id
int64 173M
173M
| flagged
bool 1
class | index
int64 1
98
| questionChoiceId
null | marksheetId
int64 6.49M
6.5M
| timeTaken
null | isAnswered
bool 1
class | striked
sequencelengths 0
0
| mark
null | questionId
int64 264
22.8k
| question
dict | __typename
stringclasses 1
value |
|---|---|---|---|---|---|---|---|---|---|---|---|
173,465,464 | false | 20 | null | 6,495,184 | null | false | [] | null | 17,463 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. An assessment of joint position tests proprioception, transmitted in the dorsal column pathway. Signals from peripheral sensory receptors in the upper limbs (T6 and above), including from the thumb travel to the fasciculus cuneatus in the medulla, where the first-order and second-order neurons synapse. Eventually, the second-order neurons synapse at the thalamus and proprioception signals are transmitted to the post-central gyrus.",
"id": "10025325",
"label": "a",
"name": "Fasciculus cuneatus",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An assessment of joint position tests proprioception, transmitted in the dorsal column pathway. The spinal lemniscus transmits signals in the spinothalamic pathway to the thalamus. In the dorsal column pathway, proprioceptive signals from the upper limbs (T6 and above), including from the thumb travel to the fasciculus cuneatus in the medulla, where the first-order and second-order neurons synapse. Eventually, the second-order neurons synapse at the thalamus and proprioception signals are transmitted to the post-central gyrus.",
"id": "10025328",
"label": "d",
"name": "Spinal lemniscus",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An assessment of joint position tests proprioception, transmitted in the dorsal column pathway. The nucleus proprius is where the first-order and second-order neurons synapse in the spinothalamic pathway. In the dorsal column pathway, proprioceptive signals from the upper limbs (T6 and above), including from the thumb travel to the fasciculus cuneatus in the medulla, where the first-order and second-order neurons synapse. Eventually, the second-order neurons synapse at the thalamus and proprioception signals are transmitted to the post-central gyrus.",
"id": "10025327",
"label": "c",
"name": "Nucleus proprius",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An assessment of joint position tests proprioception, transmitted in the dorsal column pathway. The arcuate fasciculus is a white matter bundle that connects the temporal and inferior parietal lobe to locations in the frontal lobe. One of the key roles is connecting Broca's and Wernicke's areas involved in the comprehension of language and production of speech. It is not related to the dorsal column pathway. In the dorsal column pathway, proprioceptive signals from the upper limbs (T6 and above), including from the thumb travel to the fasciculus cuneatus in the medulla, where the first-order and second-order neurons synapse. Eventually, the second-order neurons synapse at the thalamus and proprioception signals are transmitted to the post-central gyrus.",
"id": "10025329",
"label": "e",
"name": "Arcuate fasciculus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An assessment of joint position tests proprioception, transmitted in the dorsal column pathway. Although fasciculus gracilis is one of the anatomical structures in the dorsal column pathway, it only transmits signals from the lower limbs (below T6). Signals from the upper limbs (T6 and above), including from the thumb travel to the fasciculus cuneatus in the medulla, where the first-order and second-order neurons synapse. Eventually, the second-order neurons synapse at the thalamus and proprioception signals are transmitted to the post-central gyrus.",
"id": "10025326",
"label": "b",
"name": "Fasciculus gracilis",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5831",
"name": "Dorsal columns",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5831,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17463",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old female patient presents to the orthopaedic clinic with complaints of pain and stiffness in her right thumb. On examination, the clinician assesses the patient's awareness of joint position using the right thumb.\n\nWhich of the following anatomical structures receives proprioceptive information from the right thumb?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,465 | false | 21 | null | 6,495,184 | null | false | [] | null | 17,464 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Cushing's syndrome. Nelson syndrome is a condition that can occur in patients with a history of Cushing's disease (typically due to a pituitary adenoma) who have undergone bilateral adrenalectomy as part of their treatment. After adrenalectomy, cortisol production ceases, and ACTH levels rise as the body attempts to stimulate the remaining pituitary tumour cells. As a result, the pituitary tumour can grow, leading to the characteristic features seen in Nelson syndrome: including weight gain, skin hyperpigmentation, menstrual irregularities, and other symptoms. This patient has had no previous surgeries, ruling out this option.",
"id": "10025334",
"label": "e",
"name": "Nelson syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This patient has Cushing's syndrome. The most common cause of Cushing's syndrome is the long-term, high-dose use of glucocorticoids. Given the patient's history of inflammatory bowel disease, she may have been prescribed corticosteroids as part of her treatment, contributing to the development of Cushing syndrome.",
"id": "10025330",
"label": "a",
"name": "Iatrogenic corticosteroid use",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Cushing's syndrome. Adrenal carcinoma is a rare cancer of the adrenal cortex that can lead to excessive cortisol production. However, it usually presents with more severe and aggressive symptoms. Although it can be associated with Cushing's syndrome, the clinical presentation is often distinct and may include features like rapid weight gain, hypertension, and a palpable abdominal mass due to the tumour. In addition, adrenal carcinomas are relatively rare compared to other causes of Cushing's syndrome.",
"id": "10025332",
"label": "c",
"name": "Adrenal carcinoma",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Cushing's syndrome. The patient's low ACTH levels suggest that the source of the excess cortisol is not an overproduction of ACTH due to a pituitary adenoma, the most common cause of Cushing's disease. In Cushing's disease, the pituitary tumour results in high ACTH levels, which, in turn, stimulate the adrenal glands to produce excess cortisol. However, in this scenario, the patient's ACTH levels are low, indicating a different cause for the elevated cortisol levels.",
"id": "10025331",
"label": "b",
"name": "Pituitary adenoma",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Cushing's syndrome. The condition that involves many small cysts on the ovaries is polycystic ovary syndrome (PCOS). It is a common hormonal disorder in women that can cause menstrual irregularities and weight gain, like in this patient vignette, but it does not involve low ACTH levels, elevated cortisol levels, or easy bruising.",
"id": "10025333",
"label": "d",
"name": "Many small cysts on the ovaries",
"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": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3764,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17464",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 37 year old woman presents to her GP with weight gain and menstrual irregularities. She has also noticed that her skin has started to bruise more easily. She has a past medical history of inflammatory bowel disease and has had a recent exacerbation of this. Otherwise, she is fit and well and works full-time as an engineer. She has no allergies and has had no previous surgeries.\n\nLaboratory tests show low ACTH levels and elevated serum cortisol levels.\n\nWhich of the following is the most likely cause of her symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,466 | false | 22 | null | 6,495,184 | null | false | [] | null | 17,465 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This vignette describes a boy who has delayed puberty. A testicular volume of <4ml, in addition to the absence of facial or body hair, reveals that this boy is still in the prepubertal stage. In males, LH stimulates the Leydig cells in the testes to produce testosterone. Low LH levels suggest a lack of stimulation of the testes, leading to reduced testosterone production. Similarly, low FSH levels indicate inadequate stimulation of the testes and reduced sperm production. This is known as hypogonadotropic hypogonadism.",
"id": "10025335",
"label": "a",
"name": "Low luteinizing hormone (LH), low follicle-stimulating hormone (FSH), low testosterone",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes a boy who has delayed puberty. A testicular volume of <4ml, in addition to the absence of facial or body hair, reveals that this boy is still in the prepubertal stage. In males, LH stimulates the Leydig cells in the testes to produce testosterone. Low LH levels suggest a lack of stimulation of the testes, leading to reduced testosterone production. Similarly, low FSH levels indicate inadequate stimulation of the testes and reduced sperm production. This is known as hypogonadotropic hypogonadism. We would therefore expect low LH, low FSH and low testosterone.",
"id": "10025337",
"label": "c",
"name": "High luteinizing hormone (LH), low follicle-stimulating hormone (FSH), high testosterone",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes a boy who has delayed puberty. A testicular volume of <4ml, in addition to the absence of facial or body hair, reveals that this boy is still in the prepubertal stage. In males, LH stimulates the Leydig cells in the testes to produce testosterone. Low LH levels suggest a lack of stimulation of the testes, leading to reduced testosterone production. Similarly, low FSH levels indicate inadequate stimulation of the testes and reduced sperm production. This is known as hypogonadotropic hypogonadism. We would therefore expect low LH, low FSH and low testosterone.",
"id": "10025339",
"label": "e",
"name": "High luteinizing hormone (LH), low follicle-stimulating hormone (FSH), low testosterone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes a boy who has delayed puberty. A testicular volume of <4ml, in addition to the absence of facial or body hair, reveals that this boy is still in the prepubertal stage. In males, LH stimulates the Leydig cells in the testes to produce testosterone. Low LH levels suggest a lack of stimulation of the testes, leading to reduced testosterone production. Similarly, low FSH levels indicate inadequate stimulation of the testes and reduced sperm production. This is known as hypogonadotropic hypogonadism. High LH, high FSH, and low testosterone would represent hypergonadotropic hypogonadism, commonly seen in Klinefelter Syndrome and chemotherapy patients.",
"id": "10025336",
"label": "b",
"name": "High luteinizing hormone (LH), high follicle-stimulating hormone (FSH), low testosterone",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes a boy who has delayed puberty. A testicular volume of <4ml, in addition to the absence of facial or body hair, reveals that this boy is still in the prepubertal stage. In males, LH stimulates the Leydig cells in the testes to produce testosterone. Low LH levels suggest a lack of stimulation of the testes, leading to reduced testosterone production. Similarly, low FSH levels indicate inadequate stimulation of the testes and reduced sperm production. This is known as hypogonadotropic hypogonadism. We would therefore expect low LH, low FSH and low testosterone.",
"id": "10025338",
"label": "d",
"name": "Low luteinizing hormone (LH), high follicle-stimulating hormone (FSH), low testosterone",
"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": "4312",
"name": "Delayed puberty",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4312,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17465",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 16 year old teenager presents to his GP surgery with concerns about his short stature. He is self-conscious because all his friends in school are taller than him and have a deeper voice.\n\nUpon examination, testicular volume using an orchidometer is 3ml. There is no evidence of facial or body hair growth. Laboratory tests are ordered, including hormone panels to assess his growth hormone, thyroid function, and sex hormone level.\n\nWhich of the following blood results are most likely to confirm the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,467 | false | 23 | null | 6,495,184 | null | false | [] | null | 17,466 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Diabetes insipidus (DI) is a condition characterized by the reduced production or response to antidiuretic hormone (ADH), resulting in excessive urination and thirst. Causes can be central or nephrogenic. A water deprivation test is a diagnostic tool used to differentiate between central and nephrogenic diabetes insipidus. It involves depriving the patient of fluids and administering exogenous desmopressin (ADH) whilst monitoring urine osmolality and body weight changes.\n\nA specific diagnosis must be obtained as treatment between the two types of diabetes insipidus differs. Note that although very dilute random urine samples of <300mosmol/kg make psychogenic polydipsia unlikely, a water deprivation test is also helpful to conclusively rule this out.",
"id": "10025340",
"label": "a",
"name": "Conduct water deprivation test",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A water deprivation test is a diagnostic tool used to differentiate between central and nephrogenic diabetes insipidus, and so is the next more appropriate investigation. An MRI brain may be indicated if the water deprivation test indicates a central diabetes insipidus, however it is not required at this time.",
"id": "10025342",
"label": "c",
"name": "MRI brain",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A diagnosis of diabetes insipidus is normally not given before the water deprivation test. After checking that urine is not normally concentrated by taking random urine samples, the next most appropriate step is to conduct the water deprivation test. This is a diagnostic tool used to differentiate between central and nephrogenic diabetes insipidus. The specific diagnosis must be obtained as treatment between the two types of diabetes insipidus differs.",
"id": "10025341",
"label": "b",
"name": "No further investigations needed: diabetes insipidus and treat accordingly",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Early morning urine samples are not necessary as the random urine samples are sufficient to show that the urine is never normally concentrated. The next most appropriate step is to conduct the water deprivation test. This is a diagnostic tool used to differentiate between central and nephrogenic diabetes inspidus. The specific diagnosis must be obtained as treatment between the two types of diabetes inspidus differs.",
"id": "10025343",
"label": "d",
"name": "Early morning urine osmolarity",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A water deprivation test is a diagnostic tool used to differentiate between central and nephrogenic diabetes insipidus, and so is the next more appropriate investigation. A CT abdomen may be indicated if the water deprivation test indicates a nephrogenic diabetes insipidus, however it is not required at this time.",
"id": "10025344",
"label": "e",
"name": "CT abdomen",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3754",
"name": "Diabetes insipidus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3754,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17466",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 50 year old man consults his GP due to concerns around urinary frequency. Over the past 6 months, he has begun passing urine up to 20 times a day. He reports feeling thirsty and thus drinking a lot of water.\n\nHis blood tests, including a capillary blood glucose, are within normal limits. Random urine samples come back as very dilute (<300mosmol/kg). The clinician wishes to distinguish between central and nephrogenic diabetes insipidus.\n\nWhich of the following is the next most appropriate investigation to confirm the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,468 | false | 24 | null | 6,495,184 | null | false | [] | null | 17,467 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In patients with cranial diabetes insipidus, a fluid deprivation test typically results in an increase in urine osmolality after the administration of DDAVP. This is because cranial diabetes inspidus is characterised by a deficiency of ADH production in the brain. Administering DDAVP (synthetic ADH) during the test usually corrects the defect, and urine osmolality increases. In contrast, in nephrogenic diabetes inspidus, urine osmolality remains low even after DDAVP administration because the kidney tubules do not respond to ADH. Therefore, nephrogenic diabetes insipidus is the correct answer.",
"id": "10025346",
"label": "b",
"name": "Cranial diabetes inspidus",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with psychogenic polydipsia can produce concentrated urine when they are deprived of fluids. In this vignette, the patient's urine remained dilute even after dehydration and the administration of DDAVP, which suggests a problem with the kidney's response to ADH rather than a psychological issue. The correct answer is nephrogenic diabetes insipidus, a rare condition characterised by a defect in the kidney's ability to respond to ADH, leading to the inability to concentrate urine and resulting in excessive thirst and polyuria.",
"id": "10025349",
"label": "e",
"name": "Psychogenic polydipsia",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Based on the findings of the fluid deprivation test, the patient's inability to concentrate his urine even after DDAVP administration suggests a diagnosis of nephrogenic diabetes insipidus. This is a rare condition characterised by a defect in the kidney's ability to respond to ADH, leading to the inability to concentrate urine. Patients commonly present with excessive thirst and polyuria, as in this case.",
"id": "10025345",
"label": "a",
"name": "Nephrogenic diabetes inspidus",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although renal function tests are an important investigation, they were normal in this patient. This is also indicated by the absence of oedema, the young age of the patient and the absence of a family history of renal diseases. Based on the findings of the fluid deprivation test, this patient's inability to concentrate his urine even after DDAVP administration suggests a diagnosis of nephrogenic diabetes insipidus. This is a rare condition characterised by a defect in the kidney's ability to respond to ADH, leading to the inability to concentrate urine and resulting in excessive thirst and polyuria.",
"id": "10025348",
"label": "d",
"name": "Chronic kidney disease",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osmotic diuresis occurs when there are high levels of solutes, such as glucose, calcium and urea in the urine that cause an osmotic gradient, drawing water into the urine. This results in increased urine output. In this vignette, the normal blood tests, particularly normal glucose level, rule out osmotic diuresis. Based on the findings of the fluid deprivation test, this patient's inability to concentrate his urine even after DDAVP administration suggests a diagnosis of nephrogenic diabetes insipidus. This is a rare condition characterised by a defect in the kidney's ability to respond to ADH, leading to the inability to concentrate urine and resulting in excessive thirst and polyuria.",
"id": "10025347",
"label": "c",
"name": "Osmotic diuresis",
"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": "5832",
"name": "Fluid deprivation tests",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5832,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17467",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 24 year old male attends his GP practice due to a persistent issue with excessive urination and excessive thirst. He feels otherwise well and denies fever, weight loss and fatigue. There is no family history of renal disease.\n\nOn examination, there is no central or peripheral oedema. Observations are within normal limits. Blood test results, including serum glucose and renal function tests, are unremarkable aside from a mild hypernatraemia. However, he showed no increase in urine osmolality even after dehydration and desmopressin (DDAVP) administration in a fluid deprivation test.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,469 | false | 25 | null | 6,495,184 | null | false | [] | null | 17,468 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "PCOS can be diagnosed if at least two of the following criteria are met:\n\n* Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)\n* Oligo-/anovulation\n* Clinical or biochemical features of hyperandrogenism\n\nAlthough this patient has some features of hyperandrogenism, such as hirsutism and a slightly elevated BMI, she has normal ovaries and normal menstrual function. Thus, she meets only one of the above criteria. In addition, she has normal LH, FSH and testosterone levels. These make PCOS unlikely.",
"id": "10025352",
"label": "c",
"name": "Polycystic ovary syndrome (PCOS)",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Excessive hair growth may be hereditary and familial in some cases, without a specific underlying medical cause. This is more likely if there is a family history of hirsutism, although this is unknown from this vignette. Menstrual function and hormonal investigations are normal, suggesting that there are no underlying endocrine or gynaecological disorders.",
"id": "10025350",
"label": "a",
"name": "Idiopathic or familial hirsutism",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Drug-induced hirsutism can occur due to the use of certain medications, such as steroids and cyclosporine, that can lead to increased hair growth. It is not associated with antihistamine or paracetamol administration. Furthermore, the normal hormonal and ultrasound findings do not suggest a direct correlation with drug-induced hirsutism.",
"id": "10025351",
"label": "b",
"name": "Drug induced hirsutism",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CAH typically results in elevated androgen levels due to an enzymatic deficiency in the adrenal glands, leading to virilising effects. However, in this patient, normal hormone levels are observed. CAH is also more likely to lead to irregular menstrual periods or even amenorrhea due to hormonal imbalances. This patient reports regular, albeit lengthy, menstrual cycles.",
"id": "10025353",
"label": "d",
"name": "Congenital adrenal hyperplasia (CAH)",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cushing's disease is an endocrine disorder normally caused by an ACTH-secreting pituitary adenoma, leading to excessive cortisol production. It typically presents with symptoms related to excess cortisol production, such as weight gain, central obesity, easy bruising, and a distinct clinical profile that includes high blood pressure. However, the patient's blood pressure is within normal limits. Although hirsutism is also a feature of Cushing's disease, the patient does not experience other prominent cushingoid symptoms or signs, making Cushing's disease unlikely.",
"id": "10025354",
"label": "e",
"name": "Cushing's disease",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5833",
"name": "Hirsutism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5833,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17468",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 19 year old female attends her GP surgery with concerns about excessive hair on her face and chest. She reports starting her period at 13 years old. These periods usually last 7 days and occur regularly. She takes antihistamines for hay fever during the summer and occasional paracetamol when she has a headache.\n\nShe is 162cm tall and weighs 68kg. Her blood pressure, luteinising hormone, follicle-stimulating hormone, prolactin, and testosterone levels are within normal limits. She undergoes a pelvic ultrasound scan which is unremarkable.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,470 | false | 26 | null | 6,495,184 | null | false | [] | null | 17,469 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has hyperthyroidism as shown by her symptoms and laboratory results. Diarrhoea, rather than constipation, is commonly seen in hyperthyroidism. This option is therefore incorrect.",
"id": "10025358",
"label": "d",
"name": "Constipation",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has hyperthyroidism as shown by her symptoms and laboratory results. Brittle nails are a symptom of hypothyroidism. The reduced metabolic rate in hypothyroidism affects the body's ability to produce and utilise various nutrients. Slower metabolism can lead to impaired circulation to the nail bed, limiting the delivery of vital nutrients. Furthermore, the thyroid hormones also play a role in regulating protein synthesis, including the production of keratin, a key structural protein found in nails.",
"id": "10025359",
"label": "e",
"name": "Brittle nails",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has hyperthyroidism as shown by her symptoms and laboratory results. Bradycardia is a symptom of hypothyroidism. The slow metabolic rate reduces heart rate. In addition, hypothyroidism may shift our body towards increased parasympathetic nervous system activity, which slows down the heart rate. By contrast, hyperthyroidism is more commonly associated with tachycardia.",
"id": "10025356",
"label": "b",
"name": "Bradycardia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has hyperthyroidism as shown by her symptoms and laboratory results. Cold sensitivity is a symptom of hypothyroidism. When thyroid hormone levels are reduced, the metabolic rate decreases, resulting in reduced heat production by the body. The body may also have difficulty maintaining adequate peripheral blood flow, which can lead to cold extremities and an overall feeling of coldness. By contrast, hyperthyroidism is more commonly associated with heat intolerance.",
"id": "10025357",
"label": "c",
"name": "Cold sensitivity",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This patient has hyperthyroidism as shown by her symptoms and laboratory results. Elevated levels of thyroid hormones can lead to irregular or absent ovulation. Hyperthyroidism may shorten the luteal phase of the menstrual cycle, resulting in a shorter and lighter menstrual flow. Additionally, weight loss can disrupt normal hormonal signalling in the body, impacting the menstrual cycle.",
"id": "10025355",
"label": "a",
"name": "Hypomenorrhea",
"picture": null,
"votes": 23
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3959",
"name": "Hyperthyroidism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3959,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17469",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 25 year old woman attends her GP surgery with concerns that she has lost weight despite eating a normal diet. She also reports feeling very hot and sweaty, but when she measured her temperature it is within the normal range. Laboratory blood tests show a high T4 and low thyroid stimulating hormone.\n\nWhich of the following additional symptoms are most likely to be reported?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,471 | false | 27 | null | 6,495,184 | null | false | [] | null | 17,470 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Although the quality and quantity of oocytes in ovarian follicles decrease significantly, uterine tissue is still capable of responding to the hormonal signals it receives. The responsiveness of the uterus to hormones is not solely dependent on the ovaries; it is also influenced by the presence of hormone receptors in uterine tissue and the overall health of the uterine lining. This explains why pregnancy is still possible after menopause with exogenous hormonal stimulation and assisted reproductive technology.",
"id": "10025360",
"label": "a",
"name": "Loss of ovarian hormonal function in menopause does not directly affect uterine hormone responsiveness",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cardiovascular risk normally increases after menopause, due to reduced oestrogen levels. Oestrogen functions to promote vascular remodelling and elasticity, and regulate reactive dilation and local inflammatory activity. Loss of oestrogen may lead to impaired endothelial function and vascular changes. Therefore, the risk of cardiovascular conditions such as atherosclerosis and ischaemic heart disease increases.",
"id": "10025362",
"label": "c",
"name": "Cardiovascular risk decreases after menopause",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although HRT provides symptom control, research suggests oral HRT brings an increased risk of breast cancer, ovarian cancer and thrombosis. Therefore, some women are not suitable for HRT, particularly breast, endometrium, and ovarian cancer patients. There is no one-size-fits-all management plan for menopause.",
"id": "10025364",
"label": "e",
"name": "Hormone replacement therapy (HRT) is recommended for all women during menopause to alleviate symptoms",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Smoking has been associated with an earlier onset of menopause. Women who smoke may experience menopause, on average, about one to two years earlier than non-smokers. Alcohol can disrupt hormonal balance, including changes in oestrogen levels, which can influence the timing of menopause. Both smoking and alcohol can exacerbate menopausal symptoms.",
"id": "10025363",
"label": "d",
"name": "Smoking and alcohol consumption have no impact on the timing and severity of menopause symptoms",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The average age of menopause is 51 years old, with typical range from 45 to 55 years old.",
"id": "10025361",
"label": "b",
"name": "The average age of menopause is 55 years old, with typical range from 50 to 60 years old",
"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": "3980",
"name": "Menopause",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3980,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17470",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 49 year old woman attends her GP surgery with low mood and frequent hot flushes. Her periods are gradually becoming more infrequent. She is keen to learn more about the menopause and the changes taking place in her body.\n\nWhich of the following statements about menopause is true?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,472 | false | 28 | null | 6,495,184 | null | false | [] | null | 17,471 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this case, the patient's tall stature, coarse and thickened skin, enlarged hands and feet, joint pain, headaches, and excessive sweating are all consistent with the clinical features of acromegaly. Acromegaly results from the excessive production of GH from the pituitary gland, typically due to a pituitary adenoma. This condition leads to the overgrowth of bones and tissues and is associated with various systemic symptoms and complications. By contrast, the raised thyroid stimulating hormone seen in hyperthyroidism would not explain the joint pain and stiffness, coarse skin, and excessive growth.",
"id": "10025368",
"label": "d",
"name": "Raised thyroid stimulating hormone",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this case, the patient's tall stature, coarse and thickened skin, enlarged hands and feet, joint pain, headaches, and excessive sweating are all consistent with the clinical features of acromegaly. Acromegaly results from the excessive production of GH from the pituitary gland, typically due to a pituitary adenoma. This condition leads to the overgrowth of bones and tissues and is associated with various systemic symptoms and complications. By contrast, excessive cortisol leads to symptoms such as weight gain, central obesity, easy bruising, hypertension, and mood disturbances. It does not fit with the clinical picture in this vignette.",
"id": "10025369",
"label": "e",
"name": "Cortisol",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. In this case, the patient's tall stature, coarse and thickened skin, enlarged hands and feet, joint pain, headaches, and excessive sweating are all consistent with the clinical features of acromegaly. Acromegaly results from the excessive production of GH from pituitary gland, typically due to a pituitary adenoma. This condition leads to the overgrowth of bones and tissues and is associated with various systemic symptoms and complications.",
"id": "10025365",
"label": "a",
"name": "Raised growth hormone (GH)",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this case, the patient's tall stature, coarse and thickened skin, enlarged hands and feet, joint pain, headaches, and excessive sweating are all consistent with the clinical features of acromegaly. Acromegaly results from the excessive production of GH from the pituitary gland, typically due to a pituitary adenoma. This condition leads to the overgrowth of bones and tissues and is associated with various systemic symptoms and complications. By contrast, elevated testosterone levels are related to symptoms of hyperandrogenism such as hirsutism, acne and obesity. It does not fit with the clinical picture in this vignette.",
"id": "10025367",
"label": "c",
"name": "Raised testosterone",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this case, the patient's tall stature, coarse and thickened skin, enlarged hands and feet, joint pain, headaches, and excessive sweating are all consistent with the clinical features of acromegaly. Acromegaly results from the excessive production of GH from the pituitary gland, typically due to a pituitary adenoma. When GH enters the blood, it then signals the liver to produce IGF-I, causing bones and tissues to grow. Since this question is asking for the underlying cause, the answer should be GH, not IGF-1.",
"id": "10025366",
"label": "b",
"name": "Raised insulin-like growth factor I (IGF-I)",
"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": "3979",
"name": "Acromegaly",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3979,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17471",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 37 year old homeless man presents to the GP clinic for the first time in his life. He is strikingly tall and has coarse and thickened skin on his palms and soles of his feet. He has come in because he can no longer stand the headaches that have become increasingly worse over the years. He often feels fatigued on the street. He also experiences joint pain and stiffness, especially in his knees and hips, which he attributes to the cold.\n\nUpon examination, the patient's skin feels warm to the touch, and he is visibly sweating during the examination.\n\nWhich of the following is the most likely underlying cause of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,473 | false | 29 | null | 6,495,184 | null | false | [] | null | 17,472 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pheochromocytoma is a rare adrenal gland tumour that can lead to the overproduction of catecholamines, epinephrine and norepinephrine. Catecholamines originate from the adrenal medulla, not the zona glomerulosa of the adrenal cortex. This option is therefore incorrect.",
"id": "10025373",
"label": "d",
"name": "Pheochromocytoma",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Addison's disease is characterised by adrenal insufficiency, resulting in low levels of cortisol and aldosterone. Similarly, hypotension and hyperkalaemia are most commonly seen in Addison's disease, whereas the opposite is true in this case. The high aldosterone/renin ratio further supports a diagnosis of Conn's syndrome.",
"id": "10025371",
"label": "b",
"name": "Addison's disease",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Conn's syndrome, also known as primary hyperaldosteronism, is a condition characterised by the overproduction of aldosterone, primarily originating from the zona glomerulosa. Aldosterone plays a crucial role in regulating sodium and potassium balance in the body. Excess aldosterone can lead to hypertension and low potassium levels.",
