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"answer": true,
"explanation": "The most likely diagnosis is systemic lupus erythematosus (SLE). 99% of patients with SLE are ANA positive.",
"id": "10027821",
"label": "a",
"name": "Anti-nuclear antibodies (ANA)",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the pathophysiology of myasthenia gravis, which does not match the symptoms of this woman.",
"id": "10027822",
"label": "b",
"name": "Anti-acetylcholine receptor antibodies",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the autoantibody driving Grave's disease. Antibodies against the thyroid-stimulating hormone (TSH) receptor are formed causing hyperthyroidism.",
"id": "10027825",
"label": "e",
"name": "Anti-TSH receptor",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This autoantibody is positive in patients with polymyositis. This patient has features of SLE: malar rash, fatigue, joint pains and thrombocytopenia.",
"id": "10027824",
"label": "d",
"name": "Anti-Jo-1",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the autoantibody-positive in rheumatoid arthritis, it can be positive in patients with SLE but is less likely than ANA.",
"id": "10027823",
"label": "c",
"name": "Anti-Rheumatoid factor",
"picture": null,
"votes": 8
}
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"name": "Autoantibodies",
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"typeId": 7
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"question": "A 20-year-old woman presents with ongoing fatigue, joint pains and alopecia. She has also noticed she is bruising more easily. On examination, there is an erythematous rash across her cheeks.\n\nGiven the most likely diagnosis, which autoantibody is most likely to be positive?",
"sbaAnswer": [
"a"
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"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "The middle cerebral artery supplies the lateral parts of the cerebral hemispheres. Due to this, more functions are likely affected leading to symptoms such as aphasia. Also, the upper limb would be more affected than the lower limb as the upper limb is represented on the lateral part of the motor homunculus.",
"id": "10027828",
"label": "c",
"name": "Left middle cerebral artery",
"picture": null,
"votes": 13
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "The anterior cerebral artery is correct as the motor and sensory cortexes are affected. However, nerves cross over after leaving the central nervous system so lesions on the left-hand side of the brain will affect the right-hand side of the body.",
"id": "10027827",
"label": "b",
"name": "Right anterior cerebral artery",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A stroke in the basilar artery would lead to \"locked-in\" syndrome where the patient is unable to move at all, apart from eye movements.",
"id": "10027830",
"label": "e",
"name": "Basilar artery",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient's right-hand side is affected, the lesion will be in the left-hand side of the brain. This is because the nerve fibres cross over after leaving the central nervous system. Furthermore, if it were a middle cerebral artery occlusion, a homonymous hemianopia may be seen due to the involvement of the optic radiation.",
"id": "10027829",
"label": "d",
"name": "Right middle cerebral artery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The anterior cerebral artery supplies the medial portion of each hemisphere, including the parietal and frontal lobes. Therefore, both motor and sensory functions are impaired. The lower limb is more affected than the right in terms of motor function because the lower limb is represented more medially on the motor homunculus.",
"id": "10027826",
"label": "a",
"name": "Left anterior cerebral artery",
"picture": null,
"votes": 26
}
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"id": "3743",
"name": "Ischaemic Stroke",
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"question": "A 67-year-old woman is rushed to A+E as her partner believes she is having a stroke. On examination, power is 5/5 for both left limbs, but reduced to 2/5 for the right lower limb and 3/5 for the right lower limb. There is also sensory loss on the entire right-hand side.\n\nWhich artery has likely been affected?",
"sbaAnswer": [
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173,467,041 | false | 22 | null | 6,495,229 | null | false | [] | null | 17,964 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would result in hyponatraemia which is not seen in this patient's blood results.",
"id": "10027833",
"label": "c",
"name": "Syndrome of inappropriate anti-diureitc hormone secretion (SIADH)",
"picture": null,
"votes": 3
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a condition where the renal tubules can no longer handle acids effectively. This results in hypokalaemia, as the kidneys try to compensate for the acidosis. However, for this case, it would not explain the hypophosphataemia or hypomagnesemia.",
"id": "10027834",
"label": "d",
"name": "Renal tubular acidosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would make sense with this woman's history of chemotherapy. However, it only explains the hypokalaemia, not the other electrolyte abnormalities.",
"id": "10027832",
"label": "b",
"name": "Prolonged vomiting",
"picture": null,
"votes": 7
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The history of loss of appetite followed by sudden return to usual eating habits fits with the downregulation of enzymes in the urea cycle and then the build-up of toxic waste products once eating commences. The fact she is cachexic supports the idea that she has not been eating well for a long time and is therefore at risk of refeeding syndrome. The blood results show hypophosphatemia, hypokalaemia and hypomagnesemia which happens due to the shifting of electrolytes into the intracellular space from the extracellular spaces.",
"id": "10027831",
"label": "a",
"name": "Refeeding syndrome",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin D deficiency would explain the hypophosphataemia, but not the other electrolyte abnormalities.",
"id": "10027835",
"label": "e",
"name": "Vitamin D deficiency",
"picture": null,
"votes": 1
}
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"name": "Refeeding syndrome",
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"name": "Clinical Chemistry",
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"question": "You are asked to review a 45-year-old woman who is complaining of fatigue and muscle cramping. She finished her third round of chemotherapy for metastatic breast cancer last week. She tells you that the chemotherapy made her lose her appetite completely, but since it finished she has gone back to her usual appetite. On examination, she appears very cachexic but otherwise well.\nBlood results are shown below:\n\n\n||||\n|---------------------------|:-------:|--------------------|\n|Sodium|136 mmol/L|135 - 145|\n|Potassium|2.7 mmol/L|3.5 - 5.3|\n|Magnesium|0.65 mmol/L|0.7 - 1.0|\n|Phosphate|0.33 mmol/L|0.8 - 1.5|\n|Urea|3.4 mmol/L|2.5 - 7.8|\n|Creatinine|59 µmol/L|60 - 120|\n\n\nWhat is the most likely cause of this electrolyte abnormality?",
"sbaAnswer": [
"a"
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173,467,042 | false | 23 | null | 6,495,229 | null | false | [] | null | 17,965 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of metformin, which is a biguanide.",
"id": "10027838",
"label": "c",
"name": "Decreases gluconeogenesis and increases insulin sensitivity",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of exenatide. It stimulates insulin secretion and reduces glucagon secretion.",
"id": "10027840",
"label": "e",
"name": "Analogue to glucagon-like peptide-1 (GLP-1) receptors",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the mechanism of action of SGLT-2 inhibitors such as dapagliflozin.",
"id": "10027836",
"label": "a",
"name": "Inhibits sodium-glucose co-transporters (SGLTs) in the proximal convoluted tubules",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of sulfonylureas such as gliclazide.",
"id": "10027837",
"label": "b",
"name": "Stimulates pancreatic beta cells",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of sitagliptin.",
"id": "10027839",
"label": "d",
"name": "Inhibits dipeptidyl peptidase (DPP-4)",
"picture": null,
"votes": 4
}
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"name": "SGLT-2 inhibitors",
"status": null,
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"name": "Pharmacology",
"typeId": 7
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"question": "A patient in the GP practice is started on dapagliflozin for their type 2 diabetes mellitus.\n\nWhat is the mechanism of action of this drug?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
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"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cold sores, or HSV infections will cause a vesicular rash. There will be fluid-filled lesions, which are not seen in this case.",
"id": "10027844",
"label": "d",
"name": "Herpes simplex virus (HSV) infection",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The image shows a superficial erosion with the classic golden crusting seen in impetigo.",
"id": "10027841",
"label": "a",
"name": "Impetigo",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atopic dermatitis, or eczema, is typically seen on the flexor surfaces of the elbows and knees. It can be seen on the face, but the golden crusting in this case is more suggestive of an infective cause, such as impetigo.",
"id": "10027843",
"label": "c",
"name": "Atopic dermatitis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This normally involves an erythematous, pruritic rash. There is also often a pattern suggestive of the contact allergen e.g. on hands.",
"id": "10027842",
"label": "b",
"name": "Contact dermatitis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tinea Corporis, or ringworm, usually causes a rash that is circular and erythematous with central paleness. In the image, the lesions are the same colour throughout and are golden/ yellow rather than erythematous.",
"id": "10027845",
"label": "e",
"name": "Tinea Corporis",
"picture": null,
"votes": 1
}
],
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"id": "6008",
"name": "Impetigo",
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"name": "Dermatology",
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"__typename": "Picture",
"caption": "https://upload.wikimedia.org/wikipedia/commons/a/a4/Impetigo2020.jpg",
"createdAt": 1701429737,
"id": "2314",
"index": 0,
"name": "Impetigo.jpeg",
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"question": "A father brings his four-year-old daughter into the GP concerned about a rash on her face. Based on the image below, what is the most likely diagnosis?\n\n[lightgallery]",
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"a"
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173,467,044 | false | 25 | null | 6,495,229 | null | false | [] | null | 17,967 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Shoulder dystocia is a risk factor for upper brachial plexus injuries as it is stretched due to traction when trying to deliver the stuck infant. Erb's palsy presents with the affected limb being held internally rotated, adducted and extended.",
"id": "10027846",
"label": "a",
"name": "Erb's palsy",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The axillary nerve is a terminal nerve of the brachial plexus, so does not arise until after the plexus has passed through the axilla. In this case, the actual brachial plexus is more likely to be injured as the neck is being stretched during delivery.",
"id": "10027848",
"label": "c",
"name": "Axillary nerve palsy",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The median nerve is a terminal nerve of the brachial plexus, so does not arise until after the plexus has passed through the axilla. In this case, the actual brachial plexus is more likely to be injured as the neck is being stretched during delivery.",
"id": "10027849",
"label": "d",
"name": "Median nerve palsy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a lower brachial plexus injury which is caused when the lower part of the brachial plexus is stretched e.g. catching onto a tree when falling from height. In this case, the upper brachial plexus injury is more likely as the neck is where traction is applied to try and deliver the baby.",
"id": "10027847",
"label": "b",
"name": "Klumpke's palsy",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The musculocutaneous nerve is a terminal nerve of the brachial plexus, so does not arise until after the plexus has passed through the axilla. In this case, the actual brachial plexus is more likely to be injured as the neck is being stretched during delivery.",
"id": "10027850",
"label": "e",
"name": "Musculocutaneous nerve palsy",
"picture": null,
"votes": 1
}
],
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"id": "3864",
"name": "Brachial plexus injuries",
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"typeId": 7
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"question": "A woman is in the maternity centre giving birth. It has been an uncomplicated pregnancy and delivery so far. However, the baby now seems to be stuck. The registrar tells you this is shoulder dystocia as the infant's shoulder is behind the maternal pubic symphysis despite delivery of the head.\n\nWhich neurological problem is the infant most at risk of?",
"sbaAnswer": [
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173,467,045 | false | 26 | null | 6,495,229 | null | false | [] | null | 17,968 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This case is a description of Brown-Sequard syndrome. While very rare, it explains the physiology of the ascending tracts well. The fibres of the spinothalamic tract (pain and temperature sensation) cross over at the level of innervation. Hence, in this case, the fibres from the left lower limb are affected.",
"id": "10027851",
"label": "a",
"name": "Hemiparesis of the right below L2, loss of proprioception and vibration sense on the right lower limb, and loss of pain and temperature sensation on the left lower limb",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be the case for a complete transection of the spinal cord but, in this case, only half of the spinal cord is affected.",
"id": "10027855",
"label": "e",
"name": "Complete loss of all movement and sensation below L2",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is the spinothalamic fibres that cross over at the level of innervation so pain and temperature sensation would be lost on the left for this patient.",
"id": "10027854",
"label": "d",
"name": "Hemiparesis of the right below L2, loss of proprioception and vibration sense of the left lower limb, and loss of pain and temperature sensation of the right lower limb",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect because the spinal cord nerves on the right-hand side are innervating the right side of the body, except the spinothalamic fibres. This results in hemiparesis and loss of dorsal column modalities on the right and loss of spinothalamic modalities on the left.",
"id": "10027853",
"label": "c",
"name": "Hemiparesis of the left below L2, and loss of all sensory modalities on the left",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would make sense for a hemisection of the right-hand side. However, the spinothalamic fibres cross over at the level of their innervation. So in this case, there will be fibres from the left-hand side involved. This will mean that pain and temperature sensation will be lost on the left but maintained on the right.",
"id": "10027852",
"label": "b",
"name": "Hemiparesis of the right side below L2, and loss of all sensation modalities on the right side",
"picture": null,
"votes": 3
}
],
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"name": "Brown-Sequard syndrome",
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"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
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"question": "A 23-year-old man is involved in a fight outside the pub, and is stabbed in his back. An MRI spine is taken and shows a hemisection of the spinal cord at the L2 level on the right-hand side.\n\nWhat examination findings would be expected?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
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173,467,046 | false | 27 | null | 6,495,229 | null | false | [] | null | 17,969 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is acutely unwell, a referral is very unlikely to happen in time to help. Therefore, an urgent hospital admission is needed to assess for and treat acute epiglottitis.",
"id": "10027860",
"label": "e",
"name": "Refer to Respiratory",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate management for tonsilitis. However, this patient would score only a two on the feverPAIN score. This would be for her fever and absent cough. The fact the tonsils are not inflamed or covered by exudate makes tonsilitis less likely.",
"id": "10027858",
"label": "c",
"name": "Prescribe phenoxymethylpenicillin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is having difficulty breathing and experiencing stridor which both suggest inflammation causing an airway obstruction. Therefore, urgent hospital admission is necessary.",
"id": "10027857",
"label": "b",
"name": "Encourage oral fluids and analgesia with safety netting advice",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has some red flag features of epiglottitis which requires urgent hospital admission. The fact she has developed stridor, drooling and difficulty breathing are key indicators of this condition.",
"id": "10027856",
"label": "a",
"name": "Ring for an ambulance",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate management for tonsilitis, in this case, the patient is scoring 2 on the feverPAIN score so a backup antibiotic prescription is indicated. However, the child is more acutely unwell with epiglottitis so needs to be urgently assessed at the hospital.",
"id": "10027859",
"label": "d",
"name": "Prescribe a backup course of phenoxymethylpenicillin",
"picture": null,
"votes": 1
}
],
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"id": "6010",
"name": "Stridor",
"status": null,
"topic": {
"__typename": "Topic",
"id": "138",
"name": "Ear, Nose & Throat",
"typeId": 7
},
"topicId": 138,
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"question": "A mother brings her two-year-old daughter to a GP appointment. She tells you that her child has been unwell for four days with a fever and is generally irritable. This morning, she noticed her daughter was making a high-pitched noise as she was breathing in. On examination, the child looks unwell and has a temperature of 38.0. You notice she is drooling as well as having some difficulty breathing. On inspection of the oral cavity, the tonsils are not inflamed or covered in exudate.\n\nGiven the likely diagnosis, what is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
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173,467,047 | false | 28 | null | 6,495,229 | null | false | [] | null | 17,970 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the number of cigarettes this woman smokes a day. The number of years she has been smoking also needs to be taken into consideration for the pack years calculation.",
"id": "10027863",
"label": "c",
"name": "25",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the number of years this woman has been smoking. The amount she smokes a day also needs to be accounted for.",
"id": "10027862",
"label": "b",
"name": "30",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The pack years calculation is done by multiplying the number of years a person has been smoking by how many packs a day. There are 20 cigarettes in a pack so this woman smokes 1.25 a day. 1.25 times 30 is 37.5",
"id": "10027861",
"label": "a",
"name": "37.5",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pack years calculation is done by multiplying the number of years a person has been smoking by how many packs a day. There are 20 cigarettes in a pack so this woman smokes 1.25 a day. 1.25 times 30 is 37.5",
"id": "10027864",
"label": "d",
"name": "32.5",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pack years calculation is done by multiplying the number of years a person has been smoking by how many packs a day. There are 20 cigarettes in a pack so this woman smokes 1.25 a day. 1.25 times 30 is 37.5",
"id": "10027865",
"label": "e",
"name": "27.5",
"picture": null,
"votes": 0
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4522",
"name": "Smoking Cessation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
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"question": "A 47-year-old woman makes an appointment to discuss stopping smoking. She has smoked 25 cigarettes a day since she was 17.\n\nWhat are her pack years?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,048 | false | 29 | null | 6,495,229 | null | false | [] | null | 17,971 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The 1st pharyngeal arch forms the trigeminal nerve, maxillary artery, bones of the middle ear, muscles of mastication and the tympanic membrane.",
"id": "10027866",
"label": "a",
"name": "1st",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 4th pharyngeal nerve forms parts of the vagus nerve and the muscles it supplies as well as the thyroid cartilage structures.",
"id": "10027869",
"label": "d",
"name": "4th",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 5th pharyngeal arch is also involved in forming the vagus nerve and the muscles it supplies as well as the thyroid cartilage structures.",
"id": "10027870",
"label": "e",
"name": "5th",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 2nd pharyngeal arch forms the facial nerve and its associated muscles of facial expression. It also forms the bones of the middle ear, but not the tympanic membrane.",
"id": "10027867",
"label": "b",
"name": "2nd",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The 3rd pharyngeal arch forms the glossopharyngeal nerve, common carotid artery, hyoid bone and stylopharyngeus. All these structures are below the tympanic membrane.",
"id": "10027868",
"label": "c",
"name": "3rd",
"picture": null,
"votes": 15
}
],
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},
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"demo": null,
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"id": "6011",
"name": "Development of the pharyngeal arches",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
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},
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"question": "The tympanic membrane is a derivative of which pharyngeal arch?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,049 | false | 30 | null | 6,495,229 | null | false | [] | null | 17,972 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "von Willebrand's disease is a lifelong coagulopathy. It is less likely in this case because there is no mention of recurrent bleeding before this episode. The acute history after a major trauma makes DIC more likely.",
"id": "10027874",
"label": "d",
"name": "von Willebrand's disease",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haematological malignancy can cause disseminated intravascular coagulation (DIC) but is less likely in this cause because of the acute setting, following a major trauma.",
"id": "10027873",
"label": "c",
"name": "Haematological malignancy",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haemophilia is a lifelong coagulopathy which increases bleeding. For this case, the acute history following a major trauma makes DIC more likely.",
"id": "10027872",
"label": "b",
"name": "Haemophilia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin K deficiency is an acquired coagulopathy. It is unlikely in this case because of the acute onset and associated major trauma.",
"id": "10027875",
"label": "e",
"name": "Vitamin K deficiency",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "DIC is a condition where the clotting cascade is inappropriately activated, resulting in many small thrombi forming and using up the clotting factors. The thrombi cause a purpuric rash under the skin and the absence of clotting factors means that the patient is more likely to bleed. The risk factors for DIC include major trauma (in this case), sepsis, obstetric emergencies and malignancy.",
"id": "10027871",
"label": "a",
"name": "Disseminated intravascular coagulation (DIC)",
"picture": null,
"votes": 36
}
],
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"id": "6012",
"name": "Disseminated intravascular coagulation (DIC)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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"question": "A 35-year-old woman is admitted to the ICU with a number of injuries following a high-speed road traffic collision. She is currently unconscious and intubated. However, a purpuric rash is noted across her chest and she starts bleeding from the cannula sites and her blood pressure is dropping.\n\nWhat is the likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,050 | false | 31 | null | 6,495,229 | null | false | [] | null | 17,973 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Prolactinomas are the most common hormone-secreting tumours from the pituitary gland. However, there are no features to suggest this in this case, except for the bitemporal hemianopia which is a result of the tumour itself, not the hormone it is secreting. If a tumour is secreting prolactin, there may be galactorrhea, erectile dysfunction and oligomenorrhea.",
"id": "10027877",
"label": "b",
"name": "Prolactin",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "TSH is made in the anterior pituitary so could be produced in a pituitary adenoma. However, there are no features of hypothyroidism that would indicate excess TSH. These features may include weight gain, low mood, and fatigue.",
"id": "10027878",
"label": "c",
"name": "Thyroid-stimulating hormone (TSH)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ACTH stimulates the adrenal gland to produce cortisol, therefore excess cortisol would result in Cushing's syndrome. Features of Cushing's syndrome include abdominal obesity, rounding of the face and purple striae on the abdomen. An ACTH-secreting pituitary adenoma is also called Cushing's disease.",
"id": "10027880",
"label": "e",
"name": "Adrenocorticotrophic hormone (ACTH)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has features of acromegaly (large hands and more prominent facial features). Acromegaly is caused by excess growth hormone.",
"id": "10027876",
"label": "a",
"name": "Growth hormone",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxytocin is produced by the hypothalamus and then secreted by the posterior pituitary gland. Therefore, it could not be produced in excess by a pituitary adenoma.",
"id": "10027879",
"label": "d",
"name": "Oxytocin",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6013",
"name": "Growth hormone (GH)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
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},
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"question": "A 64-year-old man presents with a headache, which has been going on for a few months now. Over this time, he also mentions he is bumping into doorways in his home. On examination, you note large hands and large prominent facial features. He states that his wife thinks he looks different in recent years. An MRI head reveals a pituitary adenoma.\n\nGiven the clinical picture, which hormone is being secreted?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,051 | false | 32 | null | 6,495,229 | null | false | [] | null | 17,974 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Due to endocrine dysfunction, males with liver cirrhosis may experience gynaecomastia.",
"id": "10027881",
"label": "a",
"name": "Gynaecomastia",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dyspnoea in someone with established liver disease may suggest hepatopulmonary syndrome, which is uncommon and only present in patients with advanced liver disease. For those reasons, this is not the most likely additional sign.",
"id": "10027884",
"label": "d",
"name": "Dyspnoea",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In ascites, the excess fluid collects in the peritoneal space. Due to the mechanism of fluid retention, it is unlikely that fluid will also collect in the peripheries such as the lower legs.",
"id": "10027883",
"label": "c",
"name": "Peripheral oedema",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Portal hypertension is a common complication of liver cirrhosis. However, it does not typically cause hypertension in the systemic circulation.",
"id": "10027885",
"label": "e",
"name": "Hypertension",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In liver cirrhosis, the liver becomes fibrotic and therefore smaller. This is especially true in more established disease, like this man.",
"id": "10027882",
"label": "b",
"name": "Hepatomegaly",
"picture": null,
"votes": 19
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4343",
"name": "Liver Cirrhosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"userChapter": null,
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},
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"question": "A 60-year-old man with a background of liver cirrhosis due to chronic alcohol abuse is admitted for an ascitic drain.\n\nWhich additional sign is most likely to be found on examination?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,052 | false | 33 | null | 6,495,229 | null | false | [] | null | 17,975 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lamotrigine is considered to be safe in pregnancy, so would not need to be stopped in this case. There are some concerns as the data is quite limited, but it is safer for both the foetus and the mother to have adequate seizure control.",
"id": "10027887",
"label": "b",
"name": "Lamotrigine",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is an increased risk of congenital malformations with the use of carbamazepine. Therefore, it should be avoided in pregnancy. However, it is not as important to stop as valproate, as this has a known highly teratogenic effect.",
"id": "10027890",
"label": "e",
