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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. 3β-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.",
"id": "10027325",
"label": "e",
"name": "3β-hydroxylase",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. 11β-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.",
"id": "10027323",
"label": "c",
"name": "11β-hydroxylase",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. 17α-hydroxylase is an enzyme in the adrenal steroidogenesis pathway, but it is not the most common enzymatic defect in congenital adrenal hyperplasia.",
"id": "10027322",
"label": "b",
"name": "17α-hydroxylase",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The steroidogenic acute regulatory protein is a regulator of cholesterol transfer within the mitochondria, which is also known as the rate-limiting step in the adrenal steroidogenesis pathway. However, it is not the most common enzymatic defect in congenital adrenal hyperplasia and is known to cause lipoid congenital adrenal hyperplasia if deficient.",
"id": "10027324",
"label": "d",
"name": "Steroidogenic acute regulatory protein",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Congenital Adrenal Hyperplasia (CAH) is a group of inherited, autosomal recessive genetic disorders caused by enzyme defects in the adrenal cortex, which disrupts steroid hormone synthesis. The most common variant, 21-hydroxylase deficiency, is the only one you have to remember. Diagnosis is made through hormone assays and genetic testing.",
"id": "10027321",
"label": "a",
"name": "21-Hydroxylase",
"picture": null,
"votes": 35
}
],
"comments": [],
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5779",
"name": "Congenital Adrenal Hyperplasia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
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"question": "Which of the following is the most common enzymatic defect in congenital adrenal hyperplasia?",
"sbaAnswer": [
"a"
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"totalVotes": 40,
"typeId": 1,
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173,466,627 | false | 20 | null | 6,495,215 | null | false | [] | null | 17,863 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Aldosterone increases Na+ reabsorption and K+ secretion in the collecting duct and late distal convoluted tubule by stimulating the sodium-potassium ATPase on the basal side of the tubular cells",
"id": "10027326",
"label": "a",
"name": "Increased Na+ reabsorption and K+ secretion in the collecting duct and late distal convoluted tubule",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Renin, secreted by juxtaglomerular cells, is responsible for converting angiotensinogen (produced in the liver) into angiotensin I.",
"id": "10027327",
"label": "b",
"name": "It converts angiotensinogen to angiotensin I",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is one of the actions of angiotensin II, which also stimulates aldosterone secretion.",
"id": "10027330",
"label": "e",
"name": "Directly stimulates vasoconstriction",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The Angiotensin-Converting Enzyme (ACE), produced in the lungs, is responsible for converting angiotensin I to angiotensin II.",
"id": "10027328",
"label": "c",
"name": "It converts angiotensin I to angiotensin II",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is one of the actions of angiotensin II, which also stimulates aldosterone secretion.",
"id": "10027329",
"label": "d",
"name": "It increases Na+ resorption via stimulation of sodium-hydrogen ion exchanger activity via AT1 receptors in the tubular cells",
"picture": null,
"votes": 4
}
],
"comments": [],
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5969",
"name": "Renin Angiotensin System",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
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"question": "Aldosterone is a steroid hormone involved in the renin-angiotensin-aldosterone system (RAAS).\n\nWhat is the effect of this hormone?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
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173,466,628 | false | 21 | null | 6,495,215 | null | false | [] | null | 17,864 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Parafollicular C cells & capillaries do not contain TSH receptors, and therefore would not respond to TSH.",
"id": "10027335",
"label": "e",
"name": "Decreased number of parafollicular C cells and capillaries",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Follicular cells are simple cuboidal cells which constitute the major cell type in the thyroid gland. These cells are responsible for the production and secretion of thyroid hormones triiodothyronine (T3) and thyroxine (T4). When the thyroid gland is stimulated by TSH, the follicular cells become active and thus, columnar-shaped.",
"id": "10027331",
"label": "a",
"name": "Columnar-shaped follicular cells",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Thyroid follicles contain colloid, thyroglobulin, which is a acidophilic secretory glycoprotein. In the resting (inactive) stage, follicular cells are simple squamous cells with abundant collide within the lumen. When stimulated by TSH, I.e. active, the follicular cells are simple columnar with a scanty volume of colloid in the lumen. As such, there would not be an abundance of colloid in the follicular cells' lumen.",
"id": "10027334",
"label": "d",
"name": "Abundance of colloid in follicular cells' lumen",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Parafollicular C cells are derived from the neural crest cells and secrete calcitonin, a polypeptide hormone. These cells do not contain TSH receptors, and therefore, are not stimulated by TSH.",
"id": "10027333",
"label": "c",
"name": "Increased number of parafollicular C cells",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. TSH stimulates follicular cells to release thyroid hormones, it does not result in a decreased number of follicular cells.",
"id": "10027332",
"label": "b",
"name": "Decreased number of follicular cells",
"picture": null,
"votes": 3
}
],
"comments": [],
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5970",
"name": "Thyroid physiology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
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"topicId": 167,
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"question": "The histology of a thyroid gland being stimulated by thyroid stimulating hormone (TSH) would show which of the following features?",
"sbaAnswer": [
"a"
],
"totalVotes": 37,
"typeId": 1,
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173,466,629 | false | 22 | null | 6,495,215 | null | false | [] | null | 17,865 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Somatostatin (Growth hormone-inhibiting hormone) is produced and secreted by the delta cells of the endocrine pancreatic islets. It is released into the bloodstream after a meal and exerts an inhibitory effect on its target organs. D cells in the antrum of the stomach can also secrete somatostatin.",
"id": "10027336",
"label": "a",
"name": "Somatostatin",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Insulin is secreted by the beta cells of the endocrine pancreas, which make up about 70% of the proportion of islet cells.",
"id": "10027337",
"label": "b",
"name": "Insulin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Pancreatic polypeptide (PP) is secreted by the PP cells of the endocrine pancreas.",
"id": "10027339",
"label": "d",
"name": "Pancreatic polypeptide",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Glucagon is secreted by the alpha cells of the endocrine pancreas, which make up about 25% of the proportion of islet cells.",
"id": "10027338",
"label": "c",
"name": "Glucagon",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Somatotrophin (Growth hormone) is secreted by the anterior pituitary gland.",
"id": "10027340",
"label": "e",
"name": "Somatotrophin",
"picture": null,
"votes": 3
}
],
"comments": [],
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5971",
"name": "Endocrine pancreas physiology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
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"question": "Which of the following hormones is secreted by the delta cells of the pancreatic islets?",
"sbaAnswer": [
"a"
],
"totalVotes": 38,
"typeId": 1,
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} | MarksheetMark |
173,466,630 | false | 23 | null | 6,495,215 | null | false | [] | null | 17,866 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Corticotrophic basophils in the pars distalis (anterior) of the pituitary gland synthesize ACTH.",
"id": "10027341",
"label": "a",
"name": "Basophils in pars distalis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Chromophobes are progenitor cells, also known as resting or undifferentiated chromophils, that do not secrete ACTH.",
"id": "10027342",
"label": "b",
"name": "Chromophobes in the pars distalis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Not to be confused with the corticotropic basophils in the pars distalis, those in the pars intermedia secrete melanocyte-stimulating hormone (MSH).",
"id": "10027343",
"label": "c",
"name": "Basophils in the pars intermedia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Neurons of the paraventricular nuclei in the hypothalamus synthesize anti-diuretic hormone (vasopressin) and oxytocin, not ACTH",
"id": "10027345",
"label": "e",
"name": "Neurons of the paraventricular nuclei in the hypothalamus",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The infundibulum of the posterior lobe (neurohypophysis) of the pituitary gland is continuous with the median eminence located at the base of the hypothalamus, where neurosecretory cells release hypothalamic-releasing hormones into the portal capillary bed for transport to the anterior pituitary.",
"id": "10027344",
"label": "d",
"name": "Neurosecretory cells in the median eminence",
"picture": null,
"votes": 2
}
],
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"id": "5972",
"name": "Adrenocorticotropic hormone (ACTH)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
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"question": "Which of the following cells synthesises Adrenocorticotropic hormone (ACTH)?",
"sbaAnswer": [
"a"
],
"totalVotes": 38,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,631 | false | 24 | null | 6,495,215 | null | false | [] | null | 17,867 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The umbilical cord contains 2 umbilical arteries and 1 umbilical vein, where the latter carries oxygenated blood from the placenta to the fetus. The physiological remnant of this structure is the ligamentum teres (also known as the round ligament) which is a fibrous cord that runs from the umbilicus to the left lobe of the liver in the free border of the falciform ligament.",
"id": "10027346",
"label": "a",
"name": "Umbilical vein",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The allantois is a canal within the umbilical cord that drains urine from the bladder of the fetus. The physiological remnant of the allantois is a fibrous structure known as the urachus, which then definitively forms the median umbilical ligament later on.",
"id": "10027348",
"label": "c",
"name": "Allantois",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The ductus arteriosus is a blood vessel connecting the proximal descending aorta to the trunk of the pulmonary artery in the developing fetus. This allows the majority of the blood from the right ventricle to bypass the fetus's fluid-filled and non-functioning lungs. The physiological remnant of this structure, which is formed within three weeks post-birth, is the ligamentum arteriosum.",
"id": "10027349",
"label": "d",
"name": "Ductus arteriosus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In the developing fetus, the ductus venosus is a shunt that allows some of the oxygenated blood from the umbilical vein to bypass the liver and directly flow into the inferior vena cava. The ductus venosus, ductus arteriosus and, foramen ovale contribute to the essential role of shunting oxygenated blood preferentially to the fetal brain. The physiological remnant of this structure, a fibrous structure that may be continuous with the ligamentum teres, is the ligamentum venosum.",
"id": "10027350",
"label": "e",
"name": "Ductus venosus",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The umbilical cord contains 2 umbilical arteries and 1 umbilical vein, where the former carries deoxygenated blood from the fetus to the placenta. The physiological remnants of the umbilical arteries are the round ligaments of the bladder.",
"id": "10027347",
"label": "b",
"name": "Umbilical artery",
"picture": null,
"votes": 4
}
],
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"name": "Development of foetal circulation",
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"id": "171",
"name": "Embryology",
"typeId": 7
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"question": "The ligamentum teres is a physiological remnant of which embryological feature?",
"sbaAnswer": [
"a"
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173,466,632 | false | 25 | null | 6,495,215 | null | false | [] | null | 17,868 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In human embryos, there are five pairs of pharyngeal pouches, but only four give rise to the head and neck structures. As such, there is no fifth pharyngeal pouch involved in the formation of structures in the head and neck such as the superior parathyroid glands.",
"id": "10027355",
"label": "e",
"name": "Fifth pharyngeal pouch",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. In the fourth and fifth weeks of development, mesenchymal (connective) tissue growth in the cranial region results in the formation of the pharyngeal arches. Simultaneously, outpocketings form on the lateral aspect of the pharynx known as pharyngeal pouches. The pharyngeal arches are separated by pharyngeal clefts on the endodermal surface, and by pharyngeal pouches on the ectodermal surface. In human embryos, there are five pairs of pharyngeal pouches, but only four give rise to the head and neck structures. The fourth pharyngeal pouch gives rise to the superior parathyroid glands.",
"id": "10027351",
"label": "a",
"name": "Fourth pharyngeal arch",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The third pharyngeal pouch gives rise to the inferior parathyroid glands and the thymus.",
"id": "10027354",
"label": "d",
"name": "Third pharyngeal pouch",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The first pharyngeal pouch gives rise to the Eustachian tube and middle ear cavity",
"id": "10027352",
"label": "b",
"name": "First pharyngeal pouch",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The second pharyngeal pouch gives rise to the lining of the palatine tonsils.",
"id": "10027353",
"label": "c",
"name": "Second pharyngeal pouch",
"picture": null,
"votes": 5
}
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"name": "Development of pharyngeal arches",
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"question": "Which pharyngeal pouch do the superior parathyroid glands originate from?",
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"a"
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173,466,633 | false | 26 | null | 6,495,215 | null | false | [] | null | 17,869 | {
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"__typename": "QuestionChoice",
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"explanation": "This is not the correct answer. In the fourth week, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. As such, while it is true that the kidneys become functional by the twelfth week of gestation, it is not accurate that the definitive kidney, the metanephros, is formed by week 4 as the metanephric system is formed in the fifth week of gestation.",
"id": "10027357",
"label": "b",
"name": "4, 12",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. In the fourth week of gestation, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. Ureteric buds develop from the mesonephric ducts, which are a remnant of the pronephric duct, and this induces the development of the definitive kidney known as the metanephros by week 5 of development. The metanephric system is composed of the excretory and collecting system and its development is initiated in the pelvis during the fifth week before the kidneys ascend into the abdomen and become functional by the twelfth week of gestation.",
"id": "10027356",
"label": "a",
"name": "5, 12",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While it is correct that the definitive kidney (i.e. the metanephros) is formed in week 5, it is not true that the kidneys become functional by week 7. By the seventh week of gestation, the cloaca is divided into two structures by the urorectal septum, namely the urogenital sinus and the anal canal. The kidneys become functional when they ascend into the abdomen by the twelfth week of gestation.",
"id": "10027359",
"label": "d",
"name": "5, 7",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While it is correct that the kidneys become functional by the twelfth week of gestation, it is not true that the definitive kidney, the metanephros, is formed by week 7 as the metanephric system is formed in the fifth week of gestation.",
"id": "10027360",
"label": "e",
"name": "7, 12",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The metanephric system is formed in the fifth week of gestation, as such, the definitive kidney (i.e. the metanephros) is formed in week 5, not 4. The significance of the seventh week of gestation is that during weeks 4-7 of gestation, the cloaca is divided into two structures by the anorectal septum, namely the urogenital sinus and the anal canal. It does not indicate the stage of gestation when the kidney becomes functional as the development of the metanephros is initiated in the pelvis during the fifth week before the kidneys ascend into the abdomen and become functional by the twelfth week of gestation.",
"id": "10027358",
"label": "c",
"name": "4, 7",
"picture": null,
"votes": 2
}
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"name": "Development of the urinary tract",
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"typeId": 7
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"question": "Which option is most appropriate to complete this statement - The definitive kidney is formed by week __ and becomes functional by week __",
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"a"
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173,466,634 | false | 27 | null | 6,495,215 | null | false | [] | null | 17,870 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. During puberty, oestrogen is responsible for external genital development in females. During the follicular phase of the menstrual cycle, oestrogen is secreted by the granulosa cells surrounding the follicles in the ovary which exerts a negative feedback on the pituitary gland to decrease secretion of Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH). This allows only one follicle to mature, and subsequently, when the oestrogen levels are high enough, it triggers positive feedback to the hypothalamic-pituitary-gonadal axis which results in a surge of LH that stimulates the dominant follicle to release an ovum. As such, oestrogen is not involved in the regression of the paramesonephric duct.",
"id": "10027365",
"label": "e",
"name": "Oestrogen",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. At puberty, Luteinizing Hormone (LH) secreted by the anterior pituitary gland stimulates the Leydig cells to produce androgens (testosterone). This results in the spermatogenic tubules canalising and the process of spermatogenesis initiating when the cells become more organized. In females, the lack of testosterone due to the absence of Leydig cells results in the regression of the mesonephric duct, while the absence of anti-mullerian hormone stimulates the development of paramesonephric ducts which subsequently give rise to the internal female genitalia. As such, testosterone is not involved in the regression of the paramesonephric duct.",
"id": "10027364",
"label": "d",
"name": "Testosterone",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. During the fifth to sixth week of development, primordial germ cells migrate into the intermediate mesoderm of the genital ridge, surrounded and supported by somatic cells. The intermediate mesoderm forms two ductal systems, namely the mesonephric duct and the paramesonephric (Mullerian) duct. If the genital ridge expresses SRY (Sex determining region of Y chromosome), the somatic cells differentiate as Sertoli cells which secrete Anti-Mullerian Hormone (AMH), causing the paramesonephric (Mullerian) duct to degenerate. This prevents the female reproductive tract from developing. In females, the absence of AMH stimulates the development of the paramesonephric ducts, which give rise to the internal female genitalia.",
"id": "10027361",
"label": "a",
"name": "Anti-Mullerian Hormone (AMH)",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH) are glycoproteins secreted by the gonadotropic basophils in the anterior pituitary gland that correlate with the menstrual cycle in females. FSH acts on Sertoli cells resulting in spermatogenesis in males and follicular development (oestrogen production) in females. As such, it does not contribute to the regression of the paramesonephric duct.",
"id": "10027362",
"label": "b",
"name": "Follicular Stimulating Hormone (FSH)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Luteinizing hormone (LH) and Follicular Stimulating Hormone (FSH) are glycoproteins secreted by the gonadotropic basophils in the anterior pituitary gland that correlate with the menstrual cycle in females. LH acts on Leydig cells resulting in testosterone production in males and corpus luteum production (progesterone production) in females. As such, it does not contribute to the regression of the paramesonephric duct.",
"id": "10027363",
"label": "c",
"name": "Luteinising Hormone (LH)",
"picture": null,
"votes": 2
}
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"id": "3871",
"name": "Development of the male reproductive system",
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"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
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"question": "During embryogenesis, what hormone is secreted by males which results in the regression of the paramesonephric duct?",
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"a"
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173,466,635 | false | 28 | null | 6,495,215 | null | false | [] | null | 17,871 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the sympathetic innervation for the midgut which extends from the common bile duct to the proximal two-thirds of the transverse colon, whereas the sigmoid colon is part of the hindgut.",
"id": "10027370",
"label": "e",
"name": "Lesser splanchnic nerve",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The sigmoid colon is part of the hindgut which extends from the distal one-third of the transverse colon to the anorectal junction (cloacal membrane). It receives innervation from the inferior mesenteric plexus where the sympathetic innervation is from the lumbar splanchnic nerve and the parasympathetic innervation is from the pelvic splanchnic nerve.",
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"label": "a",
"name": "Pelvic splanchnic nerve",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the parasympathetic innervation for the foregut which extends from the oesophagus to the proximal duodenum just before the opening of the common bile duct, whereas the sigmoid colon is part of the hindgut. The foregut arises from the endoderm and is therefore developmentally distinct from the midgut and hindgut. The vagus nerve and the enteric nervous system contribute to the innervation of the foregut structures.",
"id": "10027368",
"label": "c",
"name": "Vagus nerve",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the parasympathetic innervation for the midgut which extends from the common bile duct to the proximal two-thirds of the transverse colon, whereas the sigmoid colon is part of the hindgut.",
"id": "10027369",
"label": "d",
"name": "Superior mesenteric plexus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While it arises from the inferior mesenteric plexus which is the nerve supply for the hindgut organs, the lumbar splanchnic nerve is the sympathetic innervation to the hindgut, not the parasympathetic innervation.",
"id": "10027367",
"label": "b",
"name": "Lumbar splanchnic nerve",
"picture": null,
"votes": 3
}
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"id": "3944",
"name": "Development of the hindgut",
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"name": "Embryology",
"typeId": 7
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"question": "What is the parasympathetic nerve innervating the sigmoid colon?",
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"a"
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"typeId": 1,
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} | MarksheetMark |
173,466,636 | false | 29 | null | 6,495,215 | null | false | [] | null | 17,872 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The endoderm forms cells of many internal organs and glands such as the lining of the airways, thyroid and pancreatic cells.",
"id": "10027372",
"label": "b",
"name": "The lining of the airways",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The endoderm forms cells of many internal organs and glands such as the lining of the airways, thyroid and pancreatic cells.",
"id": "10027373",
"label": "c",
"name": "Thyroid and pancreatic cells",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The mesoderm forms the cells of the heart, blood, bone and cartilage, muscles (smooth, cardiac and skeletal), and kidneys.",
"id": "10027374",
"label": "d",
"name": "Muscle cells",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer.",
"id": "10027375",
"label": "e",
"name": "Cardiac cells",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Gastrulation begins after the formation of the primitive streak, where epiblasts migrate into the primitive streak and form three distinct germ layers known as the endoderm (inner), mesoderm (middle) and ectoderm (outer) germ layer. The ectoderm is responsible for the formation of epidermal cells, as well as cells of the nervous system, eyes, inner ears and many connective tissues",
"id": "10027371",
"label": "a",
"name": "Epidermis and epithelial line of the mouth and anus",
"picture": null,
"votes": 23
}
],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "4029",
"name": "Gastrulation",
"status": null,
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"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
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"question": "Which of the following is a derivative of the ectoderm?",
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"a"
],
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"typeId": 1,
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173,466,637 | false | 30 | null | 6,495,215 | null | false | [] | null | 17,873 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While the order of the developmental stages from the earliest stage to the latest stage is correct, the corresponding anatomical regions are inaccurate.",
"id": "10027380",
"label": "e",
"name": "Pronephros (abdominal region), Mesonephros (cervical region), Metanephros (pelvic region)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While the corresponding anatomical regions are accurate, the order of the developmental stages from the earliest stage to the latest stage is incorrect",
"id": "10027377",
"label": "b",
"name": "Pronephros (cervical region), Metanephros (pelvic region), Mesonephros (abdominal region)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Both the order of the developmental stages from the earliest stage to the latest stage and the corresponding anatomical regions are incorrect.",
"id": "10027379",
"label": "d",
"name": "Mesonephros (cervical region), Pronephros (abdominal region), Metanephros (pelvic region)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. In the fourth week of gestation, the pronephros appear in the cervical region of the embryo. It is non-functional and regresses completely by the end of that week, leading to the development of the mesonephros which functions as the primitive excretory system. Ureteric buds develop from the mesonephric ducts, which are a remnant of the pronephric duct, and this induces the development of the definitive kidney known as the metanephros. The metanephric system is composed of the excretory and collecting system and its development is initiated in the pelvis before the kidneys ascend into the abdomen. As such, the corresponding anatomical regions for the mesonephros and metanephros are the abdominal region and pelvic region respectively.",
"id": "10027376",
"label": "a",
"name": "Pronephros (cervical region), Mesonephros (abdominal region), Metanephros (pelvic region)",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While the corresponding anatomical regions are accurate, the order of the developmental stages from the earliest stage to the latest stage is incorrect",
"id": "10027378",
"label": "c",
"name": "Mesonephros (abdominal region), Pronephros (cervical region), Metanephros (pelvic region)",
"picture": null,
"votes": 2
}
],
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"__typename": "Chapter",
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"id": "4466",
"name": "Development of the urinary tract",
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"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
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"topicId": 171,
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"question": "What is the order of the development of the kidney and in which corresponding anatomical region, where the developmental stages are from the earliest stage to the latest stage? The corresponding anatomical region is shown in the brackets.\n\n",
"sbaAnswer": [
"a"
],
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173,466,638 | false | 31 | null | 6,495,215 | null | false | [] | null | 17,874 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In metabolic acidosis, the pH would be low and the bicarbonate level would be low. The PaCO2 may be low if compensation due to hyperventilation is present. In this case, the clinical picture is that of metabolic alkalosis as the pH is high and the bicarbonate levels are high. There is also partial compensation due to hypoventilation present as the pH is still not in the normal range but the PaCO2 level is elevated. Some examples of causes of metabolic alkalosis with raised anion gap include lactic acidosis, diabetic ketoacidosis and starvation. Metabolic acidosis with a normal anion gap is usually secondary to excessive loss of HCO3-, causes of which include diarrhoea, adrenal insufficiency, and use of spironolactone.",
"id": "10027382",
"label": "b",
"name": "Metabolic acidosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. There is alkalosis present as the pH is high, however, in a respiratory alkalosis the PaCO2 will be low while in a metabolic alkalosis, as seen in the scenario, the bicarbonate level is high. There is also partial compensation due to hypoventilation present as the pH is still not in the normal range but the PaCO2 level is elevated. Some examples of causes of respiratory alkalosis include respiratory causes (pulmonary oedema, pneumonia, pneumothorax, chronic obstructive pulmonary disease etc.), hyperventilation, salicylate poisoning and compensation for metabolic acidosis.",
"id": "10027383",
"label": "c",
