 | null | false | [] | null | 13,574 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Metformin is contraindicated in those with a low eGFR.",
"id": "10005136",
"label": "a",
"name": "Metformin",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These reduce glucose reabsorption and increase urinary glucose excretion. These are used as monotherapy if metformin is inappropriate or with other antidiabetic drugs.",
"id": "10005139",
"label": "d",
"name": "SGLT2 inhibitors e.g. canagliflozin",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These increase insulin secretion and lower glucagon secretion.\nThis is used as monotherapy if metformin is inappropriate or with other antidiabetic drugs.",
"id": "10005138",
"label": "c",
"name": "Incretins e.g. linagliptin",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are utilised when there is some residual pancreatic beta-cell activity. Care should be taken when prescribing to the elderly. Contraindications include those with acute pyphorias for gliclazide, or anyone with DKA for all sulphonylureas.",
"id": "10005140",
"label": "e",
"name": "Sulphonylureas e.g. gliclazide",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used as monotherapy if metformin is inappropriate or in combination with metformin or sulphonylureas.",
"id": "10005137",
"label": "b",
"name": "Pioglitazone",
"picture": null,
"votes": 11
}
],
"comments": [],
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"id": "4376",
"name": "Metformin",
"status": null,
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"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
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"question": "A 67-year-old female presents to the hospital with complaints of fatigue, increased thirst, and increased frequency of urination. She has an eGFR of 23 mL/minute/1.73 m<sup>2</sup> and is found to be a type 2 diabetic.\n\nWhich one of the following drugs would be unsuitable to use when treating this patient?",
"sbaAnswer": [
"a"
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"typeId": 1,
"userPoint": null
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173,461,928 | false | 30 | null | 6,495,069 | null | false | [] | null | 13,575 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is one of Zola's triggers. If someone is unable to walk/carry out activity they are more likely to visit the GP.",
"id": "10005143",
"label": "c",
"name": "Perceived interference with vocational or physical activity",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not one of Zola's 5 triggers and describes a different concept. Parson's sick role describes the role a patient may take on once they have been diagnosed with a condition. These people are unable to fulfill their normal social roles.",
"id": "10005142",
"label": "b",
"name": "Assuming Parson's sick role",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is one of Zola's triggers. People who do not want to consult healthcare professionals are often encouraged to by family members.",
"id": "10005145",
"label": "e",
"name": "Sanctioning",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is one of Zola's triggers. People usually wait a couple of days for symptoms to resolve, if these symptoms persist they are more likely to visit the GP.",
"id": "10005141",
"label": "a",
"name": "Temporalising symptomatology",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is one of Zola's triggers. If a person's social life is affected they are more likely to visit the GP.",
"id": "10005144",
"label": "d",
"name": "Perceived interference with social or personal relations",
"picture": null,
"votes": 14
}
],
"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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"id": "4377",
"name": "Consulting patients",
"status": null,
"topic": {
"__typename": "Topic",
"id": "219",
"name": "Medicine in society",
"typeId": 7
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"topicId": 219,
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"question": "Which one of Zola's 5 triggers describes people waiting for symptoms to resolve after a certain period before consulting healthcare professionals?",
"sbaAnswer": [
"a"
],
"totalVotes": 148,
"typeId": 1,
"userPoint": null
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173,461,929 | false | 31 | null | 6,495,069 | null | false | [] | null | 13,576 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes cultural iatrogenesis.",
"id": "10005149",
"label": "d",
"name": "Destruction of traditional ways of dealing with death, suffering, and sickness",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes cascade/medical iatrogenesis.",
"id": "10005147",
"label": "b",
"name": "Ill health contracted in hospital. This could be due to medical error or medicinal side effects",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes cascade iatrogenesis.",
"id": "10005146",
"label": "a",
"name": "Serial development of multiple complications from a seemingly harmless first event e.g. polypharmacy",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes iatrogenesis as a general concept. The other options mention different types of iatrogenesis: clinical/medical, social, cascade, and cultural.",
"id": "10005150",
"label": "e",
"name": "Causation of a disease or other ill effects by any medical activity",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes social iatrogenesis.",
"id": "10005148",
"label": "c",
"name": "Sponsoring sickness by reinforcing society to become consumers of medicine",
"picture": null,
"votes": 8
}
],
"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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"demo": null,
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"id": "4378",
"name": "Iatrogenesis",
"status": null,
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"__typename": "Topic",
"id": "219",
"name": "Medicine in society",
"typeId": 7
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"topicId": 219,
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"question": "Which one of the following descriptions relates to cascade iatrogenesis?",
"sbaAnswer": [
"a"
],
"totalVotes": 147,
"typeId": 1,
"userPoint": null
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173,461,930 | false | 32 | null | 6,495,069 | null | false | [] | null | 13,577 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity. If the patient did lack capacity this would be a reasonable course of action",
"id": "10005154",
"label": "d",
"name": "Discuss with the family and make a best interest decision",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity.\nIf the patient does lack capacity temporarily (e.g. loss of consciousness) and the decision is non-urgent you could wait but in this instance that would not apply.",
"id": "10005152",
"label": "b",
"name": "Wait until the patient can give consent",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's capacity has not yet been assessed. You cannot assume that a patient lacks capacity and that healthcare professionals are entitled to make decisions for them.",
"id": "10005153",
"label": "c",
"name": "Take the patient for the operation immediately",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this instance, the patient's capacity has been assessed. However, a best interest decision must be made taking into consideration the views of the family members and what is best for the patient.",
"id": "10005155",
"label": "e",
"name": "Carry out the operation immediately, once the patient has been assessed as lacking capacity",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the best course of action as the patient has not yet been assessed, therefore carrying out a capacity assessment would tell you if the patient can make a decision about their care.",
"id": "10005151",
"label": "a",
"name": "Carry out a capacity assessment",
"picture": null,
"votes": 148
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "4379",
"name": "Best interest decisions in patients who lack capacity",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
"topicId": 184,
"totalCards": null,
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"question": "An 80-year-old male has presented to the emergency department following a fall at home resulting in a neck of femur fracture. He appears to be slightly confused but has not yet been assessed. You need him to consent to an operation to repair the fracture.\n\nWhich one of the following is the best course of action?",
"sbaAnswer": [
"a"
],
"totalVotes": 172,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,931 | false | 33 | null | 6,495,069 | null | false | [] | null | 13,578 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the patient is Gillick competent then you cannot break confidentiality and inform her parents.",
"id": "10005159",
"label": "d",
"name": "Inform her parents without her consent",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Gillick competency refers to a child under 16 years old being able to make decisions about their treatment without their parents'/carers' consent. If a child is Gillick competent then according to Fraser guidelines they can access contraception without the consent of their carers.",
"id": "10005156",
"label": "a",
"name": "Assess if the patient has Gillick competency, as she is less than 16 years old",
"picture": null,
"votes": 169
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You have to assess whether the patient has Gillick competency first before discussing risks and benefits. If the patient is Gillick competent then the patient should be told about risks and benefits so she can make a well-informed decision.",
"id": "10005157",
"label": "b",
"name": "Give it to her straight away without discussing the risks and benefits of the treatment",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an extreme measure and would not be considered unless the partner is significantly older and the patient is being groomed. In this instance, the parents would also be informed.",
"id": "10005160",
"label": "e",
"name": "Call child services",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an unsuitable response. If the patient is Gillick competent there is no reason for you to refuse to give oral contraception.",
"id": "10005158",
"label": "c",
"name": "Don't give the contraception to her as she is too young and you think it is not appropriate for her age",
"picture": null,
"votes": 1
}
],
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"name": "Gillick competency",
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"name": "Medicine in society",
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"question": "A 14-year-old girl has presented to the GP asking for contraception as she has recently become sexually active with her 15-year-old partner.\n\nWhich one of the following is the best course of action?",
"sbaAnswer": [
"a"
],
"totalVotes": 175,
"typeId": 1,
"userPoint": null
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173,461,932 | false | 34 | null | 6,495,069 | null | false | [] | null | 13,579 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Healthcare professionals are not allowed to disclose confidential information to anyone that is not the patient. Unless the patient has given explicit consent to do so.",
"id": "10005163",
"label": "c",
"name": "Telling a patient's test results to her husband because the patient is unavailable",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Even when a patient passes away, you must maintain patient confidentiality, you cannot disclose the cause of death.",
"id": "10005164",
"label": "d",
"name": "When a patient asks about the cause of death of someone who has passed away on the ward",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would only be required to disclose information about serious communicable diseases.",
"id": "10005162",
"label": "b",
"name": "Disclosing information relating to the influenza infection",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the Fraser guidelines relating to contraception and sexual health, a teenager can start contraception without parental consent if they are deemed Gillick competent.",
"id": "10005165",
"label": "e",
"name": "When the parents of a 15-year-old Gillick competent teenager ask if their daughter has seen you regarding oral contraception",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "It is your professional duty to break confidentiality when there is a threat to others.",
"id": "10005161",
"label": "a",
"name": "If there is a threat to others",
"picture": null,
"votes": 169
}
],
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"id": "4140",
"name": "Situations in which the law obliges doctors to breach confidentiality",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
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"question": "For which one of the following reasons can you break patient confidentiality?",
"sbaAnswer": [
"a"
],
"totalVotes": 175,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,933 | false | 35 | null | 6,495,069 | null | false | [] | null | 13,580 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is classified as a group 1 therapy, which are professionally organised alternative therapies.",
"id": "10005168",
"label": "c",
"name": "Chiropractor",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is classified as a group 1 therapy, which are professionally organised alternative therapies.",
"id": "10005169",
"label": "d",
"name": "Herbal medicine",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is classified as a group 1 therapy, which are professionally organised alternative therapies.",
"id": "10005167",
"label": "b",
"name": "Acupuncture",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a group 2 therapy. Group 2 includes complementary therapies.",
"id": "10005166",
"label": "a",
"name": "Meditation",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is classified as a group 1 therapy, which are professionally organised alternative therapies.",
"id": "10005170",
"label": "e",
"name": "Homeopathy",
"picture": null,
"votes": 20
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
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"demo": null,
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"id": "4381",
"name": "Complementary and alternative therapies",
"status": null,
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"name": "Medicine in society",
"typeId": 7
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"qaAnswer": null,
"question": "According to the House of Lords classification of CAM (Complementary and Alternative therapies) which one of the following therapies is located in group 2?",
"sbaAnswer": [
"a"
],
"totalVotes": 140,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,934 | false | 36 | null | 6,495,069 | null | false | [] | null | 13,581 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Incorrect. Gender reassignment is a protected characteristic.",
"id": "10005175",
"label": "e",
"name": "Gender reassignment is not a protected characteristic",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Equality Act was formed in 2010.",
"id": "10005173",
"label": "c",
"name": "The Equality Act was formed in 2009",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It actually encourages fair employment opportunities.",
"id": "10005174",
"label": "d",
"name": "It discourages fair employment opportunities",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a protected characteristic.",
"id": "10005172",
"label": "b",
"name": "Occupation is a protected characteristic under the Equality Act",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct.",
"id": "10005171",
"label": "a",
"name": "Age is a protected characteristic under the Equality Act",
"picture": null,
"votes": 110
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
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"id": "4382",
"name": "Equality Act 2010",
"status": null,
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"id": "219",
"name": "Medicine in society",
"typeId": 7
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"topicId": 219,
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"question": "Which one of the following about the Equality Act is correct?",
"sbaAnswer": [
"a"
],
"totalVotes": 161,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,935 | false | 37 | null | 6,495,069 | null | false | [] | null | 13,582 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inequity is **not** a fundamental condition for health.",
"id": "10005177",
"label": "b",
"name": "Inequity, food, shelter, and education are all included as fundamental conditions for health",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are actually 9 fundamental conditions for health. These include peace, shelter, education, food, income, a stable ecosystem sustainable resources, social justice, and equity.",
"id": "10005179",
"label": "d",
"name": "There are 7 fundamental conditions for health according to the Ottawa Charter",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Ottawa charter **does** include sustainable resources as a fundamental condition for health.",
"id": "10005180",
"label": "e",
"name": "The Ottawa charter does not include sustainable resources as a fundamental condition for health",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. These are all mentioned in the Ottawa Charter.",
"id": "10005176",
"label": "a",
"name": "Peace, shelter, food, and education are all included as fundamental conditions for health",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are actually 9 fundamental conditions for health. These include peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.",
"id": "10005178",
"label": "c",
"name": "There are 8 fundamental conditions for health according to the Ottawa Charter",
"picture": null,
"votes": 15
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"demo": null,
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"id": "4383",
"name": "Major determinants of health",
"status": null,
"topic": {
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"name": "Medicine in society",
"typeId": 7
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"question": "Which one of the following is correct with respect to the Ottawa charter’s fundamental conditions for health?",
"sbaAnswer": [
"a"
],
"totalVotes": 137,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,936 | false | 38 | null | 6,495,069 | null | false | [] | null | 13,583 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the process that occurs due to Botulinum toxin, preventing the release of acetylcholine from the neuromuscular junction.",
"id": "10005183",
"label": "c",
"name": "Breakdown of SNARE proteins",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Guillain-Barre syndrome is a rare complication of an initial viral infection leading to an autoimmune response.",
"id": "10005181",
"label": "a",
"name": "Post-infectious autoimmune neuropathy",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the pathophysiology of motor neurone disease.",
"id": "10005182",
"label": "b",
"name": "Spontaneous death of motor neurons",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the pathophysiology of poliomyelitis.",
"id": "10005184",
"label": "d",
"name": "Cell death of cell bodies in the ventral horn",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is describing myasthenia gravis.",
"id": "10005185",
"label": "e",
"name": "Rare autoimmune disease of the neuromuscular junction",
"picture": null,
"votes": 48
}
],
"comments": [],
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"demo": null,
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"id": "4384",
"name": "Guillain-Barre Syndrome",
"status": null,
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
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"question": "Which of the following is the pathophysiology of Guillain-Barré syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 156,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,937 | false | 39 | null | 6,495,069 | null | false | [] | null | 13,584 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as depolarisation of the pre-synaptic neurone would cause voltage-gated Ca<sup>2+</sup> ions to open.",
"id": "10005190",
"label": "e",
"name": "Depolarisation of the pre-synaptic neurone causes voltage-gated Mg<sup>2+</sup> channels to open",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This process is describing the role of Ca<sup>2+</sup> in excitation-contraction coupling. The influx of Ca<sup>2+<sup/> leads to a conformational change of synaptotagmin (a protein) which causes ACh vesicles to fuse with the presynaptic membrane, resulting in exocytosis.",
"id": "10005186",
"label": "a",
"name": "Ca<sup>2+</sup> influx in the pre-synaptic neurone triggers acetylcholine (ACh) release into the synapse",
"picture": null,
"votes": 139
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The opposite occurs – the EPP decreases further away from the end-plate as there is a lack of nicotinic acetylcholine receptors away from the synapse.",
"id": "10005189",
"label": "d",
"name": "The end-plate potential (EPP) increases further away from the motor end-plate",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ACh is hydrolysed by acetylcholinesterase to acetyl and choline.",
"id": "10005188",
"label": "c",
"name": "Acetylcholine (ACh) is broken down by acetylcholinase within the synaptic cleft",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Little K+ efflux occurs here as the resting membrane potential of the muscle fibre is very close to the K<sup>+</sup> equilibrium constant (E<sup>k</sup>).",
"id": "10005187",
"label": "b",
"name": "Many K<sup>+</sup> ions leave the muscle cell membrane after the binding of acetylcholine (ACh)",
"picture": null,
"votes": 2
}
],
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"id": "3820",
"name": "Neuromuscular junction",
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"name": "Neuroscience",
"typeId": 7
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"question": "Which of the following occurs at the neuromuscular junction?",