"name": "Carbamazepine",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Valproate has an established highly teratogenic side effect. It should definitely be avoided in pregnancy as it can cause neural tube defects. This woman ideally should be taking a different anti-epileptic for this reason but valproate may be the only option for adequate seizure control.",
"id": "10027886",
"label": "a",
"name": "Sodium valproate",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is a possibility of adverse effects on neurodevelopment with the use of phenytoin in pregnancy. As the risk is there, it should be avoided but it is not as important to stop as valproate.",
"id": "10027889",
"label": "d",
"name": "Phenytoin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Levetiracetam is considered to be safe in pregnancy, so would not need to be stopped in this case. There are some concerns as the data is quite limited, but it is safer for both the foetus and the mother to have adequate seizure control.",
"id": "10027888",
"label": "c",
"name": "Levetiracetam",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6014",
"name": "Valproate",
"status": null,
"topic": {
"__typename": "Topic",
"id": "195",
"name": "Pharmacology",
"typeId": 7
},
"topicId": 195,
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"question": "A 24-year-old woman presents to the neurology clinic for a review of her epilepsy. She says she has been thinking of starting a family but is aware she will need advice about her medication before starting to try for a pregnancy.\n\nWhich anti-epileptic drug would be most important to switch out if she was taking it?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,053 | false | 34 | null | 6,495,229 | null | false | [] | null | 17,976 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a description of the pain in pancreatitis. In terms of anatomy, the epigastric region is roughly where the pancreas is located. However, the appendix is in the right lower quadrant.",
"id": "10027895",
"label": "e",
"name": "Epigastric pain which radiates to the back",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a description of the pain caused by renal stones. The pain follows this pattern because of where the kidneys are and how the ureters descend to enter the pelvis.",
"id": "10027892",
"label": "b",
"name": "Severe back or loin pain which radiates to the lower abdomen",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Suprapubic pain is a common symptom of urinary tract infections or cystitis. This is because of where the bladder is located anatomically. During the first part of appendicitis, patients may complain of suprapubic pain as part of the generalised pain they are feeling.",
"id": "10027893",
"label": "c",
"name": "Suprapubic pain",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct, this change in pain sensation is due to the afferent nerve fibres from the visceral and parietal peritoneum surrounding the appendix. When the appendix is first inflamed only the visceral peritoneum is irritated which is innervated by nerve fibres from T8-T10. Once the appendix is more inflamed, the parietal peritoneum is also involved which is innervated by the somatic nerve fibres from T10-L1. As these fibres are somatic the pain is more accurately localised to where the appendix is anatomically located.",
"id": "10027891",
"label": "a",
"name": "Generalised or central abdominal discomfort which progresses to localised pain in the right iliac fossa",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a description of the pain felt in cholecystitis (inflammation of the gallbladder). The right side of the body is correct for the appendix but it is in the lower quadrant rather than the upper. The pain radiates to the shoulder tip due to the involvement of the phrenic nerve. This could also happen in appendicitis if the appendix ruptures causing peritonitis.",
"id": "10027894",
"label": "d",
"name": "Right upper quadrant pain which radiates to the shoulder tip",
"picture": null,
"votes": 3
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4486",
"name": "Appendicitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4486,
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"question": "In appendicitis, what is the most common description of the pain?",
"sbaAnswer": [
"a"
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"totalVotes": 46,
"typeId": 1,
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} | MarksheetMark |
173,467,054 | false | 35 | null | 6,495,229 | null | false | [] | null | 17,977 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Group B streptococci have been isolated and identified as a causative organism for uncomplicated UTIs in some women. However, this is a lot less common than E. coli.",
"id": "10027899",
"label": "d",
"name": "Group B streptococci",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Staph. aureus* is a commensal of the skin. It therefore has the potential to ascend the urethra and cause cystitis, but this is relatively uncommon.",
"id": "10027900",
"label": "e",
"name": "*Staphylococcus aureus*",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Klebsiella species are also commensals on the colon so can cause UTIs if they ascend the urethra and reach the bladder to cause cystitis. This is less common than E. coli however.",
"id": "10027897",
"label": "b",
"name": "*Klebsiella species*",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "*E. coli* is identified as the causative organism in 70-95% of UTI cases. As E. coli is a colonic commensal bacteria, it is thought that it ascends the urethra to reach the bladder and causes cystitis. The female urethra is shorter than the male, so women are more likely to get urinary tract infections.",
"id": "10027896",
"label": "a",
"name": "*Escherichia coli*",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Candida is the main cause of fungal UTIs, but these typically only happen in patients who are immunocompromised for whatever reason. Hence, it is unlikely to be the case for an immunocompetent young woman. A simple E. coli UTI is much more likely.",
"id": "10027898",
"label": "c",
"name": "*Candida albicans*",
"picture": null,
"votes": 0
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "4613",
"name": "Urinary tract infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"userNote": null,
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},
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"question": "What is the most common causative organism of a bacterial urinary tract infection (UTI) in a 23-year-old woman who is normally fit and well?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,055 | false | 36 | null | 6,495,229 | null | false | [] | null | 17,978 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The middle meningeal artery is damaged in an extradural haematoma. Typically the history follows a direct blow to the side of the head resulting in a lucid interval followed by deteriorating consciousness. Furthermore, the shape of the haematoma would be biconvex rather than crescentic as described above.",
"id": "10027902",
"label": "b",
"name": "Middle meningeal artery",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the typical mechanism of a subarachnoid haemorrhage. It is normally described as a thunderclap headache, or a very severe sudden onset headache. On neuroimaging, the haematoma would appear almost spider-shaped (hence \"arachnoid\" in subarachnoid space!).",
"id": "10027905",
"label": "e",
"name": "Ruptured berry aneurysm",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The middle meningeal vein follows the same route as the middle meningeal artery so could be damaged in a direct blow to the side of the head. However, it would not cause any significant intracranial haemorrhage.",
"id": "10027903",
"label": "c",
"name": "Middle meningeal vein",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis for this patient is a chronic subdural haematoma. The history of multiple falls and the hypodensity suggests a chronic bleed. The shape of the haematoma suggests that the bridging veins have been damaged. This is more common in elderly people due to cerebral atrophy.",
"id": "10027901",
"label": "a",
"name": "Bridging veins between cortex and venous sinus",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The bridging veins are between the cortex and venous sinuses rather than the third ventricles. The sinuses drain away deoxygenated blood to the internal jugular vein whereas the ventricles are involved in maintaining and draining cerebrospinal fluid.",
"id": "10027904",
"label": "d",
"name": "Bridging veins between cortex and third ventricle",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6015",
"name": "Subdural haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "191",
"name": "Geriatrics",
"typeId": 7
},
"topicId": 191,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6015,
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"question": "A 95-year-old woman is reviewed in A+E. She is normally fit and well but has fallen a few times in the past few months. This morning she fell again and now her grandson is getting concerned. There are no obvious injuries but there are concerns she may have hit her head so a CT head is done. It shows a right-sided crescentic area of hypodensity lateral to the right parietal lobe.\n\nWhat is the most likely source of bleeding?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,056 | false | 37 | null | 6,495,229 | null | false | [] | null | 17,979 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Heinz bodies are red blood cells with areas of dark staining within them. This is due to precipitated haemoglobin. Due to the lack of glucose 6-phosphate dehydrogenase, the red blood cells cannot cope with any increase in oxidative stress. In this case, the oxidative stress has come from the broad beans.",
"id": "10027906",
"label": "a",
"name": "Heinz bodies",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Howell-Jolly bodies describe red blood cells with inclusions of DNA or nuclear fragments. Normally these cells would be removed by the spleen, so they may be seen in someone post splenectomy.",
"id": "10027909",
"label": "d",
"name": "Howell-Jolly bodies",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Target cells are typically seen in thalassaemia and after splenectomy. They are pale with an outer rim and central ring of staining, giving them a target appearance. Heinz bodies, which are seen in G6PD deficiency, are typically darker staining than normal due to precipitated haemoglobin.",
"id": "10027908",
"label": "c",
"name": "Target cells",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sickle cells are classic of sickle cell disease due to the presence of HbS rather than normal adult Hb. Heinz bodies, which are seen in G6PD deficiency, are a normal shape but darker in colour due to precipitated haemoglobin.",
"id": "10027907",
"label": "b",
"name": "Sickle-shaped cells",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hereditary spherocytosis and autoimmune haemolytic anaemia are causes of round red blood cells (spherocytes). In G6PD deficiency, Heinz bodies are normally seen, which are normally shaped red blood cells which are darker stained.",
"id": "10027910",
"label": "e",
"name": "Spherocytes",
"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": "6016",
"name": "G6PD deficiency",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6016,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17979",
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"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A three-year-old boy is seen after becoming very unwell. He is visibly jaundiced and more fatigued than usual. His parents are very worried as they also noted dark urine this morning. They say this seems to have started following eating a new dish containing broad beans. A blood film is done and the results help diagnose G6PD deficiency.\n\nWhat was likely seen on the blood film?",
"sbaAnswer": [
"a"
],
"totalVotes": 42,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,057 | false | 38 | null | 6,495,229 | null | false | [] | null | 17,980 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgG is the only immunoglobulin that can cross the placenta.",
"id": "10027913",
"label": "c",
"name": "IgE",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgG is the only immunoglobulin that can cross the placenta.",
"id": "10027914",
"label": "d",
"name": "IgA",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "IgG is the only immunoglobulin that can cross the placenta.",
"id": "10027911",
"label": "a",
"name": "IgG",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgG is the only immunoglobulin that can cross the placenta.",
"id": "10027915",
"label": "e",
"name": "IgD",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgG is the only immunoglobulin that can cross the placenta.",
"id": "10027912",
"label": "b",
"name": "IgM",
"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": "5809",
"name": "Immunoglobulins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5809,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17980",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "Which immunoglobulin can cross the placenta?",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,058 | false | 39 | null | 6,495,229 | null | false | [] | null | 17,981 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes pre-clinical trials rather than any phases of clinical trials.",
"id": "10027917",
"label": "b",
"name": "Animal testing to gather information about efficacy and toxicity",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a stage of a clinical trial as it happens once the drug is already being widely used.",
"id": "10027920",
"label": "e",
"name": "Surveillance of side effects after the release of the drug",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is phase 1 of clinical trials. Finding appropriate dosing is the first step.",
"id": "10027919",
"label": "d",
"name": "Testing of the drug on healthy volunteers to find appropriate dosing",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "After finding appropriate dosing, the efficacy and safety of the drug needs to be confirmed.",
"id": "10027916",
"label": "a",
"name": "Testing of a drug on a large group of patients to assess efficacy and safety",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes a phase 3 clinical trial which is the stage after phase 2. At this point, the drug is considered to be generally safe so the comparison to existing treatments is needed.",
"id": "10027918",
"label": "c",
"name": "Testing of the drug on a large group of patients to confirm effectiveness and safety, and comparing to existing interventions",
"picture": null,
"votes": 14
}
],
"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": "6017",
"name": "Clinical trials",
"status": null,
"topic": {
"__typename": "Topic",
"id": "178",
"name": "Medical Statistics",
"typeId": 7
},
"topicId": 178,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6017,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"isLikedByMe": null,
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"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "What is the role of a phase 2 clinical trial?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,059 | false | 40 | null | 6,495,229 | null | false | [] | null | 17,982 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This woman has sepsis from the cellulitis in her leg. It is important to recognise and treat sepsis quickly. The treatment for sepsis includes the sepsis 6: take lactate level, blood culture and urine output, and administer oxygen, IV fluid and IV antibiotics. In this case, IV fluids are most important because of her haemodynamic instability.",
"id": "10027921",
"label": "a",
"name": "Start IV fluids",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxygen does make up part of the sepsis 6, so is important to consider here. However, this woman's oxygen saturations are currently stable so oxygen is not currently indicated. It would be more important to start IV fluids as she is hypotensive.",
"id": "10027924",
"label": "d",
"name": "Give Oxygen",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The origin of the infection for this woman is cellulitis in her leg. Therefore, a skin swab may help advise narrow-range antibiotics based on what is cultured. However, this woman is showing red flag signs of sepsis so needs to be stabilised and treated first. This will include broad-spectrum antibiotics.",
"id": "10027922",
"label": "b",
"name": "Skin swab",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paracetamol is used to treat pyrexia, but in this case, it is important to promptly treat the cause of the fever. The cellulitis this woman has is now causing sepsis which may be life-threatening if not treated quickly.",
"id": "10027923",
"label": "c",
"name": "Prescribe paracetamol",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is a bacterial infection going on so antibiotics would be important. However, she is acutely unwell with sepsis so these would need to be IV to act quickly and effectively.",
"id": "10027925",
"label": "e",
"name": "Oral antibiotics",
"picture": null,
"votes": 7
}
],
"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": "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": null,
"highlights": [],
"id": "17982",
"isLikedByMe": null,
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"multiAnswer": null,
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"question": "A 45-year-old woman is brought to A+E after becoming increasingly unwell. She complains of feeling feverish and has a red patch on her leg. She states she scratched the area while gardening last week. On examination, there is an erythematous, tender patch on her right shin. She tells you it has been getting bigger. The area is also warm to touch.\nHer observations include a temperature of 38.7 degrees, a heart rate of 120/min, a blood pressure of 90/40 mmHg, a respiratory rate of 21 and oxygen saturation of 94%.\nWhat is the first step in managing this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 42,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,060 | false | 41 | null | 6,495,229 | null | false | [] | null | 17,983 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment.",
"id": "10027929",
"label": "d",
"name": "Refer non-urgently for a colonoscopy",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a very acute history for Crohn's which makes it unlikely. It would be inappropriate to refer to gastroenterology as an anal fissure would likely have healed by the appointment with appropriate management from primary care.",
"id": "10027927",
"label": "b",
"name": "Refer to gastroenterology for suspected Crohn's disease",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment.",
"id": "10027928",
"label": "c",
"name": "Refer via 2-week wait pathway for suspected colorectal cancer",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment. Topical analgesics such as lidocaine are used alongside increased dietary fibre and fluid intake to soften the stools.",
"id": "10027926",
"label": "a",
"name": "Advise use of topical analgesics",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. There are some surgical management options for anal fissures, including sphincterotomy, but this is reserved for chronic anal fissures that have not responded to conservative management options.",
"id": "10027930",
"label": "e",
"name": "Refer to general surgeons",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6018",
"name": "Anal Fissure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
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"question": "A 32-year-old man presents to his GP with bleeding per rectum. He states that it is very painful to pass stools and on wiping there is bright red blood on the tissue. This has been going on for a few days. He is very worried and would like a colonoscopy to rule out bowel cancer, which his father has recently been diagnosed with.\n\nWhat is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,061 | false | 42 | null | 6,495,229 | null | false | [] | null | 17,984 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pink cocci represent gram-negative cocci, such as *Neisseria meningitides*.",
"id": "10027934",
"label": "d",
"name": "Pink-coloured cocci",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes gram-positive Staphylococcus such as *Staph. aureus*.",
"id": "10027932",
"label": "b",
"name": "Purple-coloured clusters of cocci",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Purple rods represent gram-positive bacilli, such as *Clostridium difficile*.",
"id": "10027935",
"label": "e",
"name": "Purple-coloured rods",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pink on gram staining means that the bacteria are gram-negative. Therefore, pink rods represent gram-negative bacilli such as *Treponema pallidum* which causes syphilis.",
"id": "10027933",
"label": "c",
"name": "Pink-coloured rods",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "*Streptococcus pneumonia* is an example of a gram-positive cocci, so will appear purple. Streptococci means that the cocci are arranged in chains.",
"id": "10027931",
"label": "a",
"name": "Purple-coloured chains of cocci",
"picture": null,
"votes": 19
}
],
"comments": [],
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"id": "6019",
"name": "Gram-positive cocci",
"status": null,
"topic": {
"__typename": "Topic",
"id": "148",
"name": "Microbiology",
"typeId": 7
},
"topicId": 148,
"totalCards": null,
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},
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"question": "A 77-year-old woman is admitted with suspected community-acquired pneumonia. A sputum culture is collected. Given that the most likely cause of her community-acquired pneumonia is *Streptococcus pneumoniae*\n\nwhat will be seen on the gram-staining slide?",
"sbaAnswer": [
"a"
],
"totalVotes": 41,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,062 | false | 43 | null | 6,495,229 | null | false | [] | null | 17,985 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rapidly progressive glomerulonephritis causes nephritic syndrome so the main presentation features would be haematuria and hypertension. Furthermore, it primarily affects adults aged 20 to 50 years old.",
"id": "10027940",
"label": "e",
"name": "Rapidly progressive glomerulonephritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IgA nephropathy is a cause of nephritic syndrome so would cause haematuria and hypertension rather than oedema and proteinuria. IgA nephropathy is also associated with previous respiratory or gastrointestinal infection which is not mentioned in this case.",
"id": "10027938",
"label": "c",
"name": "IgA nephropathy",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with oedema and proteinuria, which are signs of nephrotic syndrome. The most common cause of nephrotic syndrome in this age group is minimal change disease.",
"id": "10027936",
"label": "a",
"name": "Minimal change disease",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would present with features of nephritic syndrome due to the inflammation in the glomerulus (i in nephritic for inflammation). There would likely be blood in the urine and no oedema in the face or peripheries. For post-streptococcus glomerulonephritis, there would also be a previous history of an infection or being generally unwell.",
"id": "10027937",
"label": "b",
"name": "Post-streptococcus glomerulonephritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Membranous glomerulonephritis typically presents with nephrotic syndrome so would fit with this case. This is because of proteinuria and oedema. However, membranous glomerulonephritis affects adults aged 30-50 whereas minimal change disease typically affects children.",
"id": "10027939",
"label": "d",
"name": "Membranous glomerulonephritis",
"picture": null,
"votes": 1
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4060",
"name": "Nephrotic Syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"question": "A five-year-old girl is brought to the GP by her mother. Her mother states that the girl's face looks swollen, despite no trauma or bruising. She has now noticed a similar effect around the girl's ankles. A urine sample is taken and shows marked proteinuria but no blood.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,063 | false | 44 | null | 6,495,229 | null | false | [] | null | 17,986 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The sural nerve is a purely sensory nerve of the lower limb and supplies the skin of the lateral ankle and lateral border of the foot. Any damage to the sural nerve will result in loss of sensation in those areas.",
"id": "10027945",
"label": "e",
"name": "Sural nerve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The tibial nerve is a terminal branch of the sciatic nerve. It arises at the superior aspect of the popliteal fossa. It innervates the posterior compartment of the leg and many of the intrinsic muscles of the foot. Therefore, the motor deficit if the tibial nerve was affected would be loss of plantarflexion. These patients would not be able to walk on tip-toes.",
"id": "10027942",
"label": "b",
"name": "Tibial nerve",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The common peroneal nerve is a terminal branch of the sciatic nerve. It arises at the superior aspect of the popliteal fossa where the sciatic nerve splits into the common peroneal and the tibial nerves. The common peroneal nerve innervates the short head of the biceps femoris and muscles in the lateral and anterior compartments of the leg. Due to the loss of these muscles, the patient is unable to dorsiflex the affected foot which results in a high steppage gait.",
"id": "10027941",
"label": "a",
"name": "Common peroneal nerve",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The femoral nerve innervates the anterior thigh muscles and the skin of the anteromedial thigh medial leg and foot. While femoral nerve injuries are uncommon, we know that the functions of those muscles as well as sensation in that area will be lost. Patients may have weakness in hip flexion and active knee extension. Some hip flexion will remain intact due to the action of psoas major and minor in particular.",
"id": "10027944",
"label": "d",
"name": "Femoral nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The sciatic nerve is the largest nerve in the body so has many functions. If the sciatic nerve were damaged, a patient may complain of pain down the entire posterior lower limb as well as weakness in dorsiflexion, plantarflexion, inversion and eversion of the ankle. The common peroneal and tibial nerves are branches of the sciatic nerve so make up those functions.",
"id": "10027943",
"label": "c",
"name": "Sciatic nerve",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3856",
"name": "Foot drop",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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},
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"question": "A 65-year-old presents with difficulty walking. On examination, you notice a high-stepping gait and difficulty dorsiflexing the right foot.\n\nWhich nerve has been affected?",
"sbaAnswer": [
"a"
],
"totalVotes": 44,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,064 | false | 45 | null | 6,495,229 | null | false | [] | null | 17,987 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cyclizine is a histamine (H1) receptor antagonist. Therefore, it is safe to use in Parkinson's disease as it does not affect the dopamine levels in the brain.",
"id": "10027948",
"label": "c",
"name": "Cyclizine",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ondansetron is the first-line anti-emetic drug. It is a serotonin (5HT3) receptor antagonist and acts centrally in the chemotherapy trigger zone. As it is not affecting the dopamine levels in the brain, it is safe to use with Parkinson's disease.",
"id": "10027947",
"label": "b",
"name": "Ondansetron",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyoscine hydrobromide is an example of an anti-muscarinic. It is an antagonist of the muscarinic receptors in the chemoreceptor trigger zone in the brain. It is safe for use in Parkinson's disease as it is not affecting dopamine levels in the brain.",
"id": "10027949",
"label": "d",
"name": "Hyoscine hydrobromide",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Metaclopramide is a dopamine (D2) receptor antagonist. This will worsen Parkinson's symptoms as Parkinson's is caused by a lack of dopamine.",
"id": "10027946",
"label": "a",
"name": "Metoclopramide",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dexamethasone is a corticosteroid that is used as an anti-emetic alongside some chemotherapy agents. It is safe for use in Parkinson's disease as dopamine is not suppressed in the brain.",
"id": "10027950",
"label": "e",
"name": "Dexamethasone",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6020",
"name": "Anti-emetics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "195",
"name": "Pharmacology",
"typeId": 7
},
"topicId": 195,
"totalCards": null,
"typeId": null,
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},
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"conditions": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "Due to its mechanism of action, which anti-emetic is contraindicated in patients with Parkinson's disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,065 | false | 46 | null | 6,495,229 | null | false | [] | null | 17,988 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The Wells' score is used to assess the probability of a DVT. It guides the need for further investigation and urgent treatment.",
"id": "10027955",
"label": "e",
"name": "Wells' criteria",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The GAD7 questionnaire is used as a screening and severity assessment tool for generalised anxiety disorder.",
"id": "10027952",
"label": "b",
"name": "GAD7",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The New York (NYHA) classification has classes of heart failure based on the severity of dyspnoea.",
"id": "10027954",
"label": "d",
"name": "NYHA",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used to assess the severity of pneumonia and therefore guide treatment.",
"id": "10027953",
"label": "c",
"name": "CURB-65",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The PHQ9 is a questionnaire that is used to assess the severity of depression. It includes questions about losing interest in doing things, feeling down and changes to sleep and appetite",