"name": "Respiratory alkalosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In respiratory acidosis, the pH would be low and the PaCo2 would be high. The bicarbonate level would be normal, or high if compensation is present. In this case, the pH is high, implying an alkalosis, and the bicarbonate level is high which implies a metabolic cause. There is also partial compensation due to hypoventilation present as the pH is still not in the normal range but the PaCO2 level is elevated.",
"id": "10027384",
"label": "d",
"name": "Respiratory acidosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The clinical picture above is indeed that of a patient with metabolic alkalosis. However, since the pH is still not within the normal range, there is insufficient compensation. Hypoventilation increases the arterial partial pressure of carbon dioxide and compensates for metabolic alkalosis, which is seen in this case with the elevated PaCO2. As such, there is partial compensation.",
"id": "10027385",
"label": "e",
"name": "Metabolic alkalosis with compensation",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The pH is high, implying an alkalosis, and the bicarbonate level is high which implies a metabolic cause. Metabolic alkalosis can be compensated for by hypoventilation as carbon dioxide is a limiting factor for compensation, which is seen in this case with the reduced respiratory rate and elevated PaCO2 as hypoventilation increases the arterial partial pressure of carbon dioxide. Since the pH is still abnormal, there is insufficient compensation, however, since there is an increase in PaCO2, there is partial compensation. Some examples of causes of metabolic alkalosis include vomiting, diuretic use, Cushing syndrome and Conn's syndrome.",
"id": "10027381",
"label": "a",
"name": "Metabolic alkalosis with partial compensation",
"picture": null,
"votes": 28
}
],
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"typeId": 7
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"demo": null,
"entitlement": null,
"id": "5975",
"name": "Metabolic alkalosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
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"question": "A 39-year-old man comes into the A&E complaining of vomiting for the past five hours. His respiratory rate is 7 breaths per minute. Blood results from ABG show: \n\n\n||||\n|--------------|:-------:|------------------|\n|pH|8.25|7.35 - 7.45|\n|PaO₂|11 kPa|11 - 15|\n|PaCO₂|8.1 kPa|4.6 - 6.4|\n|Bicarbonate|35 mmol/L|22 - 30|\n\n\nWhat is the acid-base disturbance seen?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,466,639 | false | 32 | null | 6,495,215 | null | false | [] | null | 17,875 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from hypokalaemia, this feature can also be found in the digoxin effect but the downsloping ST depressions have a characteristic \"reverse tick\" or \"Salvador Dali sagging\" appearance.",
"id": "10027389",
"label": "d",
"name": "Widespread ST depression and T wave flattening or inversion",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from severe hypokalaemia, prominent U waves can also be found in bradycardia.",
"id": "10027390",
"label": "e",
"name": "Prominent U waves in precordial leads V2-V3",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Features of hyperkalaemia include peaked (tall) T waves, PR prolongation, bradyarrhythmias, conduction blocks and QRS widening with bizarre morphology",
"id": "10027386",
"label": "a",
"name": "Broad QRS complex",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is one of the ECG features of hypokalaemia, which includes prolongation of the PR interval, increased P wave amplitude, widespread ST depression and T wave flattening or inversion, and prominent U waves in precordial leads V2-V3. Aside from hypokalaemia, peaked P waves, especially in lead II, can also be found in right atrial enlargement (E.g. P pulmonale)",
"id": "10027388",
"label": "c",
"name": "Increased P wave amplitude",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In terms of T wave morphology, hyperkalaemia classically presents with peaked/ tall T waves. T wave inversion is commonly seen as a normal finding in children, or as a pathological finding in bundle branch block, pulmonary embolism, myocardial ischemia or infarction, ventricular hypertrophy and so forth.",
"id": "10027387",
"label": "b",
"name": "T wave inversion",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5976",
"name": "Hyperkalemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"difficulty": 1,
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"highlights": [],
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"question": "Which of the following features is most consistent with a patient presenting with hyperkalemia?",
"sbaAnswer": [
"a"
],
"totalVotes": 37,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,640 | false | 33 | null | 6,495,215 | null | false | [] | null | 17,876 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This describes the epithelial lining of the lower 1/3rd of the oesophagus. This is also why adenocarcinomas are often found in the lower third of the oesophagus, as opposed to squamous cell carcinoma in the upper 2/3rd as the latter is lined by non-keratinized stratified squamous epithelium.",
"id": "10027392",
"label": "b",
"name": "Simple columnar",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The oesophagus does not have keratinized epithelium as it is not exposed to dryness, friction or abrasion.",
"id": "10027394",
"label": "d",
"name": "Keratinized stratified squamous epithelium",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Simple cuboidal epithelium is commonly found in glandular secreting tissue and kidney tubules. The upper 2/3rd of the oesophagus is lined by non-keratinized stratified squamous epithelium.",
"id": "10027395",
"label": "e",
"name": "Simple cuboidal epithelium",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This describes the \"Z line\" at the gastroesophageal (squamocolumnar) junction, which demarcates the transition from non-keratinized stratified squamous epithelium to simple columnar epithelium of the gastric cardia. This is also the landmark for Barrett's oesophagus in oesophagogastroduodenoscopy and on biopsy where the Z line will appear irregular due to intestinal metaplasia. The upper 2/3rd of the oesophagus is lined by non-keratinized stratified squamous epithelium.",
"id": "10027393",
"label": "c",
"name": "Combination of non-keratinized stratified squamous and simple columnar",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This describes the epithelial lining of the upper 2/3rd of the oesophagus, while the lower 1/3rd is lined by simple columnar epithelium. This is also why adenocarcinomas are often found in the lower third of the oesophagus, as opposed to squamous cell carcinoma in the upper 2/3rd.",
"id": "10027391",
"label": "a",
"name": "Non-keratinized stratified squamous epithelium",
"picture": null,
"votes": 29
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
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"entitlement": null,
"id": "3985",
"name": "Oesophageal carcinoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "What type of epithelium lines upper 2/3rd the oesophagus?",
"sbaAnswer": [
"a"
],
"totalVotes": 37,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,641 | false | 34 | null | 6,495,215 | null | false | [] | null | 17,877 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Dark urine implies conjugated hyperbilirubinemia as conjugated bilirubin is water-soluble, and this is found in hepatic (hepatocellular) and post-hepatic (obstructive) jaundice. Cholecystitis can be caused by various hepatic and post-hepatic causes, however, it will most likely present with a positive Murphy's sign upon palpation of the right upper quadrant, and not a non-tender palpable mass. A non-tender palpable mass in the right upper quadrant accompanied with jaundice implies a positive Courvoisier sign, where the cause of the obstructive jaundice is likely to be a head of pancreas malignancy until proven otherwise.",
"id": "10027398",
"label": "c",
"name": "Cholecystitis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Hepatocellular carcinoma (HCC) is a primary tumour of the liver that can be a cause of hepatic jaundice, which presents with a mix of unconjugated and conjugated hyperbilirubinemia. Liver cirrhosis-related HCC patients can present with jaundice and a palpable mass, however, it would not present as suddenly as the patient in the scenario and it is usually accompanied by other symptoms such as pruritus, ascites, cachexia (weight loss, early satiety), fever, malaise and so forth. A non-tender palpable mass in the right upper quadrant accompanied with jaundice implies a positive Courvoisier sign, where the cause of the obstructive jaundice is likely to be a head of pancreas malignancy until proven otherwise.",
"id": "10027400",
"label": "e",
"name": "Hepatocellular carcinoma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Dark urine implies conjugated hyperbilirubinemia as conjugated bilirubin is water-soluble, and this is found in hepatic (hepatocellular) and post-hepatic (obstructive) jaundice. Gallstones are indeed a post-hepatic cause of jaundice, however, palpation of the right upper quadrant will most likely elicit a positive Murphy's sign where pain occurs while palpating the right subcostal area while the patient is asked to take in and hold a deep breath as the inflamed gall bladder comes into contact with the examiner's hand, especially if there is gallstone induced cholecystitis present. A non-tender palpable mass in the right upper quadrant accompanied with jaundice implies a positive Courvoisier sign, where the cause of the obstructive jaundice is likely to be a head of pancreas malignancy until proven otherwise.",
"id": "10027397",
"label": "b",
"name": "Gallstones",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Dark urine implies conjugated hyperbilirubinemia as conjugated bilirubin is water-soluble, and this is found in hepatic (hepatocellular) and post-hepatic (obstructive) jaundice. A non-tender palpable mass in the right upper quadrant accompanied with jaundice implies a positive Courvoisier sign, where the cause of the obstructive jaundice is likely to be a head of pancreas malignancy until proven otherwise. Cholangiocarcinomas can also present with a positive Courvoisier sign",
"id": "10027396",
"label": "a",
"name": "Head of pancreas malignancy",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia, unlike the scenario in the question. In addition, a non-tender palpable mass in the right upper quadrant accompanied with jaundice implies a positive Courvoisier sign, where the cause of the obstructive jaundice is likely to be a head of pancreas malignancy until proven otherwise.",
"id": "10027399",
"label": "d",
"name": "Gilbert's syndrome",
"picture": null,
"votes": 2
}
],
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"id": "4049",
"name": "Jaundice",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 48-year-old woman comes into the ward with a 1-day history of yellowish discolouration of skin and sclera. Abdominal examination reveals a palpable mass that is non-tender in the right upper quadrant. The urine sample shows dark urine.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 35,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,642 | false | 35 | null | 6,495,215 | null | false | [] | null | 17,878 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Oesophageal cancer can be divided into squamous cell carcinoma (SCC) and adenocarcinoma. The lower 1/3rd of the oesophagus, which is lined by simple columnar epithelium, and the gastroesophageal junction is where an oesophageal adenocarcinoma is most likely to occur while the upper 2/3rd of the oesophagus, which is lined by non-keratinized stratified squamous epithelium, is the most likely region for oesophageal SCC to occur. The gastroesophageal (squamocolumnar) junction, known as the \"Z line\", demarcates the transition from non-keratinized stratified squamous epithelium to simple columnar epithelium of the gastric cardia. This is also the landmark for Barrett's oesophagus in oesophagogastroduodenoscopy and on biopsy where the line will appear irregular due to intestinal metaplasia. Gastro-oesophageal reflux disease (GORD) is a risk factor for the development of Barrett's oesophagus, which in turn is a risk of oesophageal adenocarcinoma. In contrast, risk factors such as a history of smoking, excess alcohol consumption, and a poor diet (low in fruits and vegetables) account for 90% of oesophageal SCC. Other predisposing factors include anatomical abnormalities such as achalasia, caustic stricture, oesophageal webs (Plummer-Vinson syndrome), history of gastrectomy, atrophic gastritis, and so forth.",
"id": "10027401",
"label": "a",
"name": "Gastro-oesophageal reflux disease",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Caustic strictures in the oesophagus arise following accidental or intentional ingestion of a corrosive substance, and this can pre-dispose to malignant strictures and is a risk factor for oesophageal squamous cell carcinoma (SCC). Oesophageal cancer can be divided into squamous cell carcinoma (SCC) and adenocarcinoma. The lower 1/3rd of the oesophagus, which is lined by simple columnar epithelium, and the gastroesophageal junction is where an oesophageal adenocarcinoma is most likely to occur while the upper 2/3rd of the oesophagus, which is lined by non-keratinized stratified squamous epithelium, is the most likely region for oesophageal SCC to occur. 80% of oesophageal adenocarcinomas are attributed to Barrett's oesophagus. This is most commonly associated with gastro-oesophageal reflux disease, but can also be seen in other conditions that increase oesophageal acid exposure and predispose to intestinal metaplasia such as Zollinger-Ellison syndrome or use of lower oesophageal sphincter relaxing drugs/ procedures. Risk factors such as a history of smoking, excess alcohol consumption, and a poor diet (low in fruits and vegetables) account for 90% of oesophageal SCC. Other predisposing factors include anatomical abnormalities such as achalasia, caustic stricture, oesophageal webs (Plummer-Vinson syndrome), history of gastrectomy, atrophic gastritis, and so forth.",
"id": "10027404",
"label": "d",
"name": "Caustic oesophageal stricture",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. NSAIDs reduce inflammation and pain and are not associated with increasing risk of oesophageal adenocarcinoma. Oesophageal cancer can be divided into squamous cell carcinoma (SCC) and adenocarcinoma. The lower 1/3rd of the oesophagus, which is lined by simple columnar epithelium, and the gastroesophageal junction is where an oesophageal adenocarcinoma is most likely to occur while the upper 2/3rd of the oesophagus, which is lined by non-keratinized stratified squamous epithelium, is the most likely region for oesophageal SCC to occur. 80% of oesophageal adenocarcinomas are attributed to Barrett's oesophagus. This is most commonly associated with gastro-oesophageal reflux disease, but can also be seen in other conditions that increase oesophageal acid exposure and predispose to intestinal metaplasia such as Zollinger-Ellison syndrome or use of lower oesophageal sphincter relaxing drugs/ procedures. Risk factors such as a history of smoking, excess alcohol consumption, and a poor diet (low in fruits and vegetables) account for 90% of oesophageal SCC. Other predisposing factors include anatomical abnormalities such as achalasia, caustic stricture, oesophageal webs (Plummer-Vinson syndrome), history of gastrectomy, atrophic gastritis, and so forth.",
"id": "10027403",
"label": "c",
"name": "Regular nonsteroidal anti-inflammatory drugs (NSAIDs) use",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Plummer-Vinson syndrome is a classic triad of iron deficiency anaemia, dysphagia and oesophageal webs. Anatomical abnormalities such as achalasia, caustic stricture, oesophageal webs (Plummer-Vinson syndrome), history of gastrectomy, atrophic gastritis, and so forth are risk factors for oesophageal SCC, not adenocarcinoma. However, 90% of the cases of oesophageal SCC are accounted for by a history of smoking, excess alcohol consumption, and a poor diet (low in fruits and vegetables). On the other hand, 80% of oesophageal adenocarcinomas are attributed to Barrett's oesophagus. This is most commonly associated with gastro-oesophageal reflux disease, but can also be seen in other conditions that increase oesophageal acid exposure and predispose to intestinal metaplasia such as Zollinger-Ellison syndrome or use of lower oesophageal sphincter relaxing drugs/ procedures.",
"id": "10027405",
"label": "e",
"name": "Plummer-Vinson syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Alcohol consumption has not been associated with oesophageal adenocarcinoma. Oesophageal cancer can be divided into squamous cell carcinoma (SCC) and adenocarcinoma. The lower 1/3rd of the oesophagus, which is lined by simple columnar epithelium, and the gastroesophageal junction is where an oesophageal adenocarcinoma is most likely to occur while the upper 2/3rd of the oesophagus, which is lined by non-keratinized stratified squamous epithelium, is the most likely region for oesophageal SCC to occur. 80% of oesophageal adenocarcinomas are attributed to Barrett's oesophagus. This is most commonly associated with gastro-oesophageal reflux disease, but can also be seen in other conditions that increase oesophageal acid exposure and predispose to intestinal metaplasia such as Zollinger-Ellison syndrome or use of lower oesophageal sphincter relaxing drugs/ procedures. Risk factors such as a history of smoking, excess alcohol consumption, and a poor diet (low in fruits and vegetables) account for 90% of oesophageal SCC. Other predisposing factors include anatomical abnormalities such as achalasia, caustic stricture, oesophageal webs (Plummer-Vinson syndrome), history of gastrectomy, atrophic gastritis, and so forth.",
"id": "10027402",
"label": "b",
"name": "Alcohol consumption",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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},
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"entitlement": null,
"id": "3985",
"name": "Oesophageal carcinoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "Which of the following is considered a significant risk factor for oesophageal adenocarcinoma, but not for oesophageal squamous cell carcinoma?",
"sbaAnswer": [
"a"
],
"totalVotes": 35,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,643 | false | 36 | null | 6,495,215 | null | false | [] | null | 17,879 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While albumin is the major plasma protein that bilirubin binds to in the bloodstream to be transported to the liver for conjugation, a lack of will not necessarily imply a decrease in bilirubin conjugation and subsequent excretion. More specifically, stercobilin is the brown pigment responsible for the colour of stool and a lack of stercobilin will result in pale stools.",
"id": "10027410",
"label": "e",
"name": "Albumin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Stercobilin is the brown pigment found in faeces, hence responsible for the colour. In hepatic and post-hepatic jaundice, there is a mixed (unconjugated and conjugated) hyperbilirubinaemia, and conjugated hyperbilirubinaemia respectively. Either way, conjugated bilirubin is water-soluble and can be excreted via the urine, while unconjugated bilirubin cannot. Consequently, a dark \"coca-cola\" urine can be seen in mixed or conjugated disease, accompanied by pale stools due to reduced levels of stercobilin entering the gastrointestinal tract. As such an excess of conjugated bilirubin often presents with pale stool, however, a lack of is unlikely to cause reduced levels of stercobilin in stools.",
"id": "10027408",
"label": "c",
"name": "Conjugated bilirubin",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Bilirubin is the normal breakdown product formed from the destruction of red blood cells (catabolism of haem). It undergoes conjugation in the liver forming conjugated bilirubin (water-soluble), and is then excreted via bile into the gastrointestinal tract. The majority of it is egested in the faeces as urobilinogen and stercobilin, where the latter is a breakdown product of urobilinogen. 10% of urobilinogen is reabsorbed in the bloodstream and excreted through the kidneys. Urobilinogen is colourless while stercobilin is the brown pigment responsible for the colour.",
"id": "10027407",
"label": "b",
"name": "Urobilinogen",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Unconjugated hyperbilirubinemia is seen in pre-hepatic jaundice where there is excess breakdown of red blood cells, and this presents with normal/ darker stool colour as stercobilin still enters the GI tract. In contrast, a lack of unconjugated bilirubin will not necessarily imply lower levels of stercobilin in stool and consequently, pale stools.",
"id": "10027409",
"label": "d",
"name": "Unconjugated bilirubin",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Bilirubin is the normal breakdown product formed from the destruction of red blood cells (catabolism of haem). It undergoes conjugation in the liver forming conjugated bilirubin (water-soluble), and is then excreted via bile into the gastrointestinal tract. The majority of it is egested in the faeces as urobilinogen and stercobilin, where the latter is a breakdown product of urobilinogen. 10% of urobilinogen is reabsorbed in the bloodstream and excreted through the kidneys. Stercobilin is the brown pigment found in faeces, hence responsible for the colour. As such, a lack of stercobilin will result in the patient's pale stools.",
"id": "10027406",
"label": "a",
"name": "Stercobilin",
"picture": null,
"votes": 22
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "4049",
"name": "Jaundice",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"difficulty": 1,
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"question": "A 45-year-old patient presents with jaundice, right-sided abdominal pain, dark urine and pale stools.\n\nThe lack of which of the following is the likely cause of this patient's pale stools?",
"sbaAnswer": [
"a"
],
"totalVotes": 36,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,644 | false | 37 | null | 6,495,215 | null | false | [] | null | 17,880 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia and recurrent episodes of jaundice especially after a trigger such as febrile illnesses, fasting, menstruation, physical exertion and so forth. UDP-glucuronosyltransferase 1 is important for converting unconjugated to conjugated bilirubin (water-soluble), and a defect in the gene results in unconjugated hyperbilirubinemia and pre-hepatic jaundice.",
"id": "10027411",
"label": "a",
"name": "UDP-glucuronosyltransferase",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia and recurrent episodes of jaundice, especially after certain triggers. On the other hand, a defect in the ATP7B gene is seen in Wilson disease, which is an autosomal recessive disorder with a characteristic copper-transporting P-type ATPase defect (ATP7B molecular defect) in 80% of cases.",
"id": "10027413",
"label": "c",
"name": "ATP7B",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia and recurrent episodes of jaundice, especially after certain triggers. On the other hand, G6PD is the catalyst in the rate-limiting first step of the pentose phosphate pathway, and a deficiency can result in acute haemolytic anaemia.",
"id": "10027414",
"label": "d",
"name": "glucose-6-phosphate dehydrogenase (G6PD)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia and recurrent episodes of jaundice, especially after certain triggers. On the other hand, Congenital Adrenal Hyperplasia (CAH) is a group of inherited, autosomal recessive genetic disorders caused by enzyme defects in the adrenal cortex, which disrupts steroid hormone synthesis. The most common variant is a 21-hydroxylase deficiency.",
"id": "10027412",
"label": "b",
"name": "21-hydroxylase",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gilbert's syndrome is an autosomal recessive disorder of bilirubin metabolism in the liver due to a defect in the UDP-glucuronosyltransferase 1 gene. It is a pre-hepatic cause of jaundice which presents with unconjugated hyperbilirubinemia and recurrent episodes of jaundice, especially after certain triggers. On the other hand, Pyruvate kinase deficiency is an autosomal recessive non-spherocytic anaemia which can present with unconjugated hyperbilirubinaemia (pre-hepatic jaundice) and hepatosplenomegaly.",
"id": "10027415",
"label": "e",
"name": "Pyruvate kinase",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5823",
"name": "Gilbert's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "Which of the following enzyme's activity is impaired in Gilbert's syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 33,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,645 | false | 38 | null | 6,495,215 | null | false | [] | null | 17,881 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. While gastroenteritis can present with similar symptoms such as abdominal discomfort, bloating, and diarrhoea, it is more likely to present for a shorter duration and with symptoms such as nausea, vomiting and fever. However, given the association with diabetes type 1 and dermatitis herpetiform, systemic symptoms and clinical features of malabsorption, the more likely diagnosis is coeliac disease. A stool culture can be taken to rule out infectious causes. The gold standard diagnosis to confirm coeliac disease would be an oesophago-gastroduodenoscopy with biopsy. Other tests to support the diagnosis include serological tests that would most likely show anti-TTG antibodies and anti-endomysial antibodies, and blood tests (FBC may show anaemia, Iron, B12 and folate levels may be low and so forth).",
"id": "10027420",
"label": "e",
"name": "Gastroenteritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Irritable bowel syndrome is characterised by similar symptoms such as abdominal pain, bloating, and altered bowel habits. However, given the association with diabetes type 1 and dermatitis herpetiform, systemic symptoms and clinical features of malabsorption, the more likely diagnosis is coeliac disease. The gold standard diagnosis to confirm coeliac disease would be an esophagogastroduodenoscopy with biopsy. Other tests to support the diagnosis include serological tests that would most likely show anti-TTG antibodies and anti-endomysial antibodies, and blood tests (FBC may show anaemia, Iron, B12 and folate levels may be low and so forth).",
"id": "10027417",
"label": "b",
"name": "Irritable bowel syndrome",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Coeliac disease is an autoimmune condition where the body has a T cell-mediated inflammatory response to gluten, leading to small bowel injury and subsequent malabsorption. This causes gastrointestinal symptoms such as abdominal pain, bloating, diarrhoea, nausea and vomiting, and steatorrhoea in severe disease. It can also cause systemic symptoms such as fatigue and weight loss. Dermatological manifestations include dermatitis herpetiformis which presents with pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs, and trunk, as seen in this patient where she has an itchy bumpy rash on the extensors of her elbows. Due to malabsorption, clinical features of vitamin and mineral deficiencies may be present as well such as bruising due to vitamin K deficiency, or as seen in this patient, low ferritin and folate levels. Lastly, coeliac disease is associated with a positive family history, the HLA-DQ2 allele, and other autoimmune diseases such as type 1 diabetes mellitus which is present in this patient.",
"id": "10027416",
"label": "a",
"name": "Coeliac disease",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Food intolerance can present with similar symptoms such as abdominal discomfort, bloating, and diarrhoea. However, given the association with diabetes type 1 and dermatitis herpetiform, systemic symptoms and clinical features of malabsorption, the more likely diagnosis is coeliac disease. The gold standard diagnosis to confirm coeliac disease would be an oesophago-gastroduodenoscopy with biopsy. Other tests to support the diagnosis include serological tests that would most likely show anti-TTG antibodies and anti-endomysial antibodies, and blood tests (FBC may show anaemia, Iron, B12 and folate levels may be low and so forth).",
"id": "10027419",
"label": "d",
"name": "Food intolerance",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease and may present with similar symptoms such as abdominal pain, diarrhoea, and weight loss. The gold standard diagnosis to confirm coeliac disease would be an oesophagogastroduodenoscopy with biopsy. Other tests to support the diagnosis include serological tests that would most likely show anti-TTG antibodies and anti-endomysial antibodies, and blood tests (FBC may show anaemia, Iron, B12 and folate levels may be low and so forth).",
"id": "10027418",
"label": "c",
"name": "Inflammatory bowel disease",
"picture": null,
"votes": 18
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4236",
"name": "Coeliac disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"question": "A 35-year-old woman presents with a 12-month history of unintentional weight loss, fatigue, bloating, diarrhoea, mouth ulcers and an itchy bumpy rash on the extensors of her elbows. She has a past medical history of type 1 diabetes mellitus. Her full blood count shows low haemoglobin, her iron studies show low ferritin and her haematinics screen shows she is folate deficient.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,646 | false | 39 | null | 6,495,215 | null | false | [] | null | 17,882 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is where the majority of the absorption of iron takes place. The absorption of vitamin B12 takes place mainly in the terminal ileum.",
"id": "10027422",
"label": "b",
"name": "Duodenum",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The stomach is where intrinsic factor (IF) is secreted by gastric parietal cells. B12 then binds to IF to be absorbed in the terminal ileum.",
"id": "10027423",
"label": "c",
"name": "Stomach",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is where the majority of the absorption of vitamin B3 (niacin) takes place. The absorption of vitamin B12 takes place mainly in the terminal ileum.",
"id": "10027425",
"label": "e",
"name": "Upper ileum",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is where amino acids, folic acid, iron, water, sugars (glucose, fructose, galactose, maltose), and various other substances are absorbed. The absorption of vitamin B12 takes place mainly in the terminal ileum.",
"id": "10027424",
"label": "d",
"name": "Duodenom and upper jejunum",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Vitamin B12 binds to an intrinsic factor (secreted by gastric parietal cells in the stomach), which then binds to specific receptors in the terminal ileum for absorption called cubulin. The B12 is then absorbed and binds to transcobalamin.",
"id": "10027421",
"label": "a",
"name": "Terminal ileum",
"picture": null,
"votes": 28
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5977",
"name": "Digestion and absorption in the small intestine",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
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},
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"qaAnswer": null,
"question": "Where is vitamin B12 primarily absorbed?",
"sbaAnswer": [
"a"
],
"totalVotes": 34,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,647 | false | 40 | null | 6,495,215 | null | false | [] | null | 17,883 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Vitamin K is a fat-soluble vitamin that is needed for the synthesis of clotting factors II, VII, IX and X. It does not aid in the absorption of non-ferrous iron.",
"id": "10027429",
"label": "d",
"name": "Vitamin K",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Vitamin A is a fat-soluble vitamin that is important for the maintenance of the immune system, for vision, and embryological growth and development. It does not aid in the absorption of non-ferrous iron.",
