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"comment": "In the stem of this question it says gliclazide BD which would mean you need the equivalent of 160mg/ day... however the answer doesn't seem to take this into account. ",
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"comment": "I agree, can some please explain this.",
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"comment": "160mg of standard formulation gliclazide would be bioequivalent to 60mg gliclazide modified release, which means 2x30mg gliclazide modified release tablets per day and therefore 2x14=28 across 2 weeks",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"explanation": "Tablets needed a day\n= Standard formulation gliclazide 80mg BD\n= 2 modified release 30mg a day\nTotal tablets in 2 weeks\n= 2 x 14 days = 28 tablets",
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"question": "A 75-year-old gentleman attended his GP clinic for a follow up appointment following his discharge from the hospital for a chest infection. The discharge summary noted that the patient was diagnosed with Type 2 Diabetes on admission and requested the GP to change his standard formulation gliclazide to modified release medication. PMH Type 2 Diabetes Mellitus DH Metformin 500mg tablets (2 tablets BD), standard formulation Gliclazide 80mg BD. \n\nGliclazide modified release 30mg and standard formulation Gliclazide 80mg are bioequivalent.\n\nHow many Gliclazide modified release 30mg tablets does the GP need to dispense for a treatment duration of 2 weeks?",
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173,468,234 | false | 32 | null | 6,495,256 | null | false | [] | null | 6,920 | {
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"explanation": "Dose of carbamazepine\n= 500mg BD = 1000mg a day\nSuppositories 125mg =100mg\nNumber of suppositories needed in a day\n= 1000mg /100mg x 125mg\n= 1250mg",
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"question": "A 45-year-old patient is admitted to Hyperacute Stroke Unit for left MCA stroke. SALT assessment concluded that he has unsafe swallow and kept him NBM. PMH Focal seizure DH Carbamazepine 500mg PO BD.\n\n\nSuppositories of 125mg may be considered to be approximately equivalent in therapeutic effect to tablets of 100mg but final adjustment should always depend on clinical response.\n\nWhat is the total dose (mg) of carbamazepine in suppositories that is needed in a day?",
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173,468,235 | false | 33 | null | 6,495,256 | null | false | [] | null | 6,927 | {
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Steroid conversion",
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"explanation": "Normal dose of prednisolone per day = 5mg\nEquivalent dose of hydrocortisone per day = 20mg\nDouble dose of hydrocortisone in line with sick day rules = 40mg\n\nNote that most patients are given hydrocortisone as this is the most physiological choice of corticosteroid, although adherence might be an issue as this is a thrice-daily regimen. In addition, the reason why hydrocortisone is given instead is because prednisolone cannot be given intravenously.",
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"question": "A 55-year-old patient suffers from Addison's disease and currently takes 5mg of prednisolone as a once-daily regimen. She has recently been taken ill with vomiting and unable to have any oral intake. The doctor decides to administer corticosteroid replacement using intravenous hydrocortisone instead with a view of doubling the normal dose in line with sick-day rules.\n\n\nGiven that 1mg of prednisolone is equivalent to 4mg of hydrocortisone, what is the total dose of hydrocortisone given per day?",
"sbaAnswer": null,
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173,468,236 | false | 34 | null | 6,495,256 | null | false | [] | null | 6,929 | {
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Calculation of infusion rate",
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"explanation": "A concentration of 20% is 20kg in 100L = 20mg in 0.1mL = 200mg in 1mL. Since the patient requires 10g of magnesium sulphate, the minimum volume of 0.9% sodium chloride is: 10g ÷ 200mg/mL = 50mL.\n\nConcentration ratios (20% in this case) are based on units of kilogram and litre as they belong to the International System of Units (SI units) which are used by convention.",
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"question": "A 38-year-old patient suffers from hypomagnesaemia. She is prescribed a magnesium sulphate infusion of 10g once-daily for five days in a 0.9% sodium chloride solution. The concentration of magnesium sulphate should not exceed 20%.\n\n\nWhat is the minimum volume of 0.9% sodium chloride required to safely make up the magnesium sulphate solution?",
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173,468,237 | false | 35 | null | 6,495,256 | null | false | [] | null | 6,933 | {
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Weight-based dosing",
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"explanation": "The dose of amoxicillin normally for an 8-year-old child is 500mg three times a day. This can be increased to 30mg/kg three times a day. Based on the patient's weight of 35kg, the dose would be: 35kg x 30mg/kg = 1050mg. However, there is restricted to the cap of 1g per dose. Since this is given three times a day, the maximum dose is: 1g x 3 times a day = 3g a day.",
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"question": "A 8-year-old patient who weighs 35kg has community-acquired pneumonia. He is prescribed amoxicillin orally.\n\nWhat is the maximum total dose (in grams) of amoxicillin he can be given per day?",
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173,468,238 | false | 36 | null | 6,495,256 | null | false | [] | null | 6,936 | {
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Calculation of infusion rate",
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"typeId": 5
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"explanation": "- Dose of labetalol given at 20mg/hour: 20mg/hour x 0.5 hours = 10mg\n- Dose of labetalol given at 40mg/hour: 40mg/hour x 0.5 hours = 20mg\n- Dose of labetalol given at 80mg/hour: 80mg/hour x 0.25 hours = 20mg\n\nTotal dose of labetalol given: 10mg + 20mg + 20mg = 50mg",
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"question": "A 37-year-old patient with hypertension in pregnancy is prescribed labetalol by intravenous infusion. She was initially given 20mg/hour, which was increased to 40mg/hour after 30 minutes, and then to 80mg/hour after another 30 minutes. This continued for 15 minutes, after which the response was satisfactory and the infusion was stopped.\n\n\nWhat is the total dose of labetalol given?",
"sbaAnswer": null,
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173,468,239 | false | 37 | null | 6,495,256 | null | false | [] | null | 10,096 | {
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"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
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"name": "Weight based prescribing",
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"explanation": "To calculate the patients weight: volume required/volume per hour= 1200/25= 48kg\n\nPatients require the replacement of 1mmol/kg of potassium each day.\n\n1x48=48mmol required\n\n",
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"question": "A 89-year-old patient requires maintenance fluids as she is Nil-by-mouth due to an unsafe swallow. She is prescribed 1200ml of 0.9% sodium chloride every 24 hours - calculated based on requirements of 25ml/kg/day.\n\nHow many mmol of potassium should she be given in 24 hours?",
"sbaAnswer": null,
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173,468,240 | false | 38 | null | 6,495,256 | null | false | [] | null | 10,150 | {
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"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
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"name": "Total number of tablets needed when tapering the steroid dose needed after a diagnosis of giant cell arteritis",
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"explanation": "WEEK 1: 40mg dose / 5 = 8\n\nTherefore 8 x 5mg tablets are needed per day for 7 days.\n\n8 x 7 = 56 tablets are needed in week 1.\n\nWEEK 2: 30mg dose / 5 = 6\n\nTherefore 6 x 5mg tablets are needed per day for 7 days.\n\n6 x 7 = 42 tablets are needed in week 2.\n\nWEEK 3: 20mg dose / 5 = 4\n\nTherefore 4 x 5mg tablets are needed per day for 7 days.\n\n4 x 7 = 28 tablets are needed in week 3.\n\nWEEK 4: 10mg dose / 5 = 2\n\nTherefore 2 x 5mg tablets are needed per day for 7 days.\n\n2 x 7 = 14 tablets are needed in week 2.\n\n56 + 42 + 28 + 14 = 140 tablets needed",
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"question": " \n\nCase Presentation:\n\nA 65-year-old gentleman is discharged from the hospital following a diagnosis of Giant Cell Arteritis (GCA).\n\nHe has been given the following information on how his condition is to be treated:\n\nPrednisolone PO 40mg/day for 7 days.\n\nPrednisolone PO 30mg/day for 7 days\n\nPrednisolone PO 20mg/day for 7 days.\n\nPrednisolone PO 10mg/day for 7 days.\n\nHe has been told to take 5mg prednisolone tablets to treat his condition.\n\nHow many prednisolone tablets does this patient require to complete his GCA treatment?",
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"explanation": "Ipratroprium bromide does not commonly cause cholestatic jaundice",
"id": "34208",
"label": "d",
"name": "Ipratroprium bromide 40 micrograms INH TDS",
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"votes": 4
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"explanation": "Clindamycin does not commonly cause cholestatic jaundice",
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"explanation": "Fusidic acid is associated with elevated liver enzymes, hyperbilirubinaemia and jaundice with systemic use. These effects are usually reversible following withdrawal of therapy.",
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"name": "Fusidic acid 250mg BD PO",
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"comment": "jaundice is listed as a side effect of clindamycin with paraenteral use though?",
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"comment": "Yeah but PO fusidic acid has its own section on jaundice, deranged LFTs and hyperbilirubinemia. ",
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"comment": "and it is also listed as a SE for clindamycin for oral use as well",
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"explanation": "# Summary\n\n# Definition\n\nJaundice is yellowing of the skin, sclerae and mucosae due to raised plasma bilirubin. The causes of jaundice can be split up into pre-hepatic, hepatic and post-hepatic causes.\n\n# Epidemiology\n\nPrevalence varies globally, with regions such as Africa experiencing higher rates due to infectious causes like malaria. In the UK, annual incidence estimates range from 5 to 10%, with age, gender, and socioeconomic factors influencing prevalence.\n\n# Normal physiology\n\nJaundice can be classified according to whether it is pre-hepatic, hepatic or post-hepatic. \r\n\n- Normal bilirubin metabolism: red blood cells contain haemoglobin; haemoglobin is made up of haem and globin. \n- Haem is metabolised to unconjugated bilirubin. Unconjugated bilirubin is insoluble and is formed into a water-soluble conjugated bilirubin in the liver to aid excretion. \n- Conjugated bilirubin then passes into the common bile duct into the gut and is either re-taken up by the liver (enterohepatic circulation) or is converted to urobilinogen by gut macrophages. \n- Uribilinogen is reabsorbed and excreted by the kidney or is converted to stercobilin (leading to brown faeces). \n- Jaundice occurs when there is disruption to the above pathway at some point and leads to key distinguishing features.\n\n[lightgallery]\r\n\n# Aetiology\n\n## Pre-hepatic\n\n- Increased breakdown of haemoglobin into haem and globin – liver cannot conjugate bilirubin ‘fast’ enough, leading to raised unconjugated bilirubin. \n- Unconjugated bilirubin is not water soluble and so cannot enter the urine. It is therefore also known as acholuric jaundice.\n\nCauses:\n\n- Conjugation disorders, such as Gilbert's disease and Crigler-Naajjar\n- Haemolysis (such as malaria or haemolytic anaemia)\n- Drugs, such as contrast or rifampicin\n\n## Hepatic\n\n- The liver is unable to/has reduced capacity for forming unconjugated and conjugated bilirubin, resulting in a mixed conjugated/unconjugated hyperbilirubinaemia. \n\nCauses of hepatocellular dysfunction include:\n\n- Viruses (hepatitis, CMV, EBV)\n- Drugs, including paracetamol overdose, nitrofurantoin, halothane, valproate, statins, tuberculosis antibiotics\n- Alcohol\n- Cirrhosis\n- Liver mass (abscess or malignancy)\n- Haemochromatosis\n- Autoimmune hepatitis\n- Alpha-1 antitrypsin deficiency\n- Budd-Chiari\n- Wilson's disease\n- Failure to excrete conjugated bilirubin (Rotor and Dubin-Johnson syndromes)\n \n## Post-hepatic\n \n- The liver able to conjugate bilirubin, but unable to excrete it. \n- This results in a rise in insoluble conjugated hyperbilirubin, which is then unable to pass into gut (so no there is stercobilin and no urobilinogen production) which causes pale stools and dark urine. Bile salts are also then deposited in the skin, resulting in pruritus.\r\n\nPost-hepatic causes include:\n\n- Primary biliary cirrhosis\n- Primary sclerosing cholangitis\n- Common bile duct gallstones or Mirrizi's syndrome (CBD compression from a gallstone in the cystic duct)\n- Drugs, including coamoxiclav, flucloxacillin, steroids, sulfonylureas\n- Malignancy, such as head of the pancreas adenocarcinoma, cholangiocarcinoma\n- Caroli's disease\n- Biliary atresia\n\n# Signs and Symptoms\n\n- **Pre-hepatic:** haemolysis, anaemia (fatigue, chest pain, palpitations, lightheadedness)\r\n- **Hepatic:** RUQ pain, fever, viral illness, risk factors include: IVDU/tattoo, UPSI\r\n- **Post-hepatic:** dark urine, pale stools, itch \n\nNB: Courvoisier’s law – jaundice and palpable painless gallbladder not due to gallstones. Painless jaundice – red flag for **pancreatic cancer or cholangiocarcinoma**\r\n\n\n# Investigations\n\r\n\nBedside:\n\n- Urobilinogen is normally found in the urine. This is decreased or absent in cases of obstructive jaundice, but increased in cases of pre-hepatic causes of hyperbilirubinaemia or hepatocellular disease.\n\n| Urinalysis | Normal | Prehepatic disease | Hepatic disease | Posthepatic disease |\n| ------------ | ------- | ------------------ | --------------- | ------------------- |\n| Bilirubin | Absent | Absent | Present | Present |\n| Urobilinogen | Present | Increased | Increased | Decreased / absent |\n\nBloods:\n\n- FBC, U&E, LFTS (and split bilirubin to show conjugated/unconjugated amounts), reticulocytes, DAT, haptoglobin (goes down in pre-hepatic jaundice as it mops up free haem) \n- In LFTs - hepatocellular picture (raised AST/ALT), and cholestatic picture (raised GGT/ALP)\n- Synthetic function of the liver - albumin, INR/coagulation screen\n\nImaging:\n\n- 1st line is abdominal USS (to look for duct dilatation)\n- 2nd line is MRCP \n- CT/MRI may be done if the presentation is suspicious for malignancy\n- Liver biopsy may also be considered if there is diagnostic doubt\n\n# Management\n\n- Management of jaundice depends on the underlying cause. See separate management sections on the aetiologies described above in this chapter.\n\n# NICE Guidelines\n\n[NICE CKS - Jaundice in Adults](https://cks.nice.org.uk/topics/jaundice-in-adults/)",
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"question": "Case Presentation: A 70-year-old man was admitted to the respiratory ward two days ago following a recent chest infection. PMH Community acquired pneumonia, Mild COPD, TB, Diabetic foot infection. DH His current regular medicines are listed (below).\n\n\nOn examination\nThere is visible yellowing of his sclera and evidence of pruritus on his arm.\nInvestigation\n\n||||\n|---------------------------|:-------:|--------------------|\n|Alanine Aminotransferase (ALT)|150 IU/L|10 - 50|\n|Aspartate Aminotransferase (AST)|50 IU/L|10 - 40|\n|Alkaline Phosphatase (ALP)|450 IU/L|25 - 115|\n|Bilirubin|60 µmol/L|< 17|\n|Gamma Glutamyl Transferase (GGT)|50 U/L|9 - 40|\n\n\nQuestion: Select the prescription that is most likely to contribute to his cholestatic jaundice.",
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"__typename": "QuestionChoice",
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"explanation": "Cyclizine does not commonly cause visual hallucinations",
"id": "34228",
"label": "d",
"name": "Cyclizine 50mg PO TDS",
"picture": null,
"votes": 568
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Selegiline would not be prescribed for nausea and vomiting, and does not commonly cause visual hallucinations",
"id": "34226",
"label": "b",
"name": "Selegiline hydrochloride 5mg PO OD",
"picture": null,
"votes": 1920
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"explanation": "Haloperidol exert its anti-emetic effect by blocking central dopamine receptors in the chemoreceptor trigger zone in the brain. Its inhibition on D2 receptors, in particular, can worsen the symptoms of LBD as patients with LBD has increased neuroleptic sensitivity and when given typical antipsychotics like haloperidol, they can experience worsening hallucination, cognition and increased parkinsonism",
"id": "34225",
"label": "a",
"name": "Haloperidol 5mg PO BD",
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"votes": 1950
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"__typename": "QuestionChoice",
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"explanation": "Ondansetron does not commonly cause visual hallucinations",
"id": "34229",
"label": "e",
"name": "Ondansetron 8mg PO BD",
"picture": null,
"votes": 122
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"explanation": "Clozapine would not be prescribed for nausea and vomiting, and does not commonly cause visual hallucinations",
"id": "34227",
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"name": "Clozapine 12.5mg PO OD",
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"comment": "Under common side effects in the BNF for selegiline hydrochloride it has hallucinations - am I just being dumb, how do you know which one it should be?",
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"comment": "This question requires some clinical reasoning. You are right that Selegilline causes hallucinations, but there is no indication to prescribing Selegilline as it not given for N&V. Haloperidol would go against the Levodopa and is indicated for N&V as per BNF and physiology of acting on the Dopamine receptors in the CTZ.",
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"comment": "hallucinations are not listed as a side effect of haloperidol in the BNF ",
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"comment": "but BNF states the lewy body dementia is a contraindication to giving Haloperiodol",
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"comment": "says visual disorder until side effects",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"question": "Case Presentation: A 75-year-old man was admitted to the Care of the Elderly Ward following a urinary tract infection 3 days ago. A day after his admission, he felt nauseous and vomited twice in the morning. There was no blood noted in the vomitus. He was prescribed a medication for symptomatic relief of his nausea and vomiting by the on call doctor. However, on the next day, he started experiencing visual hallucinations. PMH Lewy Body Dementia. DH Rivastigmine, Levodopa.\r\n\r\n\nQuestion: Select the prescription that is most likely to contribute to his visual hallucinations.",
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"explanation": "Dermol cream does not commonly cause rash",
"id": "34233",
"label": "d",
"name": "Dermol cream TOP OD",
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"votes": 7
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"__typename": "QuestionChoice",
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"explanation": "Salbutamol does not commonly cause rash",
"id": "34231",
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"name": "Salbutamol 2 puff PRN INH",
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"votes": 24
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"__typename": "QuestionChoice",
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"explanation": "Hydrocortisone does not commonly cause rash",
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"votes": 69
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"picture": null,
"votes": 35
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"__typename": "QuestionChoice",
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"explanation": "Prescribing amoxicillin in patients presenting with infectious mononucleosis can result in a widespread maculopapular rash. Drug induced maculopapular eruptions are due to delayed type hypersensitivity reactions and these eruptions are enhanced by viral infections such as EBV, possibly due to molecular mimicry between amoxicillin and viral molecules, inducing a loss of tolerance state towards amoxicillin and a transient immune reaction",
"id": "34230",
"label": "a",
"name": "Amoxicillin 500mg PO TDS",
"picture": null,
"votes": 4241
}
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"question": "Case Presentation: A 5-year-old boy was brought in to the GP three days ago by his parents following a cough and sore throat that has been present for the past 4 days. On examination, he was pyrexic with a temperature of 38.5oC, his cervical lymph nodes were tender and swollen. He was prescribed antibiotics by the GP who then provided the parents with safety-netting advice. Today, he re-attended the GP with a widespread, itchy, macular papular rash that developed this morning. PMH Atopic eczema, Asthma. DH His current regular medicines are listed (below).\r\n\r\n\nQuestion: Select the prescription that is most likely to contribute to his rash.",
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"explanation": "Ciprofloxacin does not commonly cause symptoms of reflux",
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"name": "Reflux",
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"__typename": "QuestionChoice",
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"explanation": "Ciprofloxacin does not commonly cause ototoxicity",
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"__typename": "QuestionChoice",
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"explanation": "Ciprofloxacin does not commonly cause optic neuritis",
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"__typename": "QuestionChoice",
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"explanation": "Ciprofloxacin is the only oral antibiotic available for pseudomonal infection. Along with other antibiotic classes such as cephalosporins, penicillins and clindamycin, it is commonly associated with causing C difficile diarrhoea due to its destructive effect on the gut flora, allowing C difficile to grow out of control, leading to C. difficile infections and diarrhoea",
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"explanation": "Ciprofloxacin does not commonly cause cholestatic hepatitis",
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"picture": null,
"votes": 28
}
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"comment": "Lol, did even read the last sentence of the question lmao",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Ciprofloxacin side effects",
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"typeId": 5
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"question": "Case Presentation: A 45 year old man was admitted following an episode of productive cough and fever. Sputum culture was positive for Pseudomonas Aeruginosa, sensitive to ciprofloxacin and gentamicin. He had completed a 6 day course of gentamicin during his admission and has clinically improved since. He will be discharged with a 14 day course of 750mg BD ciprofloxacin.\r\n\r\n\nQuestion: Select the adverse effect that is most likely to be caused by this treatment.",
"sbaAnswer": [
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173,468,245 | false | 43 | null | 6,495,256 | null | false | [] | null | 6,862 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Captopril is another example of ACE-i and so is unlikely to help with the dry cough",
"id": "34257",
"label": "c",
"name": "Stop lisinopril in exchange for captopril 25 mg PO twice daily",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metformin is not known to cause dry cough",
"id": "34256",
"label": "b",
"name": "Stop metformin hydrochloride in exchange for gliclazide 40 mg PO once daily",
"picture": null,
"votes": 4
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lisinopril is an angiotensin converting enzyme inhibitor (ACE-I) that is used as a first line antihypertensive for patients with type 2 diabetes mellitus. Dry cough is a common or very common side effect of ACE-I. The mechanism of action is believed to be related to a decrease in degradation and subsequently an increase in buildup of bradykinin. NICE guidance recommends for an angiotensin receptor block (ARB), for example losartan potassium, to be offered if ACE-i is not tolerated",
"id": "34255",
"label": "a",
"name": "Stop lisinopril in exchange for losartan potassium 50 mg PO once daily",
"picture": null,
"votes": 4480
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sertraline is not known to cause dry cough. Amoxicillin is not required because the dry cough is less likely to be caused by infection in view of the clinical picture described",
"id": "34259",
"label": "e",
"name": "Stop sertraline and commence treatment with amoxicillin 500 mg PO three times daily",
"picture": null,
"votes": 7
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sertraline is not known to cause dry cough",
"id": "34258",
"label": "d",
"name": "Stop sertraline in exchange for citalopram 20 mg PO once daily",
"picture": null,
"votes": 3
}
],
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "ACE inhibitor side effects",
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"question": "Case presentation: A 60-year-old man visits his GP for medication review. He complains of a recent-onset persistent dry cough but denies having fever or any coryzal symptoms. The cough is not worse when lying down. The patient is not a smoker and the cough only happened after he started on a new prescription. \r\n\nPMH: Diabetes Mellitus, Hypertension, Depression\nDH: Metformin 500 mg PO TDS, Lisinopril 20 mg PO OD, Sertraline 50 mg PO OD\nObservations: Temperature 36.5, Respiratory rate 12, Blood pressure 125/85, Heart rate 78\nOn Examination: Chest is clear with no added sounds. HS I+II+0.\n\nQuestion: Select the most appropriate option for the management of the adverse drug reaction.",
"sbaAnswer": [
"a"
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"totalVotes": 4525,
"typeId": 1,
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} | MarksheetMark |
173,468,246 | false | 44 | null | 6,495,256 | null | false | [] | null | 10,078 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril is an angiotensin-converting enzyme inhibitor used to treat hypertension. It is not known to interact with clopidogrel.",
"id": "50152",
"label": "b",
"name": "Ramipril 5mg OD",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amlopidine is a calcium channel blocker used to treat hypertension. It is not known to interact with clopidogrel.",
"id": "50153",
"label": "c",
"name": "Amlodipine 10mg OD",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Simvastatin is used to treat hypercholesterolaemia and reduce the risk of ischaemic events. Simvastatin is not known to interact with clopidogrel.",
"id": "50154",
"label": "d",
"name": "Simvastatin 40mg OD",
"picture": null,
"votes": 110
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aspirin is an anti-platelet used in conjunction with clopidogrel in dual antiplatelet therapy. Although used together there is an increased risk of bleeding, the benefits in preventing atherothrombotic events outweigh this risk when used short-term following high-risk TIAs.",
"id": "50155",
"label": "e",
"name": "Aspirin 75mg OD",
"picture": null,
"votes": 1200
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Esomeprazole is a proton pump inhibitor used to treat gastro-oesophageal reflux disease. Esomeprazole has been shown to decrease the efficacy of clopidogrel. Alternatives to esomeprazole such as H2 receptor antagonists should be considered.",
"id": "50151",
"label": "a",
"name": "Esomeprazole 40mg BD",
"picture": null,
"votes": 1516
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "The question should be phrased better. Should have said which drug reduces efficacy. ",