"id": "10027951",
"label": "a",
"name": "PHQ9",
"picture": null,
"votes": 30
}
],
"comments": [],
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},
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"demo": null,
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"id": "3971",
"name": "Depression",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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},
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"question": "What is the scoring system used in the diagnosis of depression?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,066 | false | 47 | null | 6,495,229 | null | false | [] | null | 17,989 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although it is very important to address the patient's concerns, a diagnosis of a cancer is very unlikely. There is no discrete lump firstly, but there are also features of varicocele which is more common.",
"id": "10027958",
"label": "c",
"name": "Testicular tumour",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The enlarged veins and aching pain at the end of the day indicates a diagnosis of varicocele. Typically, the enlarged veins may be described as a \"bag of worms\".",
"id": "10027956",
"label": "a",
"name": "Varicocele",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Epididymo-orchitis is an infection of the epididymis and testes. It can cause pain and swelling. However, the pain is usually severe and sudden onset which is not the description of pain in the case above. As this is an infection, the patient may also have a fever and other signs of infection such as urethral discharge.",
"id": "10027960",
"label": "e",
"name": "Epididymo-orchitis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hydrocoele is the accumulation of fluid within the tunica vaginalis. This presents with a swelling in the scrotum, but this is normally painless rather than the aching pain that is described in this case.",
"id": "10027957",
"label": "b",
"name": "Hydrocoele",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Testicular torsion is a urological emergency so is very important to rule it out. Typically, the pain in testicular torsion is very severe and sudden onset. There may also be nausea and vomiting. In this case, there are no features of being acutely unwell so we can rule out testicular torsion.",
"id": "10027959",
"label": "d",
"name": "Testicular torsion",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4423",
"name": "Varicocele",
"status": null,
"topic": {
"__typename": "Topic",
"id": "179",
"name": "Vascular Surgery",
"typeId": 7
},
"topicId": 179,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4423,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "A 23-year-old man presents with a swelling and aching feeling in his testicles. It is worst at the end of the day when he feels \"heavy\". He is concerned about the swelling and thinks he may have a testicular tumour. On examination, there are visibly enlarged veins in the scrotum.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,067 | false | 48 | null | 6,495,229 | null | false | [] | null | 17,990 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A ventricular thrombus can form as a complication of an acute ST-elevation myocardial infarction (STEMI), but this is unlikely in this patient as her myocardial infarction was four years ago.",
"id": "10027963",
"label": "c",
"name": "Cardiac ventricles",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Endocarditis is a potential source of emboli in mesenteric ischaemia. In this case, there are no indications of this as an underlying diagnosis. These features might include a fever, Osler's nodes and Roth spots.",
"id": "10027965",
"label": "e",
"name": "Heart valves",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Deep vein thrombosis typically causes pulmonary embolism, rather than emboli in the mesenteries.",
"id": "10027964",
"label": "d",
"name": "Veins of the leg",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most common cause of acute mesenteric ischaemia is atrial fibrillation, which this woman has. This is due to the stasis of blood in the atria which allows a thrombus to form. This can lead to an emboli which can block the blood supply to the mesenteries in the bowel. This is the same process for ischaemic strokes caused by atrial fibrillation.",
"id": "10027961",
"label": "a",
"name": "Cardiac atrium",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atherosclerosis in the arteries, such as the abdominal aorta, can create a thrombus which then embolises to a distant site. However, this embolus is more likely to lodge in the peripheries causing acute limb ischameia rather than lodging in the mesenteries.",
"id": "10027962",
"label": "b",
"name": "Abdominal aorta",
"picture": null,
"votes": 12
}
],
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"id": "3714",
"name": "Atrial fibrillation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 75-year-old woman presents with severe abdominal pain. It is thought she has acute mesenteric ischaemia. She has a history of diabetes, atrial fibrillation, hypertension and a myocardial infarction four years ago.\n\nWhat is the most likely origin site of the embolus causing the mesenteric ischaemia?",
"sbaAnswer": [
"a"
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"totalVotes": 43,
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} | MarksheetMark |
173,467,068 | false | 49 | null | 6,495,229 | null | false | [] | null | 17,991 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Long-acting beta-2 agonists such as salmeterol are used in the management of asthma, but are not the first-line reliever for acute symptoms. This is simply because they are long-acting so will take a while to work effectively.",
"id": "10027968",
"label": "c",
"name": "Long-acting beta-2 agonist",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Theophylline is the main example of a xanthine. Theophylline is used in patients with inadequate control of their asthma despite the use of SABAs (short-acting beta-2 agonists) and ICS (inhaled corticosteroids). Therefore, it is unlikely to be given to this young girl as a first-line reliever therapy.",
"id": "10027970",
"label": "e",
"name": "Xanthine",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The blue inhaler patients are given typically contains salbutamol, which is a short-acting beta-2 agonist. It works by relaxing the bronchial muscles to improve airflow to the lungs.",
"id": "10027966",
"label": "a",
"name": "Short-acting beta-2 agonist",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inhaled corticosteroids are typically in a brown inhaler, and are used as preventers rather than relievers. This is because they are reducing the inflammation in the bronchi.",
"id": "10027967",
"label": "b",
"name": "Inhaled corticosteroid",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Montelukast is an example of a leukotriene receptor antagonist. It is used in the management of asthma if SABA (short-acting beta-2 agonists) and ICS (inhaled corticosteroids) are not providing adequate control of their asthma symptoms. Therefore, this patient will have been started on these medications first.",
"id": "10027969",
"label": "d",
"name": "Leukotriene receptor antagonist",
"picture": null,
"votes": 0
}
],
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"name": "Asthma",
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"id": "132",
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"typeId": 7
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"question": "A seven-year-old girl is brought by her parents following a diagnosis of asthma. They have questions about her new inhaler regime.\n\nWhat is the drug class of the \"blue reliever\" inhaler?",
"sbaAnswer": [
"a"
],
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173,467,069 | false | 50 | null | 6,495,229 | null | false | [] | null | 17,992 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. The extracellular fluid is the remaining 14L and the plasma volume is 25% of that- which is 3.5L.",
"id": "10027974",
"label": "d",
"name": "3.5 L",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. 14L represents the extracellular fluid (one-third of 42L).",
"id": "10027972",
"label": "b",
"name": "14 L",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L.",
"id": "10027971",
"label": "a",
"name": "28 L",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. The extracellular fluid is the remaining 14L, the interstitial fluid makes up 75% of this so is 10.5 L.",
"id": "10027973",
"label": "c",
"name": "10.5 L",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The estimated volume of blood is 5L in a 70kg male.",
"id": "10027975",
"label": "e",
"name": "5 L",
"picture": null,
"votes": 5
}
],
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"id": "6021",
"name": "Distribution and measurement of body fluids",
"status": null,
"topic": {
"__typename": "Topic",
"id": "313",
"name": "Renal and Electrolyte Physiology",
"typeId": 7
},
"topicId": 313,
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"question": "Based on a 70kg male, what is the approximate volume of fluid in the intracellular compartment?",
"sbaAnswer": [
"a"
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173,467,132 | false | 1 | null | 6,495,234 | null | false | [] | null | 17,993 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The MenACWY vaccine helps to protect against meningitis infections. It is given as a single injection, most commonly to students going to university for the first time.",
"id": "10027980",
"label": "e",
"name": "MenACWY vaccine",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has the clinical signs and symptoms of heart failure and should be **offered an annual influenza vaccine** and a one-off pneumococcal vaccination. The vaccine is offered annually because this patient's chronic heart failure puts him into a clinical risk group. Patients in a clinical risk group are at a higher risk of getting seriously ill, in this case, from influenza infection.",
"id": "10027976",
"label": "a",
"name": "Influenza vaccine",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The MMR vaccine is usually given in 2 doses as a child and confers long-lasting protection. It is not necessary or indicated for a patient with heart failure.",
"id": "10027977",
"label": "b",
"name": "MMR vaccine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pneumococcal vaccine helps to protect against meningitis and pneumonia. Children and adults who are in a clinical risk group and at higher risk of getting seriously ill are offered a one-off dose of the pneumococcal vaccine for extra protection.",
"id": "10027978",
"label": "c",
"name": "Pneumococcal vaccine",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The BCG vaccine helps to protect against tuberculosis (TB). It is only given once in a lifetime and only when a patient has an increased risk of coming into contact with TB, either through their work or if they are travelling from or travelling to a country with a high rate of TB.",
"id": "10027979",
"label": "d",
"name": "BCG vaccine",
"picture": null,
"votes": 2
}
],
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"id": "3798",
"name": "Heart Failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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},
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"question": "A 57-year-old man presents to the GP with a longstanding history of cough and breathlessness, which is worse when lying down and at night. On examination, crackles can be heard bilaterally at the lung bases. His blood test results show a raised BNP. He is already taking an ACE inhibitor and a beta-blocker for this condition.\n\nWhich of the following is the most likely intervention to be offered annually to this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 99,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,133 | false | 2 | null | 6,495,234 | null | false | [] | null | 17,994 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A Monteggia fracture describes a fracture of the proximal ulna with an associated radial head dislocation.",
"id": "10027981",
"label": "a",
"name": "Monteggia fracture",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Greenstick fracture happens when a bone breaks on one side only and not all the way through the bone. This is the most common type of fracture seen in children as they have softer bones than adults.",
"id": "10027985",
"label": "e",
"name": "Greenstick fracture",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Smith fracture is a fracture of the distal radius with volar displacement of the distal fragment. This means the fragment of the radius that has broken off projects towards the palm side of the hand. It usually happens after a fall onto the back of the hand while the wrist is flexed.",
"id": "10027983",
"label": "c",
"name": "Smith fracture",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Bennet fracture is a fracture of the first metacarpal at the base of the thumb. This usually happens from forced abduction of the first metacarpal.",
"id": "10027984",
"label": "d",
"name": "Bennet fracture",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Galeazzi fracture is a fracture of the radial shaft with dislocation of the distal radioulnar joint.",
"id": "10027982",
"label": "b",
"name": "Galeazzi fracture",
"picture": null,
"votes": 15
}
],
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"id": "6022",
"name": "Monteggia and Galeazzi fractures",
"status": null,
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"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
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},
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"question": "An 8-year-old boy presents to A&E with pain in his arm following a fall off a bike. X-ray shows a fracture of the proximal ulna and a dislocation of the radial head.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 88,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,134 | false | 3 | null | 6,495,234 | null | false | [] | null | 17,995 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Episcleritis is another cause of red eye, which is typically not painful but may cause discomfort and tenderness over the inflamed area.",
"id": "10027989",
"label": "d",
"name": "Episcleritis",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anterior uveitis often has a more insidious onset, with symptoms that develop gradually and persist over time. The characteristic features of anterior uveitis are a painful red eye, blurred vision, and photophobia. Patients may also present with constricted or irregular pupils due to synechiae, which are adhesions between the lens and iris.",
"id": "10027987",
"label": "b",
"name": "Anterior uveitis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Conjunctivitis typically presents with a red, itchy, irritated eye with increased lacrimation and discharge. The type of discharge would depend on the underlying cause, whether that is allergic, viral, or bacterial in origin.",
"id": "10027988",
"label": "c",
"name": "Conjunctivitis",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Scleritis typically presents with a painful red eye and pain on eye movement. It is commonly associated with rheumatological conditions such as rheumatoid arthritis, so patients may also have systemic symptoms.",
"id": "10027990",
"label": "e",
"name": "Scleritis",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A subconjunctival haemorrhage occurs when blood vessels in the conjunctiva rupture and leak blood into the surrounding tissue. It characteristically causes a painless red eye. Subconjunctival haemorrhages are more likely to occur in individuals taking warfarin because it is an anticoagulant which increases the risk of bleeding. This diagnosis is further supported because of the sudden onset presentation, normal visual acuity, lack of pain or itching and normal pupillary reflexes.",
"id": "10027986",
"label": "a",
"name": "Subconjunctival haemorrhage",
"picture": null,
"votes": 48
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6023",
"name": "Differentials of red eye",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
"typeId": null,
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},
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"difficulty": 1,
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"id": "17995",
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"question": "A 79-year-old woman presents to the GP with a 6-hour history of a red eye. She reports no changes in vision, no pain, and no itching. Her pupillary reflexes are normal. Her drug history shows she is taking warfarin.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 89,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,135 | false | 4 | null | 6,495,234 | null | false | [] | null | 17,996 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lying and standing blood pressure is a useful investigation when orthostatic hypotension is suspected.",
"id": "10027994",
"label": "d",
"name": "Lying and standing blood pressure",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This man has presented with symptoms of peripheral arterial disease. ECG is not the primary investigation for peripheral arterial disease and is typically performed to assess the electrical activity and function of the heart.",
"id": "10027992",
"label": "b",
"name": "Electrocardiogram (ECG)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A duplex ultrasound scan is a non-invasive imaging test that can be used to assess the blood flow in the arteries and identify any blockages or narrowing of the blood vessels in the legs. However, it is not as readily available as an ABPI to perform in initial screening of peripheral arterial disease.",
"id": "10027995",
"label": "e",
"name": "Duplex ultrasound",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CT angiography is an advanced imaging technique that uses contrast dye and X-rays to create detailed images of blood vessels. However, it is more invasive and costly, so simple investigations like ABPI are more appropriate to perform first.",
"id": "10027993",
"label": "c",
"name": "CT angiography",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An ABPI is a non-invasive investigation used to assess blood flow to the lower extremities and diagnose peripheral arterial disease. When performed, it measures the ratio of the systolic blood pressure at the ankle to that in the arm. The score helps to determine the appropriate treatment and if a referral for specialist vascular assessment is required.",
"id": "10027991",
"label": "a",
"name": "Ankle-Brachial Pressure Index (ABPI)",
"picture": null,
"votes": 68
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4187",
"name": "Peripheral arterial disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "179",
"name": "Vascular Surgery",
"typeId": 7
},
"topicId": 179,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4187,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
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"highlights": [],
"id": "17996",
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"question": "A 61-year-old man presents to the GP with a non-healing leg ulcer and crampy pain in his calf when walking uphill and downhill. The pain is relieved by rest. He has a past medical history of hypertension and hypercholesterolaemia.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 87,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,136 | false | 5 | null | 6,495,234 | null | false | [] | null | 17,997 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary sclerosing cholangitis (PSC) is a chronic liver disease characterised by inflammation and scarring of the bile ducts. It can also lead to raised liver enzymes and cholestasis. PSC is often associated with inflammatory bowel disease and has a strong association with ulcerative colitis.",
"id": "10027998",
"label": "c",
"name": "Primary sclerosing cholangitis",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Autoimmune hepatitis is characterised by autoimmune-mediated inflammation of the liver. It can also present with raised ALP and bilirubin however, it is typically associated with anti-smooth muscle antibodies and not anti-mitochondrial antibodies.",
"id": "10027997",
"label": "b",
"name": "Autoimmune hepatitis",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatocellular carcinoma is a malignancy of the liver and usually occurs in patients with underlying liver disease such as cirrhosis. It can cause raised liver enzymes, jaundice and dark urine.",
"id": "10027999",
"label": "d",
"name": "Hepatocellular carcinoma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Non-alcoholic fatty liver disease (NAFLD) is characterised by the accumulation of fat in the liver and can progress to non-alcoholic steatohepatitis (NASH). Raised liver enzymes can also occur in NAFLD, but NAFLD does not cause the characteristic cholestasis as seen in PBC.",
"id": "10028000",
"label": "e",
"name": "Non-alcoholic fatty liver disease",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Primary biliary cholangitis (PBC) is a chronic autoimmune disease characterised by the progressive destruction of small bile ducts within the liver. The symptoms of itching, jaundice and dark urine with raised bilirubin are indicative of cholestasis resulting from impaired bile flow. Raised ALP is found due to damage to the bile ducts. Anti-mitochondrial antibodies are found in more than 90% of individuals with PBC.",
"id": "10027996",
"label": "a",
"name": "Primary biliary cholangitis",
"picture": null,
"votes": 54
}
],
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"id": "6024",
"name": "Primary biliary cholangitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 45-year-old woman presents to the GP with a longstanding history of itching, jaundice and dark urine. Her blood results show raised alkaline phosphatase (ALP) and bilirubin levels and anti-mitochondrial antibodies.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
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"totalVotes": 83,
"typeId": 1,
"userPoint": null
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173,467,137 | false | 6 | null | 6,495,234 | null | false | [] | null | 17,998 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Section 17 of the Mental Health Act allows a guardian to be appointed to oversee the care and treatment of a patient with a psychiatric condition while they are living in the community. This may be used when patients are discharged from the hospital and require ongoing support and treatment.",
"id": "10028005",
"label": "e",
"name": "Section 17",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Section 5 (2) of the Mental Health Act allows registered medical practitioners in a hospital to detain patients who need assessment and treatment for up to 72 hours. It is used in emergency situations when a patient's safety is at risk.",
"id": "10028001",
"label": "a",
"name": "Section 5 (2)",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Section 4 of the Mental Health Act allows for the detention of patients who require immediate treatment for a psychiatric condition but who are unable or unwilling to consent to it. This can be converted into a Section 2 if required.",
"id": "10028003",
"label": "c",
"name": "Section 4",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Section 3 of the Mental Health Act allows for the detention of patients who have a formal psychiatric diagnosis in place and who require treatment. Patients detained under Section 3 can be kept in the hospital for up to 6 months.",
"id": "10028002",
"label": "b",
"name": "Section 3",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Section 2 of the Mental Health Act allows for the detention of patients for a maximum of 28 days to determine if they have a psychiatric condition and if they require treatment. This can only occur if two medical practitioners agree that it is necessary.",
"id": "10028004",
"label": "d",
"name": "Section 2",
"picture": null,
"votes": 31
}
],
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"name": "The Mental Health Act",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
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"topicId": 173,
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"question": "A 35-year-old woman on an inpatient ward appears agitated and is complaining that her insides are rotting. She tells the staff on the ward that she plans to solve this using medication she has stockpiled.\n\nWhich of the following sections of the Mental Health Act would be most appropriate to use in this situation?",
"sbaAnswer": [
"a"
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"totalVotes": 82,
"typeId": 1,
"userPoint": null
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173,467,138 | false | 7 | null | 6,495,234 | null | false | [] | null | 17,999 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ANCA testing is used to evaluate for certain types of vasculitis, such as granulomatosis with polyangiitis. GCA is not associated with the presence of ANCA.",
"id": "10028009",
"label": "d",
"name": "Antineutrophil cytoplasmic antibodies (ANCA)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A temporal artery biopsy is the definitive investigation to confirm GCA. The characteristic findings in GCA include granulomatous inflammatory changes within the artery wall and giant cells. However, it is not a first-line test in suspected GCA.",
"id": "10028008",
"label": "c",
"name": "Temporal artery biopsy",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A non-contrast CT head can help identify certain causes of headaches, such as intracranial bleeding, but may not provide specific information about GCA.",
"id": "10028007",
"label": "b",
"name": "Non-contrast CT head",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is highly suggestive of giant cell arteritis (GCA), a type of vasculitis that primarily affects the temporal arteries. ESR is an important investigation in the context of GCA as it is a non-specific inflammatory marker that is commonly raised in this condition and can help support the diagnosis.",
"id": "10028006",
"label": "a",
"name": "Erythrocyte Sedimentation Rate (ESR)",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An FBC may provide information about a patient's overall health and detect anaemias or other abnormalities.",
"id": "10028010",
"label": "e",
"name": "Full blood count (FBC)",
"picture": null,
"votes": 1
}
],
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"id": "3948",
"name": "Headache",
"status": null,
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"question": "A 65-year-old woman presents to the emergency department with a sudden-onset headache and scalp tenderness. On fundoscopy, her optic disc is swollen and pale with blurred margins.\n\nWhich of the following is the next best investigation?",
"sbaAnswer": [
"a"
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"totalVotes": 85,
"typeId": 1,
"userPoint": null
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173,467,139 | false | 8 | null | 6,495,234 | null | false | [] | null | 18,000 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rheumatoid factor is an autoantibody commonly associated with rheumatoid arthritis.",
"id": "10028012",
"label": "b",
"name": "Rheumatoid factor",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "dsDNA antibodies are a hallmark of systemic lupus erythematosus (SLE).",
"id": "10028013",
"label": "c",
"name": "dsDNA antibodies",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of symptoms described is suggestive of Sjogren's syndrome, an autoimmune disorder that primarily affects the exocrine glands of the eyes and mouth. The presence of auto-antibodies Anti-Ro and Anti-La supports the diagnosis of Sjogren's.",
"id": "10028011",
"label": "a",
"name": "Anti-Ro and Anti-La antibodies",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ANCA testing is used to evaluate for certain types of vasculitis, such as granulomatosis with polyangiitis.",
"id": "10028014",
"label": "d",
"name": "Antineutrophil cytoplasmic antibodies (ANCA)",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HLA-B27 is a genetic marker associated with several autoimmune conditions, such as ankylosing spondylitis.",
"id": "10028015",
"label": "e",
"name": "HLA-B27",
"picture": null,
"votes": 7
}
],
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"id": "6025",
"name": "Sjogrens syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
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"question": "A 50-year-old woman presents to an outpatient clinic. She states she has joint pain, fatigue, red, gritty eyes, and is frequently drinking due to a dry mouth.\n\nWhich of the following is most likely to be found in her blood results?",
"sbaAnswer": [
"a"
],
"totalVotes": 87,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,140 | false | 9 | null | 6,495,234 | null | false | [] | null | 18,001 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Undescended testes are more prone to torsion. However, it is not as strong of a risk factor compared to a bell clapper deformity.",
"id": "10028018",
"label": "c",
"name": "Undescended testes",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paraphimosis is a medical condition in which the foreskin becomes trapped behind the glans, causing swelling. It is not a common risk factor for testicular torsion.",
"id": "10028019",
"label": "d",
"name": "History of paraphimosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Trauma can precipitate testicular torsion, but it is not the most common risk factor out of the options given.",
"id": "10028017",
"label": "b",
"name": "Trauma",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A UTI does not typically lead to acute testicular pain and vomiting.",
"id": "10028020",
"label": "e",
"name": "UTI",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Bell clapper deformity is an anatomical abnormality where the testicles are not fixed to the scrotum, allowing them to rotate freely. This increases the risk of testicular torsion, which occurs when the spermatic cord twists and cuts off blood flow to the testicle, causing severe pain.",
"id": "10028016",
"label": "a",
"name": "Bell clapper deformity",
"picture": null,
"votes": 53
}
],
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"demo": null,
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"name": "Testicular Torsion",
"status": null,