"id": "10027428",
"label": "c",
"name": "Vitamin A",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Vitamin B12 (cobalamin) is a water-soluble vitamin that is important for DNA synthesis, maintaining nerve function (synthesis of myelin), and in the circulatory system (maturation of red blood cells). It does not aid in the absorption of non-ferrous iron.",
"id": "10027427",
"label": "b",
"name": "Vitamin B12 (Cobalamin)",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Vitamin C (Ascorbic acid) is a water-soluble vitamin that is important for tissue repair and collagen formation, has an important role in the functioning of a normal immune system, and helps to keep iron in the reduced ferrous state. After uptake of iron, it binds to a protein, transferrin, and is absorbed in the duodenum. Transferrin contains the non-ferrous (ferric) iron, Fe3+, and is reduced from Fe3+ to Fe2+ (ferrous) iron in the bone marrow, allowing it to be stored as ferritin. Ferritin is then incorporated into haemoglobin, allowing iron to be stored and released in a controlled manner as needed. As such, vitamin C aids in the absorption of non-ferrous iron by keeping it in the reduced ferrous state which is more soluble and easily absorbable.",
"id": "10027426",
"label": "a",
"name": "Vitamin C (Ascorbic acid)",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Vitamin D is a fat-soluble vitamin that is important for calcium homeostasis and metabolism. It does not aid in the absorption of non-ferrous iron.",
"id": "10027430",
"label": "e",
"name": "Vitamin D",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "5977",
"name": "Digestion and absorption in the small intestine",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
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"userChapter": null,
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},
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"highlights": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "What vitamin aids the absorption of non-ferrous (ferric) iron, Fe3+?",
"sbaAnswer": [
"a"
],
"totalVotes": 30,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,648 | false | 41 | null | 6,495,215 | null | false | [] | null | 17,884 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Blumberg's sign, more commonly known as rebound tenderness, is positive when there is pain upon removal of pressure rather than applying pressure to the abdomen, where the latter is known as abdominal tenderness. Positive rebound tenderness is classically elicited in peritonitis.",
"id": "10027434",
"label": "d",
"name": "Blumber's sign",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The McBurney's sign is classically elicited in acute appendicitis, where applying slow pressure and releasing over the McBurney's point located one-third of the distance between the anterior superior iliac spine and the umbilicus in the right lower quadrant will result in pain if positive.",
"id": "10027432",
"label": "b",
"name": "McBurney's sign",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Psoas sign is positive if the pain is felt when the examiner asks patients to actively extend their right hip against the examiner's hand while the patient is lying on their pack. This indicates iliopsoas muscle group irritation, which occurs specifically when the appendix is inflamed in the retrocaecal orientation as the iliopsoas muscle group is located retroperitoneally.",
"id": "10027435",
"label": "e",
"name": "Psoas sign",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The Rovsing sign is positive when pain is elicited in the right lower quadrant when palpating the left lower quadrant and is classically elicited in acute appendicitis.",
"id": "10027433",
"label": "c",
"name": "Rovsing sign",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. This patient is presenting with clinical features of acute cholecystitis. The classic sign elicited in these patients is the Murphy's sign, where a positive finding means there is pain when palpating the right subcostal area while the patient is asked to take in and hold a deep breath. This indicates gall bladder hypersensitivity, where pain occurs on inspiration as the inflamed gall bladder comes into contact with the surface under the examiner's hand.",
"id": "10027431",
"label": "a",
"name": "Murphy's sign",
"picture": null,
"votes": 26
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5978",
"name": "Cholecystitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"question": "A 28-year-old woman presents in the A&E with right upper quadrant pain, jaundice and fever. The doctor palpates the region where the costal margin meets the rectus abdominis on the right side, which induces pain. This indicates a positive sign.\n\nWhat is the name of this sign?",
"sbaAnswer": [
"a"
],
"totalVotes": 33,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,649 | false | 42 | null | 6,495,215 | null | false | [] | null | 17,885 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Chronic kidney disease is defined as abnormalities in kidney function or structure for at least 3 months. The KDIGO guidelines classify the severity and progression of chronic kidney disease based on the level of persistent albuminuria and the Glomerular Filtration Rate (GFR). In this case, an eGFR of 20ml/min/1.73m^2 puts the patient in the category of stage 4, which ranges from 15-29ml/min/1.73m^2 and indicates severely decreased kidney function",
"id": "10027436",
"label": "a",
"name": "Stage 4",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In stage 3b, the GFR ranges from 45-59ml/min/1.73m^2, which implies mild to moderately decreased kidney function.",
"id": "10027438",
"label": "c",
"name": "Stage 3b",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In stage 1, the GFR range is 90ml/min/1.73m^2 and above, which implies normal or high kidney function.",
"id": "10027440",
"label": "e",
"name": "Stage 1",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In stage 2, the GFR ranges from 60-89ml/min/1.73m^2, which implies mildly decreased kidney function.",
"id": "10027439",
"label": "d",
"name": "Stage 2",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. In stage 2, the GFR ranges from 30-44ml/min/1.73m^2, which implies moderately to severely decreased kidney function.",
"id": "10027437",
"label": "b",
"name": "Stage 3a",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3753",
"name": "Chronic kidney disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
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},
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"question": "A 72-year-old male with chronic kidney disease needs a medication review as his eGFR has dropped to 20ml/min/1.73m2.\n\nWhat stage of CKD is this patient in?",
"sbaAnswer": [
"a"
],
"totalVotes": 30,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,650 | false | 43 | null | 6,495,215 | null | false | [] | null | 17,886 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In terms of somatic innervation, the pudendal nerve (S2-S4) innervates the external urethral sphincter and provides voluntary control over micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.",
"id": "10027441",
"label": "a",
"name": "Pelvic nerve",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the sympathetic innervation to the bladder. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In terms of somatic innervation, the pudendal nerve (S2-S4) innervates the external urethral sphincter and provides voluntary control over micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.",
"id": "10027442",
"label": "b",
"name": "Hypogastric nerve",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the somatic innervation to the bladder, more specifically the external urethral sphincter. It provides voluntary control over micturition. The nervous supply to the bladder consists of autonomic and somatic input. In terms of autonomic input, the hypogastric nerve (T12-L2) provides the sympathetic supply which allows the bladder to relax the detrusor muscle to promote urine retention, while the pelvic nerve (S2-S4) provides the parasympathetic supply which allows the bladder to contract the detrusor muscle to stimulate micturition. In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that signal the need to urinate when the bladder becomes full.",
"id": "10027443",
"label": "c",
"name": "Pudendal nerve",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The sacral splanchnic nerves are not involved in the parasympathetic innervation of the bladder. In general, splanchnic nerves are bilateral visceral autonomic nerves that consist of the thoracic, lumbar, sacral and pelvic splanchnic nerves. However, all of these except for the pelvic splanchnic nerves (parasympathetic) provide sympathetic innervation to the respective organs.",
"id": "10027445",
"label": "e",
"name": "Sacral splanchnic nerves",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is the sympathetic innervation to the rectum, alongside the superior and inferior hypogastric plexuses",
"id": "10027444",
"label": "d",
"name": "Lumbar splanchnic nerves",
"picture": null,
"votes": 5
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
"entitlement": null,
"id": "5783",
"name": "Urinary bladder",
"status": null,
"topic": {
"__typename": "Topic",
"id": "308",
"name": "Pelvic anatomy",
"typeId": 7
},
"topicId": 308,
"totalCards": null,
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"question": "What is the parasympathetic supply to the bladder?",
"sbaAnswer": [
"a"
],
"totalVotes": 30,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,651 | false | 44 | null | 6,495,215 | null | false | [] | null | 17,887 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous epithelium. However, the epithelium is not keratinized as stated in this option.",
"id": "10027447",
"label": "b",
"name": "Stratified squamous keratinised epithelium",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Simple cuboidal epithelium is commonly found in glandular secreting tissue and kidney tubules. On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.",
"id": "10027449",
"label": "d",
"name": "Simple cuboidal epithelium",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Simple columnar epithelium can be found in the endocervical canal (endocervix). On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.",
"id": "10027448",
"label": "c",
"name": "Simple columnar epithelium",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus. The ectocervix, which is the distal portion of the cervix that projects into the vagina, is also lined by this type of epithelium.",
"id": "10027446",
"label": "a",
"name": "Stratified squamous non-keratinised epithelium",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This describes the transformation zone between the ectocervix and endocervix, which is the usual site at risk of human papillomavirus high-risk subtypes (16 and 18) infection and cervical carcinoma. On the other hand, the vagina is a muscular tube which is composed of four histological layers, where the outermost epithelial layer is the stratified squamous non-keratinised epithelium. This layer provides protection and is lubricated by cervical mucus.",
"id": "10027450",
"label": "e",
"name": "Combination of non-keratinized stratified squamous and simple columnar",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5979",
"name": "Vagina",
"status": null,
"topic": {
"__typename": "Topic",
"id": "308",
"name": "Pelvic anatomy",
"typeId": 7
},
"topicId": 308,
"totalCards": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "What is the epithelial lining of the vagina?",
"sbaAnswer": [
"a"
],
"totalVotes": 28,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,652 | false | 45 | null | 6,495,215 | null | false | [] | null | 17,888 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Loop diuretics such as furosemide and bumetanide inhibit the sodium-potassium-chloride (Na-K-Cl) cotransporters, also known as NKCC, which are found in the thick ascending limb of the loop of Henle. This reduces the absorption of sodium, potassium and chloride ions, as well as water alongside sodium. As a result, urine output increases and subsequently, blood pressure decreases. Side effects include hypotension, electrolyte disturbances (hyponatremia, hypokalaemia, etc.), ototoxicity and gout.",
"id": "10027451",
"label": "a",
"name": "NKCC2 (Na-K-Cl co-transporters) antagonist",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Thiazide diuretics such as bendroflumethiazide and indapamide block the sodium-chloride symporter in the distal convoluted tubule, preventing the reabsorption of sodium and chloride ions. Water is excreted alongside sodium ions and this results in increased urine output and subsequent reduced blood pressure. On the other hand, furosemide is a loop diuretic that inhibits the sodium-potassium-chloride (Na-K-Cl) cotransporters, also known as NKCC, found in the thick ascending limb of the loop of Henle.",
"id": "10027453",
"label": "c",
"name": "Sodium-chloride symporter antagonist",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Mineralocorticoid antagonists such as spironolactone and eplerenone bind to mineralocorticoid receptors in the renal tubule cells, leading to increased sodium excretion and potassium reabsorption in the distal tubule and collecting duct. Water is excreted alongside sodium ions and this results in increased urine output and subsequent reduced blood pressure. On the other hand, furosemide is a loop diuretic that inhibits the sodium-potassium-chloride (Na-K-Cl) cotransporters, also known as NKCC, found in the thick ascending limb of the loop of Henle.",
"id": "10027452",
"label": "b",
"name": "Mineralocorticoid receptor antagonist",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. angiotensin-II receptor blockers such as candesartan, irbesartan and losartan block angiotensin-II receptors in smooth muscle cells in vessels, adrenal gland cortical cells and adrenergic nerve synapses. This results in vasodilation, decreased secretion of vasopressin and decreased production of aldosterone respectively, leading to reduced blood pressure.",
"id": "10027455",
"label": "e",
"name": "angiotensin-II receptor antagonist",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Carbonic anhydrase inhibitors such as acetazolamide prevent the reabsorption of bicarbonate, which requires this enzyme to be reabsorbed in the proximal convoluted tubule. This results in bicarbonate and associated sodium and water loss, enabling this drug to act as a weak diuretic. The bicarbonate loss also results in metabolic acidosis, thus useful in altitude sickness as it stimulates compensatory hyperventilation (increased respiratory depth and frequency), allowing better acclimatisation to low oxygen environments. On the other hand, furosemide is a loop diuretic that inhibits the sodium-potassium-chloride (Na-K-Cl) cotransporters, also known as NKCC, found in the thick ascending limb of the loop of Henle.",
"id": "10027454",
"label": "d",
"name": "Carbonic anhydrase inhibitor",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5980",
"name": "Loop diuretics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "195",
"name": "Pharmacology",
"typeId": 7
},
"topicId": 195,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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"difficulty": 1,
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"likes": 0,
"multiAnswer": null,
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "Furosemide is a commonly used diuretic agent.\n\nWhat is the mode of action of this drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 34,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,653 | false | 46 | null | 6,495,215 | null | false | [] | null | 17,889 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Anti-muscarinic agents such as dicycloverine can be used to reduce gastrointestinal motility and associated symptoms seen in conditions such as irritable bowel syndrome (IBS) or diverticular disease. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.",
"id": "10027460",
"label": "e",
"name": "Anti-muscarinic",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Cimetidine is a H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as heartburn (dyspepsia), peptic ulcer disease and gastro-oesophageal reflux disease.",
"id": "10027456",
"label": "a",
"name": "H2 receptor antagonist",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. H1 receptor antagonists such as cyclizine are anti-emetics used to treat nausea and vomiting. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as heartburn (dyspepsia), peptic ulcer disease and gastro-oesophageal reflux disease.",
"id": "10027457",
"label": "b",
"name": "H1 receptor antagonist",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Antacids such as aluminium hydroxide, calcium carbonate, sodium bicarbonate and so forth can come in liquid form or as chewable tablets. They neutralize stomach acid to relieve symptoms such as heartburn and dyspepsia, which this patient has. However, in this case, cimetidine was used which is a H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.",
"id": "10027459",
"label": "d",
"name": "Antacid",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Mebeverine is an example of an antispasmodic used to relax intestinal smooth muscle, thus relieving symptoms associated with irritable bowel syndrome (IBS) such as crampy abdominal pain caused by intestinal spasms and bloating. On the other hand, cimetidine is an H2 receptor antagonist. It competitively inhibits histamine in H2 receptors of parietal cells, suppressing the normal secretion of stomach acid from parietal cells, thus treating acid-related gastrointestinal conditions such as dyspepsia, peptic ulcer disease and gastro-oesophageal reflux disease.",
"id": "10027458",
"label": "c",
"name": "Antispasmodic",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5981",
"name": "H2 receptor antagonists",
"status": null,
"topic": {
"__typename": "Topic",
"id": "195",
"name": "Pharmacology",
"typeId": 7
},
"topicId": 195,
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"question": "A 55-year-old man complains of frequent heartburn and is prescribed cimetidine by his GP.\n\nWhat is this medication's class of drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 31,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,654 | false | 47 | null | 6,495,215 | null | false | [] | null | 17,890 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). JG cells are modified smooth muscle cells found surrounding the afferent arteriole and sometimes efferent arteriole as well. Systemic blood pressure is regulated by the renin-angiotensin-aldosterone system (RAAS), where baroreceptors are stimulated by low systemic blood pressure and trigger the JG cells to secrete renin. Renin then activates the RAAS, raising blood pressure through the actions of angiotensin and aldosterone.",
"id": "10027461",
"label": "a",
"name": "Juxtaglomerular cells",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). The macula densa responds to high sodium levels by releasing vasoconstrictor chemicals that constrict the afferent arteriole. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).",
"id": "10027463",
"label": "c",
"name": "Macula densa cells",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Podocytes are found on the visceral layer of the Bowman's capsule. These cells have finger-like projections (pedicles) and form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep.",
"id": "10027462",
"label": "b",
"name": "Podocytes",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. intercalated cells fall under one of the cell types found in the collecting duct of the renal tubule. They are scattered amongst principal cells and have a role in acid-base balance. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).",
"id": "10027465",
"label": "e",
"name": "Intercalated cells",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The juxtaglomerular apparatus functions in regulating glomerular blood flow, filtration rate and systemic blood pressure regulation. It is formed by three cell types, namely the macula densa, juxtaglomerular granular (JG) cells and extraglomerular mesangial cells (Lacis cells). Lacis cells are located in the space between the afferent and efferent arterioles. On the other hand, JG cells secrete renin and help in the regulation of systemic blood pressure through the renin-angiotensin-aldosterone system (RAAS).",
"id": "10027464",
"label": "d",
"name": "Extraglomerular mesangial cells",
"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": "5982",
"name": "Functions of the kidney",
"status": null,
"topic": {
"__typename": "Topic",
"id": "313",
"name": "Renal and Electrolyte Physiology",
"typeId": 7
},
"topicId": 313,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 5982,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17890",
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "Which type of cell secretes renin?",
"sbaAnswer": [
"a"
],
"totalVotes": 35,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,655 | false | 48 | null | 6,495,215 | null | false | [] | null | 17,891 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The proximal convoluted tubule is made of simple cuboidal epithelium and functions in the absorption and secretion of water and molecules. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.",
"id": "10027469",
"label": "d",
"name": "Proximal convoluted tubule",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The Bowman's capsule consists of two layers, parietal (outer) and visceral (inner), where the visceral layer is made of podocytes. Podocytes have finger-like projections (pedicles) and form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep.",
"id": "10027466",
"label": "a",
"name": "Visceral layer Bowman's capsule",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. The Bowman's capsule consists of two layers, parietal (outer) and visceral (inner), where the visceral layer is made of podocytes while the parietal layer is made of simple squamous epithelium.",
"id": "10027467",
"label": "b",
"name": "Parietal layer Bowman's capsule",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Similar to the proximal convoluted tubule, the distal convoluted tubule is made of simple cuboidal epithelium and functions in the absorption and secretion of water and molecules. However, it has less well-developed microvilli as its reabsorption and secretion occur to a lesser degree comparatively. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.",
"id": "10027470",
"label": "e",
"name": "Distal convoluted tubule",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. the glomerular capillaries are made of fenestrated endothelium, where the fenestration functions as pores. The glomerular capillaries form part of the glomerular filtration barrier which consists of the podocytes, the glomerular basement membrane and the glomerular capillaries from superficial to deep. On the other hand, podocytes are found on the visceral layer of the Bowman's capsule.",
"id": "10027468",
"label": "c",
"name": "Glomerular capillaries endothelium",
"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": "5982",
"name": "Functions of the kidney",
"status": null,
"topic": {
"__typename": "Topic",
"id": "313",
"name": "Renal and Electrolyte Physiology",
"typeId": 7
},
"topicId": 313,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5982,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17891",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "Podocytes are found on the epithelial lining of which structure?",
"sbaAnswer": [
"a"
],
"totalVotes": 30,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,656 | false | 49 | null | 6,495,215 | null | false | [] | null | 17,892 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. This is not the correct answer. Luteinizing hormone (LH) and follicular stimulating hormone (FSH) are secreted by the anterior pituitary gland and their secretion correlates with the menstrual cycle in females where they rise during the follicular phase, peak around ovulation, and fall after. FSH acts on Sertoli cells to promote spermatogenesis in males and follicular development (oestrogen production) in females.",
"id": "10027473",
"label": "c",
"name": "Follicular stimulating hormone (FSH)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. After the implantation of a fertilized egg, the corpus luteum secretes progesterone in the early pregnancy until the placenta develops and takes over progesterone production for the remainder of the pregnancy. Progesterone is involved in prepping the endometrium for implantation of the fertilized egg and maintenance of the pregnancy.",
"id": "10027475",
"label": "e",
"name": "Progesterone",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. If uterine implantation of the fertilized egg takes place, the syncytiotrophoblast cells of the blastocyst secrete human chorionic gonadotropin (HCG) which is responsible for the maintenance of the corpus luteum. Subsequently, the corpus luteum secretes progesterone in the early pregnancy until the placenta develops and takes over progesterone production for the remainder of the pregnancy. HCG is secreted by day nine, as such, HCG levels can be used to ascertain a pregnancy 10-11 days after conception.",
"id": "10027471",
"label": "a",
"name": "human chorionic gonadotropin (hCG)",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Luteinizing hormone (LH) and follicular stimulating hormone (FSH) are secreted by the anterior pituitary gland and their secretion correlates with the menstrual cycle in females where they rise during the follicular phase, peak around ovulation, and fall after. LH acts on Leydig cells to promote testosterone production in males and corpus luteum development (progesterone production) in females.",
"id": "10027472",
"label": "b",
"name": "Luteinizing hormone (LH)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the correct answer. Gonadotropin-releasing hormone (GnRH) is released by the hypothalamus and stimulates the release of luteinizing hormone (LH) and follicular stimulating hormone (FSH) from the anterior pituitary gland.",
"id": "10027474",
"label": "d",
"name": "Gonadotropin-releasing hormone (GnRH)",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5983",
"name": "Fertilisation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "175",
"name": "Reproductive Physiology",
"typeId": 7
},
"topicId": 175,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"question": "The corpus luteum switches to producing progesterone after ovulation. If implantation fails to occur, it will regress.\n\nWhich hormone is responsible for the maintenance of the corpus luteum if fertilisation occurs?",
"sbaAnswer": [
"a"
],
"totalVotes": 31,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,817 | false | 1 | null | 6,495,222 | null | false | [] | null | 17,893 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a CYP450 enzyme inhibitor, not an inducer.",
"id": "10027480",
"label": "e",
"name": "Isoniazid",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a CYP450 enzyme inhibitor, not an inducer.",
"id": "10027477",
"label": "b",
"name": "Grapefruit",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This does not affect the CYP450 enzyme system.",
"id": "10027479",
"label": "d",
"name": "Pyrazinamide",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This does not affect the CYP450 enzyme system.",
"id": "10027478",
"label": "c",
"name": "Ethambutol",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Rifampicin is a hepatic enzyme (p450) inducer. Therefore it is important to check interactions with other medications such as oral contraceptives as this will greatly reduce the efficacy. Patients who are on oral contraceptives and rifampicin should be counselled to use alternative contraception during treatment.",
"id": "10027476",
"label": "a",
"name": "Rifampicin",
"picture": null,
"votes": 125
}
],
"comments": [],
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"id": "4473",
"name": "Treatment of tuberculosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "223",
"name": "Antibiotic pharmacology",
"typeId": 7
},
"topicId": 223,
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"dislikes": 1,
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"question": "A 40 year old man presents to the Emergency Department with a 4 day history of a cough that is productive of green sputum. He has also noticed fevers and night sweats.\n\nHe is currently homeless and uses heroin recreationally, but takes no prescribed medications and has not seen a GP for many years.\n\nAcid-fast bacilli are seen on sputum sample and interferon gamma release assay is positive for tuberculosis. A chest x-ray displays a cavitating lesion in the upper left lobe. The patient is started on the tuberculosis protocol.\n\nWhich of the following medications is a CYP450 inducer?",
"sbaAnswer": [
"a"
],
"totalVotes": 247,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,818 | false | 2 | null | 6,495,222 | null | false | [] | null | 17,894 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a proteinogenic non-essential amino acid. Under stress, it may be essential to obtain from diet as the body's demand has increased.",
"id": "10027484",
"label": "d",
"name": "Glutamine",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a proteinogenic essential amino acid. This is used in the synthesis of proteins.",
"id": "10027482",
"label": "b",
"name": "Methionine",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Leucine is a branched-chain essential amino acid with the primary end products being acetyl-CoA and acetoacetate, precursors for ketone body synthesis. The only other pure ketogenic amino acid is lysine.",
"id": "10027481",
"label": "a",
"name": "Leucine",
"picture": null,
"votes": 117
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a proteinogenic non-essential amino acid. This is used in the synthesis of proteins.",
"id": "10027483",
"label": "c",
"name": "Alanine",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a proteinogenic essential amino acid.",
"id": "10027485",
"label": "e",
"name": "Valine",
"picture": null,
"votes": 5
}
],
"comments": [],
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "4206",
"name": "Amino acids",
"status": null,
"topic": {
"__typename": "Topic",
"id": "180",
"name": "Biochemistry",
"typeId": 7
},
"topicId": 180,
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"question": "A 25 year old female attends the GP wishing to understand the ketogenic diet in more detail, in particular which amino acids are associated. The GP explains that proteins can be degraded into amino acids for energy, particularly during long stages of fasting.\n\nWhich of the following are ketogenic amino acids?",
"sbaAnswer": [
"a"
],
"totalVotes": 222,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,819 | false | 3 | null | 6,495,222 | null | false | [] | null | 17,895 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Actinic keratosis is a pre-malignant skin condition that can lead to squamous cell carcinoma (SCC). The lesions normally appear as thickened papules or plaques with the skin texture appearing erythematous and keratotic. The incidence rate is higher in populations with fairer complexions and increased sun exposure. The keratinised nature and ulcerated edge of the lesion in this case makes an SCC more likely than actinic keratosis.",
"id": "10027488",
"label": "c",
"name": "Actinic Keratosis",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Although dermatofibromas can sometimes present with mild tenderness on palpation, they tend to be asymptomatic and do not share the same characteristics of squamous cell carcinomas such as ulceration and bleeding.",
"id": "10027489",
"label": "d",