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"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,461,938 | false | 40 | null | 6,495,069 | null | false | [] | null | 13,585 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the definition of neurotmesis. Causes include severe contusion, stretch and laceration.",
"id": "10005193",
"label": "c",
"name": "The entire nerve fibre is cut",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the definition for axonotmesis, not neuropraxis. Causes include crush injuries, traction and compression.",
"id": "10005192",
"label": "b",
"name": "Damage to the axon but not the endoneurium, lost portion of axon regenerates",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct definition.",
"id": "10005191",
"label": "a",
"name": "Loss of neuronal function only, due to focal demyelination",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This cannot occur if the cell body dies as neurons are post-mitotic and therefore not replaced.",
"id": "10005194",
"label": "d",
"name": "Regeneration of neurone after cell death",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the definition of re-innervation.",
"id": "10005195",
"label": "e",
"name": "Re-growth of a nerve to re-supply a muscle/effector",
"picture": null,
"votes": 6
}
],
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"name": "Central and peripheral nervous system",
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"typeId": 7
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"question": "Which of the following is the definition of neuropraxis?",
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"typeId": 1,
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173,461,939 | false | 41 | null | 6,495,069 | null | false | [] | null | 13,586 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a topical route of administration.",
"id": "10005200",
"label": "e",
"name": "Application onto the surface of the region",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is also known as intrathecal administration. It is used for genital, urinary tract, or lower body procedures.",
"id": "10005196",
"label": "a",
"name": "Injection into CSF within subarachnoid space",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is infiltration anaesthesia not spinal.",
"id": "10005198",
"label": "c",
"name": "Injection into the tissue",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of a nerve block.",
"id": "10005197",
"label": "b",
"name": "Injection close to nerve course",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is epidural anaesthesia used in labour and delivery, or operations involving the pelvis and legs. The epidural space is the area between the dura mater and the vertebral bodies.",
"id": "10005199",
"label": "d",
"name": "Injection into the epidural space",
"picture": null,
"votes": 91
}
],
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"status": null,
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"name": "Anesthetics and Intensive Care Medicine",
"typeId": 7
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"question": "Which of these describes the spinal route of anaesthetic administration?",
"sbaAnswer": [
"a"
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"totalVotes": 163,
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173,461,940 | false | 42 | null | 6,495,069 | null | false | [] | null | 13,587 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acetylcholine is not a monoamine neurotransmitter. The monoamine neurotransmitters include noradrenaline, dopamine and 5-hydroxytryptamine (serotonin). Acetylcholine is found at the neuromuscular junction.",
"id": "10005203",
"label": "c",
"name": "Acetylcholine",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The monoamine neurotransmitters include noradrenaline, dopamine and 5-hydroxytryptamine (serotonin).",
"id": "10005201",
"label": "a",
"name": "Noradrenaline",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of an amino acid neurotransmitter.",
"id": "10005204",
"label": "d",
"name": "Glycine",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of an amino acid neurotransmitter.",
"id": "10005205",
"label": "e",
"name": "Glutamate",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of a neuroactive peptide.",
"id": "10005202",
"label": "b",
"name": "Secretin",
"picture": null,
"votes": 9
}
],
"comments": [],
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"name": "Synaptic neurotransmitter function",
"status": null,
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"typeId": 7
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"question": "Which one of the following neurotransmitters is classified as a monoamine?",
"sbaAnswer": [
"a"
],
"totalVotes": 162,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,941 | false | 43 | null | 6,495,069 | null | false | [] | null | 13,588 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ca2+ ions are not involved in the hyperpolarisation of a neurone.",
"id": "10005209",
"label": "d",
"name": "Ca2<sup>+</sup> efflux",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the cause of depolarisation, not hyperpolarisation.",
"id": "10005207",
"label": "b",
"name": "Voltage-gated Na<sup>+</sup> channels open",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In an inhibitory response, the impulse would cause a Cl<sup>-</sup> **influx** to hyperpolarise the cell membrane",
"id": "10005210",
"label": "e",
"name": "Cl<sup>-</sup> efflux",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is what allows the process of repolarisation to occur.",
"id": "10005208",
"label": "c",
"name": "Voltage-gated Na<sup>+</sup> channels close",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The membrane potential lowers more than the resting potential because of the delayed closing of the voltage-gated K+ channels, allowing more K+ ions to leave the membrane.",
"id": "10005206",
"label": "a",
"name": "Due to excess K<sup>+</sup> efflux",
"picture": null,
"votes": 119
}
],
"comments": [],
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"name": "Membrane Potential",
"status": null,
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"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"question": "How does hyperpolarisation occur during an action potential?",
"sbaAnswer": [
"a"
],
"totalVotes": 179,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,942 | false | 44 | null | 6,495,069 | null | false | [] | null | 13,589 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A refractory period is the time from the initial depolarisation of the first action potential to the point at which a second action potential can be stimulated.",
"id": "10005214",
"label": "d",
"name": "Refractory period",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Conductance is a measure of ion channel activity. If more ion channels are present within the membrane, these channels' activity will increase. Therefore, the conductance will also be higher.",
"id": "10005213",
"label": "c",
"name": "Through conductance",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This occurs in a myelinated axon. The myelin will increase the speed of transmission of an action potential along the axon as the ions flow from one node to another. This causes depolarisation and opens voltage-gated sodium channels to produce another action potential.",
"id": "10005211",
"label": "a",
"name": "Saltatory conduction",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This happens in an unmyelinated axon. Differences in charges inside the axon will cause positive ions to flow forwards or backwards. These ions will move and depolarise the membrane. The depolarisation will open voltage-gated channels in that section of the membrane and cause an action potential. This will then trigger further action potentials in the next part of the axon.",
"id": "10005212",
"label": "b",
"name": "Electrotonic spread",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This refers to the net movement of small molecules from an area of high concentration to an area of low concentration and does not relate to action potentials.",
"id": "10005215",
"label": "e",
"name": "Diffusion",
"picture": null,
"votes": 3
}
],
"comments": [],
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"name": "Membrane Potential",
"status": null,
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"name": "Neuroscience",
"typeId": 7
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"sbaAnswer": [
"a"
],
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"typeId": 1,
"userPoint": null
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173,461,943 | false | 45 | null | 6,495,069 | null | false | [] | null | 13,590 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are star-shaped cells located in the CNS. They have multiple functions some of which include: forming the blood-brain barrier, providing nutrients to nervous tissue and repairing after infection/traumatic injuries.",
"id": "10005220",
"label": "e",
"name": "Astrocytes",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ependymal cells are types of glial cells that line the ventricles in the brain as well as the central columns of the spinal cord. They secrete cerebrospinal fluid.",
"id": "10005219",
"label": "d",
"name": "Ependymal cells",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are located in the peripheral nervous system (PNS) and cover neuronal cell bodies in the ganglia.\nThese provide nutrient support and protection to neurones.",
"id": "10005217",
"label": "b",
"name": "Satellite cells",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These are located in the CNS and create myelin sheaths for ~50 axons. These sheaths support and insulate the axons.",
"id": "10005216",
"label": "a",
"name": "Oligodendrocytes",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are located in the peripheral nervous system (PNS). Each Schwann cell will produce a myelin sheath for 1 axon. These sheaths support and insulate the axons.",
"id": "10005218",
"label": "c",
"name": "Schwann cells",
"picture": null,
"votes": 66
}
],
"comments": [],
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},
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"demo": null,
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"id": "3826",
"name": "Central and peripheral nervous system",
"status": null,
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"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"question": "Which of the following cells functions in the central nervous system (CNS) to myelinate axons?",
"sbaAnswer": [
"a"
],
"totalVotes": 176,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,944 | false | 46 | null | 6,495,069 | null | false | [] | null | 13,591 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a connective tissue layer which holds nerve fascicles together. It is loose and protects the inner fascicles against outside pressure.",
"id": "10005221",
"label": "a",
"name": "Epineurium",
"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most dense and thinnest layer. It has perineural cells which form tight junctions. These protect the cell by forming a blood-nerve barrier.",
"id": "10005223",
"label": "c",
"name": "Perineurium",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a thin layer of connective tissue which surrounds an individual nerve fibre.",
"id": "10005225",
"label": "e",
"name": "Endoneurium",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a small bundle of nerve fibres enclosed by perineurium. A fascicle is **not** a tissue envelope.",
"id": "10005222",
"label": "b",
"name": "Fascicle",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This refers to the axon of a neurone and is **not** a tissue envelope.",
"id": "10005224",
"label": "d",
"name": "Nerve fibre",
"picture": null,
"votes": 8
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4385",
"name": "Spinal cord grey matter",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"typeId": null,
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"question": "Which one of the following is the most outer tissue envelope of a spinal nerve?",
"sbaAnswer": [
"a"
],
"totalVotes": 167,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,945 | false | 47 | null | 6,495,069 | null | false | [] | null | 13,592 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a later effect of **lower motor neurone (LMN)** lesions and occurs because of denervation and disuse of the muscle.",
"id": "10005230",
"label": "e",
"name": "Muscle atrophy",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alpha motor neurones stimulate target muscle fibres. A **lower motor neuron (LMN)** lesion will cause decreased muscle tone because the alpha motor neurons are damaged and therefore muscle fibres cannot be stimulated. In a UMN lesion, there will be hypertonia.",
"id": "10005228",
"label": "c",
"name": "Hypotonia",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In a UMN lesion, inhibitory modulation of the descending pathways is lost. Therefore, the myotatic (stretch) reflex will be exaggerated thus causing hypertonia. In a lower motor neuron (LMN) lesion you will see hyporeflexia.",
"id": "10005226",
"label": "a",
"name": "Hyperreflexia",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alpha motor neurones are affected in **lower motor neuron (LMN)** lesions, therefore, there will be abnormal activity thus causing fasciculations.\nIn UMN lesions alpha motor neurones are spared so there are no fasciculations present.",
"id": "10005229",
"label": "d",
"name": "Fasciculations",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The alpha motor neurones causing muscle contraction become damaged in a **lower motor neuron (LMN)** lesion, therefore there is hyporeflexia. In a UMN lesion, you will see hyperreflexia.",
"id": "10005227",
"label": "b",
"name": "Hyporeflexia",
"picture": null,
"votes": 23
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4386",
"name": "Upper motor neuron lesions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
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},
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"question": "Which of the following is a sign of an upper motor neurone (UMN) lesion?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,946 | false | 48 | null | 6,495,069 | null | false | [] | null | 13,593 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient being **on** anti-coagulation therapy would be a contraindication because of the associated increased risk of bleeding.",
"id": "10005232",
"label": "b",
"name": "If the patient is not on anti-coagulant therapy",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the patient had a spinal abscess this **would be** a contraindication for a lumbar puncture. This is because the procedure can cause bacteria to spread into the subarachnoid space.",
"id": "10005234",
"label": "d",
"name": "If there is no clinical suspicion of a spinal abscess",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If a patient had thrombocytopenia or a clotting disorder this **would be** a contraindication for carrying out a lumbar puncture.",
"id": "10005233",
"label": "c",
"name": "If the patient does not have thrombocytopenia or other clotting disorders",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spinal trauma would be a contraindication for a lumbar puncture. This is because the anatomy and spinal structure would be altered thus resulting in the unsafe placement of the needle.",
"id": "10005235",
"label": "e",
"name": "If there is no acute spinal trauma",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "If a lumbar puncture is carried out in those with a raised intracranial pressure due to a space occupying lesion this can precipitate brainstem herniation. This is because there is a sudden decrease in pressure within the spinal cord by removing cerebrospinal fluid (CSF). Other causes of raised intracranial pressure can be treated with a lumbar puncture, for example in hydrocephalus.",
"id": "10005231",
"label": "a",
"name": "If the patient has raised intracranial pressure due to a space occupying lesion",
"picture": null,
"votes": 129
}
],
"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": "4387",
"name": "Raised intracranial pressure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"question": "In which of the following instances is it contraindicated to perform a lumbar puncture?",
"sbaAnswer": [
"a"
],
"totalVotes": 159,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,947 | false | 49 | null | 6,495,069 | null | false | [] | null | 13,594 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a rapid-onset muscle weakness affecting peripheral nerves. It begins in the feet and hands and is usually bilateral. It can be life-threatening if the diaphragm is affected. The cause is unknown but most often the immune system's dysfunction is precipitated by an infection.",
"id": "10005236",
"label": "a",
"name": "Guillain-Barré Syndrome",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is when the nerves in the lower back become compressed. The patient gets sciatica on both sides, saddle anaesthesia and weakness in both legs which becomes progressively worse. This is a medical emergency! In this scenario the patient has weakness but no sciatica so it is less likely to be cauda equina syndrome, however, it should always be considered as an important differential.",
"id": "10005239",
"label": "d",
"name": "Cauda equina syndrome",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a condition caused by a lesion or damage in one half of the spinal cord. Paralysis and loss of proprioception occur on the ipsilateral side of the lesion and loss of pain/temperature sensation on the contralateral side. In this scenario, both sides of the patient's body are affected.",
"id": "10005238",
"label": "c",
"name": "Brown-Séquard syndrome",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is when the botulinum toxin attacks the nervous system. This results in muscle paralysis and can be reversed if given treatment. If the muscles of the diaphragm are affected it can be fatal. In this scenario, the patient has not presented with any muscle paralysis.",
"id": "10005240",
"label": "e",
"name": "Botulism",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a demyelinating disease which damages nerve cells in the brain and spinal cord. Symptoms include diplopia, muscle weakness and sensation/coordination impairment. This may present similarly to Guillain-Barré Syndrome but its onset time is usually much longer thus making it more difficult to diagnose.",
"id": "10005237",
"label": "b",
"name": "Multiple Sclerosis",
"picture": null,
"votes": 14
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4388",
"name": "Guillain-Barré Syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 56-year-old male has presented to the emergency department. He describes that a week ago he had numbness in his feet and that this has now progressed, causing weakness in his legs and hands. He has no relevant past medical history except that a couple of weeks ago he caught a stomach bug from his grandson.\n\nWhich one of the following conditions is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,461,948 | false | 50 | null | 6,495,069 | null | false | [] | null | 13,595 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes uncal herniation and is a complication of raised intracranial pressure. This can occur following a haemorrhage when there is lots of blood collecting within the skull.",
"id": "10005245",
"label": "e",
"name": "Rising intracranial pressure causes the brain to move from one intracranial compartment to another",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a subdural haemorrhage.\nThis usually occurs due to the tearing of veins across the subdural space. There is increased intracranial pressure leading to compression of the brain.",
"id": "10005242",
"label": "b",
"name": "Blood collecting between the dura mater and arachnoid mater",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes subarachnoid haemorrhage. The subarachnoid space is located between the arachnoid mater and the pia mater. The patient usually describes a severe headache, reaching maximal intensity very quickly. The raised intracranial pressure begins to compress the brain and causes symptoms described in the scenario above.",
"id": "10005241",
"label": "a",
"name": "Bleeding between the arachnoid mater and the pia mater",
"picture": null,
"votes": 102
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes an intraparenchymal haemorrhage. It can occur due to hypertension, arteriovenous malformations and aneurysm rupture.",
"id": "10005244",
"label": "d",
"name": "Bleeding into the tissues of the brain",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes an epidural haemorrhage.\nSymptoms usually include a severe headache and loss of consciousness however are usually post-trauma to the skull.",
"id": "10005243",
"label": "c",
"name": "Typically due to middle meningeal artery damage leading to arterial bleeding into the epidural space",
"picture": null,
"votes": 13
}
],
"comments": [],
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4193",
"name": "Subarachnoid haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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},
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"dislikes": 0,
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"question": "A 25-year-old male has presented to the emergency department by ambulance. The paramedics tell you that he described a sudden severe headache reaching maximal intensity almost immediately. He also had some nausea and vomiting.\n\nOn examination, the patient has double vision and has started to become increasingly drowsy.\n\nWhich of the following describes a subarachnoid haemorrhage?",
"sbaAnswer": [
"a"
],
"totalVotes": 167,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,117 | false | 1 | null | 6,495,076 | null | false | [] | null | 13,596 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Costochondritis is a cause of chest wall pain that results from inflammation of the costal cartilage, the cartilage that connects the ribs to the sternum. It classically presents with pain when taking a deep breath or in certain positions. It often occurs after a recent illness with coughing or after intense exercise and is mostly of unilateral origin. The pain is reproduced on palpation of the affected area too - commonly ribs two to five.",