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"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
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"question": "A 17-year-old male presents with sudden onset unilateral testicular pain and vomiting. He reports no recent trauma or trigger.\n\nWhat is the most common risk factor for the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,141 | false | 10 | null | 6,495,234 | null | false | [] | null | 18,002 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lying and standing blood pressure is a useful investigation when orthostatic hypotension is suspected.",
"id": "10028025",
"label": "e",
"name": "Lying and standing blood pressure",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An ECG is typically performed to assess the electrical activity and function of the heart. It is not involved in the treatment of hypertension.",
"id": "10028024",
"label": "d",
"name": "Do an ECG",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has high blood pressure and a background of type 2 diabetes and, therefore, should be initiated on an ACE inhibitor such as Rampiril.",
"id": "10028021",
"label": "a",
"name": "Start Ramipril",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amlodipine is a calcium channel blocker used to lower blood pressure. It is the first-line treatment in patients with hypertension without type 2 diabetes if they are >55 years old or of black African or African-Caribbean family origin. It is not the first-line treatment for a patient with type 2 diabetes.",
"id": "10028022",
"label": "b",
"name": "Start amlodipine",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Spironolactone is a potassium-sparing diuretic that can be used in the management of hypertension, but it is not typically used as first-line therapy.",
"id": "10028023",
"label": "c",
"name": "Start spironolactone",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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"videos": []
},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "18002",
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"question": "A 44-year-old man with type 2 diabetes attends his GP with his ambulatory blood pressure monitoring (ABPM) results.\n\nHis average blood pressure result is 152/78 mmHg.\n\nWhat is the next best step in the management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 87,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,142 | false | 11 | null | 6,495,234 | null | false | [] | null | 18,003 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Laryngeal cancer should be suspected in patients who are 45 years and over with persistent and unexplained hoarseness. The smoking history also adds to the suspicion of laryngeal cancer.",
"id": "10028026",
"label": "a",
"name": "Urgent 2-week wait cancer referral",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst referral to ENT is necessary, an urgent referral is more appropriate in this case due to the red flag symptoms and risk factors.",
"id": "10028027",
"label": "b",
"name": "Routine referral to ENT",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Referral to a smoking cessation service is important, but it is not the most important management at this point in time. Immediate evaluation for laryngeal cancer is the priority.",
"id": "10028029",
"label": "d",
"name": "Refer to a smoking cessation service",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Discharging the patient without a referral for further evaluation could lead to a delay in cancer diagnosis and a poorer prognosis.",
"id": "10028028",
"label": "c",
"name": "Send the patient home",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Admission to hospital is not the first step for a patient presenting with hoarseness. An outpatient referral for evaluation is more appropriate.",
"id": "10028030",
"label": "e",
"name": "Admit to hospital",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "6026",
"name": "Hoarseness",
"status": null,
"topic": {
"__typename": "Topic",
"id": "138",
"name": "Ear, Nose & Throat",
"typeId": 7
},
"topicId": 138,
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},
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"question": "A 53-year-old man presents to the GP with a 1-month history of hoarseness. He has no other symptoms. He does not drink alcohol but has a 5-pack-year smoking history.\n\nWhat is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 85,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,143 | false | 12 | null | 6,495,234 | null | false | [] | null | 18,004 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thiazolidinediones increase insulin sensitivity of muscle and adipose tissue. An example of a drug in this drug class is pioglitazone. These drugs can be used as part of second-line therapy for diabetes but are not the appropriate choice for a patient with established cardiovascular disease.",
"id": "10028032",
"label": "b",
"name": "Increases insulin sensitivity of muscle and adipose tissue",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Insulin stimulates glucose uptake by insulin-sensitive cells and is used in the management of Type 1 and Type 2 diabetes. It is not an appropriate management choice in this situation.",
"id": "10028034",
"label": "d",
"name": "Stimulates glucose uptake by insulin-sensitive cells",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "SGLT-2 inhibitors should be started as this patient has established cardiovascular disease. SGLT-2 inhibitors work by blocking the sodium-glucose transporter in the kidney, thus increasing urinary excretion of glucose.",
"id": "10028031",
"label": "a",
"name": "Blocks renal sodium-glucose transporter",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dipeptidyl peptidase-4 (DDP-4) inhibitors reduce the inactivation of incretins. An example of a drug in this class is sitagliptin. These drugs can be used in the second-line therapy of diabetes.",
"id": "10028033",
"label": "c",
"name": "Reduces the inactivation of incretins",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral biguanides such as metformin inhibit hepatic gluconeogenesis. This patient is already on metformin.",
"id": "10028035",
"label": "e",
"name": "Inhibits hepatic gluconeogenesis",
"picture": null,
"votes": 5
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "6027",
"name": "Diabetes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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},
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"question": "A 42-year-old man with type 2 diabetes presents to the GP with symptoms of dizziness and fatigue. He has a past medical history of a myocardial infarction.\n\nHis HbA1c is 65 mmol/mol. He is currently taking metformin for his diabetes.\n\nWhat is the mechanism of action of the most appropriate medication to add in this situation?",
"sbaAnswer": [
"a"
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"totalVotes": 83,
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173,467,144 | false | 13 | null | 6,495,234 | null | false | [] | null | 18,005 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paracetamol is used for pain relief and is unlikely to cause the symptoms described when taken at the recommended doses.",
"id": "10028040",
"label": "e",
"name": "Paracetamol",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that relieves pain and inflammation. Whilst it can have side effects such as gastrointestinal discomfort or headache, it is less likely to cause electrolyte imbalances.",
"id": "10028039",
"label": "d",
"name": "Ibuprofen",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Indapamide is a thiazide-like diuretic commonly prescribed for hypertension. Thiazide-like diuretics can cause electrolyte imbalances such as hypokalaemia, which manifests with symptoms like headache, fatigue and dizziness. These symptoms are indicative of hypokalaemia, a known side effect of indapamide.",
"id": "10028036",
"label": "a",
"name": "Indapamide",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nifedipine has side effects such as ankle oedema and dizziness; however, it does not typically cause hypokalaemia.",
"id": "10028038",
"label": "c",
"name": "Nifedipine",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril can cause hyperkalaemia by blocking the aldosterone pathway, leading to potassium retention.",
"id": "10028037",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 13
}
],
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"id": "6028",
"name": "Hypokalaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
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"question": "A 78-year-old woman presents with headache, fatigue and dizziness. Her past medical history includes hypertension and osteoarthritis. She is currently taking ramipril, indapamide, nifedipine, paracetamol and ibuprofen.\n\nWhich of the following drugs is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
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"totalVotes": 85,
"typeId": 1,
"userPoint": null
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173,467,145 | false | 14 | null | 6,495,234 | null | false | [] | null | 18,006 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Constipation is a common side effect associated with opioid medications prescribed for moderate-to-severe pain, including cancer-related pain.",
"id": "10028041",
"label": "a",
"name": "Constipation",
"picture": null,
"votes": 80
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fatigue can be a side effect of various medications, including some antihistamines and sedatives. Whilst opioids can cause drowsiness, it is typically different from the generalised fatigue associated with other medications.",
"id": "10028044",
"label": "d",
"name": "Fatigue",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Weight gain can occur as a side effect of certain medications, such as antidepressants, antipsychotics, or corticosteroids.",
"id": "10028043",
"label": "c",
"name": "Weight gain",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dry cough is a side effect commonly associated with medications like angiotensin-converting enzyme (ACE) inhibitors, e.g. ramipril, which are used to treat hypertension.",
"id": "10028042",
"label": "b",
"name": "Dry cough",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperkalaemia can result from certain medications, such as potassium-sparing diuretics or angiotensin receptor blockers (ARBs).",
"id": "10028045",
"label": "e",
"name": "Hyperkalaemia",
"picture": null,
"votes": 2
}
],
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"id": "6029",
"name": "WHO Pain Ladder",
"status": null,
"topic": {
"__typename": "Topic",
"id": "225",
"name": "Oncology and Palliative Care",
"typeId": 7
},
"topicId": 225,
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"question": "A 58-year-old man presents to his GP experiencing moderate back pain from prostate metastases. He is taking paracetamol and ibuprofen for the pain, but these are not helping.\n\nAccording to the WHO pain ladder, what is a potential side effect of the medication he should try next?",
"sbaAnswer": [
"a"
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"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,146 | false | 15 | null | 6,495,234 | null | false | [] | null | 18,007 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Voltage-gated K+ channels are important in the repolarisation phase (Phase 3) of the cardiac action potential in atrial myocytes. During this phase, K+ channels open, allowing the efflux of potassium ions, which leads to the restoration of the resting membrane potential. In AF, where normal electrical signalling in the atria is disrupted, medications can be used to target voltage-gated K+ channels to help restore a more regular rhythm by influencing the repolarisation of atrial cells.",
"id": "10028046",
"label": "a",
"name": "Voltage-gated K+ channels",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HCN channels are involved in generating the pacemaker potential in the cells of the sinoatrial node, regulating heart rate.",
"id": "10028050",
"label": "e",
"name": "Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chloride channels play a role in cardiac action potentials but are not primary targets for antiarrhythmic medications.",
"id": "10028049",
"label": "d",
"name": "Voltage-gated Cl- channels",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These channels are important in the cardiac action potential's plateau phase (Phase 2). They allow calcium ions to enter the cells, contributing to the sustained depolarization of the myocardium.",
"id": "10028048",
"label": "c",
"name": "Voltage-gated Ca2+ channels",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These channels are important in the cardiac action potential depolarisation phase (Phase 0) by allowing the influx of sodium ions.",
"id": "10028047",
"label": "b",
"name": "Voltage-gated Na+ channels",
"picture": null,
"votes": 11
}
],
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"id": "6030",
"name": "Cardiac Action Potential",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
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"question": "A 78-year-old man presents with recurrent episodes of palpitations and dizziness.\n\nECG reveals an irregular rhythm with no P waves. Holter monitor confirms atrial fibrillation (AF).\n\nHe is prescribed an antiarrhythmic medication which targets the ion channel involved in the repolarisation phase of the cardiac action potential.\n\nWhat ion channel plays a crucial role in the repolarisation phase of the cardiac action potential in atrial myocytes?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,147 | false | 16 | null | 6,495,234 | null | false | [] | null | 18,008 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with thrombotic thrombocytopenic purpura characteristically present with a fever, acute kidney injury and neurological changes.",
"id": "10028055",
"label": "e",
"name": "Thrombotic thrombocytopenic purpura",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients with HSP present with a characteristic tetrad of symptoms - abdominal pain, joint pain, renal disease and a rash.",
"id": "10028053",
"label": "c",
"name": "Henoch-Schonlein purpura (HSP)",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Certain medications can cause a drop in platelet count, leading to petechiae and bruising. These include carbamazepine, vancomycin and heparin.",
"id": "10028052",
"label": "b",
"name": "Drug-induced thrombocytopenia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "ITP is a condition characterised by a low platelet count (thrombocytopenia) due to the destruction of platelets by the body's immune system. This destruction results in bleeding manifestations such as petechiae and easy bruising, both of which are characteristic symptoms of ITP. ITP also often presents without hepatosplenomegaly or lymphadenopathy, making it a likely diagnosis in this case.",
"id": "10028051",
"label": "a",
"name": "Immune thrombocytopenic purpura (ITP)",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an inherited bleeding disorder caused by a reduction in von Willebrand Factor. It typically presents earlier in life. Patients may have a history of excess or prolonged bleeding from minor wounds, nosebleeds and periods.",
"id": "10028054",
"label": "d",
"name": "Von Willebrand Disease",
"picture": null,
"votes": 1
}
],
"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": "6031",
"name": "Immune thrombocytopenic purpura",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "18008",
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"question": "A 32-year-old female presents to an outpatient clinic. She has developed petechiae and bruising over the last 3 weeks. She has recently had a cold but has recovered and has no other symptoms, such as hepatosplenomegaly or lymphadenopathy.\n\nShe is not on any regular medications.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,148 | false | 17 | null | 6,495,234 | null | false | [] | null | 18,009 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In some instances, a court-appointed advocate may be involved to represent the minor's best interests in court proceedings. However, they cannot override the child's decision without court approval.",
"id": "10028058",
"label": "c",
"name": "A court-appointed advocate",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A person with parental responsibility, such as a parent or legal guardian, has the authority to make medical decisions on behalf of a minor child, even if the child is Gillick competent. Whilst a Gillick competent child can refuse medical treatment, if they refuse medical treatment, which may lead to their death or severe permanent harm, this decision can be overridden by a person with parental responsibility.",
"id": "10028056",
"label": "a",
"name": "A person with parental responsibility",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A patient must be at least 18 to appoint a lasting power of attorney.",
"id": "10028060",
"label": "e",
"name": "Lasting power of attorney",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A teacher does not typically have legal authority to make medical decisions on behalf of a student.",
"id": "10028059",
"label": "d",
"name": "The patient's teacher",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Friends do not generally have the legal authority to make medical decisions on behalf of minors or override their refusal.",
"id": "10028057",
"label": "b",
"name": "A close friend of the patient",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6032",
"name": "Justifications for withdrawing and withholding treatment",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
"topicId": 184,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "18009",
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"question": "A 15-year-old girl presents to the emergency department with abdominal pain. The A&E doctors suspect appendicitis and would like to admit her for surgery; however, the girl is refusing to have the surgery. She is deemed to be Gillick competent.\n\nOut of the following options, who can consent on her behalf and override her refusal?",
"sbaAnswer": [
"a"
],
"totalVotes": 83,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,149 | false | 18 | null | 6,495,234 | null | false | [] | null | 18,010 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An OGD examines the upper GI tract, including the oesophagus, stomach and duodenum. It is more appropriate for assessing symptoms related to acid reflux, gastritis, upper GI bleeding and peptic ulcers.",
"id": "10028062",
"label": "b",
"name": "Oesophago-gastro-duodenoscopy (OGD)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Helicobacter pylori testing is appropriate for assessing upper GI symptoms, particularly in suspected peptic ulcers or gastritis. It would not directly assess this patient's lower GI symptoms of chronic diarrhoea and weight loss.",
"id": "10028063",
"label": "c",
"name": "Helicobacter pylori testing",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IBS is a diagnosis of exclusion, and it is important to rule out other potential causes before considering IBS.",
"id": "10028065",
"label": "e",
"name": "Diagnosis of irritable bowel syndrome (IBS) and reassurance",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A trial of a gluten-free diet is appropriate when coeliac disease is suspected.",
"id": "10028064",
"label": "d",
"name": "Trial of a gluten-free diet",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient's symptoms suggest they possibly have inflammatory bowel disease (IBD). Colonoscopy with biopsy would allow direct visualisation of the colon to evaluate the extent of the inflammation, and the biopsy sample can help to confirm or rule out IBD.",
"id": "10028061",
"label": "a",
"name": "Colonoscopy with biopsy",
"picture": null,
"votes": 66
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4000",
"name": "Crohn's disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
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"videos": []
},
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"question": "A 28-year-old male presents to the gastroenterology clinic experiencing chronic diarrhoea, abdominal cramping and weight loss of 15 pounds over the past 3 months. He reports no blood in his stool, but the diarrhoea occurs multiple times daily and wakes him up at night.\n\nOn examination, he has mild tenderness in the lower abdomen.\n\nBlood results reveal anaemia and raised inflammatory markers. Faecal calprotectin is significantly raised.\n\nWhat is the most appropriate next step in investigating this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,150 | false | 19 | null | 6,495,234 | null | false | [] | null | 18,011 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cushing's syndrome is characterised by excessive cortisol and typically leads to hypernatraemia rather than hyponatraemia due to sodium retention.",
"id": "10028068",
"label": "c",
"name": "Cushing's syndrome",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Addison's disease can lead to hyponatraemia by reducing sodium re-absorption in the kidneys. However, the history of smoking and small cell lung cancer makes SIADH a more likely diagnosis.",
"id": "10028070",
"label": "e",
"name": "Addison's Disease",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "SIADH is caused by the excess secretion of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatraemia. In this case, the source is from the paraneoplastic secretion of ADH from a likely underlying small cell lung cancer (SCLC).",
"id": "10028066",
"label": "a",
"name": "Syndrome of Inappropriate ADH (SIADH)",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary hyperaldosteronism is characterised by increased aldosterone production and typically leads to hypernatraemia rather than hyponatraemia due to increased sodium retention by the kidneys.",
"id": "10028067",
"label": "b",
"name": "Primary hyperaldosteronism",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes insipidus is caused by inadequate secretion of ADH by the posterior pituitary. It typically causes hypernatraemia due to excessive excretion of dilute urine.",
"id": "10028069",
"label": "d",
"name": "Diabetes insipidus",
"picture": null,
"votes": 5
}
],
"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": "6033",
"name": "SIADH",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
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},
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"conditions": [],
"difficulty": 1,
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"highlights": [],
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"question": "A 60-year-old man presents to A&E experiencing weakness, confusion and generalised swelling for the past week. He is a smoker and drinks 20 units of alcohol a week.\n\nPhysical examination shows he has pitting oedema in his legs.\n\nBlood results show hyponatraemia and a low serum osmolality.\n\nA chest x-ray shows he has a small mass in his lungs.\n\nWhat is the most likely cause of this patient's hyponatraemia?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,151 | false | 20 | null | 6,495,234 | null | false | [] | null | 18,012 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this type of hallucination, individuals hear voices that speak about them or discuss their actions in the third person.",
"id": "10028073",
"label": "c",
"name": "Third-person auditory hallucination",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tactile hallucinations involve a false perception of physical sensations — for example, insects crawling on the skin.",
"id": "10028075",
"label": "e",
"name": "Tactile hallucination",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This type of hallucination is when individuals can hear a voice or voices that talk directly to them or command them. In this case, the patient hears voices threatening her and instructing her to perform harmful actions.",
"id": "10028071",
"label": "a",
"name": "Second-person auditory hallucination",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This involves perceiving things, people or objects that are not present.",
"id": "10028074",
"label": "d",
"name": "Visual hallucination",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this type of hallucination, individuals hear themselves and their own thoughts spoken aloud.",
"id": "10028072",
"label": "b",
"name": "First-person auditory hallucination",
"picture": null,
"votes": 10
}
],
"comments": [],
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"__typename": "Concept",
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"demo": null,
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"id": "3972",
"name": "Schizophrenia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"question": "A 25-year-old female attends a psychiatry appointment. During the appointment, she says that she can hear three voices threatening her and telling her to harm her family.\n\nWhat type of hallucination is being described?",
"sbaAnswer": [
"a"
],
"totalVotes": 82,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,152 | false | 21 | null | 6,495,234 | null | false | [] | null | 18,013 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Based on the clinical presentation and microscopy findings, the most likely diagnosis is trichomoniasis. Metronidazole is the treatment for trichomoniasis. It is a sexually transmitted infection caused by the protozoan parasite *Trichomonas vaginalis*.",
"id": "10028076",
"label": "a",
"name": "Metronidazole",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical steroids are used to treat various inflammatory conditions but are inappropriate for treating trichomoniasis.",
"id": "10028080",
"label": "e",
"name": "Topical steroids",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fluconazole is an antifungal medication used to treat candidiasis.",
"id": "10028077",
"label": "b",
"name": "Fluconazole",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ceftriaxone is an antibiotic commonly used to treat gonorrhoea.",
"id": "10028079",
"label": "d",
"name": "Ceftriaxone",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clindamycin is an antibiotic used to treat infections, including bacterial vaginosis.",
"id": "10028078",
"label": "c",
"name": "Clindamycin",
"picture": null,
"votes": 12
}
],
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"demo": null,
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"id": "6034",
"name": "Trichomoniasis infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "163",
"name": "Genitourinary medicine",
"typeId": 7
},
"topicId": 163,
"totalCards": null,
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"question": "A 28-year-old woman presents to the gynaecology clinic with vaginal itching, foul-smelling vaginal discharge and occasional discomfort when urinating.\n\nOn examination, a frothy, greenish-yellow discharge and vulvar erythema and oedema are visible.\n\nWet mount microscopy of the discharge reveals motile, flagellated protozoa.\n\nConsidering the most likely diagnosis, which of the following is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,153 | false | 22 | null | 6,495,234 | null | false | [] | null | 18,014 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Urinary tract infections are not typically considered a direct sign of ovarian cancer. However, urinary symptoms can occur if the tumour compresses nearby structures.",
"id": "10028085",
"label": "e",
"name": "Frequent urinary tract infections",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hot flushes are a common symptom in postmenopausal women due to hormonal changes but are not specific to ovarian cancer.",
"id": "10028082",
"label": "b",
"name": "Hot flushes",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Unintentional weight loss in the context of persistent abdominal discomfort and bloating can raise suspicion of ovarian cancer.",
"id": "10028081",
"label": "a",
"name": "Weight loss over the past year",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ovarian cancer is more likely to cause fatigue and general feelings of unwellness as it progresses.",
"id": "10028084",
"label": "d",
"name": "Increased energy levels",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Irregular menstrual cycles are a common symptom during menopause and are not typically associated with ovarian cancer.",
"id": "10028083",
"label": "c",
"name": "Irregular menstrual cycles",
"picture": null,
"votes": 14
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3843",
"name": "Ovarian cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "176",
"name": "Gynaecology",
"typeId": 7
},
"topicId": 176,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"conditions": [],
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"question": "A 52-year-old postmenopausal woman presents to her GP with concerns about abdominal discomfort and bloating that have persisted for several months. She reports feeling full quickly when eating and has noticed a gradual increase in abdominal girth.\n\nShe has no significant medical history.\n\nOn examination, there is abdominal distension and a palpable mass in her lower abdomen.\n\nWhich of the following signs or symptoms would raise suspicion for ovarian cancer in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,154 | false | 23 | null | 6,495,234 | null | false | [] | null | 18,015 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Liver disease can impair the production of clotting factors, including those dependent on vitamin K. These factors are essential for both the intrinsic (APTT) and extrinsic (PT) coagulation pathways. Vitamin K is necessary for synthesising factors II, VII, IX and X. The impaired synthesis and decreased availability of vitamin K in liver disease can lead to prolonged PT and APTT.",
"id": "10028086",
"label": "a",
"name": "Vitamin K deficiency",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thrombocytosis refers to an elevated platelet count and is not a common cause of prolonged PT and APTT.",
"id": "10028090",
"label": "e",
"name": "Thrombocytosis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Factor IX deficiency is associated with haemophilia B and typically results in prolonged APTT; however, it does not significantly affect PT.",
"id": "10028089",
"label": "d",
"name": "Factor IX deficiency",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Factor VIII deficiency is associated with haemophilia A. It typically results in prolonged APTT but does not significantly affect PT.",