"name": "Dermatofibroma",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Keratoacanthomas typically grow rapidly and develop from hair follicles in sun-exposed skin. They tend to appear as a dome-shaped nodule with a central keratin-filled hole. They can appear similar to a squamous cell carcinoma and therefore excision is usually recommended.",
"id": "10027490",
"label": "e",
"name": "Keratoacanthoma",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Squamous Cell Carcinomas (SSCs) tend to form on skin that is frequently exposed to the sun. They are a keratinocyte cancer, or non-melanoma, derived from cells within the epidermis that make keratin. They are invasive and can metastasise. SCCs can grow over weeks to months, may ulcerate and bleed, and are often painful.",
"id": "10027486",
"label": "a",
"name": "Squamous Cell Carcinoma",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This type of skin cancer is also a non-melanoma which develops in the basal cells. These cells produce new types of skin cells when the older cells die off. Although basal cell carcinomas (BCC) also develop on sun exposed skin, these nodules tend to be asymptomatic (i.e. no pain or bleeding) and can have a pearly surface with a rolled edge.",
"id": "10027487",
"label": "b",
"name": "Basal Cell Carcinoma",
"picture": null,
"votes": 56
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5787",
"name": "Benign and malignant tumours",
"status": null,
"topic": {
"__typename": "Topic",
"id": "182",
"name": "Cancer Biology",
"typeId": 7
},
"topicId": 182,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5787,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17895",
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"likes": 2,
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"question": "A 60 year old caucasian female attends the dermatology clinic as they are concerned about a raised nodule on their ear. She states the growth has been slow but that the lesion has recently started bleeding. She is otherwise fit and well, with no regular medications. Although she is now retired, she used to work as a gardener.\n\nOn examination, the lesion appears keratinised with scale and an ulcerated edge. It is tender on palpation.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 218,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,820 | false | 4 | null | 6,495,222 | null | false | [] | null | 17,896 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Atrial fibrillation is characterised by irregular, uncontrolled electrical activity in the atria of the heart. This can be seen on the ECG as an absence of P waves and an irregularly irregular rhythm. The patient has been experiencing palpitations and dizziness which are also symptoms of atrial fibrillation.",
"id": "10027491",
"label": "a",
"name": "Atrial Fibrillation",
"picture": null,
"votes": 196
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ventricular fibrillation is a life-threatening arrhythmia whereby the ventricles contract in an uncoordinated manner. Blood ceases to be pumped around the body, thus resulting in a cardiac arrest. Ventricular fibrillation is classed as a \"shockable\" rhythm that can respond well to defibrillation. It is characterised by rapid fibrillation waves of varying amplitude with no discernible P, QRS or T waves.",
"id": "10027493",
"label": "c",
"name": "Ventricular Fibrillation",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although patients with atrial fibrillation commonly experience palpitations, in atrial flutter the electrical activity in the atria is coordinated. This leads to a rapid atrial rate and a reduced ventricular rate leading to the characteristic flutter or 'sawtooth' waves seen on an ECG.",
"id": "10027492",
"label": "b",
"name": "Atrial Flutter",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ventricular tachycardia is a medical emergency. It can be pulsed or pulseless (i.e. when in cardiac arrest) and needs immediate management. Ventricular tachycardia would present on an ECG with a broad QRS complex and a rate greater than 100 beats per minute.",
"id": "10027495",
"label": "e",
"name": "Ventricular Tachycardia",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Anxiety and panic attacks can present with dizziness and palpitations, however, the pulse would be regular and the ECG would show a normal sinus rhythm.",
"id": "10027494",
"label": "d",
"name": "Anxiety",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3714",
"name": "Atrial fibrillation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
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"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1701429421,
"id": "2311",
"index": 0,
"name": "ECG_Atrial_Fibrillation_98_bpm.jpeg",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/vcba5s1r1701430385899.jpg",
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"path512": "images/vcba5s1r1701430385899_512.jpg",
"thumbhash": "OSgCA4ArlxyZovckR4aAdAc=",
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"updatedAt": 1708373886
}
],
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"question": "A 78 year old female attends the GP complaining of intermittent palpitations and dizziness for the past three months. She describes the palpitations as a fluttering in her chest, as if her heart has skipped a beat. She feels lightheaded during these episodes.\n\nThe only past medical history of note is hypertension for which she takes amlodipine.\n\nOn examination the patient appears comfortable at rest and her pulse is irregularly irregular. The GP decides to take an ECG, as shown below. [lightgallery]\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 220,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,821 | false | 5 | null | 6,495,222 | null | false | [] | null | 17,897 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG shows a supraventricular tachycardia (SVT) with a regular rhythm, in the context of a clinically stable patient. The first line management is a Valsalva manoeuvre. By contrast, cardioversion should be used in a patient in SVT who is unstable and has adverse features such as heart failure, ischaemia, shock or syncope.",
"id": "10027498",
"label": "c",
"name": "Synchronised direct current cardioversion",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The ECG shows a supraventricular tachycardia with a regular rhythm, in the context of a clinically stable patient. The first line management is a Valsalva manoeuvre. This aims to increase vagal tone and slow the conduction through the atrioventricular node, thus leading to a slowing of the heart rate.",
"id": "10027496",
"label": "a",
"name": "Valsalva manoeuvre",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG shows a supraventricular tachycardia (SVT) with a regular rhythm, in the context of a clinically stable patient. By contrast, flecainide is the pharmacological management for rhythm control in a patient with fast atrial fibrillation.",
"id": "10027499",
"label": "d",
"name": "Flecainide",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG shows a supraventricular tachycardia with a regular rhythm, in the context of a clinically stable patient. The first line management is a Valsalva manoeuvre. By contrast, adenosine is the treatment of choice in a stable supraventricular tachycardia if vagal manoeuvres have failed. Adenosine temporarily blocks the conduction through the AV node and should always be followed by 20ml IV normal saline. Patients must be warned about experiencing difficulty in breathing, chest tightness and flushing.",
"id": "10027497",
"label": "b",
"name": "Adenosine 6mg",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG shows a supraventricular tachycardia (SVT) with a regular rhythm, in the context of a clinically stable patient. By contrast, amiodarone is used mainly for stable patients with a broad complex tachycardia or for both rate and rhythm control in atrial fibrillation. It is not the first line management for SVT.",
"id": "10027500",
"label": "e",
"name": "Amiodarone",
"picture": null,
"votes": 16
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5886",
"name": "Acute narrow complex tachycardias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"conceptId": 5886,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17897",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "A 65 year old male patient is brought into A&E by ambulance. He had been feeling generally unwell with palpitations and dizziness for the last 3 hours. The paramedics state the only past medical history of note is high cholesterol for which the patient takes atorvastatin and they have no allergies. The paramedic crew have not yet administered any treatment.\n\nObservations are as follows:\nHR: 156bpm.\nRR: 22.\nBP: 130/78.\nTemp: 36.7.\nO2 Sats: 98% on room air.\nBM: 6.2mmol.\n\nBlood tests and a chest x-ray are requested. The ECG shows a supraventricular tachycardia with a regular rhythm\n\nWhich of the following is the first line management of this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 211,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,822 | false | 6 | null | 6,495,222 | null | false | [] | null | 17,898 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most likely diagnosis. This patient has been experiencing angina, dyspnoea and one episode of syncope. Her past medical history includes risk factors for aortic stenosis such as hypertension, high cholesterol and cigarette smoking. The ejection systolic murmur indicates aortic stenosis as the diagnosis.",
"id": "10027501",
"label": "a",
"name": "Aortic stenosis",
"picture": null,
"votes": 163
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient experienced a loss of consciousness with twitching movements, this is also fairly common in vasovagal syncope due to a brief decrease in blood flow to the brain; especially given there is no past medical history of epilepsy. There is no evidence of a post-ictal period and no tongue-biting or incontinence. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.",
"id": "10027504",
"label": "d",
"name": "Hypoglycaemia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient most likely experienced vasovagal syncope, this is not the root cause of the issue. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.",
"id": "10027503",
"label": "c",
"name": "Vasovagal syncope",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient presents with breathlessness on exertion and is a smoker, her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.",
"id": "10027505",
"label": "e",
"name": "Chronic Obstructive Pulmonary Disease",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient experienced a loss of consciousness with twitching movements, this is also fairly common in vasovagal syncope due to a brief decrease in blood flow to the brain; especially given there is no past medical history of epilepsy. There is no evidence of a post-ictal period and no tongue-biting or incontinence. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.",
"id": "10027502",
"label": "b",
"name": "Tonic-clonic seizure",
"picture": null,
"votes": 8
}
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"id": "5984",
"name": "Seizures and Blackouts",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"difficulty": 1,
"dislikes": 0,
"explanation": "Aortic stenosis",
"highlights": [],
"id": "17898",
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"question": "A 63 year old female attends their GP practice with chest pain and shortness of breath on exertion, which has been present for around 6 months. Last week, she lost consciousness while cleaning the kitchen, preceded by light-headedness. Her daughter witnessed the episode, noting brief twitching but no tongue biting or incontinence.\n\nShe has a history of hypertension and high cholesterol, and smokes 10 cigarettes per day.\n\n\nOn examination:\n\n\n * HR: 78bpm.\n * BP: 146/87.\n * O2 sats: 96% on air.\n * RR 18.\n * Temp: 37.1.\n\n\nThe GP notes an ejection systolic murmur over the second intercostal space on the right side of the sternum.\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 204,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,823 | false | 7 | null | 6,495,222 | null | false | [] | null | 17,899 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Beta-blockers are contraindicated in COPD. Therefore a rate-limiting calcium channel blocker is the medication of choice.",
"id": "10027507",
"label": "b",
"name": "Bisoprolol",
"picture": null,
"votes": 107
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient is stable and there is no clear onset time of the atrial fibrillation. If it were persistent the patient would need to be anticoagulated before cardioversion due to the increased risk of throwing off a clot. A rate-limiting calcium channel blocker is the medication of choice.",
"id": "10027508",
"label": "c",
"name": "DC cardioversion",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is usually considered in those with non-paroxysmal atrial fibrillation who are sedentary. It would not be used first line in this situation. A rate-limiting calcium channel blocker is the medication of choice.",
"id": "10027509",
"label": "d",
"name": "Digoxin",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The patient is suffering from fast atrial fibrillation (AF). The patient is stable and there is no clear onset time of their AF, thus it should be managed by rate control. As they have COPD beta-blockers are contra-indicated. Therefore a rate-limiting calcium channel blocker is the medication of choice.",
"id": "10027506",
"label": "a",
"name": "Diltiazem",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is used in rhythm control of fast atrial fibrillation if the onset time is <48hrs. As the onset time appears to be around 7 days in this case, the patient should be rate-controlled. Therefore a rate-limiting calcium channel blocker is the medication of choice.",
"id": "10027510",
"label": "e",
"name": "Flecainide",
"picture": null,
"votes": 13
}
],
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"id": "5985",
"name": "Class II anti-arrhythmics: Beta-blockers",
"status": null,
"topic": {
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"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "A 57 year old male presents to A&E with palpitations and dizziness for the past 7 days. He denies any chest pain or loss of consciousness.\n\nHe has a past medical history of high cholesterol and chronic obstructive pulmonary disease (COPD), but is able to stay fit and active, and enjoys country walks.\n\nOn examination:\nA - clear and patent.\nB - chest clear, bilateral equal air entry, trachea central.\nC - bilateral equal radial pulses, irregularly irregular pulse, heart sounds I+II+0.\nD - BM 6.5, temperature 37.2.\n\nObservations are as follows:\nHR 125.\nRR 20.\nSaturations 95% on air.\nGCS 15/15.\nBP 138/84.\n\nAn ECG shows fast atrial fibrillation.\n\nWhich of the following is the first-line treatment?",
"sbaAnswer": [
"a"
],
"totalVotes": 201,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,824 | false | 8 | null | 6,495,222 | null | false | [] | null | 17,900 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Both aortic and pulmonary valves close during S2.",
"id": "10027513",
"label": "c",
"name": "Pulmonary only",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The tricuspid valve closes during S1 along with the mitral valve. Both aortic and pulmonary valves close during S2.",
"id": "10027514",
"label": "d",
"name": "Tricuspid only",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The mitral valve closes during S1 along with the tricuspid valve. Both aortic and pulmonary valves close during S2.",
"id": "10027515",
"label": "e",
"name": "Mitral only",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. During S2 the ventricles relax and the pressure in the aorta and pulmonary artery exceeds the ventricular pressure. Both valves close, however the aortic will close slightly before the pulmonary valve.",
"id": "10027511",
"label": "a",
"name": "Aortic and pulmonary",
"picture": null,
"votes": 181
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Both aortic and pulmonary valves close during S2.",
"id": "10027512",
"label": "b",
"name": "Aortic only",
"picture": null,
"votes": 8
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "4231",
"name": "Blood flow through the heart",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
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"conditions": [],
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"question": "An 80 year old female attends her GP surgery for a routine review. The clinician auscultates the heart, and notes the first heart sound (S1) and second heart sounds (S2), with no murmurs.\n\nWhich of the following heart valves closes during the second heart sound (S2)?",
"sbaAnswer": [
"a"
],
"totalVotes": 203,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,825 | false | 9 | null | 6,495,222 | null | false | [] | null | 17,901 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although an important differential diagnosis to consider, it is unlikely in this case. Leukaemia can present with a petechial rash and raised inflammatory markers, however a raised white cell count and pancytopenia are also likely to be present on a full blood count.",
"id": "10027520",
"label": "e",
"name": "Leukaemia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would usually not present with abdominal pain or arthritis and is often associated with thrombocytopenia.",
"id": "10027518",
"label": "c",
"name": "Immune thrombocytopenic purpura",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although presenting with a rash of a similar nature and raised inflammatory markers, meningitis would usually present with neck stiffness, photophobia and fever. On examination Brudzinski's and Kernig's signs may be present.",
"id": "10027517",
"label": "b",
"name": "Meningitis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Henoch-Schonlein Purpura (HSP) is a small vessel vasculitis mediated by IgA. It mainly affects the skin, gastrointestinal tract and the kidneys. This child is suffering from the classical symptoms of abdominal pain, arthritis and the palpable purpuric rash over the extensor surfaces of the lower limbs. Renal function will need to be monitored, and she will need to be monitored for signs of intussusception.",
"id": "10027516",
"label": "a",
"name": "Henoch-Schonlein Purpura",
"picture": null,
"votes": 158
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although presenting with a rash of a similar nature and raised inflammatory markers, meningitis would usually present with neck stiffness, photophobia and fever. On examination Brudzinski's and Kernig's signs may be present.",
"id": "10027519",
"label": "d",
"name": "Haemolytic Uraemic Syndrome",
"picture": null,
"votes": 9
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5986",
"name": "Henoch-Schonlein Purpura",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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},
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"dislikes": 0,
"explanation": "Henoch-Schonlein Purpura",
"highlights": [],
"id": "17901",
"isLikedByMe": null,
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"likes": 0,
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"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1701429421,
"id": "2312",
"index": 0,
"name": "Purpuraschoenleinhennoch2.jpeg",
"overlayPath": null,
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"path": "images/h719qq851701430385899.jpg",
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"thumbhash": "ZygKFQZXiXyIB1iYh4dpeEmAkRMI",
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"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
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"topicId": 144,
"updatedAt": 1708373886
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"question": "A 6-year-old girl presents to A&E with a week of feeling unwell, including sore throat, reduced appetite, abdominal pain, and joint pain. The parents are concerned as she has now developed a rash that they noticed earlier in the day. They deny any diarrhoea or vomiting.\n\nOn, the patient is generally tender across her abdomen. A petechial rash is seen across the back of her legs and buttocks. Neurological examination is unremarkable.\n\n\nObservations are as follows:\nBP - 100/62.\nHR - 89bpm.\nSaturations - 98% on room air.\nRR - 24.\nTemperature - 37.8C.\n\n\nThe rash can be seen below. [lightgallery]\n\n\nBlood tests show a raised CRP and IgA levels.\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 203,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,826 | false | 10 | null | 6,495,222 | null | false | [] | null | 17,902 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the incorrect answer. This would usually indicate the patient is suffering from a sinusitis.",
"id": "10027522",
"label": "b",
"name": "Purulent nasal discharge",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Unilateral polyps are concerning for nasopharyngeal carcinomas and require urgent referral.",
"id": "10027521",
"label": "a",
"name": "Worsening unilateral nasal obstruction",
"picture": null,
"votes": 185
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although unilateral sinus pain is a red flag symptom, bilateral pain is more suggestive of sinusitis, and would not requite a 2 week wait suspected cancer referral.",
"id": "10027524",
"label": "d",
"name": "Bilateral sinus pain",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sneezing is a common symptom in allergic rhinitis, rhinosinusitis and nasal obstruction and does not in itself prompt an urgent ENT referral.",
"id": "10027525",
"label": "e",
"name": "Sneezing",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Nasal pruritis is a common symptoms in seasonal allergies and allergic rhinitis. It often improves with anti-histamines, and does not requite a 2 week wait suspected cancer referral.",
"id": "10027523",
"label": "c",
"name": "Nasal pruritis",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5987",
"name": "Red flag nasal symptoms",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"question": "A 52 year old male of Chinese descent presents to the GP with a feeling of persistent feeling of nasal congestion. They have tried over the counter allergy medications which have not improved their symptoms. As well as nasal congestion, the patient reports frequent sneezing and a tickly cough. He is otherwise well, with no past medical history and no regular medications, although he notes that his diet can be quite high in salt.\n\nHe has a family history of nasopharyngeal carcinoma, and is very worried about also having cancer.\n\nWhich of the following symptoms would prompt the GP to make a 2 week suspected cancer referral to Ear Nose and Throat (ENT)?",
"sbaAnswer": [
"a"
],
"totalVotes": 196,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,827 | false | 11 | null | 6,495,222 | null | false | [] | null | 17,903 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this should also be considered, this patient's tachycardia is likely due to her septic shock rather than primary cardiac pathology. Fluid resuscitation should therefore be prioritised.",
"id": "10027529",
"label": "d",
"name": "Perform a head-tilt chin-lift manouvre",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. It is important to correct the patient's severe hypotension first. This, along with her tachycardia, indicates septic shock which may be secondary to a urinary tract infection.",
"id": "10027526",
"label": "a",
"name": "Administer 500ml bolus of 0.9% saline",
"picture": null,
"votes": 176
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. The patient's saturations are within normal limits. It is therefore more important to address her hypotension.",
"id": "10027528",
"label": "c",
"name": "Give 15L oxygen through a non-rebreather mask",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Blood glucose can be used to guide management in sepsis however glucose is already reported on the patient's venous blood gas.",
"id": "10027530",
"label": "e",
"name": "Measure capillary blood glucose",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this should also be considered, this patient's tachycardia is likely due to her septic shock rather than primary cardiac pathology. Fluid resuscitation should therefore be prioritised.",
"id": "10027527",
"label": "b",
"name": "Perform a 12 lead ECG",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4035",
"name": "Sepsis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4035,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Administer 500ml bolus of 0.9% saline",
"highlights": [],
"id": "17903",
"isLikedByMe": null,
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"question": "A 25-year-old female is brought to A&E by ambulance on day 2 of antibiotics for a suspected UTI. She reports feeling extremely unwell with nausea and lower back pain. She has no past medical history and no allergies to any medication.\n\n\n\nOn examination:\n\n\n\nShe is alert to voice, appears pale and has an elevated work of breathing.\n\n\n\nHer observations are as follows:\n\n\n\nRR - 24.\nHR - 123.\nBP - 81/55.\nTemperature - 38.5C.\nO2 saturations - 97% on air.\n\n\n\nAn venous blood gas is obtained and the results are shown below:\n\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.2|7.35 - 7.45|\n|PaO₂|12.5 kPa|11 - 15|\n|PaCO₂|4.6 kPa|4.6 - 6.4|\n|Bicarbonate|20 mmol/L|22 - 30|\n|Lactate|5 mmol/L|0.6 - 1.4|\n|Non-fasting Glucose|9.7 mmol/L|< 6.1|\n\n\n\nWhat is the most important initial management step?",
"sbaAnswer": [
"a"
],
"totalVotes": 195,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,828 | false | 12 | null | 6,495,222 | null | false | [] | null | 17,904 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Resuscitation is a team effort and it is important to be able to delegate tasks. Cardiopulmonary rescusitation can begin as long as help is on the way.",
"id": "10027531",
"label": "a",
"name": "Call for help",
"picture": null,
"votes": 159
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This might be necessary once advanced life support in in progess however it is not the most important initial management step.",
"id": "10027532",
"label": "b",
"name": "Administer 500ml bolus of 0.9% saline through an IV cannula",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. As soon as help is on the way CPR can be started however resuscitation is a team effort and the patient will have a more favourable outcome if tasks are delegated effectively.",
"id": "10027534",
"label": "d",
"name": "Begin cardiopulmonary resuscitation (CPR)",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although useful in managing an airway during cardiac arrest, it is not helpful at this stage.",
"id": "10027533",
"label": "c",
"name": "Perform a jaw-thrust manouvre",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. It is most important to call for help in this scenario. Administering five initial rescue breaths forms part of paediatric resuscitation guidelines. High quality CPR and early defibrillation are prioritised in adult resuscitation.",
"id": "10027535",
"label": "e",
"name": "Administer five initial breaths through a bag-valve-mask (BVM)",
"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": "4442",
"name": "Advanced Life Support",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
"conceptId": 4442,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"multiAnswer": null,
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"question": "A 60 year old male patient is recovering from a myocardial infarction on the cardiology ward. A medical student plans to obtain a blood sample, but on arrival at the cubicle, the patient is unresponsive.\n\nOn examination, there is obvious work of breathing and no central pulse.\n\nWhich of the following is the most important initial management step?",
"sbaAnswer": [
"a"
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"totalVotes": 195,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,829 | false | 13 | null | 6,495,222 | null | false | [] | null | 17,905 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a test for pheochromocytoma. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.",
"id": "10027539",
"label": "d",
"name": "Plasma metanephrines",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a test for Cushing's syndrome. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.",
"id": "10027538",
"label": "c",
"name": "Low dose dexamethasone suppression test",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a test for acromegaly. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.",
"id": "10027537",
"label": "b",
"name": "IGF1",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a test used when hyperaldosteronism or Conn's is suspected. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.",
"id": "10027540",
"label": "e",
"name": "Aldosterone/Renin ratio",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. Hyponatraemia and hyperkalaemia, as well as postural hypotension, are also characteristic. A significant autoimmune past medical history also makes primary adrenal insufficiency (Addison's disease) more likely. The short synacthen test is the gold standard investigation to confirm the diagnosis of adrenal insufficiency. Her 9 am cortisol level would most likely be low.",
"id": "10027536",
"label": "a",
"name": "Short synacthen test",
"picture": null,
"votes": 139
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5988",
"name": "Adrenal Insufficiency and Addison's",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5988,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17905",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "A 30 year old female presents to her GP surgery with extreme fatigue for the past 6 months. She also report bouts of abdominal pain over this time that are accompanied by nausea, and has lost approximately 6kg unintentionally over this time. The only medication they take is levothyroxine for Hashimoto's thyroiditis. They have no other past medical history.\n\nOn examination, there is bronzing to the skin of their palms. Observations are within normal limits except for their blood pressure which is 126/82 when lying down and 100/71 when standing.\n\nTheir blood results are as follows:\n\nGlucose 3.9mmol.\nSodium 130.\nPotassium 5.7.\nNormal thyroid panel.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 192,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,830 | false | 14 | null | 6,495,222 | null | false | [] | null | 17,906 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Amiodarone-induced thyrotoxicosis is a recognized complication. The patient is suffering from symptoms of hyperthyroidism. Amiodarone is rich in iodine which is a compound of thyroid hormone, manifestations can occur in both iodine-deficient and iodine sufficient patients.",
"id": "10027541",
"label": "a",
"name": "Amiodarone",
"picture": null,
"votes": 145
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an anti-arrhythmic used in the treatment of atrial fibrillation however side effects would mostly likely be arrhythmias and dizziness.",
"id": "10027543",
"label": "c",
"name": "Flecainide",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Apixaban is a direct oral anticoagulant medication used to prevent clot formation in atrial fibrillation. This medication is more likely to cause complications such as haemorrhage and anemia.",
"id": "10027542",
"label": "b",
"name": "Apixaban",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Digoxin side effects include arrhythmias, conduction disorders, dizziness and vomiting. Overdose can cause gastrointestinal upset, visual symptoms and ECG abnormalities.",
"id": "10027545",
"label": "e",
"name": "Digoxin",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Beta-blockers such as propranolol can be used to treat the symptoms of hyperthyroidism.",
"id": "10027544",
"label": "d",
"name": "Bisoprolol",
"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": "3695",