"createdAt": 1675361220,
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"comment": "This is a good trick question. If you didn't read the stem and blindly searched in the BNF interaction checker, you wouldve probably picked aspirin.\n\nThe stem literally says he was discharged on dual antiplatelet therapy. The BNF treatment summary under \"Stroke\" also states that they should be considered for dual antiplatelet therapy of clopi and aspirin if there is low risk of bleeding.\n\nSo the next best option that has a potential interaction would be esomeprazole.\n",
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"comment": "I was in the midsts of writing a paragraph in rebuttal of your comment @Biopsy Cystic, only to conclude that you're actually right. Esomeprazole is the correct answer. ",
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"displayName": "Retake Prophylaxis ",
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"comment": "i read the stem and thought he was discharged on dual antiplatelet and then proceeded to have a reaction to clopi so needed alteration of the dual antiplatelet by the gp and was so confused, i dont think this question is super well worded",
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"__typename": "QuestionComment",
"comment": "Decreased efficacy is hardly an adverse reaction?",
"createdAt": 1709585101,
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"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
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"demo": null,
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"id": "3610",
"name": "Clopidogrel and Omeprazole",
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"id": "92",
"name": "General Practice",
"typeId": 5
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"question": "Case Presentation: A 67-year-old man attends GP for follow-up after discharge from hospital following a crescendo TIA. His medications are listed on the right. He is discharged on dual antiplatelet therapy for 90 days. \n\n\n**PMH**\n\n* Stroke\n* Hypertension\n* Hyperlipidaemia\n* GORD\n\n**On examination**\n\n* Chest: Clear, RR 18\n* HS: S1 S2 + no added sounds\n\nQuestion: Which of the following medications should the GP consider stopping due to an adverse drug reaction to clopidogrel?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,468,247 | false | 45 | null | 6,495,256 | null | false | [] | null | 10,081 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sertraline does not commonly interact with insulin to precipitate hypoglycaemia.",
"id": "50167",
"label": "b",
"name": "Sertraline 50mg PO OD",
"picture": null,
"votes": 256
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cetirizine does not commonly interact with insulin to precipitate hypoglycaemia.",
"id": "50170",
"label": "e",
"name": "Cetirizine 10mg PO OD",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paracetamol does not commonly interact with insulin to precipitate hypoglycaemia.",
"id": "50169",
"label": "d",
"name": "Paracetamol 1g PO QDS",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hydromol cream does not commonly interact with insulin to precipitate hypoglycaemia.",
"id": "50168",
"label": "c",
"name": "Hydromol cream one application to affected area BD",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clarithromycin can increase the likelihood of hypoglycaemia when taken alongside insulin. Clarithromycin is a macrolide antibiotic that works by inhibiting bacterial protein synthesis by binding to the 50s ribosomal subunit.",
"id": "50166",
"label": "a",
"name": "Clarithromycin 500mg PO BD",
"picture": null,
"votes": 2533
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
"files": null,
"highlights": [],
"id": "2657",
"pictures": [],
"typeId": 5
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"chapterId": 2657,
"demo": null,
"entitlement": null,
"id": "3613",
"name": "Taking both clarithromycin and insulin increases the risk of hypoglycaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "91",
"name": "Paediatrics",
"typeId": 5
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"topicId": 91,
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"question": "Case Presentation: A 16-year-old boy is brought to A&E by his mother as he is very drowsy. He is a known type 1 diabetic and treats this with insulin. He has recently had an ear infection, which is currently being treated with antibiotics by his GP. His regular medicines are listed (below).\n\n\n\n\n **PH** Type 1 diabetes mellitus, Depression, Eczema, Allergic Rhinitis\n\n\n **DH** Sertraline 50mg PO OD, Hydromol cream one application to affected area BD, Clarithromycin 500mg PO BD, Paracetamol 1g PO QDS, Cetirizine 10mg PO OD\n\n\nAllergic to penicillin - comes out in a rash\n\n\n **On examination**\nBP 109/68mmHg, HR 108, RR 24\n\n\nNeurological exam: Difficult to rouse the patient.\n\n\n **Investigation**\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.27|7.35 - 7.45|\n|PaO₂|10.0 kPa|11 - 15|\n|PaCO₂|3.4 kPa|4.6 - 6.4|\n|Bicarbonate|14 mmol/L|22 - 30|\n|Lactate|3 mmol/L|0.6 - 1.4|\n\n\nSerum BM 2.6 mmol/L (Fasting: 4.0 - 5.4 mmol/L, 2hrs post prandial: <7.8 mmol/L) , ketones 0.4mmol/L (<0.6 mmol/L)\n\n\nQuestion: Select the medication that is most likely to have interacted with this patient's diabetes medication to produce this clinical picture.",
"sbaAnswer": [
"a"
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173,468,248 | false | 46 | null | 6,495,256 | null | false | [] | null | 10,129 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Amlodipine is a common cause of peripheral oedema. Calcium channel blockers cause oedema by increasing the pressure within capillaries. This in turn causes fluid to leak out which results in peripheral oedema.",
"id": "50374",
"label": "a",
"name": "Amlodipine 5mg PO OD",
"picture": null,
"votes": 2669
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril does not commonly cause peripheral oedema",
"id": "50376",
"label": "c",
"name": "Ramipril 10mg PO OD",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metformin does not commonly cause peripheral oedema",
"id": "50375",
"label": "b",
"name": "Metformin 500mg PO BD",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atorvastatin does not commonly cause peripheral oedema",
"id": "50377",
"label": "d",
"name": "Atorvastatin 200mg PO OD",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pioglitazone can cause peripheral oedema however this isn't as commonly seen as with amlodipine use.",
"id": "50378",
"label": "e",
"name": "Pioglitazone 30mg PO OD",
"picture": null,
"votes": 45
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
"files": null,
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"id": "2657",
"pictures": [],
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"chapterId": 2657,
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"id": "3658",
"name": "A common side effect of amlodipine is peripheral oedema",
"status": null,
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"__typename": "Topic",
"id": "92",
"name": "General Practice",
"typeId": 5
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"question": "Case Presentation: A 61-year-old gentleman attends his GP complaining of ankle swelling. His regular medicines are listed (below). Weight 88kg.\n\n\n**PH** Type 2 diabetes mellitus, Hypertension, Hypercholesterolaemia\n\n**DH** Metformin 500mg PO BD, Ramipril 10mg PO OD, Amlodipine 5mg PO OD, Atorvastatin 200mg PO OD, Pioglitazone 30mg PO OD\n\n**On examination**\nBP 143/85mmHg, HR 74, RR 12, Weight 95kg\n\n**Investigation**\nChest clear, no added breath sounds. Heart sounds I + II present, no added sounds. Abdomen soft and non-tender.\n\nBilateral pitting oedema in both ankles.\n\nQuestion: Select the prescription that is most likely to have contributed to the patient's ankle swelling.",
"sbaAnswer": [
"a"
],
"totalVotes": 2750,
"typeId": 1,
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173,468,249 | false | 47 | null | 6,495,256 | null | false | [] | null | 6,878 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This has no role or relevance in the monitoring of patients taking statins",
"id": "34337",
"label": "c",
"name": "Full blood count",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should be measured if statin-associated myopathy or rhabdomyolysis is suspected. It is not part of routine monitoring while taking a statin",
"id": "34336",
"label": "b",
"name": "Creatinine kinase",
"picture": null,
"votes": 403
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is recommended that lipids be measured prior to starting treatment and may be measured for the duration of taking atorvastatin, but not for assessing the adverse effects of this drug",
"id": "34338",
"label": "d",
"name": "Lipid profile",
"picture": null,
"votes": 162
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is recommended to measure renal function prior to starting atorvastatin but routine monitoring is not necessary",
"id": "34339",
"label": "e",
"name": "Urea and electrolytes",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "It is recommended that liver function should be measured prior to starting treatment and at 3 months and 12 months afterwards as atorvastatin is known to be hepatotoxic",
"id": "34335",
"label": "a",
"name": "Liver function tests",
"picture": null,
"votes": 3739
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"id": "2810",
"name": "Atorvastatin side effects",
"status": null,
"topic": {
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"id": "9",
"name": "Internal Medicine",
"typeId": 5
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"question": "Case Presentation: A 46 year old woman attends a follow-up appointment at her GP. **PMH** hyperlipidaemia. **DH** atorvastatin 20mg PO OD, started three months ago. **FH** father died of heart attack at the age of 53. **SH** current smoker, 15-20 cigarettes a day but currently attending smoking cessation counselling.\n\n\n**Investigations**\n\nQ-risk score: 14%\n\nQuestion: Select the most appropriate option to monitor for adverse effects of the atorvastatin at this stage.",
"sbaAnswer": [
"a"
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"totalVotes": 4357,
"typeId": 1,
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173,468,250 | false | 48 | null | 6,495,256 | null | false | [] | null | 6,882 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not necessary when starting low molecular weight heparin",
"id": "34359",
"label": "e",
"name": "Prothrombin time",
"picture": null,
"votes": 318
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be measured if the patient was receiving an unfractionated heparin infusion rather than low molecular weight heparin",
"id": "34356",
"label": "b",
"name": "Activated partial thromboplastin time",
"picture": null,
"votes": 479
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is of limited usefulness with regard to anticoagulation therapy",
"id": "34357",
"label": "c",
"name": "Factor VIII levels",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "There are no routine monitoring parameters available for low molecular weight heparin, although one may consider assessing renal function prior to administering this drug. In some instances, Factor Xa levels can be checked and the dose modified but this usually guided by the haematology team",
"id": "34355",
"label": "a",
"name": "No routine monitoring parameter is available",
"picture": null,
"votes": 3582
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Heparin has no effect on the production of white blood cells and routine monitoring is not necessary",
"id": "34358",
"label": "d",
"name": "White cell count",
"picture": null,
"votes": 110
}
],
"comments": [],
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"id": "2814",
"name": "LMWH side effects",
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"id": "13",
"name": "Neurosurgery",
"typeId": 5
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"question": "Case Presentation: A 72 year old woman is recovering on the surgical ward following a total hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. She is receiving tinzaparin 3500 units SC ON as prophylaxis against deep vein thrombosis.\n\n\nQuestion: Select the most appropriate option to monitor the effectiveness of this treatment.",
"sbaAnswer": [
"a"
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"totalVotes": 4526,
"typeId": 1,
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173,468,251 | false | 49 | null | 6,495,256 | null | false | [] | null | 6,896 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is not necessary to monitor creatine kinase during anti-hypertensive treatment with calcium channel blockers",
"id": "34427",
"label": "c",
"name": "Creatine kinase",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is not necessary to monitor bone profile during anti-hypertensive treatment with calcium channel blockers",
"id": "34426",
"label": "b",
"name": "Bone profile",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "It is generally not necessary to perform routine monitoring during anti-hypertensive treatment with calcium channel blockers apart from asking about adverse symptoms to optimise adherence",
"id": "34425",
"label": "a",
"name": "No routine monitoring is required",
"picture": null,
"votes": 3984
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Calcium channel blockers are not known to cause renal impairment. It is not necessary to monitor renal function during treatment",
"id": "34429",
"label": "e",
"name": "Renal function tests",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is not necessary to perform routine ECG monitoring during anti-hypertensive treatment with calcium channel blockers",
"id": "34428",
"label": "d",
"name": "ECG",
"picture": null,
"votes": 114
}
],
"comments": [],
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"id": "2828",
"name": "CCB side effects",
"status": null,
"topic": {
"__typename": "Topic",
"id": "92",
"name": "General Practice",
"typeId": 5
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"question": "Case Presentation: A 67 year old man attends a follow-up appointment at his GP after being discharged from hospital. He had been admitted for three days to manage an acute infective exacerbation of COPD, during which it was noted that his recorded blood pressure consistently ran above 150/90mmHg. The medical team have requested the GP to prescribe antihypertensive treatment.\n\n\nThe GP decides to prescribe amlodipine 5mg PO OD and schedules a follow-up appointment in 2 weeks.\n\nQuestion: Select the most appropriate option to monitor for adverse effects of this treatment.",
"sbaAnswer": [
"a"
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"totalVotes": 4276,
"typeId": 1,
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173,468,252 | false | 50 | null | 6,495,256 | null | false | [] | null | 6,897 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An increase in exercise tolerance due to a reduction in angina symptoms indicates effective treatment with bisoprolol",
"id": "34430",
"label": "a",
"name": "Exercise tolerance",
"picture": null,
"votes": 3252
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An elevation in cardiac enzymes may suggest some ongoing myocardial ischaemia and can be useful in the general clinical setting on a background of acute chest pain, but is of limited usefulness to determine effectiveness of treatment with bisoprolol",
"id": "34434",
"label": "e",
"name": "Troponin",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stress echocardiography may be indicated following a full specialist assessment but is unlikely to be used to demonstrate effectiveness of treatment with bisoprolol",
"id": "34433",
"label": "d",
"name": "Stress echocardiogram",
"picture": null,
"votes": 215
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Her heart rate is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment",
"id": "34432",
"label": "c",
"name": "Heart rate",
"picture": null,
"votes": 675
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Her blood pressure is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment",
"id": "34431",
"label": "b",
"name": "Blood pressure",
"picture": null,
"votes": 156
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "in the psa practice papers, it states the best way to assess whether a BB is working is via HR?",
"createdAt": 1675105265,
"dislikes": 0,
"id": "17454",
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"__typename": "QuestionComment",
"comment": "For AF ",
"createdAt": 1675382825,
"dislikes": 0,
"id": "17657",
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"__typename": "QuestionComment",
"comment": "Agreed re:AF \n+ the way I thought about it was he is in Normal sinus (ignoring AF) he is not tachy. Therefore is not tachy so why would HR help ",
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"comment": "Where can I find this in the BNF?",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
"files": null,
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"name": "Beta blocker monitoring",
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"typeId": 5
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"question": "Case Presentation: A 56 year old woman with no significant past medical history attends her GP with intermittent chest pain. The pain is central and constricting with no radiation into her jaw or arms. She only has the pain a few times a week and notices that it comes on when she is either climbing stairs or running for the bus. She denies syncope, sweating, shortness of breath or any other symptoms of ill health.\n\n\n**Investigations**\n\nECG: Normal sinus rhythm\n\nHer GP decides to make a routine referral to the outpatient cardiology clinic and prescribes bisoprolol fumarate 5mg PO OD.\n\nQuestion: Select the most appropriate option to assess the beneficial effects of this treatment.",
"sbaAnswer": [
"a"
],
"totalVotes": 4306,
"typeId": 1,
"userPoint": null
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173,468,253 | false | 51 | null | 6,495,256 | null | false | [] | null | 6,898 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Effective treatment with levothyroxine would be indicated by a resolution of symptoms. The patient’s body temperature may well rise with successful treatment and as a result she may report feeling less cold, but monitoring temperature in of itself is generally not useful as a marker of benefit",
"id": "34439",
"label": "e",
"name": "Temperature",
"picture": null,
"votes": 111
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Effective treatment with levothyroxine would be indicated by a resolution of symptoms. A lower heart rate may be purely physiological in some patients and is not a useful marker of effective treatment with levothyroxine",
"id": "34437",
"label": "c",
"name": "Heart rate",
"picture": null,
"votes": 366
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient’s respiratory rate is unlikely to change significantly with successful treatment and is thus not a useful marker of benefit",
"id": "34438",
"label": "d",
"name": "Respiratory rate",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient’s blood pressure is unlikely to change significantly with successful treatment and is thus not a useful marker of benefit",
"id": "34436",
"label": "b",
"name": "Blood pressure",
"picture": null,
"votes": 108
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Effective treatment with levothyroxine would be indicated by a resolution of symptoms including an improvement in the patient’s energy levels",
"id": "34435",
"label": "a",
"name": "Patient reports of energy levels",
"picture": null,
"votes": 3727
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
"files": null,
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"pictures": [],
"typeId": 2
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"chapterId": 2618,
"demo": null,
"entitlement": null,
"id": "2830",
"name": "Levothyroxine monitoring",
"status": null,
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"id": "92",
"name": "General Practice",
"typeId": 5
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"question": "Case Presentation: A 34-year-old woman attends her GP with symptoms of tiredness, menstrual irregularities and feeling cold all the time. **PMH** coeliac disease\n\n\n**O/E**\n\nHR 53, RR 10, BP 106/65, Temperature 35.7°C. Peripheries cool. Mild periorbital oedema. Smooth non-tender goitre on palpation.\n\nHer GP makes a provisional diagnosis of Hashimoto’s thyroiditis. She books the patient for a blood test and prescribes levothyroxine sodium 100 micrograms PO OD.\n\nQuestion: Select the most appropriate monitoring option to assess the beneficial effects of this treatment.",
"sbaAnswer": [
"a"
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173,468,254 | false | 52 | null | 6,495,256 | null | false | [] | null | 10,086 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. A full blood count is part of routine monitoring due to the high risk of agranulocytosis when taking clozapine. A lipid profile is part of routine monitoring due to the increased risk of dyslipidaemia. A fasting blood glucose part of routine monitoring due to the increased risk of developing diabetes mellitus.",
"id": "50191",
"label": "a",
"name": "Full blood count, lipid profile, fasting blood glucose",
"picture": null,
"votes": 2644
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Hepatic function is not normally monitored in patients taking clozapine.",
"id": "50193",
"label": "c",
"name": "Full blood count, liver function tests, lipid profile",
"picture": null,
"votes": 83
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Hepatic function is not normally monitored in patients taking clozapine. A chest x-ray is also not a part of the routine monitoring.",
"id": "50194",
"label": "d",
"name": "Full blood count, chest x-ray, liver function tests",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Renal function is not normally monitored in patients taking clozapine.",
"id": "50192",
"label": "b",
"name": "Full blood count, renal function, fasting blood glucose",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine monitoring includes: ECG, prolactin, full blood count, lipid profile and fasting blood glucose. Renal and hepatic function tests are not normally monitored in patients taking clozapine.",
"id": "50195",
"label": "e",
"name": "Full blood count, renal function, liver function tests",
"picture": null,
"votes": 49
}
],
"comments": [],
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"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
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"question": "Case Presentation: A 26-year-old known schizophrenic is seen in the outpatient psychiatric department.\n\n\n**Investigations**\n\nCardiovascular examination: Heart sounds I + II present, no added sounds.\n\nECG today: normal sinus rhythm\n\nProlactin today: 6 ng/mL (<20 ng/mL)\n\nHe is complaining of ongoing symptoms despite being treated with risperidone. He has also previously been treated with quetiapine which had to be switched due to lack of efficacy.\n\nIt is decided that he should be switched from risperidone to clozapine.\n\nQuestion: What monitoring is required if a patient is taking clozapine?",
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173,468,255 | false | 53 | null | 6,495,256 | null | false | [] | null | 10,138 | {
"__typename": "QuestionSBA",
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"explanation": "There are no common ophthalmic side effects associated with azathioprine use. Therefore monitoring is not required.",
"id": "50423",
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"votes": 3
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"explanation": "The enzyme thiopurine methyltransferase is responsible for the metabolism of thiopurine drugs. If TPMT activity is reduced, there is an increased risk of myelosuppression (and subsequent severe infection) as there is improper clearance of azathioprine.",
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"id": "50420",
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"explanation": "Azathioprine is not known to impair renal function. If renal function is impaired when taking azathioprine, a full blood count should be monitored more frequently.",
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"question": "Case Presentation: A 24-year-old gentleman is admitted to hospital following 2 weeks of abdominal pain, diarrhoea and blood in his stool. Weight 60kg.\n\n\n\n\n **Investigations**\n\n\nCRP: 65 mg/L (< 5mg/L)\n\n\nImaging: Sigmoidoscopy shows oedematous mucosa, erythema and bowel inflammation shown up to the level of the sigmoid colon.\n\n\nIt is decided that based on his history and investigations that he has a diagnosis of ulcerative colitis. This is treated acutely with IV hydrocortisone.\n\n\nTo maintain remission, azathioprine 120mg PO OD is prescribed.\n\n\nQuestion: Which investigation is necessary before this patient can start his azathioprine?",
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173,468,256 | false | 54 | null | 6,495,256 | null | false | [] | null | 10,139 | {
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"explanation": "Metformin doesn't cause cardiac side effects therefore ECG monitoring isn't warranted.",
"id": "50426",
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"__typename": "QuestionChoice",
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"explanation": "Whilst metformin can cause a reduced absorption of vitamin B12, this is a very rare side effect and therefore isn't routinely monitored.",
"id": "50427",
"label": "d",
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"votes": 5
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"explanation": "Whilst metformin can cause hepatic injury through hepatitis, this is a very rare side effect and therefore isn't routinely monitored for.",
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"picture": null,
"votes": 51
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"explanation": "Metformin doesn't cause side effects involving the thyroid therefore thyroid function test monitoring isn't warranted.",
"id": "50428",
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"picture": null,
"votes": 5
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"__typename": "QuestionChoice",
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"explanation": "One of the most important side effects of metformin is lactic acidosis. Renal impairment increases the likelihood of this occurring due to improper clearance of metformin. It is therefore very important to monitor renal function prior to starting metformin therapy.",
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"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
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"question": "Case Presentation: A 31-year-old woman attends the outpatient gynaecology department.\n\n\n**PMH** Polycystic ovary syndrome, Depression\n\n**DH** Sertraline 50mg PO OD\n\nShe wants to conceive and has already been treated with clomifene citrate. Unfortunately, this hasn't worked and her Gynaecologist has recommended metformin 500mg PO OD as the next step in her management.\n\nQuestion: Which investigation should this patient undergo prior to starting metformin?",
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173,468,257 | false | 55 | null | 6,495,256 | null | false | [] | null | 6,904 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Variable rate insulin infusion is only started when ketone levels falls below 0.6mmol/L",
"id": "34467",
"label": "c",
"name": "Change to variable rate insulin infusion",
"picture": null,
"votes": 267
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is on 0.1units/kg/hour of fixed rate insulin infusion, however, the response is inadequate (ketone reduction <0.5mM/h, glucose reduction < 3mM/h). Hence, decreasing the rate of insulin infusion will not be appropriate",
"id": "34468",
"label": "d",
"name": "Decrease fixed rate insulin Actrapid infusion to 1.5units/hour",
"picture": null,
"votes": 281
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As K has dropped to 3.5-5.5mmol, 40mmol of KCl should be added to the bag of fluid as this patient would require continuous insulin infusion, which can result in the redistribution of potassium into the cells and the serum potassium level to decrease further",
"id": "34466",
"label": "b",
"name": "Increase fixed rate insulin Actrapid infusion to 2.8 units/hour",
"picture": null,
"votes": 745
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Starting 1L of 10% dextrose over 8 hours is not necessary at this point as the blood glucose level is still above 14mmol/L but should be considered if the glucose level falls below 14mmol/L",
"id": "34469",