"id": "10005249",
"label": "d",
"name": "Costochondritis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myocarditis affects people of all ages (symptom onset is typically in those 20 to 50 years of age) and has a wide range of clinical presentations making its diagnosis challenging. Although it may be asymptomatic, the most common presenting features are chest pain (in 85–95% of cases), fever (in approximately 65%) and dyspnoea (19–49% of cases). Other features include palpitations, syncope and fatigue. Up to 80% of patients with acute myocarditis have prodromal symptoms. Patients may have a history of a preceding flu-like, respiratory and/or gastrointestinal illness, making this a less likely diagnosis.",
"id": "10005250",
"label": "e",
"name": "Acute myocarditis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Chest pain typical of angina is defined by the following three features: constriction-like pain in chest/neck/arm/jaw, brought on by physical activity, and alleviated by rest or glyceryl trinitrate within minutes. Two out of three features indicate atypical angina pain.",
"id": "10005246",
"label": "a",
"name": "Stable angina",
"picture": null,
"votes": 431
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. It is characterised by specific clinical findings of prolonged (>20 minutes) angina at rest; new onset of 'severe' angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of myocardial infarction. None of these apply to this case of stable angina.",
"id": "10005247",
"label": "b",
"name": "Unstable angina",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute Pericarditis is inflammation of the pericardial sac. It presents most often in men aged 20 to 50 years old with acute retrosternal, sharp, pleuritic chest pain that varies in severity. It is frequently exacerbated in the supine position, by coughing, and with inspiration. Classic ECG changes occur in around 90% of patients and include widespread concave upward ST-segment elevation and PR-segment depression without T-wave inversions.",
"id": "10005248",
"label": "c",
"name": "Acute pericarditis",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__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": "3721",
"name": "Stable angina",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"conditions": [],
"difficulty": 1,
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"question": "A 70-year-old man presents to the rapid access chest pain clinic with constricting discomfort in the front of his chest, precipitated by physical exertion and relieved by rest within five minutes. He has no relevant past medical history and had been well before this occurred. His examination is entirely normal with no chest wall tenderness and his resting ECG is in sinus rhythm.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 477,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,118 | false | 2 | null | 6,495,076 | null | false | [] | null | 13,597 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a rare condition often caused by pulmonary hypertension or infective endocarditis. It is usually asymptomatic. The murmur of pulmonary regurgitation is an early decrescendo murmur heard loudest over the left sternal edge during inspiration.",
"id": "10005255",
"label": "e",
"name": "Pulmonary regurgitation",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The murmur described is the classic examination finding of mitral regurgitation. Patients may also present with dyspnoea (usually on exertion), lower limb oedema, palpitations, and/or decreased exercise tolerance. First-line investigations would be an ECG and transthoracic echocardiogram.",
"id": "10005251",
"label": "a",
"name": "Mitral regurgitation",
"picture": null,
"votes": 326
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mitral stenosis is usually caused by rheumatic valvulitis. There is often a history of rheumatic fever, but other symptoms do include dyspnoea and orthopnoea. On examination, a loud S1 is heard with a low-pitched, rumbling, mid-diastolic murmur, loudest over the apex.",
"id": "10005252",
"label": "b",
"name": "Mitral stenosis",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Often caused by calcification of the aortic valve, aortic stenosis is characterised by an ejection systolic murmur heard loudest over the aortic area. The murmur may radiate to the carotid arteries and is typically loudest on expiration and when the patient is sitting forwards.",
"id": "10005254",
"label": "d",
"name": "Aortic stenosis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic regurgitation is the diastolic leakage of blood from the aorta into the left ventricle. It has a typical decrescendo early diastolic murmur, heard loudest at the left sternal edge. Other examination features include a collapsing pulse or displaced hyperdynamic apex beat.",
"id": "10005253",
"label": "c",
"name": "Aortic regurgitation",
"picture": null,
"votes": 22
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4020",
"name": "Mitral Regurgitation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
"conceptId": 4020,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 65-year-old man presents to his GP with symptoms of fatigue and orthopnea. On examination, S3 is present and there is a holosystolic (pansystolic) murmur, heard best at the apex with the diaphragm of the stethoscope when the patient is in the left lateral decubitus position.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 454,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,119 | false | 3 | null | 6,495,076 | null | false | [] | null | 13,598 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is infective endocarditis. Intravenous drug use is a risk factor for this. Splinter haemorrhages and janeway lesions are cardinal signs too. First-line imaging investigation in endocarditis is transthoracic echo and it should be performed as soon the diagnosis of endocarditis is suspected. It is required as part of the major Duke criteria for diagnosis. Vegetation, abscess, partial dehiscence of prosthetic valve or new valvular regurgitation may be identified. Transoesophageal echocardiogram has a higher sensitivity of 90% but is much more invasive and often not available as promptly as required.",
"id": "10005256",
"label": "a",
"name": "Transthoracic echocardiogram",
"picture": null,
"votes": 321
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test should be performed at admission and throughout to check for new changes but again does not form part of the diagnostic Duke criteria and is therefore not as appropriate as an echocardiogram. A new AV block is suggestive of abscess formation.",
"id": "10005259",
"label": "d",
"name": "Resting 12-lead ECG",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a scan which images the pulmonary arteries, often reserved to diagnose or exclude pulmonary emboli - an unlikely diagnosis here.",
"id": "10005260",
"label": "e",
"name": "CT Pulmonary Angiogram",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest x-ray does not form part of the diagnostic Duke criteria and is therefore not as appropriate as an echocardiogram. A chest x-ray in infective endocarditis may show evidence of heart failure and cardiomegaly in extreme cases though. A combination of sepsis and pulmonary infiltrates on a chest x-ray is highly suggestive of right-sided endocarditis.",
"id": "10005257",
"label": "b",
"name": "Chest X-ray",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CT Chest also does not form part of the diagnostic Duke criteria and is therefore not as appropriate as an echocardiogram. It may have value in identifying septic emboli or if a chest x-ray shows pathology which is not certain.",
"id": "10005258",
"label": "c",
"name": "CT Chest",
"picture": null,
"votes": 15
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3710",
"name": "Infective Endocarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3710,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13598",
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"question": "A 45-year-old male is reviewed in the infectious diseases ward. He is a known intravenous drug user and has been injecting heroin daily for the last five years. He reports feeling feverish and having extreme malaise over the last 5 days. On examination, he has numerous splinter haemorrhages and janeway lesions on his hands. The rest of his examination is unremarkable, and he has no audible murmur.\n\nWhich of the following is the most appropriate first-line diagnostic investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 444,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,120 | false | 4 | null | 6,495,076 | null | false | [] | null | 13,599 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Heparin (i.e. “unfractionated”) bolus dose of 5000 units should be given in cases of patients who are to receive the percutaneous coronary intervention (PCI) for their STEMI. It is not considered an immediate pharmacotherapy.",
"id": "10005262",
"label": "b",
"name": "Unfractionated heparin",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This drug is a glycoprotein IIb/IIIa inhibitor. These drugs are used alongside heparin at the time of PCI among patients who have high-risk clinical and angiographic characteristics or who continue to have ischemia despite other treatments.",
"id": "10005264",
"label": "d",
"name": "Tirofiban",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bivalirudin is a direct thrombin inhibitor. It may be considered as an alternative to glycoprotein IIb/IIIa inhibition and heparin among patients with acute coronary syndromes undergoing PCI with clinical features associated with an increased risk of bleeding or requiring femoral instead of radial access.",
"id": "10005265",
"label": "e",
"name": "Bivalirudin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is ST-elevation myocardial infarction (STEMI). NICE guideline NG185 states that in the treatment of this, you should offer a 300mg loading dose of aspirin as soon as possible and continue aspirin indefinitely unless contraindicated.",
"id": "10005261",
"label": "a",
"name": "Aspirin",
"picture": null,
"votes": 384
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Beta-blockers are generally reserved for secondary prevention following STEMI. They are appropriate lifelong therapies in haemodynamically stable patients with reduced left ventricular systolic function (left ventricular ejection fraction < 40%) unless contraindicated. In those without reduced LVEF, it may be appropriate to discontinue beta-blocker therapy after 12 months.",
"id": "10005263",
"label": "c",
"name": "Atenolol",
"picture": null,
"votes": 25
}
],
"comments": [],
"concept": {
"__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": "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,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 60-year-old male lifelong smoker presents to the emergency department with crushing, central 10/10 chest pain which radiates to his left jaw. His ECG reveals ST elevation in V3-V6.\n\nWhich of the following is the most appropriate immediate pharmacotherapy?",
"sbaAnswer": [
"a"
],
"totalVotes": 442,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,121 | false | 5 | null | 6,495,076 | null | false | [] | null | 13,600 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest X-ray is frequently normal in acute pericarditis unless there is a sizeable pericardial effusion. It is therefore of limited value initially.",
"id": "10005268",
"label": "c",
"name": "Chest X-ray",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical description of a patient presenting with acute pericarditis. ECG is a quick and easy bedside test which can exclude other more sinister causes of the chest pain. ECG signs of saddle-shaped ST-elevation and/or PR-depression also form part of the diagnostic criteria for pericarditis alongside pericarditic chest pain, pericardial rub and non-trivial new or worsening pericardial effusion.",
"id": "10005266",
"label": "a",
"name": "12-lead ECG",
"picture": null,
"votes": 251
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an investigation most commonly reserved for the detection of coronary artery disease in symptomatic patients without known heart disease. It is used for those who do not wish to proceed with invasive coronary angiography or in those who coronary angiography may be problematic or high-risk (e.g. coronary artery bypass grafts, severe aortic stenosis, adult congenital heart disease).",
"id": "10005269",
"label": "d",
"name": "Cardiac CT",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an investigation often used in the work-up of myocarditis, unclear heart failure or cardiomyopathy and in acute coronary syndromes without angiographic evidence.",
"id": "10005270",
"label": "e",
"name": "Cardiac MRI",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an investigation used to visualise the coronary arteries and is generally reserved for those presenting with ischaemic symptoms and signs suggestive of coronary artery disease.",
"id": "10005267",
"label": "b",
"name": "Coronary angiography",
"picture": null,
"votes": 53
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "3708",
"name": "Pericarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 45-year-old female is seen in the urgent cardiology clinic. She describes sharp, pleuritic, retrosternal chest pain. She says the pain is improved by sitting up and leaning forward. On examination, she has a low-grade fever of 38.1 degrees. There is a scratchy noise heard on her left lower sternal edge. The noise is best heard with the diaphragm of the stethoscope and with her holding her breath.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 431,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,122 | false | 6 | null | 6,495,076 | null | false | [] | null | 13,601 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Brugada syndrome is a genetic condition caused by sodium channelopathies. It is also a common cause of sudden cardiac death. The condition is usually diagnosed by characteristic ECG changes and at least one clinical criterion. Examples include ventricular fibrillation (VF) or polymorphic VT, a family history of sudden cardiac death under the age of 45, syncope, ECG signs in the family, inducible VT and nocturnal agonal breathing. Special provocation tests eg ajmaline, are also used for diagnosis.",
"id": "10005274",
"label": "d",
"name": "Brugada syndrome",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes of the proteins that code for the sarcomere such as myosin, troponin and alpha-tropomyosin. It is often asymptomatic and thereby comprises the most common cause of sudden cardiac death in the young. Symptoms may include exertional dyspnoea, chest pain or syncope after exercise. ECG changes include typical left ventricular hypertrophy tall QRS complexes, non-specific ST segment and T-wave abnormalities, progressive T-wave inversion and deep Q waves.",
"id": "10005272",
"label": "b",
"name": "Hypertrophic obstructive cardiomyopathy",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Polymorphic VT is a broad-complex tachycardia originating from a ventricular ectopic focus. It has the potential to precipitate ventricular fibrillation and hence requires urgent treatment. It is a diagnosis which is split into subtypes. The most common subtype of polymorphic VT is torsades de pointes which is precipitated by prolongation of the QT interval - not present in this case. The electrocardiogram characteristically shows QRS complexes 'twisting' around the isoelectric line.",
"id": "10005273",
"label": "c",
"name": "Polymorphic ventricular tachycardia (VT)",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Wolff-Parkinson-White (WPW) syndrome is caused by a congenital accessory conducting pathway between the atria and ventricles leading to an atrioventricular re-entry tachycardia (AVRT). Typical ECG features include a short PR interval, wide QRS complexes with a slurred upstroke - 'delta wave' as well as left axis deviation if right-sided accessory pathways exist and right axis deviation if left-sided accessory pathways are present.",
"id": "10005271",
"label": "a",
"name": "Wolff-Parkinson-White syndrome",
"picture": null,
"votes": 397
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pulmonary embolism (PE) is when a blood clot in the pulmonary arterial vasculature develops, usually from an underlying deep vein thrombosis (DVT) of the lower limbs. Sudden-onset shortness of breath, pleuritic chest pain, and haemoptysis are the 'typical' triad, although note that all three features are rarely present. ECG findings include normal or sinus tachycardia most commonly. In a massive PE, there may be evidence of right-heart strain (with P pulmonale, right axis deviation, right bundle branch block, and non-specific ST/T wave changes). The classic S1Q3T3 (deep S waves in lead I, pathological Q waves in lead III, and inverted T waves in lead III) is relatively uncommon (<20% of patients).",
"id": "10005275",
"label": "e",
"name": "Pulmonary embolism",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"demo": null,
"entitlement": null,
"id": "3700",
"name": "Wolff-Parkinson-White syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 20-year-old male presents to his GP with palpitations. He reports his heart skips a beat and then races for 30 seconds to a minute. On examination, he is tachycardic with a heart rate of 103 and his ECG was regular but revealed a short PR interval, wide QRS complexes with a slurred upstroke - 'delta wave'.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 426,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,123 | false | 7 | null | 6,495,076 | null | false | [] | null | 13,602 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tiotropium is a long-acting muscarinic agonist predominantly used in the maintenance treatment of COPD and occassionally in severe but stable asthma. It is not recommended in the acute setting.",
"id": "10005279",
"label": "d",
"name": "Inhaled tiotropium",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IV aminophylline may be considered following consultation with senior medical staff for patients who fail to respond and are requiring senior critical care support. They should be treated in an appropriate ITU/HDU setting if requiring IV aminophylline.",
"id": "10005278",
"label": "c",
"name": "IV Aminophylline",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a treatment commonly reserved for life-threatening asthma or unresponsive severe asthma. BTS notes that the evidence base is mixed for this treatment.",
"id": "10005277",
"label": "b",
"name": "IV Magnesium Sulphate",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic presentation of an acute attack of asthma. According to the BTS classification, this acute asthma is classified as severe. Initial management should consist of oxygen to ensure saturations of 94-98%, nebulised salbutamol and ipratropium and a five-day course of oral prednisolone.",
"id": "10005276",
"label": "a",
"name": "Nebulised salbutamol and ipratropium",
"picture": null,
"votes": 367
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Umeclidinium is a long-acting muscarinic antagonist used in the maintenance treatment of COPD or in severe (but stable) asthma. It is not recommended in the acute setting.",
"id": "10005280",
"label": "e",
"name": "Inhaled umeclidinium",
"picture": null,
"votes": 0
}
],
"comments": [],
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"id": "3725",
"name": "Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"question": "An 18-year-old female, with a past medical history significant for asthma, presents to the emergency department. She complains of a two-hour history of worsening dyspnoea, wheeze and a cough that is not responding to her blue salbutamol inhaler. On examination her airway is patent. Her oxygen saturations are 90% on air, her respiratory rate is 26 and she is unable to speak in full sentences. She is tachycardic with a pulse rate of 112 and her peak expiratory flow rate is 45% of her normal.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 423,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,124 | false | 8 | null | 6,495,076 | null | false | [] | null | 13,603 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be the next best step if there were asthmatic features or features suggesting steroid-responsiveness.",
"id": "10005285",
"label": "e",
"name": "Combined long-acting beta 2 agonist and inhaled corticosteroid",
"picture": null,
"votes": 154
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the relevant 2018 NICE guideline, this should be combined with a long-acting muscarinic antagonist (such as ipratropium) for optimum control.",
"id": "10005282",
"label": "b",
"name": "Long-acting beta 2 agonist",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Following the 2018 NICE guidelines, the next step in management would be a combined long-acting beta 2 agonist (such as salmeterol) + a long-acting muscarinic antagonist (such as ipratropium). This is because there are no 'asthmatic features/features suggesting steroid responsiveness'.",
"id": "10005281",
"label": "a",
"name": "Combined long-acting beta 2 agonist and long-acting muscarinic antagonist",
"picture": null,
"votes": 143
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be considered following a trial of a combined long-acting beta 2 agonist and long-acting muscarinic antagonist if the person still has one severe or two moderate exacerbations within a year.",
"id": "10005284",
"label": "d",
"name": "Combined long-acting beta 2 agonist, long-acting muscarinic antagonist and inhaled corticosteroid",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to the relevant 2018 NICE guideline, this should be combined with a long-acting beta 2 agonist (such as salmeterol) for optimum control.",
"id": "10005283",
"label": "c",
"name": "Long-acting muscarinic antagonist",
"picture": null,
"votes": 44
}
],