"name": "Side effects of amiodarone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3695,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17906",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 55 year old male has recently been started on a medication for their atrial fibrillation. They attend their GP due to heat intolerance, weight loss, diarrhoea and restlessness. They explain they have not been sleeping well recently and they are feeling nervous a lot of the time. Their symptoms began approximately three weeks ago.\n\n\nOn examination the patient appears diaphoretic and has a fine tremor. Their pulse is fast at 115bpm.\n\n\nA blood test is ordered and results are below:\n\n\n||||\n|---------------------------|:-------:|------------------------------|\n|Thyroid Stimulating Hormone|6.7 mU/L|0.3 - 4.2|\n|Free T4|30 pmol/L|9 - 25|\n|Free T3|10 pmol/L|3.1 - 6.8|\n\nWhich of the following medications is most likely to cause this presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 193,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,831 | false | 15 | null | 6,495,222 | null | false | [] | null | 17,907 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Metformin is a biguanide medication that reduces gluconeogenesis in the liver and increases glucose uptake, therefore improving insulin sensitivity. This is the first-line oral anti-diabetic drug.",
"id": "10027546",
"label": "a",
"name": "Increased insulin sensitivity",
"picture": null,
"votes": 163
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Thiazolidenediones such as Pioglitazone have this mechanism of action. This promotes increased storage of free fatty acids reducing the amount available to be used by the cells. Peripheral tissues therefore become more depending on carbohydrates for energy.",
"id": "10027547",
"label": "b",
"name": "Stimulates nuclear receptor (peroxisome proliferator activated receptors)",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of action of GLP-1 analogues such as Liraglutide. These stimulate insulin release and inhibit glucagon release.",
"id": "10027548",
"label": "c",
"name": "Incretin effects",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sulfonylureas work in this way by closing ATP sensitive potassium channels on pancreatic beta cells causing membrane depolarisation and a calcium influx into the cell. This leads to insulin secretion.",
"id": "10027550",
"label": "e",
"name": "Increased insulin release",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Dapagliflozin is an example of a medication with this mechanism of action. THey work by binding to SGLT2 receptors in the proximal convoluted tubule leading to increased glycosuria and reduced reabsorption of glucose.",
"id": "10027549",
"label": "d",
"name": "Sodium dependent glucose cotransporter 2 inhibitor",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4376",
"name": "Metformin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "220",
"name": "Endocrine Pharmacology",
"typeId": 7
},
"topicId": 220,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4376,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17907",
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"likes": 0,
"multiAnswer": null,
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"question": "A 52 year old female attends her GP surgery to discuss her latest blood results, which show an HbA1c of 55 and a new diagnosis of type 2 diabetes. The GP recommends taking metformin to manage her diabetes.\n\nWhich of the following describes the mechanism of action of metformin?",
"sbaAnswer": [
"a"
],
"totalVotes": 195,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,832 | false | 16 | null | 6,495,222 | null | false | [] | null | 17,908 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The patient is suffering from a urine infection which is treatable with antibiotics. They have a fever and their white blood cells are likely to be low after their chemotherapy.",
"id": "10027551",
"label": "a",
"name": "Administer antibiotics",
"picture": null,
"votes": 161
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient is suffering from a urinary tract infection and their advanced care directive permits antibiotic use; they do not want to be for intensive care interventions, which do not appear to be indicated at this stage. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.",
"id": "10027553",
"label": "c",
"name": "Do not treat the patient",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient's advanced directive that states they do not want intensive care intervention. It also does not seem to be indicated in this stage. Administration of antibiotics should be the first step.",
"id": "10027555",
"label": "e",
"name": "Refer for treatment in the intensive care unit",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would be inappropriate as the patient has the capacity to make decisions for themselves. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.",
"id": "10027554",
"label": "d",
"name": "Encourage cranberry juice",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would be inappropriate as the patient has the capacity to make decisions for themselves. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.",
"id": "10027552",
"label": "b",
"name": "Contact the patient's next of kin to discuss their treatment",
"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": "5805",
"name": "DNACPR decisions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
"topicId": 184,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5805,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Administer antibiotics",
"highlights": [],
"id": "17908",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 67-year-old woman presents to A&E feeling unwell, with increased frequency of very dark urine and a burning sensation on urination for the past dayShe has a history of Stage 2 breast cancer and completed her last chemotherapy cycle 5 days ago. She has a Do Not Attempt CPR (DNACPR) form with them and an advanced directive that states she does not want intensive care intervention.\n\n\nOn examination, they are tender to palpate in the suprapubic region and are warm to touch. They are alert and oriented and appear to have capacity.\n\n\nTheir observations are as follows:\n\n\nHR 97bpm.\nRR 20bpm.\nO2 saturations 97% on air.\nBP 115/78.\nTemperature 37.9C.\n\n\nWhich of the following is the most appropriate management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 190,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,833 | false | 17 | null | 6,495,222 | null | false | [] | null | 17,909 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although sarcoidosis can affect both the liver and the lungs, their chest x-ray would likely show granulomas and they would be more likely to have other features such as erythema nodosum, a chronic dry cough and lymphadenopathy.",
"id": "10027560",
"label": "e",
"name": "Sarcoidosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient most likely has emphysema, the underlying cause is alpha-1 antitrypsin deficiency rather than COPD.",
"id": "10027557",
"label": "b",
"name": "Chronic obstructive pulmonary disease (COPD)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient has deranged liver function tests, a diagnosis of chronic viral hepatitis does not explain the respiratory symptoms.",
"id": "10027559",
"label": "d",
"name": "Chronic viral hepatitis",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Alpha-1 antitrypsin deficiency is a genetic condition. Alpha-1 antitrypsin inhibits neutrophil elastase which normally breaks down connective tissue. A deficiency therefore leaves the lungs and liver unprotected from proteolytic damage. It is associated with an increased risk of emphysema and liver damage. The typical presentation is males in their 30s and 40s.",
"id": "10027556",
"label": "a",
"name": "Alpha-1 antitrypsin deficiency",
"picture": null,
"votes": 143
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Alpha-1 antitrypsin deficiency carries a higher risk of developing hepatocellular carcinoma, however, this does not itself explain the respiratory symptoms. It is also less likely as the patient has not lost any weight.",
"id": "10027558",
"label": "c",
"name": "Hepatocellular carcinoma",
"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": "4593",
"name": "Alpha-1 Antitrypsin Deficiency",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4593,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17909",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 37 year old male attends the GP practice due to abdominal pain that has been present for around 3 months. He describes the pain as a dull ache, 3/10 in severity. More recently he has noticed that the whites of his eyes appear more yellow when looking in the mirror. He has not lost any weight.\n\nHe is currently waiting for a respiratory clinic appointment, as he has been struggling with shortness of breath on minimal exertion for around 6 months. He does not smoke or drink alcohol, and takes no regular medications.\n\nBlood results demonstrate deranged liver function tests. A chest x-ray shows hyperexpansion of the lungs and a flattened diaphragm.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 191,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,834 | false | 18 | null | 6,495,222 | null | false | [] | null | 17,910 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Loss of haustral markings is seen in ulcerative colitis.",
"id": "10027565",
"label": "e",
"name": "Loss of haustral markings",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Continuous Inflammation is more in keeping with ulcerative colitis. By contrast, skip lesions are seen in Crohn's disease.",
"id": "10027562",
"label": "b",
"name": "Continuous Inflammation",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Rose-thorn ulcers are a result of transmural inflammation and may be accompanied by fistulae or abscesses. Crohn's disease is associated with intermittent inflammation, cobblestone mucosa and rose-thorn ulcers.",
"id": "10027561",
"label": "a",
"name": "Rose-thorn ulcers",
"picture": null,
"votes": 104
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Loss of goblet cells is seen in ulcerative colitis.",
"id": "10027563",
"label": "c",
"name": "Loss of goblet cells",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Crypt abscesses are seen in ulcerative colitis.",
"id": "10027564",
"label": "d",
"name": "Crypt abscess",
"picture": null,
"votes": 43
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4000",
"name": "Crohn's disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4000,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17910",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 25 year old male presents to their GP with diarrhoea and increased bowel movements up to 8 times a day. This is starting to affect their work as a secretary as they are constantly using the toilet and feel tired all the time. They are struggling with their body image as they are finding it difficult to put on weight.\n\nBlood tests show a positive faecal calprotectin. The patient is referred for a colonoscopy with biopsy.\n\nWhich of the following findings on colonoscopy would support a diagnosis of Crohn's disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 191,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,835 | false | 19 | null | 6,495,222 | null | false | [] | null | 17,911 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cholecystokinin is a peptide hormone released in the duodenum that stimulates the release of digestive enzymes from the gallbladder and pancreas.",
"id": "10027567",
"label": "b",
"name": "Cholecystokinin",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Secretin is released into the intestinal lumen in response to low duodenal pH.",
"id": "10027568",
"label": "c",
"name": "Secretin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Gastrin is a peptide hormone that stimulates the secretion of hydrochloric acid in the stomach.",
"id": "10027569",
"label": "d",
"name": "Gastrin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This inhibits pancreatic secretion stimulated by cholecystokinin by relaxing the gallbladder. It also stimulates gastric acid secretion.",
"id": "10027570",
"label": "e",
"name": "Pancreatic polypeptide",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Pernicious anaemia is caused by a lack of vitamin B12. It is caused by autoimmune destruction of gastric parietal cells that are responsible for producing intrinsic factor, a protein necessary for vitamin B12 absorption. Patients may present with symptoms of anaemia such as fatigue and pallor, along with neurological deficits such as paraesthesia and loss of sensation. The patient's past medical history of type 1 diabetes is a risk factor for pernicious anaemia.",
"id": "10027566",
"label": "a",
"name": "Intrinsic Factor",
"picture": null,
"votes": 179
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5682",
"name": "Intrinsic factor",
"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": 5682,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17911",
"isLikedByMe": null,
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"question": "A 29 year old female attends her GP surgery. She has been struggling with fatigue for the last 3 months, despite sleeping for at least 9 hours a day. It makes it difficult to concentrate at work. She also reports pins and needles in her lower limbs. She has a past medical history of type 1 diabetes.\n\nBlood tests show a macrocytic anaemia and vitamin B12 deficiency.\n\nWhich of the following proteins in the gastrointestinal tract are essential for the absorption of vitamin B12?",
"sbaAnswer": [
"a"
],
"totalVotes": 194,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,836 | false | 20 | null | 6,495,222 | null | false | [] | null | 17,912 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. VIP increases the secretion of bicarbonate and inhibits pepsin secretion.",
"id": "10027575",
"label": "e",
"name": "Vasoactive intestinal peptide (VIP)",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is released by pancreatic acinar cells. It stimulates, rather than inhibits the release of CCK.",
"id": "10027572",
"label": "b",
"name": "Monitor peptide",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Motilin is a polypeptide hormone that increases gastrointestinal motility and gastric emptying.",
"id": "10027574",
"label": "d",
"name": "Motilin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Somatostatin is a hormone with a range of functions. Primarily, it inhibits the release of gastrin and parietal cell acid secretion. It also suppresses pancreatic secretions by inhibiting CCK secretion.",
"id": "10027571",
"label": "a",
"name": "Somatostatin",
"picture": null,
"votes": 169
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Acetylcholine does not inhibit the secretion of CCK.",
"id": "10027573",
"label": "c",
"name": "Acetylcholine",
"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": "5989",
"name": "Cholecystokinin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "165",
"name": "Gastrointestinal physiology",
"typeId": 7
},
"topicId": 165,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5989,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17912",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 45 year old patient is recovering in the general surgical ward following a cholecystectomy. They had some complications and receive total parenteral nutrition. They have been doing some research and have questions regarding the role of hormones in their gastrointestinal tract.\n\nCholecystokinin (CCK) is a hormone released in the duodenum in response to a meal.\n\nWhich of the following biochemicals inhibits CCK secretion?",
"sbaAnswer": [
"a"
],
"totalVotes": 189,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,837 | false | 21 | null | 6,495,222 | null | false | [] | null | 17,913 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.",
"id": "10027579",
"label": "d",
"name": "Positively bifringent needle shaped crystals",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Positively bifringent rhomboid-shaped crystals are indicative of pseudogout.",
"id": "10027577",
"label": "b",
"name": "Positively bifringent rhomboid-shaped crystals",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.",
"id": "10027578",
"label": "c",
"name": "Gram stain positive and neutrophils present",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Gout is a type of arthritis caused by the accumulation of monosodium urate crystals in and around the joints. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.",
"id": "10027576",
"label": "a",
"name": "Negatively bifringent needle-shaped crystals",
"picture": null,
"votes": 166
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.",
"id": "10027580",
"label": "e",
"name": "Negatively bifringent rhomboid shaped crystals",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4463",
"name": "Gout",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4463,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17913",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"qaAnswer": null,
"question": "A 50 year old male attends A&E due to a painful swollen big toe. This has been troubling him for around 24 hours. He feels systemically well, with no shivering or temperatures. He denies any trauma to the joint.\n\nOn examination, central obesity is noted. Their left big toe appears swollen and inflamed around the metatarsophalangeal joint.\n\nAn aspiration of the affected joint is performed, and the synovial fluid is analysed.\n\nWhich of the following synovial fluid analysis findings would indicate a diagnosis of gout?",
"sbaAnswer": [
"a"
],
"totalVotes": 193,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,838 | false | 22 | null | 6,495,222 | null | false | [] | null | 17,914 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type 1 hypersensitivity reactions occur much more rapidly after exposure. They are IgE-mediated. Examples include atopy and anaphylaxis.",
"id": "10027585",
"label": "e",
"name": "Type 1 Hypersensitivity",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There is no such thing as a type 5 hypersensitivity reaction.",
"id": "10027584",
"label": "d",
"name": "Type 5 Hypersensitivity",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type 2 reactions are IgG or IgM antibody-mediated and usually onset time is hours to days. Examples include haemolytic disease of the newborn and autoimmune haemolytic anaemia.",
"id": "10027582",
"label": "b",
"name": "Type 2 Hypersensitivity",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an antigen-antibody immune complex-mediated reaction that usually arises between hours and weeks after exposure. Examples include serum sickness and post-streptococcal glomerulonephritis.",
"id": "10027583",
"label": "c",
"name": "Type 3 Hypersensitivity",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Type 4 hypersensitivity is known as delayed hypersensitivity. The reaction occurs 24 to 72 hours after exposure and is T-cell mediated. Stevens-Johnson syndrome is a type IV reaction that involves the skin and mucus membranes.",
"id": "10027581",
"label": "a",
"name": "Type 4 Hypersensitivity",
"picture": null,
"votes": 125
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4091",
"name": "Hypersensitivity reactions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4091,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17914",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 60 year old female attends A&E as she notices a new blistering rash across her chest, as well as multiple painful mouth ulcers. 3 days ago she started a course of amoxicillin that was prescribed by her GP for a community-acquired pneumonia. She is diagnosed with Stevens-Johnson Syndrome.\n\nWhich of the following hypersensitivity reactions is this an example of?",
"sbaAnswer": [
"a"
],
"totalVotes": 192,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,839 | false | 23 | null | 6,495,222 | null | false | [] | null | 17,915 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Also known as infectious mononucleosis, glandular fever presents similarly with sore throat, fever and headache. However glandular fever is less common, and additional symptoms including severe fatigue and splenomegaly may also be present.",
"id": "10027590",
"label": "e",
"name": "Glandular fever",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The CENTOR criteria indicate the likelihood of tonsillitis being bacterial. Patients showing tonsillar exudate, tender cervical lymphadenopathy, fever and the absence of a cough are more likely to have bacterial tonsillitis compared to viral tonsillitis.",
"id": "10027588",
"label": "c",
"name": "Viral tonsilitis",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Laryngitis is inflammation of the larynx. Symptoms usually include hoarseness, a sore throat and a cough. A sore throat, fever and a headache with tender lymphadenopathy is suggestive of bacterial tonsillitis.",
"id": "10027589",
"label": "d",
"name": "Laryngitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A sore throat, fever and a headache with tender lymphadenopathy is suggestive of bacterial tonsillitis.",
"id": "10027587",
"label": "b",
"name": "Pharyngitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The CENTOR criteria indicate the likelihood of tonsillitis being bacterial. Patients showing tonsillar exudate, tender cervical lymphadenopathy, fever and the absence of a cough are more likely to have bacterial tonsillitis compared to viral tonsillitis.",
"id": "10027586",
"label": "a",
"name": "Bacterial tonsilitis",
"picture": null,
"votes": 148
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4332",
"name": "Streptococcal sore throat",
"status": null,
"topic": {
"__typename": "Topic",
"id": "194",
"name": "Infectious Diseases",
"typeId": 7
},
"topicId": 194,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4332,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17915",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 27 year old male attends their GP practice due to a sore throat and feeling generally unwell. They also complain about a headache that is not relieved by paracetamol. Their symptoms began a day ago. He denies nausea, vomiting, or coughing.\n\nOn examination, he is warm to touch. The throat appears erythematous with white exudate on the tonsils. Tender lymphadenopathy is noted on palpation of the neck. He is able to speak in full sentences with no signs of airway compromise.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 189,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,840 | false | 24 | null | 6,495,222 | null | false | [] | null | 17,916 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the karyotype for Jacob's Syndrome. This is also characterised by a male genotype and tall stature. However, Jacob's syndrome is also associated with aggression and a predisposition to mental illness.",
"id": "10027592",
"label": "b",
"name": "XYY",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Klinefelter syndrome is not an inherited condition and it occurs spontaneously. The phenotype is male with a tall stature, gynaecomastia, small testes and a feminine fat distribution. In Klinefelter syndrome, one of the X chromosomes is inactivated, becoming a 'Barr body'. These patients can also present with hypogonadotropic hypogonadism and high urinary gonadotropins.",
"id": "10027591",
"label": "a",
"name": "47 XXY",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Individuals with triple X syndrome are generally phenotypically female.",
"id": "10027595",
"label": "e",
"name": "47 XXX",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the karyotype for Turner's syndrome, which is characterised by the loss of an X chromosome. This is also a sporadic genetic condition but presents with a female phenotype.",
"id": "10027594",
"label": "d",
"name": "45 XO",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Fragile X syndrome is an inherited condition presenting with features such as a long face, large protruding ears, intellectual impairment and post-pubertal macroorchidism (large testes).",
"id": "10027593",
"label": "c",
"name": "Fra (X)",
"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": "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": "17916",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "An 18 year old male attends his GP surgery with concerns about his body image. He has not got any pubic hair and is self-conscious because he has a large amount of breast tissue compared with his other male friends.\n\nOn examination, the patient is tall and lean with wide hips. The GP notes small testes.\n\nWhich of the following is the most likely karyotype of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 190,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,841 | false | 25 | null | 6,495,222 | null | false | [] | null | 17,917 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Legionella pneumophilia infections typically present with fever, myalgia and malaise followed by a dry cough. It is usually seen in patients exposed to poor hotel air conditioning.",
"id": "10027600",
"label": "e",
"name": "Legionella pneumophilia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a gram-positive cocci found in clusters and is associated with intravenous drug users, elderly patients or patients who already have an influenza infection. Although it is the most common type of pneumonia it is not the most common in those with cystic fibrosis.",
"id": "10027597",
"label": "b",
"name": "Streptococcus pneumoniae",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is a gram-negative rod and is a multi-drug-resistant pathogen. *P. aerunginosa* is the most common pathogen in people with cystic above the age of 16. Management should involve blood cultures and local infectious disease guidelines. Antibiotics such as ciprofloxacin are usually given first line, at a higher dose than for those without cystic fibrosis.",
"id": "10027596",
"label": "a",
"name": "Pseudomonas aeruginosa",
"picture": null,
"votes": 96
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a gram-negative anaerobic rod that typically affects those with a weakened immune system: the elderly, alcoholics and diabetics. It usually presents with the classic 'red currant jelly' sputum. It is a less common cause of a lower respiratory tract infection in those with cystic fibrosis than Pseudomonas aeruginosa.",
"id": "10027599",
"label": "d",
"name": "Klebsiella pneumoniae",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although a common cause of pneumonia, it is not the most common in those with cystic fibrosis.",
"id": "10027598",
"label": "c",
"name": "Haemophilus influenzae",
"picture": null,
"votes": 22
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5990",
"name": "Pseudomonas",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
},
"topicId": 148,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5990,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17917",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 16 year old girl presents to the children's A&E department with her parents. She has a cough productive of green sputum and is feeling generally unwell. Her past medical history includes cystic fibrosis.\n\nOn examination of the respiratory system, crackles can be heard bilaterally.\n\nTheir blood tests reveal an elevated white blood cell count.\n\nWhich of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 189,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,842 | false | 26 | null | 6,495,222 | null | false | [] | null | 17,918 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.",
"id": "10027602",
"label": "b",
"name": "Bone remodelling, soft callus, hard callus, inflammation",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.",
"id": "10027603",
"label": "c",
"name": "Inflammation, hard callus, soft callus, bone remodelling",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.",
"id": "10027605",
"label": "e",
"name": "Bone remodelling, restructuring, ossification, repair",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling. Ossification relates to soft and hard callus formation.",
"id": "10027604",
"label": "d",
"name": "Bone remodelling, ossification, restructuring, repair",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. A fibrin clot is formed at the site of the fracture, followed by soft callus formation whereby cartilage and collagen unite. After this, a hard callus forms as the cartilage becomes woven bone through ossification. Finally, woven bone is converted into lamellar bone during the bone remodelling stage.",
"id": "10027601",
"label": "a",
"name": "Inflammation, soft callus, hard callus, bone remodelling",
"picture": null,
"votes": 154
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4209",
"name": "Fracture Healing",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4209,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17918",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 25 year old female is brought into A&E after falling from a horse. She sustained a mid-shaft femur fracture.\n\nWhich of the following describes the order of fracture healing?",
"sbaAnswer": [
"a"
],
"totalVotes": 189,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,843 | false | 27 | null | 6,495,222 | null | false | [] | null | 17,919 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is associated with rickets which also carries an increased fracture risk. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.",
"id": "10027607",
"label": "b",
"name": "Vitamin D deficiency",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Paget's disease is associated with excessive bone turnover due to the increase in osteoclast and osteoblast activity. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.",
"id": "10027609",
"label": "d",
"name": "Increased osteoclast and osteoblast activity",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Osteogenesis imperfecta is a genetic disorder of type 1 collagen. It causes fragile bones and low trauma fractures. Education about the condition and its treatment is essential.",
"id": "10027606",
"label": "a",
"name": "Type 1 collagen synthesis defect",
"picture": null,
"votes": 158
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is associated with achondroplasia. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.",
"id": "10027610",
"label": "e",
"name": "Mutated fibroblast growth factor receptor (FGFR)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would explain Marfan syndrome - a connective tissue disorder. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.",
"id": "10027608",
"label": "c",
"name": "Genetic defect in fibrillin synthesis",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4669",
"name": "Osteogenesis Imperfecta",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4669,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17919",
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"question": "A 5 year old female presents to a paediatric orthopaedic clinic. Her parents are very worried because she has sustained multiple low-trauma fractures. She is also known to have hearing loss, scoliosis, easy bruising and a blue tinge to her sclera.\n\nAfter ruling out non-accidental injury, she is diagnosed with osteogenesis imperfecta.\n\nWhich of the following describes the pathophysiology of osteogenesis imperfecta?",
"sbaAnswer": [
"a"
],
"totalVotes": 188,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,844 | false | 28 | null | 6,495,222 | null | false | [] | null | 17,920 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient has had a myocardial infarction likely from a thrombus, the patient will have suffered cardiogenic shock from the tamponade, thus causing reduced perfusion to the kidneys.",
"id": "10027612",
"label": "b",
"name": "Renal - renal vein thrombosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The cardiogenic shock from the cardiac tamponade caused reduced perfusion to the kidneys, resulting in a pre-renal AKI.",
"id": "10027611",
"label": "a",
"name": "Pre-renal - cardiogenic shock",