"label": "e",
"name": "Start 1L 10% dextrose over 8hours",
"picture": null,
"votes": 687
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is on 0.1units/kg/hour of fixed rate insulin infusion, however, the response is inadequate (ketone reduction <0.5mM/h, glucose reduction < 3mM/h). Hence, an increase in insulin rate by 1unit/hour increments hourly is necessary until the ketones are falling at target rates. As K has dropped to 3.5-5.5mmol, 40mmol of KCl should be added to the bag of fluid as this patient would require continuous insulin infusion, which can result in the redistribution of potassium into the cells and the serum potassium level to decrease further",
"id": "34465",
"label": "a",
"name": "Increase fixed rate insulin Actrapid infusion to 2.8 units/hour and add 40mmol/L potassium chloride to 0.9% normal saline bag",
"picture": null,
"votes": 2312
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],
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{
"__typename": "QuestionComment",
"comment": "K should be given at 1mmol/kg/hr. So in 24hrs he shouldnt have more than 18mmol. Yet your flooding this child with 40mmol. Cant be right?",
"createdAt": 1647169980,
"dislikes": 2,
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"comment": "That's for maintenance fluids, not in the treatment of DKA. It's right. ",
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"comment": "I thought the same thing too.\nNICE guidelines for DKA in children: 'Include 40 mmol/litre (or 20 mmol/500 ml) potassium chloride in all fluids (except the initial intravenous boluses) given to children and young people with DKA, unless they have anuria or their potassium level is above the normal range. Do not delay potassium replacement, because hypokalaemia can occur once the insulin infusion starts.'",
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"comment": "are the aims for ketone and glucose reduction available on BNF?\n",
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"comment": "I can't find it so I'm assuming not? ",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"name": "Diabetic Ketoacidosis",
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"question": "Case Presentation:\n\n\nA 5-year-old is admitted to the Emergency Department 3 hours ago and is being treated for Diabetic Ketoacidosis with 0.9% normal saline and fixed rate insulin Actrapid infusion 1.8units/hour IV.\n\n\n **On Examination**\nRR 45/min (22-34).\n\n\nTemperature 37.5 <sup>o</sup> C\n\n\nHR 100/min (75-110)\n\n\nO2 sats 96% RA.\n\n\nWeight 18kg.\n\n\nBP 110/80 mmHg.\n\n\n **Investigations**\n 3 hours ago:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.2|7.35 - 7.45|\n|PaO₂|11 kPa|11 - 15|\n|PaCO₂|4 kPa|4.6 - 6.4|\n|Bicarbonate|12 mmol/L|22 - 30|\n|Potassium|6 mmol/L|3.5 - 5.3|\n|Non-fasting Glucose|18 mmol/L|< 6.1|\n|Ketones (Serum)|3 mmol/L|< 0.6|\n\n\nNow:\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.25|7.35 - 7.45|\n|PaO₂|10 kPa|11 - 15|\n|PaCO₂|4.5 kPa|4.6 - 6.4|\n|Bicarbonate|15 mmol/L|22 - 30|\n|Potassium|4 mmol/L|3.5 - 5.3|\n|Non-fasting Glucose|16 mmol/L|< 6.1|\n|Ketones (Serum)|2 mmol/L|< 0.6|\n\n\n\n\nQuestion:\nSelect the most appropriate decision option with regard to his DKA management based on these data.",
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173,468,258 | false | 56 | null | 6,495,256 | null | false | [] | null | 6,905 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "As there are no signs of toxicity such as coarse tremor, dysarthria or ataxia, there is no need to stop his lithium immediately or carry out haemodialysis",
"id": "34472",
"label": "c",
"name": "Carry out haemodialysis on the patient",
"picture": null,
"votes": 147
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "As there are no signs of toxicity such as coarse tremor, dysarthria or ataxia, there is no need to stop his lithium immediately or carry out haemodialysis",
"id": "34471",
"label": "b",
"name": "Stop the lithium and restart at a 300mg OD",
"picture": null,
"votes": 2491
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is also not advisable to ignore the raised serum level and maintain his current dose, appropriate investigation should be done to identify the cause of elevated lithium in order to guide management",
"id": "34474",
"label": "e",
"name": "Maintain the dose of lithium carbonate",
"picture": null,
"votes": 294
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lithium carbonate has a narrow therapeutic index and hence monitoring of serum lithium is often done to ensure it is within therapeutic range. Concentrations are often taken 12 hours after administration and target range of 0.8-1.0 mmol/L is required. The patient’s examination findings are mainly side effects of the medication and not signs of toxicity. Hence, it is necessary to repeat a serum lithium level and check if his renal function is affecting the clearance of lithium",
"id": "34470",
"label": "a",
"name": "Recheck the level of lithium and his renal function",
"picture": null,
"votes": 1572
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In this case, the patient had a serum lithium of 1.2mmol/L, which is higher than the target range, hence, further increasing the dose of lithium is inappropriate",
"id": "34473",
"label": "d",
"name": "Increase the dose of lithium carbonate to 550mg OD",
"picture": null,
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}
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"__typename": "QuestionComment",
"comment": "fine tremor = early sign of lithium toxicity, BNF says to reduce dose",
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"comment": "BNF: 'The early clinical features are non-specific and may include apathy and restlessness which could be confused with mental changes arising from the patient's depressive illness. Vomiting, diarrhoea, ataxia, weakness, dysarthria, muscle twitching, and tremor may follow. Severe poisoning is associated with convulsions, coma, renal failure, electrolyte imbalance, dehydration, and hypotension.'\n\nThis pt is only complaining of a fine tremor & metallic taste which are more consistent with side effects of lithium rather than toxicity. ",
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"comment": "\"... without features of ftoxicity, all that is usually necesary is to take measures to increase urine output (e.g. by increasing fluid intake but avoiding diuretics)\"\n\nSo when it is out of the therapeutic window but there are no features of toxicity, you assess renal function and double check lithium levels (to ensure its not an anomaly). At the same time, you try to encourage more fluid intake and to pass more urine. \n\nIf there are features of toxicity, you stop the dose. If conc is in excess of 2mmol/L, you consider haemodialysis (if neurological signs or renal failure present)",
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"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
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"question": "Case Presentation:\n\n\n\n\nA 45-year-old man was admitted to Psychiatry Ward following a failed suicidal attempt due to a depressive episode. PMH Bipolar disorder. DH Lithium carbonate 400mg PO OD.\nDue to the acute relapse of her bipolar disorder, it has been decided that her lithium carbonate will be increased to 500mg OD and the first dose was given at 0800 today. Weight 75kg.\n\n\n **On Examination**\nPatient had fine tremor on both hands and complained of a lingering metallic taste.\nBP 118/75 mmHg, HR 75/min, RR 12, moist mucous membrane with CRT 2s.\n\n\n **Investigations**\nSerum lithium at 2200 is 1.2 mmol/L (Therapeutic dose 0.6-1.0 mmol/L)\n\n\nQuestion:\nSelect the most appropriate decision option based on these data.",
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173,468,259 | false | 57 | null | 6,495,256 | null | false | [] | null | 6,906 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antiepileptics including phenytoin should not be given, likewise for tocolytics, as this woman is 38 weeks pregnant and delivery would help with her eclampsia",
"id": "34479",
"label": "e",
"name": "Atosiban 6.75mg IV over 1 minute",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antiepileptics including phenytoin should not be given, likewise for tocolytics, as this woman is 38 weeks pregnant and delivery would help with her eclampsia",
"id": "34477",
"label": "c",
"name": "Two doses of Lorazepam 6mg IV followed by phenytoin 1.2g IV",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a history of headache, abdominal pain and presented with generalized tonic clonic seizure. In addition, her blood pressure at 25 weeks was normal but is currently significantly elevated. Her signs and symptoms in combination with her investigation results of haemolytic anaemia, elevated liver transaminases and lower platelet count is suggestive of eclampsia with HELLP syndrome. Magnesium sulphate should be given to treat eclampsia alongside antihypertensive medications such as labetalol",
"id": "34475",
"label": "a",
"name": "Magnesium sulphate IV 4g over 5-15minutes, labetalol hydrochloride 20mg/hour IV",
"picture": null,
"votes": 3609
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Magnesium sulphate should be given to treat eclampsia alongside antihypertensive medications such as labetalol. Dexamethasone is not necessary as this woman is currently 38 weeks pregnant",
"id": "34476",
"label": "b",
"name": "Magnesium sulphate IV 4g over 5-15minutes, labetalol hydrochloride 20mg/hour IV,\ndexamethasone 8mg IV",
"picture": null,
"votes": 845
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antiepileptics including phenytoin should not be given, likewise for tocolytics, as this woman is 38 weeks pregnant and delivery would help with her eclampsia",
"id": "34478",
"label": "d",
"name": "Terbutaline 5 micrograms/minute for 20 minutes",
"picture": null,
"votes": 7
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "As she has HELLP syndrome, shouldn't the first line treatment be to deliver i.e. give IV dexamethasone + Magnesium sulfate and labetalol?",
"createdAt": 1646499276,
"dislikes": 1,
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"replies": [
{
"__typename": "QuestionComment",
"comment": "You wouldn't give dexmethasone because this is not pre-term (the pregnancy is >37 weeks). in addition the dexamethasone is usually given IM",
"createdAt": 1673877913,
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"chapter": {
"__typename": "Chapter",
"explanation": "#### Monitoring\r\n\r\nThe BNF advises to monitor lung function (in patients with a history of obstructive airway disease).\r\n\r\n#### Overdoses\r\n\r\nOverdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).\r\nNon-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.\r\n\r\nManagement\r\n - Airway protection \r\n - Activated charcoal within 1 hour\r\n - IV Fluids\r\n \r\nIV glucagon is the first-line management.\r\n \r\nFor symptomatic bradycardia, IV atropine may be used.\r\n",
"files": null,
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"id": "2618",
"pictures": [],
"typeId": 2
},
"chapterId": 2618,
"demo": null,
"entitlement": null,
"id": "2838",
"name": "Eclampsia treatment",
"status": null,
"topic": {
"__typename": "Topic",
"id": "76",
"name": "Obstetrics and Gynaecology",
"typeId": 5
},
"topicId": 76,
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"question": "Case Presentation:\n\n\nA 38-week pregnant lady is admitted to the Emergency Department with generalized tonic-clonic seizure. Prior to the onset of the seizure, her husband mentioned she had been complaining of headache and abdominal pain. PMH Gestational diabetes. DH Metformin 1g BD PO. Weight 60kg\n\n\n **On Examination**\nBP 205/100 mmHg (on admission) (<140/90mmHg), HR 92/min, RR 22\nBP 92/50 mmHg (at 25 weeks)\n\n\n **Investigations**\nUrine dipstick ++ protein\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|110 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|8x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|80x10<sup>9</sup>/L|150 - 400|\n|Bilirubin|1.5 µmol/L|< 17|\n|Aspartate Aminotransferase (AST)|80IU/L|10 - 40|\n|Alanine Aminotransferase (ALT)|140 IU/L|10 - 50|\n|Creatinine|123 µmol/L|60 - 120|\n|Creatinine|0.66 mmol/L|0.19 - 0.36|\n\n\nQuestion:\nSelect the most appropriate decision option with regard to the treatment of her eclampsia based on these data.",
"sbaAnswer": [
"a"
],
"totalVotes": 4488,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,260 | false | 58 | null | 6,495,256 | null | false | [] | null | 10,093 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is very unwell, likely due to biliary sepsis. This question requires you to identify that this patient needs urgent fluid resuscitation - this includes giving a 500ml bolus of fluid in less than 15 minutes. 45 minutes would take too long to give the fluid in this type of scenario.",
"id": "50230",
"label": "e",
"name": "A fluid bolus of 500ml should be prescribed and given over 45 minutes",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is very unwell, likely due to biliary sepsis. This question requires you to identify that this patient needs urgent fluid resuscitation - this includes giving a 500ml bolus of fluid in less than 15 minutes. 30 minutes would take too long to give the fluid in this type of scenario. A 250ml bolus is also not enough, this would typically be used in patients with pre-existing heart failure.",
"id": "50229",
"label": "d",
"name": "A fluid bolus of 250ml should be prescribed and given over 30 minutes",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is very unwell, likely due to biliary sepsis. This question requires you to identify that this patient needs urgent fluid resuscitation - this includes giving a 500ml bolus of fluid in less than 15 minutes. 30 minutes would take too long to give the fluid in this type of scenario.",
"id": "50228",
"label": "c",
"name": "A fluid bolus of 500ml should be prescribed and given over 30 minutes",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is very unwell, likely due to biliary sepsis. This question requires you to identify that this patient needs urgent fluid resuscitation - this includes giving a 500ml bolus of fluid in less than 15 minutes.",
"id": "50226",
"label": "a",
"name": "A fluid bolus of 500ml should be prescribed and given over <15 minutes",
"picture": null,
"votes": 2719
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is very unwell, likely due to biliary sepsis. This question requires you to identify that this patient needs urgent fluid resuscitation - this includes giving a 500ml bolus of fluid in less than 15 minutes. Giving a 250ml bolus is preferred if the patient has pre-existing heart failure.",
"id": "50227",
"label": "b",
"name": "A fluid bolus of 250ml should be prescribed and given over <15 minutes",
"picture": null,
"votes": 17
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
"files": null,
"highlights": [],
"id": "2657",
"pictures": [],
"typeId": 5
},
"chapterId": 2657,
"demo": null,
"entitlement": null,
"id": "3623",
"name": "Replacing fluid in a patient who is in shock",
"status": null,
"topic": {
"__typename": "Topic",
"id": "13",
"name": "Neurosurgery",
"typeId": 5
},
"topicId": 13,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "10093",
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"question": "Case Presentation: A 34-year-old gentleman is admitted to ED with generalised abdominal pain.\n\n\n\n\n **PMH** Nil\n\n\n **DH** Nil\n\n\n **Investigations**\n\n\nObservations: HR 112 bpm, RR 21, blood pressure 84/44 mmHg, temperature 38.4, O2 saturations 93% on RA\n\n\nAbdominal examination: tender to palpation in RUQ, bowel sounds present.\n\n\nBloods: CRP 211 mg/L (<5 mg/L), WCC 18.9 x 10<sup>9</sup>)L (3.6 – 11.0 x 10<sup>9</sup>)L)\n\n\nQuestion: Select the most appropriate decision option based on this data",
"sbaAnswer": [
"a"
],
"totalVotes": 2763,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,261 | false | 59 | null | 6,495,256 | null | false | [] | null | 10,145 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Addison's disease and will be steroid dependent. Her corticosteroid and mineralocorticosteroid medications must not be stopped.",
"id": "50458",
"label": "e",
"name": "Stop both her hydrocortisone and fludrocortisone immediately",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Addison's disease. When patients with Addison's disease have a concurrent illness their hydrocortisone dose should be doubled whilst their fludrocortisone dose should remain unchanged.",
"id": "50457",
"label": "d",
"name": "Make no changes to her medications",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Addison's disease. When patients with Addison's disease have a concurrent illness their hydrocortisone dose should be doubled whilst their fludrocortisone dose should remain unchanged.",
"id": "50456",
"label": "c",
"name": "Increase her hydrocortisone to 40mg PO BD and increase her fludrocortisone dose to 100 micrograms PO OD",
"picture": null,
"votes": 319
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has Addison's disease. When patients with Addison's disease have a concurrent illness their hydrocortisone dose should be doubled whilst their fludrocortisone dose should remain unchanged.",
"id": "50454",
"label": "a",
"name": "Increase her hydrocortisone to 40mg PO BD, don't change her fludrocortisone dose",
"picture": null,
"votes": 2336
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has Addison's disease. When patients with Addison's disease have a concurrent illness their hydrocortisone dose should be doubled whilst their fludrocortisone dose should remain unchanged.",
"id": "50455",
"label": "b",
"name": "Increase her fludrocortisone dose to 100 micrograms PO OD, do not change her hydrocortisone dose",
"picture": null,
"votes": 52
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": "Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.\n\n**Symptoms and Signs**\n\n- Generally asymptomatic until a fragility fracture occurs\n- Back pain\n- Kyphosis (stooped posture)\n- Fragility fractures\n\n**Risk factors**\n\n- Female sex\n- Increasing age\n- Smoking\n- Corticosteroid use\n- Low BMI (< 20-25kg/m<sup>2</sup>)\n- Low body weight (<58kg)\n- Vitamin D deficiency\n\n**Protective factors**\n\n- Higher BMI\n- Exercise - mechanical loading stimulates bone formation\n\n**Diagnosis**\nOsteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.\nA T score of < -2.5 indicates osteoporosis\n\n**Management**\n\n- Fall prevention\n- Vitamin D and calcium supplementation\n- Hormone replacement therapy (postmenopausal women)\n- Oral bisphosphonates",
"files": null,
"highlights": [],
"id": "2657",
"pictures": [],
"typeId": 5
},
"chapterId": 2657,
"demo": null,
"entitlement": null,
"id": "3674",
"name": "Sick day rules in patients with Addison's disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "9",
"name": "Internal Medicine",
"typeId": 5
},
"topicId": 9,
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},
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"difficulty": 1,
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"question": "Case Presentation: A 48-year-old woman is attends her GP due to an ongoing cough. She has had this cough for the last 2 days. It is productive of green sputum. She has also been experiencing feverish symptoms since her cough started.\n\n\n**PMH** Addison's disease\n\n**DH** Hydrocortisone 20mg PO BD, Fludrocortisone 50 micrograms PO OD\n\nQuestion: Select the most appropriate decision option based on this data",
"sbaAnswer": [
"a"
],
"totalVotes": 2723,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,262 | false | 60 | null | 6,495,256 | null | false | [] | null | 18,112 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although Diamorphine is sometimes used in syringe drivers, this is the incorrect dose equivalence. With 120mg Morphine sulfate taken orally in the past 24 hours, this would be equivalent to 40mg s/c Diamorphine.",
"id": "10028551",
"label": "e",
"name": "Switch to subcutaneous infusion of 30mg Diamorphine hydrochloride over 24 hours",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has taken (40x2) + (10x4) = 120mg Morphine sulfate PO in the last 24 hours. To convert PO morphine to SC morphine you simply have to divide the total 24 hour dose by 2.",
"id": "10028547",
"label": "a",
"name": "Switch to subcutaneous infusion of 60mg Morphine sulfate over 24 hours",
"picture": null,
"votes": 1424
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be correct if the total oral intake of Morphine sulfate over the last 24 hours was 180mg.",
"id": "10028548",
"label": "b",
"name": "Switch to subcutaneous infusion of 90mg Morphine sulfate over 24 hours",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this is the correct conversion, syringe drivers typically run over 24 hours, rather than every 12 hours.",
"id": "10028549",
"label": "c",
"name": "Switch to subcutaneous infusion of 30mg Morphine sulfate over 12 hours",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "When converting from oral to subcutaneous you cannot simply use the same dosage as the bioavailability is different. This would result in a overdose of morphine to the patient.",
"id": "10028550",
"label": "d",
"name": "Switch to subcutaneous infusion of 120mg Morphine sulfate over 24 hours",
"picture": null,
"votes": 36
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6086",
"name": "Opioid conversion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "328",
"name": "Palliative care prescribing",
"typeId": 5
},
"topicId": 328,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6086,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "18112",
"isLikedByMe": 0,
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"likes": 0,
"multiAnswer": null,
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"psaSectionId": 8,
"qaAnswer": null,
"question": "Case Presentation:\n\n\nA 93-year-old inpatient on the Senior Health ward is commenced on palliative care, and his analgesia regimen needs to be converted from oral to a syringe driver.\n\n**PMH** Small cell lung cancer, Osteoarthritis, COPD.\n\n**DH** Morphine sulfate M/R 40mg PO BD, Morphine sulfate 10 mg/5 mL solution (Oramorph) 5 mL PO PRN. Paracetamol 1g PO QDS, Ibuprofen 400mg PO TDS, Salmeterol 50 micrograms INH BD. He has taken 4 doses of her Oramorph in the last 24 hours.\n\nQuestion:\nSelect the most appropriate decision option with regard to his pain management based on these data.",
"sbaAnswer": [
"a"
],
"totalVotes": 1531,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,318 | false | 1 | null | 6,495,259 | null | false | [] | null | 19,369 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the patient was pre-menopausal, tamoxifen would be an appropriate anti-oestrogen medication to use, given that the cancer is oestrogen receptor-positive. However, as the patient is post-menopausal, an aromatase inhibitor should be used in preference.",
"id": "10034828",
"label": "b",
"name": "Tamoxifen",
"picture": null,
"votes": 329
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A sentinel lymph node biopsy is a surgical procedure that often occurs at the time of a wide local excision or mastectomy, depending on the invasiveness of the cancer. In this case, the patient has expressed a wish to not undergo operative intervention, so this is not a suitable choice. Oral anti-oestrogen medications are likely to be offered.",
"id": "10034831",
"label": "e",
"name": "Sentinel lymph node biopsy",
"picture": null,
"votes": 112
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This could be an option, however, the patient has expressed she is not keen on surgical management. Anti-oestrogen therapy (letrozole/anastrozole) will likely be offered to slow tumour growth, as the tumour is oestrogen receptor-positive.",
"id": "10034830",
"label": "d",
"name": "Wide local excision",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Trastuzumab (brand name Herceptin) is a HER-2-directed monoclonal antibody, which may be used by itself or with other chemotherapy. As this cancer is HER-2 negative, it is not an appropriate choice.",
"id": "10034829",
"label": "c",
"name": "Trastuzumab",
"picture": null,
"votes": 102
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This woman has an oestrogen receptor-positive breast carcinoma. Anti-oestrogen therapy is likely to be used in this case. As the patient is post-menopausal, an aromatase inhibitor (like anastrozole or letrozole) would be used instead of a selective oestrogen receptor modulator. This is because the majority of oestrogen production in post-menopausal females is due to the aromatisation of androgens in the fatty tissues, muscles, and skin.",
"id": "10034827",
"label": "a",
"name": "Letrozole",
"picture": null,
"votes": 2461
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3779",
"name": "Breast Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "151",
"name": "Breast Disease",
"typeId": 7
},
"topicId": 151,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3779,
"conditions": [],
"difficulty": 1,
"dislikes": 2,
"explanation": null,
"highlights": [],
"id": "19369",
"isLikedByMe": 0,
"learningPoint": "Letrozole, an aromatase inhibitor, is the preferred treatment for post-menopausal women with oestrogen receptor-positive invasive ductal carcinoma.",
"likes": 4,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 74-year-old woman is referred to the 2-week-wait breast clinic after finding a lump in the upper outer quadrant of her left breast on self-examination.\n\nShe is not keen to have any operative interventions.\n\nTriple assessment outcome:\n\n* Clinical examination - P4 (suspicious of malignancy)\n\n* Imaging (mammography) - M5 (malignant)\n\n* Biopsy - B5 (malignant). Invasive ductal carcinoma.\n\nImmunohistochemistry:\n\n* Oestrogen receptor: strongly positive\n\n* Progesterone receptor: mildly positive\n\n* Human epidermal growth factor receptor 2 (HER2): not expressed\n\nWhich of the following is most likely to be a part of her management?",
"sbaAnswer": [
"a"
],
"totalVotes": 3074,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,319 | false | 2 | null | 6,495,259 | null | false | [] | null | 19,370 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The question does not mention breastfeeding. The management of lactational mastitis is to encourage breastfeeding for 12-24 hours and review the need for antibiotics.",
"id": "10034833",
"label": "b",
"name": "Encourage breastfeeding and review",
"picture": null,
"votes": 1082
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no signs of a breast abscess at present. The diagnosis is non-lactational mastitis, for which co-amoxiclav should be prescribed.",
"id": "10034834",
"label": "c",
"name": "Incision and drainage",
"picture": null,
"votes": 369
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Warm compresses may provide symptomatic relief, however, antibiotic treatment is required in all cases of non-lactational mastitis.",
"id": "10034835",
"label": "d",
"name": "Warm compresses",
"picture": null,
"votes": 460
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has signs of non-lactational mastitis, which usually presents in a wedge-shaped distribution. NICE recommends all patients with this condition receive co-amoxiclav (or erythromycin/clarithromycin + metronidazole), with a review at 48 hours.",
"id": "10034832",
"label": "a",
"name": "Oral co-amoxiclav",
"picture": null,
"votes": 1083
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate; the patient is in pain and requires antibiotic treatment. The first choice antibiotic in non-lactational mastitis is co-amoxiclav.",
"id": "10034836",
"label": "e",
"name": "Watch and wait",
"picture": null,
"votes": 55
}
],
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"demo": null,
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"id": "6090",
"name": "Mastitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "151",
"name": "Breast Disease",
"typeId": 7
},
"topicId": 151,
"totalCards": null,
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"difficulty": 1,
"dislikes": 45,
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"id": "19370",
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"learningPoint": "Non-lactational mastitis presents with a warm, tender, wedge-shaped erythematous patch and is typically treated with oral co-amoxiclav.",
"likes": 6,
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"question": "A 31-year-old woman is experiencing tenderness and pain in her right breast 10 weeks after giving birth. Her baby has been bottle-fed for the past few weeks. She has not experienced this issue before, is feeling unwell and is in significant pain. \n\nOn examination, she has a warm, tender, wedge-shaped erythematous patch on the right breast, with no palpable masses and no visible discharge.\n\nWhat is the single best course of management?",
"sbaAnswer": [
"a"
],