"id": "10025370",
"label": "a",
"name": "Conn's syndrome",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CAH is characterised by enzyme deficiencies in the adrenal glands, leading to excessive production of androgens and, in some cases, mineralocorticoids. Androgens are produced in the zona reticularis of the adrenal cortex, while aldosterone is produced in the zona glomerulosa. This option is therefore incorrect.",
"id": "10025374",
"label": "e",
"name": "Congenital Adrenal Hyperplasia (CAH)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cushing's syndrome involves the overproduction of cortisol, leading to symptoms such as weight gain, high blood pressure, and easy bruising. It is commonly associated with hypotension and hyperkalaemia, thus making Cushing's syndrome an unlikely diagnosis in this case.",
"id": "10025372",
"label": "c",
"name": "Cushing's syndrome",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5834",
"name": "Mineralocorticoid excess",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5834,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17472",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 21 year old female is investigated by her GP for treatment-resistant hypertension. She reports a healthy diet and active lifestyle, and reports drinking lots of water. She notes feeling more tired than usual for the past 6 months, and has frequent headaches, but can work full time as a shop assistant.\n\nShe undergoes a range of blood tests, which find an elevated aldosterone/renin ratio as well as a mild hypokalaemia. The clinician explains there is an overproduction of a hormone produced by the zona glomerulosa of the adrenal cortex.\n\nWhich of the following it the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,474 | false | 30 | null | 6,495,184 | null | false | [] | null | 17,473 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Growth hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH). Growth hormone is produced by the anterior pituitary gland.",
"id": "10025378",
"label": "d",
"name": "Growth hormone",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prolactin is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).",
"id": "10025377",
"label": "c",
"name": "Prolactin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adrenocorticotrophic hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).",
"id": "10025376",
"label": "b",
"name": "Adrenocorticotrophic hormone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroid-stimulating hormone is produced by the anterior pituitary gland. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).",
"id": "10025379",
"label": "e",
"name": "Thyroid-stimulating hormone (TSH)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. There are only two hormones that are produced in the posterior pituitary gland, which are oxytocin and vasopressin (also known as ADH).",
"id": "10025375",
"label": "a",
"name": "Oxytocin",
"picture": null,
"votes": 48
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3960",
"name": "Hormones of the posterior pituitary gland",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3960,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17473",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 34 year old man with a benign pituitary adenoma is reviewed in an endocrinology clinic. He is keen to learn more about the hormones of the pituitary gland.\n\nWhich of the following hormones is produced in the posterior pituitary gland?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,475 | false | 31 | null | 6,495,184 | null | false | [] | null | 17,474 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Given the recent neck surgery, it is possible that accidental damage to or removal of the parathyroid glands during surgery occurred. Damage or removal of the parathyroid glands leads to reduced parathyroid hormone levels which in turn leads to reduced calcium levels. Therefore, symptoms of hypocalcaemia and Chvostek sign (twitching when the course of the facial nerve is tapped) are observed.",
"id": "10025380",
"label": "a",
"name": "Decreased parathyroid hormone levels leading to hypocalcaemia",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given the recent neck surgery, it is possible that accidental damage to or removal of the parathyroid glands during surgery occurred. Damage or removal of the parathyroid glands leads to reduced parathyroid hormones which causes reduced calcium levels, not increased calcium levels. Therefore, symptoms of hypocalcaemia including Chvostek sign (twitching when the course of the facial nerve is tapped) are observed.",
"id": "10025381",
"label": "b",
"name": "Decreased parathyroid hormone levels leading to hypercalcaemia",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's lack of a significant past medical history related to autoimmune disorders makes it less likely that her current symptoms are due to an autoimmune condition. A positive Chvostek sign is more suggestive of neuromuscular irritability, as may be seen in hypocalcaemia. This may occur due to parathyroid gland dysfunction, which can affect calcium regulation and neuromuscular excitability. This aligns with her recent history of neck surgery which could have potentially damaged the parathyroid gland.",
"id": "10025383",
"label": "d",
"name": "Autoimmune disorder leading to hypercalcaemia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's lack of a significant past medical history related to autoimmune disorders makes it less likely that her current symptoms are due to an autoimmune condition. A positive Chvostek sign is more suggestive of neuromuscular irritability, as may be seen in hypocalcaemia. This may occur due to parathyroid gland dysfunction, which can affect calcium regulation and neuromuscular excitability. This aligns with her recent history of neck surgery which could have potentially damaged the parathyroid gland.",
"id": "10025382",
"label": "c",
"name": "An autoimmune disorder leading to hypocalcaemia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Indeed, symptoms of hypocalcaemia such as Chvostek's sign (twitching when the course of the facial nerve is tapped) are observed. Although acute pancreatitis can lead to hypocalcaemia, there are no symptoms that point to pancreatitis. Specifically, the patient is not experiencing any pain. By contrast, pancreatitis is associated with severe pain in the abdomen, nausea and fever.",
"id": "10025384",
"label": "e",
"name": "Pancreatitis leading to hypocalcaemia",
"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": "4625",
"name": "Hypoparathyroidism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4625,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17474",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old woman is referred to a neurologist for a comprehensive evaluation due to concerning signs and symptoms that have been affecting her daily life. She presents with several neurological issues, including muscle cramps, tingling sensations, and episodes of muscle weakness. She denies any pain, fever or weight loss. She has had a recent surgical procedure to her neck, but no other past medical history.\n\nOn examination, her observations are all within normal limits. A positive Chvostek sign is observed.\n\nWhich of the following best describes the pathophysiology of this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,476 | false | 32 | null | 6,495,184 | null | false | [] | null | 17,475 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. In addition to bone, PTH directly influences calcium metabolism in the kidneys by regulating calcium reabsorption and promoting the excretion of phosphate. PTH helps to conserve calcium and increase its concentration in the bloodstream by enhancing its reabsorption in the renal tubules.",
"id": "10025385",
"label": "a",
"name": "Kidneys",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although PTH indirectly influences calcium absorption in the intestines by stimulating calcitriol production, its primary sites of action for calcium regulation are the bones and kidneys.",
"id": "10025389",
"label": "e",
"name": "Intestines",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The parathyroid gland that produces PTH is located behind the thyroid gland. Despite the close location, the thyroid gland is not involved in calcium metabolism. It only helps to regulate the blood calcium levels, by producing and releasing the calcitonin hormone. It opposes the action of the PTH.",
"id": "10025387",
"label": "c",
"name": "Thyroid gland",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vast majority of vitamin D is produced in the skin through exposure to UV light. Activated vitamin D increases calcium absorption. However, PTH does not act on the skin to affect calcium metabolism.",
"id": "10025388",
"label": "d",
"name": "Skin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The liver's primary function related to calcium is the synthesis of vitamin D-binding protein and the conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D (calcitriol). Calcitriol is increased by PTH and is essential for calcium absorption in the intestines. Although the liver is involved in the production of calcitriol, which indirectly influences calcium absorption, it is not a direct target of PTH in calcium regulation.",
"id": "10025386",
"label": "b",
"name": "Liver",
"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": "4371",
"name": "Calcium levels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4371,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17475",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old woman with recurrent low-impact fractures is assessed in the bone health clinic. She is found to have hypercalcaemia and an elevated plasma parathyroid hormone (PTH) level. The clinician explains that PTH acts upon bones, stimulating the release of calcium and thus weakening them.\n\nWhich of the following other organs does PTH act upon directly to influence calcium metabolism?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,477 | false | 33 | null | 6,495,184 | null | false | [] | null | 17,476 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently.",
"id": "10025391",
"label": "b",
"name": "Hydrophilic, diffuses through cell membrane",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The thyroid hormones, thyroxine (T4) and triiodothyronine (T3), are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require vesicles to be transported.",
"id": "10025394",
"label": "e",
"name": "Lipophilic, transported in vesicles",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require carrier proteins to be transported; these are normally for hydrophilic molecules.",
"id": "10025392",
"label": "c",
"name": "Hydrophilic, transport mediated by carrier proteins",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently. It does not require carrier proteins to be transported, these are normally for hydrophilic molecules.",
"id": "10025393",
"label": "d",
"name": "Lipophilic, transport mediated by carrier proteins",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The thyroid hormones, thyroxine (T4) and triiodothyronine (T3) are lipid-soluble molecules. Therefore, levothyroxine, as a synthetic form of T4, needs to be lipophilic to mimic the properties of the natural hormone. The cell membrane is primarily composed of a lipid bilayer. Lipophilic substances, like levothyroxine, have the advantage of being able to pass through the lipid bilayer of cell membranes efficiently.",
"id": "10025390",
"label": "a",
"name": "Lipophilic, diffuses through cell membrane",
"picture": null,
"votes": 16
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5835",
"name": "Levothyroxine",
"status": null,
"topic": {
"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5835,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17476",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 30 year old woman with hypothyroidism attends a routine review with her GP. She is prescribed levothyroxine, which she understands targets thyroid hormone receptors.\n\nWhich of the following best describes the biochemical properties of levothyroxine?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,478 | false | 34 | null | 6,495,184 | null | false | [] | null | 17,477 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Agranulocytosis is a condition in which there is a severe reduction of neutrophils. Therefore, any symptoms of infection, such as high fever, sore throat, or mouth ulcers must be reported promptly, as these could be early signs of agranulocytosis. The exact mechanism by which carbimazole induces agranulocytosis is not fully understood, but it is believed to be an idiosyncratic reaction in some individuals.",
"id": "10025395",
"label": "a",
"name": "Carbimazole has a rare side effect of agranulocytosis",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Carbimazole is not administered as a one-time injection. It is usually prescribed in tablet form and taken orally. The treatment involves taking the medication over an extended period, often for several months, to manage hyperthyroidism.",
"id": "10025399",
"label": "e",
"name": "Carbimazole is typically administered as a one-time injection for long-term management of hyperthyroidism",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In pregnant women with overt hyperthyroidism, the use of anti-thyroid medications like carbimazole requires very careful consideration, and its continuation or discontinuation depends on the specific clinical circumstances. Carbimazole is known to cross the placenta and can affect the developing foetus. There is an associated risk of foetal congenital anomalies, particularly involving the development of the thyroid gland. In pregnancy, propylthiouracil is often preferred over carbimazole due to its lower risk of causing congenital anomalies.",
"id": "10025396",
"label": "b",
"name": "Carbimazole should be continued by pregnant women with overt hyperthyroidism",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Carbimazole inhibits the thyroid peroxidases (TPO) enzyme that catalyses the iodination of tyrosine residues in thyroglobulin. It also decreases the inorganic iodine uptake and concentration by thyroid cells. Eventually, it reduces both T3 and T4 levels.",
"id": "10025398",
"label": "d",
"name": "Carbimazole functions to increase T3 and decrease T4",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Carbimazole has no role in the treatment of allergies or hay fever. It is specific to thyroid-related conditions, particularly hyperthyroidism, as its mechanism of action is inhibition of thyroid peroxidases (TPO) that catalyses the iodination of tyrosine residues in thyroglobulin.",
"id": "10025397",
"label": "c",
"name": "Carbimazole can also be used to treat seasonal allergies and hay fever",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5836",
"name": "Carbimazole",
"status": null,
"topic": {
"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5836,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17477",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 39 year old patient has been recently diagnosed with hyperthyroidism. Her endocrinologist has prescribed her a medication called carbimazole to help manage her condition. They counsel her regarding its use.\n\nWhich of the following is true of carbimazole?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,479 | false | 35 | null | 6,495,184 | null | false | [] | null | 17,478 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Body temperature regulation is primarily controlled by the hypothalamus in the brain and involves other mechanisms and hormones, such as sweating, shivering, and the regulation of blood flow to the skin. The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water.",
"id": "10025404",
"label": "e",
"name": "Control of body temperature",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water. It increases the permeability of the renal collecting ducts to water. This allows the kidneys to reabsorb more water from the urine, reducing the volume of urine and concentrating it.",
"id": "10025400",
"label": "a",
"name": "Conservation of water by increasing water reabsorption in the kidneys",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The hormone that primarily regulates blood pressure by increasing heart rate is epinephrine, also known as adrenaline. In addition, norepinephrine, released by the adrenal glands, also plays a role in regulating blood pressure and heart rate. Both hormones are part of the sympathetic nervous system's response to stress and are essential for adjusting cardiovascular function during fight-or-flight situations. The primary physiological function of ADH in the human body is to regulate and control the balance of body fluids by conserving water.",
"id": "10025401",
"label": "b",
"name": "Regulation of blood pressure by increasing heart rate",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "When ADH is released into the bloodstream, it binds to receptors on the smooth muscle cells of blood vessels to bring about vasoconstriction. This leads to the contraction of smooth muscle, resulting in a reduction in the diameter of the blood vessels, which, in turn, increases vascular resistance. Increased vascular resistance leads to a rise in blood pressure. This answer is therefore incorrect.",
"id": "10025403",
"label": "d",
"name": "Vasoconstriction to reduce blood pressure",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The stretching of the bladder wall as it fills with urine is an important mechanism that stimulates the urge to urinate. When the bladder reaches a certain level of distension, mechanoreceptors in the bladder wall send signals to the brain, indicating that it's time to empty the bladder. ADH reduces urine production by concentrating urine. As a result, one may feel less urgency to urinate when ADH levels are higher, however, this is not its direct effect.",
"id": "10025402",
"label": "c",
"name": "Stimulation of sensation of urge to urinate",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5837",
"name": "Vasopressin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5837,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17478",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 47 year old man is reviewed in an endocrinology clinic, and diagnosed with a syndrome of inappropriate antidiuretic hormone release (SIADH).\n\nWhich of the following is a primary physiological function of ADH in the human body?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,480 | false | 36 | null | 6,495,184 | null | false | [] | null | 17,479 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An infection of the female reproductive organs is pelvic inflammatory disease (PID). Although it can present with pelvic pain, it is often associated with symptoms like fever, abnormal vaginal discharge, and a history of sexually transmitted infections. The absence of these characteristic features in the patient's history makes PID less likely in this case.",
"id": "10025408",
"label": "d",
"name": "An infection of the female reproductive organs",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Benign uterine growths, called fibroids can cause pelvic pain and other symptoms. However, the key feature in this case is the progressive nature of the pain and its association with dysmenorrhea, which is more indicative of endometriosis rather than fibroids. Fibroids tend to cause more chronic, non-cyclical pain and may lead to heavy menstrual bleeding.",
"id": "10025406",
"label": "b",
"name": "Benign uterine growths",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The vignette describes endometriosis, which is characterised by endometrial tissue outside the uterus. Endometriosis is known for causing severe pelvic pain, which is often cyclical and can worsen over time. This aligns with the patient's complaint of progressively worsening pain. The symptoms of dysmenorrhea, dyspareunia, subfertility and bleeding between periods fit the clinical picture of endometriosis. Examination findings of tenderness upon palpation of the pelvic area indicate endometriotic lesions causing localised inflammation and sensitivity in this region.",
"id": "10025405",
"label": "a",
"name": "Endometrial tissue outside the uterus",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Idiopathic or primary dysmenorrhea is characterised by crampy pelvic pain at the onset of menses with no identifiable pelvic pathology. However, in this vignette, the clinical picture points to endometriosis, with dysmenorrhoea, dyspareunia, bleeding between periods and subfertility.",
"id": "10025409",
"label": "e",
"name": "Idiopathic, no pelvic pathology",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ovarian cysts are fluid-filled sacs that can form in the ovaries. They can cause discomfort and pain, but the patient's symptoms, including severe pelvic pain and painful intercourse, are more strongly associated with endometriosis. This is characterised by endometrial tissue outside the uterus.",
"id": "10025407",
"label": "c",
"name": "Fluid-filled sacs in the ovaries",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5838",
"name": "Dysmenorrhoea",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5838,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17479",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old woman presents to her gynaecologist with a history of severe pelvic pain and dysmenorrhea. She describes the pain as progressively worsening over the past few years and is particularly noticeable during sexual intercourse. The pain is not relieved by over-the-counter pain relievers. Sometimes, she observes vaginal bleeding between her periods.\n\nShe has a single sexual partner and denies any abnormal vaginal discharge. She and her partner are currently awaiting an appointment with a fertility specialist, as they have not been able to conceive despite trying for over a year.\n\nOn physical examination, there is tenderness upon palpation of the pelvic area. All observations are within normal limits.\n\nWhich of the following is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,481 | false | 37 | null | 6,495,184 | null | false | [] | null | 17,480 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a situation where the advantages generally outweigh the risks of prescribing a combined oral contraceptive pill. Since combined oral contraceptive pills increase cardiovascular risks, it is safe to be prescribed to diabetic patients without vascular disease, for safe contraception and even reduced risk of ovarian and endometrial cancers.",
"id": "10025413",
"label": "d",
"name": "Type 2 diabetes mellitus, no vascular disease",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a situation whereby the risks may outweigh the advantages of prescribing a combined oral contraceptive pill. However, it is not considered an 'unacceptable' health risk. Combined oral contraceptive pills can also increase the risk of cardiovascular events, such as venous thromboembolism and stroke. Consistent hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) is an unacceptable health risk to using combined oral contraceptive pills, but if blood pressure is controlled their use is permissible.",
"id": "10025411",
"label": "b",
"name": "Hypertension controlled with antihypertensive medication",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a situation where the advantages generally outweigh the risks of prescribing a combined oral contraceptive pill. Irregular bleeding is common in the first few months of oral contraceptive use, but a change in preparation or method should be considered if it persists and is troublesome for the patient.",
"id": "10025414",
"label": "e",
"name": "Unexplained vaginal bleeding",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. If an individual with a history of VTE were to use combined oral contraceptive pills, there is a greater likelihood of experiencing recurrent VTE events, which can be life-threatening. Oestrogen-containing contraceptives induce a procoagulant state, increasing the likelihood of blood clot formation.",
"id": "10025410",
"label": "a",
"name": "Previous venous thromboembolism (VTE)",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a situation whereby proven risks usually outweigh the advantages of prescribing a combined oral contraceptive pill. However, it is not considered an 'unacceptable' health risk. Current breast cancer is an unacceptable health risk to using combined oral contraceptive pills, as the oestrogen they contain can promote cell growth in breast tissue.",
"id": "10025412",
"label": "c",
"name": "Past breast cancer",
"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": "5839",
"name": "Contraindications to the oral contraceptive pill",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5839,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17480",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 31 year old woman consults her GP regarding contraception. She would like to try the combined oral contraceptive pill.\n\nWhich of the following medical condition represents an unacceptable health risk for the use of the combined oral contraceptive pills, according to the UK Medical Eligibility Criteria?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,482 | false | 38 | null | 6,495,184 | null | false | [] | null | 17,481 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Oestrogen can have an anti-apoptotic effect, which means it can reduce or inhibit the normal apoptosis of cells. This effect is particularly relevant in the context of cancer because apoptosis serves as a natural mechanism to eliminate damaged or potentially cancerous cells from the body.",
"id": "10025415",
"label": "a",
"name": "Decreases apoptosis activity",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oestrogen is not typically associated with anti-inflammatory functions; it can promote inflammation in some cases of ovarian cancers. Oestrogen is involved in the initiation and progression of ovarian cancer. It also plays a role in increasing oncogenes and decreasing apoptosis and tumour suppressors in the ovaries.",
"id": "10025417",
"label": "c",
"name": "Anti-inflammatory function",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oestrogen has been linked to decreasing tumour suppressors in ovarian cancer. Oestrogen is involved in the initiation and progression of ovarian cancer. It also plays a role in increasing oncogenes and decreasing apoptosis in the ovaries.",
"id": "10025418",
"label": "d",
"name": "Increases tumour suppressors",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oestrogen is involved in the initiation and progression of ovarian cancer. It plays a role in transforming the ovarian cells; including the surface epithelial cells, germ cells and stromal cells into carcinogenic cells. It also plays a role in increasing oncogenes and decreasing apoptosis and tumour suppressors in the ovaries.",
"id": "10025419",
"label": "e",
"name": "Decreases the risk of epithelial cell transformation",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oestrogen has been associated with stimulating the growth and proliferation of cells, rather than inhibiting or slowing down their proliferation. Oestrogen can have a proliferative effect on various tissues, including the ovaries. By contrast, progesterone slows down the proliferation of ovarian cells, as it represses oestrogen-induced gene expression.",
"id": "10025416",
"label": "b",
"name": "Slows down the proliferation of ovarian cells",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3843",
"name": "Ovarian cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3843,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17481",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 61 year old woman receives a new diagnosis of ovarian cancer. She is currently taking hormone replacement therapy that contains oestrogen, and wonders whether she should stop.\n\nWhich of the following best describes the role of oestrogen in the pathophysiology of ovarian cancer?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,483 | false | 39 | null | 6,495,184 | null | false | [] | null | 17,482 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although the combination of hirsutism and irregular menstrual periods is suggestive of a hormonal disorder, it is less likely to be associated with weight loss. This combination of symptoms is suggestive of polycystic ovary syndrome (PCOS). Instead, weight gain or difficulty losing weight is a more common finding in PCOS due to insulin resistance. Elevated androgens such as testosterone that are seen in PCOS can disrupt oestrogen levels and contribute to central fat distribution, resulting in abdominal obesity.",
"id": "10025424",
"label": "e",
"name": "Weight loss",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Galactorrhoea is the spontaneous flow of milk from the breast unrelated to childbirth or nursing. It can be a symptom of certain hormonal disorders but is not typically associated with the combination of hirsutism and irregular menstrual periods. Galactorrhoea is more commonly linked to hyperprolactinaemia (elevated levels of the hormone prolactin) and can result from various causes, such as a pituitary tumour. This vignette is more suggestive of polycystic ovary syndrome (PCOS).",
"id": "10025422",
"label": "c",
"name": "Galactorrhoea",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hot flashes are typically linked to fluctuations in oestrogen levels that occur during the perimenopausal and menopausal periods. Although the patient has increasingly irregular periods, menopause is not seen with hirsutism. Furthermore, her young age makes menopause unlikely, as menopause normally occurs between the ages of 45 to 55. This vignette is more suggestive of polycystic ovary syndrome (PCOS).",
"id": "10025423",
"label": "d",
"name": "Hot flashes",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Polycystic ovary syndrome (PCOS) can be diagnosed if at least two of the following criteria are met:\n\n* Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)\n* Oligo-/anovulation\n* Clinical or biochemical features of hyperandrogenism\n\nIn this case, two criteria are met: oligoovulation (irregular periods) and features of hyperandrogenism (hirsutism). Acanthosis nigricans can also be seen in PCOS. It refers to the thickening and coarsening of the skin, commonly observed in the armpits and elbows, and is characterised by a velvety texture. This skin condition is associated with insulin resistance. Insulin resistance causes the pancreas to increase the production of insulin, which stimulates the release of androgens including testosterone from the ovaries and adrenal gland. This further contributes to hyperandrogenism in PCOS.",
"id": "10025420",
"label": "a",
"name": "Acanthosis nigricans",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Easy bruising is a common feature in Cushing's syndrome or disease, characterised by excess cortisol. Irregular menstrual periods can occur in Cushing's syndrome, but they are often not the primary symptom. Increased ACTH stimulation on the zona reticularis can cause excessive androgen secretion, thus hirsutism is also possible, but again should not be the primary symptom in Cushing's syndrome or disease. In addition, the lack of other cushingoid signs make Cushing's syndrome or disease unlikely. This vignette is more suggestive of polycystic ovary syndrome (PCOS).",
"id": "10025421",
"label": "b",
"name": "Easy bruising",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4319",
"name": "Polycystic ovary syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4319,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17482",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old female presents to the GP surgery with concerns about excessive hair growth on her face and chest. She reports that for the past year, her periods have become increasingly unpredictable. While she used to have a fairly regular 28-day cycle, she now experiences menstruation at varying intervals, ranging from 24 to 55 days. She denies any significant changes to her lifestyle.\n\nOn examination, the presence of terminal hair growth in male-pattern distribution is noted.\n\nWhich of the following additional symptoms is most likely to be seen?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,484 | false | 40 | null | 6,495,184 | null | false | [] | null | 17,483 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum FSH could be taken if pregnancy is ruled out and perimenopause is suspected, in which a marked increase in FSH levels would be seen. In this vignette, the patient describes symptoms that could be seen in both pregnancy and menopause, such as weight gain, night sweats and mood changes. Therefore, the initial step is to first rule out pregnancy with a urinary β-hCG test.",
"id": "10025426",
"label": "b",
"name": "Serum FSH",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prolactin levels are more commonly assessed when there is a suspicion of hyperprolactinemia as a cause of amenorrhea. This condition can lead to irregular menstrual cycles and can sometimes present with other symptoms, but it is not as time-sensitive as ruling out pregnancy. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.",
"id": "10025428",
"label": "d",
"name": "Serum prolactin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroid function tests can be considered, as a thyroid imbalance can cause menstrual irregularities. However, the combination of symptoms described, including oligomenorrhoea and weight gain, should prompt us to consider the possibility of pregnancy, especially given the patient's age and the fact that she is sexually active. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.",
"id": "10025429",
"label": "e",
"name": "Thyroid function tests",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum oestrogen levels is not the initial investigation of choice because they do not directly address the primary concern of missed menstruation and the potential for pregnancy. Once pregnancy is ruled out, further evaluation including assessing hormonal levels, can be considered to investigate the underlying cause of secondary amenorrhea and associated symptoms. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.",
"id": "10025427",
"label": "c",
"name": "Serum oestrogen",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Remember that it is essential to rule out pregnancy as a potential cause of amenorrhoea in women who are sexually active and are potentially at childbearing age. A urinary β-hCG test can quickly and definitively determine whether the patient is pregnant. When an embryo attaches to the uterine lining, it begins to produce hCG. In a healthy pregnancy, hCG levels rise rapidly in the early weeks.",
"id": "10025425",
"label": "a",
"name": "Urinary β-hCG",
"picture": null,
"votes": 34
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5840",
"name": "Secondary amenorrhoea",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5840,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17483",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 44 year old woman is concerned about the recent changes in her menstrual cycle. She has been experiencing regular monthly periods throughout her life but has not had a menstrual period for the past 2-3 months. She reports weight gain and occasional night sweats. Her husband adds that she sometimes becomes more irritable than usual. Her exercise routine has remained consistent with her usual activity level. She is sexually active, and takes no regular medications.\n\nA physical examination is unremarkable.\n\nWhat is the best initial investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,485 | false | 41 | null | 6,495,184 | null | false | [] | null | 17,484 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tanner stage 1 describes the prepubertal stage, with testicular volume <1.5ml, and no pubic hair. By contrast, this patient currently fits Tanner stage 2.",
"id": "10025431",
"label": "b",
"name": "Stage 1",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Tanner stage 2 describes penis growth in length only, testicular volume 1.5-6ml, and some downy hair at the base of the penis in males. This therefore fits the clinical vignette.",