"picture": null,
"votes": 180
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There is nothing in the patient's history to suggest they suffer from benign prostatic hypertrophy.",
"id": "10027613",
"label": "c",
"name": "Post-renal - benign prostatic hypertrophy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There is nothing in the stem to suggest the patient is suffering from a kidney stone.",
"id": "10027615",
"label": "e",
"name": "Post-renal - kidney stone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient is most likely suffering from cardiogenic shock which would cause a pre-renal AKI.",
"id": "10027614",
"label": "d",
"name": "Renal - acute glomerulonephritis",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3752",
"name": "Acute Kidney Injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3752,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17920",
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"likes": 0,
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"question": "A 58 year old male is being treated in the intensive care unit following a myocardial infarction, after which he suffered a cardiac tamponade as a complication. He is found to have reduced urine output and an acute kidney injury (AKI) on their latest set of blood tests.\n\nWhich of the following best categorises this patient's AKI?",
"sbaAnswer": [
"a"
],
"totalVotes": 186,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,845 | false | 29 | null | 6,495,222 | null | false | [] | null | 17,921 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient is suffering from an AKI, the underlying cause is rhabdomyolysis.",
"id": "10027619",
"label": "d",
"name": "Acute kidney injury",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The patient is at risk of this condition due to her fall with a long lie. Rhabdomyolysis occurs when skeletal muscle is injured and rapidly breaks down, causing the release of intracellular myoglobin and potassium. It can present with muscle pain and swelling, red/brown urine and acute kidney injury. Treatment is mostly supportive with intravenous fluids and hyperkalaemia correction.",
"id": "10027616",
"label": "a",
"name": "Rhabdomyolysis",
"picture": null,
"votes": 169
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient is suffering from pain and swelling in their lower limb, a deep vein thrombosis would not cause so significant a rise in creatinine kinase. Furthermore, the negative d-dimer makes a deep vein thrombosis extremely unlikely.",
"id": "10027618",
"label": "c",
"name": "Deep vein thrombosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient presented with a swollen and painful calf, there is no paralysis and peripheral pulses are palpable. The acute kidney injury along with the markedly raised creatinine kinase points towards an underlying diagnosis of rhabdomyolysis.",
"id": "10027617",
"label": "b",
"name": "Compartment syndrome",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would not account for the extremely high creatinine kinase and acute kidney injury, and would not be expected to result from a fall with a long lie.",
"id": "10027620",
"label": "e",
"name": "Myositis",
"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": "4410",
"name": "Rhabdomyolysis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4410,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17921",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
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"question": "An 82 year old female is brought into the A&E department following a fall. The paramedics report she had been on the floor overnight for approximately 10 hours. The patient describes severe pain in her left leg, which she had been lying on.\n\n\nOn examination, the patient's left leg looks markedly swollen compared to her right. She can move her toes, and peripheral pulses are palpable. The patient is catheterised and her urine appears dark and tea-coloured.\n\n\nBlood results are as follows:\n\n\n||||\n|---------------------------|:-------:|--------------------|\n|Sodium|135 mmol/L|135 - 145|\n|Potassium|6.2 mmol/L|3.5 - 5.3|\n|Urea|8.1 mmol/L|2.5 - 7.8|\n|Creatinine|170 µmol/L|60 - 120|\n|Creatine Kinase|5100 U/L|(M) 25 - 200, (F) 25 - 175|\n\nD-dimer is negative.\n\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 188,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,846 | false | 30 | null | 6,495,222 | null | false | [] | null | 17,922 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a progressive fibrotic lung disease associated with shortness of breath. However, the symptoms of Cushing's syndrome in this case point more towards a paraneoplastic small cell lung carcinoma.",
"id": "10027624",
"label": "d",
"name": "Interstitial Lung Disease",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient's shortness of breath and weight loss point towards lung cancer. However, adenocarcinoma is less likely to cause paraneoplastic syndromes such as Cushing's syndrome.",
"id": "10027622",
"label": "b",
"name": "Adenocarcinoma",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Squamous cell carcinomas often cause hypercalcaemia and can be associated with hypertrophic pulmonary osteoarthropathy. The symptoms of Cushing's syndrome point more towards a paraneoplastic small cell lung carcinoma.",
"id": "10027623",
"label": "c",
"name": "Squamous Cell Carcinoma",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most likely diagnosis. Small cell carcinomas arise from endocrine Kulchitsky cells in the lungs. These secrete polypeptides including adrenocorticotrophic hormone and can present as Cushing's syndrome: characterised by the patient's symptoms of fragile skin, low mood and a 'moon' shaped face.",
"id": "10027621",
"label": "a",
"name": "Small cell lung carcinoma",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although COPD can explain the shortness of breath, the symptoms of Cushing's syndrome point more towards a paraneoplastic small cell lung carcinoma.",
"id": "10027625",
"label": "e",
"name": "Chronic Obstructive Pulmonary Disease (COPD)",
"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": "5991",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "225",
"name": "Oncology and Palliative Care",
"typeId": 7
},
"topicId": 225,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5991,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17922",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 72 year old man attends his GP surgery with shortness of breath that has been present for around 3 months. He has also noticed that his clothes have become very loose. The patient's primary concern is that his face has become noticeably rounder and 'puffy', his skin has become more fragile and he is feeling low in mood.\n\n\nHis observations are all within normal limits. Blood tests reveal a potassium of 2.9mmol/L (normal range 3.5-5.3 mmol/L).\n\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 187,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,847 | false | 31 | null | 6,495,222 | null | false | [] | null | 17,923 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Colorectal cancer will primarily spread through the portal vein system to the liver.",
"id": "10027629",
"label": "d",
"name": "Endoluminal spread",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Colorectal cancer will primarily spread through the portal vein system to the liver. Veins are more likely to be invaded than arteries as their walls are thinner.",
"id": "10027626",
"label": "a",
"name": "Haematogenously via the portal vein",
"picture": null,
"votes": 123
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Colorectal cancer can spread through the lymphatic system but it will cause metastatic deposits in the lymph nodes before reaching the liver.",
"id": "10027627",
"label": "b",
"name": "Lymphatic spread",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Transcoelomic spread occurs when the cancer penetrates the surface of the peritoneal cavity and spreads through it. Ovarian tumours are likely to take this route to metastasize to the liver, however colorectal cancer will primarily spread through the portal vein system to the liver.",
"id": "10027628",
"label": "c",
"name": "Transcoelomic spread",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Haematogenous spread is the most likely route of metastasis of colorectal cancer to the liver however it would most likely spread via the portal vein.",
"id": "10027630",
"label": "e",
"name": "Haematogenously via the hepatic artery",
"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": "5992",
"name": "Routes of Metastasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "225",
"name": "Oncology and Palliative Care",
"typeId": 7
},
"topicId": 225,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5992,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17923",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 62 year old female is diagnosed with colorectal cancer and attends the oncology clinic for the results of her most recent CT scan. It is found that her cancer has metastasized to her liver.\n\nBy which of the following routes has the cancer spread?",
"sbaAnswer": [
"a"
],
"totalVotes": 183,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,848 | false | 32 | null | 6,495,222 | null | false | [] | null | 17,924 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Anterior uveitis should be considered in patients with a painful red eye. However, it is typically also associated with blurred vision and headaches.",
"id": "10027635",
"label": "e",
"name": "Anterior uveitis",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although this can also present with a red eye, eye itching, irritation and excessive tearing would also be present. Pain is typically not as severe.",
"id": "10027633",
"label": "c",
"name": "Conjunctivitis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Scleritis presents with a painful red eye and pain on eye movements. It is more common in those with autoimmune conditions such as rheumatoid arthritis. Mild scleritis tends to be treated with NSAIDs and more severe or necrotising scleritis can be treated with corticosteroids.",
"id": "10027631",
"label": "a",
"name": "Scleritis",
"picture": null,
"votes": 128
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is inflammation of the optic nerve and causes painful eye movements. However, optic neuritis is also associated with vision loss and red-green colour discrimination deficits, which this patient does not have.",
"id": "10027634",
"label": "d",
"name": "Optic neuritis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although episcleritis also presents with a red eye, episcleritis is inflammation of the episclera underneath the conjunctiva. Episcleritis tends to present with milder pain, and episcleral vessels will blanch. Management is mostly supportive and can include the use of artificial tears for symptomatic relief.",
"id": "10027632",
"label": "b",
"name": "Episcleritis",
"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": "5993",
"name": "Episcleritis and Scleritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5993,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17924",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 43 year old male attends eye casualty complaining of a painful right eye. He describes the pain as 9/10 in severity which becomes worse when he moves his eye. He denies any headaches or blurred vision.\n\nThe only medical history of note is rheumatoid arthritis for which he takes methotrexate and folic acid.\n\nOn examination, the sclera is diffusely erythematous. Fluorescein eye stain does not detect any foreign bodies, and episcleral vessels do not move or blanch when pressed with a cotton bud. Visual acuity and colour vision is normal.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 182,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,849 | false | 33 | null | 6,495,222 | null | false | [] | null | 17,925 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The gold standard investigation for cauda equina syndrome is a whole spine MRI.",
"id": "10027638",
"label": "c",
"name": "Order an x-ray spine",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This patient presents with symptoms concerning for cauda equina syndrome. The gold standard investigation for cauda equina syndrome is a whole spine MRI.",
"id": "10027640",
"label": "e",
"name": "Insert a urinary catheter",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. It is important to confirm and find the cause of the patient's cauda equina before considering surgery.",
"id": "10027639",
"label": "d",
"name": "Lumbar decompression surgery",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The gold standard investigation for cauda equina syndrome is a whole spine MRI.",
"id": "10027637",
"label": "b",
"name": "Order a CT spine",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Whole spine MRI is the gold standard test for suspected cauda equina syndrome. This will identify the cause and location of the cord compression. The patient has a past medical history of prostate cancer and therefore the cause of their cauda equina is likely to be spinal metastasis.",
"id": "10027636",
"label": "a",
"name": "Order a whole spine MRI",
"picture": null,
"votes": 161
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3772",
"name": "Cauda equina syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3772,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17925",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
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"question": "An 81 year old male presents to the A&E department due to back pain. He reports shooting pains in his buttocks radiating down both legs for 5 days. He became particularly concerned earlier that day whilst using the toilet; he noticed he was unable to feel the toilet paper when wiping.\n\nThe patient has a past medical history of prostate cancer, but is not currently receiving chemotherapy.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 187,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,850 | false | 34 | null | 6,495,222 | null | false | [] | null | 17,926 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would generally be used for non-displaced intracapsular fractures and therefore would be inappropriate for this patient.",
"id": "10027645",
"label": "e",
"name": "Cannulated screw fixation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would generally be used for more stable extracapsular fractures.",
"id": "10027644",
"label": "d",
"name": "Dynamic hip screw",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would be used if the patient had significant comorbidities or was generally less mobile. As the patient is generally well and mobile, she is likely to tolerate a total hip arthroplasty with good outcomes.",
"id": "10027643",
"label": "c",
"name": "Hemiarthroplasty",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although can be useful for pain management it is not the definitive treatment for a neck of femur fracture. She requires surgical intervention; likely a total hip arthroplasty.",
"id": "10027642",
"label": "b",
"name": "Femoral nerve block",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. Garden stage IV represents a complete fracture of the femoral neck. As the patient is generally well and mobile, she is likely to tolerate the procedure with good outcomes. A total hip arthroplasty would be used to replace both the femoral head and the acetabulum.",
"id": "10027641",
"label": "a",
"name": "Total hip arthroplasty",
"picture": null,
"votes": 109
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3907",
"name": "fractured neck of femur",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3907,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17926",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
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"question": "A 73 year old female is brought into A&E by ambulance following a fall in her garden. She is normally fit and well aside from mild hay fever, and does not use any walking aids. She reports pain in her left hip despite intravenous paracetamol and oramorph. Her left leg appears to be shortened and internally rotated.\n\nAn x-ray is taken and a garden stage IV fracture can be seen with displacement.\n\nWhich of the following is the definitive management for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 183,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,851 | false | 35 | null | 6,495,222 | null | false | [] | null | 17,927 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Coarctation of the aorta, ventricular septal defects and patent ductus arteriosus are all forms of acyanotic heart disease. These conditions do not cause cyanosis and instead might present with tachypnoea, feeding difficulties, poor weight gain, pallor and tachycardia.",
"id": "10027646",
"label": "a",
"name": "Coarctation of the aorta",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an example of a cyanotic heart disease in which the aorta and pulmonary trunk insertions are swapped around.",
"id": "10027647",
"label": "b",
"name": "Transposition of the great arteries",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an example of a cyanotic heart disease in which pulmonary stenosis is coupled with a large ventricular septal defect and results in a left-to-right ventricular shunt.",
"id": "10027650",
"label": "e",
"name": "Tetralogy of Fallot",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an example of a cyanotic heart disease in which the pulmonary valve controlling blood flow from the right side of the heart does not form.",
"id": "10027648",
"label": "c",
"name": "Pulmonary atresia",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is an example of a cyanotic heart disease in which the tricuspid valve controlling blood flow from the right side of the heart does not form.",
"id": "10027649",
"label": "d",
"name": "Tricuspid atresia",
"picture": null,
"votes": 22
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5994",
"name": "Acyanotic Heart Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5994,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17927",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 6 week old baby is brought into A&E by their mother as they are concerned they are not feeding properly and appear pale. On examination, the baby is tachypnoeic and does not appear to be gaining weight appropriately. The doctor is concerned the infant might have a congenital heart disease.\n\nWhich of the following is an example of an acyanotic heart disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 184,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,852 | false | 36 | null | 6,495,222 | null | false | [] | null | 17,928 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although babies should be able to pincer grasp by 10 months it is not a red flag for referral. If they are still unable to pincer grasp by 12 months this is a red flag.",
"id": "10027653",
"label": "c",
"name": "No pincer grip by 10 months",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Hand regard is usually present by 3-4 months.",
"id": "10027654",
"label": "d",
"name": "No hand regard by 6 weeks",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Palmar grasp is usually established by 6 months along with being able to transfer objects between hands. No palmar grasp by 3 months is not a red flag.",
"id": "10027655",
"label": "e",
"name": "No palmar grasp by 3 months",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Fixing and following refers to the ability to accurately fixate on and follow stimuli in the environment with their eye. This is usually achieved by 2-3 months of age. Not fixing and following by 3 months is a red flag and would warrant further investigation.",
"id": "10027651",
"label": "a",
"name": "Not fixing and following by 3 months",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Most children will be able to point with their finger and look at pictures by 12 months. Failing to point with a finger by 6 months is not a red flag.",
"id": "10027652",
"label": "b",
"name": "Does not point with a finger by 6 months",
"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": "4125",
"name": "Developmental milestones - fine motor and vision",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4125,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17928",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 14 week old baby boy is brought into the GP for a routine review.\n\nWhich of the following is a red flag for abnormal development?",
"sbaAnswer": [
"a"
],
"totalVotes": 182,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,853 | false | 37 | null | 6,495,222 | null | false | [] | null | 17,929 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Fraser guidelines are criteria that must be met for children under 16 to be advised on sexual health without breaking confidentiality. As this patient meets these criteria, a contraceptive may be prescribed despite her age.",
"id": "10027658",
"label": "c",
"name": "Do not prescribe the pill as the patient is not of legal age",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. According to the Fraser Guidelines, if the patient has the maturity and intelligence to understand the treatment, cannot be persuaded to tell their parents, is likely to begin sexual intercourse without contraception, or if their mental health is likely to suffer without the treatment it is in their best interests to provide this treatment.",
"id": "10027656",
"label": "a",
"name": "Prescribe the contraceptive pill",
"picture": null,
"votes": 163
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would be inappropriate as the patient is 'Fraser competent' and can therefore receive advice and or treatment without breaking confidentiality.",
"id": "10027657",
"label": "b",
"name": "Prescribe the contraceptive pill and tell the patient's parents",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient is unlikely to abstain and would be likely to come to harm if this advice is given.",
"id": "10027660",
"label": "e",
"name": "Advise the patient to abstain from sexual intercourse until they are 16",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This would breach confidentiality as the patient is fraser competent.",
"id": "10027659",
"label": "d",
"name": "Ask the patient's parents for consent to prescribe",
"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": "5909",
"name": "Fraser guidelines",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5909,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17929",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 15 year old female patient attends her GP practice as she would like some contraception advice. She requests the combined oral contraceptive pill, as she is thinking of having sexual intercourse with her boyfriend who is also 15. She appears to understand the importance of safe sex and understands how to take the combined contraceptive pill correctly.\n\nShe does not want her parents to know as they do not think they would understand. She also notes that if she were not prescribed the pill they would have sexual intercourse regardless, however would rather be safe.\n\nWhich of the following is the most appropriate management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 187,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,854 | false | 38 | null | 6,495,222 | null | false | [] | null | 17,930 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is used to relieve abdominal cramps and bloating associated with IBS. Other examples of antispasmodics include peppermint oil tablets and buscopan.",
"id": "10027661",
"label": "a",
"name": "Mebeverine",
"picture": null,
"votes": 112
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although paracetamol can help the pain associated with IBS, it is not specifically an antispasmodic medication.",
"id": "10027663",
"label": "c",
"name": "Paracetamol",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a laxative agent usually avoided in IBS as it can cause bloating.",
"id": "10027665",
"label": "e",
"name": "Lactulose",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a laxative. Although IBS can involve constipation, this patient's primary symptom is loose stool. Ispaghula husk would therefore not be appropriate.",
"id": "10027664",
"label": "d",
"name": "Ispaghula husk",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a laxative. Although IBS can involve constipation, this patient's primary symptom is loose stool. Bisacodyl would therefore not be appropriate.",
"id": "10027662",
"label": "b",
"name": "Bisacodyl",
"picture": null,
"votes": 28
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5995",
"name": "Mebeverine",
"status": null,
"topic": {
"__typename": "Topic",
"id": "229",
"name": "Pharmacology of the gastro-intestinal system",
"typeId": 7
},
"topicId": 229,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5995,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17930",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 21 year old male attends their GP surgery as they are experiencing uncomfortable abdominal cramps and loose stool. They state they are under a lot of pressure in their final year of university. These symptoms started approximately 3 weeks ago when they started writing their dissertation.\n\nA blood test is unremarkable, and their faecal calprotectin is negative. He is diagnosed with irritable bowel syndrome (IBS).\n\nWhich of the following is an anti-spasmodic medication used to treat the symptoms associated with IBS?",
"sbaAnswer": [
"a"
],
"totalVotes": 185,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,855 | false | 39 | null | 6,495,222 | null | false | [] | null | 17,931 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Simvastatin can be used with caution in those with renal impairment: it is unlikely to cause AKI. Statins tend to affect the liver more than the kidneys.",
"id": "10027667",
"label": "b",
"name": "Simvastatin",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). Although NSAIDs can cause or exacerbate AKI, it is unlikely to have caused AKI if given in topical form.",
"id": "10027668",
"label": "c",
"name": "Topical diclofenac gel",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. ACE inhibitors are a known cause of AKI along with NSAIDs, aminoglycosides, angiotensin receptor blockers and diuretics.",
"id": "10027666",
"label": "a",
"name": "Ramipril",
"picture": null,
"votes": 140
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Amlodipine is not known to cause or exacerbate an AKI.",
"id": "10027670",
"label": "e",
"name": "Amlodipine",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Mebeverine is not known to cause or exacerbate an AKI.",
"id": "10027669",
"label": "d",
"name": "Mebeverine",
"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": "4435",
"name": "ACE inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4435,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17931",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 50 year old female with a past medical history of hypertension, osteoarthritis, irritable bowel syndrome and high cholesterol is admitted to the ward with an acute kidney injury (AKI).\n\nWhich of the following medications could have caused her AKI?",
"sbaAnswer": [
"a"
],
"totalVotes": 184,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,856 | false | 40 | null | 6,495,222 | null | false | [] | null | 17,932 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phosphate is more likely to accumulate in CKD.",
"id": "10027672",
"label": "b",
"name": "Hypophosphataemia",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Higher levels of urate can be expected in CKD. This can lead to uraemic encephalopathy.",
"id": "10027675",
"label": "e",
"name": "Hypouricemia",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Phosphate accumulates in CKD as the kidneys are unable to remove excess phosphate. This is why patients are often counselled on a low phosphate diet in CKD. They might also be given phosphate binding medication.",
"id": "10027671",
"label": "a",
"name": "Hyperphosphataemia",
"picture": null,
"votes": 94
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sodium levels are more likely to be low in CKD. With higher fluid intake the kidneys are unable to dilute urine further, therefore resulting in hyponatremia and oedema.",
"id": "10027674",
"label": "d",
"name": "Hypernatremia",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Potassium is more likely to be raised in CKD as the kidney is unable to excrete potassium effectively.",
"id": "10027673",
"label": "c",
"name": "Hypokalaemia",
"picture": null,
"votes": 27
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4243",
"name": "Chronic Kidney Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4243,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17932",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 62 year old male attends their GP practice following a recent diagnosis of chronic kidney disease (CKD). He is keen to learn more about his condition.\n\nWhich of the following electrolytes are most likely to be deranged in CKD?",
"sbaAnswer": [
"a"
],
"totalVotes": 186,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,857 | false | 41 | null | 6,495,222 | null | false | [] | null | 17,933 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although some potassium reabsorption occurs here, there is also secretion of potassium.",
"id": "10027679",
"label": "d",
"name": "Collecting Duct",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Potassium is freely filtered at the renal glomerulus, not reabsorbed.",
"id": "10027680",
"label": "e",
"name": "The glomerulus",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Potassium is passively secreted here via the sodium-potassium pump.",
"id": "10027677",
"label": "b",
"name": "Distal Convoluted Tubule",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although potassium reabsorption does occur in the Loop of Henle, more occurs in the proximal convoluted tubule.",
"id": "10027678",
"label": "c",
"name": "Loop of Henle",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Potassium is filtered in the glomerulus of the kidney. It then passes through to the PCT, where most of it is reabsorbed. There is some reabsorption in the Loop of Henle, as well as the distal convoluted tubule and collecting duct. However, potassium secretion also occurs at these sites.",
"id": "10027676",
"label": "a",
"name": "Proximal convoluted tubule",
"picture": null,
"votes": 127
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5773",
"name": "Potassium excretion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5773,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17933",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
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"pictures": [],
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"qaAnswer": null,
"question": "A 67 year old patient attends their GP practice for monitoring of their serum potassium level. They have required treatment for hyperkalaemia in the past and are keen to know more about how potassium levels are regulated in the body.\n\nWhich of the following parts of the nephron is responsible for the majority of potassium reabsorption?",
"sbaAnswer": [
"a"
],
"totalVotes": 186,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,858 | false | 42 | null | 6,495,222 | null | false | [] | null | 17,934 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While a panic attack may cause shortness of breath and hyperventilation, it is not associated with a cough or with type two respiratory failure as shown on the ABG. The patient is more likely to be suffering from an exacerbation of COPD.",
"id": "10027684",
"label": "d",
"name": "Asthma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient presents with globally reduced breath sounds which is likely due to limitations in airflow or poor sound transmission in COPD. In pleural effusion, breath sounds are usually reduced or absent over one area and percussion would generate a stony dull note.",