"id": "10028088",
"label": "c",
"name": "Factor VIII deficiency",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Platelet dysfunction is not typically associated with prolonged PT and APTT. It is more relevant to bleeding disorders related to platelet function, such as von Willebrand disease.",
"id": "10028087",
"label": "b",
"name": "Platelet dysfunction",
"picture": null,
"votes": 9
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4340",
"name": "Interpretation of blood results in bleeding disorders",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"question": "A 59-year-old man presents with a 2-day history of abdominal pain and dark, tarry stools.\n\nHe has a history of liver disease.\n\n**Blood results reveal the following:**\n\n* Haemoglobin: 7.8 g/dL *(normal range: >12 g/dL)*\n* Platelet count: 190,000/uL *(normal range: 150,000 - 45000/uL)*\n* Prothrombin Time (PT): *26 seconds (normal range: 11 - 13.5 seconds)*\n* Activated Partial Thromboplastin Time (APTT): 53 seconds *(normal range: 27 - 41 seconds)*\n\nWhich of the following factors is most likely contributing to the abnormal blood results in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,155 | false | 24 | null | 6,495,234 | null | false | [] | null | 18,016 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroid disorders are not typically the primary cause of acute hyponatraemia symptoms such as confusion.",
"id": "10028093",
"label": "c",
"name": "Thyroid function tests",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A serum osmolality test would tell you the overall concentration of solutes in the blood and help you to differentiate between true hyponatraemia and pseudohyponatraemia and also rule out hyperglycaemia, which can also cause low serum sodium.",
"id": "10028091",
"label": "a",
"name": "Serum osmolality",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This test helps differentiate between different causes of hyponatraemia once you have ruled out pseudohyponatraemia and hyperglycaemia. In conditions like SIADH, urine osmolality is high.",
"id": "10028092",
"label": "b",
"name": "Urine osmolality",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Blood cultures are important for identifying potential sources of infection, especially in a patient with confusion, but they do not directly investigate the hyponatraemia.",
"id": "10028095",
"label": "e",
"name": "Blood Cultures",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A urine dipstick can provide information about urinary sodium and specific gravity, which may help assess the cause of the hyponatraemia but is not the most appropriate initial investigation.",
"id": "10028094",
"label": "d",
"name": "Urine dipstick",
"picture": null,
"votes": 6
}
],
"comments": [],
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},
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"demo": null,
"entitlement": null,
"id": "4014",
"name": "Hyponatraemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
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},
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"question": "A 68-year-old female presents with symptoms of headache, confusion and nausea. She has a past medical history of heart failure.\n\n\nOn examination, she appears lethargic and has signs of peripheral oedema.\n\n\nBlood results show she has a serum sodium level of 120 mmol/L *(normal range: 135-145 mmol/L)*.\n\n\nWhat is the most appropriate initial investigation to investigate the underlying cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,156 | false | 25 | null | 6,495,234 | null | false | [] | null | 18,017 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoarthritis is typically seen in older adults and can cause back pain.",
"id": "10028098",
"label": "c",
"name": "Osteoarthritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lumbar disc herniation typically presents with back and radicular pain (leg pain and numbness). Improvement with exercise is less typical.",
"id": "10028097",
"label": "b",
"name": "Lumbar disc herniation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This condition typically presents with inflammatory back pain that is worst in the morning and improves with exercise. It often affects young patients and can be associated with a positive HLA-B27 antigen.",
"id": "10028096",
"label": "a",
"name": "Ankylosing spondylitis",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Scoliosis may cause back pain but is usually identified in childhood or adolescence. Its symptoms are not typically related to morning stiffness and exercise.",
"id": "10028100",
"label": "e",
"name": "Scoliosis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mechanical lower back pain is a common cause of back pain and can be related to posture and physical activity. However, it does not typically involve morning stiffness.",
"id": "10028099",
"label": "d",
"name": "Mechanical lower back pain",
"picture": null,
"votes": 17
}
],
"comments": [],
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"__typename": "Concept",
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},
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"demo": null,
"entitlement": null,
"id": "3911",
"name": "ankylosing spondylitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
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},
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"question": "A 25-year-old female presents to her GP with a history of back pain persisting for 4 months. She reports that her back feels stiff in the morning, and the pain gradually improves as she cycles to work. She denies any trauma.\n\nShe has no significant past medical history.\n\nAn X-ray of her spine shows no abnormalities.\n\nWhich of the following is the most likely diagnosis for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,157 | false | 26 | null | 6,495,234 | null | false | [] | null | 18,018 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "UTIs present with urinary symptoms such as frequent urination, pain or burning during urination and urgency. Whilst UTIs can progress to serious kidney infections such as pyelonephritis, which may cause an AKI, these infections are often accompanied by fever and flank pain.",
"id": "10028105",
"label": "e",
"name": "Urinary tract infection (UTI)",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although renal calculi can cause an AKI, renal calculi-associated AKIs are more commonly associated with severe, colicky flank pain, haematuria, nausea and vomiting.",
"id": "10028102",
"label": "b",
"name": "Renal calculi",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "ATN is a common cause of intrinsic renal AKI and typically presents with haematuria and oedema. Various factors, including medications, can trigger it. Given this patient's recent initiation of a new hypertension medication and his clinical presentation, ATN secondary to medication is the most likely cause of his AKI.",
"id": "10028101",
"label": "a",
"name": "Acute tubular necrosis (ATN)",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Renal artery stenosis may cause hypertension and fluid retention but does not typically present with fluid overload symptoms such as ankle swelling or oedema. AKIs from renal artery stenosis often develop gradually over time and do not typically have a rapid onset of symptoms.",
"id": "10028103",
"label": "c",
"name": "Renal artery stenosis",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sepsis typically presents with symptoms of infection, such as fever, tachycardia, chills, and evidence of systemic inflammation. Sepsis can lead to an AKI but usually develops due to the systemic inflammatory response to an infection. This patient developed an AKI one week after starting a new hypertension medication.",
"id": "10028104",
"label": "d",
"name": "Sepsis",
"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": "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": "18018",
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"question": "A 61-year-old man presents with decreased urine output, haematuria, ankle swelling and fatigue. His past medical history includes hypertension and type 2 diabetes. He recently started a new medication for his hypertension one week ago.\n\nWhat is the most likely cause of this patient's acute kidney injury (AKI)?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,158 | false | 27 | null | 6,495,234 | null | false | [] | null | 18,019 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metronidazole and tetracycline can be used as part of a *H. pylori* eradication regimen but are not typically used together as first-line treatment. ",
"id": "10028109",
"label": "d",
"name": "Metronidazole and tetracycline",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Doxycycline and bismuth subsalicylate are used in salvage therapy for resistant cases of *H. pylori* but are not included in the first-line treatment regimen.",
"id": "10028110",
"label": "e",
"name": "Doxycycline and bismuth subsalicylate",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This combination of antibiotics may be used for *H. pylori* eradication, but should also be combined with a PPI and metronidazole.",
"id": "10028108",
"label": "c",
"name": "Clarithromycin and amoxicillin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The first-line therapy for *H.Pylori* infection typically includes a PPI to reduce stomach acid production in combination with amoxicillin, clarithromycin (or metronidazole). This is recommended to improve eradication rates and overcome antibiotic resistance.",
"id": "10028106",
"label": "a",
"name": "Triple therapy with a PPI, amoxicillin, clarithromycin or metronidazole",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Monotherapy with a PPI is not sufficient for eradicating *H. pylori* infection. PPIs can reduce acid production and improve symptoms but do not directly target the bacteria.",
"id": "10028107",
"label": "b",
"name": "Monotherapy with a proton pump inhibitor (PPI)",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
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"demo": null,
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"id": "4019",
"name": "H. Pylori",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 45-year-old female presents to the gastroenterology clinic with a history of epigastric pain and occasional nausea, which has persisted for the past few months.\n\nAn upper gastrointestinal endoscopy reveals gastritis, and a biopsy confirms the presence of *Helicobacter pylori (H. pylori)* infection.\n\nShe has no known allergies or intolerances to medications.\n\nWhich of the following treatment regimens is the most appropriate first-line therapy for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
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173,467,159 | false | 28 | null | 6,495,234 | null | false | [] | null | 18,020 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Emergency contraception is not needed in this case because she has not had any recent unprotected sex since missing her COCP pills.",
"id": "10028114",
"label": "d",
"name": "Take today's pill and yesterday's pill, and take an emergency contraceptive pill",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "She should take today's pill and yesterday's pill, even if it means taking 2 pills in 24 hours to catch up on the missed doses. No emergency contraception is needed as she has not had any unprotected sex.",
"id": "10028111",
"label": "a",
"name": "Take today's pill and yesterday's pill. No emergency contraception is needed",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She should take today's pill and yesterday's pill. Emergency contraception is intended for use after unprotected sex, which has not occurred in this case.",
"id": "10028115",
"label": "e",
"name": "Skip today's pill and take an emergency contraceptive pill",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Skipping today's pill and using condoms does not solve the issue at hand. She would need to take today's pill as normal and yesterday's missed pill. Although using condoms is good practice to protect against STIs, no additional contraceptive precautions would be needed if there was consistent, correct use in the previous 7 days.",
"id": "10028113",
"label": "c",
"name": "Skip today's pill and use condoms for the next 7 days",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "She should be advised to take today's pill **and** yesterday's missed pill.",
"id": "10028112",
"label": "b",
"name": "Take today's pill only",
"picture": null,
"votes": 19
}
],
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"demo": null,
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"id": "5999",
"name": "Missed oral contraceptive pills",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
"totalCards": null,
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"question": "A 22-year-old female presents to the GP after forgetting to take some of her oral contraceptive pills. She presents at 11 a.m. and usually takes her COCP pill at 9 a.m. every day. She missed her COCP pills on days 11 and 12 of her cycle. She is now on day 13 of her cycle. She has not had any recent unprotected sex.\n\nWhich of the following management options is most appropriate for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 73,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,160 | false | 29 | null | 6,495,234 | null | false | [] | null | 18,021 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A DEXA scan measures bone mineral density and is used to diagnose osteoporosis. Whilst the patient has risk factors for osteoporosis (fracture and stooped posture), the forward flexion of the spine suggests an additional issue.",
"id": "10028117",
"label": "b",
"name": "Order a DEXA scan",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bisphosphonates are used to treat osteoporosis. The diagnosis should be confirmed first before starting treatment.",
"id": "10028119",
"label": "d",
"name": "Prescribe bisphosphonate medication",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lifestyle modifications are essential for overall health, but the stooped posture and fractures suggest an underlying condition requiring evaluation.",
"id": "10028120",
"label": "e",
"name": "Recommend lifestyle modifications, including dietary changes",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reasonable next step to address the patient's risk of falls. However, the underlying condition of the patient's presentation should be investigated first.",
"id": "10028118",
"label": "c",
"name": "Initiate physiotherapy and balance exercises",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An MRI can help evaluate the spine for possible compression fractures and other structural abnormalities. Given the patient's stooped posture and fractures, this is the most appropriate step.",
"id": "10028116",
"label": "a",
"name": "Order an MRI of the spine",
"picture": null,
"votes": 10
}
],
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"demo": null,
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"id": "4616",
"name": "Osteoporosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
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"question": "A 67-year-old man presents with a stooped posture and a history of falling twice in the last year, leading to a fractured arm.\n\nHe is not taking any medications and is independent at home.\n\nOn examination, there is a forward flexion of the thoracolumbar spine and a loss of height. There is no evidence of muscle weakness or sensory deficits.\n\nWhat is the next appropriate step in the management of this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
"userPoint": null
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173,467,161 | false | 30 | null | 6,495,234 | null | false | [] | null | 18,022 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would help detect features like anaemia and leukocytosis, which may be seen in TB. However, it is a non-specific test and alone cannot confirm the diagnosis of pulmonary tuberculosis.",
"id": "10028122",
"label": "b",
"name": "Full blood count",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a chest X-ray is a valuable diagnostic tool and can show characteristic findings of TB, such as infiltrates, cavities and pleural effusions, it is not as specific as a sputum sample in confirming the presence of *Mycobacterium tuberculosis*.",
"id": "10028124",
"label": "d",
"name": "Chest X-ray",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary function tests are not typically used as the primary diagnostic tests for TB. PFTs are used to assess lung function and are more useful for conditions like COPD, asthma and interstitial lung diseases.",
"id": "10028125",
"label": "e",
"name": "Pulmonary function tests (PFT)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Serum urea and electrolytes is not a primary diagnostic test for TB.",
"id": "10028123",
"label": "c",
"name": "Urea and electrolytes",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Sputum samples can be examined under microscopy for the presence of acid-fast bacilli, characteristic of *Mycobacterium tuberculosis*. It is a specific diagnostic test for confirming pulmonary TB.",
"id": "10028121",
"label": "a",
"name": "Sputum samples and microscopy",
"picture": null,
"votes": 61
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "3697",
"name": "Tuberculosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 35-year-old man presents to a respiratory clinic with a 2-month history of persistent cough, weight loss and night sweats. He mentions that he was in contact with a family member with confirmed pulmonary tuberculosis (TB) 6 months ago.\n\nOn examination, he has decreased breath sounds and dullness to percussion over the right upper lung field.\n\nWhich of the following investigations is the most specific for confirming the most likely diagnosis in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 74,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,162 | false | 31 | null | 6,495,234 | null | false | [] | null | 18,023 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Given this patient's age, an ultrasound of the breast is the most appropriate next step. An ultrasound is used over a mammogram in women under 40 as younger individuals have denser breast tissue.",
"id": "10028126",
"label": "a",
"name": "Ultrasound of the breast",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Breast tomosynthesis is an advanced form of mammography that can provide 3D images of the breast tissue. It may be used along standard mammography but is not typically performed first-line.",
"id": "10028130",
"label": "e",
"name": "Breast tomosynthesis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thermography is not a recommended initial imaging test for the evaluation of breast lumps. It is considered less reliable than other imaging methods for diagnosing breast cancer.",
"id": "10028129",
"label": "d",
"name": "Breast thermography",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An MRI of the breast is a highly sensitive test used to evaluate breast lesions. It is typically used when mammography or ultrasound findings are inconclusive.",
"id": "10028128",
"label": "c",
"name": "Breast MRI",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mammography is commonly used for breast lump screening in women over 40. Mammograms are less sensitive in younger individuals who have denser breast tissue.",
"id": "10028127",
"label": "b",
"name": "Mammogram",
"picture": null,
"votes": 27
}
],
"comments": [],
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"chapterId": 2693,
"demo": null,
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"id": "3779",
"name": "Breast Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "151",
"name": "Breast Disease",
"typeId": 7
},
"topicId": 151,
"totalCards": null,
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"question": "A 32-year-old woman presents to the breast clinic after discovering a small fixed lump in her right breast six weeks ago.\n\nShe has no significant past medical history.\n\nAfter taking a thorough history and doing a clinical examination of the lump, which of the following is most appropriate for further evaluation of the breast lump?",
"sbaAnswer": [
"a"
],
"totalVotes": 72,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,163 | false | 32 | null | 6,495,234 | null | false | [] | null | 18,024 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Coeliac disease is an autoimmune condition triggered by gluten consumption. It can lead to gastrointestinal symptoms (abdominal pain, bloating) and systemic symptoms, like fatigue. Dermatitis herpetiformis, an itchy skin rash, is a characteristic feature of coeliac diseases.",
"id": "10028131",
"label": "a",
"name": "Coeliac disease",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Crohn's disease is a type of inflammatory bowel disease that can cause abdominal symptoms. However, it is less likely to present with an itchy rash.",
"id": "10028135",
"label": "e",
"name": "Crohn's Disease",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Food allergies can cause various symptoms, including skin rashes. However, coeliac disease is specifically associated with gluten, not other food allergens. The combination of abdominal symptoms and a rash is more suggestive of coeliac disease.",
"id": "10028133",
"label": "c",
"name": "Food allergy",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gastroenteritis can cause abdominal pain and sometimes fatigue, but it is typically associated with diarrhoea and vomiting rather than a persistent itchy rash.",
"id": "10028132",
"label": "b",
"name": "Gastroenteritis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IBS can cause abdominal pain and bloating; however, it does not present with an itchy rash. It is a diagnosis of exclusion.",
"id": "10028134",
"label": "d",
"name": "Irritable bowel syndrome (IBS)",
"picture": null,
"votes": 1
}
],
"comments": [],
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6035",
"name": "Dermatitis herpetiformis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
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"caption": null,
"createdAt": 1701429875,
"id": "2315",
"index": 0,
"name": "Dermatitis-herpetiformis2.jpeg",
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"updatedAt": 1708375229
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"question": "A 23-year-old female presents to the GP with a history of intermittent abdominal pain, bloating and fatigue.\n\nShe also reports having an itchy rash on her knees and her buttocks.\n\n[lightgallery]\n\nWhat is the most likely diagnosis for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,164 | false | 33 | null | 6,495,234 | null | false | [] | null | 18,025 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms and DRE findings are more suggestive of prostate cancer than prostatitis. Prostatitis symptoms include fever, pelvic pain or discomfort, urinary symptoms (frequency, urgency, dysuria, haematuria, hesitancy) and flu-like symptoms.",
"id": "10028137",
"label": "b",
"name": "Prescribe antibiotics for prostatitis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "5-alpha reductase inhibitors are typically used to treat benign prostatic hyperplasia, not prostate cancer. Initiating treatment without a confirmed diagnosis would not be appropriate.",
"id": "10028139",
"label": "d",
"name": "Initiate treatment with a 5-alpha reductase inhibitor",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These findings are concerning for prostate cancer. To get a definitive diagnosis or rule out prostate cancer, a transrectal ultrasound-guided prostate biopsy is needed. This procedure involves taking small samples of prostate tissue to determine if cancer cells are present. This is the most appropriate next step in the evaluation of a patient with suspected prostate cancer.",
"id": "10028136",
"label": "a",
"name": "Perform a transrectal ultrasound-guided prostate biopsy",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Radiotherapy is a treatment option for prostate cancer but would not be attempted before a confirmed diagnosis and discussion of appropriate treatment options.",
"id": "10028138",
"label": "c",
"name": "Refer the patient for radiotherapy",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bone scans are important for staging cancers but are typically done after a confirmed diagnosis. The initial step is to obtain a tissue diagnosis through a biopsy.",
"id": "10028140",
"label": "e",
"name": "Order a bone scan to evaluate for metastatic disease",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3755",
"name": "Prostate cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"difficulty": 1,
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"question": "A 70-year-old male presents to the urology clinic with lower urinary tract symptoms of increased frequency, nocturia and a weak urinary stream.\n\nOn digital rectal examination (DRE), his prostate feels firm and nodular. His prostate-specific antigen (PSA) level is found to be elevated at 7.5 ng/mL.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 73,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,165 | false | 34 | null | 6,495,234 | null | false | [] | null | 18,026 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sialadenitis is an inflammation of the salivary glands and does not typically result in a midline neck mass.",
"id": "10028144",
"label": "d",
"name": "Sialadenitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lymphoma is a type of cancer. It can present as a neck mass but does not have the same soft, painless and fluctuant characteristics described in this case.",
"id": "10028143",
"label": "c",
"name": "Lymphoma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dermoid cysts can occur in various locations, including the neck, but they are typically firm and may contain various tissue types, including skin, hair and sebaceous material.",
"id": "10028142",
"label": "b",
"name": "Dermoid cyst",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The thyroglossal duct is an embryological structure that connects the thyroid gland to the tongue during development. Sometimes, a remnant of this duct can persist, forming a midline neck mass, often near the hyoid bone. These masses are typically soft and fluctuant.",
"id": "10028141",
"label": "a",
"name": "Thyroglossal duct",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Branchial cysts are typically lateral neck masses that result from developmental remnants of the branchial arches.",
"id": "10028145",
"label": "e",
"name": "Branchial cyst",
"picture": null,
"votes": 8
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5792",
"name": "Thyroid gland",
"status": null,
"topic": {
"__typename": "Topic",
"id": "201",
"name": "Head and neck anatomy",
"typeId": 7
},
"topicId": 201,
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"question": "An 8-year-old boy presents with a mobile midline mass in the neck.\n\nThe mass is painless, soft and fluctuant.\n\nWhat is the most likely cause of the mass?",
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"a"
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"totalVotes": 73,
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173,467,166 | false | 35 | null | 6,495,234 | null | false | [] | null | 18,027 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Piperacillin/tazobactam could be used to treat neutropenic sepsis as it provides adequate coverage for the range of pathogens that can cause sepsis in neutropenic sepsis. However, it is not commonly used in combination with doxycycline.",
"id": "10028150",
"label": "e",
"name": "Doxycycline and piperacillin/tazobactam",
"picture": null,
"votes": 16
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gentamicin is an aminoglycoside antibiotic that may be used in combination therapy for neutropenic sepsis, but it is typically combined with a beta-lactam antibiotic like cefepime, not clindamycin. This combination does not provide broad coverage.",
"id": "10028147",
"label": "b",
"name": "Gentamicin and clindamycin",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
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"explanation": "This patient has neutropenic sepsis and active breast cancer. She is a high-risk patient, so she should be treated with empirical broad-spectrum antibiotics and hospitalised for further management. Treatment with piperacillin/tazobactam (Tazocin) is used as empiric therapy for febrile neutropenia in cancer patients because it provides coverage against a wide range of potential pathogens. Note: You should always check your local hospital guidelines and healthcare institution algorithms before deciding which antibiotics to prescribe.",
"id": "10028146",
"label": "a",
"name": "Piperacillin/tazobactam",
"picture": null,
"votes": 41
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amoxicillin-clavulanate (Co-amoxiclav) is not typically used as initial empiric therapy for neutropenic sepsis, as it lacks the broad-spectrum coverage needed for this high-risk condition.",
"id": "10028148",
"label": "c",
"name": "Amoxicillin-clavulanate",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This combination lacks coverage against resistant Gram-positive bacteria and some Gram-negative pathogens.",
"id": "10028149",
"label": "d",
"name": "Azithromycin and ceftriaxone",
"picture": null,
"votes": 6
}
],
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"question": "An 81-year-old woman presents to the emergency department reporting a high fever, chills and weakness. She has a medical history of breast cancer and is receiving chemotherapy. She has no known allergies.\n\n\nPhysical examination reveals hypotension and signs of sepsis. Blood tests show a neutrophil count of 0.2 x 10^9/L *(normal range = 2.0-7.5 x 10^9/L)*.\n\n\nWhich of the following is the most appropriate initial treatment for this patient?",
"sbaAnswer": [
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173,467,167 | false | 36 | null | 6,495,234 | null | false | [] | null | 18,028 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "All pregnant women in England who are carriers of the sickle cell gene are offered a screening test for sickle cell disease. This is a different test from the combined screening test.",
"id": "10028155",
"label": "e",