"id": "10025430",
"label": "a",
"name": "Stage 2",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tanner stage 4 describes the development of the glans penis, darkening of the scrotal skin, testicular volume 12-20ml, and adult pubic hair, not spreading to the thighs. By contrast, this patient currently fits Tanner stage 2.",
"id": "10025433",
"label": "d",
"name": "Stage 4",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tanner stage 3 describes penis growth further in length as well as circumference, testicular volume 6-12ml, and coarser, plus thicker and curlier hair that spreads laterally to cover more of the pubis. By contrast, this patient currently fits Tanner stage 2.",
"id": "10025432",
"label": "c",
"name": "Stage 3",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tanner stage 5 describes adult genitalia, testicular volume >20ml, and adult pubic hair spreading to the medial thighs. By contrast, this patient currently fits Tanner stage 2.",
"id": "10025434",
"label": "e",
"name": "Stage 5",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4031",
"name": "Tanner staging of puberty",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4031,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17484",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 12 year old male presents to his GP with concerns about delayed puberty.\n\nOn examination, he has testicular volume of 6 mL bilaterally, and his pubic hair is limited to a few fine, straight hairs at the base of the penis.\n\nBased on Tanner staging, which of the following best represents this patient's current stage of pubertal development?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,486 | false | 42 | null | 6,495,184 | null | false | [] | null | 17,485 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This karyotype represents Triple X syndrome, a genetic condition in females characterised by an extra X chromosome. It is associated with mild developmental and learning difficulties but does not typically manifest with the specific features described in this vignette.",
"id": "10025436",
"label": "b",
"name": "47, XXX",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This karyotype represents Klinefelter syndrome, which typically presents in males with features such as tall stature, gynaecomastia, delayed puberty, and often infertility. This patient is female and does demonstrate these clinical features.",
"id": "10025437",
"label": "c",
"name": "47, XXY",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This karyotype represents Tetrasomy X. It is not typically associated with distinctive physical features, although some individuals with XXXX Syndrome may have a taller stature than average for their age, as opposed to the short stature in this vignette. Subtle learning and behavioural differences are sometimes seen.",
"id": "10025439",
"label": "e",
"name": "48, XXXX",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Turner syndrome is a genetic condition that typically occurs in females and is characterised by the partial or complete absence of one X chromosome. The clinical features mentioned, including short stature, webbed neck (known as 'pterygium colli'), delayed puberty, high-arched palate, and widely spaced nipples, are consistent with Turner syndrome. While some individuals with Turner syndrome may have congenital heart defects, the absence of such defects in this patient does not rule out the diagnosis.",
"id": "10025435",
"label": "a",
"name": "45, XO",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This karyotype represents Down syndrome. Down syndrome is characterised by distinctive facial features, intellectual disability, speech delays, and an increased risk of congenital heart defects. Although also associated with short stature, the other symptoms described in this vignette such as a high-arched palate and widely spaced nipples are more suggestive of Turner syndrome.",
"id": "10025438",
"label": "d",
"name": "47, XX, +21",
"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": "5841",
"name": "Turner's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5841,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17485",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 17 year old female attends her GP surgery for a review of her thyroid medication. She is noted to have a short stature, webbed neck, and delayed puberty.\n\nExamination reveals a high-arched palate and widely spaced nipples. There is no evidence of any congenital heart defects.\n\nWhich of the following is the most likely karyotype for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,487 | false | 43 | null | 6,495,184 | null | false | [] | null | 17,486 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient with 47 XXY karyotype has Klinefelter syndrome. Although prolactin has a role in breast development, elevated prolactin is not typically associated with Klinefelter syndrome. Elevated prolactin levels are more commonly associated with other medical conditions, such as prolactinomas, certain medications and stress.",
"id": "10025443",
"label": "d",
"name": "Elevated prolactin levels",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient with 47 XXY karyotype has Klinefelter syndrome. Elevated LH levels are indeed a common feature of Klinefelter syndrome. In response to testicular dysfunction and decreased testosterone production, the pituitary gland releases higher levels of FSH and LH in an attempt to stimulate the testes. However, LH is not the primary hormone causing gynaecomastia; oestrogen is.",
"id": "10025442",
"label": "c",
"name": "Elevated LH levels",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient with 47 XXY karyotype has Klinefelter syndrome. Elevated FSH levels are indeed a common feature of Klinefelter syndrome. In response to testicular dysfunction and decreased testosterone production, the pituitary gland releases higher levels of FSH and LH in an attempt to stimulate the testes. However, FSH is not the primary hormone causing gynaecomastia; oestrogen is.",
"id": "10025441",
"label": "b",
"name": "Elevated FSH levels",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient with 47 XXY karyotype has Klinefelter syndrome. It is characterised by reduced testosterone levels due to testicular dysfunction and impaired testosterone production. Furthermore, if testosterone levels were to be elevated, it would not cause gynaecomastia. Instead, it would cause hyperandrogenic features such as hirsutism and acne.",
"id": "10025444",
"label": "e",
"name": "Elevated testosterone levels",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This patient with 47 XXY karyotype has Klinefelter syndrome. The additional X chromosome leads to testicular dysfunction, leading to reduced testosterone production. With lower testosterone levels and an inadequate testosterone-to-oestrogen ratio, there is a relative excess of oestrogen in the body. This hormonal imbalance can result in the development of secondary sexual characteristics that are more characteristic of females, such as gynaecomastia and less body and facial hair.",
"id": "10025440",
"label": "a",
"name": "Elevated oestrogen levels",
"picture": null,
"votes": 34
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5842",
"name": "Klinefelter syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "156",
"name": "Medical Genetics",
"typeId": 7
},
"topicId": 156,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5842,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17486",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 24 year old male attends his GP surgery with difficulty conceiving. He and his partner have been trying to conceive through regular sexual intercourse for around 18 months.\n\nOn examination, a tall stature, long limbs, and small testes are noted. There is also evidence of gynaecomastia. A karyotype analysis reveals a 47, XXY chromosomal pattern.\n\nWhich of the following hormones is primarily responsible for the development of gynecomastia in this case?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,488 | false | 44 | null | 6,495,184 | null | false | [] | null | 17,487 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's presentation is consistent with Narcissistic Personality Disorder (NPD). NPD is characterised by a pervasive pattern of grandiosity, a strong need for admiration, and arrogance. NPD is a Class B personality disorder; a group of mental health conditions characterised by dramatic, emotional, or erratic behaviours. By contrast, dissociative disorders are characterised by the presence of two or more distinct personality states, which involve a disruption in identity, consciousness, and memory. It may present with amnesia, gaps in memory, or the presence of different identities.",
"id": "10025449",
"label": "e",
"name": "Dissociative disorders",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's presentation is consistent with Narcissistic Personality Disorder (NPD). NPD is characterised by a pervasive pattern of grandiosity, a strong need for admiration, and arrogance. NPD is a Class B personality disorder; a group of mental health conditions characterised by dramatic, emotional, or erratic behaviours. By contrast, Class A personality disorders are characterised by odd or eccentric behaviours such as paranoid or schizoid personality disorder.",
"id": "10025446",
"label": "b",
"name": "Class A personality disorder",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's presentation is consistent with Narcissistic Personality Disorder (NPD). NPD is characterised by a pervasive pattern of grandiosity, a strong need for admiration, and arrogance. NPD is a Class B personality disorder; a group of mental health conditions characterised by dramatic, emotional, or erratic behaviours. By contrast, Class C personality disorders are characterised by excessive fear or anxiety, such as avoidant or obsessive-compulsive personality disorder.",
"id": "10025447",
"label": "c",
"name": "Class C personality disorders",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's presentation is consistent with Narcissistic Personality Disorder (NPD). NPD is characterised by a pervasive pattern of grandiosity, a strong need for admiration, and arrogance. NPD is a Class B personality disorder; a group of mental health conditions characterised by dramatic, emotional, or erratic behaviours. By contrast, depressive disorders are mood disorders with symptoms such as low mood, reduced interest in daily activities, fatigue and suicidal thoughts.",
"id": "10025448",
"label": "d",
"name": "Depressive disorders",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This patient's presentation is consistent with Narcissistic Personality Disorder (NPD). NPD is characterised by a pervasive pattern of grandiosity, a strong need for admiration, and arrogance as seen in this case. NPD is a Class B personality disorder; a group of mental health conditions characterised by dramatic, emotional, or erratic behaviours.",
"id": "10025445",
"label": "a",
"name": "Class B personality disorder",
"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": "4622",
"name": "Class B Personality Disorders",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4622,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17487",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old corporate manager who has had a history of strained relationships with colleagues, friends, and family members attends a mental health clinic. He describes a pattern of feeling undervalued, even though he believes he deserves admiration and recognition for his accomplishments.\n\nHe is noted to show a grandiose sense of self-importance, and a tendency to dominate conversations, often steering them toward topics that highlight his achievements and success.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 40,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,489 | false | 45 | null | 6,495,184 | null | false | [] | null | 17,488 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms and examinations are consistent with a paracetamol overdose. Naloxone is used for an opioid overdose, not a paracetamol overdose. This patient's symptoms, including nausea, vomiting, severe right upper abdominal pain, and a history of taking paracetamol, are more in line with an acute paracetamol overdose and liver injury. These symptoms do not fit an opioid overdose; symptoms such as respiratory depression, pinpoint pupils and altered mental status would be expected.",
"id": "10025454",
"label": "e",
"name": "Treat with naloxone immediately",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms and examinations are consistent with a paracetamol overdose. More than eight hours have passed since the paracetamol ingestion, so the benefit of activated charcoal in reducing absorption is significantly diminished. Only if the paracetamol overdose occurred less than 1 hour ago, should activated charcoal be administered instead of N-acetylcysteine. The patient's clinical presentation, including severe right upper abdominal pain, an enlarged liver, and elevated ALT, is concerning for potential paracetamol-induced liver injury. Specific antidote therapy (N-acetylcysteine) should be given immediately.",
"id": "10025451",
"label": "b",
"name": "Treat with activated charcoal immediately",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms and examinations are consistent with a paracetamol overdose. More than eight hours have passed since the paracetamol ingestion, so the benefit of activated charcoal in reducing absorption is significantly diminished. Only if the paracetamol overdose occurred less than 1 hour ago, should activated charcoal be administered instead of N-acetylcysteine. The patient's clinical presentation, including severe right upper abdominal pain, an enlarged liver, and elevated ALT, is concerning for potential paracetamol-induced liver injury. Specific antidote therapy (N-acetylcysteine) should be given immediately.",
"id": "10025453",
"label": "d",
"name": "Conduct a psychosocial assessment",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Her symptoms and examination findings are consistent with a paracetamol overdose, although she does not remember how many pills she has taken. The time of ingestion has been more than 8 hours, and she also appears malnourished. Therefore it is the safest option to start administering N-acetylcysteine immediately. The effectiveness of NAC in preventing or mitigating liver damage is highest when administered early, ideally within the first 8-10 hours after overdose. This can help prevent liver damage and reduce the risk of progression to severe liver injury and failure.",
"id": "10025450",
"label": "a",
"name": "Treat with N-acetylcysteine immediately",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms and examinations are consistent with a paracetamol overdose. The reason to not wait until 12 hours after ingestion and order more laboratory tests is related to the urgency of treating paracetamol overdose effectively. The efficacy of the antidote for paracetamol overdose, N-acetylcysteine (NAC) is time-sensitive. NAC is most effective when administered early, within the first 8-10 hours after the overdose. Waiting until 12 hours after ingestion may significantly reduce the effectiveness of the antidote, and liver damage could progress.",
"id": "10025452",
"label": "c",
"name": "Order more laboratory tests and wait until 12 hours after ingestion",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5843",
"name": "Paracetamol Overdose",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5843,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Treat with N-acetylcysteine immediately",
"highlights": [],
"id": "17488",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35-year-old female presents with nausea, vomiting, and severe abdominal pain. She reports that earlier in the day, she had been feeling very unwell due to flu-like symptoms and a headache, for which she took paracetamol. She does not remember how many she took but suspects it may have been more than the recommended limit, starting at 8 am that morning.\n\n\nHer observations are within the normal range. She appears pale and malnourished with right upper abdominal tenderness, enlarged liver, and pain on deep inspiration. Blood tests show deranged liver function with ALT twice the upper limit.\n\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,490 | false | 46 | null | 6,495,184 | null | false | [] | null | 17,489 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Frontotemporal dementia (FTD) typically presents with profound behavioural and personality changes, often affecting social conduct. Hallucinations are also not uncommon. These are not seen in this patient. In FTD, the cognitive decline is usually gradual and not associated with stepwise progression. This patient also has significant vascular risk factors that increase the likelihood of cerebrovascular disease, making vascular dementia more likely.",
"id": "10025457",
"label": "c",
"name": "Frontotemporal dementia",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The stepwise progression of symptoms, where there are noticeable declines in cognitive function followed by periods of stability, is more characteristic of vascular dementia. Alzheimer's disease typically exhibits a gradual, progressive decline in cognitive function without distinct, stepwise changes. Furthermore, Alzheimer's disease is primarily associated with memory, cognitive and behavioural changes and may not manifest with motor symptoms in the early stages. This patient also has significant vascular risk factors that increase the likelihood of cerebrovascular disease, making vascular dementia more likely.",
"id": "10025456",
"label": "b",
"name": "Alzheimer's disease",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The patient has diabetes and a history of hypertension and myocardial infarction, all of which are significant vascular risk factors for the development of vascular dementia. These conditions increase the risk of cerebrovascular disease and damage to the brain's blood vessels, which can lead to vascular dementia. The patient's condition deteriorating in an incremental or stepwise nature is a classic feature of vascular dementia, as vascular events such as small infarcts can lead to several small, sudden declines in cognitive function.",
"id": "10025455",
"label": "a",
"name": "Vascular dementia",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Visual hallucinations and fluctuating attention and alertness are more common in Lewy body dementia, which are not described in this vignette. A stepwise progression is less typical of dementia with Lewy bodies, which tends to have a more fluctuating course. This patient also has significant vascular risk factors that increase the likelihood of cerebrovascular disease, making vascular dementia more likely.",
"id": "10025458",
"label": "d",
"name": "Dementia with Lewy bodies",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "First of all, this patient does not have an excessive alcohol intake as she drinks around 5 units every week, which is less than the recommended 14 unit limit. Although alcohol-related dementia could also present with memory problems, her moderate alcohol intake makes alcohol-related dementia highly unlikely. Given her old age, diagnosis of a form of dementia due to age-related neuropathologic changes is much more likely. The patient's vascular risk factors and step-wise progression points towards a diagnosis of vascular dementia.",
"id": "10025459",
"label": "e",
"name": "Alcohol related dementia",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "# Summary\n\nVascular dementia (VaD) is a cognitive impairment resulting from cerebrovascular disease, often presenting with progressive stepwise cognitive deterioration over months or years. Typical presentations are stroke-related vascular disease, subcortical vascular dementia, and mixed dementia. Diagnosis is established via comprehensive history, formal cognitive screening, medication review, exclusion of reversible organic causes, and neuroimaging, preferably MRI. Management revolves around symptomatic treatment, detection and control of cardiovascular risk factors, and advanced care planning.\n\n# Definition\n\nVascular dementia is an umbrella term denoting a collection of cognitive impairment syndromes caused by cerebrovascular disease.These include stroke-related vascular disease, subcortical vascular dementia, and mixed dementia —a combination of Alzheimer's disease and vascular dementia.\n\n# Epidemiology\n\nVascular dementia (VaD) is the second most common type of dementia after Alzheimer's disease, accounting for around 15-20% of all dementia cases.\n\nPrevalence of VaD increases with age, being rare before the age of 65 but significantly rising thereafter. \n\nThe incidence of VaD is higher in males than in females, and higher in individuals with cardiovascular risk factors.\n\n# Aetiology\n\nThe primary cause of vascular dementia is ischemic or hemorrhagic cerebrovascular disease, which leads to brain damage. \n\nVarious vascular events or conditions can lead to VaD, including multi-infarct dementia, single-infarct dementia, subcortical vascular dementia (also known as Binswanger's disease), and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).\n\nRisk factors for VaD mirror those for stroke and other cardiovascular diseases: hypertension, diabetes mellitus, hyperlipidemia, smoking, and atrial fibrillation are significant risk factors. \n\nLess common causes include inflammatory and immunological vascular disorders, genetic conditions, and infections that affect the brain's blood vessels.\n\n# Signs and Symptoms\n\nThe hallmark of vascular dementia is a progressive, **stepwise** deterioration in cognition. This typically occurs over a span of several months to years. Patients may present with a history of strokes, which may be accompanied by stepwise cognitive decline or sudden changes in cognitive function, as well as stroke-like symptoms:\n\n- Visual disturbance\n- Sensory or motor symptoms\n- Difficulty with attention and concentration\n- Seizures\n- Memory disturbance\n- Gait/speech/emotional disturbance\n\nTo compare with Alzheimer's dementia, there is less impairment in episodic memory and more in visual skills, semantic memory and executive functioning.\n\n# Differential Diagnosis\n\nThe differential diagnosis for vascular dementia includes, but is not limited to:\n\n- **Alzheimer's disease**: Predominant memory impairment, slower and continuous decline, usually lack of significant vascular risk factors or neuroimaging evidence of cerebrovascular disease.\n- **Lewy body dementia**: Fluctuating cognition, visual hallucinations, Parkinsonism, and REM sleep behavior disorder are the core features.\n- **Frontotemporal dementia**: Prominent changes in personality and behavior or language difficulties with relative sparing of memory.\n- **Normal pressure hydrocephalus**: Gait disturbance, urinary incontinence, and cognitive impairment (triad of Hakim-Adams).\n\n# Investigations\n\nThe investigations for vascular dementia generally include:\n\n- Comprehensive history and examination.\n- Formal cognition screening, such as MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment).\n- Medication review to exclude medication-induced cognitive impairment.\n- Exclusion of reversible organic causes such as vitamin B12 or folic acid deficiency, hypothyroidism, or normal pressure hydrocephalus.\n- MRI Head, to identify vascular changes, infarcts, or white matter hyperintensities indicative of cerebrovascular disease. The hallmark of vascular dementia is extensive white matter change and infarcts evident on MRI imaging.\n\n[lightgallery]\n\n# Management\n\nThe management of vascular dementia involves:\n\n- Detection of and addressing cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, and smoking to slow disease progression.\n- Cognitive stimulation programmes, music and art therapy, etc. to help with cognitive impairment. \n- Symptomatic treatment, including cognitive enhancers such as cholinesterase inhibitors or memantine - if there is evidence of co-existent AD, Parkinson's dementia, or dementia with Lewy bodies. Management of neuropsychiatric symptoms.\n- Advanced care planning to prepare for progressive cognitive and physical decline.\n\n# NICE Guidelines\n\n[NICE CKS - Dementia](https://cks.nice.org.uk/topics/dementia/)",
"files": null,
"highlights": [],
"id": "912",
"pictures": [
{
"__typename": "Picture",
"caption": "Brain atrophy seen in vascular dementia.",
"createdAt": 1665036196,
"id": "941",
"index": 0,
"name": "Atrophy brain (Vascular dementia).png",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/3jfkzu1w1665036171691.jpg",
"path256": "images/3jfkzu1w1665036171691_256.jpg",
"path512": "images/3jfkzu1w1665036171691_512.jpg",
"thumbhash": "CwgKBQAHiId3CLh3h3d3hwAAAAAA",
"topic": null,
"topicId": null,
"updatedAt": 1708373886
}
],
"typeId": 2
},
"chapterId": 912,
"demo": null,
"entitlement": null,
"id": "5844",
"name": "Vascular Dementia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5844,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17489",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 77 year old woman attends her GP surgery accompanied by her daughter, who is concerned about her memory. This has been getting incrementally worsening over the last 1-2 years, but around 1 month ago deteriorated again to the point that it is now difficult to complete day-to-day activities like cooking and shopping. For the last month, there have been instances of difficulty with fine motor tasks, such as buttoning shirts and tying shoelaces. She has a past medical history of diabetes and hypertension and had a myocardial infarction 15 years ago. She has stopped smoking since her myocardial infarction, and only drinks two glasses of wine every weekend.\n\nBoth the patient and her daughter deny any personality changes or hallucinations.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,491 | false | 47 | null | 6,495,184 | null | false | [] | null | 17,490 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes mild depression as although it fulfils the DSM-V criteria of depression, there seem to be no major functional impairments. Green social prescribing involves using nature-based interventions and activities to connect people to natural environments. Although green social prescribing is proven to work in some cases of mild depression, it should be referred to on a case-to-case basis. In this vignette, the patient mentions that he has already been going on jogs with his partner and admits to making extra efforts to do so. Therefore, prescribing more nature-based interventions may not be the most helpful.",
"id": "10025463",
"label": "d",
"name": "Green social prescribing",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes mild depression as although it fulfils the DSM-V criteria of depression, there seem to be no major functional impairments. Vagus nerve stimulation is a treatment that implants a device that sends electrical impulses to the vagus nerve, to stimulate the vagal brainstem pathways associated with mood regulation. This treatment is invasive and is only suitable for severe, treatment-resistant depression.",
"id": "10025464",
"label": "e",
"name": "Vagus nerve stimulation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes mild depression as although it fulfils the DSM-V criteria of depression, there seem to be no major functional impairments. Although mirtazapine may be prescribed for moderate to severe depression that does not respond to selective serotonin reuptake inhibitors or psychological interventions, it is not indicated at this stage.",
"id": "10025461",
"label": "b",
"name": "Start mirtazapine treatment",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This vignette describes mild depression as although it fulfils the DSM-V criteria of depression, there seem to be no major functional impairments. Initial treatment may consist of low-intensity psychological interventions such as individual or group-based Cognitive Behavioural Therapy (CBT).",
"id": "10025460",
"label": "a",
"name": "Individual or group-based Cognitive Behavioural Therapy",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This vignette describes mild depression as although it fulfils the DSM-V criteria of depression, there seems to be no major functional impairments. Referral to specialist mental health services is normally needed when there are red flags such as suicidal ideation and thoughts, more severe depression or chronic depressive symptoms, and significant co-existing mental and physical health conditions. In this vignette, there are no red flags, therefore, referral at this stage is not necessary although follow-up should be arranged through primary care.",
"id": "10025462",
"label": "c",
"name": "Referral to specialist mental health services",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3971",
"name": "Depression",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3971,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17490",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 34 year old man attends his GP surgery with two months of persistent low mood, poor sleep and an inability to enjoy any of his former interests and hobbies. He had a similar episode two years earlier. There have been no suicidal thoughts so far.\n\nHe lives with his partner and works as an IT consultant. Although he enjoys his job less than he used to, he has so far managed to maintain his performance. He makes an effort to go for jogs with his partner, which can boost his mood. He drinks 10 units of alcohol per week, and has no past medical history.\n\nWhich of the following is the most appropriate initial management?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,492 | false | 48 | null | 6,495,184 | null | false | [] | null | 17,491 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Susceptibility bias refers to the phenomenon in which a particular group of individuals within a study population may have a higher or lower susceptibility to the condition or outcome under investigation. It is unrelated to the way participants are recruited into the study but rather how certain factors or characteristics may make some participants more or less likely to develop the condition or experience the outcome.",
"id": "10025466",
"label": "b",
"name": "Susceptibility bias",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Exclusion bias refers to the phenomenon whereby the researchers intentionally remove important variables or factors that should be included in the analysis from the model. For example, if the researchers purposely exclude some subgroups from the sample population. This is not the best answer because for this context because the researchers in this trial are not actively removing subgroups of participants from the clinical trial.",
"id": "10025467",
"label": "c",
"name": "Exclusion bias",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Attrition bias refers to the phenomenon where there is a systematic loss of participants or data throughout the study. This loss of participants to follow up eventually leads to systematic differences between groups and thus unrepresentative samples. This is not the best answer for this context because it does not mention attrition of data or any participant dropouts.",
"id": "10025468",
"label": "d",
"name": "Attrition bias",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Time interval bias refers to the phenomenon whereby researchers intentionally change a specified range of time or duration to support their desired findings. For example, when there is a discrepancy in the timing and duration of follow-up or observation between different study groups or exposure levels, it can lead to a distortion of the observed relationships or outcomes in the study. Although this is a type of selection bias, it does not fit this vignette.",
"id": "10025469",
"label": "e",
"name": "Time interval bias",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. By using only online mediums, this study primarily attracts tech-savvy, younger individuals who are active online and on social platforms. This is also known as convenience sampling. The trial excludes older adults and individuals with limited internet access. Therefore, the selection of participants for this clinical trial is not representative of the broader population or the specific patient group of interest, introducing sampling bias.",
"id": "10025465",
"label": "a",
"name": "Sampling bias",
"picture": null,
"votes": 33
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4470",
"name": "Selection Bias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4470,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17491",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A pharmaceutical company is conducting a clinical trial to test the effectiveness of a new medication for Type 2 diabetes. To recruit participants for the study, they decide to advertise the trial exclusively through online platforms and social media.\n\nWhich of the following forms of selection bias could affect the validity of this trial?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,493 | false | 49 | null | 6,495,184 | null | false | [] | null | 17,492 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.",
"id": "10025470",
"label": "a",
"name": "Stating a treatment has a significant benefit when in fact it does not",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a type 1 error. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'. However, a biased sample may reduce the validity of results.",
"id": "10025474",
"label": "e",
"name": "Obtaining a biased sample to receive the treatment",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of a Type II error, which is also known as a false negative. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.",
"id": "10025471",
"label": "b",
"name": "Stating a treatment has no significant benefit when in fact it does",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a correct outcome. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.",
"id": "10025472",
"label": "c",
"name": "Stating a treatment has no significant benefit when in fact it does not",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of publication bias. A type I error occurs when the null hypothesis is true (e.g. there is no effect, or no significant difference between groups), but researched falsely reject it in favour of the alternative hypothesis. It is also known as a 'false positive'.",
"id": "10025473",
"label": "d",
"name": "Only publishing significant results",
"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": "5845",
"name": "Types of error",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5845,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17492",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 37 year old man with colorectal cancer reviews some academic research into an experimental new treatment. He is concerned about the types of error that may be present.\n\nWhich of the following is an example of a type I error?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,494 | false | 50 | null | 6,495,184 | null | false | [] | null | 17,493 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. To increase statistical power, the sample size should be increased. Increasing the sample size reduces sampling variability; providing more precise estimates, increasing test sensitivity, narrowing confidence intervals, and improving the ability to detect both large and small effects.",
"id": "10025478",
"label": "d",
"name": "It is unrelated to sample size",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. If we increase the significance level, we lower the bar for statistical significance, which makes it easier to obtain significant results. This therefore increases statistical power.",
"id": "10025475",
"label": "a",
"name": "It increases with increasing significance level",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. Greater statistical power is associated with a smaller standard deviation, or less variability in the data. This means a smaller sample size is required to achieve the same level of power, as it becomes easier to detect true effects or relationships in the data.",
"id": "10025477",
"label": "c",