"id": "10027685",
"label": "e",
"name": "Pleural effusion",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While a panic attack may cause shortness of breath and hyperventilation, it is not associated with a cough or with type two respiratory failure as shown on the ABG. The patient is more likely to be suffering from an exacerbation of COPD.",
"id": "10027682",
"label": "b",
"name": "Panic attack",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although pulmonary fibrosis is also associated with a cough and shortness of breath, this is associated with restrictive rather than obstructive changes on spirometry. The lack of exposure to occupational triggers or pets is another clue that COPD is a more likely diagnosis.",
"id": "10027683",
"label": "c",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. It is likely that the patient is suffering from an exacerbation of COPD. The ABG demonstrates a type two respiratory failure with hypoxia and hypercapnia. There is some metabolic compensation, meaning it is likely that the respiratory derangement is chronic.",
"id": "10027681",
"label": "a",
"name": "Chronic Obstructive Pulmonary Disease (COPD)",
"picture": null,
"votes": 168
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5996",
"name": "Chronic Obstructive Pulmonary Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5996,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Chronic Obstructive Pulmonary Disease (COPD)",
"highlights": [],
"id": "17934",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 67 year old male attends A&E with worsening shortness of breath and a productive cough for one month. He has no significant medical history or medication allergies. A former smoker (10/day for 30 years), he quit at 45. He denies asbestos exposure or owning pets.\n\nOn examination, the patient uses accessory muscles to breathe, with decreased breath sounds and a loud bilateral wheeze. Percussion is resonant.\n\n\n\n\nSpirometry shows an obstructive pattern of lung disease. An arterial blood gas (ABG) gives the following results:\n\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.23|7.35 - 7.45|\n|PaO₂|9 kPa|11 - 15|\n|PaCO₂|8.9 kPa|4.6 - 6.4|\n|Bicarbonate|28 mmol/L|22 - 30|\n|Base Excess|+3 mmol/L|-2 to +2|\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 186,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,859 | false | 43 | null | 6,495,222 | null | false | [] | null | 17,935 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In bronchiectasis, an obstructive pattern would be seen on spirometry.",
"id": "10027688",
"label": "c",
"name": "Bronchiectasis",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient takes methotrexate which is a known risk factor for pulmonary fibrosis. Her spirometry also shows a restrictive pattern with both FEV1 and FVC below the predicted normal level and a ratio >0.7. The pattern is specific to pulmonary fibrosis as the DLCO is also reduced.",
"id": "10027686",
"label": "a",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 158
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In asthma, an obstructive pattern would be seen on spirometry.",
"id": "10027689",
"label": "d",
"name": "Asthma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although a restrictive pattern would also be seen in obesity hypoventilation syndrome, DLCO would not be expected to be affected.",
"id": "10027690",
"label": "e",
"name": "Obesity hypoventilation syndrome",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In COPD, an obstructive pattern would be seen on spirometry.",
"id": "10027687",
"label": "b",
"name": "Chronic obstructive pulmonary disease (COPD)",
"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": "3693",
"name": "Pulmonary Fibrosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3693,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17935",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old female is seen in the respiratory clinic to receive her most recent spirometry results. She has been experiencing a dry cough and shortness of breath which has been progressively worsening over the last 4 months.\n\npatient has a past me dical history of rheumatoid arthritis and takes methotrexate. They have never smoked and have no allergies.\n\nThe spirometry results are as follows:\n\nFEV1: 68%\nFVC: 60%\nFEV1/FVC ratio: 0.84\n\nDiffusion Capacity of the Lungs for carbon monoxide (DLCO): reduced.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 187,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,860 | false | 44 | null | 6,495,222 | null | false | [] | null | 17,936 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. According to the British thoracic guidelines (BTS) adding in an ICS such as beclomethasone is the next management step after a short-acting beta2 agonist. These would be used in combination and the patient counselled on how and when to use them.",
"id": "10027691",
"label": "a",
"name": "Prescribe a low dose inhaled corticosteroid (ICS)",
"picture": null,
"votes": 169
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Leukotriene receptor antagonists such as Montelukast can be trialled after low-dose inhaled corticosteroids and long-acting beta-2 agonists. According to the British thoracic guidelines (BTS) adding in an inhaled corticosteroid such as beclomethasone is the next management step after a short-acting beta2 agonist.",
"id": "10027694",
"label": "d",
"name": "Oral leukotriene receptor antagonist",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although theophylline can be used in asthma management, it is not the next management step when only a beta2 agonist has been tried so far. According to the British thoracic guidelines (BTS) adding in an inhaled corticosteroid such as beclomethasone is the next management step after a short-acting beta2 agonist.",
"id": "10027693",
"label": "c",
"name": "Oral theophylline",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. According to the British thoracic guidelines (BTS) adding in an inhaled corticosteroid such as beclomethasone is the next management step after a short-acting beta2 agonist.",
"id": "10027695",
"label": "e",
"name": "Add long acting beta-2 agonist",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient states their asthma is well managed they are still having to use their salbutamol inhaler several times a week and are experiencing nocturnal symptoms. Therefore a low dose inhaled corticosteroid inhaler should be added.",
"id": "10027692",
"label": "b",
"name": "Review in 6 months",
"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": "4228",
"name": "Treatment options in Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "189",
"name": "Respiratory Pharmacology",
"typeId": 7
},
"topicId": 189,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4228,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17936",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 19 year old male patient presents to the GP for an asthma review. They were diagnosed with the condition at the age of 15 and the only medication they take is a salbutamol inhaler. They feel it is well-controlled and have never been admitted to hospital because of their asthma.\n\nThe patient reports using their salbutamol inhaler 5 times a week before football practice and waking up one night a week with a tight chest.\n\nWhich of the following is the best next step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 187,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,861 | false | 45 | null | 6,495,222 | null | false | [] | null | 17,937 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The normal inspiratory reserve volume of a person without lung disease is approximately 3000ml, however, this can vary between patients.",
"id": "10027696",
"label": "a",
"name": "Approximately 3000ml",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the inspiratory capacity",
"id": "10027699",
"label": "d",
"name": "Approximately 3500ml",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the normal expiratory reserve volume.",
"id": "10027697",
"label": "b",
"name": "Approximately 1000ml",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the total lung capacity.",
"id": "10027700",
"label": "e",
"name": "Approximately 6000ml",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the normal residual volume.",
"id": "10027698",
"label": "c",
"name": "Approximately 1500ml",
"picture": null,
"votes": 93
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4212",
"name": "Lung volumes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4212,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17937",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 17 year old girl attends her GP surgery for a review of her asthma symptoms. She undergoes spirometry to determine her lung volume.\n\nWhich of the following is the normal inspiratory reserve volume of a person without lung disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 184,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,862 | false | 46 | null | 6,495,222 | null | false | [] | null | 17,938 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sjogren's syndrome is associated with a positive anti-Ro and anti-La. Symptoms of fatigue, fever and myalgia, although non-specific are all congruent with a diagnosis of SLE. The positive antibodies confirm this diagnosis.",
"id": "10027703",
"label": "c",
"name": "Sjogren's syndrome",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Symptoms of fatigue, fever and myalgia, although non-specific are all congruent with a diagnosis of SLE. The positive antibodies confirm this diagnosis.",
"id": "10027701",
"label": "a",
"name": "Systemic lupus erythematous (SLE)",
"picture": null,
"votes": 173
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Approximately 50-90% of patients with rheumatoid arthritis present with a positive rheumatoid factor and >95% present with a positive anti-CCP. Symptoms of fatigue, fever and myalgia, although non-specific are all congruent with a diagnosis of SLE. The positive antibodies confirm this diagnosis.",
"id": "10027702",
"label": "b",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Wegener's granulomatosis is associated with a positive cANCA. Symptoms of fatigue, fever and myalgia, although non-specific are all congruent with a diagnosis of SLE. The positive antibodies confirm this diagnosis.",
"id": "10027704",
"label": "d",
"name": "Wegener's granulomatosis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Diffuse cutaneous systemic sclerosis is associated with a positive Anti-Scl-70. Symptoms of fatigue, fever and myalgia, although non-specific are all congruent with a diagnosis of SLE. The positive antibodies confirm this diagnosis.",
"id": "10027705",
"label": "e",
"name": "Diffuse cutaneous systemic sclerosis",
"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": "5687",
"name": "Antibodies in rheumatological disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5687,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17938",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 33 year old female attends their GP to discuss the results of a recent blood test. They have been feeling more tired than usual and complain of a low-grade fever affecting their ability to concentrate. They also report widespread muscle and joint aches despite minimal physical exertion.\n\nTheir blood results are as follows:\n\nAnti-dsDNA: positive.\nAnti-sm: positive.\nANA: positive.\n\nAll other auto-antibody tests were negative.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 184,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,863 | false | 47 | null | 6,495,222 | null | false | [] | null | 17,939 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This presents as a rapidly progressive glomerulonephritis with pulmonary haemorrhage.",
"id": "10027710",
"label": "e",
"name": "Microscopic polyangiitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient is presenting with nasal polyps this is not the underlying condition and does not account for the lower respiratory tract symptoms or blood results.",
"id": "10027709",
"label": "d",
"name": "Nasal polyps",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although the patient is presenting with an allergic clinical picture, allergic rhinitis would not have a positive ANCA and would not present with symptoms of neuropathy.",
"id": "10027708",
"label": "c",
"name": "Allergic rhinitis",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. GPA (Wegener's Granulomatosis) is also a small and medium vessel vasculitis. However, as well as upper and lower respiratory tract symptoms it is characterised by pauci-immune glomerulonephritis. Additional symptoms such as haematuria or frothy urine may be seen, associated with a positive p and c-ANCA.",
"id": "10027707",
"label": "b",
"name": "Granulomatosis with polyangiitis (GPA)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient is suffering from asthma with nasal polyps, symptoms of neuropathy and eosinophilia along with a positive pANCA. EGPA is an inflammatory small and medium vessel vasculitis.",
"id": "10027706",
"label": "a",
"name": "Eosinophilic granulomatosis with polyangiitis (EGPA)",
"picture": null,
"votes": 148
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5997",
"name": "Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5997,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17939",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old male patient attends the GP as they have begun to feel wheezy and short of breath with a nocturnal cough. It worsens when pollen is high. He has also been suffering from chronic sinusitis for the last 4 months. They have also experienced some pins and needles in their legs.\n\n\nOn examination, bilateral nasal polyps can be seen and a global wheeze can be heard on auscultation.\n\n\nBlood test results are as follows:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|110 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|7.5x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|250x10<sup>9</sup>/L|150 - 400|\n|Mean Cell Volume (MCV)|85 fL|80 - 96|\n|Neutrophils|5x10<sup>9</sup>/L|2.0 - 7.5|\n|Lymphocytes|3.5x10<sup>9</sup>/L|1.5 - 4.0|\n|Eosinophils|0.9x10<sup>9</sup>/L|0 - 0.4|\n|Basophils|0.05x10<sup>9</sup>/L|0 - 0.1|\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 184,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,864 | false | 48 | null | 6,495,222 | null | false | [] | null | 17,940 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Dyspepsia is a known side effect of bisphosphonates. Patients are advised to take the medication on an empty stomach with plenty of water while sitting or standing and should stay upright for at least 30 minutes afterwards.",
"id": "10027711",
"label": "a",
"name": "Alendronic acid",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Statin medications are less likely to cause reflux or dyspepsia compared to bisphosphonates.",
"id": "10027712",
"label": "b",
"name": "Atorvastatin",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Calcium channel blockers are more likely to cause peripheral oedema than dyspepsia symptoms.",
"id": "10027714",
"label": "d",
"name": "Amlodipine",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although thiazide diuretics can cause gastric side effects such as diarrhoea and nausea, they are unlikely to cause reflux or dyspepsia.",
"id": "10027715",
"label": "e",
"name": "Indapamide",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although corticosteroid inhaler can cause oral issues such as candidiasis, they do not cause reflux or dyspepsia.",
"id": "10027713",
"label": "c",
"name": "Beclomethasone inhaler",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5998",
"name": "Side effects of Bisphosphonates",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "An 83 year old female attends her GP practice for a medication review. She has been struggling with reflux and dyspepsia since starting a new medication. She past medical history includes hypertension, osteoporosis, asthma and high cholesterol.\n\nWhich of the following medications is most likely to be causing her symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 185,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,865 | false | 49 | null | 6,495,222 | null | false | [] | null | 17,941 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Apoptosis, or programmed cell death, allows for the safe removal of virally infected or mutated cells. It ultimately ends with phagocytosis by macrophages.",
"id": "10027720",
"label": "e",
"name": "Phagocytosis - chromatin compaction - cell shrinkage - cell fragmentation - apoptotic blebbing",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Apoptosis, or programmed cell death, allows for the safe removal of virally infected or mutated cells. The first stage is cell shrinkage.",
"id": "10027719",
"label": "d",
"name": "Apoptotic blebbing - cell shrinkage - chromatin compaction - cell fragmentation - phagocytosis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Apoptosis, or programmed cell death, allows for the safe removal of virally infected or mutated cells. It ultimately ends with phagocytosis by macrophages.",
"id": "10027718",
"label": "c",
"name": "Cell shrinkage - chromatin compaction - phagocytosis - apoptotic blebbing - cell fragmentation",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Apoptosis, or programmed cell death, allows for the safe removal of virally infected or mutated cells. It ultimately ends with phagocytosis by macrophages.",
"id": "10027716",
"label": "a",
"name": "Cell shrinkage - chromatin compaction - apoptotic blebbing - cell fragmentation - phagocytosis",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Apoptosis, or programmed cell death, allows for the safe removal of virally infected or mutated cells. The first stage is cell shrinkage.",
"id": "10027717",
"label": "b",
"name": "Chromatin compaction - cell shrinkage - cell fragmentation - apoptotic blebbing - phagocytosis",
"picture": null,
"votes": 34
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3886",
"name": "Apoptosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
"totalCards": null,
"typeId": null,
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"question": "A 76 year old male has recently been diagnosed with lung cancer. He has been thoroughly researching his condition and is keen to learn more about the process of apoptosis.\n\nWhich of the following are the appropriate steps in apoptosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 180,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,466,866 | false | 50 | null | 6,495,222 | null | false | [] | null | 17,942 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The rough endoplasmic reticulum is responsible for the manufacturing of lysosomal enzymes and secreted proteins as well as N-linked glycosylation. Glycolysis occurs in the cytosol of the cell. The energy created from this process is used to form adenosine triphosphate (ATP).",
"id": "10027724",
"label": "d",
"name": "Rough endoplasmic reticulum",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Glycolysis occurs in the cytosol of the cell. The energy created from this process is used to form adenosine triphosphate (ATP).",
"id": "10027721",
"label": "a",
"name": "The cytosol",
"picture": null,
"votes": 126
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ribosomes are responsible for mRNA translation. Glycolysis occurs in the cytosol of the cell. The energy created from this process is used to form adenosine triphosphate (ATP).",
"id": "10027723",
"label": "c",
"name": "The ribosomes",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The golgi apparatus packages proteins into vesicles before they are sent to their destination. Glycolysis occurs in the cytosol of the cell. The energy created from this process is used to form adenosine triphosphate (ATP).",
"id": "10027725",
"label": "e",
"name": "Golgi apparatus",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Glycolysis occurs in the cytosol of the cell. The energy created from this process is used to form adenosine triphosphate (ATP).",
"id": "10027722",
"label": "b",
"name": "The mitochondrion",
"picture": null,
"votes": 42
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4565",
"name": "Glycolysis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "17942",
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"question": "A 36 year old woman with chronic obesity consults her GP regarding some weight loss advice. She is highly informed and has been researching the biochemical pathways involved in metabolism. The clinician explains that glycolysis is an important cellular pathway that converts glucose into pyruvate for energy.\n\nIn which of the following parts of the cell does glycolysis occur?",
"sbaAnswer": [
"a"
],
"totalVotes": 185,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,020 | false | 1 | null | 6,495,229 | null | false | [] | null | 17,943 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While the description of vertigo would fit with acute labyrinthitis, the fact there is no hearing loss or tinnitus makes this less likely.",
"id": "10027727",
"label": "b",
"name": "Acute Labyrinthitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classical description of BPPV; the otoconia in the inner ear become dislodged by head movements such as getting out of bed. This stimulates the hair cells which causes the vertigo or the sensation of the room spinning.",
"id": "10027726",
"label": "a",
"name": "Benign paroxysmal positional vertigo (BPPV)",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an important differential for vertigo as there may be ischaemia in the cerebellum causing her symptoms. However, this is less likely in this case. In particular, the fact there are no neurological findings mentioned makes BPPV most likely.",
"id": "10027730",
"label": "e",
"name": "Transient ischaemic attack (TIA)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reactivation of the varicella-zoster virus along the facial nerve (CN VII). Whilst some vertigo may be associated, the presenting complaint is likely to be facial droop due to facial nerve palsy.",
"id": "10027729",
"label": "d",
"name": "Ramsay-Hunt syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Typically vestibular schwannomas cause unilateral sensorineural hearing loss and progressive tinnitus. This is because they affect the conductivity of the vestibulocochlear nerve (CN VIII).",
"id": "10027728",
"label": "c",
"name": "Vestibular schwannoma",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3999",
"name": "Benign Paroxysmal Positional Vertigo (BPPV)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3999,
"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17943",
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"question": "A 45-year-old woman presents to her GP complaining of recurrent episodes of dizziness. Upon further questioning, she describes episodes of \"the room spinning\" which lasts 30-60 seconds at a time. She has noticed that getting out of bed can be a trigger. There is no tinnitus or hearing loss associated with this episode, however, she does state that she often feels very nauseous and has vomited on one occasion.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,021 | false | 2 | null | 6,495,229 | null | false | [] | null | 17,944 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this woman is in the last week of her cycle, likely, ovulation has already been prevented. Furthermore, no history of unprotected sexual intercourse (UPSI) is mentioned.",
"id": "10027732",
"label": "b",
"name": "Offer an emergency contraception such as the Ella one pill",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the best option to prevent pregnancy for this woman as she is in the final week of her cycle (as she only has five pills left in the packet). Likely, ovulation has already been prevented for this cycle. However, it is important for the next cycle, hence starting the next pack immediately after.",
"id": "10027731",
"label": "a",
"name": "Take the last pill that was missed, finish the current pack and start the next pack immediately after",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no mention of unprotected sexual intercourse (UPSI) in this time of missed pills. Furthermore, ovulation was likely already prevented as this woman is in the last week of her cycle.",
"id": "10027734",
"label": "d",
"name": "Offer an immediate pregnancy test",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The priority for this woman is maintaining the pill's effectiveness for her next cycle. Ovulation was likely already prevented before her sickness so barrier contraception is not needed. However, to maintain the effectiveness for her next cycle, it is important she takes the last missed pill as soon as possible and then starts the next pack immediately after finishing this one.",
"id": "10027733",
"label": "c",
"name": "Carry on with pills as normal and use barrier contraception in the pill-free week",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a form of emergency contraception, which is not needed in this case. Ovulation was likely already prevented before the missed pills. It is more important to maintain effective contraception for the next cycle. This woman may want to switch to another form of contraception if she is consistently struggling to take pills at the same time each day but this is not the most important step at the moment.",
"id": "10027735",
"label": "e",
"name": "Switch to a copper IUD",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5999",
"name": "Missed oral contraceptive pills",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17944",
"isLikedByMe": 0,
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"question": "A 21-year-old is asking for advice about her oral contraceptive pill. For the past few days, she has been vomiting. She thinks this started after eating a \"dodgy\" takeaway. As she has been vomiting she has not been able to keep any food or drink down, including her combined oral contraceptive pill. Further questioning reveals she has missed three days of her pill. She also tells you she has only five pills left in the current pack and has taken the pills correctly for this cycle. She has not had any intercourse since her last withdrawal bleed, and now feels recovered and no longer feels nauseous. \n\nWhat is the most appropriate advice to give her?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,022 | false | 3 | null | 6,495,229 | null | false | [] | null | 17,945 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would represent the sensitivity of the test. In other words, the proportion of people with the disease with a positive test result.",
"id": "10027738",
"label": "c",
"name": "21%",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would represent the negative predictive value. This describes the proportion of people with a negative test result who truly do not have the disease.",
"id": "10027737",
"label": "b",
"name": "54%",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The specificity of a test is the proportion of people without the disease who test negative. In this example that is 470 out of 500 total patients without the disease, or 94%.",
"id": "10027736",
"label": "a",
"name": "94%",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This represents the false positive rate. Which is the proportion of those without the condition who will test positive. It is calculated with this equation: false positive rate = 1 - specificity",
"id": "10027740",
"label": "e",
"name": "6%",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would represent the positive predictive value or the proportion of people with a positive test result who actually have the disease.",
"id": "10027739",
"label": "d",
"name": "78%",
"picture": null,
"votes": 6
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
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"demo": null,
"entitlement": null,
"id": "4325",
"name": "Evaluation of a diagnostic test",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4325,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17945",
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"question": "Prostate-specific antigen (PSA) can be used to help identify potential cases of prostate cancer.\n\n| PSA test result | Patients with prostate cancer | Patients without prostate cancer |\n| --- | --- | --- |\n| Positive | 105 | 30 |\n| Negative | 395 | 470 |\n\nUsing the information in the table, what is the specificity of the PSA test?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,023 | false | 4 | null | 6,495,229 | null | false | [] | null | 17,946 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be inappropriate for a few reasons. Firstly, the patient is still smoking which creates a risk of fire. Secondly, we do not know if this patient would benefit from additional oxygen. They have airway obstruction but no signs of hypoxia such as cyanosis or chronically low oxygen saturations.",
"id": "10027744",
"label": "d",
"name": "Refer to receive long-term oxygen therapy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a very invasive procedure which should not be used so early in this patient's journey. Trialling non-pharmacological and medical management options first is more appropriate.",
"id": "10027742",
"label": "b",
"name": "Refer to thoracic surgeons for lung volume reduction surgery",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be considered as a next step in pharmacological management, as the patient is not benefiting from salbutamol alone. However, offering smoking cessation advice and services is more important.",
"id": "10027743",
"label": "c",
"name": "Add in a tiotropium inhaler once daily",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the single most important management step as smoking cessation is the most effective way of reducing the decreasing lung function in these patients.",
"id": "10027741",
"label": "a",
"name": "Offer smoking cessation advice",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be a good next step for the pharmacological management of this patient's COPD. However, smoking cessation is more important in the first instance as it will slow the progression of the disease.",
"id": "10027745",
"label": "e",
"name": "Add in an inhaled corticosteroid inhaler (e.g. Beclomethasone)",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3717,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 56-year-old man presents for a review. He was diagnosed with chronic obstructive pulmonary disorder (COPD) last year. He feels his breathlessness is getting worse despite the use of his salbutamol inhaler. He is currently still smoking and has a 30-pack-year smoking history.\n\nWhich management option is the most important?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,024 | false | 5 | null | 6,495,229 | null | false | [] | null | 17,947 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no features of stress incontinence alongside the urgency symptoms. These features could include urine leakage when laughing and coughing.",
"id": "10027750",
"label": "e",
"name": "Mixed incontinence",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This description of incontinence could represent overflow incontinence, however, the absence of risk factors such as prostatism or structural abnormalities makes this less likely.",
"id": "10027748",
"label": "c",
"name": "Overflow incontinence",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This describes the sudden and involuntary loss of urine associated with urinary incontinence.",
"id": "10027746",
"label": "a",
"name": "Urge incontinence",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This woman has some risk factors for stress incontinence due to three vaginal deliveries of her children. However, the fact that there is no urine leakage when coughing or laughing makes this less likely.",
"id": "10027747",