"name": "Sickle cell disease",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patau's syndrome also gives similar results. However, serum B-HCG is low, not increased.",
"id": "10028153",
"label": "c",
"name": "Patau's Syndrome",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Klinefelter syndrome is not screened for in the combined test.",
"id": "10028154",
"label": "d",
"name": "Klinefelter syndrome",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Edwards' syndrome gives similar results. However, serum B-HCG is low, not increased.",
"id": "10028152",
"label": "b",
"name": "Edwards' syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combined test screens for Down's, Edwards', and Patau's syndromes. It is offered to pregnant women between 11 and 14 weeks. These test results are suggestive of the baby having a higher chance of Down's syndrome.",
"id": "10028151",
"label": "a",
"name": "Down's syndrome",
"picture": null,
"votes": 64
}
],
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"id": "6037",
"name": "Down's Syndrome",
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"question": "A 35-year-old woman who is G1P2 is offered the combined screening test when she is 11+2 weeks.\n\n**Her results show:**\n\n* Thickened nuchal translucency\n* Increased serum B-HCG\n* Reduced pregnancy-associated plasma protein A (PAPP-A)\n\nWhich of the following conditions is her baby at higher risk of?",
"sbaAnswer": [
"a"
],
"totalVotes": 70,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,168 | false | 37 | null | 6,495,234 | null | false | [] | null | 18,029 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diazepam is a benzodiazepine used to treat conditions like anxiety and seizures.",
"id": "10028158",
"label": "c",
"name": "Administer diazepam",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atropine is used to treat conditions such as bradycardia and to counteract the effects of excessive cholinergic stimulation.",
"id": "10028160",
"label": "e",
"name": "Administer atropine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Performing a chest X-ray may help diagnose certain respiratory conditions or chest injuries, but is not the primary intervention for opioid overdose.",
"id": "10028159",
"label": "d",
"name": "Perform a chest X-ray",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The clinical presentation of decreased respiratory rate, constricted pupils, confusion and evidence of needle marks is highly suggestive of opioid overdose. Naloxone is an opioid receptor antagonist that can rapidly reverse the effects of opioids.",
"id": "10028156",
"label": "a",
"name": "Administer naloxone",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Epinephrine (adrenaline) is used in other situations, such as severe allergic reactions.",
"id": "10028157",
"label": "b",
"name": "Administer epinephrine",
"picture": null,
"votes": 1
}
],
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"id": "6038",
"name": "Pharmacology of illicit substance misuse",
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"typeId": 5
},
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"question": "A 19-year-old male is brought to the emergency department with a decreased respiratory rate, constricted pupils and confusion.\n\nOn examination, there is evidence of needle track marks on his right arm.\n\nWhat is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 73,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,169 | false | 38 | null | 6,495,234 | null | false | [] | null | 18,030 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This wait-and-see approach without immediate intervention would not be the best choice as there are concerns about potential cerebral palsy due to the child showing hand preference prematurely.",
"id": "10028162",
"label": "b",
"name": "Reassure the parents and continue monitoring the child's development",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This child is showing a preference for one hand, which may be suggestive of spastic hemiplegia, which is a type of cerebral palsy. Referral to OT, PT, and speech therapy is a comprehensive approach involving specialised assessments and interventions to support the child's motor and language development.",
"id": "10028161",
"label": "a",
"name": "Referral to occupational therapy (OT), physiotherapy (PT) and speech therapy",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Evaluating the child's language skills to determine if there are any language-related delays or concerns is a valid consideration, but recognising and addressing the hand preference is more important in this case.",
"id": "10028165",
"label": "e",
"name": "Evaluate the child's language development",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This option would not address the fine motor developmental concerns in this child.",
"id": "10028163",
"label": "c",
"name": "Perform a hearing assessment",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In some cases, observing the child's development over an extended period can be valuable. However, early intervention is advised if there are concerns about cerebral palsy or developmental delays.",
"id": "10028164",
"label": "d",
"name": "Observe the child's development for the next 6 months",
"picture": null,
"votes": 25
}
],
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"id": "4125",
"name": "Developmental milestones - fine motor and vision",
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"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
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"question": "A 12-month-old child attends the GP with his parents. They are concerned that although he is walking, he is unsteady. He can say \"mama\" and \"dada\", waves \"bye-bye\" with his left hand and primarily picks up toys in his left hand.\n\nWhat is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 72,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,170 | false | 39 | null | 6,495,234 | null | false | [] | null | 18,031 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "MRI can provide detailed imaging of soft tissues but is not the initial choice in cases of suspected orbital cellulitis.",
"id": "10028168",
"label": "c",
"name": "MRI brain",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Blood cultures are important for identifying the causative pathogen in systemic infections and would be obtained before starting antibiotic therapy when starting treatment.",
"id": "10028167",
"label": "b",
"name": "Blood culture",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These symptoms are suggestive of orbital cellulitis - an infection involving the tissues behind the orbital septum. It is important to differentiate orbital cellulitis from periorbital cellulitis because the latter requires emergency admission under ophthalmology and can lead to loss of sight. A CT with contrast can help to identify the extent of the infection and assess for the presence of abscesses or other complications.",
"id": "10028166",
"label": "a",
"name": "CT sinus and orbits with contrast",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A slit lamp examination is a specialised examination which assesses the anterior segment of the eye, including the cornea, anterior chamber, iris and lens. However, orbital cellulitis primarily involves tissues within the orbit located behind the orbital septum.",
"id": "10028170",
"label": "e",
"name": "Slit lamp examination",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Visual field testing is used to assess a patient's field of vision. It may be considered later to assess the impact of the orbital cellulitis on the patient's vision, but it is not the first-line investigation in this case.",
"id": "10028169",
"label": "d",
"name": "Visual field testing",
"picture": null,
"votes": 3
}
],
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"id": "6039",
"name": "Orbital and preseptal cellulitis",
"status": null,
"topic": {
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"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
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"question": "A 39-year-old man presents with a sore, painful eye. He also reports that he has been feeling feverish and has had changes in his vision.\n\nOn examination, you note swelling and erythema around his right eye. The pain in his eye is worse upon movement.\n\nGiven his symptoms, what is the most appropriate initial investigation to confirm the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 70,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,171 | false | 40 | null | 6,495,234 | null | false | [] | null | 18,032 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Endoscopic findings in eosinophilic oesophagitis are more likely to show oesophageal rings, furrows and white exudates.",
"id": "10028175",
"label": "e",
"name": "Eosinophilic oesophagitis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Achalasia is characterised by dysphagia, regurgitation and chest pain. It occurs due to a failure of lower oesophageal sphincter relaxation and the loss of oesophagal peristalsis. This results in the accumulation of food and liquid in the oesophagus.",
"id": "10028171",
"label": "a",
"name": "Achalasia",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oesophageal cancer can present with dysphagia but is commonly associated with a variety of other systemic symptoms. The endoscopic findings described are not typical for oesophageal cancer.",
"id": "10028174",
"label": "d",
"name": "Oesophageal cancer",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst GORD can cause symptoms such as heartburn and regurgitation, the classic symptoms of GORD usually do not include progressive dysphagia.",
"id": "10028172",
"label": "b",
"name": "Gastroesophageal reflux disease (GORD)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oesophageal strictures can lead to dysphagia, but endoscopic findings would likely reveal a narrow or scarred oesophagus rather than dilatation.",
"id": "10028173",
"label": "c",
"name": "Oesophageal stricture",
"picture": null,
"votes": 18
}
],
"comments": [],
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},
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"entitlement": null,
"id": "4006",
"name": "Achalasia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 59-year-old man presents with a 6-month history of retrosternal chest pain, regurgitation of undigested food and progressive dysphagia. The symptoms worsen when lying down and improve when sitting upright.\n\nOn examination, the patient has no abdominal tenderness and no masses are found.\n\nUpper endoscopy reveals a dilated oesophagus with retained food.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 73,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,172 | false | 41 | null | 6,495,234 | null | false | [] | null | 18,033 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "EBV can cause a sore throat. It is more commonly associated with symptoms such as swollen lymph nodes and severe fatigue.",
"id": "10028177",
"label": "b",
"name": "Epstein-Barr virus (EBV)",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Allergic rhinitis primarily presents with symptoms like sneezing, itchy or watery eyes and nasal congestion.",
"id": "10028180",
"label": "e",
"name": "Allergic rhinitis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HSV can cause oral lesions but is less likely to cause a sore throat with white spots on the tonsils. Infection with HSV usually presents with painful oral ulcers.",
"id": "10028179",
"label": "d",
"name": "Herpes simplex virus (HSV)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Adenovirus can cause a sore throat but typically presents with symptoms like conjunctivitis.",
"id": "10028178",
"label": "c",
"name": "Adenovirus",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These symptoms are consistent with streptococcal pharyngitis, commonly caused by Group A streptococcus. The presence of pus-like spots on the tonsils is characteristic of bacterial infections. It is often referred to as \"strep throat.\"",
"id": "10028176",
"label": "a",
"name": "Group A Streptococcus",
"picture": null,
"votes": 54
}
],
"comments": [],
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"id": "6040",
"name": "Streptococcal sore throat",
"status": null,
"topic": {
"__typename": "Topic",
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"name": "Infectious disease",
"typeId": 7
},
"topicId": 147,
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"question": "A 19-year-old male presents to an urgent care clinic after experiencing a sore throat, fever and difficulty swallowing for the past two days.\n\nOn examination, he has a temperature of 38.6 C. His throat is erythematous, and there are white, pus-like spots on his tonsils.\n\nWhich of the following is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,173 | false | 42 | null | 6,495,234 | null | false | [] | null | 18,034 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bronchoscopy allows for direct visualisation of the airways and collection of samples. It is often used to evaluate airway abnormalities, retrieve specimens for culture or biopsy, and assess for conditions like lung cancer.",
"id": "10028183",
"label": "c",
"name": "Bronchoscopy",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An ABG is not typically the initial diagnostic test for pulmonary fibrosis.",
"id": "10028184",
"label": "d",
"name": "ABG",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Echocardiography is a diagnostic tool for assessing heart function and structural abnormalities.",
"id": "10028185",
"label": "e",
"name": "Echocardiography",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pulmonary function tests (PFTs), including spirometry and lung volumes, are valuable tools for assessing lung function and identifying restrictive lung diseases, including pulmonary fibrosis. This patient's symptoms and radiological findings suggest the presence of pulmonary fibrosis. PFTs can help confirm the diagnosis by revealing restrictive lung patterns with decreased lung volumes and impaired gas exchange.",
"id": "10028181",
"label": "a",
"name": "Pulmonary function tests",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sputum culture is typically used to identify respiratory infections, such as pneumonia. The symptoms and radiological findings here are more indicative of a chronic, non-infectious condition like pulmonary fibrosis.",
"id": "10028182",
"label": "b",
"name": "Sputum culture",
"picture": null,
"votes": 5
}
],
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"name": "Pulmonary Fibrosis",
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"id": "132",
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"question": "A 50-year-old man presents with a 7-month history of a persistent dry cough and exertional dyspnoea. He has no chest pain, fever, or haemoptysis. He is a non-smoker. He has had occupational exposure to asbestos.\n\nOn lung auscultation, there are fine inspiratory crackles.\n\nHigh-resolution CT shows a honeycomb pattern in the lungs.\n\nWhat is the most appropriate initial diagnostic test for confirming the diagnosis in this patient?",
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173,467,174 | false | 43 | null | 6,495,234 | null | false | [] | null | 18,035 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is highly suggestive of bacterial vaginosis (BV). Oral metronidazole is the first-line treatment for this condition.",
"id": "10028186",
"label": "a",
"name": "Oral metronidazole",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IM ceftriaxone is the recommended treatment for gonorrhoea - a sexually transmitted infection caused by the bacterium *Neisseria gonorrhoeae*. When viewed under microscopy, *Neisseria gonorrhoea* appears as gram-negative diplococci.",
"id": "10028188",
"label": "c",
"name": "IM ceftriaxone",
"picture": null,
"votes": 8
},
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"__typename": "QuestionChoice",
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"explanation": "Given the clinical presentation and presence of clue cells, this is unlikely to be a normal physiological variation. Appropriate treatment for suspected BV is indicated.",
"id": "10028190",
"label": "e",
"name": "No treatment",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hormonal therapy with progesterone is not indicated for the treatment of vaginal discharge.",
"id": "10028189",
"label": "d",
"name": "Intravaginal progesterone therapy",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This treatment is used for vaginal yeast infections. This presents with symptoms such as itching and the presence of white, cottage cheese-like discharge.",
"id": "10028187",
"label": "b",
"name": "Topical antifungal cream",
"picture": null,
"votes": 7
}
],
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"name": "Bacterial vaginosis",
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"id": "163",
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"question": "A 25-year-old female presents with a 3-day history of abnormal vaginal discharge. She describes the discharge as thin and watery. She does not describe itchiness.\n\nMicroscopic examination of the discharge reveals the presence of clue cells.\n\nWhat is the most appropriate management for this patient?",
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"a"
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173,467,175 | false | 44 | null | 6,495,234 | null | false | [] | null | 18,036 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Polycystic ovary syndrome is a condition that primarily affects females and is characterised by hormonal imbalances, ovarian cysts and features such as irregular menstrual cycles, hirsutism and acne.",
"id": "10028194",
"label": "d",
"name": "Polycystic ovary syndrome",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Testicular cancer typically presents with masses in the testicles or pain and discomfort.",
"id": "10028192",
"label": "b",
"name": "Testicular cancer",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudogynecomastia refers to fat deposits in the breast area without glandular breast tissue enlargement. It can be caused by obesity, but this patient's BMI is 23, so obesity is not a likely cause of his breast swelling.",
"id": "10028195",
"label": "e",
"name": "Pseudogynecomastia",
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"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Gynaecomastia is the development of enlarged breast tissue in males. Spironolactone can cause gynecomastia as a side effect.",
"id": "10028191",
"label": "a",
"name": "Gynaecomastia due to spironolactone",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gynaecomastia is not a common or specific feature of hypothyroidism. Given this patient's BMI of 23, hypothyroidism is quite unlikely.",
"id": "10028193",
"label": "c",
"name": "Hypothyroidism",
"picture": null,
"votes": 0
}
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"name": "Gynaecomastia",
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"question": "A 45-year-old man presents to his GP expressing concerns that he has swollen breasts. He has no other symptoms. His BMI is 23.\n\nHe has a past medical history of ascites and hypertension.\n\nHe is currently taking furosemide and spironolactone.\n\nWhich of the following is the most likely cause of this patient's symptoms?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,467,176 | false | 45 | null | 6,495,234 | null | false | [] | null | 18,037 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hurthle cell thyroid cancer is a subtype of follicular thyroid cancer. A rapidly enlarging neck lump is less typical for this subtype.",
"id": "10028200",
"label": "e",
"name": "Hurthle cell thyroid cancer",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Papillary thyroid cancer is the most common type of well-differentiated thyroid cancer. It is more common in women and is more common in people in their 30s and 40s.",
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"label": "a",
"name": "Papillary thyroid cancer",
"picture": null,
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"__typename": "QuestionChoice",
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"explanation": "Anaplastic thyroid cancer is a poorly differentiated and highly aggressive type of thyroid cancer.",
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"label": "d",
"name": "Anaplastic thyroid cancer",
"picture": null,
"votes": 2
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Medullary thyroid cancer is a type of thyroid cancer arising from the parafollicular C cells and typically does not present with hoarseness.",
"id": "10028198",
"label": "c",
"name": "Medullary thyroid cancer",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Follicular thyroid cancer is another type of well-differentiated thyroid cancer. It is more common in people aged between 40 and 60.",
"id": "10028197",
"label": "b",
"name": "Follicular thyroid cancer",
"picture": null,
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}
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"question": "A 38-year-old woman presents with a 2-month history of hoarseness and a rapidly enlarging neck lump.\n\nCore biopsy results reveal the lump is a well-differentiated thyroid cancer.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
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173,467,177 | false | 46 | null | 6,495,234 | null | false | [] | null | 18,038 | {
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"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A stool culture can be used to diagnose gastrointestinal infections. It is not relevant for assessing complications of Kawasaki disease.",
"id": "10028205",
"label": "e",
"name": "Stool culture",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An FBC can provide information about the presence of infection and inflammation but is not a primary investigation to assess for coronary artery aneurysms in Kawasaki disease.",
"id": "10028202",
"label": "b",
"name": "Full blood count (FBC)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A throat swab can be used to identify streptococcal throat infections such as streptococcal pharyngitis. Whilst streptococcal infections can cause a fever and red throat, this presentation is more consistent with Kawasaki disease.",
"id": "10028203",
"label": "c",
"name": "Throat swab",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "These symptoms are concerning for Kawasaki disease - an inflammatory condition that can affect the blood vessels, including the coronary arteries. One of the potential complications of this disease is coronary artery aneurysms. An echocardiogram is the most appropriate investigation to assess for this complication.",
"id": "10028201",
"label": "a",
"name": "Echocardiogram",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A chest X-ray is not the primary investigation to assess for coronary artery aneurysms, which are a specific concern in Kawasaki disease.",
"id": "10028204",
"label": "d",
"name": "Chest X-ray",
"picture": null,
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}
],
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{
"__typename": "QuestionComment",
"comment": "How could you determine this was Kawasaki disease and not Scarlet Fever? Thanks! ",
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"__typename": "QuestionComment",
"comment": "Hi there! Kawasaki disease has a typical fever lasting >5 days, unlike scarlet fever, and is diagnosed based on the specific clinical criteria described above. With scarlet fever, although there is overlap, it would be very rare to have the features above, without evidence of pharyngitis, and diagnosis would then be confirmed with e.g. throat swab. The rash (at least in exams) is often described as 'sandpaper-like' too. Hope that helps!",
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"question": "A 3-year-old girl presents with a rash, red tongue and a fever lasting for the past 6 days.\n\nWhat is the most appropriate investigation to assess for a potential complication of the likely diagnosis?",
"sbaAnswer": [
"a"
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173,467,178 | false | 47 | null | 6,495,234 | null | false | [] | null | 18,039 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Staphylococcus aureus* is a bacterial pathogen which does not cause molluscum contagiosum.",
"id": "10028207",
"label": "b",
"name": "*Staphylococcus aureus*",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HPV can cause various warts and skin lesions but does not cause molluscum contagiosum.",
"id": "10028210",
"label": "e",
"name": "Human Papillomavirus (HPV)",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is consistent with molluscum contagiosum - a viral skin infection caused by the poxvirus. It typically presents with small, dome-shaped, pink or flesh-coloured lesions.",
"id": "10028206",
"label": "a",
"name": "Poxvirus",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Streptococcus pyogenes* can cause streptococcal skin infections. It is not associated with molluscum contagiosum.",
"id": "10028209",
"label": "d",
"name": "*Streptococcus pyogenes*",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "HSV typically causes cold sores and genital herpes.",
"id": "10028208",
"label": "c",
"name": "Herpes simplex virus (HSV)",
"picture": null,
"votes": 14
}
],
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"name": "Molluscum Contagiosum",
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"question": "A 35-year-old male presents to his general practitioner with pink lesions on his arm that have been present for the past 2 weeks. The lesions are not painful but are itchy. He tells the GP that he has noticed similar lesions on the trunk of his 3-year-old son.\n\n**A photo of the lesions is shown below:**\n\n[lightgallery]\n\nWhat organism is the most likely cause of this condition?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,467,179 | false | 48 | null | 6,495,234 | null | false | [] | null | 18,040 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Wellens syndrome is associated with critical stenosis of the left anterior descending coronary artery. Wellens syndrome patterns on ECG are deeply inverted T-waves in leads V2-V3.",
"id": "10028215",
"label": "e",
"name": "Wellens syndrome pattern",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is seen in pericarditis but is not the most specific ECG finding.",
"id": "10028213",
"label": "c",
"name": "PR segment depression",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not associated with pericarditis but may be seen in other cardiac conditions or as a side effect of medications.",
"id": "10028212",
"label": "b",
"name": "Prolonged QT interval",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Diffuse concave ST elevation is the most specific ECG finding associated with pericarditis. The widespread, concave ST segment elevation is typically seen in multiple leads on the ECG.",
"id": "10028211",
"label": "a",
"name": "Diffuse concave ST elevation",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is more indicative of myocardial infarction and chronic myocardial damage.",
"id": "10028214",
"label": "d",
"name": "Pathological Q waves",
"picture": null,
"votes": 12
}
],
"comments": [],
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"name": "Pericarditis",
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"question": "A 33-year-old woman presents with central chest pain. The pain is worse when she breathes in and when she is lying down.\n\nShe has no significant past medical history.\n\n**Her ECG is shown below:**\n\n[lightgallery]\n\nWhich is the most specific ECG finding associated with the underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,180 | false | 49 | null | 6,495,234 | null | false | [] | null | 18,041 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A lumbar puncture may be performed if the CT head scan is inconclusive, but clinical suspicion for the subarachnoid remains high. Lumbar punctures are also helpful when patients present a while after headache onset, as the breakdown of red blood cells in the CSF can be picked up as xanthochromia.",
"id": "10028218",
"label": "c",
"name": "Lumbar puncture",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may help alleviate the headache, but the first priority should be to rule out serious causes of the sudden headache.",
"id": "10028219",
"label": "d",
"name": "Administer pain relief",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation raises concern for a potential subarachnoid haemorrhage, which is a medical emergency. A non-contrast CT head scan is the gold standard for ruling out a subarachnoid haemorrhage, especially considering this patient has presented within 6 hours of headache onset (CT head is almost 100% sensitive and specific for subarachnoid haemorrhages if performed within 6 hours of headache onset). It can quickly detect blood in the subarachnoid space.",
"id": "10028216",
"label": "a",
"name": "Non-contrast CT head scan",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may help to relieve the patient's nausea and vomiting, but it should not replace investigation with a CT head scan.",
"id": "10028220",
"label": "e",
"name": "Adminster an antiemetric",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Waiting for reassessment is inappropriate in this case as it may delay the diagnosis and treatment of a potentially life-threatening condition.",
"id": "10028217",
"label": "b",
"name": "Observation with reassessment",
"picture": null,
"votes": 1
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "4193",
"name": "Subarachnoid haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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"userNote": null,
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"question": "A 45-year-old male presents to the emergency department with a severe occipital headache that started 3 hours ago. He has been experiencing vomiting but reports no sensitivity to light or neck stiffness.\n\nHe has no history of head trauma.\n\nWhat is the most appropriate initial management option for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 73,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,181 | false | 50 | null | 6,495,234 | null | false | [] | null | 18,042 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Delirium is characterised by acute and fluctuating confusion, disorientation, agitation and impaired attention and cognition. In this case, the patient's abrupt onset of confusion and agitation suggests delirium, which is often reversible with appropriate management.",