"totalVotes": 3049,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,320 | false | 3 | null | 6,495,259 | null | false | [] | null | 19,371 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect - stage IV lymphoma implies there is disease above and below the diaphragm, as well as organ involvement. The 'B' after the numerical stage is correct, however, as the patient is suffering from B symptoms.",
"id": "10034839",
"label": "c",
"name": "Stage IV B",
"picture": null,
"votes": 146
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer as the patient has two sites of disease on either side of the diaphragm (above - axillary and below - para-aortic nodes), as well as B symptoms (weight loss, night sweats, fevers).",
"id": "10034837",
"label": "a",
"name": "Stage III B",
"picture": null,
"votes": 1632
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect - B symptoms (weight loss, night sweats, fevers) are present, so the letter following the numerical stage would be 'B', rather than 'A'.",
"id": "10034838",
"label": "b",
"name": "Stage III A",
"picture": null,
"votes": 742
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect - stage I lymphoma implies there is disease in just one group of lymph nodes, or a single organ. Furthermore, B symptoms (weight loss, night sweats, fevers) are present, so the letter following the numerical stage would be 'B', rather than 'A'.",
"id": "10034840",
"label": "d",
"name": "Stage I A",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect - stage I lymphoma implies there is disease in just one group of lymph nodes, or a single organ. The 'B' after the numerical stage is correct, however, as the patient is suffering from B symptoms.",
"id": "10034841",
"label": "e",
"name": "Stage I B",
"picture": null,
"votes": 477
}
],
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"__typename": "QuestionComment",
"comment": "Low Yield",
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"id": "6091",
"name": "Ann Arbor staging system",
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"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
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"topicId": 157,
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"isLikedByMe": 0,
"learningPoint": "Stage III B lymphoma indicates extensive lymph node involvement on both sides of the diaphragm, with systemic B symptoms like fever, night sweats, and weight loss.",
"likes": 6,
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"question": "A 32-year-old man has a PET-CT scan after being referred to the haematology 2-week wait clinic. He initially visited his GP as he had been experiencing weight loss, night sweats, and fevers.\n\nOn examination, he has axillary lymphadenopathy, but no splenomegaly. No other lymph node groups are palpable. A diagnosis of lymphoma is made from a lymph node biopsy.\n\nA PET-CT shows avidity in the para-aortic nodes, as well as the axilla.\n\nWhich of the following best describes the stage of the patient's lymphoma?",
"sbaAnswer": [
"a"
],
"totalVotes": 3015,
"typeId": 1,
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} | MarksheetMark |
173,468,321 | false | 4 | null | 6,495,259 | null | false | [] | null | 19,372 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A bacterial infection causing reactive neutrophilia is the second most likely diagnosis and should be excluded. His observations being within normal limits (e.g. him being afebrile) and being otherwise well suggests infection is less likely. He has likely received prednisolone for his RA flare, resulting in neutrophilia.",
"id": "10034844",
"label": "c",
"name": "Infection",
"picture": null,
"votes": 438
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely given the clinical history. Leukaemias such as CML may result in a leukocytosis/neutrophilia, but there are no other cell lines affected, nor is there a compatible clinical history.",
"id": "10034843",
"label": "b",
"name": "Leukaemia",
"picture": null,
"votes": 338
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Methotrexate can cause bone marrow suppression and pancytopenia, rather than neutrophilia. It is more likely that this patient has received a course of prednisolone for his RA flare.",
"id": "10034845",
"label": "d",
"name": "Methotrexate use",
"picture": null,
"votes": 564
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Neutrophilia can be caused by infections (particularly bacterial), medications (steroids and lithium predominantly), inflammation, stress, and malignancies. In this case, the patient has likely received steroids for their flare of rheumatoid arthritis, resulting in neutrophilia.",
"id": "10034842",
"label": "a",
"name": "Prednisolone",
"picture": null,
"votes": 1598
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NSAIDs are not known to cause neutrophilia. It is more likely that this patient has received a course of prednisolone for his RA flare, causing neutrophilia.",
"id": "10034846",
"label": "e",
"name": "NSAID use",
"picture": null,
"votes": 41
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "What is causing the iron deficiency anaemia?\n",
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"likes": 10,
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"__typename": "QuestionComment",
"comment": "i assumed it was anaemia of chronic disease from RA",
"createdAt": 1736243332,
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"name": "Neutrophilia",
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"name": "Haematology",
"typeId": 7
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"dislikes": 8,
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"id": "19372",
"isLikedByMe": 0,
"learningPoint": "Prednisolone can cause neutrophilia, often seen in patients with inflammatory conditions like rheumatoid arthritis.",
"likes": 3,
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"question": "A patient is called by his GP with concerns about his blood test results. He has had routine investigations as he has been feeling very fatigued recently. He has a background of rheumatoid arthritis which he has just experienced a severe flare of.\n\n\nOn examination, he looks well and observations are within normal limits.\n\n\nBlood test results:\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|121 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|23.2x10<sup>9</sup>/L|3.0 - 10.0|\n|Mean Cell Volume (MCV)|77.1 fL|80 - 96|\n|Neutrophils|17.8x10<sup>9</sup>/L|2.0 - 7.5|\n|Lymphocytes|2.9x10<sup>9</sup>/L|1.5 - 4.0|\n|Eosinophils|0.1x10<sup>9</sup>/L|0 - 0.4|\n|Basophils|0.1x10<sup>9</sup>/L|0 - 0.1|\n|C Reactive Protein|15.2 mg/L|< 5|\n\nWhat is the most likely explanation for this abnormality?",
"sbaAnswer": [
"a"
],
"totalVotes": 2979,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,322 | false | 5 | null | 6,495,259 | null | false | [] | null | 19,373 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "'Flash' pulmonary oedema can occur after an acute myocardial event or acute kidney injury. This is a possibility, however, the most likely diagnosis is TACO, caused by the infusion of large volumes of fluid in a patient with a background of heart failure.",
"id": "10034849",
"label": "c",
"name": "Acute myocardial infarction causing flash pulmonary oedema",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pulmonary oedema caused by circulatory overload is the most likely diagnosis. The x-ray shows 'bat wing' alveolar oedema and fluid in the right horizontal fissure. The patient has received a significant amount of fluid via blood transfusions; each unit of packed red cells contains around 300ml, and each pool of FFP contains 200-250ml. The patient's background of HFpEF puts them at risk of this condition.",
"id": "10034847",
"label": "a",
"name": "Transfusion-associated circulatory overload (TACO)",
"picture": null,
"votes": 1292
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anaphylaxis can occur following blood transfusion, however, it would usually present with hypotension and airway compromise (i.e. a mention of stridor). It would not typically cause the appearance of pulmonary oedema on a chest x-ray.",
"id": "10034850",
"label": "d",
"name": "Anaphylaxis",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary haemorrhage is a rare (and often fatal) consequence of DIC. It is rare and may present with haemoptysis. The most likely diagnosis is TACO, caused by the infusion of large volumes of fluid in a patient with known HFpEF. Additionally, the infiltrates of diffuse pulmonary haemorrhage are usually described as 'fluffy', in contrast to the typical 'bat-wing' opacification seen in pulmonary oedema (and in this x-ray).",
"id": "10034851",
"label": "e",
"name": "Pulmonary haemorrhage",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While TRALI is a differential, it is rare, and TACO is the most likely diagnosis given the patient's background of HFpEF. Patients with TRALI may become hypotensive and febrile, as the pulmonary oedema is caused by neutrophil activation causing leakage in capillaries. TRALI may be considered more likely if there is an inadequate response to diuresis with furosemide.",
"id": "10034848",
"label": "b",
"name": "Transfusion-associated lung injury (TRALI)",
"picture": null,
"votes": 1554
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "spent so long looking for a blood pressure :( feel like this was way too vague icl",
"createdAt": 1738015269,
"dislikes": 0,
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"__typename": "QuestionComment",
"comment": "agreed",
"createdAt": 1738323259,
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"chapterId": 2693,
"demo": null,
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"id": "6093",
"name": "Blood Products, Groups and Transfusions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "157",
"name": "Haematology",
"typeId": 7
},
"topicId": 157,
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"conditions": [],
"difficulty": 1,
"dislikes": 35,
"explanation": null,
"highlights": [],
"id": "19373",
"isLikedByMe": 0,
"learningPoint": "Transfusion-associated circulatory overload (TACO) can occur in patients with heart failure after significant fluid administration, leading to pulmonary oedema.",
"likes": 10,
"multiAnswer": null,
"pictures": [
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"question": "A 68-year-old lady is admitted to hospital with severe bleeding after a tooth extraction. She has a history of diabetes, hypertension, and heart failure with a reduced ejection fraction (HFpEF). Investigations showed a haemoglobin concentration of 34 g/L (normal range 115-155 g/L), with fragments on the blood film. Her D-dimer was raised, and clotting was significantly deranged, in keeping with disseminated intravascular coagulation (DIC).\n\n\nShe receives 5 units of packed red cells and 3 pools of fresh frozen plasma (FFP) as part of the major haemorrhage protocol.\n\n\nShe becomes acutely breathless and hypoxaemic, with saturations of 84% on air. A chest x-ray shows:\n\n\n [lightgallery]\n\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2953,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,323 | false | 6 | null | 6,495,259 | null | false | [] | null | 19,374 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing colicky pain due to peristalsis against the malignant obstruction. Opiates are very likely to be helpful in this situation, however, they will not treat the cause of the pain. Hyoscine is an antispasmodic and antimuscarinic, which will suppress peristalsis and help to relieve this colicky pain, and would therefore be the most useful medication. It can be added to a syringe driver if regular PRN doses are helpful.",
"id": "10034853",
"label": "b",
"name": "Morphine",
"picture": null,
"votes": 1105
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing colicky pain due to peristalsis against the malignant obstruction. Opiates are very likely to be helpful in this situation, however, they will not treat the cause of the pain. Further, codeine can only be taken orally and therefore is likely not suitable in this case. Hyoscine is an antispasmodic and antimuscarinic, which will suppress peristalsis and help to relieve this colicky pain, and would therefore be the most useful medication. It can be added to a syringe driver if regular PRN doses are helpful.",
"id": "10034855",
"label": "d",
"name": "Codeine",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing colicky pain due to peristalsis against the malignant obstruction. Opiates are very likely to be helpful in this situation, however, they will not treat the cause of the pain. Hyoscine is an antispasmodic and antimuscarinic, which will suppress peristalsis and help to relieve this colicky pain, and would therefore be the most useful medication. It can be added to a syringe driver if regular PRN doses are helpful.",
"id": "10034856",
"label": "e",
"name": "Oxycodone",
"picture": null,
"votes": 353
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing colicky pain due to peristalsis against the malignant obstruction. Hyoscine is an antispasmodic and antimuscarinic, which will suppress peristalsis and help to relieve this colicky pain. It can be added to a syringe driver if regular PRN doses are helpful. Opiates may be helpful in addition, however, they will not treat the cause of the pain.",
"id": "10034852",
"label": "a",
"name": "Hyoscine butylbromide",
"picture": null,
"votes": 1275
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is experiencing colicky pain due to peristalsis against the malignant obstruction. Opiates are very likely to be helpful in this situation, however, they will not treat the cause of the pain. Hyoscine is an antispasmodic and antimuscarinic, which will suppress peristalsis and help to relieve this colicky pain, and would therefore be the most useful medication. It can be added to a syringe driver if regular PRN doses are helpful.",
"id": "10034854",
"label": "c",
"name": "Diamorphine",
"picture": null,
"votes": 146
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "explanation is wrong - can't give opiates in bowel obstruction",
"createdAt": 1709474287,
"dislikes": 4,
"id": "43592",
"isLikedByMe": 0,
"likes": 1,
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"__typename": "QuestionComment",
"comment": "This is wrong ",
"createdAt": 1709542228,
"dislikes": 0,
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"id": "6094",
"name": "End of Life Care Medications",
"status": null,
"topic": {
"__typename": "Topic",
"id": "225",
"name": "Oncology and Palliative Care",
"typeId": 7
},
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"dislikes": 18,
"explanation": null,
"highlights": [],
"id": "19374",
"isLikedByMe": 0,
"learningPoint": "Hyoscine butylbromide is effective for managing colicky abdominal pain by suppressing peristalsis in cases of malignant bowel obstruction.",
"likes": 7,
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"question": "An 89-year-old woman has been admitted to a hospice with malignant bowel obstruction as she is not suitable for operative management.\n\nShe is awake and alert, but reports being troubled by severe pain in her abdomen that comes and goes in waves. She says that when present, this pain reaches 9/10 in intensity.\n\nWhich of the following medications would be most helpful in managing the cause of her pain?",
"sbaAnswer": [
"a"
],
"totalVotes": 2941,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,324 | false | 7 | null | 6,495,259 | null | false | [] | null | 19,375 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; the Mental Capacity Act requires people to specify (in lay or medical terms) the treatment they wish to refuse and they may specify the circumstances, if any, in which that treatment is to be refused.",
"id": "10034861",
"label": "e",
"name": "It does not have to specify which treatments the patient wishes to refuse",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; while patients may want/benefit from the support of a clinician, there is no legal requirement for this to be the case.",
"id": "10034858",
"label": "b",
"name": "It must be made in front of a doctor",
"picture": null,
"votes": 274
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; advanced directives often concern life-sustaining treatment. It is important that the advanced decision is written down, signed, and witnessed if this is the case.",
"id": "10034860",
"label": "d",
"name": "It is invalid, as the patient is refusing life-sustaining treatment",
"picture": null,
"votes": 103
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; if the patient verbalises or indicates that they have changed their mind, their advanced decision no longer stands.",
"id": "10034859",
"label": "c",
"name": "It stands, even if the patient verbally says they have changed their mind",
"picture": null,
"votes": 91
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct - advanced decisions to refuse treatment that concern life-sustaining measures must be signed by a witness, as well as the patient. Without this, the advanced decision is invalid in law, but this could be considered an advanced statement that could be used to help inform a best interests decision.",
"id": "10034857",
"label": "a",
"name": "It must be signed by a witness",
"picture": null,
"votes": 2361
}
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"question": "A patient with a recent diagnosis of motor neurone disease is admitted to hospital with a suspected subarachnoid haemorrhage.\n\nThey were unconscious and were intubated as soon as they arrived in the emergency department.\n\nThe patient's wife arrives at the hospital and informs staff that her husband has made an advanced decision to refuse treatment (ADRT), which specifies that he is not to be intubated and ventilated under any circumstances. She asks that he be extubated.\n\nWhich of the following is required to ensure the ADRT is valid?",
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"a"
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173,468,325 | false | 8 | null | 6,495,259 | null | false | [] | null | 19,376 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has a complication of gallstone disease, ascending cholangitis. While a cholecystectomy will eventually be required, this will not definitively manage the CURRENT issue. Laparoscopic cholecystectomy is usually preferred over the open approach. The obstructing, infected area needs to be decompressed by ERCP.",
"id": "10034866",
"label": "e",
"name": "Open cholecystectomy",
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"__typename": "QuestionChoice",
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"explanation": "This patient has ascending cholangitis and presents with the typical triad of jaundice, fever, and right upper quadrant pain. Antibiotics and fluids will be administered as supportive therapy, but this will not definitively control the source of the infection. An ERCP is required so that the biliary tree can be visualised, and the obstructing stone can be removed, relieving the obstruction and controlling the source of the infection.",
"id": "10034864",
"label": "c",
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"explanation": "This patient has ascending cholangitis and presents with the typical triad of jaundice (high bilirubin), fever, and right upper quadrant pain. She also has obstructive-pattern liver enzyme derangements. An ERCP is required so that the biliary tree can be visualised, and the obstructing stone can be removed, relieving the obstruction and controlling the source of the infection.",
"id": "10034862",
"label": "a",
"name": "Endoscopic retrograde cholangiopancreatography (ERCP)",
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient has a complication of gallstone disease, ascending cholangitis. While a cholecystectomy will eventually be required, this will not definitively manage the CURRENT issue. The obstructing, infected area needs to be decompressed by ERCP.",
"id": "10034865",
"label": "d",
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},
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"__typename": "QuestionChoice",
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"explanation": "This patient has ascending cholangitis and presents with the typical triad of jaundice (high bilirubin), fever, and right upper quadrant pain. A PTC is a way of assessing the biliary tree, however, an ERCP is less invasive and allows better access for decompression of the infected area and removal of stones.",
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"label": "b",
"name": "Percutaneous transhepatic cholangiography (PTC)",
"picture": null,
"votes": 25
}
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"__typename": "QuestionComment",
"comment": "You can have high bili but not have jaundice - is this still cholangitis?!\n",
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"comment": "think is something of a question error; tend to get jaundice once bilirubin reaches around 50",
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"comment": "how would i differentiate between this and cholecystitis??\n",
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"__typename": "QuestionComment",
"comment": "Raised bilirubin + confusion and hypotension; only in asc cholangitis",
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"question": "A 64-year-old lady is admitted to the hospital with severe abdominal pain and rigors. She is confused and is unable to elaborate on her history. On examination, she is exquisitely tender in the right upper quadrant.\n\n\nObservations:\n\n * Heart rate: 112 beats/minute\n\n * Blood pressure: 102/69 mmHg\n\n * Respiratory rate: 17 breaths/minute\n\n * Temperature: 38.7 degrees\n\n * Oxygen saturations (room air): 98%\n\n\nBloods:\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|121 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|21x10<sup>9</sup>/L|3.0 - 10.0|\n|Mean Cell Volume (MCV)|77.1 fL|80 - 96|\n|Creatinine|100 µmol/L|60 - 120|\n|Alanine Aminotransferase (ALT)|61 IU/L|10 - 50|\n|Aspartate Aminotransferase (AST)|64 IU/L|10 - 40|\n|Alkaline Phosphatase (ALP)|428 IU/L|25 - 115|\n|Bilirubin|87 µmol/L|< 17|\n\n\nWhich of the following is the definitive management of her acute presentation?",
"sbaAnswer": [
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173,468,326 | false | 9 | null | 6,495,259 | null | false | [] | null | 19,377 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The x-ray shows large bowel obstruction, as the dilated bowel loops are peripheral and show haustra (rather than the valvulae conniventes seen in small bowel obstruction). Adhesions usually cause small bowel obstruction, not large bowel obstruction.",
"id": "10034868",
"label": "b",
"name": "Adhesional bowel obstruction",
"picture": null,
"votes": 763
},
{
"__typename": "QuestionChoice",
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"explanation": "The x-ray appearances are in keeping with large bowel obstruction, which is commonly caused by colorectal carcinoma. Mesenteric ischaemia would present more acutely, with severe pain and without these x-ray findings. The serum lactate may be raised.",
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"label": "e",
"name": "Mesenteric ischaemia",
"picture": null,
"votes": 123
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"__typename": "QuestionChoice",
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"id": "10034870",
"label": "d",
"name": "Pseudo-obstruction (Ogilve's Syndrome)",
"picture": null,
"votes": 500
},
{
"__typename": "QuestionChoice",
"answer": true,
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"id": "10034867",
"label": "a",
"name": "Colorectal carcinoma",
"picture": null,
"votes": 1392
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The appearance of the x-ray and the clinical presentation is suggestive of large bowel obstruction, likely secondary to a tumour. Inflammatory bowel disease can cause toxic megacolon (which has a different appearance), or classically small bowel obstruction (e.g. in Crohn's). The history does not mention a chronic course of events.",
"id": "10034869",
"label": "c",
"name": "Inflammatory bowel disease",
"picture": null,
"votes": 107
}
],
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"__typename": "QuestionComment",
"comment": "where are the haustra???",
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{
"__typename": "QuestionComment",
"comment": "Thats Coffee bean sign on abdo xray, sigmoid vulvulus causing obstruction likely due to cancer.",
"createdAt": 1718362532,
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"question": "A 77-year-old man has had severe progressive constipation for the past week and has started vomiting today. His GP referred him to the emergency department as he was in significant discomfort.\n\nOn examination, he has a tense, distended, uncomfortable abdomen. There are no signs of peritonism. His rectum is empty on PR examination, with no masses or faeces noted.\n\nObservations are stable. Blood tests show hypernatraemia and a raised CRP.\n\nAn abdominal x-ray is performed:\n\n[lightgallery]\n\nWhat is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
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173,468,327 | false | 10 | null | 6,495,259 | null | false | [] | null | 19,378 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a mild lactic (metabolic) acidosis. This is likely due to organ hypoperfusion caused by heart failure. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.",
"id": "10034872",
"label": "a",
"name": "Metformin",
"picture": null,
"votes": 2274
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no indication to hold atorvastatin in this case, such as rhabdomyolysis or statin-induced myopathy. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.",
"id": "10034874",
"label": "c",
"name": "Atorvastatin",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Furosemide will be required to treat this patient's pulmonary oedema and heart failure. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.",
"id": "10034873",
"label": "b",
"name": "Furosemide",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Ramipril increases life expectancy in patients with heart failure. There is no current indication to hold it, e.g. an acute kidney injury or hypotension. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.",
"id": "10034876",
"label": "e",
"name": "Ramipril",
"picture": null,
"votes": 257
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient's blood sugar is within range, and there is no reason at present to hold gliclazide. It may be held or reduced if the patient is commenced on a variable rate insulin infusion, however. Metformin has been linked to the development/exacerbation of lactic acidosis, and therefore is the most important medication to hold.",
"id": "10034875",
"label": "d",
"name": "Gliclazide",
"picture": null,
"votes": 221
}
],
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"name": "Anesthetics and Intensive Care Medicine",
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"learningPoint": "Metformin-associated lactic acidosis is a rare but serious complication, typically occurring in patients with renal impairment or conditions causing hypoxia. It results from lactate accumulation due to impaired gluconeogenesis and metabolism",
"likes": 1,
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"question": "A patient is admitted to hospital with a severe exacerbation of heart failure. They have a background of type 2 diabetes, hypertension, and hypercholesterolaemia.\n\n\nAn infusion of furosemide (10mg/hour) is commenced due to significant pulmonary oedema. A venous blood gas (VBG) shows:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.32|7.35 - 7.45|\n|PaO₂|4.9 kPa|11 - 15|\n|PaCO₂|3.2 kPa|4.6 - 6.4|\n|Bicarbonate|20.8 mmol/L|22 - 30|\n|Lactate|3.4 mmol/L|0.6 - 1.4|\n|Sodium|136 mmol/L|135 - 145|\n|Potassium|4.3 mmol/L|3.5 - 5.3|\n|Non-fasting Glucose|6.9 mmol/L|< 6.1|\n\n\nWhich medication is most important to stop in light of these results?",
"sbaAnswer": [
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173,468,328 | false | 11 | null | 6,495,259 | null | false | [] | null | 19,379 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CPAP provides continuous pressure during inhalation and exhalation (like trying to breathe against the wind). This is better for improving oxygenation, e.g. in acute heart failure and respiratory distress, rather than ventilation. This patient has a type 2 respiratory failure with associated acidosis, so BiPAP (which will improve ventilation and the removal of CO2) is a more appropriate choice here.",
"id": "10034878",
"label": "b",
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"picture": null,
"votes": 211
},
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"__typename": "QuestionChoice",