"label": "b",
"name": "Stress incontinence",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is an abnormality with this patient's bladder making it overactive. She should not be consistently waking in the night with urgency symptoms. Therefore, we can rule out functional incontinence.",
"id": "10027749",
"label": "d",
"name": "Functional incontinence",
"picture": null,
"votes": 6
}
],
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"demo": null,
"entitlement": null,
"id": "6000",
"name": "Types of urinary incontinence",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"question": "A 62-year-old woman presents to her GP with episodes of incontinence. She describes episodes of waking up in the night feeling desperate to pass urine. She states that she never makes it on time so is leaking urine into the bed almost every night. On further questioning, she tells you that there is no leaking of urine on coughing or laughing. She also tells you she has had three vaginal deliveries previously.\n\nWhat is the most likely form of urinary incontinence in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,025 | false | 6 | null | 6,495,229 | null | false | [] | null | 17,948 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of an angiotensin-converting enzyme (ACE) inhibitor. These are considered first-line anti-hypertensives for people who are aged under 55 and not of black African or African-Caribbean family origin. Another consideration for patients with type 2 diabetes.",
"id": "10027752",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a beta blocker, which is only considered in resistant hypertension after three other drugs have already been added.",
"id": "10027754",
"label": "d",
"name": "Bisoprolol",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of a thiazide-like diuretic. It is used in the pharmacological management of hypertension, but it is not first-line.",
"id": "10027755",
"label": "e",
"name": "Indapamide",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This man is over 55 without a diagnosis of type 2 diabetes so a calcium channel blocker such as amlodipine is most appropriate.",
"id": "10027751",
"label": "a",
"name": "Amlodipine",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angiotensin-II receptor blockers (ARBs) are considered first-line for people who are aged under 55 and not of black African or African-Caribbean family origin or those with type 2 diabetes. They may also be considered if someone does not tolerate ACE inhibitors.",
"id": "10027753",
"label": "c",
"name": "Candesartan",
"picture": null,
"votes": 0
}
],
"comments": [],
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"id": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 56-year-old white man presents after home blood pressure monitoring (HBPM). He has already been offered lifestyle advice which has been ineffective in lowering his blood pressure. He has no history of type 2 diabetes.\n\nYou are considering starting a medication, which would be the most appropriate?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,026 | false | 7 | null | 6,495,229 | null | false | [] | null | 17,949 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Barrett's may progress to an adenocarcinoma which would be a neoplasm. However, Barrett's by itself is not a malignant condition.",
"id": "10027758",
"label": "c",
"name": "Neoplasia of the distal oesophagus",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is damage to the oesophagus in Barrett's, but it does not cause tearing. It damages the cells themselves rather than the structure.",
"id": "10027760",
"label": "e",
"name": "Oesophageal tears",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dysplasia refers to the presence of abnormal cells- which can sometimes be present in later stages of Barrett's. However, this is not always the case so does not make up the usual pathophysiology.",
"id": "10027757",
"label": "b",
"name": "Dysplasia of the distal oesophagus",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would more closely describe achalasia, which would present with difficulty swallowing rather than reflux.",
"id": "10027759",
"label": "d",
"name": "Narrowing of the oesophagus",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The normal oesophageal epithelium is stratified squamous. In long-term exposure to stomach acid, this changes to columnar epithelium like in the stomach. This change from one cell type to another is called metaplasia.",
"id": "10027756",
"label": "a",
"name": "Metaplasia of the distal oesophagus",
"picture": null,
"votes": 36
}
],
"comments": [],
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},
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"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,
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"question": "A 45-year-old woman presents for a review. She has had ongoing dyspepsia which is not controlled with omeprazole. This has been occurring for most of her adult life. She is at risk of Barrett's oesophagus due to this.\n\nWhich of the following best describes the pathophysiology of Barrett's oesophagus?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,027 | false | 8 | null | 6,495,229 | null | false | [] | null | 17,950 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are a few factors that make a fracture more likely than a simple sprain or strain. The inability to weight bear, immediate swelling and bony tenderness all suggest a fracture. The mechanism of injury suggests a base of the 5th metatarsal fracture.",
"id": "10027762",
"label": "b",
"name": "Ankle sprain",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are factors suggesting a fracture such as the inability to weight bear. However, the bony tenderness to just the lateral aspect of the foot makes a metatarsal fracture more likely than an ankle fracture.",
"id": "10027763",
"label": "c",
"name": "Ankle fracture",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient describes sudden inversion of her foot, this will put pressure on the tendon to the 5th metatarsal. This causes an avulsion fracture as the force pulls off part of the bone.",
"id": "10027761",
"label": "a",
"name": "5th metatarsal fracture",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Charcot arthropathy describes a damaged joint secondary to loss of sensation. It is common in diabetics. For this patient, there is no description of loss of sensation and her symptoms have started more acutely following an injury.",
"id": "10027765",
"label": "e",
"name": "Charcot arthropathy",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's description of her injury does not fit with an Achilles tendon rupture. She may have described a loud pop or snap. The twisting she describes is not typical for the mechanism of injury of Achilles tendon rupture. Furthermore, this injury is most common in men aged 30-50 years old.",
"id": "10027764",
"label": "d",
"name": "Achilles tendon rupture",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4186",
"name": "Foot fractures",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4186,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "A 15-year-old female patient presents to A+E having injured herself during a PE lesson at school. She describes \"landing funny\" on her left foot and that she \"went over on it\". Since this incident, she has been unable to weight bear. On examination, the left foot is swollen and there is bony tenderness along the lateral aspect of the left foot.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,028 | false | 9 | null | 6,495,229 | null | false | [] | null | 17,951 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of warfarin, which acts as an anticoagulant by preventing the production of vitamin K-dependent factors (II, VII, IX and X).",
"id": "10027770",
"label": "e",
"name": "Inhibits vitamin K epoxide reductase complex",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of clopidogrel and ticagrelor (thienopyridines).",
"id": "10027769",
"label": "d",
"name": "P2Y12 receptor antagonist",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of action of low molecular weight heparins (LMWH) such as dalteparin.",
"id": "10027768",
"label": "c",
"name": "Forms a complex that inhibits factor Xa",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Rivaroxaban is an example of a direct oral anticoagulant. These drugs have this mechanism of action on the blood clotting pathway.",
"id": "10027766",
"label": "a",
"name": "Direct factor Xa inhibitor",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the anticoagulant mechanism of action of aspirin.",
"id": "10027767",
"label": "b",
"name": "Inhibits thromboxane A2",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6001",
"name": "Direct oral anticoagulants",
"status": null,
"topic": {
"__typename": "Topic",
"id": "195",
"name": "Pharmacology",
"typeId": 7
},
"topicId": 195,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"question": "A 54-year-old woman is seen after an episode of syncope. During this, an ECG is performed which shows absent P waves and an irregularly irregular rhythm. Atrial fibrillation is diagnosed and subsequently, rivaroxaban is started.\n\nWhat is the mechanism of action of this drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,029 | false | 10 | null | 6,495,229 | null | false | [] | null | 17,952 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Damage to the optic nerve (e.g. glaucoma) would present with more generalised visual loss or diplopia. As this man's double vision is only on looking down this makes optic nerve damage less likely.",
"id": "10027774",
"label": "d",
"name": "Optic nerve (CN II)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The trochlear nerve innervates the superior oblique muscle which is responsible for depression of the eye. As this muscle is not working, there will be diplopia whilst looking down.",
"id": "10027771",
"label": "a",
"name": "Trochlear nerve (CN IV)",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The trigeminal nerve is not involved in eye movement so a palsy of the trigeminal nerve would not cause diplopia. The trigeminal nerve is instead involved in providing sensation to the face and innervating the muscles of mastication.",
"id": "10027775",
"label": "e",
"name": "Trigeminal nerve (CN V)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The oculomotor nerve innervates most of the muscles of the eye. The presentation of a third nerve palsy is the action of the other extra-ocular muscles. The eye will be \"down and out\" due to the action of the superior oblique and lateral rectus.",
"id": "10027772",
"label": "b",
"name": "Oculomotor never (CN III)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The abducens nerve innervates the lateral rectus muscle which is responsible for abduction of the eyes. This would present with diplopia when looking away from the midline as well as bumping into things on the affected side.",
"id": "10027773",
"label": "c",
"name": "Abducens nerve (CN VI)",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3970",
"name": "Isolated cranial nerve palsies affecting the eye",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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},
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"question": "A 67-year-old man presents after a fall down the stairs. Luckily, there are no obvious injuries at present. On further questioning, he mentions he has been struggling when coming down the stairs for a few weeks as he feels he can not see where he is going. As part of the examination, a full neurological assessment is carried out which shows difficulty looking down.\n\nWhich cranial nerve is likely affected?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,030 | false | 11 | null | 6,495,229 | null | false | [] | null | 17,953 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The stage of an AKI can be calculated based on how many times the creatinine has increased from the baseline. In this example, 78 has increased to 242 which is more than 3 times. This means there is a stage 3 AKI. Stage 1 is creatinine 1.5-1.9 times the baseline value.",
"id": "10027778",
"label": "c",
"name": "AKI stage 1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The stage of an AKI can be calculated based on how many times the creatinine has increased from the baseline. In this example, 78 has increased to 242 which is more than 3 times. This means there is a stage 3 AKI. Stage 2 is creatinine 2-2.9 times the baseline value.",
"id": "10027779",
"label": "d",
"name": "AKI stage 2",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no stage 4 for AKI.",
"id": "10027780",
"label": "e",
"name": "AKI stage 4",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The creatinine level at present is 3 times the baseline, hence AKI stage 3.",
"id": "10027776",
"label": "a",
"name": "AKI stage 3",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The raised creatinine, urea and low eGFR all suggest an acute kidney injury. The history given is also consistent with rhabdomyolysis, following a fall with a long lie the muscles start to break down and release myoglobin which in turn damages the glomeruli.",
"id": "10027777",
"label": "b",
"name": "Consider an alternative diagnosis",
"picture": null,
"votes": 17
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3752",
"name": "Acute Kidney Injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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},
"conceptId": 3752,
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"difficulty": 1,
"dislikes": 3,
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"id": "17953",
"isLikedByMe": 0,
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"question": "An 80-year-old woman is brought to A+E after being found on the floor in the kitchen by her carers this morning. They believe she may have been there all night. Your main differential is an acute kidney injury (AKI) secondary to rhabdomyolysis. Using the U+E results table below, what is the stage of this woman's AKI?\n \n| | | |\n| --------------------------- | :-------: | -------------------- |\n| Sodium | 134 mmol/L | 135 - 145 |\n| Potassium | 4.7 mmol/L | 3.5 - 5.3 |\n| Urea | 5.2 mmol/L | 2.5 - 7.8 |\n| Creatinine | 78 µmol/L | 60 - 120 |\n| eGFR | >90 mL/min/1.73m<sup>2</sup> | > 60 |",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
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} | MarksheetMark |
173,467,031 | false | 12 | null | 6,495,229 | null | false | [] | null | 17,954 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This bone is on the ulnar side of the wrist, the fractured bone is seen just above the radius. Hence, the fractured bone is the scaphoid.",
"id": "10027783",
"label": "c",
"name": "Hammate",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This bone is in the distal row of carpal bones (Trapezium, Trapezoid, Capitate, Hamate) whereas the fractured bone in the image is seen in the proximal row (Scaphoid, Lunate, Triquetrum, Pisiform). As the fractured bone is under the thumb (on the radial side), it is the scaphoid.",
"id": "10027785",
"label": "e",
"name": "Capitate",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This bone is on the ulnar side of the wrist, but the fractured bone is seen just above the radius. Hence the bone fractured is the scaphoid.",
"id": "10027784",
"label": "d",
"name": "Pisiform",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While the fractured bone can be seen under the thumb, the trapezium is in the distal row of carpal bones rather than directly articulating with the radius.",
"id": "10027782",
"label": "b",
"name": "Trapezium",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The fractured bone is just above the radius so is the scaphoid bone. On gross anatomy, this would represent the anatomical snuffbox which is a site of tenderness in scaphoid fractures.",
"id": "10027781",
"label": "a",
"name": "Scaphoid",
"picture": null,
"votes": 35
}
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"question": "A 23-year-old man presents after falling onto an outstretched hand (FOOSH). He now complains of pain in his wrist. An X-ray is taken (see below), and the arrow indicates the fracture. Which bone of the wrist is fractured?\n\n[lightgallery]",
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173,467,032 | false | 13 | null | 6,495,229 | null | false | [] | null | 17,955 | {
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Low mood has a very wide differential list. However, the fact she is experiencing cold intolerance and weight gain makes hypothyroidism the most likely.",
"id": "10027786",
"label": "a",
"name": "Hypothyroidism",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The low mood and tiredness could be explained by iron deficiency anaemia, but the weight gain is not typical. Furthermore, it is likely that there would be additional features such as pallor and shortness of breath.",
"id": "10027788",
"label": "c",
"name": "Iron deficiency anaemia",
"picture": null,
"votes": 0
},
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"explanation": "This would affect the patient in the opposite way to described. They may be losing weight and becoming intolerant to heat. They may still be fatigued.",
"id": "10027789",
"label": "d",
"name": "Hyperthyroidism",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The low mood and tiredness could be explained by anaemia, however, it is likely that there would be additional symptoms such as shortness of breath and pallor. For pernicious anaemia, in particular, there is an association with autoimmune conditions such as type 1 diabetes.",
"id": "10027790",
"label": "e",
"name": "Pernicious anaemia",
"picture": null,
"votes": 0
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Depression is a good differential diagnosis for low mood and tiredness, however, physical health conditions need to be ruled out first as they can be managed and the low mood treated. Furthermore, the weight gain and cold intolerance are more indicative of hypothyroidism.",
"id": "10027787",
"label": "b",
"name": "Depression",
"picture": null,
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}
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"question": "A 44-year-old woman presents to her GP with low mood. She describes feeling down and tired for a few months now. Nothing seems to have triggered this episode. She also has gained some weight in this time, but she puts this down to comfort eating. You notice that in the consulting room, she is wearing multiple layers despite it being 20 degrees outside.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
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173,467,033 | false | 14 | null | 6,495,229 | null | false | [] | null | 17,956 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Postmenopausal bleeding is a red flag for gynaecological malignancy, as well as the fact this patient is losing weight. The fact she is nulliparous is a risk factor for endometrial cancer.",
"id": "10027791",
"label": "a",
"name": "Endometrial cancer",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Postmenopausal bleeding is a red flag for gynaecological malignancy, as well as the fact this patient is losing weight. The fact she is nulliparous is a risk factor for endometrial cancer. There is no mention of risk factors for cervical cancer such as smoking or multiple sexual partners. Additionally, post-menopausal bleeding should always be considered endometrial cancer until proven otherwise.",
"id": "10027794",
"label": "d",
"name": "Cervical cancer",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common cause of postmenopausal bleeding, however, malignancy should be considered and ruled out first. There are also some red flag symptoms in this patient's history such as weight loss.",
"id": "10027795",
"label": "e",
"name": "Vaginal atrophy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cyclical combined HRT can cause vaginal bleeding- it is quite common in the first six months of use. However, this woman has been taking HRT for three years so any side effects are unlikely to start now.",
"id": "10027792",
"label": "b",
"name": "Side effect of HRT",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no mention of bleeding anywhere else in the body, such as recurrent epistaxis, that would suggest a systemic bleeding disorder.",
"id": "10027793",
"label": "c",
"name": "Bleeding disorder",
"picture": null,
"votes": 0
}
],
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"name": "Endometrial cancer",
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"question": "A 68-year-old woman comes to you complaining of vaginal bleeding. She states she went through menopause over 10 years ago so she is not sure why her periods have suddenly come back. Upon further questioning, she tells you that she has not had a period for 5 years, but before that there was some spotting and irregular bleeding. She thinks she may have lost some weight recently as her clothes feel a bit baggier. She does not have any children and has never been pregnant. She also has been taking hormone replacement therapy (HRT) to help manage her menopausal symptoms for 3 years.\n\nIn terms of her current symptoms, what is the most important diagnosis to consider?",
"sbaAnswer": [
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173,467,034 | false | 15 | null | 6,495,229 | null | false | [] | null | 17,957 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a very important differential for chest pain. However, it is unlikely in this case because of the description of the pain and the duration of symptoms. Classically, acute coronary syndromes cause crushing, central chest pain which may radiate to the left jaw or shoulder. The duration of symptoms is also likely to be a lot shorter.",
"id": "10027798",
"label": "c",
"name": "Acute coronary syndrome",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The fever and feeling unwell with chest pain could suggest pneumonia. However, this is not a typical description of pleuritic chest pain, which would be sharp in nature and worse on breathing in. Also, there is no cough or difficulty breathing to suggest pathology within the lungs.",
"id": "10027797",
"label": "b",
"name": "Community-acquired pneumonia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Costochondritis is inflammation of the cartilage between the ribs and the sternum. This causes sharp, well-localised pain in this area. As this patient describes a burning pain, this makes this less likely.",
"id": "10027799",
"label": "d",
"name": "Costochondritis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The burning pain is a typical description of neuropathic pain, which is seen in shingles due to the reactivation of the varicella-zoster virus in the dorsal root ganglion of nerves. This patient may have the classical vesicular rash but be unable to see it due to it being beneath her breast, and often the pain may be present before the characteristic rash appears.",
"id": "10027796",
"label": "a",
"name": "Shingles",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The burning pain described could apply to GORD, however, this is more likely to be central and higher up the chest. It may also get worse after eating.",
"id": "10027800",
"label": "e",
"name": "Gastro-oesophageal reflux disease (GORD)",
"picture": null,
"votes": 4
}
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"id": "6003",
"name": "Varicella zoster virus",
"status": null,
"topic": {
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"id": "194",
"name": "Infectious Diseases",
"typeId": 7
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"question": "A 75-year-old woman presents complaining of chest pain. She describes a burning pain on the left side of her chest which has been there for three days now. When asked to point to where the pain is, she points to just below her breast. She has also been experiencing a headache and fever for the last few days.\n\nWhat is the most likely diagnosis for this woman's chest pain?",
"sbaAnswer": [
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173,467,035 | false | 16 | null | 6,495,229 | null | false | [] | null | 17,958 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Both Crohn's and ulcerative colitis can cause inflammatory arthritis as they are both inflammatory bowel conditions.",
"id": "10027804",
"label": "d",
"name": "Inflammatory arthritis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inflammation of the subcutaneous fat, typically on the shins. It causes tender, erythematous, nodular lesions. Both Crohn's and ulcerative colitis can cause erythema nodosum as they are both inflammatory conditions.",
"id": "10027803",
"label": "c",
"name": "Erythema nodosum",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
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"explanation": "Crohn's disease causes transmural inflammation of the intestinal mucosa so connections between two epithelial-lined surfaces (fistulae) can form.",
"id": "10027801",
"label": "a",
"name": "Perianal fistulae",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is more commonly associated with ulcerative colitis. Primary sclerosing cholangitis describes inflammation of the bile ducts.",
"id": "10027805",
"label": "e",
"name": "Primary sclerosing cholangitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inflammation of the iris and ciliary body, causing an acutely red eye. It is associated with many inflammatory conditions, including both Crohn's disease and ulcerative colitis.",
"id": "10027802",
"label": "b",
"name": "Anterior uveitis",
"picture": null,
"votes": 2
}
],
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"id": "4000",
"name": "Crohn's disease",
"status": null,
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"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
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"question": "A 25-year-old man presents for a review of his Crohn's disease.\n\nWhich of these extra-intestinal features is more suggestive of Crohn's disease rather than ulcerative colitis?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
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173,467,036 | false | 17 | null | 6,495,229 | null | false | [] | null | 17,959 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is also a feature of the first stage of labour.",
"id": "10027810",
"label": "e",
"name": "Rupture of membranes",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The second stage of labour starts with complete cervical dilation and ends with the delivery of the foetus.",
"id": "10027806",
"label": "a",
"name": "Delivery of the foetus",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of the first stage of labour, the foetal head descends into the pelvis.",
"id": "10027809",
"label": "d",
"name": "Descent of the foetus",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the end of the third stage of labour, which is the last stage of labour.",
"id": "10027807",
"label": "b",
"name": "Delivery of the placenta and foetal membranes",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the process that indicates the end of the first stage and the start of the second stage of labour.",
"id": "10027808",
"label": "c",
"name": "Complete cervical dilation",
"picture": null,
"votes": 6
}
],
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"name": "The second stage of labour",
"status": null,
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"question": "The second stage of labour ends with what?",
"sbaAnswer": [
"a"
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173,467,037 | false | 18 | null | 6,495,229 | null | false | [] | null | 17,960 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There may be drooping of the face which appears like ptosis in Bell's palsy. However, it will affect the entire side of the face.",
"id": "10027814",
"label": "d",
"name": "Bell's palsy",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In Horner's syndrome, only the sympathetic fibres along the oculomotor nerve are affected. In a true oculomotor nerve palsy, there will also be ophthalmoplegia due to the loss of innervation to the extraocular muscles.",
"id": "10027812",
"label": "b",
"name": "Oculomotor nerve palsy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ptosis may be a feature of myasthenia gravis, but it varies throughout the day. There may also be muscle weakness and fatigue which is not mentioned in this case.",
"id": "10027813",
"label": "c",
"name": "Myasthenia gravis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of partial ptosis, miosis and oculomotor nerve palsy suggests Horner's syndrome. In this case, it may be due to a pancoast tumour in the apex of the lung. He is cachexic and has a significant smoking history. Horner's syndrome also includes anhydrosis (lack of sweating) on the affected side.",
"id": "10027811",
"label": "a",
"name": "Horner's syndrome",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "More symptoms are going on than just simple age-related vision loss. Miosis and partial ptosis suggest a problem with the cranial nerves. In this case, the sympathetic fibres of CN III.",
"id": "10027815",
"label": "e",
"name": "Age-related vision loss",
"picture": null,
"votes": 1
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4339",
"name": "Horner's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"question": "A 72-year-old man presents complaining of difficulty seeing out of his right eye. On general examination, he appears cachexic. On closer inspection, his right pupil is constricted. There is also a partial ptosis on the right-hand side. He is a lifelong smoker.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,038 | false | 19 | null | 6,495,229 | null | false | [] | null | 17,961 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "COPD shows an obstructive rather than restrictive pattern on spirometry. This would result in a FEV1/ FVC ratio less than 0.7.",
"id": "10027817",
"label": "b",
"name": "Chronic obstructive pulmonary disease",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pneumoconiosis (coal miner's lung) does cause a restrictive pattern on spirometry so would match this patient. However, there is no significant history of coal exposure to make that possible.",
"id": "10027818",
"label": "c",
"name": "Pneumoconiosis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The spirometry results show a restrictive pattern as the FEV1/FEVC ratio is greater than 0.7. The smoking history alongside this makes idiopathic pulmonary fibrosis the most likely.",
"id": "10027816",
"label": "a",
"name": "Idiopathic pulmonary fibrosis",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bronchiectasis is an obstructive lung disease so the FEV1/ FVC ratio would be reduced (less than 0.7).",
"id": "10027819",
"label": "d",
"name": "Bronchiectasis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lung cancer may affect the functioning of the lungs but spirometry is not usually diagnostic. There would likely be other features of underlying malignancy such as weight loss, haemoptysis and hoarseness of voice. This makes lung cancer less likely in this patient.",
"id": "10027820",
"label": "e",
"name": "Lung cancer",
"picture": null,
"votes": 4
}
],
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"id": "3726",
"name": "Spirometry",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
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"videos": []
},
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"difficulty": 1,
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"question": "A 72-year-old woman has been referred to the pulmonary clinic. She presents with progressively worsening breathlessness and a dry cough. She smokes a pack a day and has done so for 50 years. Her spirometry results are shown below:\n\n| FEV1 | FVC |\n| ------------- |:-------------:|\n| 1.57 L (50% of predicted) | 1.63 L (40% of predicted)|\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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