"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": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 65-year-old male is reviewed in the chronic obstructive pulmonary disease (COPD) clinic. He was diagnosed with COPD five years ago and is currently maintained on a salbutamol inhaler as required. He has recently started nicotine replacement therapy and stopped smoking. His latest FEV1 was 41% of predicted. Despite his current therapy he complains of frequent exacerbations. There is no history of asthma, eosinophilia or FEV1 variation.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 421,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,125 | false | 9 | null | 6,495,076 | null | false | [] | null | 13,604 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Retinoblastoma is a malignant tumour of the retina, and the most common intraocular tumour of childhood. The most common sign of retinoblastoma is leukocoria (white pupil). However, it may also present as deteriorating vision, strabismus or failure to thrive if not recognised early. It is not a relevant differential in this case.",
"id": "10005287",
"label": "b",
"name": "Retinoblastoma",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical description of Horner's syndrome which is characterised by ptosis and miosis, with or without anhidrosis. It is due to an interruption of the sympathetic nerve supply to the eye and can be classified into pre-ganglion causes, post-ganglionic causes and central causes. In this case, with the weight loss and shoulder pain, the most likely underlying cause is a pancoast tumour of the apex of the lung. Pancoast tumours are pre-ganglionic lesions and, thereby, the anhydrosis affects the face only.",
"id": "10005286",
"label": "a",
"name": "Horner's syndrome",
"picture": null,
"votes": 403
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cluster headache is a unilateral headache that is typically worse around the eye. Typical features include a bloodshot or teary eye, vomiting and severe headache. None of these symptoms feature in this case.",
"id": "10005289",
"label": "d",
"name": "Cluster headache",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Multiple sclerosis, not unlike cerebrovascular disease is a multifocal condition which causes wildly variable clinical features dependent on the affected area of the brain or spinal cord. This said, there are typical presentations which may occur more commonly, in particular sensory disease (patchy paraesthesia), optic neuritis (loss of central vision and painful eye movements) and internuclear ophthalmoplegia (a lesion in the medial longitudinal fasciculus of the brainstem). It is highly unlikely to present with shoulder pain or anhidrosis.",
"id": "10005288",
"label": "c",
"name": "Multiple sclerosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neuroblastoma is a rare cancer that affects children, mostly under the age of five years. It develops in early nerve cells called neuroblasts and often starts with a lump in the abdomen. It is not a relevant differential in this case.",
"id": "10005290",
"label": "e",
"name": "Neuroblastoma",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"typeId": 7
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"demo": null,
"entitlement": null,
"id": "4339",
"name": "Horner's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 75-year-old male presents to his GP. He complains of right-sided shoulder pain and of his face looking unusual for a reason he cannot pinpoint. With his face only, he has also been noticing that one side does not sweat at all. On further questioning, he reveals he has had significant weight loss in the past few months too. On examination, it is noted that he has right sided-miosis, ptosis and this is also the side he complains of facial anhidrosis.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 416,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,126 | false | 10 | null | 6,495,076 | null | false | [] | null | 13,605 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "V/Q scan is a viable scan to diagnose PE but is preferred if the patient has renal impairment, a contrast allergy or is pregnant.",
"id": "10005295",
"label": "e",
"name": "V/Q scan",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is a pulmonary embolism from an underlying deep vein thrombosis (DVT). CT pulmonary angiogram (CTPA) is the diagnostic test of choice for a PE and will show a filling defect in the pulmonary vasculature.",
"id": "10005291",
"label": "a",
"name": "CT pulmonary angiogram",
"picture": null,
"votes": 270
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lower limb Duplex can be helpful if a DVT is thought to be the cause of the PE as in this case but does not provide a definitive diagnosis for the cause of the oxygen desaturation and tachycardia which needs treating more urgently. Therefore, CTPA remains the next best investigation.",
"id": "10005294",
"label": "d",
"name": "Doppler USS left leg",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest x-rays are typically normal in PE and therefore not the next best investigation. However, possible findings include Fleischner sign (an enlarged pulmonary artery), Hampton's hump (a peripheral wedge-shaped opacity), and Westermark's sign (regional oligaemia). The chest x-ray can be helpful in ruling out differentials (e.g. pneumonia, pneumothorax) too.",
"id": "10005292",
"label": "b",
"name": "Chest x-ray",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "D-dimer is a highly non-specific test but has a 95% negative predictive value i.e. it is useful in ruling out a PE if negative. The Well's score in this case is at least 9.5 and only if the Well's score is 4 or less, a D-dimer should be measured.",
"id": "10005293",
"label": "c",
"name": "D-dimer",
"picture": null,
"votes": 52
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3724",
"name": "Pulmonary Embolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"question": "A 59-year-old male is seen in the Acute Medical Unit. He complains of sudden onset pleuritic chest pain and three episodes of coughing up blood. On examination, he has a unilateral swollen, red and tender left calf. His oxygen saturations are slightly low at 95% on air and he is tachycardic with a pulse rate of 105. He is known to have a background of bowel malignancy for which he is awaiting surgery.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 420,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,127 | false | 11 | null | 6,495,076 | null | false | [] | null | 13,606 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "According to local antimicrobial guidelines, this antibiotic would be first-line for a community-acquired pneumonia. However, provided the lack of chest sounds and pyrexia, this is a less likely diagnosis.",
"id": "10005300",
"label": "e",
"name": "Amoxicillin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Scottish Referral Guidelines for Suspected Cancer stipulate that an urgent suspicion of cancer chest x-ray should be arranged for anyone with unexplained haemoptysis or unexplained and persistent (more than three weeks) weight loss.",
"id": "10005296",
"label": "a",
"name": "Urgent suspicion of cancer chest x-ray",
"picture": null,
"votes": 384
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an investigation usually requested by specialist doctors and would be indicated if a chest x-ray reported ambiguous findings or for planning of biopsy and/or surgery.",
"id": "10005297",
"label": "b",
"name": "CT Chest",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a scan which images the pulmonary arteries, often reserved to diagnose or exclude pulmonary emboli - a less likely diagnosis here.",
"id": "10005299",
"label": "d",
"name": "CT Pulmonary Angiogram",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bronchoscopy is the primary procedure a doctor will perform to obtain a biopsy. Initially though, a suspicious lesion or area must be identified from chest x-ray and CT.",
"id": "10005298",
"label": "c",
"name": "Bronchoscopy",
"picture": null,
"votes": 8
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3702",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"question": "A 45-year-old male presents to his GP. He reports five weeks of daily small amounts of haemoptysis along with unintentional significant weight loss over the last six months. He is a lifelong smoker. On examination he is apyrexial and his chest sounds are clear.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 416,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,128 | false | 12 | null | 6,495,076 | null | false | [] | null | 13,607 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary embolism would rarely cause such significant pyrexia. Sudden-onset shortness of breath, pleuritic chest pain, and haemoptysis are the classic symptoms of pulmonary embolism, none of which are mentioned here.",
"id": "10005302",
"label": "b",
"name": "Pulmonary embolism",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fibrosis would be very unlikely to make a patient so acutely unwell within 24 hours as it is usually a slowly progressive condition. Additionally, chest x-rays commonly show bilateral lower zone reticulo-nodular shadowing.",
"id": "10005305",
"label": "e",
"name": "Idiopathic pulmonary fibrosis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Aspiration pneumonia is seen in patients with a dysfunctional or unsafe swallow. Examples include stroke (as in this case), myasthenia gravis and bulbar palsy. This patient is septic, most likely as a result of their aspiration pneumonia. On the chest x-ray, the right lower lobe is most frequently involved in aspiration pneumonia, in fitting with this case.",
"id": "10005301",
"label": "a",
"name": "Aspiration pneumonia",
"picture": null,
"votes": 363
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lung cancer is unlikely to cause such significant pyrexia without concomitant pneumonia. Chest malignancy would also be unlikely to cause hypotension so quickly.",
"id": "10005303",
"label": "c",
"name": "Lung malignancy",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with acute pulmonary oedema usually present with dyspnoea, orthopnoea and ankle swelling. Pyrexia and hypotension are not typical features.",
"id": "10005304",
"label": "d",
"name": "Pulmonary oedema",
"picture": null,
"votes": 13
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
"entitlement": null,
"id": "4389",
"name": "Aspiration Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"dislikes": 0,
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"question": "A 68-year-old female well-known to speech and language therapy for numerous swallow assessments following a recent stroke is seen by the junior doctor on the ward. The nurses were concerned as her temperature was 40 degrees, her respiratory rate was 24 with oxygen saturations of 87% on air, and her systolic blood pressure was 92mmHg. Her observations were normal 24 hours ago. The junior doctor arranged an urgent chest x-ray which has revealed new consolidation of her right middle and lower zones.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 408,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,129 | false | 13 | null | 6,495,076 | null | false | [] | null | 13,608 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "LFTs are usually attained to investigate the underlying cause of pancreatitis. They may be abnormal if there is gallstone disease or alcohol use amongst others. They are not 'diagnostic' of acute pancreatitis per se and are used more often in the severity scoring of pancreatitis.",
"id": "10005310",
"label": "e",
"name": "Liver function tests (LFTs)",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The CRP level is a prognostic factor, rather than diagnostic test, for severe acute pancreatitis and has been identified as a predictive factor for both pancreatic necrosis and infective pancreatic cysts.",
"id": "10005308",
"label": "c",
"name": "C-reactive protein (CRP)",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Leucocytosis can indicate the presence of necrotising pancreatitis but a full blood count in itself is not useful in confirmation of 'acute' pancreatitis as it is often largely unchanged.",
"id": "10005307",
"label": "b",
"name": "Full Blood Count (FBC)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ESR level is a prognostic factor, rather than diagnostic test, for severe acute pancreatitis. Literature suggests it is slightly inferior to CRP and as such is not routinely used in pancreatitis investigation or monitoring.",
"id": "10005309",
"label": "d",
"name": "Erythrocyte sedimentation rate (ESR)",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here, given the description of the pain and Cullen's sign on examination, is acute pancreatitis. An amylase 3x the upper limit of normal is extremely suggestive of acute pancreatitis and is the only serum investigation in the diagnostic criteria. It is important to note that the degree of elevation of amylase is not related to the severity of the disease.",
"id": "10005306",
"label": "a",
"name": "Amylase",
"picture": null,
"votes": 314
}
],
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3730",
"name": "Acute Pancreatitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "A 62-year-old alcohol-dependent male presents to the acute medical unit with an 18-hour history of severe stabbing-like epigastric pain which radiates to his back. He has vomited three times in the past six hours too. On examination, periumbilical discolouration is noted.\n\nWhich of the following serum investigations may be diagnostic if significantly raised?",
"sbaAnswer": [
"a"
],
"totalVotes": 411,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,130 | false | 14 | null | 6,495,076 | null | false | [] | null | 13,609 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "*Clostridium difficile* (CDI) is a gram-positive bacteria that can cause pseudomembranous colitis, commonly seen in patients who have recently been on a course of broad-spectrum antibiotics as likely in this case. Other risk factors include hospital stays and being over 65 years of age- both of which are present in this case too. Three of the most common symptoms are watery diarrhoea (which can be bloody), painful abdominal cramps and nausea.",
"id": "10005311",
"label": "a",
"name": "*Clostridium difficile* infection",
"picture": null,
"votes": 403
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a diagnosis which more commonly causes constipation. Classically, acute appendicitis presents as progressive peri-umbilical pain that moves to the right iliac fossa. Nausea and one to two episodes of vomiting are also common and not present in this case.",
"id": "10005314",
"label": "d",
"name": "Acute appendicitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of IBS are abdominal discomfort or pain that is relieved by defecation or associated with altered bowel frequency or stool form which is present here. However, the diagnostic criteria is of these symptoms and at least two of: altered stool passage (e.g. straining or urgency), abdominal bloating, symptoms made worse by eating or passage of mucous. Two of these are not present in this case.",
"id": "10005313",
"label": "c",
"name": "Irritable bowel syndrome (IBS)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of ulcerative colitis are classically diarrhoea containing blood or mucous, tenesmus or urgency and pain in the left iliac fossa. There is often associated weight loss and/or fever. The case described in this question is not in keeping with these.",
"id": "10005312",
"label": "b",
"name": "Ulcerative colitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can present with abdominal pain. However, the most common features are abdominal bloating and vomiting (bilious often), which are not mentioned here. They may also experience a failure to pass flatus or stool, rather than loose stool.",
"id": "10005315",
"label": "e",
"name": "Small bowel obstruction",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3935",
"name": "Clostridium difficile",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "A 78-year-old male presents to his GP. He was recently discharged from hospital for treatment of community-acquired pneumonia. He now complains of six to eight episodes of watery stool per day with some non-specific central abdominal cramps. His bloods reveal a white cell count of 13.5 x 10<sup>9</sup>/L (4.5 - 11).\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 408,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,131 | false | 15 | null | 6,495,076 | null | false | [] | null | 13,610 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of ulcerative colitis classically include diarrhoea. However, the stool normally contains blood or mucus. Other symptoms include tenesmus or urgency, and pain in the left iliac fossa. There is often associated weight loss and/or fever. The case described in this question is less in keeping with this.",
"id": "10005318",
"label": "c",
"name": "Ulcerative colitis",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of IBS are abdominal discomfort or pain that is relieved by defecation or associated with altered bowel frequency or stool form which is present here. However, the diagnostic criteria is of these symptoms and at least two of: altered stool passage (e.g. straining or urgency), abdominal bloating, symptoms made worse by eating or passage of mucous. Two of these are not present in this case.",
"id": "10005319",
"label": "d",
"name": "Irritable bowel syndrome (IBS)",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a condition most commonly seen in female smokers aged between 15 and 40. The right-sided abdominal pain and extreme number of diarrhoeal episodes are also indicative of Crohn's disease.",
"id": "10005316",
"label": "a",
"name": "Crohn's disease",
"picture": null,
"votes": 254
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bowel obstructions would usually present more acutely than over a three-week period. Additionally, the commonest causes of large bowel obstructions are cancer, volvulus and diverticular disease which are rare in a person of this age. Inflammatory bowel disease, which is most likely in this case, may lead to a small bowel obstruction but is unlikely to cause a large bowel obstruction. Lastly, bowel obstruction would likely present with an absence of passing stool and flatulus, whereas the opposite is true in this case.",
"id": "10005317",
"label": "b",
"name": "Large bowel obstruction",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clostridium difficile (CDI) is a gram-positive bacteria that can cause pseudomembranous colitis, commonly seen in patients who have recently been on a course of broad-spectrum antibiotics, which is not seen in this case. Other risk factors include hospital stays and being over 65 years of age, which are both absent in this case too. CDI does cause watery diarrhoea which can be bloody. However, it is classically associated with painful abdominal cramps and/or nausea.",
"id": "10005320",
"label": "e",
"name": "Clostridium difficile infection",
"picture": null,
"votes": 20
}
],
"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": "4000",
"name": "Crohn's disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A previously well 26-year-old female smoker presents to her GP. She complains of three weeks of crampy right iliac fossa abdominal pain with non-bloody diarrhoea on average 10x per day.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 406,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,132 | false | 16 | null | 6,495,076 | null | false | [] | null | 13,611 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE clinical guideline CG184 states dyspepsia in unselected people in primary care is defined broadly to include people with recurrent epigastric pain, heartburn or acid regurgitation, with or without bloating, nausea or vomiting. They state to offer H pylori 'test and treat' to people with dyspepsia.",
"id": "10005321",
"label": "a",
"name": "Stool antigen test for Helicobacter pylori (H. pylori) infection",
"picture": null,
"votes": 205
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This investigation is not used in the work-up for dyspepsia. It is often the first imaging test used to evaluate and diagnose the source of acute pain in the abdominal region and/or lower back as well as unexplained nausea and vomiting.",
"id": "10005324",
"label": "d",
"name": "Abdominal X-ray",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The test is commonly performed in people who have difficulty swallowing, a sensation of food being “stuck”, or pain on swallowing. Indigestion or dyspepsia are rarely indications, but would not be considered before H. pylori is ruled out and is not favoured over endoscopy.",
"id": "10005325",
"label": "e",
"name": "Barium swallow",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no red flags in this case as yet to merit an endoscopy and certainly a H. pylori test would be first-line before invasive endoscopy is considered. In this patient, a full-dose proton pump inhibitor for four to eight weeks should also be trialled before considering endoscopy.",
"id": "10005322",
"label": "b",
"name": "Upper GI endoscopy",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This investigation has no place in the work-up for dyspepsia. It is often used to visualise the kidneys, liver, gallbladder, bile ducts, abdominal aorta and pancreas.",
"id": "10005323",
"label": "c",
"name": "USS Abdomen",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"pictures": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4019",
"name": "H. Pylori",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "A 52-year-old woman is seen in the General Practice surgery. She complains of progressive upper abdominal pain and heartburn for the last month despite lifestyle changes. This is the second time she has presented to her GP with this complaint. She is currently taking no medication and denies nausea and vomiting or weight loss. Her abdominal examination is unremarkable.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 400,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,133 | false | 17 | null | 6,495,076 | null | false | [] | null | 13,612 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years. It is more common in men. The three symptoms described in the stem are the typical presenting features. Others include urgency and tenesmus.",
"id": "10005326",