"name": "Greater statistical power is associated with a greater standard deviation",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. Greater statistical power is associated with a greater effect size. The effect size refers to the magnitude of the difference between groups or variables in a study. A larger effect size indicates a more substantial difference. The larger the effect size, the stronger the true effect is.",
"id": "10025479",
"label": "e",
"name": "Greater statistical power is associated with a lower effect size",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Statistical power is the likelihood that an effect will be detected in the sample when one exists in reality. To increase statistical power, the sample size should be increased. Increasing the sample size reduces sampling variability; providing more precise estimates, increasing test sensitivity, narrowing confidence intervals, and improving the ability to detect both large and small effects.",
"id": "10025476",
"label": "b",
"name": "It increases with decreasing sample size",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4354",
"name": "Statistical significance",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4354,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17493",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A researcher gathers data on the effectiveness of a novel antidepressant medication in reducing symptoms of low mood. They take care to ensure adequate statistical power.\n\nWhich of the following is true of statistical power?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,515 | false | 1 | null | 6,495,187 | null | false | [] | null | 17,494 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A fungal cause of meningitis such as a Cryptococcus species is most likely when the patient is immunocompromised. A high opening pressure on lumbar puncture is also associated with fungal meningitis. In this case, the patient is otherwise fit and well, and the CSF results indicate bacterial meningitis. This answer is therefore incorrect.",
"id": "10025484",
"label": "e",
"name": "Cryptococcus",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The presence of neck stiffness and a non-blanching rash suggest a diagnosis of bacterial meningitis. By contrast, rubella is characterised by lymphadenopathy of the head and neck. Although pyrexia and a rash are also seen in rubella, the rash tends to start on the face before spreading to the body. This answer is therefore incorrect.",
"id": "10025483",
"label": "d",
"name": "Rubella",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is in keeping with bacterial meningitis. In adult populations, Streptococcus pneumoniae is one of the most common causes of meningitis.",
"id": "10025480",
"label": "a",
"name": "Streptococcus pneumoniae",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The herpes simplex virus is a common cause of viral meningitis. In this case, the presence of low glucose levels within the CSF indicates bacterial meningitis. This answer is therefore incorrect.",
"id": "10025481",
"label": "b",
"name": "Herpes simplex virus",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is in keeping with bacterial meningitis. Staphylococcus aureus is a bacterium commonly associated with skin and soft tissue infections. It is not commonly implicated in meningitis, making this answer incorrect.",
"id": "10025482",
"label": "c",
"name": "Staphylococcus aureus",
"picture": null,
"votes": 24
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3751",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3751,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17494",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "An 18-year-old male is brought to A&E by his flatmate, who is concerned that he has started behaving strangely over the past few hours. The patient confirms feeling muddled and reports that his neck feels stiff when he tries to move it. On examination, he is pyrexial with a new rash across both legs that does not fade when held against a glass. He is usually fit and well, and has just started studying at university.\n\nA lumbar puncture is performed. Cerebrospinal fluid (CSF) analysis shows raised protein levels with low glucose.\n\nWhich of the following microorganisms is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 105,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,516 | false | 2 | null | 6,495,187 | null | false | [] | null | 17,495 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypotension is another side effect one might see shortly after starting levodopa. Administration of a peripheral decarboxylase inhibitor can help with this.",
"id": "10025487",
"label": "c",
"name": "Hypotension",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperpigmentation is not a recognised side effect of levodopa therapy.",
"id": "10025488",
"label": "d",
"name": "Hyperpigmentation",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Dystonic reactions to levodopa are commonly seen after 3-5 years of taking the drug. Patients should be counselled about this risk when starting the drug.",
"id": "10025485",
"label": "a",
"name": "Involuntary jerking of his face and arms",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nausea and vomiting are most likely to be seen when first starting levodopa. Administration of a peripheral decarboxylase inhibitor can help with this.",
"id": "10025486",
"label": "b",
"name": "Nausea and vomiting",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Isolated electrolyte abnormalities (i.e. not as a result of vomiting) are not commonly caused by long-term levodopa administration. Dystonic reactions are far more common.",
"id": "10025489",
"label": "e",
"name": "Hyperchloraemia",
"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": "5846",
"name": "Levodopa",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5846,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17495",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old Caucasian male is seen in a neurology clinic with regard to his Parkinson's disease. He has been taking levodopa for 3 years now and is concerned about potential long-term side effects.\n\nWhich of the following is most likely to occur as a result of this long-term levodopa use?",
"sbaAnswer": [
"a"
],
"totalVotes": 98,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,517 | false | 3 | null | 6,495,187 | null | false | [] | null | 17,496 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Sudden abdominal pain with cloudy dialysate is a hallmark of PD peritonitis. Patients should be given intra-peritoneal antibiotics as soon as possible.",
"id": "10025490",
"label": "a",
"name": "PD peritonitis",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, fluid overload would not be expected to cause these symptoms and is not a common complication of starting peritoneal dialysis.",
"id": "10025493",
"label": "d",
"name": "Fluid overload",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, hyperbilirubinaemia is characterised by yellowing of the skin (jaundice) and is not a common complication of peritoneal dialysis.",
"id": "10025494",
"label": "e",
"name": "Hyperbilirubinaemia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, an exit-site infection is characterised by erythema and possible discharge at the catheter site.",
"id": "10025491",
"label": "b",
"name": "Exit-site infection",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, a tunnel infection is indicated by swelling and erythema at the catheter site.",
"id": "10025492",
"label": "c",
"name": "Tunnel infection",
"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": "4351",
"name": "Renal Replacement therapy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4351,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17496",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 52 year old woman is commenced on peritoneal dialysis (PD) due to her end stage kidney disease. Shortly after starting PD, she develops sudden abdominal pain. It is noted that the contents of her dialysis bag has turned cloudy.\n\nWhich of the following is the most likely cause of this patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 93,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,518 | false | 4 | null | 6,495,187 | null | false | [] | null | 17,497 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aminoglycosides such as gentamicin work by binding to ribosomes to inhibit bacterial protein synthesis. This does not describe the mechanism of action of ciprofloxacin. Quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.",
"id": "10025499",
"label": "e",
"name": "Inhibition of protein synthesis",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Programmed cell death of bacteria is not a recognised method of bacterial destruction by conventional antibiotics. This does not describe the mechanism of action of ciprofloxacin. Quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.",
"id": "10025498",
"label": "d",
"name": "Programmed cell death of bacteria",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bacterial protein synthesis inhibition describes the mechanism of action of tetracycline, macrolide and aminoglycoside antibiotics. By contrast, quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.",
"id": "10025497",
"label": "c",
"name": "Bacterial protein synthesis inhibition",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Quinolones (including ciprofloxacin), sulphonamides and nitroimidazoles work by inhibiting bacterial DNA synthesis. This answer is therefore correct.",
"id": "10025495",
"label": "a",
"name": "Inhibition of nucleic acid synthesis",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inhibition of bacterial cell wall synthesis describes the mechanism of action of penicillins and cephalosporins. By contrast, quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.",
"id": "10025496",
"label": "b",
"name": "Inhibition of bacterial cell wall synthesis",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3887",
"name": "Antibiotics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
},
"topicId": 148,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3887,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17497",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 57 year old man is prescribed ciprofloxacin for an infected diabetic ulcer. The GP explains that ciprofloxacin is a member of the quinolone family of antibiotics.\n\nWhich of the following best describes the mechanism of action of ciprofloxacin?",
"sbaAnswer": [
"a"
],
"totalVotes": 94,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,519 | false | 5 | null | 6,495,187 | null | false | [] | null | 17,498 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.",
"id": "10025500",
"label": "a",
"name": "Alcohol dehydrogenase",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acetaldehyde dehydrogenase is the enzyme responsible for converting acetaldehyde to acetyl CoA. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.",
"id": "10025501",
"label": "b",
"name": "Acetaldehyde dehydrogenase",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Isocitrate is a substrate found within within the Krebs cycle. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde",
"id": "10025504",
"label": "e",
"name": "Isocitrate",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxaloacetate is a substrate found within the Krebs cycle. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.",
"id": "10025503",
"label": "d",
"name": "Oxaloacetate",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acetyl CoA is the product arising from the joining of co-enzyme A to acetate after its production from acetaldehyde. Acetyl CoA can then go into the Krebs cycle or be converted into fatty acids. By contrast, alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.",
"id": "10025502",
"label": "c",
"name": "Acetyl CoA",
"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": "4626",
"name": "Chronic alcoholism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4626,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17498",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 21 year old woman is brought to A&E after consuming a litre of vodka and losing consciousness in the street. The clinical team discusses the process of alcohol metabolism.\n\nWhich of the following enzymes is responsible for converting ethanol to acetaldehyde?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,520 | false | 6 | null | 6,495,187 | null | false | [] | null | 17,499 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman. A 7 day course of nitrofurantoin is appropriate for pregnant women, however given the negative urine pregnancy test this option is incorrect.",
"id": "10025508",
"label": "d",
"name": "Oral nitrofurantoin twice daily for 7 days",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The symptoms of dysuria and urinary frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman. This option is therefore correct.",
"id": "10025505",
"label": "a",
"name": "Oral trimethoprim twice daily for 3 days",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman.",
"id": "10025509",
"label": "e",
"name": "Oral gentamicin twice daily for 3 days",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman.",
"id": "10025507",
"label": "c",
"name": "Oral amoxicillin twice daily for 3 days",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Intravenous ciprofloxacin can be used in the management of urinary tract infections. However, it is not the first-line treatment option in a patient with normal observations who does not require hospital admission. A 3 day oral course of trimethoprim/nitrofurantoin is most appropriate in this case.",
"id": "10025506",
"label": "b",
"name": "Intravenous ciprofloxacin twice daily for 5 days",
"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": "4613",
"name": "Urinary tract infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4613,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17499",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old woman presents to her GP with 5 days of burning pain when urinating. She also feels the urge to urinate more frequently. A urine pregnancy test is negative, but the urine dip is positive for leucocytes and nitrites. She is otherwise fit and well with normal renal function, and her observations are all within the normal range.\n\nWhich of the following antibiotic treatment regimes is most appropriate?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,521 | false | 7 | null | 6,495,187 | null | false | [] | null | 17,500 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Naproxen is a non-steroidal anti-inflammatory drug (NSAID). This class of drugs works through the inhibition of COX-1 enzymes in the gastrointestinal tract, disrupting prostaglandin secretion which usually has a cytoprotective effect on the gastric mucosa. Naproxen therefore increases the risk of gastric ulcers (peptic ulcer disease), and so is often prescribed with a proton pump inhibitor to reduce this risk.",
"id": "10025510",
"label": "a",
"name": "Naproxen",
"picture": null,
"votes": 82
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Omeprazole is a proton pump inhibitor. It works by inhibiting gastric acid secretion, thus reducing the incidence of gastric ulceration. It can also be used in the management of Helicobacter Pylori (H. Pylori) disease. This option is therefore incorrect.",
"id": "10025514",
"label": "e",
"name": "Omeprazole",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Co-codamol is a combination drug consisting of paracetamol and the opioid codeine. Neither is commonly associated with damage to the gastric mucosa. This option is therefore incorrect.",
"id": "10025511",
"label": "b",
"name": "Co-codamol",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amoxicillin is an antibiotic. It is not commonly associated with damage to the gastric mucosa. It can, however, be used in the management of Helicobacter Pylori (H. Pylori) disease, reducing the incidence of gastric ulceration. This option is therefore incorrect.",
"id": "10025512",
"label": "c",
"name": "Amoxicillin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Salbutamol is a beta-2 agonist typically used in the management of conditions such as asthma & chronic obstructive pulmonary disorder (COPD). It is not thought to contribute to gastric ulcer formation. This option is therefore incorrect.",
"id": "10025513",
"label": "d",
"name": "Salbutamol",
"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": "4052",
"name": "Peptic ulcer disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4052,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17500",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old woman discusses the results of a recent endoscopy with her GP. It notes the presence of multiple gastric ulcers.\n\nShe has been experiencing symptoms of dyspepsia for the past 6 months. She also suffers with chronic back pain and asthma, for which she takes a range of prescribed medications.\n\nWhich of the following repeat prescriptions is most likely to have contributed to her gastric ulcers?",
"sbaAnswer": [
"a"
],
"totalVotes": 92,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,522 | false | 8 | null | 6,495,187 | null | false | [] | null | 17,501 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The build-up of symptoms in the week before menstruation makes them more likely to be pre-menstrual in origin, rather than due to GAD. GAD sufferers tend to have persistent anxiety throughout the month that does not usually get better after menstruation has finished.",
"id": "10025518",
"label": "d",
"name": "General anxiety disorder (GAD)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The build-up of symptoms in the week before menstruation makes them more likely to be pre-menstrual in origin, rather than due to depression. There is no pattern of monthly alleviation and deterioration in pure depressive disease.",
"id": "10025517",
"label": "c",
"name": "Depression",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An acute stress reaction develops in response to severe physical and/or mental stress, for example witnessing a fatal road traffic accident. It should last no more than one month. This patient does not make reference to a traumatic event, and her symptoms have been ongoing for more than one month. This, plus the variation in symptom severity according to menstruation, is more in keeping with pre-menstrual syndrome than an acute stress reaction.",
"id": "10025519",
"label": "e",
"name": "Acute stress reaction",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Any long-standing psychiatric symptoms such as mood swings should always be investigated and not dismissed as normal. In this case the women is likely suffering from pre-menstrual syndrome, as her symptoms and fatigue seem to peak in the week before her period starts.",
"id": "10025516",
"label": "b",
"name": "Normal physiology",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Psychological symptoms and fatigue that seem to peak in the week before menstruation in a pre-menopausal women should raise suspicion of pre-menstrual syndrome. This typically occurs in a relapsing-remitting fashion over a number of months.",
"id": "10025515",
"label": "a",
"name": "Pre-menstrual syndrome",
"picture": null,
"votes": 80
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5847",
"name": "Pre-menstrual syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5847,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17501",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 26 year old woman has been suffering from severe mood swings, anxiety and fatigue for the past 6 months. She tells her GP that her symptoms significantly worsen in the week before her period starts, and then get somewhat better once her period has ended. She is otherwise fit and well with no regular medications.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 86,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,523 | false | 9 | null | 6,495,187 | null | false | [] | null | 17,502 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ulcerative colitis is also characterised by a change in bowel habit with abdominal pain. However, in ulcerative colitis the faecal calprotectin level will be raised. In this case, the normal faecal calprotectin is indicative of irritable bowel syndrome (IBS) instead. Relief of the pain by defecation is also characteristic of IBS rather than ulcerative colitis.",
"id": "10025522",
"label": "c",
"name": "Ulcerative colitis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combination of abdominal pain relieved by defecation, mucus in the stool and abdominal distension is in keeping with IBS. By contrast, type 1 diabetes is characterised by signs of endocrine dysfunction such as polyuria and polydipsia.",
"id": "10025524",
"label": "e",
"name": "Type 1 diabetes mellitus",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Crohn's disease is also characterised by a change in bowel habit with abdominal pain. However, in Crohn's disease the faecal calprotectin level will be raised. In this case, the normal faecal calprotectin is indicative of irritable bowel syndrome (IBS) instead. Relief of the pain by defecation is also characteristic of IBS rather than Crohn's disease.",
"id": "10025521",
"label": "b",
"name": "Crohn's disease",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of abdominal pain relieved by defecation, mucus in the stool and abdominal distension is in keeping with IBS. It is important to rule out alternative causes of these symptoms including irritable bowel disease (IBD) and coeliac disease, before a diagnosis of IBS is made.",
"id": "10025520",
"label": "a",
"name": "Irritable bowel syndrome (IBS)",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Colorectal cancer is associated with red flag features such as rectal bleeding, weight loss and in some cases, a palpable mass. These are not present in this case. Abdominal pain that is relieved by defecation, mucus in the stool and abdominal distension are all indicative of irritable bowel syndrome.",
"id": "10025523",
"label": "d",
"name": "Colorectal cancer",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5848",
"name": "Irritable bowel syndrome (IBS)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5848,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17502",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 27 year old women presents to her GP with a 3 month history of abdominal pain. This pain tends to be worse after eating, and is relieved by opening her bowels. She has noticed mucus in her stool during this time, and feels quite bloated.\n\nFull investigations are performed. Blood tests, including an IgA anti-tissue transglutaminase test, show no abnormalities. Urine pregnancy test, faecal calprotectin and stool microscopy are also normal.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 90,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,524 | false | 10 | null | 6,495,187 | null | false | [] | null | 17,503 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Given the long-term nature of the symptoms, this is unlikely to be delirium. Delirium is a more acute change in mental state caused by an underlying abnormality such as an infection or electrolyte imbalance. The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB).",
"id": "10025529",
"label": "e",
"name": "Delirium",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, patients with vascular dementia are more likely to have underlying cardiovascular risk factors such as hypertension and hyperlipidaemia. Vascular dementia is also characterised by a 'stepwise' decline rather than the more gradual and fluctuating presentation seen in DLB.",
"id": "10025526",
"label": "b",
"name": "Vascular dementia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, Alzheimer's disease does not typically feature bradykinesia or visual hallucinations.",
"id": "10025527",
"label": "c",
"name": "Alzheimer's disease",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, fronto-temporal dementia usually presents with changes to behaviour, personality and language.",
"id": "10025528",
"label": "d",
"name": "Fronto-temporal dementia",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). DLB makes up 10-15% of dementia cases.",
"id": "10025525",
"label": "a",
"name": "Dementia with Lewy bodies",
"picture": null,
"votes": 62
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5849",
"name": "Dementia with Lewy bodies",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5849,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17503",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 75 year old man presents to the GP surgery with his wife. She reports that her husband has been getting gradually more muddled over the past 8 months, forgetting where he puts things and the names of certain relatives. In the same period, his movements have become noticeably slower. He reports sometimes seeing animals in their living room that his wife says are not really there. He is otherwise fit and well, and takes no regular medications.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,525 | false | 11 | null | 6,495,187 | null | false | [] | null | 17,504 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The zona glomerulosa produces and secretes the mineralocorticoid aldosterone into the bloodstream, responding to altered serum potassium or decreased blood flow to the kidneys as part of the renin-angiotensin system. The zona fasciculata is responsible for glucocorticoid production and secretion.",
"id": "10025531",
"label": "b",
"name": "Mineralocorticoids",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a hormone released from the posterior pituitary gland in response to hyperosmolality, acting upon the collecting duct of the kidney. Addison's disease involves the adrenal glands and affects glucocorticoid production and secretion from the zona fasciculata.",
"id": "10025534",
"label": "e",
"name": "Anti-diuretic hormone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The zona fasciculata is the biggest part of the adrenal cortex and secretes glucocorticoids such as cortisol in response to adrenocorticotrophic hormone. Glucocorticoids have a vital role in regulating glucose within the body, as well as impacting blood pressure and immune function.",
"id": "10025530",
"label": "a",
"name": "Glucocorticoids",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxytocin is a hormone released from the posterior pituitary gland in response to sexual activity and childbirth. By contrast, Addison's disease involves the adrenal glands and affects glucocorticoid production and secretion from the zona fasciculata.",
"id": "10025533",
"label": "d",
"name": "Oxytocin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The adrenal medulla is responsible for secreting catecholamines. These include adrenaline and noradrenaline and are released in response to sympathetic nervous system stimulation. By contrast, Addison's disease involves the adrenal cortex and affects glucocorticoid production and secretion from the zona fasciculata.",
"id": "10025532",
"label": "c",
"name": "Catecholamines",
"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": "3812",
"name": "Adrenal cortical hormones",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3812,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17504",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 34 year old women is counselled by her GP regarding a new diagnosis of Addison's disease. She is told the disease has lead to destruction of the zona fasciculata in her adrenal cortex.\n\nWhich of the following hormones are secreted by the zona fasciculata of the adrenal cortex?",
"sbaAnswer": [
"a"
],
"totalVotes": 89,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,526 | false | 12 | null | 6,495,187 | null | false | [] | null | 17,505 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HSV 1 and 2 are both viruses commonly implicated in genital herpes. They are not typically associated with cervical cancer. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer.",
"id": "10025537",
"label": "c",
"name": "Herpes simplex virus (HSV) 1 & 2",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis B and C viruses are associated with blood-borne infections damaging the liver. They are not implicated in cervical cancer. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer. Cervical screening therefore tests for HPV 16 and 18.",
"id": "10025539",
"label": "e",
"name": "Hepatitis B & C",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer. Cervical screening therefore tests for these two viral serotypes.",
"id": "10025535",
"label": "a",
"name": "Human papillomavirus (HPV) 16 & 18",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is the correct virus species, it is HPV 16 and 18 that are more commonly associated with cervical cancer. Cervical screening therefore tests for HPV 16 and 18.",
"id": "10025538",
"label": "d",
"name": "Human papillomavirus (HPV) 10 & 14",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Epstein-Barr virus infection is not associated with an increased risk of cervical cancer. This virus is more commonly associated with glandular fever. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer.",
"id": "10025536",
"label": "b",
"name": "Epstein-Barr virus type 1 & 2",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3847",
"name": "Cervical cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3847,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17505",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old woman attends her GP practice for a cervical screen (smear test). The doctor explains that the sample is tested for viruses that increase your risk of developing cervical cancer.\n\nWhich of the following two viral serotypes are most commonly associated with an increased risk of cervical cancer?",
"sbaAnswer": [
"a"
],
"totalVotes": 88,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,527 | false | 13 | null | 6,495,187 | null | false | [] | null | 17,506 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Parietal cells of the stomach secrete hydrochloric acid. This hydrochloric acid converts the pepsinogen secreted by the chief cells into pepsin, which breaks down the protein in food into amino acids and peptides.",
"id": "10025542",
"label": "c",
"name": "Hydrochloric acid",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no evidence to indicate sulphuric acid secretion by any cells in the stomach. Chief cells secrete pepsinogen, which reacts with hydrochloric acid to form pepsin, the endopeptidase which breaks down the protein in food into amino acids and peptides.",
"id": "10025543",
"label": "d",
"name": "Sulphuric acid",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is close to being correct. The chief cells secrete pepsinogen, a proenzyme, that is converted to pepsin through a reaction with hydrochloric acid in the stomach. Pepsin is an endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.",
"id": "10025541",
"label": "b",
"name": "Pepsin",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct - pepsinogen is a proenzyme secreted by chief cells of the stomach. It reacts with hydrochloric acid to form pepsin, the endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.",
"id": "10025540",
"label": "a",
"name": "Pepsinogen",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no evidence to indicate magnesium sulphate secretion by any cells in the stomach. Chief cells secrete pepsinogen, which reacts with hydrochloric acid to form pepsin, the endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.",
"id": "10025544",
"label": "e",
"name": "Magnesium sulphate",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3776",
"name": "Gastric Secretion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3776,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17506",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 41 year old man is counselled on the use of proton pump inhibitors by an advanced nurse practitioner, after a recent diagnosis of gastro-oesophageal reflux disease. The nurse explains that the stomach contains chief cells that have a secretory function.\n\nWhich of the following compounds is secreted by chief cells of the stomach?",
"sbaAnswer": [
"a"
],
"totalVotes": 88,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,528 | false | 14 | null | 6,495,187 | null | false | [] | null | 17,507 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. DKA is far more common in individuals suffering from type 1 than type 2 diabetes.",
"id": "10025547",
"label": "c",
"name": "Type 2 diabetes mellitus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no indication this is an asthmatic attack, given the absence of shortness of breath or wheeze. This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. The most likely underlying cause of a DKA is type 1 diabetes mellitus.",
"id": "10025549",
"label": "e",
"name": "Acute asthmatic attack",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. The most likely underlying cause of DKA is type 1 diabetes mellitus. Diabetes insipidus is a condition characterised by reduced production of anti-diuretic hormone. It is unrelated to the more common diabetes mellitus which revolves around insulin insufficiency.",
"id": "10025548",
"label": "d",
"name": "Diabetes insipidus",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alcoholic ketoacidosis presents similarly with abdominal pain, nausea and vomiting but on a background of chronic alcohol misuse. There is no indication of chronic alcohol misuse in this case, making this option incorrect.",
"id": "10025546",
"label": "b",
"name": "Alcoholic ketoacidosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic presentation of diabetic ketoacidosis (DKA), caused by an underlying type 1 diabetes mellitus. In a young individual with no past medical history presenting with abdominal pain and vomiting, DKA as a first presentation of type 1 diabetes should always be towards the top of the differential list. It is made even more likely to be DKA given the classic pear drop breath sign.",
"id": "10025545",
"label": "a",
"name": "Type 1 diabetes mellitus",
"picture": null,
"votes": 78
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3937",
"name": "Type 1 Diabetes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3937,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17507",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 15 year old boy presents to the emergency department with sudden-onset diffuse abdominal pain, as well as extensive nausea and vomiting. His mother comments that his breath smells a bit like pear drops. He has never felt like this before. He has no known medical conditions and takes no regular medications.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 89,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,529 | false | 15 | null | 6,495,187 | null | false | [] | null | 17,508 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include a reduced risk of neonatal infection and improved digestive function.",
"id": "10025550",
"label": "a",
"name": "6 months",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.",
"id": "10025554",
"label": "e",
"name": "1 year",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.",
"id": "10025551",
"label": "b",
"name": "2 years",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.",
"id": "10025553",
"label": "d",
"name": "3 months",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.",
"id": "10025552",
"label": "c",
"name": "1 month",
"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": "4127",
"name": "Breastfeeding",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4127,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17508",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old woman has recently given birth to her daughter on the labour ward. She asks her midwife about how best to feed her new baby when she leaves the ward to go home. The team signpost her to the World Health Organisation (WHO) advice regarding breastfeeding.\n\nFor how long does the WHO recommend that mothers exclusively breastfeed their new-born?",
"sbaAnswer": [
"a"
],
"totalVotes": 86,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,530 | false | 16 | null | 6,495,187 | null | false | [] | null | 17,509 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Thiamine (vitamin B1) deficiency is often seen in individuals with chronic alcohol exposure. It manifests itself as a triad of confusion (demonstrated by this man not knowing where he is), ataxia (seen in the man's clumsy movements) and ophthalmoplegia (seen in the man's nystagmus). This triad is known as Wernicke's encephalopathy.",