"id": "10028221",
"label": "a",
"name": "Delirium",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Schizophrenia is a chronic psychiatric disorder characterised by hallucinations, delusions, disorganised thinking, and impaired social functioning. This patient's presentation is not typical of schizophrenia.",
"id": "10028224",
"label": "d",
"name": "Schizophrenia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dementia can also cause confusion and cognitive impairment but has a more gradual onset.",
"id": "10028222",
"label": "b",
"name": "Dementia",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Depression can lead to cognitive changes, including difficulty concentrating. It is less likely to cause acute agitation and confusion.",
"id": "10028223",
"label": "c",
"name": "Depression",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anxiety disorders can lead to heightened states of anxiety, restlessness and excessive worry, but this patient's presentation is more consistent with delirium.",
"id": "10028225",
"label": "e",
"name": "Anxiety disorder",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Chapter",
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"id": "4045",
"name": "Delirium",
"status": null,
"topic": {
"__typename": "Topic",
"id": "191",
"name": "Geriatrics",
"typeId": 7
},
"topicId": 191,
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"question": "A 72-year-old man who is an inpatient on a medical ward has become confused over the last 2 days.\n\nHe is agitated and can be seen walking around the ward, looking for his deceased wife.\n\nWhich of the following most likely explains this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 75,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,202 | false | 1 | null | 6,495,236 | null | false | [] | null | 18,043 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Diarrhoea, weight loss, and iron deficiency anaemia are all suggestive of a diagnosis of coeliac disease, due to malabsorption. This also explains the slightly low serum vitamin B12 level. While the IgA anti-TTG is the most specific blood marker for coeliac disease, it is unreliable in the case of IgA deficiency (as seen in this case). Measurement of IgG antibodies is necessary in this case. The gold standard diagnostic test for coeliac disease is a duodenal biopsy.",
"id": "10028226",
"label": "a",
"name": "Coeliac disease",
"picture": null,
"votes": 2338
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Irritable bowel syndrome is common and could account for the occasional diarrhoea, but not the iron/B12 deficiency or weight loss.",
"id": "10028230",
"label": "e",
"name": "Irritable bowel syndrome",
"picture": null,
"votes": 180
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A change in bowel habit and iron deficiency anaemia does raise suspicions for colorectal carcinoma, however this is not the most likely diagnosis in an 18-year-old patient.",
"id": "10028228",
"label": "c",
"name": "Colorectal carcinoma",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Menorrhagia is a common cause of iron deficiency anaemia in the young female population, however a history of heavy periods has not been provided. Menorrhagia would also not account for the weight loss, diarrhoea, and B12 deficiency.",
"id": "10028227",
"label": "b",
"name": "Menorrhagia",
"picture": null,
"votes": 267
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A change in bowel habit, weight loss, and iron and B12 deficiency do raise suspicions for inflammatory bowel disease and this should remain within the differential. However, this is not the most likely diagnosis given an equivocal test for coeliac disease and the absence of other symptoms (bloody stools, extra-intestinal manifestations, severe diarrhoea).",
"id": "10028229",
"label": "d",
"name": "Inflammatory bowel disease",
"picture": null,
"votes": 838
}
],
"comments": [],
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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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"conditions": [],
"difficulty": 1,
"dislikes": 16,
"explanation": null,
"highlights": [],
"id": "18043",
"isLikedByMe": 0,
"learningPoint": "Coeliac disease can present with fatigue, diarrhoea, weight loss, and iron deficiency anaemia due to malabsorption.",
"likes": 16,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A 18-year old woman visits her GP feeling 'tired all the time'. She has also had occasional diarrhoea and weight loss, but is not experiencing any other symptoms of note. Routine investigations show:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|101 g/L|(M) 130 - 170, (F) 115 - 155|\n|Mean Cell Volume (MCV)|68.9 fL|80 - 96|\n|Serum Vitamin B12|100 ng/L|160 - 925|\n|Serum Folate|5.2 μg/L|(3 - 15|\n|Ferritin|7 μg/L|12 - 200|\n|Thyroid Stimulating Hormone|3.32 mU/L|0.3 - 4.2|\n|Total IgA|0.23 g/L|0.8 - 4|\n\n\n * Serum IgA anti-tissue transglutaminase - NEGATIVE\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 3678,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,203 | false | 2 | null | 6,495,236 | null | false | [] | null | 18,044 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A 'confusion screen' - i.e. blood tests measuring B12, folate, ferritin, and potentially a head CT, are important investigations in patients presenting with altered mental status. However, the most important diagnosis to exclude in this case is SBP, so abdominal paracentesis is the next most appropriate investigation.",
"id": "10028233",
"label": "c",
"name": "Confusion screen",
"picture": null,
"votes": 221
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The combination of a fever and altered GCS do raise suspicions for meningitis, however the patient is encephalopathic (as evidenced by asterixis) and there are no features of meningism mentioned. The most likely source of infection is spontaneous bacterial peritonitis, which must be investigated for using a diagnostic paracentesis.",
"id": "10028234",
"label": "d",
"name": "Lumbar puncture",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ammonia has very limited utility in liver disease. This patient is clinically encephalopathic, so measuring the ammonia does not add any additional information.",
"id": "10028232",
"label": "b",
"name": "Serum ammonia level",
"picture": null,
"votes": 1192
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Any patient presenting with ascites in hospital should have this 'tapped' to check for spontaneous bacterial peritonitis, which has an extremely high mortality rate. The degree of suspicion for SBP in this case is increased by the fact the patient is febrile and has a tender abdomen. A white cell count of >250 with 90% neutrophils would confirm the diagnosis.",
"id": "10028231",
"label": "a",
"name": "Diagnostic paracentesis",
"picture": null,
"votes": 1922
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This will add limited information in the acute setting. Once the patient is stable, an ultrasound may help assess the liver and volume of ascites, however it is not the next most appropriate investigation.",
"id": "10028235",
"label": "e",
"name": "Ultrasound abdomen",
"picture": null,
"votes": 250
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4343",
"name": "Liver Cirrhosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 2,
"explanation": null,
"highlights": [],
"id": "18044",
"isLikedByMe": 0,
"learningPoint": "Spontaneous bacterial peritonitis (SBP) is a bacterial infection of the ascitic fluid in patients with liver disease, and diagnostic paracentesis is performed to analyze the fluid for elevated white blood cell count and the presence of bacteria, confirming the diagnosis and guiding treatment.",
"likes": 7,
"multiAnswer": null,
"pictures": [],
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"question": "A 57-year-old man with a diagnosis of cirrhosis due to alcoholic liver disease is brought to ED by his wife, who is concerned that he is more confused than normal. He has been drinking 8 cans of beer a day for the past 7 years.\n\nOn examination, he has multiple spider naevi and asterixis is present. His abdomen is tense, distended and tender.\n\nObservations:\n\n* Heart rate: 98 beats/minute\n* Blood pressure: 97/68 mmHg\n* Respiratory rate: 18 breaths/minute\n* Temperature: 38.2 degrees\n* Oxygen saturations (room air): 96%\n* GCS: 13/15\n\nWhat is the most important investigation to perform?",
"sbaAnswer": [
"a"
],
"totalVotes": 3626,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,204 | false | 3 | null | 6,495,236 | null | false | [] | null | 18,045 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A contrast study may help to clarify the diagnosis and show strictures or dysmotility, but is not indicated as the OGD has showed a simple sliding hernia.",
"id": "10028240",
"label": "e",
"name": "Arrange for a barium contrast study",
"picture": null,
"votes": 88
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Initiating a proton pump inhibitor (e.g. Omeprazole) would be the most appropriate next step, as the patient has already tried conservative management for her reflux symptoms. PPIs provide symptomatic relief and help prevent complications e.g. stricturing and Barrett's oesophagus.",
"id": "10028236",
"label": "a",
"name": "Prescribe a proton pump inhibitor",
"picture": null,
"votes": 2688
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oesophageal manometry studies may help to provide more information regarding oesophageal manometry, but would usually take place if surgery is being considered. In the first instance, medical management should be attempted.",
"id": "10028239",
"label": "d",
"name": "Arrange oesophageal manometry studies",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A surgical procedure may be required if symptoms are refractory to medical management, but this should be tried first.",
"id": "10028237",
"label": "b",
"name": "Refer for Nissen fundoplication",
"picture": null,
"votes": 594
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Heller cardiomyotomy is used in the management of achalasia, not hiatus hernias.",
"id": "10028238",
"label": "c",
"name": "Refer for Heller cardiomyotomy",
"picture": null,
"votes": 141
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4007",
"name": "Hiatus hernia management",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "18045",
"isLikedByMe": 0,
"learningPoint": "A sliding hiatus hernia occurs when part of the stomach pushes up through the diaphragm into the chest, and PPIs (proton pump inhibitors) are often used to reduce stomach acid, alleviating symptoms such as heartburn and reflux associated with this condition.",
"likes": 1,
"multiAnswer": null,
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"question": "A 53-year-old woman is referred on the two-week-wait pathway for an oesophagogastroduodenoscopy (OGD) for persistent reflux symptoms, which have not responded to lifestyle modification.\n\nThe OGD reports appearances consistent with a sliding hiatus hernia, with no concerns for malignancy.\n\nWhat is the next most appropriate step?",
"sbaAnswer": [
"a"
],
"totalVotes": 3598,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,205 | false | 4 | null | 6,495,236 | null | false | [] | null | 18,047 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anti-infliximab antibodies can be generated in response to therapy with the drug. Measuring these may be indicated if patients have an inadequate response to infliximab. They are not routinely measured at the start of therapy.",
"id": "10028250",
"label": "e",
"name": "Anti-infliximab antibodies",
"picture": null,
"votes": 425
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The majority of the adult population have been infected with EBV. Serology is only useful if an acute infection is suspected. Excluding latent TB is more important.",
"id": "10028247",
"label": "b",
"name": "Epstein Barr virus serology",
"picture": null,
"votes": 165
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Reactivation of latent TB infection is a concern with the use of biologics such as infliximab. Screening with an IGRA (e.g. the Quantiferon test) should be carried out. This is supported by NICE guidelines and the BNF.",
"id": "10028246",
"label": "a",
"name": "Tuberculosis inteferon gamma release assay (IGRA)",
"picture": null,
"votes": 2829
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis A virus causes an acute hepatitis. If there is no suspicion of infection, testing is not appropriate. Hepatitis B virus should be tested for, however, as biologics can cause virus reactivation (due to immunosuppression).",
"id": "10028248",
"label": "c",
"name": "Hepatitis A virus serology",
"picture": null,
"votes": 133
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While it is useful to confirm that patients receiving biologics have received all of their routine immunisations, testing for mumps immunity is not routine before starting biologics.",
"id": "10028249",
"label": "d",
"name": "Mumps antibodies",
"picture": null,
"votes": 17
}
],
"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": "3732",
"name": "Ulcerative Colitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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},
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"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "18047",
"isLikedByMe": 0,
"learningPoint": "A chest X-ray is recommended before starting biologic therapy to check for active tuberculosis, as these medications suppress the immune system and can increase the risk of latent TB reactivation and severe infection.",
"likes": 5,
"multiAnswer": null,
"pictures": [],
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"question": "A patient admitted with acute severe ulcerative colitis has not responded to a prolonged course of intravenous hydrocortisone. Treatment with biologics is being considered.\n\nWhich of the following investigations should be undertaken before biologics can be administered?",
"sbaAnswer": [
"a"
],
"totalVotes": 3569,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,206 | false | 5 | null | 6,495,236 | null | false | [] | null | 18,048 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient likely has hyperactive delirium. Urinary retention is a common cause of delirium in the elderly. Resistance of examination of the suprapubic region suggests there may be a tender, enlarged bladder. A bladder scan will confirm whether this is the case.",
"id": "10028251",
"label": "a",
"name": "Bedside bladder scan",
"picture": null,
"votes": 3034
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An abdominal x-ray may show faecal loading/constipation, another common cause of hyperactive delirium in older patients. However, this would not be the most appropriate next investigation as a bladder scan can be done at the bedside.",
"id": "10028252",
"label": "b",
"name": "X-ray abdomen",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A CT head may be carried out given that this patient is acutely confused, however, considering the history and examination findings, it is not the next most appropriate investigation. A bedside bladder scan can be done extremely quickly and may reveal the underlying cause for the delirium.",
"id": "10028255",
"label": "e",
"name": "CT head",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If a bladder scan does not demonstrate retention and the patient is still resisting examination of the abdomen (suggesting pain), a CT abdomen may be required. This is not currently the case.",
"id": "10028254",
"label": "d",
"name": "CT abdomen (with contrast)",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be a useful investigation to look for renal calculi or hydronephrosis. The history is not suggestive of this at present. The most pressing issue is investigating the cause of the patient's hyperactive delirium, which can be done in the first instance with a bladder scan.",
"id": "10028253",
"label": "c",
"name": "CT Kidneys, Ureters, Bladder (non-contrast)",
"picture": null,
"votes": 374
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
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"question": "A 75-year-old man is admitted to hospital from a nursing home as his carers think she is significantly more confused than normal. She has a history of Alzheimer's disease and multiple strokes.\n\nOn examination, the patient is agitated and is shouting. There is no obvious focal neurology and the patient is moving all four limbs. The patient resists examination of the suprapubic region, pushing the doctor's hands away forcefully.\n\nWhat is the next most appropriate investigation?",
"sbaAnswer": [
"a"
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"totalVotes": 3543,
"typeId": 1,
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173,467,207 | false | 6 | null | 6,495,236 | null | false | [] | null | 18,049 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate as the patient will be left in pain. After disimpaction with an enema, regular laxatives should be prescribed along with opiates to prevent this from happening again.",
"id": "10028260",
"label": "e",
"name": "Stop codeine",
"picture": null,
"votes": 851
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral vancomycin is an appropriate option for managing C.difficile-induced diarrhoea. The most likely diagnosis given the clinical scenario given is overflow diarrhoea.",
"id": "10028259",
"label": "d",
"name": "Oral vancomycin",
"picture": null,
"votes": 829
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While this may seem like a sensible option given the patient has diarrhoea, it is important to recognise that this is likely overflow due to severe constipation. Loperamide will make the situation worse.",
"id": "10028257",
"label": "b",
"name": "Loperamide",
"picture": null,
"votes": 575
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bulk forming laxatives should not be used in opiate-induced constipation or faecal impaction, as they can draw further water out of the stools, exacerbating the issue. Disimpaction is required.",
"id": "10028258",
"label": "c",
"name": "Ispaghula husk",
"picture": null,
"votes": 761
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The history is suggestive of overflow diarrhoea, caused by constipation (and likely faecal impaction) due to poor mobility and opiate use. An enema will relieve the obstructing stool, hopefully providing the patient with some relief.",
"id": "10028256",
"label": "a",
"name": "Phosphate enema",
"picture": null,
"votes": 538
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Would need history of constipation. Unrealistic that pt complains of abdo pain and it doesn't cross anyone's mind to ask if she's opened her bowels",
"createdAt": 1709462877,
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"__typename": "QuestionComment",
"comment": "Abdo pain suggests constipation plus the recent diarrhoea gives clues for overflow diarrhoea (bc of constipation). Hope this helps\n",
"createdAt": 1709575671,
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"comment": "Get this crack head off the codeine and on to good old paracetamol I say! ",
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"comment": "i mean she literally broke her tibia idk if that would do much ",
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"comment": "would you not say that the cause of the constipation is the codeine so whats most likely to relieve her discomfort is stopping the codeine? even if you give enema is there not a chance she'll get constipated agan?",
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"comment": "oh slay learning point tbf ",
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"question": "A 63-year-old woman is admitted to hospital after fracturing her tibia. She has developed progressive abdominal pain and has recently experienced a few episodes of watery diarrhoea. She has a poor appetite and is upset that her abdominal discomfort is interfering with her rehabilitation. She has been using multiple doses of PRN codeine to help with her pain.\n\nWhich intervention is most likely to relieve her discomfort?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,467,208 | false | 7 | null | 6,495,236 | null | false | [] | null | 18,050 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no reason apixaban should be stopped in Alzheimer's disease. An assesment should be made to weigh up the benefits/risks of anticoagulation, keeping in mind that the patient may be more prone to falls. Anticholinergic drugs (e.g. oxybutynin) can exacerbate cognitive decline and should be reviewed.",
"id": "10028264",
"label": "d",
"name": "Apixaban",
"picture": null,
"votes": 120
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Anticholinergic drugs create an effect similar to the acetylcholine decline that is seen in Alzheimer's disease. Pro-cholinergics (e.g. donepezil) are often used in managing Alzheimer's disease. Oxybutynin is likely to be reviewed and stopped/switched to a different drug if the patient still has urinary symptoms.",
"id": "10028261",
"label": "a",
"name": "Oxybutynin",
"picture": null,
"votes": 2962
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no reason why bisoprolol should be stopped in Alzheimer's disease. Anticholinergic drugs (e.g. oxybutynin) can exacerbate cognitive decline and should be reviewed.",
"id": "10028265",
"label": "e",
"name": "Bisoprolol",
"picture": null,
"votes": 212
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no reason why senna should be stopped in Alzheimer's disease. Anticholinergic drugs (e.g. oxybutynin) can exacerbate cognitive decline and should be reviewed.",
"id": "10028262",
"label": "b",
"name": "Senna",
"picture": null,
"votes": 167
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no reason why metformin should be stopped in Alzheimer's disease. Anticholinergic drugs (e.g. oxybutynin) can exacerbate cognitive decline and should be reviewed.",
"id": "10028263",
"label": "c",
"name": "Metformin",
"picture": null,
"votes": 65
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "hey girls, i think donepezil also has diarrhoea as key side effect, so lets not give them senna as well xxxx\n",
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"__typename": "QuestionComment",
"comment": "im a boy",
"createdAt": 1735515044,
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"likes": 1,
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"question": "A 84-year-old woman is seen in the memory clinic after a recent diagnosis of Alzheimer's dementia. She lives at home with her family. As part of the consultation, a medication review is undertaken.\n\nWhich of the following is most likely to be stopped?",
"sbaAnswer": [
"a"
],
"totalVotes": 3526,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,209 | false | 8 | null | 6,495,236 | null | false | [] | null | 18,051 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical therapies are usually used in the management of actinic keratoses and low-grade squamous cell carcinomas, when excision is unsuitable. The BCC must be excised to prevent invasion into the lip.",
"id": "10028268",
"label": "c",
"name": "Topical imiquimod",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The BCC should be excised, however a more precise approach than a wide local excision should be undertaken, given that the carcinoma is close to the lip border. A WLE may be suitable for a lesion on the limbs, for example.",
"id": "10028267",
"label": "b",
"name": "Wide local excision",
"picture": null,
"votes": 493
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although basal cell carcinomas are slow-growing, they can invade structures and should be excised. Observation is not appropriate for this reason, and the lesion should be carefully removed using Mohs surgery.",
"id": "10028270",
"label": "e",
"name": "Observation",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "While basal cell carcinomas are slow-growing, they should be excised. Mohs micrographic surgery is the procedure of choice in this case as the lesion is on the face and in proximity to the border of the lip. This means tissue loss should be minimised to prevent a poor cosmetic and functional outcome.",
"id": "10028266",
"label": "a",
"name": "Mohs micrographic surgery",
"picture": null,
"votes": 2497
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Topical therapies are usually used in the management of actinic keratoses and low-grade squamous cell carcinomas, when excision is unsuitable. The BCC must be excised to prevent invasion into the lip.",
"id": "10028269",
"label": "d",
"name": "Topical 5-flurouracil",
"picture": null,
"votes": 334
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "never heard of this finals in a week :/",
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"name": "Basal cell carcinoma",
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"learningPoint": "Mohs micrographic surgery is the preferred treatment for basal cell carcinoma located on the face to ensure minimal tissue loss and optimal cosmetic results.",
"likes": 3,
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"question": "A patient is reviewed in the dermatology clinic after a diagnosis of a 2mm basal cell carcinoma, close to the border of his lower lip.\n\nWhat is the most appropriate management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 3531,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,210 | false | 9 | null | 6,495,236 | null | false | [] | null | 18,052 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The image shows inflamed phymatous disease, which may require treatment in secondary care with oral isotretinoin, despite good compliance with first line topical and oral therapy.",
"id": "10028271",
"label": "a",
"name": "Refer to dermatology",
"picture": null,
"votes": 3139
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ivermectin is the first choice topical treatment, with metronidazole and azelaic acid reserved for patients for whom this is inappropriate (e.g. breastfeeding or where ivermectin is unavailable). Current guidelines do not suggest switching through the different topical preparation choices.",
"id": "10028272",
"label": "b",
"name": "Switch ivermectin to metronidazole",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ivermectin is the first choice topical treatment, with metronidazole and azelaic acid reserved for patients for whom this is inappropriate (e.g. breastfeeding or where ivermectin is unavailable). Current guidelines do not suggest switching through the different topical preparation choices.",
"id": "10028273",
"label": "c",
"name": "Add azelaic acid",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Doxycycline is the first choice oral antibiotic in moderate to severe disease. It is also the preferred agent when inflamed phymatous disease is present. Tetracyclines are alternative preparations for when doxycycline cannot be used. Current guidelines do not suggest switching between oral agents.",
"id": "10028274",
"label": "d",
"name": "Switch doxycycline to oxytetracycline",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate if there was prominent NON-inflamed phymatous disease. As the nose appears to be inflamed, a dermatology referral should be undertaken first, so the disease can be controlled.",
"id": "10028275",
"label": "e",
"name": "Refer to plastic surgery",
"picture": null,
"votes": 217
}
],
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{
"__typename": "QuestionComment",
"comment": "its mr jp morgan",
"createdAt": 1717012745,
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"learningPoint": "Phymatous rosacea may necessitate referral to dermatology for advanced treatment options, such as oral isotretinoin, when first-line therapies are insufficient.",
"likes": 3,
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"__typename": "Picture",
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"topicId": 144,
"updatedAt": 1708373886
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"question": "A 52-year-old woman with a long history of rosacea visits her GP as she is becoming increasingly distressed with her appearance.\n\nShe reports good compliance with UV-blocking sunscreen, topical brimonidine (used as needed for flushing) and topical ivermectin with oral doxycycline.\n\nOn examination, the following appearance is noted:\n\n[lightgallery]\n\nWhat is the most appropriate next step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 3524,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,211 | false | 10 | null | 6,495,236 | null | false | [] | null | 18,053 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ESR in rheumatic fever is likely to be prolonged, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.",
"id": "10028278",
"label": "c",
"name": "Erythrocyte sedementation rate (ESR)",
"picture": null,
"votes": 172
},
{
"__typename": "QuestionChoice",
"answer": true,
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"id": "10028276",
"label": "a",
"name": "Anti-streptolysin O titre (ASOT)",
"picture": null,
"votes": 2000
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An echocardiogram may show cardiac involvement (which is a major Jones criterion for rheumatic fever), however this has already been evidenced by the findings of a murmur on auscultation. An echocardiogram would not provide more evidence to confirm the diagnosis. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.",
"id": "10028279",
"label": "d",
"name": "Echocardiogram",
"picture": null,
"votes": 1194
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An ECG may show a prolonged PR interval in rheumatic fever due to cardiac involvement, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.",
"id": "10028277",
"label": "b",
"name": "ECG",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would certainly be an important test to carry out. The white cell count in rheumatic fever is likely to be raised, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.",
"id": "10028280",
"label": "e",
"name": "Full blood count",
"picture": null,
"votes": 127
}
],
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"typeId": 7
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"learningPoint": "An anti-streptolysin O (ASOT) titre is a blood test used to detect recent streptococcal throat infection and is often elevated in cases of rheumatic fever, helping to confirm the diagnosis when combined with clinical findings",