"label": "a",
"name": "Ulcerative Colitis",
"picture": null,
"votes": 325
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Symptoms of IBS are abdominal discomfort or pain that is relieved by defecation OR associated with altered bowel frequency or stool form which is present here. However, the diagnostic criteria is of these symptoms and at least two of: altered stool passage (e.g. straining or urgency), abdominal bloating, or symptoms made worse by eating or passage of mucous. Two of these are not present in this case.",
"id": "10005327",
"label": "b",
"name": "Irritable bowel syndrome (IBS)",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a diagnosis which more commonly causes constipation. Classically, acute appendicitis presents as progressive peri-umbilical pain that moves to the right iliac fossa and not cramping. Nausea and one to two episodes of vomiting are also common, and not present in this case.",
"id": "10005329",
"label": "d",
"name": "Acute appendicitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can present with abdominal pain. However, the most common features are abdominal bloating and vomiting (often bilious) not mentioned here. They may also experience a failure to pass flatus or stool, rather than loose stool as in this case.",
"id": "10005328",
"label": "c",
"name": "Small bowel obstruction",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a condition most commonly seen in those aged between 15 and 40. However, it is more common in females. The typical presentation is most often non-bloody diarrhoea although blood can be seen in rarer advanced Crohn's colitis. The right iliac fossa is where abdominal pain is most often described in Crohn's, rather than the left as in this case.",
"id": "10005330",
"label": "e",
"name": "Crohn's disease",
"picture": null,
"votes": 57
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": null,
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "3732",
"name": "Ulcerative Colitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"difficulty": 1,
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"question": "A normally well 19-year-old male presents to the GP with a three-week history of insidious onset crampy left iliac fossa abdominal pain, bloody diarrhoea 12-14 times per day and significant weight loss.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 398,
"typeId": 1,
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} | MarksheetMark |
173,462,134 | false | 18 | null | 6,495,076 | null | false | [] | null | 13,613 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Symptoms of progressive dysphagia and weight loss in a smoker are always highly suggestive of oesophageal malignancy. Unfortunately, these malignancies can bleed as they advance and cause haematemesis as seen here. Most often it is a small volume of blood, except as a preterminal event with erosion of major vessels. The bleeding may be recurrent until the malignancy is effectively managed.",
"id": "10005331",
"label": "a",
"name": "Oesophageal malignancy",
"picture": null,
"votes": 254
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Similar to gastric ulcers, this diagnosis usually has known antecedent reflux-type symptoms. It presents with a smaller volume of fresh blood, often streaking vomit. Medications are frequently responsible which include tetracycline antibiotics, NSAIDs and bisphosphonates.",
"id": "10005335",
"label": "e",
"name": "Oesophagitis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This occurs following bouts of repeated vomiting, often secondary to acute alcohol intoxication.",
"id": "10005334",
"label": "d",
"name": "Mallory-Weiss tear",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Varices usually present with a much larger volume of fresh blood. They are often associated with haemodynamic compromise too. Varices may stop spontaneously but re-bleeds are common until they are appropriately managed. They arise through portal hypertension, most commonly secondary to cirrhosis, not present in this case.",
"id": "10005333",
"label": "c",
"name": "Oesophageal varices",
"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a fairly rare diagnosis with duodenal ulcers being four times more common. Gastric ulcers may well cause frank haematemesis or may present with altered blood mixed with vomit. There are usually prodromal features of dyspepsia and/or medication culprits such as NSAIDs, steroids or SSRIs though. Alcohol is another risk factor not present in this case.",
"id": "10005332",
"label": "b",
"name": "Gastric ulcer",
"picture": null,
"votes": 23
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4390",
"name": "Upper GI bleed",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 68-year-old male presents to the emergency department after four recurrent episodes of haematemesis. He reports each episode was approximately two tablespoons of fresh red blood. On further questioning, he reveals an eight-week history of progressive dysphagia to solids, especially meat, and associated fatigue. He denies abdominal pain. He has a past medical history of diverticulosis and hypertension. His medications are ramipril only. He is a long-term smoker of ten cigarrettes per day and he does not drink alcohol.\n\nWhich of the following is the most likely cause of this patient’s haematemesis?",
"sbaAnswer": [
"a"
],
"totalVotes": 398,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,135 | false | 19 | null | 6,495,076 | null | false | [] | null | 13,614 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If there is a poor response after the initial four weeks of treatment with no obvious explanation then stopping the potent corticosteroid and only applying a topical vitamin D preparation twice a day for up to 12 weeks can be considered. It is not used alone as an initial flare-up treatment.",
"id": "10005339",
"label": "d",
"name": "Topical vitamin D preparation alone",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Courses of topical treatments (including corticosteroids) are used as needed to maintain satisfactory control of psoriasis, reinforcing the advice on the safe use of potent topical corticosteroids. For significant flares, a topical Vitamin D preparation should be used as well.",
"id": "10005338",
"label": "c",
"name": "Potent topical corticosteroid alone",
"picture": null,
"votes": 78
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would only be offered if there is still a poor response after eight to twelve weeks of treatment with a vitamin D preparation alone twice a day.",
"id": "10005340",
"label": "e",
"name": "Coal tar preparation",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is generally considered if the scale is the primary problematic feature of the psoriasis, which is specifically mentioned not to be the case here.",
"id": "10005337",
"label": "b",
"name": "Salicylic acid preparation",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "According to the current NICE CKS guidance on trunk and limb psoriasis, the first-line treatment for a flare of plaque psoriasis affecting extensors is a potent topical corticosteroid plus a topical vitamin D preparation (both applied once a day, but at different times of day). This is then reviewed at four weeks to assess the response of treatment. Generally, one should not prescribe potent corticosteroids for more than eight weeks at any one site.",
"id": "10005336",
"label": "a",
"name": "Potent topical corticosteroid plus a separate topical vitamin D preparation",
"picture": null,
"votes": 248
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"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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"question": "A 42-year-old male presents to his GP with a flare of his chronic plaque psoriasis on his knee. It is not significantly scaly. He is currently using over-the-counter emollients which control the plaque when not flared.\n\nWhich of the following is the most appropriate initial pharmacotherapy to treat his flare?",
"sbaAnswer": [
"a"
],
"totalVotes": 377,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,136 | false | 20 | null | 6,495,076 | null | false | [] | null | 13,615 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Erythema multiforme (EM) is also a hypersensitivity reaction that in 90% of cases is triggered by infection. The commonest infective cause is Herpes simplex virus. It presents with well-defined circular papules which evolve at different stages to form a 'target-shaped' lesion of three concentric rings of different colours. The rash tends to start on the palms/soles and spreads up the limbs to the trunk.",
"id": "10005345",
"label": "e",
"name": "Erythema multiforme",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a condition most often seen in children with atopic eczema. It often presents as a rapidly progressing painful rash. On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.",
"id": "10005344",
"label": "d",
"name": "Eczema herpeticum",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a type II hypersensitivity reaction condition most often seen in the elderly. It presents with deep, tense blisters. Unlike pemphigus vulgaris, the oral mucosa is rarely affected, although this is not mentioned here. Nikolsky sign is negative importantly.",
"id": "10005341",
"label": "a",
"name": "Bullous pemphigoid",
"picture": null,
"votes": 298
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This condition typically features fragile, superficial blisters that rupture easily and desquamation. Nikolsky sign is most often positive.",
"id": "10005342",
"label": "b",
"name": "Pemphigus vulgaris",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autoimmune blistering condition but is associated with coeliac disease. It presents with itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks). It is slightly more common in men too.",
"id": "10005343",
"label": "c",
"name": "Dermatitis herpetiformis",
"picture": null,
"votes": 13
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"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,
"userChapter": null,
"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13615",
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"question": "A 78-year-old female admitted for falls is reviewed by the dermatology doctors on the geriatric ward. She has itchy, tense and firm fluid-filled blisters symmetrically distributed over her trunk only. Nikolsky's sign is negative.\n\nWhich of the following is the most likely explanation for this patient’s physical findings?",
"sbaAnswer": [
"a"
],
"totalVotes": 367,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,137 | false | 21 | null | 6,495,076 | null | false | [] | null | 13,616 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presents as an annular patch or plaque with a slightly raised, sometimes scaly, border and central clearing.",
"id": "10005348",
"label": "c",
"name": "Fungal infection",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This typically presents with red, sharply marginated lesions with greasy scales; usually confined to areas with sebaceous gland activity (for example ears, beard area, eyebrows, scalp, and nasolabial folds).",
"id": "10005347",
"label": "b",
"name": "Seborrhoeic dermatitis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The National Institute for Health and Care Excellence (NICE) states that atopic eczema is likely if there is an itchy skin condition plus visible flexural eczema involving the skin creases, a personal history of asthma or allergic rhinitis (hayfever) and a personal history of dry skin in the last 12 months. Other criteria not present here include onset of signs and symptoms before the age of two years and personal history of flexural eczema.",
"id": "10005346",
"label": "a",
"name": "Atopic dermatitis",
"picture": null,
"votes": 338
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a less itchy rash. It normally presents with well-circumscribed, reddish, flat-topped plaques with silvery scales. It is also typically symmetrical and on the extensor surfaces.",
"id": "10005350",
"label": "e",
"name": "Psoriasis",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Scabies or other infestations should be suspected when there is a recent onset of an itchy rash in a family. It features widespread pruritus with linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist.",
"id": "10005349",
"label": "d",
"name": "Scabies",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"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,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3982,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13616",
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"question": "A six-year-old male presents to his GP with his mother. Over the last week, he has developed an itchy, erythematous, poorly demarcated rash. It is approximately 5cm x 3cm and is located in the region over the flexural aspect of his left elbow. His medication is salbutamol for asthma only. On further questioning, his mum reveals he suffered from some dry skin on his hands a few months ago too which cleared with over-the-counter emollients.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 368,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,138 | false | 22 | null | 6,495,076 | null | false | [] | null | 13,617 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient osteoporosis of the hip is a rare condition that causes bone loss temporarily in the superior section of the femur. It is mostly found in young or middle-aged men between the ages of 30 and 60, and women in their later stages of pregnancy or early postpartum period (following childbirth). The majority of patients present with a sudden onset of pain in the groin area.",
"id": "10005354",
"label": "d",
"name": "Transient osteoporosis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is is the death of the femoral head as a result of the vascular disruption. Symptoms are often similar to osteoarthritis. In mild-to-moderate AVN, radiographs may demonstrate sclerosis, although normally concomitant changes in bone density are noted. In advanced disease, bone deformities, such as flattening, subchondral radiolucent lines (crescent sign), and collapse of the femoral head, are evident.",
"id": "10005355",
"label": "e",
"name": "Avascular necrosis (AVN)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This causes lateral hip pain and is thought to be caused by inflammation of the trochanteric bursa. It often presents with pain which can radiate to the lateral knee when side-lying on the affected side or when sitting down for prolonged periods. It is typically investigated with ultrasound and then MRI if required.",
"id": "10005352",
"label": "b",
"name": "Trochanteric bursitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pain in a joint which is worse with activity is typical of osteoarthritis. X-ray signs associated with osteoarthritis are nonuniform joint space loss, osteophyte formation, cyst formation and subchondral sclerosis.",
"id": "10005351",
"label": "a",
"name": "Osteoarthritis",
"picture": null,
"votes": 360
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be unusual to present initially in the hip region. It would also normally present with morning stiffness lasting over an hour and/or systemic symptoms of fatigue, fever or loss of appetite. The pain generally gets better after activity. X-ray features would include erosions or significant soft tissue swelling.",
"id": "10005353",
"label": "c",
"name": "Rheumatoid arthritis",
"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": "3766",
"name": "Osteoarthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3766,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13617",
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"question": "An otherwise well 68-year-old female presents with pain after activity in her right groin. It started over a year ago and has been gradually worsening. Her GP sends her for a weight-bearing pelvic x-ray which reports loss of joint space, obvious osteophytes and subchondral sclerosis in the right hip joint.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 379,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,139 | false | 23 | null | 6,495,076 | null | false | [] | null | 13,618 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE guidance states to offer analgesia, particularly in the early, painful phase. Paracetamol is considered first-line. Regular dosing is more effective than 'as required use'. If paracetamol is ineffective, consider an oral NSAID (for example, ibuprofen) or codeine.",
"id": "10005356",
"label": "a",
"name": "Simple analgesia",
"picture": null,
"votes": 217
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of scan typically only requested by secondary care specialists.",
"id": "10005360",
"label": "e",
"name": "MRI",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is appropriate if the person has had pain and/or stiffness for up to three months and has not benefited from conservative measures.",
"id": "10005358",
"label": "c",
"name": "Referral to secondary care",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE states to consider an intra-articular (glenohumeral) corticosteroid injection early in the course of frozen shoulder if there is no, or slow, progress with initial conservative treatment.",
"id": "10005357",
"label": "b",
"name": "Intra-articular (glenohumeral) corticosteroid injection",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically only requested by secondary care specialists to investigate the rotator cuff and is particularly useful in diagnosing shoulder impingement, shoulder instability or rotator cuff disorders.",
"id": "10005359",
"label": "d",
"name": "Ultrasound scan",
"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": "4391",
"name": "Frozen shoulder",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13618",
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"question": "A 74-year-old diabetic man attends his GP with a six-week history of a painful and slightly stiff right shoulder. He complains of not being able to dry his hair or sleep at night due to the pain. On examination, there is restriction in all movements of his shoulder due to the pain but most significantly reduced passive external rotation. You suspect adhesive capsulitis (frozen shoulder).\n\nWhich of the following is the best next step in the management of this patient in primary care?",
"sbaAnswer": [
"a"
],
"totalVotes": 382,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,140 | false | 24 | null | 6,495,076 | null | false | [] | null | 13,619 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30-50 years old. Finkelstein's test is positive (on grasping the patient's thumb and abducting the hand to the ulnar side, there is pain over the radial styloid process). Having a young child is a risk factor as the inflammation can occur due to repeatedly lifting up a child.",
"id": "10005361",
"label": "a",
"name": "De Quervain's Tenosynovitis",
"picture": null,
"votes": 293
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Radial nerve entrapment may occur at any point along the anatomic course of the nerve. The most frequent site of compression is in the proximal forearm. It results in numbness, paresthesia, pain, and weakness in the radial nerve distribution.",
"id": "10005364",
"label": "d",
"name": "Radial nerve entrapment",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A scaphoid fracture is fracture of the scaphoid bone, mostly caused by trauma. Symptom includes pain at the base of the thumb, which is worse with use of the hand.",
"id": "10005363",
"label": "c",
"name": "Scaphoid fracture",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoarthritis is a chronic inflammatory condition of joints and is unlikely in this young patient.",
"id": "10005365",
"label": "e",
"name": "Osteoarthritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Carpal tunnel syndrome occurs following compression of the median nerve within the carpal tunnel. The symptoms include numbness, paresthesia, and pain in the median nerve distribution.",
"id": "10005362",
"label": "b",
"name": "Carpal Tunnel Syndrome",
"picture": null,
"votes": 46
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4392",
"name": "De Quervain's Tenosynovitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4392,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13619",
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"question": "A 30-year-old mother of a six-month-old infant presents to the orthopaedic outpatient clinic with a complaint of pain in her right wrist for three weeks. The pain is on the radial side of the wrist and, on examination, Finkelstein test is found to be positive.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 375,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,141 | false | 25 | null | 6,495,076 | null | false | [] | null | 13,620 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Galeazzi fracture is a fracture of the middle to distal-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ).",
"id": "10005368",
"label": "c",
"name": "Galeazzi fracture",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is also a distal radius fracture but with volar angulation of the distal fragment.",
"id": "10005370",
"label": "e",
"name": "Smith fracture",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Colles' fracture normally follows a fall on an outstretched wrist and leads to a distal radial fracture with dorsal displacement of the distal fragment. It occurs mostly in older women with osteoporotic bones.",
"id": "10005366",
"label": "a",
"name": "Colles' fracture",
"picture": null,
"votes": 315
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Bennett fracture is a fracture of the base of the thumb resulting from forced abduction of the first metacarpal. It is defined as an intra-articular two-part fracture of the base of the first metacarpal bone.",
"id": "10005369",
"label": "d",
"name": "Bennett fracture",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Monteggia fractures involve a fracture of the proximal third of the ulnar shaft and anterior dislocation of the radial head at the capitellum.",
"id": "10005367",
"label": "b",