"id": "10025555",
"label": "a",
"name": "Vitamin B1",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deficiency in vitamin A leads to problems with sight and visual loss. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.",
"id": "10025559",
"label": "e",
"name": "Vitamin A",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deficiency of vitamin C leads to scurvy, with symptoms of gingival hypertrophy and bleeding. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.",
"id": "10025556",
"label": "b",
"name": "Vitamin C",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deficiency of vitamin B3 leads to the condition pellagra, recognised by the triad of dermatitis, dementia and diarrhoea. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.",
"id": "10025557",
"label": "c",
"name": "Vitamin B3",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deficiency in vitamin D leads to osteomalacia or rickets, where bones are weak due to inadequate mineralisation. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.",
"id": "10025558",
"label": "d",
"name": "Vitamin D",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5850",
"name": "Wernicke's encephalopathy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5850,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17509",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 52 year old male presents to the emergency department with his wife. He states that he does not know where he is, and is seen stumbling around the department clumsily. On examination he is found to have bilateral nystagmus. His wife reports that he has been suffering from chronic alcoholism for at least twenty years.\n\nWhich of the following vitamins is most likely to be deficient in the condition this man is exhibiting?",
"sbaAnswer": [
"a"
],
"totalVotes": 89,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,531 | false | 17 | null | 6,495,187 | null | false | [] | null | 17,510 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of anti-viral drugs such as oseltamivir (Tamiflu). Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.",
"id": "10025563",
"label": "d",
"name": "Inhibits viral release from host cell",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of drugs such as enfuvirtide, which is used to treat human immunodeficiency virus (HIV). Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.",
"id": "10025561",
"label": "b",
"name": "Inhibits viral to host cell fusion",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.",
"id": "10025560",
"label": "a",
"name": "Inhibits viral nucleic acid replication",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of antiviral drugs such as amantadine, which treats certain influenza infections. It works by stopping the virus from releasing its genetic material once inside the host cell. Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.",
"id": "10025562",
"label": "c",
"name": "Inhibits viral uncoating",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of ledipasvir, which is also used in hepatitis C treatment. It inhibits a protein that is required for viral replication. Sofosbuvir is a nucleotide analogue that inhibits viral ribose nucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.",
"id": "10025564",
"label": "e",
"name": "Inhibits viral protein synthesis",
"picture": null,
"votes": 20
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4039",
"name": "Hepatitis viruses",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4039,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17510",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 62 year old male with deranged liver function tests is diagnosed with a chronic hepatitis C infection. His gastroenterologist recommends starting a new anti-viral medication, sofosbuvir.\n\nWhich of the following best describes the mechanism of action of sofosbuvir?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,532 | false | 18 | null | 6,495,187 | null | false | [] | null | 17,511 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Herpes infections of the genitals are associated with painful, blistering genital ulcers. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.",
"id": "10025569",
"label": "e",
"name": "Herpes-simplex virus 1",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The white, 'cottage cheese' appearance of the discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans. Being pregnant is an additional risk factor for developing thrush.",
"id": "10025565",
"label": "a",
"name": "Candida albicans",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Molluscum contagiosum infection is associated with small, pearly lesions across the genitals or all over the body. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.",
"id": "10025566",
"label": "b",
"name": "Molluscum contagiosum",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Genital discharge from Neisseria gonorrhoea is mucopurulent in nature. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.",
"id": "10025568",
"label": "d",
"name": "Neisseria gonorrhoea",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chlamydia trachomatis is a sexually transmitted infection that can manifest in a number of ways. Although it can cause changes to vaginal discharge, this is not typically white or 'cottage cheese-like'. The white, 'cottage cheese' appearance of the discharge reported in this case is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.",
"id": "10025567",
"label": "c",
"name": "Chlamydia trachomatis",
"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": "5851",
"name": "Genital candidiasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5851,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17511",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old woman presents to her GP with a change to her vaginal discharge. She says it is white and looks a little like cottage cheese. It is accompanied by some vulvar itchiness. She is 23 weeks pregnant with her first child, but the pregnancy has been uncomplicated so far. Her observations are all within the normal range, and a urine dip shows no abnormalities.\n\nWhich of the following microorganisms is most likely to account for this woman's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,533 | false | 19 | null | 6,495,187 | null | false | [] | null | 17,512 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "During ovulation, a surge in luteinizing hormone causes the dominant follicle to release an ovum from the ovary. Progesterone levels slowly build up to a peak after this, with ongoing secretion from the corpus luteum.",
"id": "10025572",
"label": "c",
"name": "Ovulation",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "During the luteal phase, the corpus luteum releases peak levels of progesterone. This functions to thicken the uterine lining and prepare for implantation. If implantation occurs, the corpus luteum continues to secrete progesterone to maintain the embryo. If there is no implantation, the corpus luteum degenerates and the cycle is restarted.",
"id": "10025570",
"label": "a",
"name": "Luteal phase",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "During the menstruation phase, follicle-stimulating hormone and luteinizing hormone levels are above that of progesterone and oestrogen respectively. The lining of the uterus is shed from the body due to the lack of implantation.",
"id": "10025571",
"label": "b",
"name": "Menstruation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The dominant hormone during the follicular phase is oestrogen. Oestrogen is secreted by the granulosa cells that surround follicles causing them to mature and be ready for ovulation.",
"id": "10025573",
"label": "d",
"name": "Follicular phase",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a recognised part of the menstrual cycle. During the luteal phase, the corpus luteum releases peak levels of progesterone to thicken the uterine lining and prepare for implantation. If implantation occurs, the corpus luteum continues to secrete progesterone to maintain the embryo. If there is no implantation then the corpus luteum degenerates and the cycle is restarted",
"id": "10025574",
"label": "e",
"name": "The thrombocytic phase",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3841",
"name": "Menstrual cycle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3841,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17512",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 33 year old marathon runner is attending a specialist gynaecological clinic to discuss her secondary amenorrhoea. She is interested in learning more about her menstrual cycle.\n\nAt which of the following points of the menstrual cycle would progesterone levels be expected to peak?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,534 | false | 20 | null | 6,495,187 | null | false | [] | null | 17,513 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myoclonic seizures involve brief, non-rhythmic jerking spasms of a muscle or group of muscles. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.",
"id": "10025577",
"label": "c",
"name": "Myoclonic seizure",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The key to this question is the rhythmic jerking of the patient's limbs coupled with muscular stiffness. These are characteristic of a tonic-clonic seizure (also called grand mal or convulsive seizures). Additional features of this type of seizure not present in this case include urinary incontinence and tongue biting.",
"id": "10025575",
"label": "a",
"name": "Tonic-clonic seizure",
"picture": null,
"votes": 76
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This type of seizure is characterised by a loss of muscle tone, with consciousness normally retained. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.",
"id": "10025578",
"label": "d",
"name": "Atonic",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Absence seizures present with brief periods of impaired awareness or responsiveness, lasting less than 20 seconds. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.",
"id": "10025576",
"label": "b",
"name": "Absence seizure",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not an epileptic-type seizure. They tend to occur in children who also have a febrile illness. The patient in this case is an adult with known epilepsy, and no febrile illness is noted. This is therefore not the most likely option.",
"id": "10025579",
"label": "e",
"name": "Febrile seizure",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3749",
"name": "Epilepsy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3749,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17513",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 30 year old man is having a picnic with his family when he suddenly stops what he is doing, stumbles to the ground and loses consciousness. His muscles visibly stiffen and his legs and arms begin to rhythmically jerk. He has a known history of epilepsy.\n\nWhich of the following terms best describes the type of epileptic seizure demonstrated?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,535 | false | 21 | null | 6,495,187 | null | false | [] | null | 17,514 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "To determine number needed to treat, start by calculating the absolute risk difference. This is the percentage of incidents (incidents being seizures in this case) in the control group (those taking sodium valproate) minus the percentage of incidents in the intervention group (those taking the new drug). For this example that would be 33 - 8 = 25. From here, the number needed to treat is simply 1/ the absolute risk difference. Bear in mind that you need to express the absolute risk difference as a integer between 0 and 1, so 0.25 in this example (1/0.25 = 4).",
"id": "10025583",
"label": "d",
"name": "8",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It looks as though you have added the difference in percentages between the control and intervention group rather than subtract them.\n\nTo determine number needed to treat, start by calculating the absolute risk difference. This is the percentage of incidents (incidents being seizures in this case) in the control group (those taking sodium valproate) minus the percentage of incidents in the intervention group (those taking the new drug). For this example that would be 33 - 8 = 25. From here, the number needed to treat is simply 1/ the absolute risk difference. Bear in mind that you need to express the absolute risk difference as a integer between 0 and 1, so 0.25 in this example (1/0.25 = 4).",
"id": "10025582",
"label": "c",
"name": "2",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "To determine number needed to treat, start by calculating the absolute risk difference. This is the percentage of incidents (incidents being seizures in this case) in the control group (those taking sodium valproate) minus the percentage of incidents in the intervention group (those taking the new drug). For this example that would be 33 - 8 = 25. From here, the number needed to treat is simply 1/ the absolute risk difference. Bear in mind that you need to express the absolute risk difference as a integer between 0 and 1, so 0.25 in this example (1/0.25 = 4).",
"id": "10025584",
"label": "e",
"name": "32",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "To determine number needed to treat, start by calculating the absolute risk difference. This is the percentage of incidents (incidents being seizures in this case) in the control group (those taking sodium valproate) minus the percentage of incidents in the intervention group (those taking the new drug). For this example that would be 33 - 8 = 25. From here, the number needed to treat is simply 1/ the absolute risk difference. Bear in mind that you need to express the absolute risk difference as a integer between 0 and 1, so 0.25 in this example (1/0.25 = 4).",
"id": "10025580",
"label": "a",
"name": "4",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It looks as though you have added the difference in percentages between the control and intervention group rather than subtracting them.\n\nTo determine number needed to treat, start by calculating the absolute risk difference. This is the percentage of incidents (incidents being seizures in this case) in the control group (those taking sodium valproate) minus the percentage of incidents in the intervention group (those taking the new drug). For this example that would be 33 - 8 = 25. From here, the number needed to treat is simply 1/ the absolute risk difference. Bear in mind that you need to express the absolute risk difference as a integer between 0 and 1, so 0.25 in this example (1/0.25 = 4).\n\nThe number needed to treat must always be rounded to a whole number!",
"id": "10025581",
"label": "b",
"name": "2.43",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5852",
"name": "Number needed to treat",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5852,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17514",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A consultant neurologist reviews the findings of a randomised control trial comparing a new anti-epileptic drug to sodium valproate. Amongst patients taking the new drug, the incidence of seizures at 3 months was 8%, compared to 33% for those taking sodium valproate.\n\nCalculate the number needed to treat with this new anti-epileptic drug in order to prevent one seizure.",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,536 | false | 22 | null | 6,495,187 | null | false | [] | null | 17,515 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This question is testing your knowledge of the dorsal column. This is the pathway through which sensory information travels to the brain, including fine touch and vibration sense. Sensory information from T7 or below (like that from the leg) enters the spinal cord via first-order neurons, forming the gracile fasciculus within the spinal cord. The first-order neuron ascends ipsilaterally within the gracile fasciculus before entering the brainstem at the gracile nucleus within the medulla. If the information was coming from above T7, then it would enter the spinal cord and form the cuneate fasciculus before entering the medulla at the cuneate nucleus.",
"id": "10025589",
"label": "e",
"name": "Cuneate fasciculus",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the pathway through which sensory information travels to the brain, including fine touch and vibration sense. Sensory information from T7 or below (like that from the leg) enters the spinal cord via first-order neurons, forming the gracile fasciculus within the spinal cord. The first-order neuron ascends ipsilaterally within the gracile fasciculus before entering the brainstem at the gracile nucleus within the medulla.",
"id": "10025587",
"label": "c",
"name": "Gracile fasciculus",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This question is testing your knowledge of the dorsal column. This is the pathway through which sensory information travels to the brain, including fine touch and vibration sense. Sensory information from T7 or below (like that from the leg) enters the spinal cord via first-order neurons, forming the gracile fasciculus within the spinal cord. The first-order neuron ascends ipsilaterally within the gracile fasciculus before entering the brainstem at the gracile nucleus within the medulla. If the information was coming from above T7, then it would enter the spinal cord and form the cuneate fasciculus before entering the medulla at the cuneate nucleus.",
"id": "10025586",
"label": "b",
"name": "Cuneate nucleus",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This question is testing your knowledge of the dorsal column. This is the pathway through which sensory information travels to the brain, including fine touch and vibration. Sensory information from T7 or below (like that of the leg) enters the spinal cord via first-order neurons, forming the gracile fasciculus within the spinal cord. The first-order neuron ascends ipsilaterally within the gracile fasciculus before entering the brainstem at the gracile nucleus within the medulla.",
"id": "10025585",
"label": "a",
"name": "Gracile nucleus",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This question is testing your knowledge of the dorsal column. This is the pathway through which sensory information travels to the brain, including fine touch and vibration sense. Sensory information from T7 or below (like that from the leg) enters the spinal cord via first-order neurons, forming the gracile fasciculus within the spinal cord. The first-order neuron ascends ipsilaterally within the gracile fasciculus before entering the brainstem at the gracile nucleus within the medulla. The ventral posterolateral nucleus is the location of the synapse between the 2nd and 3rd order neurones in this pathway, located in the thalamus.",
"id": "10025588",
"label": "d",
"name": "Ventral posterolateral nucleus",
"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": "5831",
"name": "Dorsal columns",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5831,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17515",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 55 year old man presents to the emergency department with a numb left leg. On examination, he has clear deficits in both discriminatory touch and vibration sense in his left leg. The neurological examination reveals no other abnormalities. A medical student who sees this case tries to understand the underlying sensory pathway from the leg to the brain.\n\nWithin which part of the medulla do neurons carrying discriminatory touch information from the legs enter?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,537 | false | 23 | null | 6,495,187 | null | false | [] | null | 17,516 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).",
"id": "10025592",
"label": "c",
"name": "T4 N1 M0",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).",
"id": "10025593",
"label": "d",
"name": "T3 N1 M0",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).",
"id": "10025591",
"label": "b",
"name": "T4 N2 M0",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The following explains the TNM system with regard to colorectal cancer:\n\nTumour size:\n\n* Tis - in situ\n* T1 - Extends through mucosa into submucosa\n* T2 - Extends through submucosa into muscularis\n* T3 - Extends through muscularis into subserosa\n* T4 - Extends into neighbouring organs\n\nRegional lymph Node involvement:\n\n* N0\n* N1 - 1-3 nodes\n* N2 - 4+ regional nodes\n\nDistant metastasis present :\n\n* M0 - No metastasis\n* M1 - metastasis present\n\nThis patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).",
"id": "10025590",
"label": "a",
"name": "T2 N1 M0",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).",
"id": "10025594",
"label": "e",
"name": "T3 N1 M1",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4333",
"name": "Gastric cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4333,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17516",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 38 year old man is unfortunately diagnosed with colorectal cancer, following a colonoscopy and biopsy. He undergoes a CT and PET-CT scan of the chest, abdomen and pelvis for staging purposes. This indicates a colonic tumour that had extended into the bowel muscularis but not through the subserosa. Two regional lymph nodes also show evidence of disease. No distant metastasis was found.\n\nWhich of the following tumour, node, metastasis (TNM) stages best describes this man's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,538 | false | 24 | null | 6,495,187 | null | false | [] | null | 17,517 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. Patients suffering from Anti-GBM are more likely to present with features of lung disease (e.g., haemoptysis and shortness of breath) in addition to signs of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection (URTI) only a few days prior makes this more likely to be IgA nephropathy.",
"id": "10025597",
"label": "c",
"name": "Anti-Glomerular Basement Membrane disease (Anti-GBM)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection (URTI) only a few days prior makes this more likely to be IgA nephropathy. Post-infectious glomerulonephritis tends to manifest 1 - 3 weeks after a streptococcal URTI.",
"id": "10025596",
"label": "b",
"name": "Post-infectious Glomerulonephritis",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection only a few days prior makes this more likely to be IgA nephropathy. The gold-standard method for diagnosis is renal biopsy, although urinalysis and urine cultures are also necessary.",
"id": "10025595",
"label": "a",
"name": "IgA nephropathy",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. Alport syndrome is a genetic condition, typically presenting with nephritic features alongside hearing loss and eye abnormalities. In this case, there is no evidence of hearing or eye abnormalities. IgA nephropathy is therefore the most likely diagnosis.",
"id": "10025598",
"label": "d",
"name": "Alport syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with membranoproliferative glomerulonephritis can present with a mixture of nephritic and nephrotic features, although nephritis features are most common. They typically also suffer from autoimmune conditions or hepatitis C. The patient in this case is otherwise fit and well, making IgA nephropathy the most likely diagnosis.",
"id": "10025599",
"label": "e",
"name": "Membranoproliferative glomerulonephritis",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4412",
"name": "Nephritic syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4412,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17517",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 20 year old male presents to his GP complaining of recurrent frank haematuria when passing urine for the past 24 hours. He had a sore throat around three days earlier but denies any other past medical history or relevant family history. Observations are within normal limits, aside from a raised blood pressure of 150/95.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,539 | false | 25 | null | 6,495,187 | null | false | [] | null | 17,518 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. Anti-CCP is a serum biomarker usually indicative of a patient suffering from rheumatoid arthritis. It is not typically raised in acute pancreatitis.",
"id": "10025601",
"label": "b",
"name": "Anti-Cyclic Citrullinated Peptide (Anti-CCP)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. Although hypocalcaemia is often seen in acute pancreatitis, it is not a specific marker for diagnostic purposes.",
"id": "10025602",
"label": "c",
"name": "Hypocalcaemia",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is characteristic of acute pancreatitis. ESR is a generic serum biomarker used to indicate inflammation. Whilst it may also be raised in acute pancreatitis, ESR is a less specific indicator of pancreatitis in comparison to serum amylase or lipase.",
"id": "10025603",
"label": "d",
"name": "Erythrocyte sedimentation rate (ESR)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presentation is characteristic of acute pancreatitis. ANA is a marker of a wide range of autoimmune diseases. It is not specifically associated with pancreatitis, particularly as the most likely underlying cause in this case is gallstones.",
"id": "10025604",
"label": "e",
"name": "Antinuclear antibody (ANA)",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. This patient also demonstrates Grey-Turner's sign: bruising to the flank indicating retroperitoneal bleeding associated with acute pancreatitis. Gallstones are a known cause of acute pancreatitis, as is alcohol excess. An amylase three times the upper limit of normal is indicative of acute pancreatitis, making this the correct answer. Similarly, lipase is another sensitive and specific marker or acute pancreatitis.",
"id": "10025600",
"label": "a",
"name": "Amylase",
"picture": null,
"votes": 63
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5853",
"name": "Acute pancreatitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5853,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17518",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 38 year old male presents to the emergency department with sudden onset epigastric pain that radiates to his back. The pain is eased somewhat by leaning forward. On examination, he is extremely tender in the epigastric region and has extensive bruising alongside his right flank.\n\nHe has a past medical history of gallstone disease, but is otherwise well with no regular medications. He drinks moderate amounts of alcohol, around 10 units a week.\n\nWhich of the following biochemical markers are specifically elevated in the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 81,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,540 | false | 26 | null | 6,495,187 | null | false | [] | null | 17,519 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The latent stage covers cervical dilation from 0 to 3 cm and is characterised by irregular contractions. Dilation is expected to occur at a rate of 1cm every 2 hours for a woman who has not given birth before and at 1 cm every 1 hour if they have.",
"id": "10025606",
"label": "b",
"name": "Latent 1st stage",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 2nd stage of labour involves the descent of the baby into the pelvis through to its delivery. By contrast, the 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The active phase specifically is from 4cm to 10 cm dilation and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour. This case therefore describes the 1st stage active phase of labour.",
"id": "10025607",
"label": "c",
"name": "2nd stage",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 3rd stage of labour covers the time from when the baby has been delivered through to delivery of the placenta. It typically lasts from 30 minutes to 1 hour but can be sped up by exogenous oxytocin administration. The 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The active phase specifically is from 4cm to 10 cm and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour. This case therefore describes the 1st stage active phase of labour.",
"id": "10025608",
"label": "d",
"name": "3rd stage",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The 1st stage of labour involves the initiation of contractions and dilation of the cervix up to 10 cm. It can be further subdivided into the active 1st stage and the latent 1st stage. The active 1st stage is defined as cervical dilation from 4 to 10 cm and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour.",
"id": "10025605",
"label": "a",
"name": "Active 1st stage",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a recognised stage of labour. The first stage of labour consists of the latent phase (0-3 cm of cervical dilation) and the active/established phase (4 - 10 cm dilation). This case describes the 1st stage active phase of labour.",
"id": "10025609",
"label": "e",
"name": "Engaged 1st stage",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4027",
"name": "First stage of labour",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4027,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17519",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old primiparous woman enters labour on the maternity ward. Her cervix has dilated to 5cm, and is progressing by roughly a centimetre every 2 hours.\n\nWhich of the following stages of labour is the patient in?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,541 | false | 27 | null | 6,495,187 | null | false | [] | null | 17,520 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "DPP-4 inhibitors are considered a 2nd line treatment option for type 2 diabetes. Known side effects of this group include hypoglycaemia and nausea. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.",
"id": "10025614",
"label": "e",
"name": "Sitagliptin (DPP-4 inhibitor)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "SGLT-2 inhibitors are prescribed 1st line for type 2 diabetes if individuals have risk factors for cardiovascular disease. They are associated with a predisposition to developing fungal infections, particularly genital mycotic infections as seen in this case.",
"id": "10025610",
"label": "a",
"name": "Dapagliflozin (SGLT-2 inhibitor)",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metformin is typically prescribed as 1st line in type 2 diabetes. Known side effects include gastrointestinal upset and more rarely, lactic acidosis. Metformin can be prescribed as a modified-release version to overcome gastrointestinal upset side effects. It is not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.",
"id": "10025613",
"label": "d",
"name": "Metformin (Biguanide)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thiazolidinediones are typically 2nd line options for type 2 diabetes, after metformin and SGLT-2 inhibitors. Known side effects of this drug group include oedema and weight gain. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.",
"id": "10025612",
"label": "c",
"name": "Pioglitazone (thiazolidinedione)",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sulphonylureas are typically a 2nd line option for type 2 diabetes, after metformin and SGLT-2 inhibitors. They can be used 1st line for steroid-induced hyperglycaemia. Known side effects of this group include hypoglycaemia and weight gain. They are not as closely linked to genital mycotic infections as SGLT-2 inhibitors, making this answer incorrect.",
"id": "10025611",
"label": "b",
"name": "Gliclazide (sulphonylurea)",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5789",
"name": "SGLT-2 inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5789,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17520",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 53 year old man attends his GP surgery with concerns about soreness and itching around his penis. The GP diagnoses a genital mycotic infection. The patient has a history of type 2 diabetes, for which he takes medication.\n\nWhich of the following diabetic medications is most likely to have contributed to this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,542 | false | 28 | null | 6,495,187 | null | false | [] | null | 17,521 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the 1st line treatment for opioid dependence, not an acute overdose as seen in this case. Taking methadone is known to reduce patients' withdrawal symptoms and cravings for opioids. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.",
"id": "10025616",
"label": "b",
"name": "Methadone",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a very potent, short-acting opioid. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option. It would not be appropriate to administer further opioid medications.",
"id": "10025619",
"label": "e",
"name": "Alfentanil",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an opioid receptor agonist used in the treatment of diarrhoea. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.",
"id": "10025618",
"label": "d",
"name": "Loperamide",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the 1st line treatment for individuals suffering from an acute benzodiazepine overdose. Key signs of a benzodiazepine overdose include ataxia and slurred speech. However, the patient in this case demonstrates acute opioid toxicity, making naloxone the most appropriate management option.",
"id": "10025617",
"label": "c",
"name": "Flumazenil",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The signs of respiratory depression, reduced consciousness and pinpoint pupils are strongly suggestive of an opioid overdose. Acute reversal is needed. Naloxone is the recommended reversal agent in opioid toxicity, acting as a full antagonist at opioid receptors.",
"id": "10025615",
"label": "a",
"name": "Naloxone",
"picture": null,
"votes": 70
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4034",
"name": "Opioid toxicity",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4034,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17521",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old woman is brought to the emergency department by ambulance after being found lying on the floor of her bedroom by her sister. Her sister notes she was holding an empty medication bottle when found, but is unsure what it contained.\n\nOn examination, the patient is finding it difficult to speak, muttering indistinct words and only opening her eyes to verbal commands. She is unable to pinch the fingers of one of the nurses when asked but is capable of localising to supraorbital pain. In addition, her pupils are bilaterally reduced in size. She has a respiratory rate of 8 breaths per minute, but all other observations are within the normal limits.\n\nWhich of the following is the most appropriate acute management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,543 | false | 29 | null | 6,495,187 | null | false | [] | null | 17,522 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is a part of the internal capsule, corticobulbar fibres do not pass through the anterior limb. They pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.",
"id": "10025621",
"label": "b",
"name": "Anterior limb",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a part of the internal capsule, but rather a structure of the basal ganglia. The internal capsule sits between the basal ganglia and the thalamus in the brain.",
"id": "10025623",
"label": "d",
"name": "Putamen",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is a part of the internal capsule, corticobulbar fibres do not pass through this structure. Corticobulbar fibres pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.",
"id": "10025622",
"label": "c",
"name": "Posterior limb",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a part of the internal capsule, but rather a structure of the basal ganglia. The internal capsule sits between the basal ganglia and the thalamus in the brain.",
"id": "10025624",
"label": "e",