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"explanation": "This is a mode of invasive mechanical ventilation (delivered via an endotracheal tube), which is not yet indicated. The British Thoracic Society guidelines recommend BiPAP (non-invasive ventilation) is attempted in COPD patients whose condition does not improve after 1 hour of maximal medical management and who have a pH of 7.25-7.35. Invasive ventilation would be indicated with a pH of 7.15 or below.",
"id": "10034880",
"label": "d",
"name": "Pressure support ventilation (PSV)",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a mode of invasive mechanical ventilation (delivered via an endotracheal tube), which is not yet indicated. The British Thoracic Society guidelines recommend BiPAP (non-invasive ventilation) is attempted in COPD patients whose condition does not improve after 1 hour of maximal medical management and who have a pH of 7.25-7.35. Invasive ventilation would be indicated with a pH of 7.15 or below.",
"id": "10034881",
"label": "e",
"name": "Volume-controlled ventilation (VCV)",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "BiPAP (non-invasive ventilation) is an appropriate choice for this patient; it will improve oxygenation, as well as ventilation, reducing the patient's pCO2 which is resulting in a respiratory acidosis. NIV is indicated in COPD with acidosis (pH 7.25 - 7.35), hypercapnia (pCO2 >6 kPa), or increased work of breathing (respiratory rate >23) when 1 hour of optimal medical management has not improved the situation. If the pH is 7.15-7.25, NIV can still be tried, but the patient is at very high risk of needing to be intubated and needs to be closely monitored. Intubation is advised when the pH is <7.15.",
"id": "10034877",
"label": "a",
"name": "Bi-level positive airway pressure (BiPAP)",
"picture": null,
"votes": 2565
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a mode of invasive mechanical ventilation (delivered via an endotracheal tube), which is not yet indicated. The British Thoracic Society guidelines recommend BiPAP (non-invasive ventilation) is attempted in COPD patients whose condition does not improve after 1 hour of maximal medical management and who have a pH of 7.25-7.35. Invasive ventilation would be indicated with a pH of 7.15 or below.",
"id": "10034879",
"label": "c",
"name": "Airway pressure release ventilation (APRV)",
"picture": null,
"votes": 7
}
],
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},
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"name": "Non-invasive ventilation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "177",
"name": "Anaesthetics and Intensive Care Medicine",
"typeId": 7
},
"topicId": 177,
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "19379",
"isLikedByMe": 0,
"learningPoint": "Bi-level positive airway pressure (BiPAP) is indicated in COPD exacerbations with respiratory acidosis and hypercapnia when medical management fails.",
"likes": 1,
"multiAnswer": null,
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"question": "A patient with long-standing COPD is admitted to the respiratory ward with an acute exacerbation of the disease. They have received salbutamol, ipratropium, prednisolone\n\n\nAn ABG shows:\n\n\n||||\n|--------------|:-------:|------------------|\n|pH|7.31|7.35 - 7.45|\n|PaO₂|7.2 kPa|11 - 15|\n|PaCO₂|6.6 kPa|4.6 - 6.4|\n|Bicarbonate|32.5 mmol/L|22 - 30|\n|Lactate|1.2 mmol/L|0.6 - 1.4|\n|Sodium|136 mmol/L|135 - 145|\n|Potassium|4.3 mmol/L|3.5 - 5.3|\n|Non-fasting Glucose|7 mmol/L|< 6.1|\n\n\n\n\nWhich form of respiratory support would be most appropriate to select?",
"sbaAnswer": [
"a"
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173,468,329 | false | 12 | null | 6,495,259 | null | false | [] | null | 19,380 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate. The patient is showing signs of opioid toxicity that must be treated. Supportive management is more appropriate for benzodiazepine overdoses that do not cause airway/respiratory compromise.",
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"label": "b",
"name": "Supportive management only",
"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Naloxone will be required as this is a likely opioid overdose, however, it will take time to locate, draw up, and administer this. Following the A-E approach, it is most important (assuming the airway is patent) to support this patient's breathing with a bag-valve mask connected to oxygen, until naloxone can be administered. Not doing this could lead to respiratory, and then cardiac, arrest.",
"id": "10034884",
"label": "c",
"name": "Administer naloxone",
"picture": null,
"votes": 1855
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is showing signs of opioid toxicity, potentially secondary to recreational use. Following the A-E approach, it is most important (assuming the airway is patent) to support this patient's breathing with a bag-valve mask connected to oxygen, until naloxone can be administered. Not doing this could lead to respiratory, and then cardiac, arrest.",
"id": "10034882",
"label": "a",
"name": "Bag-valve mask ventilation",
"picture": null,
"votes": 568
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is showing signs of opioid toxicity, potentially secondary to recreational use. There is no mention of airway compromise in the information given. Following the A-E approach, it is most important (assuming the airway is patent) to support this patient's breathing with a bag-valve mask connected to oxygen, until naloxone can be administered. Not doing this could lead to respiratory, and then cardiac, arrest. Intubation may be considered further down the line, but is not the next best step.",
"id": "10034885",
"label": "d",
"name": "Intubation",
"picture": null,
"votes": 394
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is showing signs of an opiate overdose. Naloxone, rather than naloxegol, is used in these situations. First, however, the patient's breathing must be supported with bag valve mask ventilation.",
"id": "10034886",
"label": "e",
"name": "Administer naloxegol",
"picture": null,
"votes": 12
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "I thought we intubate if the patient's GCS is <8 :(",
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{
"__typename": "QuestionComment",
"comment": "They havent really given you enough to assess GCS",
"createdAt": 1735597576,
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"__typename": "QuestionComment",
"comment": "I thought we put people on a 15l non-rebreathe mask in a resus situation :(",
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"comment": "i think the logic is it doesn't matter how much oxygen pt has if they have RR of 6",
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"comment": ":(",
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"question": "A patient is brought to the resuscitation room in the emergency department after being found collapsed on the street. No medical history is available.\n\nOn examination, they have small pupils, which are minimally reactive to light. They are rousable to pain but not to voice. The airway appears patent.\n\nObservations:\n\n* Heart rate: 139 beats/minute\n\n* Blood pressure: 120/76 mmHg\n\n* Respiratory rate: 6 breaths/minute\n\n* Temperature: 36.8 degrees\n\n* Oxygen saturations (room air): 89%\n\nWhat is the most important next step to take?",
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"a"
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173,468,330 | false | 13 | null | 6,495,259 | null | false | [] | null | 19,381 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The likely diagnosis is psoriatic arthritis, given the asymmetrical distribution, dactylitis, rash, and involvement of the distal interphalangeal joints. Livedo reticularis is a rash seen in some vasculitides, as well as anti-phospholipid syndrome.",
"id": "10034891",
"label": "e",
"name": "Livedo reticularis",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The likely diagnosis is psoriatic arthritis, given the asymmetrical distribution, dactylitis, rash, and involvement of the distal interphalangeal joints. Onycholysis and nail pitting are common features of the condition.",
"id": "10034887",
"label": "a",
"name": "Onycholysis",
"picture": null,
"votes": 2500
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The likely diagnosis is psoriatic arthritis, given the asymmetrical distribution, dactylitis, rash, and involvement of the distal interphalangeal joints. Paronychia is an infection of the nail fold.",
"id": "10034890",
"label": "d",
"name": "Paronychia",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The likely diagnosis is psoriatic arthritis, given the asymmetrical distribution, dactylitis, rash, and involvement of the distal interphalangeal joints. Nodules are a feature of rheumatoid, rather than psoriatic, arthritis.",
"id": "10034889",
"label": "c",
"name": "Nodules",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The likely diagnosis is psoriatic arthritis, given the asymmetrical distribution, dactylitis, rash, and involvement of the distal interphalangeal joints. Tophi are usually found in gout - these are depositions of urate crystals that are often visible and palpable.",
"id": "10034888",
"label": "b",
"name": "Tophi",
"picture": null,
"votes": 38
}
],
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"name": "Psoriatic arthritis",
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"learningPoint": "Onycholysis, the painless separation of the nail from its bed, is a common nail manifestation in psoriatic arthritis. It occurs due to inflammation, often accompanied by pitting and subungual hyperkeratosis.",
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"question": "A 43-year-old man is referred to the rheumatology clinic by his GP for investigation of joint stiffness and pain, mainly involving the hands (left more than the right)\n\nOn examination, he has marked dactylitis of the left index finger. He also has a scaly rash on his right elbow. His distal interphalangeal joints are tender to palpation.\n\nGiven the most likely diagnosis, which other finding is likely to be elicited?",
"sbaAnswer": [
"a"
],
"totalVotes": 2822,
"typeId": 1,
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} | MarksheetMark |
173,468,331 | false | 14 | null | 6,495,259 | null | false | [] | null | 19,382 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The involvement of a large, isolated joint is not classical of rheumatoid arthritis (RA). RA usually causes multiple small-joint arthritis. The most likely diagnosis here is avascular necrosis.",
"id": "10034893",
"label": "b",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 178
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "No history of trauma has been given. The most likely diagnosis in this case is avascular necrosis, likely due to steroid use for ulcerative colitis.",
"id": "10034896",
"label": "e",
"name": "Trauma",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pattern of single large joint involvement is not typical of psoriatic arthritis. There are no features in the history (e.g. DIP joint involvement, psoriasis, asymmetrical arthritis, dactylitis) to suggest this as the diagnosis. The most likely diagnosis in this case is avascular necrosis, likely due to steroid use for ulcerative colitis.",
"id": "10034895",
"label": "d",
"name": "Psoriatic arthritis",
"picture": null,
"votes": 127
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient likely has avascular necrosis of the femoral head, contributed to by long-term steroid use for ulcerative colitis. Other risk factors for this condition include smoking, alcohol use, and sickle cell anaemia. The insidious onset and pain in the groin/buttock region, as well as painful internal rotation, are classic findings in this condition. X-rays and an MRI scan will most likely be required.",
"id": "10034892",
"label": "a",
"name": "Avascular necrosis",
"picture": null,
"votes": 2289
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While osteoarthritis often affects the hips and has a gradual onset, this is a more likely diagnosis in an older patient. The most likely diagnosis in this case is avascular necrosis, likely due to prolonged steroid use for ulcerative colitis.",
"id": "10034894",
"label": "c",
"name": "Osteoarthritis",
"picture": null,
"votes": 212
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "if it's poorly controlled then surely she's not on steroids in the first place...?",
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"questionId": 19382,
"replies": [
{
"__typename": "QuestionComment",
"comment": "poorly controlled suggests that she has had repeated steroids to manage flares because steroids are not initially used in mild/moderate disease and reserved for more persistent or severe flares of UC. ",
"createdAt": 1712675534,
"dislikes": 0,
"id": "46610",
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"name": "Avascular Necrosis",
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"learningPoint": "Avascular necrosis often presents with gradual hip pain and restricted movement, commonly associated with long-term steroid use.",
"likes": 1,
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"question": "A 30-year-old woman with a history of poorly controlled ulcerative colitis is referred to the musculoskeletal clinic due to severe left groin and buttock pain that is stopping her from being able to mobilise as usual. She says this has developed gradually.\n\nOn examination of her legs, she has restricted, painful active and passive movement in the left hip joint, especially on internal rotation.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2817,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,332 | false | 15 | null | 6,495,259 | null | false | [] | null | 19,383 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Retinal toxicity is a rare, but extremely important, side effect of hydroxychloroquine therapy. This patient's symptoms may signify the development of a scotoma (visual blind spot), which is a typical presentation of hydroxychloroquine retinopathy, along with colour vision loss. Patients taking the drug should be regularly screened with retinal photography and optical coherence tomography.",
"id": "10034897",
"label": "a",
"name": "Hydroxychloroquine",
"picture": null,
"votes": 2367
},
{
"__typename": "QuestionChoice",
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"explanation": "Visual symptoms are not typical side effects of sulfasalazine therapy. More likely is retinopathy caused by hydroxychloroquine use.",
"id": "10034901",
"label": "e",
"name": "Sulfasalazine",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Visual symptoms are not typical side effects of azathioprine therapy. More likely is retinopathy caused by hydroxychloroquine use.",
"id": "10034900",
"label": "d",
"name": "Azathioprine",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Visual symptoms are not typical side effects of infliximab therapy. More likely is retinopathy caused by hydroxychloroquine use.",
"id": "10034899",
"label": "c",
"name": "Infliximab",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Visual symptoms are not typical side effects of methotrexate therapy. More likely is retinopathy caused by hydroxychloroquine use.",
"id": "10034898",
"label": "b",
"name": "Methotrexate",
"picture": null,
"votes": 173
}
],
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"name": "Side Effects of Drugs used to treat rheumatoid arthritis.",
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"typeId": 7
},
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"learningPoint": "Hydroxychloroquine can cause retinal toxicity, leading to symptoms like colour vision loss and scotomas; regular eye screening is essential for patients.",
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"question": "A patient with long-standing rheumatoid arthritis visits her rheumatologist for a routine appointment. On systemic enquiry, she reports feeling well in herself with well-controlled symptoms. She does mention, however, that she has had trouble reading recently and is seeing colours less vividly than she used to.\n\nWhich medication may account for these symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 2814,
"typeId": 1,
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} | MarksheetMark |
173,468,333 | false | 16 | null | 6,495,259 | null | false | [] | null | 19,384 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The question asks which is the most sensitive test (i.e. which would most likely be positive) for lupus, which is the most likely diagnosis. Anti-CCP antibodies are extremely specific for rheumatoid arthritis, rather than lupus.",
"id": "10034904",
"label": "c",
"name": "Anti-CCP antibodies",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The question asks which is the most sensitive test (i.e. which would most likely be positive) for lupus, which is the most likely diagnosis. Anti-Smith antibodies are extremely specific for lupus, however, they are not the most likely antibody to be found.",
"id": "10034903",
"label": "b",
"name": "Anti-Smith antibodies",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The question asks which is the most sensitive test (i.e. which would most likely be positive) for lupus, which is the most likely diagnosis. Anti-smooth muscle antibodies are more strongly associated with autoimmune hepatitis, rather than lupus.",
"id": "10034905",
"label": "d",
"name": "Anti-smooth muscle antibodies",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Anti-nuclear antibodies are found in around 99% of patients with lupus, which is the most likely diagnosis. The question asks which is the most **sensitive** test (i.e. which would most likely be positive), and so this is the correct answer.",
"id": "10034902",
"label": "a",
"name": "Anti-nuclear antibodies",
"picture": null,
"votes": 1618
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The question asks which is the most sensitive test (i.e. which would most likely be positive) for lupus, which is the most likely diagnosis. Anti-dsDNA antibodies are extremely specific for lupus, however, they are not the most likely antibody to be found.",
"id": "10034906",
"label": "e",
"name": "Anti-double-stranded DNA antibodies",
"picture": null,
"votes": 1073
}
],
"comments": [],
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},
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"id": "4036",
"name": "Systemic lupus erythematosus (SLE)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
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"highlights": [],
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"isLikedByMe": 0,
"learningPoint": "Anti-nuclear antibodies (ANAs) are autoantibodies produced by the immune system that target components of the cell nucleus, such as DNA, RNA, histones, and nuclear proteins. .",
"likes": 6,
"multiAnswer": null,
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"question": "A 19-year-old woman has been referred to the rheumatology clinic for investigation of polyarthralgia, recurrent mouth ulcers, and a butterfly-shaped rash on her face. She describes the symptoms developing over a few months and has a strong family history of autoimmune disorders.\n\nGiven the most likely diagnosis, which of the following autoantibodies is most likely to be positive?",
"sbaAnswer": [
"a"
],
"totalVotes": 2833,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,334 | false | 17 | null | 6,495,259 | null | false | [] | null | 19,385 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate; the patient has an intracapsular fracture. Dynamic hip screws are used in cases of intertrochanteric fractures. This patient requires a total hip replacement.",
"id": "10034910",
"label": "d",
"name": "Dynamic hip screw",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate; intramedullary nails are used for subtrochanteric fractures, to fix the femoral shaft. This patient requires a total hip replacement.",
"id": "10034909",
"label": "c",
"name": "Intramedullary nail",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ORIF can be considered for patients with minimally displaced (i.e. Garden I/II) fractures. This option is generally considered in younger patients, as it minimises the risk of a re-operation due to failure of a prosthetic. This patient may have been a candidate for an ORIF if their fracture was less displaced, however it has been classified Garden IV. They require a total hip replacement.",
"id": "10034911",
"label": "e",
"name": "Open reduction, internal fixation (ORIF)",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate course of treatment if the patient was older, frailer, or had poor baseline mobility. This is because while a hemiarthroplasty is less complex than a total hip replacement, the improvement in quality of life provided is not as good, and the rates of revision operations are higher.",
"id": "10034908",
"label": "b",
"name": "Hemiarthroplasty",
"picture": null,
"votes": 285
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most appropriate course of management of the options provided, as the patient has good mobility at baseline and has an intracapsular fracture. A total hip replacement is more appropriate given the patient is relatively young, as this procedure has been shown to provide patients with a better quality of life and a lower rate of needing a revision operation.",
"id": "10034907",
"label": "a",
"name": "Total hip replacement",
"picture": null,
"votes": 2289
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6102",
"name": "Fractured neck of femur",
"status": null,
"topic": {
"__typename": "Topic",
"id": "331",
"name": "Orhtopaedics",
"typeId": 7
},
"topicId": 331,
"totalCards": null,
"typeId": null,
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},
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"difficulty": 1,
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"highlights": [],
"id": "19385",
"isLikedByMe": 0,
"learningPoint": "In patients with intracapsular neck of femur fractures and good pre-injury mobility, total hip replacement is often the preferred management option.",
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"question": "A 66-year-old woman is admitted to hospital after suffering a fall at home. She has severe pain around the left hip region and says she cannot move her leg.\n\nOn examination, her left leg is shortened and externally rotated. A pelvic X-ray shows a Garden IV intracapsular neck of femur fracture.\n\nThe patient has no significant past medical history and reports being completely independent with all activities of daily living, without the need for any walking aids.\n\nWhat is the most appropriate course of management?",
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"a"
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173,468,335 | false | 18 | null | 6,495,259 | null | false | [] | null | 19,386 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although bruising may occur in ankle fractures, this is not a criterion included in the Ottawa ankle rules.",
"id": "10034914",
"label": "c",
"name": "Severe bruising in the mid-foot zone",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; according to the Ottawa ankle rules, pain at point D would qualify the patient for an ankle x-ray if there was pain in the mid-foot zone, rather than the malleolar zone.",
"id": "10034915",
"label": "d",
"name": "Point-tenderness at point D on the diagram",
"picture": null,
"votes": 217
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; the Ottawa ankle rules explicitly state that the criteria for an x-ray involve an inability to weight bear (for 4 steps) both immediately and in the emergency department. Simple pain on walking does not fall into this category.",
"id": "10034916",
"label": "e",
"name": "Pain on walking",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The Ottawa ankle rules state that an ankle X-ray is required if (with malleolar zone pain) there is either tenderness at point A, tenderness at point B, or an inability to weight bear for 4 steps both immediately AND in the emergency department.",
"id": "10034912",
"label": "a",
"name": "Tenderness at point A on the diagram",
"picture": null,
"votes": 2241
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; the Ottawa ankle rules state that an inability to weight bear (for 4 steps) should be present both immediately after the injury and also in the ED - i.e. the onset should not be gradual.",
"id": "10034913",
"label": "b",
"name": "Gradual-onset inability to weight bear after the injury",
"picture": null,
"votes": 241
}
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"name": "Ottawa Ankle Rules",
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"question": "A 22-year-old man visits the emergency department with severe pain in his left ankle, after he twisted it during a fall while walking on a slippery surface.\n\nOn examination, his left ankle is swollen and extremely tender in the malleolar zone of the foot:\n\n[lightgallery]\n\nWhich of the following would suggest that an ankle X-ray is required?",
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"a"
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"typeId": 1,
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} | MarksheetMark |
173,468,336 | false | 19 | null | 6,495,259 | null | false | [] | null | 19,387 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is suggestive of a diagnosis of congenital adrenal hyperplasia (CAH) with symptoms of dehydration and vomiting developing soon after birth. The electrolyte derangements also suggest CAH, with hyponatraemia and hyperkalaemia caused by hypoaldosteronism.",
"id": "10034917",
"label": "a",
"name": "Fused labia and urogenital sinus",
"picture": null,
"votes": 318
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is suggestive of meningitis which can present vaguely in newborns. Meningitis does not explain the hyperkalaemia and may cause respiratory symptoms or drowsiness which are not mentioned.",
"id": "10034920",
"label": "d",
"name": "Widespread petechial rash",
"picture": null,
"votes": 224
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Physiological jaundice may occur up to two weeks post-birth in healthy breastfed babies. Persistent jaundice or jaundice in the first 24 hours of life is concerning for haematological/biliary conditions.",
"id": "10034921",
"label": "e",
"name": "Jaundice",
"picture": null,
"votes": 368
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is suggestive of intussuception which tends to happen between the ages of three and 18 months. It presents with colicky abdominal pain, vomiting and red currant jelly stools.",
"id": "10034919",
"label": "c",
"name": "Sausage-shaped mass in the abdomen",
"picture": null,
"votes": 603
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is suggestive of pyloric stenosis which can present with projectile vomiting, normally 2-6 weeks after birth. Electrolyte abnormalities include hypokalaemia and hypochloraemia with metabolic alkalosis.",
"id": "10034918",
"label": "b",
"name": "Olive-shaped mass in the abdomen",
"picture": null,
"votes": 1298
}
],
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"__typename": "QuestionComment",
"comment": "what the fuck",
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"displayName": "Britney Spears",
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"__typename": "QuestionComment",
"comment": "why can't it be intussusception causing bowel obstruction causing the electrolyte disturbance and symptoms?",
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"comment": "Perhaps a bit early presentation? Not sure though",
"createdAt": 1712067826,
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"displayName": "Neoplasia Supine",
"id": 3143
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"__typename": "QuestionComment",
"comment": "Because there is hyper rather than hypokalaemia. Hyperkalaemia is due to lack of aldosterone. Excess voting depleted potassium on the contrary. ",
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"displayName": "Dorothy",
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"displayName": "Cystic Myotonia",
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{
"__typename": "QuestionComment",
"comment": "She's 5!? Surely she'd present earlier?? ",
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"id": "50298",
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"comment": "5 days old",
"createdAt": 1716744247,
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"displayName": "Jeremy Usborne",
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"comment": "5 days",
"createdAt": 1718977649,
"dislikes": 0,
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"displayName": "Dorothy",
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"__typename": "QuestionComment",
"comment": "Not me thinking she had a weird sepsis :/",
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"comment": "allow dat\n",