"name": "Monteggia fracture",
"picture": null,
"votes": 6
}
],
"comments": [],
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"name": "Colles' fracture",
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"typeId": 7
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"question": "An 82-year-old woman falls onto her outstretched hands after not seeing a kerb. She immediately cradled her right arm and complained of severe pain. An X-ray in the accident and emergency department has revealed a fracture of the distal end of the radius with dorsal displacement.\n\nWhat is the name of this kind of fracture?",
"sbaAnswer": [
"a"
],
"totalVotes": 374,
"typeId": 1,
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173,462,142 | false | 26 | null | 6,495,076 | null | false | [] | null | 13,621 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient osteoporosis of the hip is a rare condition that causes bone loss temporarily in the superior section of the femur. It is mostly found in young or middle-aged men between the ages of 30 and 60, and women in their later stages of pregnancy or early postpartum period (following childbirth). The majority of patients present with a sudden onset of pain in the groin area.",
"id": "10005372",
"label": "b",
"name": "Transient osteoporosis",
"picture": null,
"votes": 91
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "X-ray signs associated with osteoarthritis are nonuniform joint space loss, osteophyte formation, cyst formation and subchondral sclerosis.",
"id": "10005375",
"label": "e",
"name": "Osteoarthritis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This causes lateral hip pain and is thought to be caused by inflammation of the trochanteric bursa. It often presents with pain which can radiate to the lateral knee when side-lying on the affected side or when sitting down for prolonged periods. It is investigated with ultrasound and then MRI if required.",
"id": "10005374",
"label": "d",
"name": "Trochanteric bursitis",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be unusual to present initially in the hip region. It would also normally present with morning stiffness lasting over an hour and/or systemic symptoms of fatigue, fever or loss of appetite. The pain generally gets better after activity. X-ray features would include erosions or significant soft tissue swelling.",
"id": "10005373",
"label": "c",
"name": "Rheumatoid Arthritis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the death of the femoral head as a result of vascular disruption. Symptoms are often similar to osteoarthritis with progressive pain on activity. Risk factors include steroids, trauma and radiation. In mild-to-moderate AVN, radiographs may demonstrate sclerosis and changes in bone density. In advanced disease, bone deformities, such as flattening, subchondral radiolucent lines (crescent sign), and collapse of the femoral head, are evident.",
"id": "10005371",
"label": "a",
"name": "Avascular necrosis",
"picture": null,
"votes": 226
}
],
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"id": "4079",
"name": "Avascular Necrosis",
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"typeId": 7
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"question": "A 69-year-old woman who has been taking oral steroids for the last year for giant cell arteritis presents with progressive pain in her left groin. The pain started insidiously and has been getting worse for the past two months. On examination, movement of her hip is painful in all directions but there is no evidence of limb shortening or external rotation. A weight-bearing hip X-Ray shows a crescent sign.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 376,
"typeId": 1,
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173,462,143 | false | 27 | null | 6,495,076 | null | false | [] | null | 13,622 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is in diabetic ketoacidosis (DKA) by definition. There is universal agreement that the most important initial therapeutic intervention in DKA is appropriate fluid replacement followed by insulin administration. 0.9% sodium chloride solution (‘normal saline’) is the fluid resuscitation of choice according to the latest guidance from the joint British Diabetes Societies.",
"id": "10005376",
"label": "a",
"name": "IV saline (0.9% NaCl)",
"picture": null,
"votes": 253
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Conversion to a subcutaneous regime should occur when the patient is biochemically stable (capillary ketones less than 0.6 mmol/L AND pH over 7.3) and the patient is ready and able to eat.",
"id": "10005378",
"label": "c",
"name": "Subcutaneous insulin",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should occur as step 2 following commencement of 0.9% NaCl. The IV insulin should be given at a rate of 0.1unit/kg/hour.",
"id": "10005379",
"label": "d",
"name": "Intravenous insulin infusion",
"picture": null,
"votes": 91
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is universal agreement that the most important initial therapeutic intervention in DKA is appropriate fluid replacement followed by insulin administration. 0.9% sodium chloride solution (‘normal saline’) is the fluid resuscitation of choice according to the latest guidance from the Joint British Diabetes Societies.",
"id": "10005377",
"label": "b",
"name": "IV Ringer's Lactate (Hartmann's solution)",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an oral medication used in the treatment of type 2 diabetes mellitus.",
"id": "10005380",
"label": "e",
"name": "Gliclazide",
"picture": null,
"votes": 4
}
],
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"id": "4394",
"name": "Emergency Management of Diabetic Ketoacidosis",
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"id": "221",
"name": "Endocrine",
"typeId": 7
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"question": "A 26-year-old type 1 diabetic male presents to the emergency department by ambulance. His bedside glucose is 22mmol/L (nromal <6.1 mmol/L). His ketones are 3.8mmol/L (normal <0.6 mmol/L) and bicarbonate 14mmol/L (normal 22-30 mmol/L) on a venous blood gas.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 370,
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173,462,144 | false | 28 | null | 6,495,076 | null | false | [] | null | 13,623 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate treatment once the patient;s blood glucose was above 4mmol/L. It equates to 20g of long-acting carbohydrate.",
"id": "10005383",
"label": "c",
"name": "One piece of toast",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate if the patient was unconscious/fitting, very aggressive, or nil by mouth (NBM).",
"id": "10005385",
"label": "e",
"name": "IV 200ml 10% glucose over 15 minutes",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate treatment if the patient was conscious and able to swallow, but confused, disorientated or aggressive i.e. moderate hypoglycaemia.",
"id": "10005382",
"label": "b",
"name": "40% glucose oral gel (2 tubes)",
"picture": null,
"votes": 160
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The Joint British Diabetes Societies have produced an algorithm for the treatment and management of hypoglycaemia in adults with diabetes mellitus in hospital. It states that if the patient is conscious, orientated, and able to swallow, they have mild hypoglycaemia. This should be treated with 15-20g of quick-acting carbohydrate, such as five to seven Dextrosol tablets, four to five Glucotabs or 150-200ml pure fruit juice.",
"id": "10005381",
"label": "a",
"name": "Four to five Glucotabs",
"picture": null,
"votes": 140
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate if the patient was unconscious/fitting, very aggressive or nil by mouth (NBM).",
"id": "10005384",
"label": "d",
"name": "1mg IM glucagon",
"picture": null,
"votes": 3
}
],
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"id": "4395",
"name": "Hypoglycaemia",
"status": null,
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"id": "221",
"name": "Endocrine",
"typeId": 7
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"question": "An 82-year-old type 2 diabetic male complains of feeling lightheaded on the geriatric ward. The foundation doctor reviews him and requests his nurse to check his bedside blood glucose which reads 3.5mmol/L (normal <6.1 mmol/L). He is orientated to time and place, and able to swallow.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 367,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,145 | false | 29 | null | 6,495,076 | null | false | [] | null | 13,624 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be considered when dual therapy with metformin and another oral drug has not continued to control HbA1c to below the person's individually agreed threshold.",
"id": "10005387",
"label": "b",
"name": "Start insulin-based treatment",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You could consider adding this drug as a second-line. However, NICE guidance suggests as this man has established atherosclerotic cardiovascular disease, an SGLT2 is preferred first.",
"id": "10005388",
"label": "c",
"name": "Add pioglitazone",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You could consider adding this drug as a second-line. However, NICE guidance suggests as this man has established atherosclerotic cardiovascular disease, an SGLT2 is preferred first.",
"id": "10005389",
"label": "d",
"name": "Add gliclazide",
"picture": null,
"votes": 115
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Exenatide is a GLP‑1 mimetic. This would only be considered in special circumstances where triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated.",
"id": "10005390",
"label": "e",
"name": "Add Exenatide",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Dapagliflozin is an oral hypoglycaemic drug of the class SGLT2 inhibitor. NICE recomemnds for adults with type 2 diabetes at any stage after they have started first-line treatment if they have or develop chronic heart failure or established atherosclerotic cardiovascular disease, to offer an SGLT2 inhibitor in addition to current treatment.",
"id": "10005386",
"label": "a",
"name": "Add dapagliflozin",
"picture": null,
"votes": 210
}
],
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"demo": null,
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"id": "4396",
"name": "Type 2 Diabetes mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "221",
"name": "Endocrine",
"typeId": 7
},
"topicId": 221,
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"question": "A 62-year-old male visits an advanced nurse practitioner for a review of his type 2 diabetes. He has currently been taking metformin at his maximum tolerated dose for the last 6 months. His latest HbA1c result is 63mmol/mol and his individually agreed aim is 50mmol/mol. He has suffered from stable angina for the last 3 years but is otherwise well.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 362,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,146 | false | 30 | null | 6,495,076 | null | false | [] | null | 13,625 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyponatraemia is defined as serum sodium concentration <135mmol/L. Clinical features include nausea or vomiting, headache, confusion, fatigue, low blood pressure, loss of energy, muscle weakness, twitching, muscle cramps, seizures and coma. Hyponatraemia does not have any effect on the ECG, cardiac rhythm, or impulse conduction.",
"id": "10005395",
"label": "e",
"name": "Hyponatraemia",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypercalcaemia is defined as corrected calcium >2.65mmol/L. There are often clinical features such as bone pain, osteoporosis, fatigue, confusion, memory problems, depression, nausea, vomiting, abdominal pain, weight loss, thirst, polyuria, constipation, abdominal pain, renal colic, or renal impairment. ECG changes include shortening of the QT interval. In severe hypercalcaemia, Osborn waves (J waves) may be seen.",
"id": "10005392",
"label": "b",
"name": "Hypercalcaemia",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypokalaemia is defined as serum potassium concentration <3.5mmol/L. Clinical features include muscle cramps and pain with rhabdomyolysis, weakness, fatigue, palpitations, syncope, or cardiac arrhythmias. An ECG can show dynamic changes in T-wave morphology, ST-segment depression, and U waves, which are often best seen in the mid-precordial leads (V2–V4). The PR interval can also be prolonged along with an increase in the amplitude of the P wave.",
"id": "10005394",
"label": "d",
"name": "Hypokalaemia",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hypocalcaemia is a state of electrolyte imbalance in which the circulating serum calcium level is <2.1mmol/L. Clinical signs include Trousseau's sign where there is carpopedal spasm on inflation of a blood pressure cuff and Chvostek's sign where contraction of the ipsilateral facial muscles is elicited by tapping the facial nerve just anterior to the ear. The ECG hallmark of hypocalcaemia is QT interval prolongation secondary to a prolonged ST segment.",
"id": "10005391",
"label": "a",
"name": "Hypocalcaemia",
"picture": null,
"votes": 240
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperkalaemia is defined as serum potassium concentration >5.5mmol/L. Clinical features include lethargy, nausea, muscle weakness or paraesthesia. ECG changes (in order of severity) include:t all tented T-waves, flattened P-waves, prolonged PR interval, widened QRS complexes, idioventricular rhythms, sine wave patterns and VF/asystole.",
"id": "10005393",
"label": "c",
"name": "Hyperkalaemia",
"picture": null,
"votes": 43
}
],
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"demo": null,
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"id": "4397",
"name": "Hypocalcaemia",
"status": null,
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"id": "221",
"name": "Endocrine",
"typeId": 7
},
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"question": "A 55-year-old male presents to the GP with gradual onset perioral paraesthesia which developed over the last three days. On examination, Trousseau's sign is present and an urgent ECG reveals a prolonged QT interval.\n\nWhich of the following is the most likely electrolyte abnormality?",
"sbaAnswer": [
"a"
],
"totalVotes": 382,
"typeId": 1,
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} | MarksheetMark |
173,462,147 | false | 31 | null | 6,495,076 | null | false | [] | null | 13,626 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a test used in suspected Addison's disease. Patients presenting with Addison's disease usually appear tanned, lean, fatigued, and notice significant weight loss.",
"id": "10005399",
"label": "d",
"name": "Short ACTH stimulation test",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a test used in suspected acromegaly. The clinical presentation would be with increasing size of hands and feet, frontal bossing, headache, macroglossia, and proximal myopathy.",
"id": "10005398",
"label": "c",
"name": "Oral glucose tolerance test",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis in this case is Cushing's syndrome. The low-dose (overnight) dexamethasone suppression test is the most sensitive test to diagnose Cushing's syndrome and is now used first-line. In patients with Cushing's disease, there would be no change in cortisol levels. Patients without Cushing's disease will have reduced cortisol levels.",
"id": "10005396",
"label": "a",
"name": "Low-dose (overnight) dexamethasone suppression test",
"picture": null,
"votes": 261
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The high-dose dexamethasone suppression test is a localisation test once Cushing's syndrome has been diagnosed. If cortisol and ACTH are both suppressed, this is indicative of Cushing's disease. If both are NOT suppressed this indicates an ectopic ACTH syndrome. Finally, if cortisol is not suppressed but ACTH is then this is Cushing's syndrome due to other causes- for example an adrenal adenoma.",
"id": "10005400",
"label": "e",
"name": "High-dose dexamethasone suppression test",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a localisation test. CRH (Corticotrophin Releasing hormone) is given to test the responsiveness of the pituitary in producing ACTH and then cortisol. If the syndrome is of a pituitary source, cortisol rises. If it is of ectopic/adrenal source, there is no change in cortisol.",
"id": "10005397",
"label": "b",
"name": "CRH stimulation test",
"picture": null,
"votes": 3
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Low dose is first line, but I thought you then performed high dose to confirm the diagnosis?",
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"question": "A 44-year-old woman is seen in the endocrinology clinic with a five-week history of fatigue and weight gain. She has a past medical history of reflux and she denies recent infectious symptoms. On examination, she has a heart rate of 95 bpm and blood pressure of 158/98mmHg. Her skin appears thinned and there are numerous prominent bruises across her upper arms.\n\nWhich of the following initial tests is most likely to make the diagnosis?",
"sbaAnswer": [
"a"
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173,462,148 | false | 32 | null | 6,495,076 | null | false | [] | null | 13,627 | {
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Acute epiglottitis is a life-threatening cause of respiratory distress in children due to the risk of airway obstruction. It is typically caused by Haemophilus influenzae type b. Conjugate vaccines to Hib mean the disease is now much less common. However, children who are not up-to-date with their vaccinations, or in households who refuse vaccination, are at greater risk. Clinical features include rapid onset, high temperature, generally unwell, stridor, drooling of saliva and presenting in a 'tripod' position: leaning forward and extending their neck in a seated position to maximise airway opening.",
"id": "10005401",
"label": "a",
"name": "Acute Epiglottitis",
"picture": null,
"votes": 318
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Subglottic stenosis can be defined as the narrowing of the upper airway, which lies between the vocal folds and the lower border of the cricoid cartilage. It can be congenital or acquired. In congenital subglottic stenosis, symptoms usually appear shortly after birth. The main symptoms are biphasic stridor, dyspnoea, air hunger, and suprasternal, intercostal, and diaphragmatic retractions. Abnormal cry, aphonia, or hoarseness occur when the vocal cords are affected. In acquired subglottic stenosis, there is a history of laryngeal insult often by trauma, and symptoms usually occur three to four weeks after the insult.",
"id": "10005404",
"label": "d",
"name": "Subglottic stenosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a condition which can present at any age. It is an acute swelling of the upper airway that may cause dyspnoea and stridor. Fever is uncommon though. Swelling of the face, tongue, or pharynx are often also present.",
"id": "10005405",
"label": "e",
"name": "Angioneurotic oedema",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may present with sudden onset dyspnoea and stridor but there is usually a clear history of foreign body inhalation or ingestion and no prodrome or symptoms of viral illness as well as no fever (unless secondary infection).",
"id": "10005403",
"label": "c",
"name": "Foreign body obstruction",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Croup should be suspected in a child with a sudden onset of a seal-like barking cough. Hoarse voice is also common. Symptoms are typically worse at night and increase with agitation.",
"id": "10005402",
"label": "b",
"name": "Croup (Laryngotracheobronchitis)",
"picture": null,
"votes": 46
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4399",
"name": "Acute Epiglottitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
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"question": "An unvaccinated two-year-old toddler presents to the paediatric assessment unit with his mother following a referral from his GP. He is in obvious distress and presents with a fever of 40.5 degrees, as well as soft stridor. His mother says that, over that last few hours, he has been unusually drooling a lot and resting in a tripod position.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 372,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,149 | false | 33 | null | 6,495,076 | null | false | [] | null | 13,628 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This virus can cause bronchiolitis but less often so than RSV.",
"id": "10005408",
"label": "c",
"name": "Adenovirus",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Respiratory syncytial virus (RSV) is responsible for 80% of cases of bronchiolitis.",
"id": "10005406",
"label": "a",
"name": "Respiratory syncytial virus (RSV)",
"picture": null,
"votes": 314
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This bacterial pathogen causes whooping cough, not bronchiolitis.",
"id": "10005410",
"label": "e",
"name": "Bordetella pertussis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This virus can cause bronchiolitis but less often so than RSV.",
"id": "10005407",
"label": "b",
"name": "Bocavirus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This virus can cause bronchiolitis but less often so than RSV. It is the most common cause of croup, however.",
"id": "10005409",
"label": "d",
"name": "Parainfluenza virus",
"picture": null,
"votes": 33
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4400",
"name": "Bronchiolitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
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"question": "A six-month-old child with suspected bronchiolitis is reviewed on the ward round in the paediatric ward.\n\nWhich one of the following is the most likely pathogen causing this disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 379,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,150 | false | 34 | null | 6,495,076 | null | false | [] | null | 13,629 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an antibiotic. Parainfluenza virus (among other viruses) is the primary cause accounting for the vast majority of cases of croup. As such, antibiotics are not indicated in the management of croup at this stage.",