"likes": 15,
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"question": "A 7-year-old boy who has been living in a refugee camp is brought to hospital feeling generally unwell. His mother describes a history of a sore throat a few weeks ago. He has no past medical history and had an otherwise normal development.\n\nOn examination, he looks unwell, with multiple swollen joints and a fever. He also has a very short mid-diastolic murmur.\n\nWhich test would help confirm the most likely diagnosis?",
"sbaAnswer": [
"a"
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"totalVotes": 3508,
"typeId": 1,
"userPoint": null
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173,467,212 | false | 11 | null | 6,495,236 | null | false | [] | null | 18,054 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The signs and investigations so far point towards cellulitis. There are no convincing signs of a DVT. It is important to remember that the d-dimer will likely be raised due to infection in this case.",
"id": "10028285",
"label": "e",
"name": "Test d-dimer",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Benzylpenicllin has a fairly narrow spectrum. Most staphylococci are resistant to benzylpenicillin as they produce penicillinases. Flucloxacillin is resistant to these enzymes, and therefore is a good choice for treating cellulitis.",
"id": "10028284",
"label": "d",
"name": "Benzylpenicillin",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate; the patient is febrile, has evidence of cellulitis, and is bactaraemic. Culture results can be used to refine antibiotic choice, however treatment must be started as soon as possible.",
"id": "10028282",
"label": "b",
"name": "Wait for sensitivity results before commencing antibiotics",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not an unreasonable investigation if there is exudate present on the leg, however it is unlikely to change management. Antibiotics need to be administered.",
"id": "10028283",
"label": "c",
"name": "Send a skin swab",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis is cellulitis caused by staphylococci, which is also supported by the growth of clustered cocci. Flucloxacillin has good anti-staphylococcal activity and is usually the first line antibiotic for cellulitis (in the absence of a penicillin allergy).",
"id": "10028281",
"label": "a",
"name": "Flucloxacillin",
"picture": null,
"votes": 3288
}
],
"comments": [],
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"demo": null,
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"id": "6047",
"name": "Cellulitis",
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"id": "194",
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"learningPoint": "The first-line treatment for cellulitis is oral flucloxacillin, but in patients with a penicillin allergy, clindamycin or cephalexin (if the allergy is not severe) are typically used as alternatives.",
"likes": 1,
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"question": "A care home resident is admitted to hospital with rigors and fevers. They have a past medical history of diabetes and ischaemic heart disease. They have no known allergies.\n\nOn examination, they have a tender, erythematous area on the left shin.\n\nInflammatory markers are raised. Blood cultures show gram positive cocci in clusters.\n\nWhat is the most appropriate management at this stage?",
"sbaAnswer": [
"a"
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173,467,213 | false | 12 | null | 6,495,236 | null | false | [] | null | 18,055 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of flu-like symptoms, lymphadenopathy, a macular rash, and potential IV drug use/homelessness raise concerns for HIV seroconversion illness. This affects up to 80% of people who newly acquire the virus. HIV testing should be carried out. If negative, this should be repeated, in case infection has taken place inside the window period.",
"id": "10028286",
"label": "a",
"name": "HIV infection",
"picture": null,
"votes": 2731
},
{
"__typename": "QuestionChoice",
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"explanation": "This describes a phenomenon that occurs within 24 hours of antibiotic treatment in spirochete infections, e.g. syphilis, leptospirosis, and Lyme disease. There is no clinical history to indicate the patient has been treated for such an infection, and the presentation is incompatible with this reaction.",
"id": "10028289",
"label": "d",
"name": "Jarisch Herxheimer reaction",
"picture": null,
"votes": 100
},
{
"__typename": "QuestionChoice",
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"explanation": "Tertiary syphilis presents with significant neurological and cardiovascular complications. This would not explain the symptoms the patient is experiencing. Secondary syphilis (which causes a widespread maculopapular rash) could be a differential, and should be tested for, along with HIV.",
"id": "10028288",
"label": "c",
"name": "Tertiary syphilis",
"picture": null,
"votes": 341
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "EBV infection is a differential given the widespread lymphadenopathy, fevers, and rash. However, symptomatic EBV usually affects the teenage population. The risk factors mean that HIV seroconversion illness is the diagnosis that is most important to investigate for.",
"id": "10028290",
"label": "e",
"name": "Epstein Barr virus infection",
"picture": null,
"votes": 252
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary syphilis presents with a painless ulcer (a chancre), usually on the genitals. This would not explain the symptoms the patient is experiencing. Secondary syphilis (which causes a widespread maculopapular rash) could be a differential, and should be tested for, along with HIV.",
"id": "10028287",
"label": "b",
"name": "Primary syphilis",
"picture": null,
"votes": 68
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Could this be EBV associated lymphoma- hodgkins or burkitt's?",
"createdAt": 1718528440,
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"learningPoint": "Consider HIV infection in patients presenting with flu-like symptoms, lymphadenopathy, and a macular rash, especially in high-risk populations.",
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"question": "A 48-year-old man has had flu-like symptoms for the past week. He visits his GP as he has noticed multiple swellings around his neck and in both armpits. He also reports a low-grade fever.\n\nOn examination, the patient appears to have a widespread macular rash. He also has scars in both antecubital fossae.\n\nHe has not visited a doctor for 20 years and is currently homeless.\n\nWhat is the most important diagnosis to consider?",
"sbaAnswer": [
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173,467,214 | false | 13 | null | 6,495,236 | null | false | [] | null | 18,056 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
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"explanation": "There is no current indication for referral, however this may be necessary in the future. Criteria for referral are either a pH of <7.3 (note that the VBG has been reported to be normal), or all three of: INR >6.5, creatinine >300 umol/L, grade III/IV encephalopathy.",
"id": "10028294",
"label": "d",
"name": "Refer to liver transplant centre",
"picture": null,
"votes": 286
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient has suffered from a (likely unintentional) staggered paracetamol overdose, which means that N-acetylcysteine should be started straight away.",
"id": "10028291",
"label": "a",
"name": "Commence N-acetylcysteine",
"picture": null,
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"__typename": "QuestionChoice",
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"explanation": "This is inappropriate. The history and blood results are suggestive of an staggered overdose which should be treated promptly. Waiting for the paracetamol level is not necessary in a staggered overdose.",
"id": "10028293",
"label": "c",
"name": "Await paracetamol levels",
"picture": null,
"votes": 433
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the single best course of action to take. Activated charcoal may be administered in a single (not staggered) overdose, within an hour of ingestion.",
"id": "10028292",
"label": "b",
"name": "Administer activated charcoal",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate. The history and blood results are suggestive of a staggered paracetamol overdose which should be treated promptly.",
"id": "10028295",
"label": "e",
"name": "Observe for 12 hours",
"picture": null,
"votes": 48
}
],
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{
"__typename": "QuestionComment",
"comment": "You would also commence this in patients presenting after 24 hours with signs of acute liver injury and a raised ALT ",
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"comment": "How do I tell that it is staggered",
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"comment": "They were taking regular doses of paracetamol, which you assume means taken as directed. The issue is the extra cold and flu tablets she was taking which likely include paracetamol. Meaning it would be staggered throughout the courses of these painkillers. Hope that makes sense :))",
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"__typename": "QuestionComment",
"comment": "Staggered means it was taken over a period longer than 1 hour",
"createdAt": 1719265029,
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"learningPoint": "N-acetylcysteine should be started in paracetamol overdose if serum levels are above the treatment line on the nomogram, the timing of ingestion is uncertain, signs of liver damage are present or expected, or a significant amount of paracetamol has been ingested (e.g., >150 mg/kg in adults or >200 mg/kg in children).",
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"question": "A 18-year-old female has been suffering with a cold and is feeling increasingly unwell. She is admitted to hospital after blood tests performed by her GP were abnormal:\n\n\n||||\n|---------------------------|:-------:|--------------------|\n|Alanine Aminotransferase (ALT)|2044 IU/L|10 - 50|\n|Aspartate Aminotransferase (AST)|1023 IU/L|10 - 40|\n|Bilirubin|54 µmol/L|< 17|\n|Creatinine|100 µmol/L|60 - 120|\n|International Normalised Ratio (INR)|2.6|1.0|\n\n\nA venous blood gas taken in the emergency department is normal.\n\n\nOn further questioning, she reports taking regular doses of paracetamol, along with regular over the counter cold and flu tablets over the past week.\n\n\nWhat is the single best course of action to take?",
"sbaAnswer": [
"a"
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173,467,215 | false | 14 | null | 6,495,236 | null | false | [] | null | 18,057 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate; the patient may aspirate if oral intake is encouraged. They should receive IV glucose. Carbohydrates are useful after the intial episode has been managed to help build glucose stores.",
"id": "10028300",
"label": "e",
"name": "Carbohydrate snack (e.g. a slice of toast)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate; the patient may aspirate if oral intake is encouraged. They should receive IV glucose.",
"id": "10028299",
"label": "d",
"name": "A glass (200ml) of orange juice",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be inappropriate as the patient has reduced consciousness and has IV access in situ, meaning they can receive IV glucose to rapidly correct their hypoglycaemia.",
"id": "10028297",
"label": "b",
"name": "10g oral glucogel",
"picture": null,
"votes": 262
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be appropriate if IV access had not been gained, however glucagon can take some time to work, so IV glucose is the most important next intervention.",
"id": "10028298",
"label": "c",
"name": "Intramuscular glucagon",
"picture": null,
"votes": 326
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is suffering from severe hypoglycaemia. As they have IV access in situ, IV glucose should be administered to rapidly correct this.",
"id": "10028296",
"label": "a",
"name": "100ml of 20% intravenous glucose",
"picture": null,
"votes": 2840
}
],
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"name": "Emergency management of hypoglycaemia",
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"typeId": 5
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"learningPoint": "100 ml of 20% intravenous glucose contains 20 grams of glucose and is used to rapidly correct severe hypoglycaemia by providing an immediate source of glucose to raise blood sugar levels.",
"likes": 6,
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"question": "A patient is brought in to the emergency department by ambulance after being found seizing on the street. They are carrying no identification and their past medical history is unknown. They are not currently seizing. An A-E assessment is performed:\n\n\n * Airway - patent, nil added sounds\n * Breathing - no signs of respiratory distress, clear chest, oxygen saturations 100% on 15lpm oxygen\n * Circulation - cool and clammy, no added heart sounds, heart rate 94 beats/minute, blood pressure 100/68 mmHg, 2x cannulae in situ\n * Disability - rouses to pain. Blood glucose 1.2 mmol/L\n * Exposure - no obvious wounds or rashes, abdomen soft\n\n\nWhat is the most important next intervention?",
"sbaAnswer": [
"a"
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173,467,216 | false | 15 | null | 6,495,236 | null | false | [] | null | 18,058 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect - unstable angina is diagnosed when biomarkers (e.g. troponin) are not raised. In this case, the baseline troponin was raised, and there is evidence that it is rising further.",
"id": "10028302",
"label": "b",
"name": "Unstable angina",
"picture": null,
"votes": 102
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While this is correct, acute coronary syndrome (ACS) does not best describe the diagnosis. ACS encompasses ST elevation myocardial infarctions, Non-ST elevation myocardial infarctions, and unstable angina.",
"id": "10028303",
"label": "c",
"name": "Acute coronary syndrome",
"picture": null,
"votes": 108
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer, as the patient has classic cardiac chest pain, a raised (and rising) troponin, and evolving ECG changes (but without ST elevation). It is important to note that even if the ECG remained normal, this would still be categorised as an NSTEMI due to the troponin rise.",
"id": "10028301",
"label": "a",
"name": "Non-ST elevation myocardial infarction (NSTEMI)",
"picture": null,
"votes": 2247
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; stable angina is characterised by exertional chest pain that is fully relieved by rest and/or nitrate therapy. It is not associated with dynamic ECG changes or rising cardiac biomarkers.",
"id": "10028304",
"label": "d",
"name": "Stable angina",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; there is no evidence of ST elevation on the ECGs. This is a non-ST elevation myocardial infarction.",
"id": "10028305",
"label": "e",
"name": "ST elevation myocardial infarction",
"picture": null,
"votes": 1002
}
],
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{
"__typename": "QuestionComment",
"comment": "Unstable angina - normal troponin\nSTEMI / NSTEMI - raised troponin \nT wave inversion is a feature seen only with NSTEMI and unstable angina ",
"createdAt": 1715024631,
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"__typename": "QuestionComment",
"comment": "Is there not ST elevation in VI and VII? And then I thought the T wave inversion were reciprocal changes in opposite leads? Please help :(((",
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"comment": "I think the size of the ST elevation isn't enough, it has to be >2 small squares taller than the top of the P wave i think",
"createdAt": 1737020358,
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"__typename": "QuestionComment",
"comment": "yeah this should be STEMI as ST elevation in V1. Only need >2mm in v2 and v3 otherwise its >1mm",
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"typeId": 5
},
"topicId": 161,
"updatedAt": 1708373886
}
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"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 66-year-old man with a background of diabetes and hypertension arrives at the emergency department with central, crushing chest pain.\n\n\nHis initial ECG shows:\n [lightgallery]\n\n\nRepeat ECGs show some evolving T wave inversion in the inferior leads.\n\n\nHis symptoms are somewhat relieved by GTN spray and morphine. He has received 300mg aspirin and a loading dose of clopidogrel.\n\n\nHigh-sensitivity troponin T levels:\n 1st sample - 54 ng/L (<10 ng/L)\n 2nd sample - 232 ng/L (<10 ng/L)\n\n\nWhich term best describes the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 3469,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,217 | false | 16 | null | 6,495,236 | null | false | [] | null | 18,059 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As per new NICE guidance, anybody over the age of 50 with unexplained rectal bleeding should have a FIT test as opposed to a 2 week wait referral, and if positive (more than or equal to 10 nanograms), they should be referred for a colonoscopy within 2 weeks.",
"id": "10028306",
"label": "a",
"name": "Refer to 2-week wait clinic",
"picture": null,
"votes": 635
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The FOB test was historically used to detect invisible traces of blood, and triage the need for a 2-week wait referral. It has now been replaced by the FIT test. In any case, it is not a useful test in this circumstance - the patient reports passing fresh red blood.",
"id": "10028309",
"label": "d",
"name": "Faecal occult blood (FOB) test",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most important diagnosis to consider and exclude in this case is colorectal carcinoma. A faecal calprotectin test may be useful in some cases, however this is not the most appropriate next step. It is important to note that faecal calprotectin can be raised in cases of colorectal carcinoma as well as inflammatory bowel disease, especially when PR bleeding is present.",
"id": "10028308",
"label": "c",
"name": "Faecal calprotectin test",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be the most appropriate next step for a general practitioner to take. They should refer this patient along the 2-week wait pathway, where the lower GI team will choose the most appropriate investigations (likely a colonoscopy). A CT may be required if a malignancy is found on endoscopy.",
"id": "10028310",
"label": "e",
"name": "CT abdomen pelvis (with contrast)",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "As per NICE guidelines, anybody over the age of 50 with unexplained rectal bleeding should have a FIT test, and if positive (more than or equal to 10 nanograms), they should be referred for a colonoscopy within 2 weeks.",
"id": "10028307",
"label": "b",
"name": "Faecal immunochemistry (FIT) test",
"picture": null,
"votes": 2543
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "whats the point in doing a FIT when we already know that she's passing blood? ",
"createdAt": 1709300586,
"dislikes": 0,
"id": "43334",
"isLikedByMe": 0,
"likes": 23,
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"replies": [
{
"__typename": "QuestionComment",
"comment": "The rectal examination was normal. You need to confirm blood loss first",
"createdAt": 1709638399,
"dislikes": 0,
"id": "43827",
"isLikedByMe": 0,
"likes": 0,
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"user": {
"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Cystic Gas",
"id": 3462
}
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{
"__typename": "QuestionComment",
"comment": "The FIT test looks for blood in the stool which isn't visible to the naked eye. Meaning blood that is coming form higher up in the GI tract. ",
"createdAt": 1717332470,
"dislikes": 0,
"id": "51709",
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"displayName": "Supraventricular Lion",
"id": 34400
}
},
{
"__typename": "QuestionComment",
"comment": "well no? anal or rectal cancer will have fresh blood",
"createdAt": 1737236148,
"dislikes": 0,
"id": "60933",
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"likes": 0,
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"user": {
"__typename": "User",
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"displayName": "Sydney Sweeney",
"id": 30184
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}
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"id": "6050",
"name": "Lower GI Bleeding",
"status": null,
"topic": {
"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
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"topicId": 162,
"totalCards": null,
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"conditions": [],
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"learningPoint": "NICE advise FIT testing in patients over 50 with unexplained rectal bleeding prior to 2 week wait referral",
"likes": 2,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 54-year-old woman is seen by her GP for a routine diabetes review. During the consultation, she mentions that she has had a few episodes of passing fresh red blood along with her bowel motions.\n\nOther than type 2 diabetes, she has no significant past medical or family history.\n\nOn examination, she looks very well. Her abdomen is soft and non-tender with no masses palpable. A rectal examination is normal.\n\nWhat is the most appropriate next step?",
"sbaAnswer": [
"b"
],
"totalVotes": 3462,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,218 | false | 17 | null | 6,495,236 | null | false | [] | null | 18,060 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate as the patient has signs and symptoms of a community acquired pneumonia, which should be treated with appropriate antibiotics.",
"id": "10028315",
"label": "e",
"name": "Advise a 'watch and wait' strategy",
"picture": null,
"votes": 478
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no 'red flags' indicating hospital admission, e.g. hypoxia or evidence of respiratory distress. This patient's CRB-65 score is 0, indicating a low risk of mortality.",
"id": "10028312",
"label": "b",
"name": "Arrange hospital admission",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most appropriate course of action. This patient has signs of a community acquired pneumonia, with a CRB-65 score of 0, indicating a low risk of mortality. Antibiotics should be prescribed. As he reports a penicillin allergy, clarithromycin or doxycycline are appropriate agents.",
"id": "10028311",
"label": "a",
"name": "Prescribe clarithromycin",
"picture": null,
"votes": 2552
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be an appropriate choice of antibiotic, not only as the patient reports a penicillin allergy, but also as amoxicllin/doxycycline/clarithromycin are the first choice antibiotics in community acquired pneumonia, not co-amoxiclav.",
"id": "10028313",
"label": "c",
"name": "Prescribe co-amoxiclav",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be an appropriate antibiotic combination. Either doxycycline OR clarithromycin should be prescribed for the treatment of community acquired pneumonia in penicillin allergy.",
"id": "10028314",
"label": "d",
"name": "Prescribe doxycycline and clarithromycin",
"picture": null,
"votes": 341
}
],
"comments": [],
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},
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"id": "6051",
"name": "Pneumonia (Infectious Diseases)",
"status": null,
"topic": {
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"id": "162",
"name": "General practice",
"typeId": 5
},
"topicId": 162,
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"difficulty": 1,
"dislikes": 1,
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"highlights": [],
"id": "18060",
"isLikedByMe": 0,
"learningPoint": "In community-acquired pneumonia, clarithromycin is a suitable antibiotic alternative for patients with a penicillin allergy.",
"likes": 9,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
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"question": "A 43-year-old man visits his GP with a 3-week history of a cough. Recently, he has been bringing up yellow sputum. He has no chest pain and no significant medical history. He believes he may be allergic to penicillin.\n\nOn examination, he has crackles in the right basal zone of the lungs. Observations are as follows:\n\n* Heart rate: 62 beats/minute\n* Blood pressure: 140/66 mmHg\n* Respiratory rate: 16 breaths/minute\n* Temperature: 37.9 degrees\n* Oxygen saturations (room air): 98%\n\nWhat is the most appropriate course of action to take?",
"sbaAnswer": [
"a"
],
"totalVotes": 3439,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,219 | false | 18 | null | 6,495,236 | null | false | [] | null | 18,061 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This vignette suggests a diagnosis of pulmonary embolism, with sudden onset pleuritic chest pain and oxygen requirement, combined with several risk factors for VTE (obesity and use of COCP). The most common finding on ECG for patients with a PE is sinus tachycardia.\nWhilst S1Q3T3 is a specific finding, it is not the most common finding.",
"id": "10028316",
"label": "a",
"name": "Sinus tachycardia",
"picture": null,
"votes": 3161
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be seen if the history was suggestive of an infection e.g. pneumonia (which can commonly trigger AF) or if palpitations/pre-syncope were described.",
"id": "10028319",
"label": "d",
"name": "An irregularly irregular rhythm with an absence of P waves",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is normally seen in hyperkalaemia. There is nothing in the history to suggest hyperkalaemia as the admission VBG is normal.",
"id": "10028320",
"label": "e",
"name": "Tall tented T waves",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is concerning for myocardial infarction rather than PE. A right bundle branch block may be observed in unstable PE due to right heart strain.",
"id": "10028318",
"label": "c",
"name": "New left bundle branch block",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is a specific finding for a PE, it is much less commonly seen than sinus tachycardia.",
"id": "10028317",
"label": "b",
"name": "S1Q3T3 pattern",
"picture": null,
"votes": 205
}
],
"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": "3724",
"name": "Pulmonary Embolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"conceptId": 3724,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "18061",
"isLikedByMe": 0,
"learningPoint": "The most likely ECG finding in pulmonary embolism (PE) is sinus tachycardia, while the most specific finding is the S1Q3T3 pattern, which indicates right heart strain and is highly specific but less common.",
"likes": 3,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 47-year-old woman has sudden onset shortness of breath and pleuritic chest pain. She has a history of type II diabetes and obesity.\nShe medication history includes metformin and the combined oral contraceptive pill.\nHer saturations are 98% on 4 litres of oxygen via nasal cannulae. Her chest X-ray and VBG are both normal.\n\nGiven the most likely diagnosis, what is the most likely finding on her ECG?",
"sbaAnswer": [
"a"
],
"totalVotes": 3438,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,467,220 | false | 19 | null | 6,495,236 | null | false | [] | null | 18,062 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is normally seen in Klebsiella pneumoniae infection, which more commonly affects elderly patients or those with alcohol excess.",
"id": "10028324",
"label": "d",
"name": "Redcurrant jelly sputum",
"picture": null,
"votes": 206
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can be associated with Streptococcus pneumoniae infection, the most common cause of community acquired pneumonia. The presence of flu-like symptoms as well as recent air conditioning exposure make this diagnosis less likely.",
"id": "10028323",
"label": "c",
"name": "Presence of cold sores",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anaemia (specifically cold autoimmune haemolytic anaemia) is a finding associated with Mycoplasma, rather than Legionella.",
"id": "10028325",
"label": "e",
"name": "Anaemia",
"picture": null,
"votes": 82
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the erythema multiforme typically seen in Mycoplasma pneumonia, another cause of an atypical pneumonia which is less associated with exposure to air conditioning and foreign travel.",
"id": "10028322",
"label": "b",
"name": "Presence of target lesions on examination",
"picture": null,
"votes": 357
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The history of recent foreign travel (e.g. exposure to air conditioning) combined with the flu-like symptoms suggests a pneumonia caused by Legionella pneumophilia. This is thought to be due to syndrome of inappropriate ADH secretion.",
"id": "10028321",
"label": "a",
"name": "Hyponatraemia",
"picture": null,
"votes": 2752
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Why is it assumed that all 'old' hotels abroad are riddled with Legionella! Give the poor Spaniards a break! ",
"createdAt": 1719144577,
"dislikes": 1,
"id": "53600",
"isLikedByMe": 0,
"likes": 3,
"parentId": null,
"questionId": 18062,
"replies": [],
"user": {
"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Dr. Moe Lester",
"id": 63423
}
}
],
"concept": {
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3709",
"name": "Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
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"conditions": [],
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"learningPoint": "Legionella pneumophila pneumonia often presents with hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion.",
"likes": 1,
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"question": "A 65-year-old businesswoman has a dry cough and flu-like symptoms on returning home from a trip to Spain. She stayed in an old hotel whilst there. On examination, she is febrile and has bibasal crackles.\nA chest x-ray shows patchy bibasal consolidation.\n\nGiven the likely causative organism, which of the other below findings would be expected?",
"sbaAnswer": [
"a"
],
"totalVotes": 3432,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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