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"question": "A 5-day-old girl is brought to the paediatric emergency department with vomiting and poor feeding. Bloods show hyponatraemia and hyperkalaemia. She appears dehydrated with reduced skin turgor and dry mucous membranes.\n\nWhich of the following findings would most likely be found on examination?",
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} | MarksheetMark |
173,468,337 | false | 20 | null | 6,495,259 | null | false | [] | null | 19,388 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The abdominal viscera and bowel tend to push the heart from its normal anatomic location with heart sounds often better auscultated on the right side.",
"id": "10034925",
"label": "d",
"name": "Normal heart sounds in the expected location",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is suggestive of patent ductus arteriosus whereby the abnormal connection between the aorta and the pulmonary artery fails to close after birth which can present asymptomatically with a 'machinery murmur' or with symptoms of shortness of breath, poor feeding, poor weight gain and respiratory infections.",
"id": "10034924",
"label": "c",
"name": "Continuous machinery murmur",
"picture": null,
"votes": 802
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is suggestive of neonatal respiratory distress syndrome caused by a lack of lung surfactant in premature babies associated with high morbidity and mortality.",
"id": "10034923",
"label": "b",
"name": "Diffuse crackles with globally decreased air entry",
"picture": null,
"votes": 841
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Children with congenital diaphragmatic hernias are extremely unlikely to have normal lung sounds on auscultation.",
"id": "10034926",
"label": "e",
"name": "Normal lung sounds",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This vignette is suggestive of a diagnosis of congenital diaphragmatic hernia which is associated with an extremely high mortality with the bowel, stomach and possibly liver moving into the chest cavity. Auscultating the bowel in the thoracic cavity would result in tinkling sounds.",
"id": "10034922",
"label": "a",
"name": "Tinkling sounds",
"picture": null,
"votes": 1030
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Im gonna fail my exmasss. meow",
"createdAt": 1736724864,
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"likes": 7,
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{
"__typename": "QuestionComment",
"comment": "Is the cyanosis from viscera compressing on lungs/heart?",
"createdAt": 1737986852,
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"displayName": "Yersinia Gastro",
"id": 9076
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"__typename": "QuestionComment",
"comment": "Litch never heard of a scaphoid abdomen and finals in 3 days",
"createdAt": 1738325343,
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"id": "6104",
"name": "Congenital Diaphragmatic Hernia",
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"name": "Paediatrics",
"typeId": 7
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"learningPoint": "Congenital diaphragmatic hernia can cause bowel sounds in the thorax, leading to characteristic tinkling sounds on chest auscultation.",
"likes": 9,
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"question": "A 35-week-old baby is born in the maternity ward. Five minutes after birth, the baby appears to be grunting and is cyanosed with an oxygen saturation of 80%. Inspection reveals a scaphoid abdomen and a barrel chest.\n\nWhich of the following features are likely to be present on auscultation of the chest?",
"sbaAnswer": [
"a"
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"totalVotes": 2803,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,338 | false | 21 | null | 6,495,259 | null | false | [] | null | 19,389 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A healthy child should respond to their name by 9 months.",
"id": "10034931",
"label": "e",
"name": "A 1-year-old who responds to her name",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "18 months is the cut-off for concern about children walking.",
"id": "10034929",
"label": "c",
"name": "A 16-month-old not walking",
"picture": null,
"votes": 326
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is not recommended to use crawling as a developmental milestone due to variation in healthy children with different crawling styles with some children never crawling before walking.",
"id": "10034930",
"label": "d",
"name": "A 14-month-old walking who never learned to crawl",
"picture": null,
"votes": 375
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Palmar grasp develops at 3-6 months and pincer grip at 9-12 months therefore this case demonstrates regression in developmental milestones, a universally concerning feature which warrants further assessment by a paediatrician.",
"id": "10034927",
"label": "a",
"name": "A 12-month-old with a palmar grasp with a previously good pincer grip",
"picture": null,
"votes": 2017
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The absence of a social smile at **6 weeks** is concerning for a potential visual problem and requires further work up.",
"id": "10034928",
"label": "b",
"name": "A 5-week-old without a social smile",
"picture": null,
"votes": 63
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": null,
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4125",
"name": "Developmental milestones - fine motor and vision",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
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"id": "19389",
"isLikedByMe": 0,
"learningPoint": "Regression in developmental milestones, such as loss of a previously acquired pincer grip, is a significant concern in paediatric assessments.",
"likes": 7,
"multiAnswer": null,
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"question": "A number of children are seen over the day in a specialised developmental clinic.\n\nWhich of the following presentations is most concerning?",
"sbaAnswer": [
"a"
],
"totalVotes": 2793,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,339 | false | 22 | null | 6,495,259 | null | false | [] | null | 19,390 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is well-meaning but premature, a senior with experience needs to be involved in the case first.",
"id": "10034935",
"label": "d",
"name": "Call the police",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate given the safeguarding concerns in this case.",
"id": "10034933",
"label": "b",
"name": "Discharge with analgesia and safety netting",
"picture": null,
"votes": 178
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "At present, there are no specific concerns with the upper limb warranting radiation exposure. A full non-accidental injury workup may be performed which includes a skeletal survey, photography and possible ophthalmology review for retinal haemorrhages.",
"id": "10034934",
"label": "c",
"name": "Refer for upper limb X-ray",
"picture": null,
"votes": 955
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no concerns over the upper limb that warrant orthopaedic review.",
"id": "10034936",
"label": "e",
"name": "Refer to orthopaedics",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This scenario is concerning due to the delay in presentation to the ED and the mechanism of injury not being possible in a two-year-old (riding a tricycle is a skill expected in a three-year-old). Therefore, this child should be admitted and discussed with the local safeguarding lead/consultant paediatrician on-call due to possible non-accidental injury.",
"id": "10034932",
"label": "a",
"name": "Admit for observations and safeguarding review",
"picture": null,
"votes": 1610
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "A single-day delay isn't that concerning, most parents don't want to put their child through an A&E attendance unless they think it's really necessary... so often they wait to see if it gets better and will bring them in the next day. Also, milestones are AVERAGES, some 2 year olds will already be riding a normal bike, so riding a tricycle isn't unheard of. Obviously pay attention to these things, like if the proposed mechanism of injury makes sense, but also think a bit.",
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},
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"__typename": "QuestionComment",
"comment": "not being possible in a two-year-old made me laugh",
"createdAt": 1738259929,
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"learningPoint": "When non-accidental injury is suspected, admission for observation allows monitoring of the child's condition. A safeguarding review ensures the child's safety, with a thorough assessment by social services and medical professionals.",
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"question": "A two-year-old boy is brought to the emergency department with pain in his arm. His mother reports he was injured falling off his tricycle yesterday. Neurovascular assessment of the upper limb is unremarkable.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,468,340 | false | 23 | null | 6,495,259 | null | false | [] | null | 19,391 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an extremely important differential which would need to be excluded, but the timeframe, yawning, lack of fever and prematurity are more in keeping with maternal drug use.",
"id": "10034938",
"label": "b",
"name": "Neonatal sepsis",
"picture": null,
"votes": 542
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may explain the low birth weight as it can cause both macrosomia and intrauterine growth restriction but does not explain the current presentation.",
"id": "10034940",
"label": "d",
"name": "Maternal gestational diabetes mellitus",
"picture": null,
"votes": 409
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The likely diagnosis is maternal opiate use and subsequent neonatal withdrawal. Yawning is a specific sign for opioid withdrawal and being well for the first few days suggests withdrawal over other differentials such as infection. The low birth weight and prematurity also suggest maternal drug use.",
"id": "10034937",
"label": "a",
"name": "Maternal drug use",
"picture": null,
"votes": 1101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is less likely to affect babies born at 34 weeks when most babies would have produced surfactant. It would also have been present since birth and does not explain the yawning.",
"id": "10034939",
"label": "c",
"name": "Neonatal respiratory distress syndrome",
"picture": null,
"votes": 417
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presents later in life with cyanosis and cardiac signs that are not described in this scenario.",
"id": "10034941",
"label": "e",
"name": "Tetralogy of Fallot",
"picture": null,
"votes": 317
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "why cant this be neonatal hypoglycaemia?\n",
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"comment": "that would most likely present soon after birth",
"createdAt": 1709656592,
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"comment": "also would expect them to have a higher birth weight due to hyperglycaemic exposure ",
"createdAt": 1712330237,
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"__typename": "QuestionComment",
"comment": "never expected to use my opiate withdrawal knowledge in a paeds question",
"createdAt": 1710938174,
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"displayName": "Serpiginous Defibrillator",
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"id": "6106",
"name": "Neonatal mortality and stillbirth",
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"name": "Paediatrics",
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"id": "19391",
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"learningPoint": "Neonatal withdrawal symptoms, such as irritability and yawning, often indicate maternal opiate use during pregnancy.",
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"question": "A 3-day-old baby is recovering in the labour ward. On the last day, he has become irritable and has been constantly crying and frequently yawning. He was born via vaginal delivery at 34 weeks and was 1.6kg at birth. He is afebrile. He was well in his first 2 days of life.\n\nWhich of the following is the most likely aetiology of the underlying condition?",
"sbaAnswer": [
"a"
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173,468,341 | false | 24 | null | 6,495,259 | null | false | [] | null | 19,392 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neither opioid intoxication, which presents with reduced GCS, pinpoint pupils and slow breathing nor withdrawal, which presents with insomnia, yawning, diarrhoea, piloerection and lacrimation, would explain the presentation.",
"id": "10034945",
"label": "d",
"name": "Heroin",
"picture": null,
"votes": 149
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In overdose, hallucinogenic mushrooms tend to cause psychosis, renal failure, seizures and coma.",
"id": "10034944",
"label": "c",
"name": "Hallucinogenic mushrooms",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In high doses and with extensive use, marijuana can induce temporary psychotic symptoms such as paranoia, delusions, anxiety and hallucination.",
"id": "10034946",
"label": "e",
"name": "Marijuana",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This scenario describes serotonin syndrome due to time of onset, fever, sweating and hyperreflexia. Concomitant use of SSRIs and ecstasy can precipitate serotonin syndrome with the increasing incidence of ecstasy usage amongst adolescents with depressive disorders making this important knowledge for healthcare professionals.",
"id": "10034942",
"label": "a",
"name": "Ecstasy",
"picture": null,
"votes": 2566
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Neither alcohol intoxication, which presents with slurred speech, vomiting, possible loss of consciousness and mental confusion, nor alcohol withdrawal, which presents with tremors, hallucination and possible seizures, explains this presentation.",
"id": "10034943",
"label": "b",
"name": "Alcohol",
"picture": null,
"votes": 21
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "I chose MDMA because she was partying but marijuana and magic mushrooms are also highly serotonergic and could well cause serotonin syndrome especially if she is also on antidepressants ",
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"name": "Serotonin Syndrome",
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"learningPoint": "Serotonin syndrome can occur with the use of ecstasy, especially in patients on SSRIs, presenting with hyperreflexia, muscle rigidity, and autonomic instability.",
"likes": 1,
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"question": "A 23-year-old woman comes to the emergency department complaining of fever and sweating. Examination reveals hyperreflexia, hypertension and muscle rigidity. She has a background of depression and describes partying last night, admitting to recreational drug use but is unsure of the name of the drug.\n\nWhat is the most likely agent causing this presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 2785,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,342 | false | 25 | null | 6,495,259 | null | false | [] | null | 19,393 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Several antipsychotics increase the risk of developing diabetes and elevating HbA1c but this is not a priority at the moment.",
"id": "10034951",
"label": "e",
"name": "HbA1c",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst useful to stage the likely pneumonia using a CURB-65 score and assess for acute kidney injury, it is not as important as excluding agranulocytosis here. In reality, these tests would be ordered together.",
"id": "10034948",
"label": "b",
"name": "Urea and electrolytes",
"picture": null,
"votes": 160
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Clozapine can cause myocarditis with an elevated troponin but the clinical picture is in keeping with pneumonia.",
"id": "10034949",
"label": "c",
"name": "Troponin",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antipsychotics are known to worsen cholesterol levels causing them to rise but this is not a priority at the moment.",
"id": "10034950",
"label": "d",
"name": "LDL levels",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This scenario suggests this man is on clozapine as it is the only licensed option for treatment-resistant schizophrenia which can cause profound agranulocytosis, which can result in overwhelming sepsis and death.",
"id": "10034947",
"label": "a",
"name": "Full blood count",
"picture": null,
"votes": 2570
}
],
"comments": [],
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"id": "6108",
"name": "Schizophrenia",
"status": null,
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"id": "332",
"name": "Psychiatry",
"typeId": 7
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"topicId": 332,
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"difficulty": 1,
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"id": "19393",
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"learningPoint": "Clozapine can cause agranulocytosis, so regular blood tests are needed to monitor white blood cell levels and prevent serious infections and complications.",
"likes": 0,
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"question": "A 67-year-old man with treatment-resistant schizophrenia has been transferred from the psychiatric intensive care unit to the acute medical unit at the local hospital due to a productive cough with tachypnoea and hypotension.\n\nWhich of the following investigations is it most important to order?",
"sbaAnswer": [
"a"
],
"totalVotes": 2773,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,343 | false | 26 | null | 6,495,259 | null | false | [] | null | 19,394 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "SSRIs are not an option to manage acute aggression.",
"id": "10034956",
"label": "e",
"name": "Sertraline",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This scenario describes hyperactive delirium. In cases when pharmacological management is needed where there are acute risk concerns, lorazepam is preferred and haloperidol should avoided if there are Parkinsonian features such as in dementia with Lewy bodies as this can severely worsen their Parkinsonism.",
"id": "10034952",
"label": "a",
"name": "Lorazepam",
"picture": null,
"votes": 2166
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be an option later down the line, necessitating an ECG before administration to assess QT, but is not the first line.",
"id": "10034954",
"label": "c",
"name": "Risperidone",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should be avoided in patients with Parkinsonism as it will worsen it.",
"id": "10034953",
"label": "b",
"name": "Haloperidol",
"picture": null,
"votes": 506
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should be avoided due to its anticholinergic properties which may worsen delirium and confusion.",
"id": "10034955",
"label": "d",
"name": "Promethazine",
"picture": null,
"votes": 34
}
],
"comments": [],
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"__typename": "Concept",
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"id": "6109",
"name": "Delirium",
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"learningPoint": "In Lewy body dementia, lorazepam is preferred over haloperidol for managing delirium due to a lower risk of exacerbating Parkinsonism and neuroleptic sensitivity",
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"question": "A 75-year-old woman with a history of Lewy Body Dementia has been admitted to the care of the elderly ward following agitation and restlessness with a recent urinary tract infection. Her ward is finding her aggression difficult to manage as she is attempting to assault staff.\n\nWhich of the following is the most appropriate pharmacological treatment option?",
"sbaAnswer": [
"a"
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173,468,344 | false | 27 | null | 6,495,259 | null | false | [] | null | 19,395 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be useful if we are considering disseminated intravascular coagulation but there is nothing to suggest this at present.",
"id": "10034960",
"label": "d",
"name": "INR, Fibrinogen and Fibrinogen degradation products",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is useful as the patient is actively bleeding and may require transfusion if the haemoglobin drops but the bleeding is light at present and this is not the priority at present as the mother is haemodynamically stable.",
"id": "10034959",
"label": "c",
"name": "Full blood count",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this most certainly would be performed to assess the bleed, it is less useful (and insensitive) in cases where there is concealed abruption or retroplacental abruption (up to 25%) which is out of proportion with blood loss and therefore must be considered with CTG and in the overall clinical picture.",
"id": "10034958",
"label": "b",
"name": "Transabdominal ultrasound",
"picture": null,
"votes": 1301
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This scenario describes placental abruption with painful antepartum haemorrhage. Management depends on the stability of the mother and foetus and gestational age. If the pregnancy is over 34 weeks and the mother is contracting or bleeding, vaginal delivery is recommended (with possible induction). If the gestation is less than 34 weeks, the mother should be admitted with regular ultrasonography and CTG with steroids considered. CTG is the most useful measure of the stability of the baby here and can inform management thereafter.",
"id": "10034957",
"label": "a",
"name": "Continuous foetal heart rate monitoring",
"picture": null,
"votes": 1385
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CT tends to be avoided in pregnancy as much as possible due to the radiation exposure. It may however be required in cases of traumatic abruption when an ultrasound is inconclusive.",
"id": "10034961",
"label": "e",
"name": "Abdominal CT",
"picture": null,
"votes": 5
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Do you not need to do an ultrasound to be sure that it is placental abruption?",
"createdAt": 1715959843,
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"id": "49772",
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"questionId": 19395,
"replies": [
{
"__typename": "QuestionComment",
"comment": "You don’t diagnose abruption on USS, it’s a clinical Dx. USS is used in these cases to exclude placenta praevia",
"createdAt": 1717512162,
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"id": "51916",
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"displayName": "Chronic Bradykinin",
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"id": "6110",
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"__typename": "Topic",
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"name": "Obstetrics and Gynaecology",
"typeId": 7
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"question": "A 36-year-old G3P2 who is 27 weeks pregnant comes to the maternal assessment unit with lower back pain and light vaginal bleeding which started a few hours ago. On examination, a tender uterus is palpated. She is haemodynamically stable.\n\nWhich of the following investigations will prove most useful to guide management?",
"sbaAnswer": [
"a"
],
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} | MarksheetMark |
173,468,345 | false | 28 | null | 6,495,259 | null | false | [] | null | 19,396 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A sensible differential. Polycystic ovarian syndrome may present with irregular or missed periods, however core features are weight gain, acne and hirsutism, making it less likely.",
"id": "10034965",
"label": "d",
"name": "Polycystic ovarian syndrome",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not likely in this case as bloating and changes in bowel motion are not mentioned and the difficulties are primarily gynaecological.",
"id": "10034964",
"label": "c",
"name": "Irritable bowel syndrome",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A sensible differential which shares many symptoms with endometriosis. The patient's ethnicity and age render this less common as fibroids tend to develop in Afro-Caribbean women over 40 years of age. In addition, the family history and PR bleeding are more in keeping with endometriosis.",
"id": "10034963",
"label": "b",
"name": "Fibroids",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may cause heavy bleeding with a family history but none of the other listed symptoms.",
"id": "10034966",
"label": "e",
"name": "Von Willebrand Disease",
"picture": null,
"votes": 418
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The family history, dyspareunia, dysmenorrhea and rectal bleeding are all in keeping with endometriosis.",
"id": "10034962",
"label": "a",
"name": "Endometriosis",
"picture": null,
"votes": 2188
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "In her youth suggests that her mother no longer has those symptoms and fibroids improve with age... anyone else find the stem a bit misleading?",
"createdAt": 1705706385,
"dislikes": 1,
"id": "39387",
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"__typename": "QuestionComment",
"comment": "Thought you did not have heavy menstrual bleeding in endometriosis ",
"createdAt": 1717264209,
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"displayName": "Metabolism Loose",
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"__typename": "QuestionComment",
"comment": "PR BLEEDING? \n",
"createdAt": 1718116150,
"dislikes": 0,
"id": "52503",
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"accessLevel": "subscriber",
"displayName": "passmed user 1 ",
"id": 23669
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{
"__typename": "QuestionComment",
"comment": "why on earth is there rectal bleeding ",
"createdAt": 1718377928,
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"__typename": "QuestionComment",
"comment": "In endometriosis you can have endometrium-like tissue growing and attaching to outside of/into the rectum, which can result in painful bowel movements, constipation, and rectal bleeding, with the latter particularly around the time of menstruation",
"createdAt": 1718814977,
"dislikes": 0,
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"id": "6111",
"name": "Endometriosis",
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"name": "Obstetrics and Gynaecology",
"typeId": 7
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"learningPoint": "Endometriosis is a condition characterized by the growth of endometrial-like tissue outside the uterus, leading to pelvic pain, dysmenorrhea, menorrhagia, dyspareunia, and potentially infertility. Gastrointestinal symptoms are also common.",
"likes": 0,
"multiAnswer": null,
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"question": "A 20-year-old caucasian nulligravida comes to the GP surgery complaining of dysmenorrhoea and heavy periods. She further reports dyspareunia and occasionally passing fresh red blood per rectum. She reports her mother suffering from similar issues in her youth.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2768,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,346 | false | 29 | null | 6,495,259 | null | false | [] | null | 19,397 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This classically presents with thick white cottage cheese-like discharge which is not described.",
"id": "10034970",
"label": "d",
"name": "Candida Albicans infection",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presents with grey discharge, burning pain and fish-like odour which are not described.",
"id": "10034971",
"label": "e",
"name": "Bacterial vaginosis",
"picture": null,
"votes": 450
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This placental infection can occur following invasive testing and typically presents with fever and foul-smelling vaginal discharge.",
"id": "10034967",
"label": "a",
"name": "Chorioamnionitis",
"picture": null,
"votes": 1951
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A sensible differential, however, given the closed cervical os, absence of PV bleeding and the absence of systemic features of sepsis, chorioamnionitis is more likely.",
"id": "10034968",
"label": "b",
"name": "Septic Miscarriage",
"picture": null,
"votes": 173
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This classically presents with fishy green-yellow discharge and dyspareunia and is a sexually transmitted disease. The clinical picture is not in keeping with this due to recent invasive testing.",
"id": "10034969",
"label": "c",
"name": "Trichomonas Vaginalis infection",
"picture": null,
"votes": 149
}
],
"comments": [],