"name": "Globus pallidus",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct - after leaving the motor cortex and supplementary motor association area, corticobulbar fibres first pass through the corona radiata. They then pass through the middle of the internal capsule, the genu, before going on to synapse with cranial nerve nuclei.",
"id": "10025620",
"label": "a",
"name": "Genu",
"picture": null,
"votes": 37
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3826",
"name": "Central and peripheral nervous system",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3826,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17522",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old male is seen in a specialist neurology clinic. For the past month, he has been experiencing difficulty chewing, swallowing and forming words. The clinician explains that the corticobulbar tract is responsible for the motor innervation of the head and neck muscles.\n\nThrough which part of the internal capsule do fibres of the corticobulbar tract pass?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,544 | false | 30 | null | 6,495,187 | null | false | [] | null | 17,523 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This extra-pyramidal tract is responsible for modulating rotation and lifting of the head via cranial nerve XI (Spinal accessory nerve).",
"id": "10025628",
"label": "d",
"name": "Medial vestibulospinal tract",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not an extrapyramidal or motor tract but rather a sensory tract. It relays information on pain, temperature and crude touch from the face and forehead to the sensory cortex.",
"id": "10025629",
"label": "e",
"name": "Spinal tract V",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This extrapyramidal tract is responsible for maintaining posture. It works through motor neuron stimulation of the leg extensors and musculature of the trunk.",
"id": "10025627",
"label": "c",
"name": "Lateral vestibulospinal tract",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This extrapyramidal tract is responsible for modulating flexor muscle tone, modulating flexor reflexes e.g. to withdraw one's hand away from a hot pan.",
"id": "10025626",
"label": "b",
"name": "Rubrospinal tract",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct. This extrapyramidal tract originates in the superior colliculus. It is involved in coordinating reflex responses to bright lights and loud noises on the contralateral side of the body, orienting the head towards auditory and visual information.",
"id": "10025625",
"label": "a",
"name": "Tectospinal tract",
"picture": null,
"votes": 46
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5854",
"name": "Descending motor tracts",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5854,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17523",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 57 year old woman is reviewed in a specialist neurology clinic following a traumatic brain injury. She reports that she sometimes struggles to orientate herself towards sounds or sights in her environment. The clinician explains that there is a specific neurological tract that works to initiate reflex postural movements of the head in response to auditory and visual stimuli.\n\nWhich of the following extrapyramidal motor pathways is responsible for modulating reflex responses of the head to auditory and visual stimuli?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,545 | false | 31 | null | 6,495,187 | null | false | [] | null | 17,524 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin.",
"id": "10025632",
"label": "c",
"name": "Conjugated bilirubin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin.",
"id": "10025631",
"label": "b",
"name": "Unconjugated bilirubin",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin. This then travels into the colon, where bacteria deconjugate it into urobilinogen.",
"id": "10025634",
"label": "e",
"name": "Urobilinogen",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is then reduced into unconjugated bilirubin. Unconjugated bilirubin is then transported to the liver where glucuronyl transferase adds glucuronic acid to the bilirubin to make it into conjugated bilirubin. This then travels into the colon, where bacteria deconjugate it into urobilinogen.\n\nThe majority of urobilinogen is oxidised by bacteria in the intestine to form stercobilin, prior to faecal excretion.",
"id": "10025633",
"label": "d",
"name": "Stercobilin",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Haem is formed from the breakdown of haemoglobin into haem and globin. Globin is then broken down into amino acids, whilst haem is converted to iron and biliverdin via the enzyme haem oxygenase. Biliverdin is therefore the first breakdown product to be formed of the options listed.",
"id": "10025630",
"label": "a",
"name": "Biliverdin",
"picture": null,
"votes": 52
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4528",
"name": "Bile structure, function and metabolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4528,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17524",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 38 year old man presents to the emergency department with a 3 day history of fever, right upper quadrant abdominal pain and yellowing of the skin. A clinician explains that this yellowing is known as jaundice, which is caused by a build-up of bilirubin in his blood.\n\nWhich of the following substances is initially produced from the breakdown of haem?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,546 | false | 32 | null | 6,495,187 | null | false | [] | null | 17,525 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The G cells in the pyloric antrum of the stomach release the hormone gastrin, not CCK. There are many functions of gastrin including the stimulation of gastric acid secretion, promotion of gastric mucosa growth, and acceleration of gastric emptying via relaxation of the pyloric sphincter.",
"id": "10025639",
"label": "e",
"name": "G cells in the pyloric antrum of the stomach",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The PP cells of the pancreas secrete the hormone pancreatic polypeptide, not CCK. Pancreatic polypeptide counteracts CCK, inhibiting pancreatic secretion and gallbladder contraction.",
"id": "10025638",
"label": "d",
"name": "PP cells of the pancreas",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The M cells in the small intestine crypts secrete the hormone motilin, not CCK. Motilin functions to increase peristalsis and accelerate gastric emptying during a fasted state.",
"id": "10025637",
"label": "c",
"name": "M cells in the small intestine crypts",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The S cells of the duodenum secrete the hormone secretin, not CCK. Secretin functions to neutralise acid in the duodenum by stimulating the release of sodium bicarbonate. Secretin also has an osmoregulatory function in the hypothalamus",
"id": "10025636",
"label": "b",
"name": "S cells of the duodenum",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct - I cells of the duodenum secrete CCK. The presence of fatty/amino acids in the chyme stimulates the release of CCK. CCK inhibits gastric emptying (allowing time for the digestion of food further down the gastrointestinal tract) and stimulates the acinar cells of the pancreas to release digestive juices.",
"id": "10025635",
"label": "a",
"name": "I cells of the duodenum",
"picture": null,
"votes": 56
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5855",
"name": "Cholecystokinin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5855,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17525",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old women is assessed on the surgical admissions ward. She reports cramping right upper quadrant pain, especially after she has just eaten a fatty meal. She wants to better understand how fatty acids in the body are digested. The clinician explains how the hormone cholecystokinin (CCK) promotes the production of bile and stimulates the gallbladder to contract.\n\nWhich of the following cell types secretes CCK?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,547 | false | 33 | null | 6,495,187 | null | false | [] | null | 17,526 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This transporter is found on the basolateral membrane of epithelium within the distal convoluted tubule. Its role is to secret sodium ions into the extracellular fluid, to reduce intracellular sodium levels. This creates a sodium gradient for sodium to move into the epithelial cells via the apical sodium/chloride co-transporter.",
"id": "10025642",
"label": "c",
"name": "Sodium/Potassium ATPase co-transporter",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This active transporter is crucial in creating an osmotic gradient between the urine in the loop of Henle and the blood surrounding it. It draws water out of the urine and increases the concentration of the urine that passes into the collecting ducts of the nephron.",
"id": "10025640",
"label": "a",
"name": "Sodium/Potassium/2-Chloride cotransporter",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are found in the proximal convoluted tubule apical epithelium. Sodium ions move down a concentration gradient into the epithelial cells. These sodium ions are co-transported alongside other solutes such as amino acids, enabling the movement of these solutes against their concentration gradient.",
"id": "10025644",
"label": "e",
"name": "Sodium-amino acid linked transporters",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are found in the proximal convoluted tubule apical epithelium. Sodium ions move along their own concentration gradient into the epithelial cells. These sodium ions are co-transported alongside other solutes such as glucose, enabling the movement of these other solutes against their concentration gradient.",
"id": "10025643",
"label": "d",
"name": "Sodium-glucose linked transporters",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is found on the apical membrane of epithelial cells of the distal convoluted tubule. It acts to transport sodium and chloride into the cell following a sodium gradient.",
"id": "10025641",
"label": "b",
"name": "Sodium/chloride cotransporter",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4242",
"name": "Salt Transport in the loop of Henle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4242,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17526",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 72 year old man is seen by his GP. He has developed bilateral pitting oedema across both ankles, which is making it uncomfortable to walk long distances. The GP suggests trialling a loop diuretic.\n\nWhich of the following transporter acts within the thick limb of the loop of Henle?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,548 | false | 34 | null | 6,495,187 | null | false | [] | null | 17,527 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct - A type II error can be thought of as a 'false negative', where the alternative hypothesis has been rejected in favour of the null hypothesis when in fact the alternative hypothesis is true.",
"id": "10025645",
"label": "a",
"name": "Declaring results not to be statistically significant (P>0.05) when in reality there is a statistically significant difference between groups",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the correct outcome and is not a statistical error. When P values are equal to or greater than 0.05, it can be said that there is not a statistically significant difference between the groups.",
"id": "10025647",
"label": "c",
"name": "Declaring results to be not statistically significant (P>0.05) when there is no difference between the groups",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the correct outcome and is not a statistical error. When P values are less than 0.05, it can be said that there is a statistically significant difference between the groups.",
"id": "10025648",
"label": "d",
"name": "Declaring results to be statistically significant (P<0.05) when there is a difference between the groups",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a type I statistical error. This can be thought of as a 'false positive', where the null hypothesis has been rejected in favour of the alternative hypothesis when in fact the null hypothesis is true.",
"id": "10025646",
"label": "b",
"name": "Declaring results to be statistically significant (P<0.05) when in reality there is not a statistically significant difference between groups",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a study being underpowered. The power of a study is the probability that the study will find a statistically significant difference between groups should it exist. Studies not having enough participants can lead to low power and an inability to detect significant differences that may be present between groups.",
"id": "10025649",
"label": "e",
"name": "When the sample size used in a study is not large enough to be able to detect any significant differences that may exist between groups",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5845",
"name": "Types of error",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5845,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17527",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old man with heart failure is keen to conduct his own review of the literature on effective treatments. He asks his cardiology consultant to explain some key statistical terms, such as the concept of a type II error.\n\nWhich of the following best describes a type II statistical error?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,549 | false | 35 | null | 6,495,187 | null | false | [] | null | 17,528 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a hormone secreted by the hypothalamus. It works to enable the anterior pituitary gland to secrete adrenocorticotrophic hormone as part of the biological stress response.",
"id": "10025654",
"label": "e",
"name": "Corticotropin-releasing hormone",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a hormone secreted within the duodenum, pancreas and hypothalamus that acts to inhibit the function of growth hormone.",
"id": "10025653",
"label": "d",
"name": "Somatostatin",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a hormone responsible for milk production and breast development, amongst other functions. Its release from the anterior pituitary gland is stimulated by thyrotropin-releasing hormone and inhibited by dopamine.",
"id": "10025650",
"label": "a",
"name": "Prolactin",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a hormone secreted by the posterior pituitary gland. Its functions include stimulating uterine contractions and encouraging milk flow.",
"id": "10025651",
"label": "b",
"name": "Oxytocin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a hormone secreted by the posterior pituitary gland. It acts upon the renal collecting duct to increase water reabsorption back into the blood. It can be inhibited by alcohol.",
"id": "10025652",
"label": "c",
"name": "Anti-diuretic hormone",
"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": "3897",
"name": "Hormones of the anterior pituitary gland",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3897,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17528",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old woman presents to the emergency department complaining of a sudden headache that seems to focus in pain and intensity behind her eyes. In addition, she has signs of an oculomotor nerve palsy. An MRI scan identifies pituitary apoplexy. She is concerned about the long term implications of this.\n\nWhich of the following hormones is secreted from the anterior pituitary gland?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,550 | false | 36 | null | 6,495,187 | null | false | [] | null | 17,529 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a randomisation technique. Confounding is a phenomenon that occurs in research whereby an additional, unmeasured variable impacts both the independent variable (the 'cause') in the study and the outcome measure (the 'effect'). It therefore obscures the interpretation of results.",
"id": "10025659",
"label": "e",
"name": "Confounding",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a randomisation technique aiming to maintain similar numbers of participants in each condition. It does this by dividing the participant population into smaller chunks and ensuring that a set amount of participants from each chunk are allocated to each group of the study.",
"id": "10025657",
"label": "c",
"name": "Block randomisation",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This method of randomisation first divides up the participant population into groups (strata) of similar baseline characteristics. Each created strata are then allocated via simple randomisation to each study arm, with the aim being to ensure similar baseline characteristics amongst each arm of the trial.",
"id": "10025658",
"label": "d",
"name": "Stratification",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a method of randomisation that seeks to equalise baseline characteristics between groups. It is used if multiple prognostic or confounding factors in the participant population need to be accounted for. It is an adaptive method of randomisation, as future participant allocation depends on the previous allocations of other participants.",
"id": "10025655",
"label": "a",
"name": "Minimisation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a common method of participant allocation whereby a computer is used to randomly allocate trial participants to groups of a study. A limitation of simple randomisation is that baseline characteristics may differ between each condition.",
"id": "10025656",
"label": "b",
"name": "Simple randomisation",
"picture": null,
"votes": 14
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4470",
"name": "Selection Bias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4470,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17529",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old man with asthma is reviewed by his GP. The patient has read about a new randomised control trial on the effectiveness of a novel short-acting beta agonist versus salbutamol. The paper states that the first participant in the study was randomly allocated to either the new drug group or the salbutamol group via a computer. After that, participants were randomly allocated to each condition whilst ensuring that prognostic factors (age, sex and total lung capacity) were balanced across each group.\n\nWhich of the following best describes the type of randomisation used to allocate trial participants to the groups in this study?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,551 | false | 37 | null | 6,495,187 | null | false | [] | null | 17,530 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the haploid cell type that is formed once the diploid primary follicle completes meiosis I during puberty. It is formed alongside the 1st polar body (also haploid) and is the cell that gets released during ovulation.",
"id": "10025664",
"label": "e",
"name": "Secondary oocyte",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the haploid body that is formed when a primary oocyte (matured as a primary follicle by this point) is stimulated to complete meiosis I during puberty. A secondary oocyte is formed as a result of this division alongside the 1st polar body (both of which are haploid cells formed from the diploid primary follicle).",
"id": "10025663",
"label": "d",
"name": "1st polar body",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the end product of oogenesis. The ovum is formed at fertilisation when the secondary oocyte, released during ovulation, is stimulated to complete meiosis-II by being fertilised.",
"id": "10025661",
"label": "b",
"name": "Ovum",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Oogonia multiply by mitosis to form primary oocytes, which are diploid. The primary oocyte later gives rise to secondary oocytes, which are haploid.",
"id": "10025660",
"label": "a",
"name": "Primary oocyte",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the primordial germ cell that starts the process of oogenesis before birth. These cells undergo mitosis to form oogonia cells.",
"id": "10025662",
"label": "c",
"name": "Oogonium",
"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": "4649",
"name": "Ovaries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4649,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17530",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A couple attends a fertility clinic with a consultant obstetrician. They are eager to go ahead with an initial round of in-vitro fertility treatment, having been struggling to conceive for the past 2 years. As part of the counselling process, the clinician explains how the body produces egg cells.\n\nWhich of the following cell types are formed when oogonia multiply by mitosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,552 | false | 38 | null | 6,495,187 | null | false | [] | null | 17,531 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a beta-blocker that is used to control gestational hypertension. In this case, we need an agent to delay labour. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).",
"id": "10025668",
"label": "d",
"name": "Labetalol",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a technique that is commonly used to induce labour; the opposite of the desired effect in this case. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).",
"id": "10025667",
"label": "c",
"name": "Membrane sweep",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an agent that is commonly given when patients are in established labour, to speed up the process. In this case, we need an agent to delay labour. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).",
"id": "10025669",
"label": "e",
"name": "Oxytocin",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prostaglandins such as dinoprostone are used to induce labour; the opposite of the desired effect in this case. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).",
"id": "10025666",
"label": "b",
"name": "Prostaglandin E2",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a type of calcium channel blocker that is commonly used to delay the onset of labour in pre-term cases. Other suitable agents include atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug). Contraindications to giving a tocolytic agent include being > 34 weeks pregnant, being in established labour (4 cm cervical dilation) and intra-uterine death.",
"id": "10025665",
"label": "a",
"name": "Nifedipine",
"picture": null,
"votes": 36
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5856",
"name": "Preterm labour",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5856,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17531",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 33 year old women is 32 weeks pregnant when she experiences a pre-labour rupture of her membranes. She has no past medical history of note and is nulliparous. Her pregnancy has been otherwise medically unremarkable. She is prescribed medication to delay the onset of labour, to allow time for corticosteroids to mature the foetal lungs.\n\nWhich of the following is a suitable tocolytic agent?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,553 | false | 39 | null | 6,495,187 | null | false | [] | null | 17,532 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia. The patient's background of diabetes, chronic hypertension, increasing age and being nulliparous are all risk factors for developing preeclampsia.",
"id": "10025670",
"label": "a",
"name": "Preeclampsia",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HELLP syndrome, a condition affecting the liver and clotting function, is a form of preeclampsia. The patient is unlikely to have this as there is no evidence of haemolysis or elevated liver enzymes. Pre-eclampsia is therefore the most likely diagnosis.",
"id": "10025671",
"label": "b",
"name": "HELLP (Haemolysis, Elevated Liver enzymes and Low Platelets) syndrome",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An amniotic fluid embolism is a rare obstetric emergency. It typically occurs during or after labour, when amniotic fluid or other foetal material enters the maternal pulmonary circulation. Symptoms include maternal tachycardia, tachypnoea, hypoxia and hypotension. It is a life-threatening emergency that requires intensive care transfer. It is not the most likely diagnosis in this case. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.",
"id": "10025673",
"label": "d",
"name": "Amniotic fluid embolism",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gestational hypertension is a type of high blood pressure that comes on during pregnancy, and is expected to resolve after giving birth. This is unlikely to be the diagnosis in this case. The woman already has an established history of chronic hypertension before being pregnant, and the presence of proteinuria indicates preeclampsia rather than simple gestational hypertension. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.",
"id": "10025672",
"label": "c",
"name": "Gestational hypertension",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an emergency that occurs during labour. It is when the umbilical cord passes through the cervix before the passage of the baby, which can cause foetal hypoxia. It requires prompt instrumental delivery. It is not the most likely diagnosis in this case. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.",
"id": "10025674",
"label": "e",
"name": "Umbilical cord prolapse",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4510",
"name": "Pre-eclampsia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "174",
"name": "Obstetrics",
"typeId": 7
},
"topicId": 174,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4510,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17532",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 37 year old nulliparous woman who is 36 weeks pregnant is monitored on the labour ward. She has a past medical history of chronic hypertension, in addition to type 2 diabetes mellitus. She reports a severe, acute-onset headache. On examination, the patient has bilateral swelling of her legs. A urine dip is strongly positive for proteinuria, and blood tests show a haemoglobin of 140 g/L (normal range 115-155 g/L) with normal liver function tests.\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,554 | false | 40 | null | 6,495,187 | null | false | [] | null | 17,533 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Metformin is a biguanide medication used as first line treatment in type 2 diabetes. There is an established link between taking this metformin and the development of macrocytic anaemia. The patient's clinical picture of fatigue, weakness and shortness of breath all point towards anaemia, which is confirmed by the low haemoglobin levels. The mean cell volume above 100 fL reveals this as a macrocytic anaemia.",
"id": "10025675",
"label": "a",
"name": "Taking mformin",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals with heavy periods are likely to develop iron deficiency anaemia due to the high levels of blood loss. This patient is unlikely to have an iron-deficiency anaemia as the mean cell volume is > 100 fL, indicating macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels <80 fL.",
"id": "10025678",
"label": "d",
"name": "Menorrhagia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic usage of laughing gas can lead to raised homocysteine levels, which can occasionally cause macrocytic anaemia. Raised homocysteine commonly causes neurological symptoms, for example, sensory disturbance as in subacute combined spinal cord degeneration. This is therefore a less likely explanation for this patient's presentation compared to metformin use.",
"id": "10025676",
"label": "b",
"name": "Chronic nitrous oxide (laughing gas) usage",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this patient is displaying signs of anaemia (fatigue, weakness etc) as well as presenting with low haemoglobin levels, it is unlikely this is related to an underlying iron deficiency. This is due to the mean cell volume being > 100 fL, a typical sign of macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels <80 fL.",
"id": "10025677",
"label": "c",
"name": "Poor dietary intake of Iron",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst there are no signs this woman is pregnant, it is reasonable to check this possibility in a female patient of child-bearing age. Iron deficiency anaemia is the most common form of anaemia in pregnancy. This case is unlikely to be iron-deficiency related due to the mean cell volume being > 100 fL, indicating macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels <80 fL.",
"id": "10025679",
"label": "e",
"name": "Pregnancy",
"picture": null,
"votes": 19
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Laughing gas can also cause B12 deficiency which would also be a cause of macrocytic anaemia so would be good to clarify whether this is megaloblastic or non-megaloblastic anaemia",
"createdAt": 1705160303,
"dislikes": 0,
"id": "38689",
"isLikedByMe": 0,
"likes": 0,
"parentId": null,
"questionId": 17533,
"replies": [],
"user": {
"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Strowger",
"id": 33282
}
}
],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4086",
"name": "Pernicious anaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4086,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17533",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 33 year old woman attends a GP appointment after suffering from lethargy, shortness of breath and generalised weakness for the past 6 weeks. She denies any visible blood loss, change in bowel habits or weight loss. She has a past medical history of type 2 diabetes. She has no relevant family history. Her observations are within the normal limit, and a neurological examination is normal.\n\nConcerned by her symptoms, her doctor orders a blood test that shows a haemoglobin level of 10.5 g/dL and mean cell volume (MCV) of 110 fL.\n\nWhich of the following is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,555 | false | 41 | null | 6,495,187 | null | false | [] | null | 17,534 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Struvite stones account for roughly 5 - 10% of all cases of renal colic and are typically formed in individuals with a recent upper respiratory tract infection (specifically proteus bacteria). They form characteristic staghorn calculi.",
"id": "10025680",
"label": "a",
"name": "Struvite",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals with this type of renal stone typically suffer from recurrent renal colic and urinary tract infections. Cysteine calculi are linked to a genetic defect in the reabsorption of cysteine in the kidney. They are a very rare cause of renal colic.",
"id": "10025684",
"label": "e",
"name": "Cysteine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst it is true that the majority of cases of renal stones will be composed of calcium oxalate, the presence of staghorn calculi on CT imaging make these stones more likely to be composed of struvite instead.",
"id": "10025682",
"label": "c",
"name": "Calcium oxalate",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a very rare form of renal stone composition. It typically occurs in patients using the anti-viral drug indinavir e.g, as part of HIV management. The presence of staghorn calculi on CT imaging makes these stones more likely to be composed of struvite instead.",
"id": "10025683",
"label": "d",
"name": "Indinavir",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These types of renal stones are typically seen in individuals with a history of gout. They account for roughly 5-10% of all renal colic cases. The presence of staghorn calculi on CT imaging makes these stones more likely to be composed of struvite instead of uric acid.",
"id": "10025681",
"label": "b",
"name": "Uric acid",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3988",
"name": "Renal Stones",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3988,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17534",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 29 year old man presents to his local emergency department in extreme pain. He is unable to sit down and is pacing around the triage unit. He describes a sharp pain in his right flank that radiates down into the right side of his groin, which has been present for the past 3 hours. He has never experienced pain like this before. A CT scan identifies staghorn calculi within the renal pelvis.\n\nWhat is the composition of a staghorn renal calculi?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,556 | false | 42 | null | 6,495,187 | null | false | [] | null | 17,535 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cluster headaches tend to appear intermittently in irregular 'clusters', and are often described as unilateral pain around the orbit of the eye. The auras this patient experiences alongside the pulsatile, long-lasting nature of the headaches, make it more likely these are migraines.",
"id": "10025687",
"label": "c",
"name": "Cluster",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tension headaches tend to be bilateral and non-pulsatile, feeling like a 'tight band'. They do not tend to present with auras beforehand. Migraines are therefore a more likely underlying diagnosis in this case.",
"id": "10025686",
"label": "b",
"name": "Tension",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This type of headache typically presents as bilateral and non-pulsatile. In addition, they are often found to be worse in the morning. Cushing's reflex may be seen in cases of raised ICP; this is characterised by a triad of increased blood pressure, decreased heart rate and irregular breathing. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.",
"id": "10025688",
"label": "d",
"name": "Raised Intra-cranial-pressure (ICP)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The presence of a visual aura preceding a severe headache that is unilateral and pulsatile in nature is characteristic of a migraine. The nausea and vomiting also support this diagnosis. Stress is a common trigger for migraines, as alluded to by this patient changing jobs at a similar time to when the headaches first appeared.",
"id": "10025685",
"label": "a",
"name": "Migraine",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Trigeminal neuralgia is more prevalent in those over 50. It presents with sharp, stabbing pain that follows the distribution of the trigeminal nerve across one side of the face. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.",
"id": "10025689",
"label": "e",
"name": "Trigeminal neuralgia",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5857",
"name": "Headache",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5857,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17535",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 30 year old woman presents to her GP with recurrent headaches that have been present intermittently for the past 2 months. She describes seeing spots and zig zags in her vision before developing a pulsating, unilateral headache that can last for several hours. Alongside the, she reports bouts of nausea & vomiting. She takes paracetamol as needed, with little benefit.\n\nShe has no past medical history, but notes feeling particularly stressed since starting a new job 2 months ago. She does not smoke or drink alcohol, but notes her diet is 'not the best'.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,557 | false | 43 | null | 6,495,187 | null | false | [] | null | 17,536 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates classic features of nephrotic syndrome. The most common cause of nephrotic syndrome in young children is minimal change disease. By contrast, haemolytic uraemic syndrome is more likely to present with acute kidney injury, thrombocytopenia, and microangiopathic haemolytic anaemia. This option is therefore incorrect.",
"id": "10025694",
"label": "e",
"name": "Haemolytic uraemic syndrome",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates classic features of nephrotic syndrome. The most common cause of nephrotic syndrome in young children is minimal change disease. By contrast, Henoch-Schönlein purpura causes nephritic syndrome. Symptoms include a purpuric skin rash, joint pain, and gastrointestinal symptoms. This option is therefore incorrect.",