"id": "10005414",
"label": "d",
"name": "Amoxicillin",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a short-acting beta-agonist often used in the treatment of asthma and bronchospasm. It is not indicated in the management of croup at this stage.",
"id": "10005413",
"label": "c",
"name": "Salbutamol",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is croup. NICE guideline on the management of croup states to administer a dose of oral dexamethasone (0.15 mg/kg) either while awaiting admission to hospital or if hospital admission is not indicated in mild disease.",
"id": "10005411",
"label": "a",
"name": "Dexamethasone",
"picture": null,
"votes": 235
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be indicated where are there significant concerns about the airway of a child, certainly not in this case if they are speaking comfortably.",
"id": "10005415",
"label": "e",
"name": "Nebulised adrenaline",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prednisolone is a steroid drug. However, regarding anti‐inflammatory potential, dexamethasone is five to six times more potent than prednisolone. Therefore, it is preferred in treatment of croup. In addition, dexamethasone is a long-acting drug whereas prednisolone is intermediate-acting.",
"id": "10005412",
"label": "b",
"name": "Prednisolone",
"picture": null,
"votes": 45
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4401",
"name": "Croup",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"id": "13629",
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"question": "A two-year-old infant presents to the GP with her father. He reports his daughter has had a persistent barking cough over the last five days. On examination, there is an easily audible stridor and sternal wall retraction at rest, but she appears in no distress or agitation. She is interested in the stethoscope you gave her to play with and is able to speak back to you.\n\nWhich of the following is the next best step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 376,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,151 | false | 35 | null | 6,495,076 | null | false | [] | null | 13,630 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Mesenteric adenitis describes inflamed mesenteric lymph nodes. It is often preceded by a previous upper respiratory tract infection as in this case. Its' presentation is described typically here too with low-grade fever and generalised abdominal tenderness.",
"id": "10005416",
"label": "a",
"name": "Mesenteric adenitis",
"picture": null,
"votes": 186
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Classically, acute appendicitis presents as progressive peri-umbilical pain that moves to the right iliac fossa, and not as generalised tenderness. Nausea and one to two episodes of vomiting are also common, and not present in this case.",
"id": "10005418",
"label": "c",
"name": "Acute appendicitis",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Meckel's would present similarly to appendicitis with severe pain and most commonly affects children aged approximately two years old. It can also present as painless rectal bleeding.",
"id": "10005419",
"label": "d",
"name": "Meckel's diverticulum",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intussusception usually affects infants between 6-18 months old. It features intermittent, severe, crampy, progressive abdominal pain. There will also most likely be a palpable mass, often described as \"sausage-shaped\".",
"id": "10005420",
"label": "e",
"name": "Intussusception",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "He is not vomiting or had a change in bowel habit, which would be expected in gastroenteritis.",
"id": "10005417",
"label": "b",
"name": "Gastroenteritis",
"picture": null,
"votes": 103
}
],
"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": "4402",
"name": "Mesenteric adenitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4402,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13630",
"isLikedByMe": null,
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"question": "An eight-year-old boy attends the GP surgery with abdominal pain for the last six days. He is eating and drinking normally. He has no urinary symptoms and no change in bowel habit. He had experienced some upper respiratory symptoms one week ago which the advanced nurse practitioner thought was viral, but these have since subsided. Aside from this, he is generally a fit and well child with no past medical history. On examination, the abdomen is soft but mildly tender throughout. His temperature is 37.5 degrees. His chest is clear and heart sounds are normal.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 369,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,152 | false | 36 | null | 6,495,076 | null | false | [] | null | 13,631 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a rare condition, which typically presents as bilious vomiting within the first day of life.",
"id": "10005424",
"label": "d",
"name": "Malrotation",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pyloric stenosis is a condition resulting from the hypertrophy of the pyloric sphincter. It typically occurs in babies aged 6-8 weeks old. The classic presentation is of projectile vomiting as in this case. The palpable mass, often described as a smooth olive-sized mass, is the hypertrophic pyloric sphincter.",
"id": "10005421",
"label": "a",
"name": "Pyloric stenosis",
"picture": null,
"votes": 291
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gastro-oesophageal reflux affects up to 40% of children during the first 6 months of life. It can present as vomit after feeds, but is not normally projectile. There is often associated crying/irritability, arching of the back or drawing up of the knees into the chest.",
"id": "10005422",
"label": "b",
"name": "Gastro-oesophageal reflux disease",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intussusception usually affects infants between 6-18 months old. It features intermittent, severe, crampy, progressive abdominal pain. There might be a palpable mass, but the key presenting feature is usually bloody stools.",
"id": "10005425",
"label": "e",
"name": "Intussusception",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Volvulus presents with bilious vomiting, abdominal pain (if old enough to complain of) and somnolence.",
"id": "10005423",
"label": "c",
"name": "Volvulus",
"picture": null,
"votes": 27
}
],
"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": "4403",
"name": "Pyloric stenosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
"conceptId": 4403,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
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"question": "An eight-week-old baby is visited by the health visitor with projectile vomiting after feeds for the last few days. The vomit is profuse but not green and occurs within minutes of a feed. The baby remains otherwise well and still appears to have an appetite. On examination, there is a palpable mass in the upper abdomen.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 368,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,153 | false | 37 | null | 6,495,076 | null | false | [] | null | 13,632 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate prescription for a non-pregnant person with a penicillin allergy with these symptoms and signs.",
"id": "10005428",
"label": "c",
"name": "Clarithromycin",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a treatment when candidal pharyngitis is suspected in more widespread areas.",
"id": "10005429",
"label": "d",
"name": "Fluconazole",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an appropriate action that can be taken by the ENT specialists in secondary care when there is evidence of peri-tonsillar abscess, parapharyngeal abscess or retropharyngeal abscess.",
"id": "10005427",
"label": "b",
"name": "Aspiration of exudate",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a Centor score of 4 for his fever, absent cough, lymphadenopathy and tonsillar exudate. According to the NICE guidelines on acute sore throats, those with a Centor score of 3 or 4 should be prescribed phenoxymethylpenicillin first-line.",
"id": "10005426",
"label": "a",
"name": "Phenoxymethylpenicillin",
"picture": null,
"votes": 260
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate if the Centor score was less than 3.",
"id": "10005430",
"label": "e",
"name": "Supportive care",
"picture": null,
"votes": 66
}
],
"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": "4404",
"name": "Acute Tonsillitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4404,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13632",
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"question": "An 18-year-old university student attends his GP. He complains he has had a sore throat for the past six days. He denies having a cough, but does report a fever yesterday. On examination, his right tonsil appears to have exudate on its surface and tender cervical lymphadenopathy is noted. He is otherwise well and currently apyrexial. He denies having any allergies.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 373,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,154 | false | 38 | null | 6,495,076 | null | false | [] | null | 13,633 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "For people who are allergic to, or intolerant of, penicillin, it would be appropriate to prescribe a five to seven-day course of clarithromycin.",
"id": "10005432",
"label": "b",
"name": "Oral Clarithromycin",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a self-care measure for symptom relief and prevention of recurrent infection in otitis externa.",
"id": "10005435",
"label": "e",
"name": "Acetic acid 2% ear drops",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Regular doses of paracetamol or ibuprofen are advised for pain but provided this patient is systemically unwell, antibiotics are most appropriate to prevent progression to sepsis.",
"id": "10005433",
"label": "c",
"name": "Simple analgesia",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is otitis media. NICE guidance states that for people who do not require admission to hospital but are systemically very unwell as in this case, offer an immediate antibiotic prescription and if an antibiotic is required, prescribe a five to seven-day course of amoxicillin.",
"id": "10005431",
"label": "a",
"name": "Oral amoxicillin",
"picture": null,
"votes": 214
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not advised when there is tympanic perforation.",
"id": "10005434",
"label": "d",
"name": "Ear irrigation",
"picture": null,
"votes": 12
}
],
"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": "4405",
"name": "Otitis Media",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4405,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13633",
"isLikedByMe": null,
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"question": "A four-year-old boy is taken to the emergency department by his mother with a 72-hour history of left ear pain. His mother reports that his left ear started to leak some purulent material this morning. He has no significant past medical history and no allergies. On examination, the external ear did not appear erythematous and the discharge was not obvious from external inspection. He had a pulse rate of 130bpm and a temperature of 38.5 degrees. Otoscopy revealed a red tympanic membrane with a perforation and white purulent discharge in the external auditory canal.\n\nWhich of the following is the most appropriate management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 359,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,155 | false | 39 | null | 6,495,076 | null | false | [] | null | 13,634 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis here is otitis externa. Mild to moderate otitis externa as in this case can be treated with topical drops including combined antibiotic/steroid drops (e.g. Gentamix), acetic acid and other preparations. It is vital that the patient is advised to keep the ear dry for the next 7-10 days too.",
"id": "10005436",
"label": "a",
"name": "Combined topical antibiotic and steroid drops",
"picture": null,
"votes": 139
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Analgesia, ear irrigation and dry swabbing of secretions should be advised but they will not directly treat the infections per se and are therefore not as appropriate as combined topical antibiotic and steroid drops.",
"id": "10005439",
"label": "d",
"name": "Supportive care",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chloramphenicol ear drops are rarely used in practice.",
"id": "10005440",
"label": "e",
"name": "Topical chloramphenicol",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral antibiotics would be considered when there is cellulitis extending beyond the external ear canal, when the ear canal is occluded by swelling and debris and a wick cannot be inserted, or in people with diabetes or compromised immunity. It is also recommended in cases of severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa.",
"id": "10005438",
"label": "c",
"name": "Oral amoxicillin",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral antibiotics would be considered when there is cellulitis extending beyond the external ear canal, when the ear canal is occluded by swelling and debris and a wick cannot be inserted, or in people with diabetes or compromised immunity. It is also recommended in cases of severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa.",
"id": "10005437",
"label": "b",
"name": "Oral ciprofloxacin",
"picture": null,
"votes": 9
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4406",
"name": "Otitis externa",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
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"question": "A 28-year-old woman with no significant past medical history presents with two days of right ear discomfort and discharge. Her observations are normal and she has not had a recent viral illness. On examination, the auditory canal appears erythematous and there is a small amount of debris present, but you can still see the tympanic membrane intact.\n\nWhich of the following is the most appropriate management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 355,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,156 | false | 40 | null | 6,495,076 | null | false | [] | null | 13,635 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is another cause of painless visual loss, but involves the cornea and typically presents with blurred vision first thing in the morning when a patient wakes up.",
"id": "10005443",
"label": "c",
"name": "Fuch's endothelial dystrophy",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of dry age-related macular degeneration. Symptoms typically include reduced visual acuity, worse with near vision, variability in visual disturbance from day to day, poor vision at night, photopsia (perceived flickering of lights), and glare. Drusen is seen in dry ARMD as yellow pigmented spots on the retina that are collected around the macula.",
"id": "10005441",
"label": "a",
"name": "Age-related macular degeneration (ARMD)",
"picture": null,
"votes": 321
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a potential cause of painless visual loss, but drusen would not be seen on fundoscopy.",
"id": "10005442",
"label": "b",
"name": "Refractive error",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is another cause of painless visual loss but usually presents with complaints of photopsia and floaters.",
"id": "10005445",
"label": "e",
"name": "Vitreous haemorrhage",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is another cause of painless visual loss but usually patients have no visual symptoms at presentation and glaucoma is mostly diagnosed through screening tests. Fundoscopic/slit-lamp assessment of patients with open-angle glaucoma may reveal a pale optic disc (indicating optic nerve atrophy), optic disc cupping (a cup:disc ratio of >0.7), or retinal vessel 'bayonetting' (when vessels appear to have a break as they enter the deep cup and then reappear at the base).",
"id": "10005444",
"label": "d",
"name": "Primary open-angle glaucoma",
"picture": null,
"votes": 21
}
],
"comments": [],
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"demo": null,
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"id": "4407",
"name": "Age-related macular degeneration",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
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"question": "A 78-year-old female smoker attends her optician with gradually worsening painless visual loss, especially for near objects. She also reports that her vision in dim light is especially worse. The optician performs fundoscopy, which reveals the presence of drusen.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 355,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,157 | false | 41 | null | 6,495,076 | null | false | [] | null | 13,636 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anterior uveitis is inflammation of the anterior uvea, comprising the iris and/or ciliary body. Symptoms are typically a painful red eye that worsens over several days, photophobia, blurred vision\nand headache. It would not cause a fixed dilated pupil.",
"id": "10005448",
"label": "c",
"name": "Anterior uveitis",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Posterior uveitis is inflammation of the choroid and/or retina. Symptoms are classically blurred vision, progressive vision loss and flashes or floaters. It would not cause a fixed dilated pupil.",
"id": "10005449",
"label": "d",
"name": "Posterior uveitis",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic description of a case of closed-angle glaucoma. Patients typically present systemically unwell with nausea and headaches. In some, but not all, there is severe ocular pain associated with blurred vision and halos around lights. The pupil is typically in a fixed-dilated position. Primary closed-angle glaucoma is an emergency. Patients must be referred to ophthalmology immediately to prevent the progression of visual loss.",
"id": "10005446",
"label": "a",
"name": "Primary closed-angle glaucoma",
"picture": null,
"votes": 218
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Classically, a migraine is a unilateral throbbing headache preceded by an aura, such as visual (eg. lines, zigzags) or sensory (paraesthesia spreading from fingers to face) symptoms. The headache is associated with photophobia and phonophobia often and there may be identifiable triggers such as oral contraceptives or chocolate.",
"id": "10005450",
"label": "e",
"name": "Migraine",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cluster headache is a unilateral headache that is typically worse around the eye and can cause excessive tearing. It does not typically cause nausea or dilation of the pupil though.",
"id": "10005447",
"label": "b",
"name": "Cluster headache",
"picture": null,
"votes": 35
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4408",
"name": "Primary closed-angle glaucoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
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},
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"question": "A 50-year-old man presents to the emergency department with sudden onset severe headache. He describes the pain, which is on his left side, as behind his eye. He also reports a slight loss of vision in this eye and says it has been tearing an unusually large amount. On inspection of the left eye, there is significant conjunctival haemorrhage and the cornea looks hazy. Pupillary light reflexes on the right are normal; however, the left pupil is non-reactive and fixed-dilated.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 356,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,158 | false | 42 | null | 6,495,076 | null | false | [] | null | 13,637 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Usually, patients have no visual symptoms at presentation with open-angle glaucoma, and it is mostly diagnosed through screening tests. A small proportion of patients may notice peripheral vision loss.",
"id": "10005453",
"label": "c",
"name": "Primary open-angle glaucoma",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Retinitis pigmentosa is a rare inherited condition causing retinal degeneration. Patients often present at a young age with 'tunnel vision' due to damage to the peripheral retina from pigment deposits.",
"id": "10005455",
"label": "e",
"name": "Retinitis pigmentosa",
"picture": null,
"votes": 100
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A cataract refers to an opacity in the lens due to denatured protein. Presenting symptoms vary according to the type of cataract, but the most common at presentation are painless loss of vision, difficulty reading/watching television, difficulty recognising faces, faded colour vision as well as haloes and glare around lights, particularly at night. Steroids are a specific risk factor for subcapsular cataracts.",
"id": "10005451",
"label": "a",
"name": "Subcapsular cataract",
"picture": null,
"votes": 164
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can also present with glare. However, other symptoms that are typically reported include photopsia (perceived flickering of lights) and variability in visual disturbance from day to day.",
"id": "10005452",
"label": "b",
"name": "Age-related macular degeneration (ARMD)",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be very unusual to occur in someone with no past medical history of diabetes.",
"id": "10005454",
"label": "d",
"name": "Diabetic retinopathy",
"picture": null,
"votes": 12
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4409",