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"id": "6112",
"name": "Chorioamnionitis",
"status": null,
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"typeId": 7
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"learningPoint": "Chorioamnionitis is a placental infection characterised by fever and foul-smelling vaginal discharge, often following invasive procedures during pregnancy.",
"likes": 4,
"multiAnswer": null,
"pictures": [],
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"question": "A 31-year-old G3P2 comes to the emergency department with a fever and foul-smelling vaginal discharge. She is 12 weeks pregnant and recently underwent invasive testing following a finding of thickened nuchal translucency. No PV bleeding is noted on examination and the cervical os is closed.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2763,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,347 | false | 30 | null | 6,495,259 | null | false | [] | null | 19,398 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The Mental Health Act cannot be used to treat physical health symptoms apart from a few exceptions including severe anorexia nervosa. The patient's capacity needs to be assessed to refuse this treatment and if present, even if this decision were to be deemed unwise, is his to make. If absent, action should be taken to treat him in his best interests.",
"id": "10034972",
"label": "a",
"name": "Assess his capacity to refuse treatment",
"picture": null,
"votes": 2313
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "His capacity needs to be established first before considering best interests discussions including the opinions of any appointed attornies, least restrictive options, what the patient wants now and what they wanted in the past.",
"id": "10034975",
"label": "d",
"name": "Obtain consent from a family member to treat his infective endocarditis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may well be the course of action if the patient is found to have capacity with regards to deciding to accept/reject treatment for infective endocarditis but given that it is potentially unwise, a capacity assessment should be performed.",
"id": "10034976",
"label": "e",
"name": "Do not treat his infective endocarditis as he has refused",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Physical health symptoms are generally not treated under the Mental Health Act.",
"id": "10034973",
"label": "b",
"name": "Treat his infective endocarditis under the Mental Health Act",
"picture": null,
"votes": 326
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "His capacity needs to be established first. If the patient lacks capacity, a best interests decision can be made.",
"id": "10034974",
"label": "c",
"name": "Treat his infective endocarditis as it is in his best interests",
"picture": null,
"votes": 108
}
],
"comments": [],
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},
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"demo": null,
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"id": "4142",
"name": "Key principles of MCA (Mental Capacity Act)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "184",
"name": "Ethics and Law",
"typeId": 7
},
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"highlights": [],
"id": "19398",
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"learningPoint": "Assessing capacity to refuse treatment involves evaluating the person's ability to understand the situation, weigh the benefits and risks, communicate a decision, and make a choice based on rational reasoning.",
"likes": 4,
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"question": "A 26-year-old man is an inpatient in the psychiatry ward under Section 2 due to a manic relapse of bipolar disorder. Whilst on the ward, he develops a fever and a new pan-systolic murmur can be heard. He refuses treatment for infective endocarditis despite being informed of its sequelae.\n\nWhat is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 2766,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,348 | false | 31 | null | 6,495,259 | null | false | [] | null | 19,399 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be well-meaning but it does not involve the patient being treated and would be breaking confidentiality for an inappropriate reason.",
"id": "10034980",
"label": "d",
"name": "Refuse and contact his wife to alert her of the presentation in the public interest",
"picture": null,
"votes": 244
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this may be well-meaning, it does not address his concerns and will be perceived as inflammatory. His treating doctor should advise him to disclose his history to sexual partners but should not threaten the patient.",
"id": "10034978",
"label": "b",
"name": "Refuse and remind him that he legally must tell his wife or face criminal charges",
"picture": null,
"votes": 416
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If treatment is prescribed in a GP practice, it must be documented on the records and not doing so is a probity issue.",
"id": "10034981",
"label": "e",
"name": "Accept and advise the patient that he must tell his wife",
"picture": null,
"votes": 356
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. If treatment is prescribed in a GP practice, it must be documented on the records and not doing so is a probity issue. The patient can seek help from a sexual health clinic that is not connected to the GP practice if he is concerned. The patient should be reminded of the duty of confidentiality that all doctors must abide by.",
"id": "10034977",
"label": "a",
"name": "Refuse and offer an appointment at a sexual health clinic",
"picture": null,
"votes": 1719
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If treatment is prescribed in a GP practice, it must be documented on the records and not doing so is a probity issue.",
"id": "10034979",
"label": "c",
"name": "Accept and prescribe the antibiotics without documentation",
"picture": null,
"votes": 22
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "would this be different if it was HIV rather than a different STI?",
"createdAt": 1709633603,
"dislikes": 0,
"id": "43814",
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"parentId": null,
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"replies": [],
"user": {
"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Fungal Epidermis",
"id": 40535
}
},
{
"__typename": "QuestionComment",
"comment": "hiv is still a non-communicable disease",
"createdAt": 1710254256,
"dislikes": 1,
"id": "44537",
"isLikedByMe": 0,
"likes": 2,
"parentId": null,
"questionId": 19399,
"replies": [
{
"__typename": "QuestionComment",
"comment": "\"Communicable diseases, including HIV/AIDS, tuberculosis (TB), malaria, viral hepatitis, sexually transmitted infections and neglected tropical diseases (NTDs), are among the leading causes of death and disability in low-income countries and marginalized populations.\" -WHO -- they are both communicable diseases....",
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"displayName": "Defibrillator Dominant",
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},
{
"__typename": "QuestionComment",
"comment": "i think you mean notifiable disease - https://studentnotes.themdu.com/issue-archive/autumn-2020/confidentiality-responsibilities-to-hiv-positive-patients#:~:text=Informing%20partners,their%20justifications%20for%20doing%20so. ",
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"name": "Confidentiality",
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"learningPoint": "Doctors must document information in patient records to ensure accurate, consistent care, maintain legal and ethical standards, protect patient confidentiality, and prevent potential conflicts of interest",
"likes": 4,
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"question": "During a primary care rotation, a 35-year-old man comes to the GP with burning pain during urination and urethral discharge and is diagnosed with a sexually transmitted infection. He asks if it is possible to prescribe him antibiotics without putting it on the records as his wife is friends with one of the GPs at the practice and he does not want his wife to know about his presentation.\n\nWhat is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 2757,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,349 | false | 32 | null | 6,495,259 | null | false | [] | null | 19,400 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may inform whether a CT Head is needed within 8 hours but does not necessitate one needed within an hour.",
"id": "10034986",
"label": "e",
"name": "On current anticoagulation treatment",
"picture": null,
"votes": 899
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE guidance suggests CT head within one hour if more than one episode of vomiting occurs in adults.",
"id": "10034983",
"label": "b",
"name": "One episode of vomiting since the injury",
"picture": null,
"votes": 231
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amnesia since the injury may require a CT head within one hour if combined with other features such as loss of consciousness and drowsiness but alone may either require a CT head within 8 hours or no imaging. Please see NICE CT Head guidelines for further clarity.",
"id": "10034984",
"label": "c",
"name": "Amnesia since the injury",
"picture": null,
"votes": 406
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is an extremely concerning sign of a basal skull fracture and requires urgent imaging.",
"id": "10034982",
"label": "a",
"name": "Haemotympanum since the injury",
"picture": null,
"votes": 1145
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "It is a seizure following the head injury with no epilepsy diagnosis that requires a CT head within an hour.",
"id": "10034985",
"label": "d",
"name": "One seizure occurred before the head injury",
"picture": null,
"votes": 87
}
],
"comments": [],
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},
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"id": "6114",
"name": "Head Injury - Imaging Criteria",
"status": null,
"topic": {
"__typename": "Topic",
"id": "334",
"name": "Clinical Imaging",
"typeId": 7
},
"topicId": 334,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 9,
"explanation": null,
"highlights": [],
"id": "19400",
"isLikedByMe": 0,
"learningPoint": "Haemotympanum refers to the presence of blood in the middle ear, often due to trauma, skull fractures, or barotrauma. Haemotympanum indicates potential basal skull fracture and necessitates urgent CT imaging to assess for intracranial injury.",
"likes": 3,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 40-year-old man is brought to the emergency department after a head injury.\n\nWhich of the following features, if found in the medical history, would prompt an urgent CT head within an hour according to NICE guidelines?",
"sbaAnswer": [
"a"
],
"totalVotes": 2768,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,350 | false | 33 | null | 6,495,259 | null | false | [] | null | 19,401 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is nothing to suggest a stroke at present with no localising hemiparesis, no slurred speech and no higher dysfunction e.g. dysphasia.",
"id": "10034990",
"label": "d",
"name": "Middle cerebral artery stroke",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would likely present with severe thunderclap headache and CT appearance would show widespread blood in subarachnoid space and basal cisterns.",
"id": "10034989",
"label": "c",
"name": "Subarachnoid haemorrhage.",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The history of head trauma with subsequent lucid interval, headache, confusion and vomiting as well as the CT appearance of a bi-convex bleed limited by sutures.",
"id": "10034987",
"label": "a",
"name": "Extradural haemorrhage",
"picture": null,
"votes": 2636
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely to cause so profound a presentation and would not cause the CT changes seen.",
"id": "10034991",
"label": "e",
"name": "Concussion",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This tends to occur in elderly patients, especially those with alcohol dependence issues and has a different crescentic lentiform appearance on CT Head with often a longer clinical history.",
"id": "10034988",
"label": "b",
"name": "Subdural haemorrhage",
"picture": null,
"votes": 103
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6115",
"name": "Extradural haemorrhage",
"status": null,
"topic": {
"__typename": "Topic",
"id": "334",
"name": "Clinical Imaging",
"typeId": 7
},
"topicId": 334,
"totalCards": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "19401",
"isLikedByMe": 0,
"learningPoint": "Extradural haemorrhage often presents with a lucid interval following head trauma, headache, confusion, and characteristic bi-convex CT findings.",
"likes": 2,
"multiAnswer": null,
"pictures": [
{
"__typename": "Picture",
"caption": "https://commons.wikimedia.org/wiki/File:Epidurales_Haematom.jpg",
"createdAt": 1705486548,
"id": "2342",
"index": 0,
"name": "4.jpg",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/7xrzsa8q1705486616920.jpg",
"path256": "images/7xrzsa8q1705486616920_256.jpg",
"path512": "images/7xrzsa8q1705486616920_512.jpg",
"thumbhash": "HAgOBgAHN4d3dxhHmYiHhIlY/0TzTzQ=",
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"updatedAt": 1708373886
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"question": "A 25-year-old man is brought to the emergency department by ambulance after a head injury, after which he became unconscious. At present he is conscious and confused, complaining of nausea and headache. A CT head is performed:\n\n[lightgallery]\n\nWhat is the likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2756,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,351 | false | 34 | null | 6,495,259 | null | false | [] | null | 19,402 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This should be an adjunct to medical treatment, however, due to the severity of symptoms and spinal appearance, medical management is required.",
"id": "10034993",
"label": "b",
"name": "Advise physiotherapy",
"picture": null,
"votes": 755
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The history of lower back pain with bamboo spine appearance on x-ray suggests ankylosing spondylitis with possible HLA B27 associated complications such as inflammatory bowel and uveitis. NSAIDs are first-line medical management, after which anti-TNF agents are used.",
"id": "10034992",
"label": "a",
"name": "Infliximab",
"picture": null,
"votes": 1647
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate given the symptoms and concerning appearance on imaging.",
"id": "10034995",
"label": "d",
"name": "Discharge with reassurance",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Surgery may occasionally be required for severe joint deformity later down the line whereas medical management is the initial priority here.",
"id": "10034994",
"label": "c",
"name": "Advise surgical correction",
"picture": null,
"votes": 252
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a JAK inhibitor which is an option later down the line as it is extremely expensive and reserved for recalcitrant cases.",
"id": "10034996",
"label": "e",
"name": "Upadacitinib",
"picture": null,
"votes": 104
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "as a gp i would be referring",
"createdAt": 1736872766,
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"name": "Ankylosing spondylitis",
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"learningPoint": "Infliximab, a TNF-alpha inhibitor, is commonly used as a second-line treatment for ankylosing spondylitis when NSAIDs and physical therapy are insufficient, helping reduce inflammation, pain, and improve mobility.",
"likes": 4,
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"question": "A 32-year-old man comes to the GP due to longstanding lower back pain which has proved resistant to exercise and non-steroidal analgesia. He describes multiple episodes of diarrhoea and blurred vision in the past. He is referred to specialists and imaging investigations are performed.\n\nA spine X-ray shows:\n\n[lightgallery]\n\nWhich of the following is the most appropriate management given the likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2768,
"typeId": 1,
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173,468,352 | false | 35 | null | 6,495,259 | null | false | [] | null | 19,403 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst active cancer greatly increases the risk of pulmonary embolism (PE), there is nothing in the history to suggest PE (e.g. oxygen requirement or tachycardia etc.). A CT CAP would therefore be better to assess for the presence of metastases.",
"id": "10035001",
"label": "e",
"name": "CT pulmonary angiogram",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst colorectal cancers often metastasise to the liver, a CT CAP is a preferable imaging study to perform as it can rule out metastases to other areas in the chest, abdomen and pelvis.",
"id": "10034998",
"label": "b",
"name": "Liver ultrasound",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely to be a useful imaging study unless the patient has symptoms to suggest obstruction or perforation secondary to their cancer. Even in these cases, a CT abdomen would be a much more appropriate imaging study to perform.",
"id": "10035000",
"label": "d",
"name": "Abdominal X-ray",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although colorectal cancers can metastasise to the liver and pancreas, this specific imaging is unlikely to be as useful as a CT CAP could assess for metastases in a wider range of areas.",
"id": "10034999",
"label": "c",
"name": "Magnetic resonance cholangiopancreatography (MRCP)",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In the case of confirmed malignancy, a CT CAP is advised to check for metastatic spread and help stage disease. The other investigations would not be able to assess for this adequately.",
"id": "10034997",
"label": "a",
"name": "CT scan of the chest, abdomen and pelvis (CT CAP)",
"picture": null,
"votes": 2686
}
],
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"id": "4443",
"name": "Colorectal cancer",
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"name": "Oncology and Palliative Care",
"typeId": 7
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"highlights": [],
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"learningPoint": "In colorectal adenocarcinoma, a CT scan of the chest, abdomen, and pelvis is essential for staging and detecting metastatic spread.",
"likes": 2,
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"question": "A 78-year-old male is found to have a positive faecal immunochemistry (FIT) test and undergoes colonoscopy.\n\nA suspicious mass is found in the sigmoid colon. Biopsy samples are taken and confirm a colorectal adenocarcinoma.\n\nWhat is the next most important investigation to perform?",
"sbaAnswer": [
"a"
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"totalVotes": 2755,
"typeId": 1,
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173,468,353 | false | 36 | null | 6,495,259 | null | false | [] | null | 19,404 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used for pain relief at the end of life rather than to reduce secretions.",
"id": "10035003",
"label": "b",
"name": "Oxycodone",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This medication is used to treat nausea and vomiting in end-of-life care, rather than to reduce secretions.",
"id": "10035006",
"label": "e",
"name": "Haloperidol",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically used for nausea and vomiting in end-of-life care, rather than to reduce secretions.",
"id": "10035004",
"label": "c",
"name": "Ondansetron",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This medication is used as an anxiolytic and would not reduce secretions in end-of-life care.",
"id": "10035005",
"label": "d",
"name": "Midazolam",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Of the options listed, this is the only anti-muscarinic medication which is used to reduce secretions in end-of-life care.",
"id": "10035002",
"label": "a",
"name": "Glycopyrronium bromide",
"picture": null,
"votes": 2654
}
],
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"learningPoint": "Glycopyrronium bromide is commonly prescribed to manage excessive secretions in patients receiving end-of-life care.",
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"question": "A 67-year-old female with metastatic breast cancer has a malignant pleural effusion.\n\nHer observations deteriorate during her time in hospital and she is felt to be approaching the end of her life. After a discussion between the patient, her family and the medical team, the patient opts to stop all active treatment.\n\nThe palliative care team advises that the patient is written up for anticipatory medications, to help control any symptoms she may experience.\n\nWhich of the following medications is typically prescribed to help with secretions in patients who are end of life?",
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173,468,354 | false | 37 | null | 6,495,259 | null | false | [] | null | 19,405 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Doxorubicin can be used to treat Hodgkin lymphoma and has a known side effect of cardiotoxicity. Of the medications listed, it is therefore most likely to have caused cardiomyopathy.",
"id": "10035007",
"label": "a",
"name": "Doxorubicin",
"picture": null,
"votes": 1934
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cisplatin more commonly causes nephrotoxicity than cardiomyopathy.",
"id": "10035008",
"label": "b",
"name": "Cisplatin",
"picture": null,
"votes": 254
},
{
"__typename": "QuestionChoice",
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"explanation": "Bleomycin more commonly causes lung fibrosis or pneumonitis than cardiomyopathy.",
"id": "10035010",
"label": "d",
"name": "Bleomycin",
"picture": null,
"votes": 252
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cyclophosphamide more commonly causes cystitis and bladder irritation than cardiomyopathy.",
"id": "10035011",
"label": "e",
"name": "Cyclophosphamide",
"picture": null,
"votes": 197
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vincristine more commonly causes peripheral neuropathy than cardiomyopathy.",
"id": "10035009",
"label": "c",
"name": "Vincristine",
"picture": null,
"votes": 111
}
],
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"comment": "Thank you Toxicity Bear",
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"question": "A 73-year-old male has shortness of breath on exertion and palpitations.\n\nHe has a past medical history of Hodgkin's lymphoma, treated with chemotherapy.\n\nHe is found to have cardiomyopathy on further investigation. His doctor states this is possibly due to his previous chemotherapy medication.\n\nWhich medication is most likely to have caused cardiomyopathy?",
"sbaAnswer": [
"a"
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173,468,355 | false | 38 | null | 6,495,259 | null | false | [] | null | 19,406 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is associated with parathyroid hyperplasia, phaeochromocytoma and medullary thyroid carcinoma. It is therefore unlikely to cause hereditary colorectal cancer.",
"id": "10035016",
"label": "e",
"name": "MEN Type IIA",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is associated with pancreatic tumours, pituitary adenomas and parathyroid hyperplasia. It is therefore unlikely to cause hereditary colorectal cancer.",
"id": "10035015",
"label": "d",
"name": "MEN Type I",
"picture": null,
"votes": 114
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a syndrome associated with dominant germline mutations of TSG STK11. It is associated with brown freckles on the oral mucosa, palms and soles. It greatly increases the risk of GI cancer due to the formation of multiple polyps. It is not as common as HNPCC and therefore less likely to be the underlying genetic syndrome in this scenario.",
"id": "10035014",
"label": "c",
"name": "Peutz-Jegher’s syndrome",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a less common hereditary cause of colorectal cancer. It increases the risk of duodenal tumours in addition to colorectal cancer. As a part of Gardner’s syndrome, there is also an increased risk of osteomas of the mandible and skull as well as thyroid carcinoma. Lynch syndrome therefore is more likely to be the underpinning cause of this patient’s presentation.",
"id": "10035013",
"label": "b",
"name": "Familial adenomatous polyposis",
"picture": null,
"votes": 233
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lynch syndrome (HNPCC) is the most common **hereditary** cause of colorectal cancer, which should be suspected given the young age of the patient. It also increases the risk of pancreatic and endometrial cancer.",
"id": "10035012",
"label": "a",
"name": "Lynch syndrome",
"picture": null,
"votes": 2263
}
],
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"name": "Genetic syndromes and Cancer",
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"name": "Oncology and Palliative Care",
"typeId": 7
},
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"id": "19406",
"isLikedByMe": 0,
"learningPoint": "Lynch syndrome is primarily caused by mutations in one of the mismatch repair (MMR) genes: MLH1, MSH2, MSH6, PMS2, or the EPCAM gene, leading to a higher risk of colorectal, endometrial, and other cancers.",
"likes": 1,
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"question": "A 40-year-old male has weight loss, abdominal pain and bloody diarrhoea and is diagnosed with colorectal cancer after a positive FIT test and colonoscopy.\n\nHe has a significant family history of cancer. His father died of pancreatic cancer at the age of 57 and his aunt died of endometrial cancer at the age of 55.\n\nWhich genetic syndrome is the most likely cause of this patient’s presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 2750,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,356 | false | 39 | null | 6,495,259 | null | false | [] | null | 19,407 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Non-smokers have a higher risk of post-operative nausea and vomiting when compared to smokers. The exact mechanism for this is not fully understood.",
"id": "10035018",
"label": "b",
"name": "The patient is a smoker",
"picture": null,
"votes": 818
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Female patients have a higher risk of post-operative nausea and vomiting than male patients.",
"id": "10035017",
"label": "a",
"name": "The patient is a female",
"picture": null,
"votes": 1290
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Longer operations pose a greater risk factor for postoperative nausea and vomiting.",
"id": "10035020",
"label": "d",
"name": "Shorter length of operation",
"picture": null,
"votes": 177
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Opioid analgesia increases the risk of postoperative nausea and vomiting, as is the case with opioid analgesia in any setting.",
"id": "10035021",
"label": "e",
"name": "Use of non-opioid analgesia peri-operatively",
"picture": null,
"votes": 314
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Younger patients have a higher risk of postoperative nausea and vomiting than older patients.",
"id": "10035019",
"label": "c",
"name": "Old age",
"picture": null,
"votes": 147
}
],
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"question": "A 23-year-old female with right iliac fossa pain is diagnosed with appendicitis and goes on to have a laparoscopic appendectomy.\n\nAfter her operation, she complains of significant nausea and has three episodes of vomiting.\n\nWhich of the following is a risk factor for postoperative nausea and vomiting?",
"sbaAnswer": [
"a"
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"typeId": 1,
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} | MarksheetMark |
173,468,357 | false | 40 | null | 6,495,259 | null | false | [] | null | 19,408 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is slightly too much water for one day as well as an insufficient amount of glucose for a 24-hour period.",
"id": "10035026",
"label": "e",
"name": "3.0L of water\n\n80mmol potassium, sodium and chloride\n\n25g of glucose",
"picture": null,
"votes": 138
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an insufficient quantity of potassium, sodium and chloride as well as too much glucose for a 24-hour period.",
"id": "10035025",
"label": "d",
"name": "2.5L of water\n\n40mmol of potassium, sodium and chloride\n\n150g of glucose",
"picture": null,
"votes": 164
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE guidance suggests for maintenance fluids alone patients should receive:\n\n- 25 to 30ml/kg/day of water\n\n- 1mmol/kg/day of potassium, sodium and chloride\n\n- Approximately 50 to 100g/day of glucose to limit starvation ketosis\n\nThis therefore means this is the most accurate representation of the patient’s maintenance fluid requirements in a 24-hour period.",