"id": "10025693",
"label": "d",
"name": "Henoch-Schönlein purpura",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates classic features of nephrotic syndrome. Whilst membranous nephropathy is another cause of nephrotic syndrome, the most common cause in children is minimal change disease.",
"id": "10025691",
"label": "b",
"name": "Membranous nephropathy",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient demonstrates classic features of nephrotic syndrome. Whilst diabetes mellitus is another cause of nephrotic syndrome, the most common cause in children is minimal change disease. It is less common for a child with no past medical history to present with nephrotic syndrome secondary to diabetes.",
"id": "10025692",
"label": "c",
"name": "Diabetes mellitus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient demonstrates classic features of nephrotic syndrome. The frothy urine indicates marked proteinuria and the swelling is due to oedema. Blood results would be expected to show hypoalbuminaemia. The most common cause of nephrotic syndrome in young children is minimal change disease. Whilst not specified in this question, it often occurs after an upper respiratory tract infection.",
"id": "10025690",
"label": "a",
"name": "Minimal change disease",
"picture": null,
"votes": 68
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"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,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4060,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17536",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "An 8 year old girl is brought to see her GP by her father, who is concerned that her urine has become 'frothy'. There is no blood, and the child denies any dysuria. She is otherwise fit and well and takes no regular medications.\n\nOn examination, oedema is noted on both legs. Her face appears swollen, particularly around the eyes. The father confirms this is a change from her usual appearance.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,558 | false | 44 | null | 6,495,187 | null | false | [] | null | 17,537 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Dexamethasone is a glucocorticoid medication. It is not typically used in the management of ADHD.",
"id": "10025696",
"label": "b",
"name": "Dexamethasone",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Haloperidol is a first-generation antipsychotic medication. It is not typically used in the management of ADHD.",
"id": "10025699",
"label": "e",
"name": "Haloperidol",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Diazepam is a benzodiazepine. Although it can be used to manage significant agitation, it is not typically used in the management of ADHD.",
"id": "10025698",
"label": "d",
"name": "Diazepam",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Lorazepam is a benzodiazepine. Although it can be used to manage significant agitation, it is not typically used in the management of ADHD.",
"id": "10025697",
"label": "c",
"name": "Lorazepam",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of attention deficit hyperactivity disorder (ADHD). In order for a diagnosis of ADHD to be confirmed, symptoms such as inattention and restlessness must be present in more than 1 setting, as they are for this child (home and at school). Conservative management of ADHD includes cognitive behavioural therapy (CBT), psychoeducation and extra school support. Medication is typically used if conservative options prove ineffective. These are stimulant medications such as methylphenidate or amphetamines. They work primarily in the frontal lobe, increasing executive function and attention, and reducing impulsivity.",
"id": "10025695",
"label": "a",
"name": "Methylphenidate",
"picture": null,
"votes": 54
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5858",
"name": "Amphetamines",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5858,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17537",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 10 year old boy attends a community paediatric clinic with his mother. She describes her son as easily distractible and very fidgety. He often forgets to complete his homework, and can have trouble organising his belongings. More recently, he received a worrying report from his school teacher, describing concentration problems that can disrupt other students and impair his ability to complete tasks.\n\nThey discuss conservative management of the boy's symptoms, however these have already been trialled with limited results. Both mother and son are keen to try medication.\n\nGiven the likely diagnosis, which of the following medications can be prescribed to manage the boy's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,559 | false | 45 | null | 6,495,187 | null | false | [] | null | 17,538 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the epithelium lining the oesophagus is squamous, the metaplastic change in Barrett's oesophagus is to columnar not glandular epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar. A glandular epithelium is found in organs that have secretory functions such as the pancreas.",
"id": "10025702",
"label": "c",
"name": "Stratified squamous to glandular",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the epithelium lining the oesophagus is squamous, the metaplastic change in Barrett's oesophagus is to columnar rather than cuboidal epithelium. This is because the oesophagus has to adapt to chronic acid exposure, and so the epithelium becomes like that of the stomach; columnar.",
"id": "10025701",
"label": "b",
"name": "Stratified squamous to cuboidal",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar.",
"id": "10025704",
"label": "e",
"name": "Glandular to stratified squamous",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar.",
"id": "10025703",
"label": "d",
"name": "Cuboidal to stratified squamous",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This typically occurs when oesophageal cells are chronically exposed to acidic stomach contents, as in the case of GORD. Metaplasia is a broad term in histology used to refer to the change from one differentiated cell type to another differentiated cell type.",
"id": "10025700",
"label": "a",
"name": "Stratified squamous to columnar",
"picture": null,
"votes": 50
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4350",
"name": "Barrett's oesophagus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4350,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17538",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 43 year old man with a long-standing history of gastro-oesophageal reflux disease (GORD) receives the results of a recent oesophago-gastro duodenoscopy. The clinician explains that they found evidence of a condition known as Barrett's oesophagus.\n\nWhich of the following epithelial changes is found in Barrett's oesophagus?",
"sbaAnswer": [
"a"
],
"totalVotes": 81,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,560 | false | 46 | null | 6,495,187 | null | false | [] | null | 17,539 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypotonia is a lower motor neuron pathological sign. It occurs as a result of damage to gamma motor neurons. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.",
"id": "10025707",
"label": "c",
"name": "Hypotonia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Muscular atrophy is a lower motor neuron pathological sign. It commonly occurs due to disuse of the musculature following paresis. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.",
"id": "10025706",
"label": "b",
"name": "Muscular atrophy",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Flaccid paralysis is a lower motor neuron pathological sign. It occurs as a result of damage to gamma motor neurons. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.",
"id": "10025708",
"label": "d",
"name": "Flaccid paralysis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fasciculations are a lower motor neuron pathological sign. This involves twitching of small groups of muscle fibres due to the spontaneous discharge of motor units. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.",
"id": "10025709",
"label": "e",
"name": "Fasciculations",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A positive Babinski sign, in which stroking the sole of the foot causes dorsiflexion with extension of the hallux, is a key indicator of an upper motor neuron lesion. In healthy individuals, the foot deviates downwards or does not move. Other upper motor neuron signs include spasticity and hyperreflexia.",
"id": "10025705",
"label": "a",
"name": "Upgoing plantar reflex",
"picture": null,
"votes": 63
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3743",
"name": "Ischaemic Stroke",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3743,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17539",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old man presents to the emergency department with sudden onset left-sided weakness. Neurological examination reveals a range of upper motor neuron signs. A CT head shows a hypo-dense region focused on the majority of the middle cerebral artery (MCA). An ischaemic MCA stroke is diagnosed.\n\nWhich of the following is an example of an upper motor neuron sign?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,561 | false | 47 | null | 6,495,187 | null | false | [] | null | 17,540 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes rather than through mitochondrial DNA, making this answer incorrect.",
"id": "10025714",
"label": "e",
"name": "Mitochondrial",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes, making this answer incorrect.",
"id": "10025712",
"label": "c",
"name": "X-linked recessive",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype.",
"id": "10025711",
"label": "b",
"name": "Autosomal recessive",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Familial adenomatous polyposis is an inherited disorder characterised by the growth of multiple colorectal polyps. This carries a high risk of malignant transformation and thus colorectal cancer development.\n\nIt is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype, meaning they have the disease. It also means that roughly 50% of children of an affected parent will inherit the condition. Individuals with familial adenomatous polyposis often first find out when they are genetically tested following the colorectal cancer diagnosis of a close relative.",
"id": "10025710",
"label": "a",
"name": "Autosomal dominant",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes, making this answer incorrect.",
"id": "10025713",
"label": "d",
"name": "X-linked dominant",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3731",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3731,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17540",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 36 year old man attends a colorectal clinic to discuss a recent diagnosis of colorectal cancer. When asked about his family history, he reports having both an uncle and a brother who were similarly diagnosed with colorectal cancer at a young age. The clinician suspects a genetic cancer syndrome.\n\nWhich of the following best describes the genetic inheritance pattern of familial adenomatous polyposis?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,562 | false | 48 | null | 6,495,187 | null | false | [] | null | 17,541 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although lactose intolerance is also associated with diffuse abdominal pain with distension, changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicates coeliac disease is a more likely underlying diagnosis.",
"id": "10025717",
"label": "c",
"name": "Lactose intolerance",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. This in turn leads to small bowel damage and symptoms of malabsorption; including diffuse abdominal pain, distension, steatorrhea, weight loss and dermatitis herpetiformis. IgA anti-TTG is a strong biomarker for coeliac disease, further supporting this diagnosis. Treatment involves lifelong avoidance of gluten.",
"id": "10025715",
"label": "a",
"name": "Coeliac disease",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although colorectal cancer is also associated with changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicate coeliac disease is a more likely underlying diagnosis. Furthermore, colorectal cancer does not typically cause pain except in the case of an acute bowel obstruction and is rare in a young patient.",
"id": "10025718",
"label": "d",
"name": "Colorectal cancer",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Chronic pancreatitis is associated with epigastric rather than diffuse abdominal pain, and is most commonly caused by long-term alcohol overuse. The presence of IgA anti-TTG antibodies also indicates coeliac disease is a more likely underlying diagnosis than chronic pancreatitis.",
"id": "10025719",
"label": "e",
"name": "Chronic pancreatitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although Crohn's disease is also associated with diffuse abdominal pain with distension, changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicates coeliac disease is a more likely underlying diagnosis.",
"id": "10025716",
"label": "b",
"name": "Crohn's",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3807",
"name": "Coeliac Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3807,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17541",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 2,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 20 year old woman presents to her GP with 2 months of diffuse abdominal pain and distension. This is particularly marked after eating. She has also noticed considerable weight loss and an itchy rash across her torso.\n\nThe woman also complains of particularly foul-smelling faeces over the past few months. Her only past medical history is type 1 diabetes mellitus. She denies ever drinking alcohol or smoking.\n\nHer GP decides to arrange for blood testing, with one of the results coming back strongly positive for serum IgA Anti-tissue Transglutaminase (anti-TTG). A pregnancy test is negative.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 81,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,563 | false | 49 | null | 6,495,187 | null | false | [] | null | 17,542 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a common opportunistic virus that healthcare teams need to be aware of concerning immunosuppressed individuals. As the patient has had a renal transplant, he will have been placed on immunosuppressive medications e.g., steroids and as a result be more susceptible to opportunistic microbes.",
"id": "10025720",
"label": "a",
"name": "Cytomegalovirus",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Norovirus is associated with vomiting and diarrhoea. It is one of the most common causes of gastroenteritis in the United Kingdom. It is not the best first for the clinical picture described above.",
"id": "10025724",
"label": "e",
"name": "Norovirus",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the bacterium responsible for causing chancroid and is sexually transmitted. Typical symptoms include painful blistering lesions on the skin of the genitals and painful raised lymph glands.",
"id": "10025723",
"label": "d",
"name": "Haemophilus ducreyi",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the bacterium responsible for causing syphilis and is associated with sexual transmission. Typical symptoms normally include solitary painless lesions within 90 days of being infected before the disease progresses to form maculopapular symmetrical rashes on the palms, legs, soles and face.",
"id": "10025722",
"label": "c",
"name": "Treponema Pallidum",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Entamoeba histolytica is a parasitic organism, more common in tropical areas. Typical symptoms include bloody diarrhoea and abdominal pain, which this patient does not have.",
"id": "10025721",
"label": "b",
"name": "Entamoeba histolytica",
"picture": null,
"votes": 10
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5859",
"name": "Renal transplant",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5859,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17542",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old man attends his GP surgery with a 12 hour history of feeling generally unwell with fevers and extreme fatigue. He denies any diarrhoea or abdominal pain, and reports no rashes or skin changes.\n\nThe patient is two months into his recovery from a renal transplant, that he received due to end-stage kidney disease. The operation went well with no complications, and no evidence of transplant rejection thus far. He has been fully compliant with all immunosuppressive medications that he has been prescribed following his transplant. He is not currently sexually active and does not smoke or drink alcohol. He has not left the UK for the past 5 years.\n\nWhich of the following is the most likely underlying microbiological cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,564 | false | 50 | null | 6,495,187 | null | false | [] | null | 17,543 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:\n\n3 litres x 5 = 15 units\n\n0.5 litres x 40 = 20 units\n\n15 + 20 = 35 units\n\nThis is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.",
"id": "10025728",
"label": "d",
"name": "55 units",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:\n\n3 litres x 5 = 15 units\n\n0.5 litres x 40 = 20 units\n\n15 + 20 = 35 units\n\nThis is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.",
"id": "10025727",
"label": "c",
"name": "15 units",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:\n\n3 litres x 5 = 15 units\n\n0.5 litres x 40 = 20 units\n\n15 + 20 = 35 units\n\nThis is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.",
"id": "10025725",
"label": "a",
"name": "35 units",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:\n\n3 litres x 5 = 15 units\n\n0.5 litres x 40 = 20 units\n\n15 + 20 = 35 units\n\nThis is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.",
"id": "10025729",
"label": "e",
"name": "42 units",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:\n\n3 litres x 5 = 15 units\n\n0.5 litres x 40 = 20 units\n\n15 + 20 = 35 units\n\nThis is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.",
"id": "10025726",
"label": "b",
"name": "25 units",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5860",
"name": "Alcohol units",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5860,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17543",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old woman asks her GP for support in reducing her alcohol intake. She is aware that she has developed binge drinking habits and wants to stop before she does any long-term damage to her body. The GP explores her average weekly drinking habits.\n\nThe patient reports that in a typical week, she will consume half a litre of 40% vodka alongside 6 pints of 5% beer.\n\nAssuming 1 pint = 500 millilitres, what is the patient's average weekly alcohol consumption?",
"sbaAnswer": [
"a"
],
"totalVotes": 81,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,707 | false | 1 | null | 6,495,189 | null | false | [] | null | 17,544 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The vignette describes a typical presentation of a lower urinary tract infection (UTI). According to NICE CKS, the most commonly identified causative pathogen is Escherichia coli, which is detected in more than 70% of lower UTI cases. Therefore, this is the single best answer.",
"id": "10025730",
"label": "a",
"name": "Escherichia coli",
"picture": null,
"votes": 98
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Proteus mirabilis is occasionally implicated, it is a less common cause of a UTI than Escherichia coli. Proteus mirabilis is also more common in males than females, making it less likely in this case.",
"id": "10025732",
"label": "c",
"name": "Proteus mirabilis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Klebsiella is occasionally implicated, it is a less common cause of a UTI than Escherichia coli.",
"id": "10025734",
"label": "e",
"name": "Klebsiella pneumoniae",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Staphylococcus saprophyticus is occasionally implicated, it is a less common cause of a UTI than Escherichia coli. According to NICE CKS Staphylococcus saprophyticus is present in only 5-10% of cases.",
"id": "10025731",
"label": "b",
"name": "Staphylococcus saprophyticus",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The vignette describes a typical presentation of a lower urinary tract infection (UTI). Whilst Staphyloccous aureus is a common cause of skin and soft tissue infections, it is not the most common cause of UTIs.",
"id": "10025733",
"label": "d",
"name": "Staphyloccous aureus",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4613",
"name": "Urinary tract infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4613,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17544",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 60 year old woman presents to the GP practice with painful urination. For the past three days, she has needed to pass urine a lot more frequently than usual. She reports the urge to pass urine can come on quite suddenly, but she has had no episodes of incontinence so far.\n\nThe patient's relevant urine dip results can be seen below:\n\n* Leukocytes +\n* Nitrites +\n* Blood ++\n\nWhich of the following organisms is the most likely cause of this patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 110,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,708 | false | 2 | null | 6,495,189 | null | false | [] | null | 17,545 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The Pneumococcal vaccine protects against Streptococcus pneumoniae. It is received first at 12 weeks, as well as a booster at 12 months in the current NHS vaccination schedule: [link](https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/).",
"id": "10025735",
"label": "a",
"name": "Pneumococcal vaccine",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The chickenpox vaccine is not part of the NHS Vaccination schedule and is therefore incorrect.",
"id": "10025739",
"label": "e",
"name": "Chickenpox vaccine",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The MenACWY vaccine protects against 4 strains of the meningococcal bacteria. It is received at 14 years in the NHS vaccine schedule, so a 2 year old child would not yet have had it.",
"id": "10025738",
"label": "d",
"name": "MenACWY vaccine",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This 4-in-1 pre-school booster vaccine offers protection against diphtheria, tetanus, whooping cough and\npolio. It is received at 3 years and 4 months as per the NHS vaccination schedule, so a 2 year old child would not yet have had it.",
"id": "10025736",
"label": "b",
"name": "4-in-1 pre-school booster vaccine",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The HPV vaccine protects against the human papillomavirus. It is received at 12 to 13 years in the NHS vaccination schedule, so a 2 year old child would not yet have had it.",
"id": "10025737",
"label": "c",
"name": "Human paipillomavirus (HPV) vaccine",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4602",
"name": "Vaccinations",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4602,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17545",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 2 year old child is brought to the GP surgery by his mother, who is enquiring about the UK vaccination schedule. He has lived in the UK all his life and has had all of the recommended vaccinations for his age.\n\nWhich of the following vaccinations has the child already had?",
"sbaAnswer": [
"a"
],
"totalVotes": 105,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,709 | false | 3 | null | 6,495,189 | null | false | [] | null | 17,546 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypertrophy refers to an increase in the size of cells. It does not describe the cellular changes seen in Barrett's oesophagus.",
"id": "10025744",
"label": "e",
"name": "Hypertrophy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neoplasia refers to the autonomous and uncontrolled growth of cells. This may be benign, or malignant in the case of cancer. It involves the growth of new tissue, whereas Barrett's oesophagus refers to a change in the cellular constituents of tissue. This answer is therefore incorrect.",
"id": "10025742",
"label": "c",
"name": "Neoplasia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dysplasia is the replacement of a mature cell type with an immature or abnormal cell type. Although Barrett's oesophagus can become dysplastic, the above endoscopy report identifies a change to columnar epithelium; a mature cell type. This answer is therefore incorrect.",
"id": "10025741",
"label": "b",
"name": "Dysplasia",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypoplasia describes a lack of cells in tissues. It does not describe the cellular changes seen in Barrett's oesophagus.",
"id": "10025743",
"label": "d",
"name": "Hypoplasia",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Metaplasia is the replacement of one mature cell type with another and is pathognomonic of Barrett's oesophagus",
"id": "10025740",
"label": "a",
"name": "Metaplasia",
"picture": null,
"votes": 72
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4350",
"name": "Barrett's oesophagus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4350,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17546",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 55 year old female patient attends the GP surgery to discuss the results of her recent endoscopy. She has chronic dyspepsia and has smoked one packet of cigarettes a day for the last 35 years.\n\nThe report identifies a change in the epithelial lining of the lower oesophagus from squamous to columnar epithelium. The GP explains these changes are consistent with a diagnosis of Barrett's oesophagus.\n\nWhich of the following best describes the cellular changes identified on endoscopy?",
"sbaAnswer": [
"a"
],
"totalVotes": 97,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,710 | false | 4 | null | 6,495,189 | null | false | [] | null | 17,547 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vancomycin is a glycopeptide antibiotic and exerts its effect by binding to cell wall proteins, which prevents the formation of cross-links in the peptidoglycan cell wall. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.",
"id": "10025748",
"label": "d",
"name": "Vancomycin",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amoxicillin belongs to the penicillin class of antibiotics. Penicillins exert their antimicrobial effect through the inhibition of penicillin-binding proteins. These are key in catalysing the reaction to make bacterial cell walls. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.",
"id": "10025746",
"label": "b",
"name": "Amoxicillin",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clarithromycin is a macrolide antibiotic. Macrolides exert their effects through the inhibition of protein synthesis, by binding to the 50s subunit of the ribosome. This is therefore the correct answer.",
"id": "10025745",
"label": "a",
"name": "Clarithromycin",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cefotaxime belongs to the cephalosporin class of antibiotics. Cephalosporins exert their effect through inhibiting the cross-linking of peptidoglycans in the cell wall. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.",
"id": "10025747",
"label": "c",
"name": "Cefotaxime",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gentamicin is an aminoglycoside which inhibits bacterial protein synthesis by binding to the **30S subunit** of the ribosome. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.",
"id": "10025749",
"label": "e",
"name": "Gentamicin",
"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": "5861",
"name": "Macrolides",
"status": null,
"topic": {
"__typename": "Topic",
"id": "223",
"name": "Antibiotic pharmacology",
"typeId": 7
},
"topicId": 223,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5861,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17547",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 60 year old man is admitted to the respiratory ward for treatment of a lower respiratory tract infection. An antibiotic is commenced which acts on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis.\n\nWhich of the following antibiotics is prescribed?",
"sbaAnswer": [
"a"
],
"totalVotes": 94,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,711 | false | 5 | null | 6,495,189 | null | false | [] | null | 17,548 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The clinical vignette describes a typical case of anaphylaxis. This is a type 1 hypersensitivity reaction in which mast-cells are activated via IgE antibody binding. When a person then encounters this antigen again, mediators such as histamine and leukotrienes are released, resulting in widespread vasodilation and bronchoconstriction. This bronchoconstriction is what gives rise to the wheeze that this patient demonstrates.",
"id": "10025750",
"label": "a",
"name": "Type 1 hypersensitivity reaction",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. In type 2 sensitivity reactions antigens on the cell surface are targeted by antibodies, triggering an immune response when these antigens are presented to T-cells. An example of this would be an acute transfusion reaction.",
"id": "10025751",
"label": "b",
"name": "Type 2 hypersensitivity reaction",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 5 hypersensitivity reaction involves antibodies against hormone-producing cells. An example is Graves' disease.",
"id": "10025754",
"label": "e",
"name": "Type 5 hypersensitivity reaction",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 4 hypersensitivity reactions are mediated by T-cell activation and usually occur over days as opposed to minutes. An example is contact dermatitis.",
"id": "10025753",
"label": "d",
"name": "Type 4 hypersensitivity reaction",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 3 hypersensitivity reactions involve antigen-antibody complexes that may eventually damage tissues. An example is rheumatoid arthritis.",
"id": "10025752",
"label": "c",
"name": "Type 3 hypersensitivity reaction",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4446",
"name": "Anaphylaxis (Paediatrics)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4446,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17548",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 4 year old child is rushed to A&E by his worried mum after he tried a peanut for the first time and began wheezing. On the journey, he also developed an itchy rash.\n\nOn examination the child has an increased respiratory rate and wheeze. He also has widespread erythematous wheals with well-defined borders.\n\nThe doctor administers IM adrenaline which resolves the symptoms.\n\nWhich of the following types of hypersensitivity reaction has occurred?",
"sbaAnswer": [
"a"
],
"totalVotes": 95,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,712 | false | 6 | null | 6,495,189 | null | false | [] | null | 17,549 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bendroflumethazide belongs to the thiazide class of diuretics. The sodium/amino acid symporter plays no role in the mechanism of action of thiazide diuretics but is instead responsible for the reabsorption of amino acids.",
"id": "10025759",
"label": "e",
"name": "Sodium/amino acid symporter in the proximal convoluted tubule",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bendroflumethazide belongs to the thiazide class of diuretics. The sodium/glucose linked transporter is not involved in the mechanism of action of thiazide diuretics but is the target of SGLT2 inhibitors such as empagliflozin, which is used in diabetes treatment.",
"id": "10025757",
"label": "c",
"name": "Sodium glucose linked transporter in the proximal convoluted tubule",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bendroflumethazide belongs to the thiazide class of diuretics. These drugs block the sodium-chloride symporter in the distal convoluted tubule. By contrast, sodium-potassium-chloride co-transporters are the target of loop diuretics. Whilst they work similarly to thiazide diuretics by stopping the reabsorption of sodium and thus reducing water reabsorption, they act upon a different transporter, making this option incorrect.",
"id": "10025758",
"label": "d",
"name": "Sodium-potassium-chloride co-transporters of the thick ascending limb",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bendroflumethazide belongs to the thiazide class of diuretics. Whilst thiazide diuretics do block the sodium-chloride symporter, this blockade occurs in the distal convoluted tubule not the proximal, meaning this option is incorrect.",
"id": "10025756",
"label": "b",
"name": "Sodium-chloride symporter in the proximal convoluted tubule",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Bendroflumethazide belongs to the thiazide class of diuretics. These drugs block the sodium-chloride symporter in the distal convoluted tubule, preventing the reabsorption of sodium and chloride. Remember water follows sodium so less water is also reabsorbed, reducing the circulating blood volume which in turn decreases cardiac pre-load and thus blood pressure.",
"id": "10025755",
"label": "a",
"name": "Sodium-chloride symporter in the distal convoluted tubule",
"picture": null,
"votes": 70
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5764",
"name": "Thiazide diuretics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5764,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17549",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old patient with hypertension which has failed to be controlled by first-line therapy is prescribed bendroflumethazide.\n\nWhich of the following parts of the nephron does this class of diuretic act upon?",
"sbaAnswer": [
"a"
],
"totalVotes": 91,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,713 | false | 7 | null | 6,495,189 | null | false | [] | null | 17,550 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. These drugs inhibit ACE, which mediates the conversion of angiotensin I to angiotensin II. Angiotensin II causes vasoconstriction, meaning that inhibition of this system via ACE inhibitors brings about vasodilation, thus lowering blood pressure. This answer is therefore correct.",
"id": "10025760",
"label": "a",
"name": "The conversion of angiotensin I to angiotensin II in the lungs",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. By contrast, angiotensin II stimulates aldosterone release from the zona glomerulosa of the adrenal cortex. Ramipril does not directly inhibit this process.",
"id": "10025763",
"label": "d",
"name": "The release of aldosterone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Angiotensinogen is cleaved by renin to form angiotensin I. This conversion happens independently of the action of ACE, making this option incorrect.",
"id": "10025762",
"label": "c",
"name": "The conversion of angiotensinogen to angiotensin I",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Whilst ACE is responsible for the conversion of angiotensin I to angiotensin II, this occurs mainly in the lungs rather than in the kidney. Therefore this is not the single best answer.",
"id": "10025764",
"label": "e",
"name": "The conversion of angiotensin I to angiotensin II in the kidney",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. By contrast, renin is released from the juxtaglomerular apparatus in response to the action of macula densa cells, baroreceptors or beta-1 adrenoreceptors. This option is therefore incorrect.",
"id": "10025761",
"label": "b",
"name": "The release of renin",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4215",