"name": "Ocular side effects of steroids",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4409,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "A 50-year-old woman attends her optician complaining of gradual onset noticeable fading of her colour vision as well as glare from headlights when driving in the dark. She says her symptoms do not change day to day and are getting gradually worse. She has a past medical history of polymyalgia rheumatica for which she has been using long-term prednisolone to treat. Her pupils are dilated and ophthalmoscopy is undertaken which reveals a normal fundus and optic nerve.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 354,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,159 | false | 43 | null | 6,495,076 | null | false | [] | null | 13,638 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pioglitazone has not been found to impair kidney function so can be continued in acute kidney injury. Metformin is the main diabetic drug that would need to be stopped.",
"id": "10005458",
"label": "c",
"name": "Pioglitazone",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thiamine has not been found to impair kidney function so can be continued in acute kidney injury.",
"id": "10005459",
"label": "d",
"name": "Thiamine",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sitagliptin has not been found to impair kidney function so can be continued in acute kidney injury. Metformin is the main diabetic drug that would need to be stopped.",
"id": "10005457",
"label": "b",
"name": "Sitagliptin",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "By definition, this woman has an acute kidney injury (AKI) stage 1. Ibuprofen is an NSAID drug which is nephrotoxic and should be stopped in AKI.",
"id": "10005456",
"label": "a",
"name": "Ibuprofen",
"picture": null,
"votes": 250
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amoxicillin has not been found to impair kidney function so can be continued in acute kidney injury.",
"id": "10005460",
"label": "e",
"name": "Amoxicillin",
"picture": null,
"votes": 27
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3752",
"name": "Acute Kidney Injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3752,
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"difficulty": 1,
"dislikes": 0,
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"question": "A 79-year-old woman is admitted to the geriatric ward for treatment of pneumonia. After 36 hours of admission, her bloods reveal a rise in her serum creatinine of 29 μmol/L (60-120 μmol/L).\n\nWhich of her following medications should be stopped?",
"sbaAnswer": [
"a"
],
"totalVotes": 367,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,160 | false | 44 | null | 6,495,076 | null | false | [] | null | 13,639 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE guidelines say a sample should be sent for urine culture in all women with suspected lower urinary tract infections who are older than 65 years.",
"id": "10005461",
"label": "a",
"name": "Urine culture",
"picture": null,
"votes": 272
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an investigation carried out in those with diabetes, chronic kidney disease and certain patients with proteinuria on a dipstick.",
"id": "10005462",
"label": "b",
"name": "Urine protein to creatinine ratio",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an endoscopy which visualises the urethra, certain areas of the prostate and the bladder. It is not indicated in suspected lower urinary tract infections.",
"id": "10005465",
"label": "e",
"name": "Cystoscopy",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The primary indications for this scan are suspected urolithiasis and flank pain.",
"id": "10005464",
"label": "d",
"name": "CT kidneys, ureter, bladder",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a scan often used to investigate suspected ureteral obstruction and/or hydronephrosis, urinary retention, and in the placement of Foley catheters in certain situations.",
"id": "10005463",
"label": "c",
"name": "USS renal tract",
"picture": null,
"votes": 16
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3757",
"name": "Urinary Tract Infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"userNote": null,
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"question": "A 66-year-old female presents to the GP complaining of a two-day history of dysuria and foul-smelling urine. She is systemically otherwise well. Her urine dip reveals leucocytes +++ and nitrites ++ with a trace of blood.\n\nWhich of the following is the next best investigation for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 353,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,161 | false | 45 | null | 6,495,076 | null | false | [] | null | 13,640 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test is not as specific or sensitive as creatine kinase for diagnosing rhabdomyloysis.",
"id": "10005468",
"label": "c",
"name": "Full blood count",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test is not as specific or sensitive as creatine kinase for diagnosing rhabdomyloysis.",
"id": "10005469",
"label": "d",
"name": "C-reactive protein (CRP)",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Rhabdomyolysis is caused by skeletal muscle breakdown. Creatine kinase is the most reliable indicator of muscle damage. A five-fold rise from the upper limit of the reference range suggests rhabdomyolysis although the levels are often much higher.",
"id": "10005466",
"label": "a",
"name": "Creatine kinase",
"picture": null,
"votes": 276
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test is not as specific or sensitive as creatine kinase for diagnosing rhabdomyloysis.",
"id": "10005467",
"label": "b",
"name": "Liver function tests",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test is not as specific or sensitive as creatine kinase for diagnosing rhabdomyloysis. It may reveal a metabolic acidosis if rhabdomyolysis is present.",
"id": "10005470",
"label": "e",
"name": "Venous blood gas",
"picture": null,
"votes": 13
}
],
"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": "4410",
"name": "Rhabdomyolysis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
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"question": "An 88-year-old female is brought to the emergency department after falling at home. On taking a history from the patient, you learn that she was lying on the floor for more than 24 hours before she was attended to by the ambulance service. She has no history of chronic kidney disease. She is however found to have an acute kidney injury (AKI) as a result of suspected rhabdomyolysis. Her urea and electrolytes are normal, apart from a mild hyponatraemia at 130mmol/L and elevated creatinine at 105μmol/L (normal range 60-120 μmol/L).\n\nWhich of the following serum investigation is the most appropriate to diagnose the cause of her AKI?",
"sbaAnswer": [
"a"
],
"totalVotes": 353,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,162 | false | 46 | null | 6,495,076 | null | false | [] | null | 13,641 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "PSGN is a type of glomerular nephritis that occurs one to two weeks after a streptococcal throat infection or two to six weeks after a streptococcal skin infection.",
"id": "10005472",
"label": "b",
"name": "Post streptococcal glomerulonephritis (PSGN)",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Minimal change can be associated with a viral upper respiratory tract infection in the preceding weeks. Patients suffering from minimal change disease typically present with oedema, including facial swelling and frothy urine.",
"id": "10005473",
"label": "c",
"name": "Minimal change disease",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alport's does often present in childhood. It usually presents with microscopic haematuria though alongside bilateral sensorineural hearing loss and/or retinitis pigmentosa.",
"id": "10005474",
"label": "d",
"name": "Alport's Syndrome",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rhabdomyolysis typically occurs with a history of a long-lie or seizure. Patients often complain of dark brown-coloured urine (often described as \"tea-coloured\") rather than blood in their urine.",
"id": "10005475",
"label": "e",
"name": "Rhabdomyolysis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Typically patients with IgA nephropathy present with recurrent visible or microscopic haematuria following an upper respiratory tract infection (usually 12-72 hours later) as in this case.",
"id": "10005471",
"label": "a",
"name": "IgA nephropathy",
"picture": null,
"votes": 225
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4411",
"name": "IgA nephropathy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"userChapter": null,
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},
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"difficulty": 1,
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"id": "13641",
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"question": "A nine-year-old boy presents to the GP with his father. He reports blood in his urine over the last two days. He denies dysuria, frequency or urgency. He was last at the GP just three days ago complaining of cough and coryza, which was thought to be viral in origin. A urine dipstick reveals blood +++ only.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 347,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,163 | false | 47 | null | 6,495,076 | null | false | [] | null | 13,642 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Nephrotic syndrome is a triad of proteinuria (> 3g/24hr) causing hypoalbuminaemia (< 30g/L) and oedema. These are all likely to be present here and this man has diabetes making diabetic nephropathy a highly likely cause of his syndrome.",
"id": "10005476",
"label": "a",
"name": "Diabetic nephropathy",
"picture": null,
"votes": 262
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgA nephropathy is a type of nephritic syndrome. Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine. Haematuria and oliguria are not mentioned here and this man's blood pressure is not significantly raised making this a less likely diagnosis. He more likely has a nephrotic syndrome, of which diabetic nephropathy is the only choice.",
"id": "10005480",
"label": "e",
"name": "IgA nephropathy",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Post-streptococcal glomerulonephritis is a type of nephritic syndrome. Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine. Haematuria and oliguria are not mentioned here and this man's blood pressure is not significantly raised making this a less likely diagnosis. He more likely has a nephrotic syndrome, of which diabetic nephropathy is the only choice.",
"id": "10005477",
"label": "b",
"name": "Post-streptococcal glomerulonephritis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alport's syndrome is a type of nephritic syndrome. Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine. Haematuria and oliguria are not mentioned here and this man's blood pressure is not significantly raised making this a less likely diagnosis. He more likely has a nephrotic syndrome, of which diabetic nephropathy is the only choice.",
"id": "10005479",
"label": "d",
"name": "Alports syndrome",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rapidly progressive glomerulonephritis is a type of nephritic syndrome. Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine. Haematuria and oliguria are not mentioned here and this man's blood pressure is not significantly raised making this a less likely diagnosis. He more likely has a nephrotic syndrome, of which diabetic nephropathy is the only choice.",
"id": "10005478",
"label": "c",
"name": "Rapidly progressive glomerulonephritis",
"picture": null,
"votes": 40
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4060",
"name": "Nephrotic Syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"userChapter": null,
"userNote": null,
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},
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"difficulty": 1,
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"explanation": null,
"highlights": [],
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"question": "A 47-year-old male attends the acute medical unit following a referral from his GP. He presents with complaints of bilateral generalised oedema of his legs and foamy urine. He has a past medical history significant for T2DM. His BP is 145/98mmHg and his urine dip reveals +++ protein. His biochemistry results are all normal apart from low albumin levels.\n\nWhich of the following is the most likely underlying cause?",
"sbaAnswer": [
"a"
],
"totalVotes": 344,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,164 | false | 48 | null | 6,495,076 | null | false | [] | null | 13,643 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine. Numerous of these are present here making a nephritic syndrome the most likely condition. Due to the rapid onset, rapidly progressive glomerulonephritis is a good differential. It is also the only nephritic syndrome in the answer set- the rest are examples of nephrotic syndrome.",
"id": "10005481",
"label": "a",
"name": "Rapidly progressive glomerulonephritis",
"picture": null,
"votes": 133
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Minimal change disease is an example of a nephrotic syndrome. Nephrotic syndrome is a triad of proteinuria (> 3g/24hr) causing hypoalbuminaemia (< 30g/L) and oedema. Despite proteinuria being present, oedema is not mentioned and there is no albumin result making this a less likely diagnosis. This woman is more likely to have a nephritic syndrome, of which rapidly progressive glomerulonephritis is the most likely cause.",
"id": "10005482",
"label": "b",
"name": "Minimal change disease",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Membranous glomerulonephritis is an example of a nephrotic syndrome. Nephrotic syndrome is a triad of proteinuria (> 3g/24hr) causing hypoalbuminaemia (< 30g/L) and oedema. Despite proteinuria being present, oedema is not mentioned and there is no albumin result making this a less likely diagnosis. This woman is more likely to have a nephritic syndrome, of which rapidly progressive glomerulonephritis is the most likely cause.",
"id": "10005485",
"label": "e",
"name": "Membranous glomerulonephritis",
"picture": null,
"votes": 94
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amyloidosis is an example of a nephrotic syndrome. Nephrotic syndrome is a triad of proteinuria (> 3g/24hr) causing hypoalbuminaemia (< 30g/L) and oedema. Despite proteinuria being present, oedema is not mentioned and there is no albumin result making this a less likely diagnosis. This woman is more likely to have a nephritic syndrome, of which rapidly progressive glomerulonephritis is the most likely cause.",
"id": "10005483",
"label": "c",
"name": "Amyloidosis",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "FSGS is an example of a nephrotic syndrome. Nephrotic syndrome is a triad of proteinuria (> 3g/24hr) causing hypoalbuminaemia (< 30g/L) and oedema. Despite proteinuria being present, oedema is not mentioned and there is no albumin result making this a less likely diagnosis. This woman is more likely to have a nephritic syndrome, of which rapidly progressive glomerulonephritis is the most likely cause.",
"id": "10005484",
"label": "d",
"name": "Focal segmental glomerulosclerosis (FSGS)",
"picture": null,
"votes": 72
}
],
"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": "4412",
"name": "Nephritic syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
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"question": "A 68-year-old female attends the practice nurse for her annual review of her systemic lupus erythematous. On examination, it is found that her blood pressure is 195/97mmHg. On further questionning, she reveals that she has also been bothered with blood in her urine the last few days as well as feeling significantly fatigued. Urine dipstick reveals blood +++ and protein ++.\n\nWhich of the following is the most likely condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 341,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,165 | false | 49 | null | 6,495,076 | null | false | [] | null | 13,644 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This accounts for around 5-10% of renal stones and is radio-lucent.",
"id": "10005488",
"label": "c",
"name": "Uric acid",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common type of renal stone and has an opaque radiographic appearance.",
"id": "10005487",
"label": "b",
"name": "Calcium oxalate",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a rare type of stone accounting for just 1% and is semi-opaque with a 'ground-glass' radiographic appearance.",
"id": "10005490",
"label": "e",
"name": "Cystine",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Staghorn calculi involve the renal pelvis and extend into at least two calyces. They develop in alkaline urine as in this case and are composed of struvite (ammonium magnesium phosphate, triple phosphate). Ureaplasma urealyticum and Proteus infections predispose to their formation.",
"id": "10005486",
"label": "a",
"name": "Struvite",
"picture": null,
"votes": 208
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This accounts for 10% of renal stones and has an opaque radiographic appearance.",
"id": "10005489",
"label": "d",
"name": "Calcium phosphate",
"picture": null,
"votes": 32
}
],
"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": "4413",
"name": "Renal Stones",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
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},
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"question": "A 40-year-old woman with episodes of recurrent Proteus mirabilis urinary tract sepsis presents with a suspected staghorn calculus of her right kidney. Her urinary pH is 7.2. An x-ray of the kidneys, ureter and bladder shows branching calcific densities overlying the renal outline in keeping with a staghorn calculus.\n\nWhich of the following is the most likely type of stone?",
"sbaAnswer": [
"a"
],
"totalVotes": 342,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,166 | false | 50 | null | 6,495,076 | null | false | [] | null | 13,645 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of acute urinary retention, but less common than BPH.",
"id": "10005493",
"label": "c",
"name": "Urethral stricture",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of acute urinary retention, most typically in those with high anticholinergic activity, but is less common than BPH.",
"id": "10005494",
"label": "d",
"name": "Medication",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient presents with classic acute urinary retention. BPH accounts for up to 80% of acute urinary retention and up to one-third of patients undergoing surgical treatment for BPH present with acute urinary retention. The immediate treatment is bladder decompression using urethral or suprapubic catheterisation.",
"id": "10005491",
"label": "a",
"name": "Benign prostatic hypertrophy (BPH)",
"picture": null,
"votes": 250
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of acute urinary retention, but less common than BPH.",
"id": "10005495",
"label": "e",
"name": "Detrusor muscle dysfunction",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a cause of acute urinary retention, but less common than BPH. It is less common because BPH is more likely to affect the central part of the prostate (where the urethra passes through) whereas prostate cancer is more likely to affect the peripheral zone.",
"id": "10005492",
"label": "b",
"name": "Prostate cancer",
"picture": null,
"votes": 17
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4414",
"name": "Acute Urinary Retention",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
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"question": "A 78-year-old male presents to the emergency department with a 24-hour history of inability to pass urine and significant suprapubic pain. On examination, he has a palpably distended bladder, with suprapubic tenderness. A catheter is inserted and 800mls is drained from his bladder.\n\nWhich of the following is the most common cause of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 347,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,462,197 | false | 1 | null | 6,495,079 | null | false | [] | null | 13,646 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the level of the transition between the lumbar and sacral spine. Although the risk to the spinal cord is the same as for L2,3,4, it is more challenging to identify the anatomical landmarks needed to safely insert the needle at this level.",
"id": "10005499",
"label": "d",
"name": "L5-S1",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the level of the aortic arch on the left and the superior vena cava on the right. Epidural anaesthesia at this level will risk damaging the spinal cord.",
"id": "10005497",
"label": "b",
"name": "T4-T5",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the level of the umbilicus. Injection into this site will risk damage to the spinal cord.",
"id": "10005498",
"label": "c",
"name": "T10-T11",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the base of the neck. Injection here would not target the correct nerve roots and would risk damage to the spinal cord.",
"id": "10005500",
"label": "e",
"name": "C6-C7",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Epidural is safer anywhere below L2, with L2-L3 or L3-L4 preferred. This will target the lumbar nerve roots involved in the pain sensation associated with childbirth.",
"id": "10005496",
"label": "a",
"name": "L3-L4",
"picture": null,
"votes": 163
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4415",
"name": "Epidural anaesthesia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "177",
"name": "Anaesthetics and Intensive Care Medicine",
"typeId": 7
},
"topicId": 177,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4415,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "13646",
"isLikedByMe": null,
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"likes": 0,
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"question": "A pregnant woman is asking you about the analgesic options available for delivery and wants to know what is involved in an epidural.\n\nWhich of the following is the best site to administer an epidural injection?",
"sbaAnswer": [
"a"
],
"totalVotes": 216,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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