"name": "ACE inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4215,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17550",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 48 year old caucasian male patient presents to his GP to review the results of his daily home blood pressure readings. He is subsequently diagnosed with hypertension and is prescribed ramipril as first-line therapy.\n\nWhich of the following components of the Renin-Angiotensin-Aldosterone system (RAAS) is inhibited by this drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 95,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,714 | false | 8 | null | 6,495,189 | null | false | [] | null | 17,551 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of respiratory compensation for metabolic alkalosis. The ABG shows respiratory acidosis, meaning a reduced respiratory rate would be an inappropriate response. Furthermore, this would be an example of respiratory compensation, rather than renal compensation.",
"id": "10025769",
"label": "e",
"name": "Slowing the respiratory rate to retain CO2",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In the type B intercalated cells of the distal convoluted tubule of the nephron, HCO3- can be secreted and hydrogen ions reabsorbed. This function is important in the response to **alkalosis**. By contrast, the ABG in this case shows a respiratory **acidosis**, making this option incorrect.",
"id": "10025766",
"label": "b",
"name": "The elimination of bicarbonate (HCO3-) and reabsorption of hydrogen ions",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The kidney plays a key role in acid-base balance. The intercalated cells of the distal convoluted tubule secrete hydrogen ions whilst reabsorbing HCO3- in an attempt to make blood pH more alkaline. As you can see in the ABG, HCO3- is raised, indicating the kidney has attempted to compensate for the chronic increase in CO2 secondary to COPD.",
"id": "10025765",
"label": "a",
"name": "The elimination of hydrogen ions and reabsorption of bicarbonate (HCO3-)",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An increase in respiratory rate acts to increase carbon dioxide, thus making the blood more alkalotic. This this a more acute mechanism of compensation for acidosis, whereas the vignette refers to chronic respiratory acidosis. Furthermore, an increase in respiratory rate is a respiratory method of compensation, whereas the question specifically asks for renal compensation. This is therefore not the single best answer to this question.",
"id": "10025767",
"label": "c",
"name": "Increasing respiratory rate to exhale more carbon dioxide",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Increased reabsorption of hydrogen ions in the kidney occurs in response to blood alkalosis, while increased reabsorption of HCO3- occurs in response to blood acidosis. Reabsorption of both hydrogen ions and HCO3- does not typically occur together. Another important consideration is that many of the transporters responsible for acid-base balance in the kidney can either reabsorb HCO3- and secrete hydrogen ions or vice versa.",
"id": "10025768",
"label": "d",
"name": "Reabsorption of both hydrogen ions and bicarbonate (HCO3-)",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4015",
"name": "Causes of respiratory acidosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4015,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17551",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 70 year old man presents to A&E with a cough productive of green sputum and increased shortness of breath on exertion. He was diagnosed with chronic obstructive pulmonary disease (COPD) 3 years ago and has previously been noted to retain carbon dioxide. The following arterial blood gas (ABG) is obtained:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.30|7.35 - 7.45|\n|PaO₂|9.5 kPa|11 - 15|\n|PaCO₂|7.2 kPa|4.6 - 6.4|\n|Bicarbonate|34 mmol/L|22 - 30|\n\n\nWhich of the following compensatory mechanisms has been carried out by the kidney over the course of his **chronic** COPD.",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,715 | false | 9 | null | 6,495,189 | null | false | [] | null | 17,552 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paracetamol is not associated with nephrotoxicity. However, in large doses or prolonged use, it can cause hepatic damage.",
"id": "10025772",
"label": "c",
"name": "Paracetamol",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amoxicillin is not commonly associated with nephrotoxicity and is therefore not the single best answer. Penicillins are often associated with gastrointestinal upset and allergy. There is some association between beta-lactams and acute interstitial nephritis, however, this is less common than the nephrotoxic effect of gentamycin. Furthermore, the antibiotic in this case was prescribed to treat a pseudomonas infection, which amoxicillin does not cover.",
"id": "10025771",
"label": "b",
"name": "Amoxicillin",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clarithromycin is a macrolide antibiotic and is often used when a patient has a penicillin allergy. It is associated with QT interval prolongation, gastrointestinal upset and ototoxicity, but not nephrotoxicity. This is therefore not the single best answer.",
"id": "10025774",
"label": "e",
"name": "Clarithromycin",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst intravenous sodium chloride may have been used in the treatment of a severe infection, it is not commonly associated with nephrotoxicity. Therefore this is not the single best answer.",
"id": "10025773",
"label": "d",
"name": "Intravenous sodium chloride",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Gentamicin belongs to the aminoglycoside class of antibiotics. These drugs are associated with nephrotoxicity and ototoxicity. It is important to measure renal function regularly whilst on this medication. They cause kidney damage through toxicity to tubular cells, causing acute tubular necrosis. Additionally, they are often used in severe infections caused by pseudomonas.",
"id": "10025770",
"label": "a",
"name": "Gentamicin",
"picture": null,
"votes": 76
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4471",
"name": "Aminoglycosides",
"status": null,
"topic": {
"__typename": "Topic",
"id": "223",
"name": "Antibiotic pharmacology",
"typeId": 7
},
"topicId": 223,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4471,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17552",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 40 year old man attends his GP surgery requesting a blood test to measure his kidney function. He was discharged from hospital the previous week, after receiving a course of intravenous medications for a severe pseudomonas infection. He is unable to remember which medication he received but recalls one of the doctors warned him it could damage his kidneys.\n\nWhich of the following medications is most commonly associated with nephrotoxicity?",
"sbaAnswer": [
"a"
],
"totalVotes": 90,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,716 | false | 10 | null | 6,495,189 | null | false | [] | null | 17,553 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ADH acts upon the collecting duct, rather than the proximal convoluted tubule. Nephrogenic diabetes insipidus does not involve ADH resistance of the proximal convoluted tubule, making this answer incorrect.",
"id": "10025779",
"label": "e",
"name": "The proximal convoluted tubule",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ADH is synthesised, stored and released from the **posterior** pituitary gland not the anterior. Furthermore, this question describes a case of **nephrogenic** diabetes insipidus and thus the pituitary gland is unaffected.",
"id": "10025776",
"label": "b",
"name": "Anterior pituitary gland",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ADH acts upon the collecting duct, rather than the renal glomerulus. Nephrogenic diabetes insipidus does not involve ADH resistance of the glomerulus, making this answer incorrect.",
"id": "10025778",
"label": "d",
"name": "The glomerulus of the nephron",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The posterior pituitary gland is responsible for the synthesis, storage and release of ADH. In **cranial** diabetes insipidus, there is a lack of ADH secretion. However, this question features **nephrogenic** diabetes insipidus and therefore this answer is incorrect.",
"id": "10025777",
"label": "c",
"name": "Posterior pituitary gland",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Nephrogenic diabetes insipidus is a condition in which the kidney fails to respond to ADH. This can be caused by a multitude of factors, however, the likely cause in this vignette is lithium which is being used as a mood stabiliser for this patient's bipolar affective disorder. ADH acts on the distal convoluted tubule and collecting ducts of the nephron, which increases the presence of aquaporin-2 channels allowing for water reabsorption.",
"id": "10025775",
"label": "a",
"name": "The collecting ducts of the nephron",
"picture": null,
"votes": 73
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4084",
"name": "Antidiuretic hormone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4084,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17553",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old male attends an endocrinology clinic with one month of polyuria, nocturia and polydipsia. He has a diagnosis of bipolar affective disorder but has been stable for several years on lithium. A water deprivation test diagnoses nephrogenic diabetes insipidus.\n\nWhich of the following structures has developed resistance to anti-diuretic hormone (ADH)?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,717 | false | 11 | null | 6,495,189 | null | false | [] | null | 17,554 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This release of proteolytic enzymes is key to digesting the zona pellucida. However, it plays no role in the polyspermy block and therefore is incorrect.",
"id": "10025782",
"label": "c",
"name": "Release of Proteolytic enzymes from the sperm's acrosome",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is present on the capacitated sperm cell head and is responsible for dissolving the connection between the cumulus-oocyte complex, which is necessary for sperm to penetrate the oocyte. However, it plays no role in the polyspermy block and is therefore incorrect.",
"id": "10025784",
"label": "e",
"name": "Hyaluronidase of the sperm cell head",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the final maturation process for sperm and is necessary for fertilisation. However, it plays no role in the polyspermy block and is therefore incorrect.",
"id": "10025783",
"label": "d",
"name": "Sperm capacitation",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Release of Ca2+ from the smooth endoplasmic reticulum is known as the cortical reaction and causes intracellular Ca2+ to rise, preventing polyspermy. This rise in Ca2+ stimulates a sequence of processes which hardens the membrane of the oocyte to prevent penetration of further sperm cells.",
"id": "10025780",
"label": "a",
"name": "Release of Ca2+ from the smooth endoplasmic reticulum",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Potassium ions are not involved in the polyspermy block and therefore this answer is incorrect.",
"id": "10025781",
"label": "b",
"name": "Release of K+ from the smooth endoplasmic reticulum",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3963",
"name": "Mechanisms of Fertilisation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3963,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17554",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old male attends his GP surgery to discuss the results of a recent semen analysis. The analysis shows hypospermia. The patient wishes to know more about the process by which a sperm cell can fertilise an oocyte.\n\nWhich of the following processes ensures only a single sperm cell fertilises an oocyte?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,718 | false | 12 | null | 6,495,189 | null | false | [] | null | 17,555 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combined oral contraceptive pill thickens cervical mucus. This makes it harder for sperm to reach the oocyte and therefore gives its contraceptive properties.",
"id": "10025787",
"label": "c",
"name": "Thinning of the cervical mucus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as the combined oral contraceptive pill is not used in patients who have sperm cells, or who produce semen. The COCP contains both oestrogen and progesterone. This in turn inhibits the release of FSH and LH through negative feedback, as well as causing thickening of the cervical mucus which makes it more difficult for sperm to penetrate. It also inhibits endometrial proliferation, which prevents implantation.",
"id": "10025789",
"label": "e",
"name": "Reduces the number of sperm cells in semen",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Endometrial proliferation is part of the normal physiological process of the menstrual cycle to facilitate implantation of the oocyte to the endometrium and therefore fertilisation. The high levels of oestrogen and progesterone inhibit this process preventing implantation and therefore fertilisation of the oocyte.",
"id": "10025788",
"label": "d",
"name": "Inducing endometrial proliferation",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The COCP contains both oestrogen and progesterone. This in turn inhibits the release of FSH and LH through negative feedback, as well as causing thickening of the cervical mucus which makes it more difficult for sperm to penetrate the uterus. It also inhibits endometrial proliferation, which prevents implantation. Thickening of the cervical mucus therefore correctly describes a component of the mechanism of action of the COCP.",
"id": "10025785",
"label": "a",
"name": "Thickening of the cervical mucus",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combined oral contraceptive pill contains oestrogen and progesterone. It actually reduces levels of FSH and LH, which inhibits ovulation.",
"id": "10025786",
"label": "b",
"name": "High LH and FSH levels inhibit oestrogen and progesterone levels",
"picture": null,
"votes": 19
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5862",
"name": "Contraception",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5862,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17555",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 19 year old female comes to her GP to discuss contraceptive options. After discussion, she decides that she would like to try the combined oral contraceptive pill (COCP).\n\nWhich of the following describes the mechanism of action of this drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,719 | false | 13 | null | 6,495,189 | null | false | [] | null | 17,556 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There are times when a person will be the first person in their family to have the specific mutation (de novo). This can occur due to a sporadic mutation.",
"id": "10025793",
"label": "d",
"name": "There is always a family history of autosomal dominant disorders",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. If one parent carries the abnormal allele of an autosomal dominant condition, the chance of a child inheriting the allele and becoming a carrier is 50%. If Aa is the affected parent and aa is the unaffected parent: Aa, Aa, aa and aa are the possible allele combinations. 2 out of 4 of these are affected and therefore the chance is 50%.",
"id": "10025792",
"label": "c",
"name": "There is 100% chance of a child inheriting an autosomal dominant condition if only one parent carries the gene",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Males and females are equally affected. This statement would be true of x-linked recessive conditions; as males only have one x chromosome, if they inherit a pathogenic variant of x-linked recessive condition then they will be affected.",
"id": "10025794",
"label": "e",
"name": "Only males can be affected",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. In autosomal dominant conditions, only one copy of the gene is needed for the individual to be symptomatic. This means that any patient with the abnormal allele will always be both a carrier and a sufferer. It also means that only one parent has to be a sufferer to pass on the condition.",
"id": "10025790",
"label": "a",
"name": "Only one abnormal copy of a gene is needed for an individual to be symptomatic",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In autosomal dominant conditions, if one parent carries the faulty gene there is a 50% chance that their offspring will inherit it, and in turn become symptomatic.",
"id": "10025791",
"label": "b",
"name": "Both parents must have a copy of the abnormal gene for the child to be symptomatic",
"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": "5863",
"name": "Autosomal dominant conditions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "156",
"name": "Medical Genetics",
"typeId": 7
},
"topicId": 156,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5863,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17556",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 20 year old woman receives a new diagnosis of Ehlers-Danlos syndrome. Her GP explains that this is an autosomal dominant condition.\n\nWhich of the following is true of autosomal dominant conditions?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,720 | false | 14 | null | 6,495,189 | null | false | [] | null | 17,557 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "After 26 weeks the developing lungs enter the terminal sac stage. This is where the alveoli develop, comprised of type 1 pneumocytes (which are simple squamous epithelial cells) and type 2 pneumocytes (which are cuboidal cells that produce surfactant). As the foetus in the clinical vignette is only at 22 weeks gestation, its lungs are yet to have developed alveoli.",
"id": "10025795",
"label": "a",
"name": "Development of the alveoli",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Formation of the respiratory diverticulum occurs during the embryonic stage of lung development at 3-6 weeks gestation. The respiratory diverticulum forms in the foregut endoderm. As the foetus in this question is at 22 weeks gestation they will have undergone this stage, making this option incorrect.",
"id": "10025797",
"label": "c",
"name": "Formation of the respiratory diverticulum",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The development of the bronchial tree occurs in the pseudoglandular stage of lung development. This occurs between 8-16 weeks gestation and involves multiple differentiations of the bronchial buds to form a primitive bronchial tree. As the foetus in this question is at 22 weeks gestation they will have undergone this stage and thus have developed a bronchial tree, making this option incorrect.",
"id": "10025796",
"label": "b",
"name": "Development of the bronchial tree",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Formation of parietal and visceral pleura occurs during the embryonic stage of lung development from around 5 weeks gestation. The pleura is developed from the mesoderm. As the foetus in this question is at 22 weeks gestation they will have undergone this stage, making this option incorrect.",
"id": "10025798",
"label": "d",
"name": "Formation of parietal and visceral pleura",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The mesoderm is one of the germ cell layers of the embryoblast. Following implantation the primitive streak appears in the epiblast and helps form new layers: firstly the endoderm and then the mesoderm, leaving the original layer of hypoblast cells (now known as the ectoderm). This occurs around weeks 2-3 of gestation. As the foetus in this question is at 22 weeks gestation they will have already undergone formation of the mesoderm, making this option incorrect.",
"id": "10025799",
"label": "e",
"name": "Formation of the mesoderm",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4533",
"name": "Development of the lungs",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4533,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17557",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old female patient presents to her GP with concerns about her pregnancy. She is currently 22 weeks pregnant and has had all of her routine checks without issue. However, she is concerned because a friend gave birth prematurely and the baby had to have \"help to breathe\". She is keen to learn more about foetal lung development.\n\nWhich of the following stages of lung development is the foetus still yet to undergo?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,721 | false | 15 | null | 6,495,189 | null | false | [] | null | 17,558 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This describes the role of the umbilical vein. This structure is closed after birth and becomes the round ligament of the liver. It can reopen later in life, for example in severe liver cirrhosis. However, it is not associated with a continuous 'machine' murmur and is therefore not the single best answer in this case.",
"id": "10025803",
"label": "d",
"name": "Delivery of oxygenated blood from placenta to foetus",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The baby in the vignette has a patent ductus arteriosus, as indicated by the continuous 'machine whirring' murmur heard on examination. A machine whirring murmur heard across the cardiac cycle is characteristic of patent ductus arteriosus. In foetal circulation the ductus arteriosus connects the pulmonary artery and the aorta, allowing blood from the right ventricle to bypass the pulmonary artery (and so bypass the inactive lungs) and instead pass around the rest of the body via the aorta.",
"id": "10025800",
"label": "a",
"name": "Allow blood to bypass the lungs",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This describes the role of the umbilical artery which after birth becomes two parts; one becomes the median umbilical ligament and another remains open as part of the internal iliac artery. It is not associated with a continuous 'machine' murmur and is therefore not the single best answer.",
"id": "10025804",
"label": "e",
"name": "Delivery of deoxygenated blood from fetus to placenta",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This describes the role of the foramen ovale. This allows oxygenated blood from the placenta to pass from the right to the left atrium. It is a relatively common cause of a murmur on auscultation of the newborn heart. However, a patent foramen ovale causes a soft ejection systolic murmur heard best at the upper left sternal border, rather than a continuous 'machine' murmur. This is therefore not the single best answer.",
"id": "10025802",
"label": "c",
"name": "Allow oxygenated blood can move from the right to left atrium",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This describes the function of the ductus venosus, which allows blood from the placenta to bypass the liver, which in foetal physiology is not as active. A patent ductus venosus is uncommon and would not cause a continuous 'machine' murmur, so this is not the single best answer.",
"id": "10025801",
"label": "b",
"name": "Allow blood to bypass the liver",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4579",
"name": "Patent Ductus arteriosus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4579,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17558",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A newborn boy is examined on the labour ward following an instrumental vaginal delivery. The baby was born at 35 weeks gestation, weighing 5 pounds 9 ounces. On examination of the heart sounds a continuous 'machine whirring' murmur is identified across all areas of the chest.\n\nWhich of the following best describes the function of the foetal circulatory structure that has remained potent in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,722 | false | 16 | null | 6,495,189 | null | false | [] | null | 17,559 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst a common peroneal nerve lesion can give rise to foot drop, sensory loss and pain, this patient's presentation is not wholly in keeping with a common peroneal nerve lesion. The impairment of inversion (a tibial nerve function), is indicative of an L5 radiculopathy rather than a common peroneal nerve lesion.",
"id": "10025808",
"label": "d",
"name": "L3",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The dermatome of L4 supplies the anterior aspect of the knee and medial malleolus, rather than the dorsum of the foot. Furthermore, the patella reflex is commonly disrupted in L4 lesions, whereas this patient demonstrated normal reflexes. L4 is therefore not the most likely location of the lesion in this case.",
"id": "10025807",
"label": "c",
"name": "L4",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst a common peroneal nerve lesion can give rise to foot drop, sensory loss and pain, this patient's presentation is not wholly in keeping with a common peroneal nerve lesion. The impairment of inversion (a tibial nerve function), is indicative of an L5 radiculopathy rather than a common peroneal nerve lesion.",
"id": "10025806",
"label": "b",
"name": "Common peroneal nerve",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This vignette is characteristic of an L5 radiculopathy. The patient demonstrates clinical signs of foot drop, including a loss of dorsiflexion and a high stepping gate. The back pain and history of heavy lifting is suggestive of a disc herniation causing sciatica-like shooting pain, while the dermatomal loss of sensation on the dorsum of the foot makes an L5 lesion most likely. Limb reflexes are intact in L5 lesions.",
"id": "10025805",
"label": "a",
"name": "L5",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Tibial nerve damage is characterised by weakness of foot plantarflexion and sensory loss over the plantar surface of the foot, rather than the dorsum. The tibial nerve is therefore not the most likely location of the lesion in this case. Another point to note is that the tibial nerve is a deep structure and is therefore not often injured through mechanical trauma.",
"id": "10025809",
"label": "e",
"name": "Tibial nerve",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3856",
"name": "Foot drop",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3856,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "L5",
"highlights": [],
"id": "17559",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 39 year old male presents to the GP surgery after a back injury sustained by picking up a heavy box at work. He experienced sudden, severe pain in his lower back with shooting pains down the back of his legs. Since the incident he has been unsteady on his feet tripping over multiple times. \nThe patient enters the consultation room with a high-stepping gait. On examination there is sensory loss over the dorsum of his left foot. Dorsiflexion, inversion and eversion of the foot are significantly weaker on the left compared to the right side, however, all reflexes of the upper and lower limbs are intact.\nWhich of the following structures is most likely implicated in the patient's presentation",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,723 | false | 17 | null | 6,495,189 | null | false | [] | null | 17,560 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The infant in this vignette shows signs of Erb's palsy, which is caused by C5-C6 nerve root damage. C8-T1 are the nerve roots affected in Klumpke's palsy not Erb's palsy. This predominantly affects the nerves of the T1 root, ulnar and medial and presents with a clawed hand appearance.",
"id": "10025813",
"label": "d",
"name": "C8-T1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The infant in this vignette shows signs of Erb's palsy, which is caused by C5-C6 nerve root damage. C3-C4 are unaffected by Erb's palsy, making this option incorrect. C3-C4 is also not part of the brachial plexus and therefore would not give rise to the clinical features described here.",
"id": "10025811",
"label": "b",
"name": "C3-C4",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The infant in this vignette shows signs of Erb's palsy, which is caused by C5-C6 nerve root damage. By contrast, T2-T3 nerve roots are not part of the brachial plexus. Therefore any damage to these roots would not give rise to the clinical presentation seen in this case.",
"id": "10025814",
"label": "e",
"name": "T2-T3",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient in the vignette demonstrates the waiter's tip sign which is characteristic of Erb's palsy. This involves damage to the nerve roots C5-C6. Being born via an instrumental vaginal delivery is a risk factor for Erb's palsy. Individuals with Erb's palsy also show dermatomal sensory loss in the C5-6 distribution.",
"id": "10025810",
"label": "a",
"name": "C5-C6",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The infant in this vignette shows signs of Erb's palsy, which is caused by C5-C6 nerve root damage. C7-C8 are unaffected by Erb's palsy, making this option incorrect. C7-C8 damage would also not give rise to the clinical signs in the vignette as the waiter's tip sign is seen due to the musculocutaneous and axillary nerves being affected.",
"id": "10025812",
"label": "c",
"name": "C7-C8",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3864",
"name": "Brachial plexus injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3864,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17560",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A newborn baby is examined by the on-call paediatrician following an instrumental vaginal delivery. The baby was born at 39 weeks gestation and weighs 7 pounds 3 ounces. On examination, the baby's right shoulder rests in adduction while the right elbow is fixed in extension. The right forearm is pronated and wrist is flexed.\n\nWhich of the following nerve roots have been damaged in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 86,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,724 | false | 18 | null | 6,495,189 | null | false | [] | null | 17,561 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The musculocutaneous nerve is responsible for elbow flexion and supination, not wrist flexion or thumb adduction. Furthermore, the sensory distribution of the musculocutaneous nerve is to the lateral part of the forearm, not the medial one-and-a-half fingers. The pattern of deficits seen in this patient is therefore most in keeping with an ulnar nerve lesion.",
"id": "10025816",
"label": "b",
"name": "Mucsculocutaneous nerve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The radial nerve is responsible for forearm, wrist, finger and thumb extension, not wrist flexion or thumb adduction. Furthermore, the sensory distribution of the radial nerve is to the dorsal aspect of the thumb, index and middle finger, as well as the lateral side of the ring finger. The pattern of deficits seen in this patient is therefore most in keeping with an ulnar nerve lesion.",
"id": "10025818",
"label": "d",
"name": "Radial nerve",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This vignette is strongly suggestive of an ulnar nerve injury. Fracture to the medial epicondyle is a common cause of ulnar nerve injury, and this is suggested by the tenderness of the medial epicondyle on a background of recent trauma. The patient also demonstrates weakness in wrist flexion and thumb adduction; both functions of the ulnar nerve. Furthermore, the patient shows a sensory deficit in the medial one-and-a-half digits of the right hand, which is supplied by the ulnar nerve.",
"id": "10025815",
"label": "a",
"name": "Ulnar nerve",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The median nerve is responsible for motor actions of the LOAF (flexor pollicis brevis, opponens pollicis, abductor pollicis brevis and lateral two lumbricals) muscles of the hand, including but not limited to little finger abduction and flexion. It is not responsible for wrist flexion or thumb adduction. Furthermore, the sensory distribution is to the lateral three-and-a-half fingers rather than the medial one-and-a-half fingers. The pattern of deficits seen in this patient is therefore most in keeping with an ulnar nerve lesion.",
"id": "10025819",
"label": "e",
"name": "Median nerve",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The axillary nerve is responsible for shoulder abduction, not wrist flexion or thumb adduction. Furthermore, the sensory distribution of the axillary nerve is the inferior region of the deltoid muscle, not the medial one-and-a-half fingers. The pattern of deficits seen in this patient is therefore most in keeping with an ulnar nerve lesion.",
"id": "10025817",
"label": "c",
"name": "Axillary nerve",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3866",
"name": "Ulnar nerve injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3866,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17561",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 25 year old male patient presents to A&E after a cricket ball hits him in the right elbow during a match. On examination, there is marked tenderness at the right medial epicondyle. There is also weakness of wrist flexion and thumb adduction on the right side compared to the left, as well as a sensory deficit in the medial one-and-a-half digits of the right hand.\n\nWhich of the following nerves is most likely to be damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,725 | false | 19 | null | 6,495,189 | null | false | [] | null | 17,562 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. There are several signs of symptoms in this case that are characteristic of rheumatoid arthritis. Prolonged morning stiffness (>30 minutes) that improves throughout the day is a characteristic of inflammatory pain such as in rheumatoid arthritis. It typically features bilateral involvement of the small joints of the hand, and is more common in women, with typical age of onset between the ages 40-60 years old.",
"id": "10025820",
"label": "a",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 78
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Reactive arthritis is an inflammatory arthritis that typically occurs in the four weeks following an infection. It is also usually a monoarthritis, most commonly affecting the large joints of the lower limbs. Rheumatoid arthritis is therefore more likely in this case.",
"id": "10025822",
"label": "c",
"name": "Reactive arthritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There are a few features of this case that make osteoarthritis less likely. Firstly, the patient is below the typical age of onset for osteoarthritis. The presence of morning stiffness that improves with activity, and involvement of the small rather than large, weight-bearing joints, is also indicative of an inflammatory arthritis such as rheumatoid arthritis.",
"id": "10025821",
"label": "b",
"name": "Osteoarthritis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Septic arthritis typically presents with an acutely painful, hot, swollen monoarthritis. Patients tend to be systemically unwell. The timeframe, multiple small joint involvement and normal observations seen in this case mean that rheumatoid arthritis is a more likely underlying diagnosis.",
"id": "10025823",
"label": "d",
"name": "Septic arthritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Psoriatic arthritis shares many characteristics with rheumatoid arthritis and with this case. However, there are key differences. Psoriatic arthritis typically involves personal or family history of psoriasis, often including nail changes or dactylitis. These features are not mentioned in this case, making rheumatoid arthritis a more likely underlying diagnosis.",
"id": "10025824",
"label": "e",
"name": "Psoriatic arthritis",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3975",
"name": "Rheumatoid Arthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3975,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17562",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 44 year old woman presents to the GP with pain in both of her hands. The pain has been present for the last month and is worse in the morning; her hands feel very stiff all morning but later improve with movement. She is otherwise fit and well, and had no other medical conditions and no recent infections. She has been taking paracetamol for the pain to limited effect but has no regular medications.\n\nOn examinatio,n she has tender, red, swollen metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally. All other joints are unremarkable. Her observations are all within normal limits.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.