"id": "10035022",
"label": "a",
"name": "2.5L of water\n\n80mmol of potassium, sodium and chloride\n\n50g of glucose",
"picture": null,
"votes": 2264
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an insufficient quantity of potassium, sodium and chloride for an 85kg patient in one day.",
"id": "10035024",
"label": "c",
"name": "2.0L of water\n\n20mmol of potassium, sodium and chloride\n\n50g of glucose",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is over the patient’s daily water requirement and the potassium amount is incorrect as potassium only comes in 20 and 40mmol bags, therefore the option has to be 60mmol or 80mmol.",
"id": "10035023",
"label": "b",
"name": "3.5L of water\n\n70mmol of potassium, sodium and chloride\n\n100g of glucose",
"picture": null,
"votes": 68
}
],
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"name": "Fluid prescribing",
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"typeId": 7
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"isLikedByMe": 0,
"learningPoint": "Maintenance fluid requirements for adults are approximately 25-30 ml/kg/day of water, alongside electrolytes and glucose to prevent starvation ketosis.",
"likes": 1,
"multiAnswer": null,
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"question": "A 57-year-old male is kept nil-by-mouth prior to an elective knee replacement.\n\nThe patient weighs 85 kilograms and he has no known heart failure or renal impairment.\n\nWhich of the following is the closest to his maintenance fluid requirements in a 24-hour period?",
"sbaAnswer": [
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"typeId": 1,
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173,468,358 | false | 41 | null | 6,495,259 | null | false | [] | null | 19,409 | {
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "The combination of pyrexia, tachycardia and fasciculations in a patient with a family history of a similar presentation suggests malignant hyperthermia. This is a condition seen as a response to certain anaesthetic agents (e.g. suxamethonium or volatile inhaled agents) in genetically susceptible individuals. Suxamethanoium is commonly used in emergency scenarios for rapid sequence induction as in this scenario.",
"id": "10035027",
"label": "a",
"name": "Malignant hyperthermia",
"picture": null,
"votes": 2378
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is prolonged paralysis which is seen as limited respiratory effort after extubation due to a lack of cholinesterase.",
"id": "10035028",
"label": "b",
"name": "Suxamethonium apnoea",
"picture": null,
"votes": 277
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is unlikely to be a normal physiological response, due to the pyrexia, tachycardia and muscle rigidity.",
"id": "10035031",
"label": "e",
"name": "Normal physiological response",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this may present with tachycardia after being given medication, it is more likely to present with hypotension and angioedema rather than pyrexia and muscle rigidity.",
"id": "10035030",
"label": "d",
"name": "Anaphylaxis",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this can present with pyrexia and tachycardia, it would be unlikely to occur suddenly after the introduction of an anaesthetic agent and may take longer to occur after a road traffic accident.",
"id": "10035029",
"label": "c",
"name": "Sepsis",
"picture": null,
"votes": 24
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3860",
"name": "Malignant hyperthermia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "177",
"name": "Anaesthetics and Intensive Care Medicine",
"typeId": 7
},
"topicId": 177,
"totalCards": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "19409",
"isLikedByMe": 0,
"learningPoint": "Malignant hyperthermia is a rare, life-threatening reaction to certain anesthetics, causing rapid muscle rigidity, high fever, and metabolic disturbances, requiring immediate treatment with dantrolene to prevent serious complications.",
"likes": 1,
"multiAnswer": null,
"pictures": [],
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"question": "A 47-year-old female is in a road traffic accident.\n\nShe requires emergency surgery for a ruptured spleen.\n\nShortly after she is sedated and intubated, she becomes extremely sweaty and her muscles become rigid. Her temperature is recorded at 38.6 degrees Celsius and her heart rate is 118.\n\nHer partner recalls her mother had a similar experience when she had an emergency appendectomy.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2733,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,359 | false | 42 | null | 6,495,259 | null | false | [] | null | 19,410 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a classic description of benign paroxysmal positional vertigo (BPPV), with short episodes of vertigo triggered by head movement. It can be treated by carrying out the Epley manoeuvre after diagnosing it using the Dix-Hallpike manoeuvre.",
"id": "10035032",
"label": "a",
"name": "Epley manoeuvre",
"picture": null,
"votes": 2638
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst a posterior circulation stroke is an important differential for sudden-onset vertigo, it would typically come on acutely and be severe and persistent.",
"id": "10035036",
"label": "e",
"name": "Advise the patient to attend A&E for an urgent CT head",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no concerning features to suggest a referral to ENT is required. If her vertigo remained persistent after the Epley manoeuvre, or if the patient developed hearing loss/tinnitus, a referral to ENT may be warranted.",
"id": "10035034",
"label": "c",
"name": "Referral to ENT",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As the patient is not complaining of nausea, an anti-emetic is unlikely to be helpful.",
"id": "10035033",
"label": "b",
"name": "Ondansetron",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient’s symptoms are not consistent with excessive ear wax and therefore prescribing olive oil drops is unlikely to be beneficial.",
"id": "10035035",
"label": "d",
"name": "Prescribe olive oil drops",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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},
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"demo": null,
"entitlement": null,
"id": "6121",
"name": "Vertigo and Dizziness",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "19410",
"isLikedByMe": 0,
"learningPoint": "Benign paroxysmal positional vertigo (BPPV) causes brief dizziness with head movements. The Epley maneuver, a series of head movements, helps reposition displaced otoliths in the inner ear to relieve symptoms.",
"likes": 0,
"multiAnswer": null,
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"qaAnswer": null,
"question": "A 36-year-old female complains of dizziness.\n\nShe states it occurs mostly when she wakes up in the morning and turns her head to look at her phone. It has been occurring for the past 10 months.\n\nIt lasts for around 30 seconds at a time and she has no associated tinnitus or hearing loss.\n\nGiven the most likely diagnosis, what is the most appropriate management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 2725,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,360 | false | 43 | null | 6,495,259 | null | false | [] | null | 19,411 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not an appropriate management option as the inflammation can be managed using topical steroids rather than systemic steroids which would be less effective at treating the condition and have a high risk of side effects.",
"id": "10035038",
"label": "b",
"name": "Prescribe oral steroids",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically only done if topical antibiotics are ineffective.",
"id": "10035039",
"label": "c",
"name": "Prescribe oral antibiotics",
"picture": null,
"votes": 148
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The tenderness of the tragus, combined with watery discharge and an erythematous auditory canal is a classic history of otitis externa. This is typically managed with topical ciprofloxacin/dexamethasone drops if the symptoms are troublesome.",
"id": "10035037",
"label": "a",
"name": "Prescribe topical combined antibiotic/steroid drops",
"picture": null,
"votes": 2442
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an appropriate strategy for malignant otitis externa, suggested by severe pain which wakes the patient at night as well as cranial nerve palsies. It is more common in older diabetic or immunocompromised patients and does not seem to be suspected in this scenario.",
"id": "10035040",
"label": "d",
"name": "Refer to hospital for IV antibiotics",
"picture": null,
"votes": 99
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst diabetes is a risk factor for otitis externa, it is reasonable to try basic topical management before investigating the patient further if the basic management is ineffective. Checking the patient’s HbA1c also does not address the patient’s symptoms in the meantime.",
"id": "10035041",
"label": "e",
"name": "Check the patient’s HbA1c",
"picture": null,
"votes": 19
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4406",
"name": "Otitis externa",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
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"typeId": null,
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"userNote": null,
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},
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"dislikes": 4,
"explanation": null,
"highlights": [],
"id": "19411",
"isLikedByMe": 0,
"learningPoint": "Otitis externa presents with ear tenderness, discharge, and erythema; initial treatment often involves topical antibiotic-steroid drops for symptom relief.",
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 27-year-old male has an itchy right ear with associated watery discharge. He is finding the symptoms incredibly bothersome as he works as a music producer.\n\nOn examination, he has tenderness on palpation of his right tragus. His auditory canal is erythematous and the tympanic membrane is intact.\n\nWhich of the following is the most appropriate initial management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 2720,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,361 | false | 44 | null | 6,495,259 | null | false | [] | null | 19,412 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst hypothyroidism can cause a hoarse voice, it is more important to exclude head and neck cancer in the initial sense. The patient also did not mention any other symptoms of hypothyroidism.",
"id": "10035046",
"label": "e",
"name": "Arrange thyroid function tests",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst an upper respiratory tract infection can cause a hoarse voice, the persistent nature of the hoarseness and smoking history is concerning and suggests the patient should be referred under a 2-week wait pathway.",
"id": "10035043",
"label": "b",
"name": "Arrange a respiratory viral swab",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A persistent hoarse voice in patients aged 45 or over warrants a referral for suspected laryngeal cancer. It is also worth noting in a smoker that lung cancer is an important differential.",
"id": "10035042",
"label": "a",
"name": "2 week-wait referral under the suspected laryngeal cancer pathway",
"picture": null,
"votes": 2697
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this is likely the investigation that will be carried out by ENT, the referral needs to be urgent to exclude laryngeal cancer.",
"id": "10035045",
"label": "d",
"name": "Non-urgent referral to ENT for nasendoscopy",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an inappropriate management strategy as the persistent hoarseness in a patient aged 45 years or older merits an urgent referral for suspected laryngeal cancer.",
"id": "10035044",
"label": "c",
"name": "Advise simple analgesia and throat lozenges",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5950",
"name": "Hoarseness",
"status": null,
"topic": {
"__typename": "Topic",
"id": "186",
"name": "Ear, Nose and Throat",
"typeId": 7
},
"topicId": 186,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5950,
"conditions": [],
"difficulty": 1,
"dislikes": 2,
"explanation": null,
"highlights": [],
"id": "19412",
"isLikedByMe": 0,
"learningPoint": "Persistent hoarseness lasting over three weeks in individuals over 45, especially smokers, requires urgent referral for suspected laryngeal cancer.",
"likes": 5,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 57-year-old male has a hoarse voice.\n\nHe initially had symptoms of a cough, nasal discharge and sore throat but the hoarseness has persisted for more than a month after these symptoms resolved.\n\nHe has no other past medical history but smokes 30 cigarettes a day.\n\nWhat is the most appropriate management option?",
"sbaAnswer": [
"a"
],
"totalVotes": 2724,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,362 | false | 45 | null | 6,495,259 | null | false | [] | null | 19,413 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Syphilis typically causes a single painless ulcer (chancre) rather than multiple painful ulcers.",
"id": "10035049",
"label": "c",
"name": "Syphilis",
"picture": null,
"votes": 114
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this can cause abscesses/ulcers, they are usually painless, and it also commonly presents with proctitis, which is not mentioned in this history.",
"id": "10035051",
"label": "e",
"name": "Lymphogranuloma venerum",
"picture": null,
"votes": 230
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are normal physiological variants which have the appearance of white/yellow papules rather than painful ulcers.",
"id": "10035050",
"label": "d",
"name": "Fordyce spots",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Multiple painful blisters suggest HSV. Dysuria is a common feature due to pain from blisters when passing urine.",
"id": "10035047",
"label": "a",
"name": "Herpes simplex",
"picture": null,
"votes": 2284
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst chancroid can cause painful ulcers, it is much less common than genital herpes.",
"id": "10035048",
"label": "b",
"name": "Chancroid",
"picture": null,
"votes": 91
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6122",
"name": "Genital Herpes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "163",
"name": "Genitourinary medicine",
"typeId": 7
},
"topicId": 163,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6122,
"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "19413",
"isLikedByMe": 0,
"learningPoint": "Herpes simplex virus typically presents with multiple painful blisters and can cause dysuria due to associated genital lesions.",
"likes": 1,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 19-year-old male has multiple painful blisters on his penis and perineum. He also states he has had pain when passing urine for the last week. When asked about his recent sexual activity, he states he has had multiple male and female sexual partners in the past 3 months. He was previously well prior to this episode.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 2723,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,363 | false | 46 | null | 6,495,259 | null | false | [] | null | 19,414 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This history is suggestive of thrush, given the pruritis and yellow-white discharge with an acidic vaginal pH. In a pregnant woman, oral fluconazole is contraindicated and so a clotrimazole pessary is the recommended option.",
"id": "10035052",
"label": "a",
"name": "Clotrimazole pessary",
"picture": null,
"votes": 1240
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be used to treat a Chlamydia trachomatis infection, which would present with dysuria and discharge, typically with no itching. It is also contraindicated in pregnancy as it is teratogenic.",
"id": "10035054",
"label": "c",
"name": "Oral doxycycline",
"picture": null,
"votes": 98
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be a first-line option in a non-pregnant patient but is contraindicated in pregnancy.",
"id": "10035053",
"label": "b",
"name": "Oral fluconazole",
"picture": null,
"votes": 704
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be used to treat a Neisseria gonorrhoea infection, which would present with dysuria and purulent discharge, typically with no itching.",
"id": "10035055",
"label": "d",
"name": "IM ceftriaxone",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used to treat bacterial vaginosis, which causes an alkaline vaginal pH.",
"id": "10035056",
"label": "e",
"name": "Oral metronidazole",
"picture": null,
"votes": 623
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6123",
"name": "Genital candidiasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "163",
"name": "Genitourinary medicine",
"typeId": 7
},
"topicId": 163,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6123,
"conditions": [],
"difficulty": 1,
"dislikes": 14,
"explanation": null,
"highlights": [],
"id": "19414",
"isLikedByMe": 0,
"learningPoint": "Clotrimazole pessaries are commonly used to treat vaginal candidiasis during pregnancy, as they effectively target the fungal infection while being considered safe for use in the second and third trimesters.",
"likes": 7,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32-year-old pregnant female complains of vulval itching and a yellow/white discharge. She is sexually active with one partner and is in a monogamous relationship.\n\nHer vaginal pH is found to be <4.5.\n\nGiven the likely diagnosis, what is the most appropriate treatment?",
"sbaAnswer": [
"a"
],
"totalVotes": 2739,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,364 | false | 47 | null | 6,495,259 | null | false | [] | null | 19,415 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a notifiable disease in the UK and is a common cause of URTIs.",
"id": "10035061",
"label": "e",
"name": "Rhinovirus",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Of all the options listed, this is the only notifiable disease. There has been an increased number of cases in recent years due to decreased vaccine uptake.",
"id": "10035057",
"label": "a",
"name": "Mumps",
"picture": null,
"votes": 2389
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a notifiable disease in the UK.",
"id": "10035060",
"label": "d",
"name": "Gonorrhoea",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a notifiable disease in the UK.",
"id": "10035058",
"label": "b",
"name": "HIV infection",
"picture": null,
"votes": 275
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not a notifiable disease in the UK and is the most common cause of sexually transmitted infection.",
"id": "10035059",
"label": "c",
"name": "Chlamydia",
"picture": null,
"votes": 23
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6124",
"name": "Notifiable diseases",
"status": null,
"topic": {
"__typename": "Topic",
"id": "335",
"name": "Social and population health",
"typeId": 7
},
"topicId": 335,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 6124,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "19415",
"isLikedByMe": 0,
"learningPoint": "Mumps is a notifiable disease in the UK, with rising cases linked to reduced vaccination coverage.",
"likes": 2,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A mother of a 12-year-old boy has refused any vaccines thus far as she is concerned about side effects. However, she agrees to have a further conversation with a doctor about the importance of vaccines.\n\nDuring the conversation, she asks about notifiable diseases as she has read about them online.\n\nWhich of the following is a notifiable disease in the UK?",
"sbaAnswer": [
"a"
],
"totalVotes": 2723,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,365 | false | 48 | null | 6,495,259 | null | false | [] | null | 19,416 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Of all the options listed, this is the only readily reversible option which is not contraindicated due to the patient’s history of migraine with aura.",
"id": "10035062",
"label": "a",
"name": "Progesterone-only pill",
"picture": null,
"votes": 2371
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this option has no period after stopping with an impact on fertility, it is less effective than medical contraceptive options. The progesterone-only pill can therefore be offered to the patient.",
"id": "10035064",
"label": "c",
"name": "Condoms alone",
"picture": null,
"votes": 122
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a long-term contraceptive option that is not readily reversible, with regular menstrual cycles often resuming several months after stopping injections",
"id": "10035065",
"label": "d",
"name": "Progesterone injection (Depo-provera)",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst readily reversible, this is also contraindicated due to the patient’s history of migraine with aura.",
"id": "10035066",
"label": "e",
"name": "Combined contraceptive patch",
"picture": null,
"votes": 85
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst readily reversible, this is contraindicated due to the patient’s history of migraine with aura.",
"id": "10035063",
"label": "b",
"name": "Combined oral contraceptive pill",
"picture": null,
"votes": 22
}
],
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"id": "6125",
"name": "Contraception",
"status": null,
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"learningPoint": "The progesterone-only pill is a good contraceptive option for women with a history of migraine with aura, as the combined pill is contraindicated in such cases.",
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"question": "A 37-year-old female would like to discuss contraceptive options.\nShe would like an option which is readily reversible, as she is considering starting a family in the next year.\n\nShe has a past medical history of asthma and migraine with aura.\n\nWhich of the following is the most appropriate contraceptive option to offer?",
"sbaAnswer": [
"a"
],
"totalVotes": 2679,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,366 | false | 49 | null | 6,495,259 | null | false | [] | null | 19,417 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nifedipine, rather than amlodipine, is the first-line calcium channel blocker for Raynaud’s phenomenon.",
"id": "10035069",
"label": "c",
"name": "Prescribe amlodipine",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an inappropriate management strategy as the patient is finding symptoms troublesome, and Raynaud’s is not considered a typical physiological response despite it being fairly common.",
"id": "10035070",
"label": "d",
"name": "Reassure the patient that this is a normal physiological variant",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can be trialled if lifestyle factors and keeping warm are ineffective.",
"id": "10035068",
"label": "b",
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"picture": null,
"votes": 660
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Keeping warm and managing lifestyle factors (e.g. smoking) is the correct first-line management of Raynaud’s phenomenon with no concerning features.",
"id": "10035067",
"label": "a",
"name": "Advise smoking cessation and encourage using gloves to keep warm",
"picture": null,
"votes": 1845
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be merited if the patient had joint pain, rashes, positive autoantibodies or raised inflammatory markers on their blood tests. In this case, conservative measures should be trialled before this is considered.",
"id": "10035071",
"label": "e",
"name": "Refer the patient to Rheumatology",
"picture": null,
"votes": 171
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Could this be buerger's syndrome instead of raynauds?",
"createdAt": 1711715224,
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"__typename": "QuestionComment",
"comment": "hit the ward buddy\n",
"createdAt": 1735329608,
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"likes": 1,
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"question": "A 27-year-old male smoker has painful pallor of his fingers in the cold, followed by cyanosis then erythema.\n\nHe denies joint pain or rashes, or any family history of connective tissue disease.\n\nHis recent blood tests including ANA and ESR were all negative.\n\nWhat is the most appropriate initial management?",
"sbaAnswer": [
"a"
],
"totalVotes": 2732,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,367 | false | 50 | null | 6,495,259 | null | false | [] | null | 19,418 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this TCA has anti-muscarinic effects, it is not recommended by NICE to treat urge incontinence.",
"id": "10035076",
"label": "e",
"name": "Prescribe imipramine",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an appropriate medication to trial if bladder training exercises and lifestyle measures are ineffective.",
"id": "10035073",
"label": "b",
"name": "Prescribe tolterodine",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an appropriate medication to trial if bladder training exercises and lifestyle measures are ineffective.",
"id": "10035074",
"label": "c",
"name": "Prescribe darifenacin",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This history is suggestive of urge incontinence. The first line management of urge incontinence is bladder training exercises whilst avoiding alcohol and caffeine which have a diuretic effect.",
"id": "10035072",
"label": "a",
"name": "Advise avoiding alcohol and caffeine and offer referral for bladder training exercises",
"picture": null,
"votes": 2426
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the first line management of stress incontinence rather than urge incontinence. Given the patient denies leaking urine on straining, urge incontinence is more likely to be the diagnosis.",
"id": "10035075",
"label": "d",
"name": "Advise avoiding alcohol and caffeine and offer referral for pelvic floor muscle training exercises",
"picture": null,
"votes": 162
}
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"question": "A 63-year-old woman experiences sudden urgency when needing to go to the toilet.\n\nShe denies any leaking of urine on coughing, laughing or sneezing.\n\nShe has no dysuria or haematuria.\n\nGiven the likely diagnosis, what is the most appropriate first-line management?",
"sbaAnswer": [
"a"
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"typeId": 1,
"userPoint": null
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173,468,569 | false | 1 | null | 6,495,268 | null | false | [] | null | 19,479 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reasonable differential for a systolic murmur, however, there are no mentions of other symptoms (syncope, angina, dyspnoea) or radiation to the carotid region. Further, aortic stenosis is more common in older patients. A flow murmur is the most likely diagnosis, exacerbated by the anaemia.",
"id": "10035378",
"label": "b",
"name": "Aortic stenosis",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reasonable differential for a systolic murmur, however a flow murmur is most likely given the patient is young and anaemic. Mitral regurgitation is more common in older patients, unless there are risk factors for valvular disease (e.g. congenital abnormalities/rheumatic fever).",
"id": "10035380",
"label": "d",
"name": "Mitral regurgitation",
"picture": null,
"votes": 158
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reasonable differential for a systolic murmur, however this is more common in older patients, and the murmur radiates to the carotid arteries. A flow murmur is the most likely diagnosis, exacerbated by the anaemia.",
"id": "10035379",
"label": "c",
"name": "Aortic sclerosis",
"picture": null,
"votes": 176
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reasonable differential for a systolic murmur, however a flow murmur is most likely given the patient is young and anaemic. Further, they have no risk factors for valvular disease or tricuspid regurgitation (e.g. pulmonary hypertension).",
"id": "10035381",
"label": "e",
"name": "Tricuspid regurgitation",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Soft, systolic, asymptomatic murmurs in young patients are often due to high flow across valves and vessels. These can be exaggerated when circulation is hyperdynamic (e.g. due to anaemia, which this patient has). An echocardiogram should be carried out to exclude structural/valvular pathology.",
"id": "10035377",
"label": "a",
"name": "Anaemia",
"picture": null,
"votes": 1547
}
],
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"id": "6128",
"name": "Ejection systolic murmurs",
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"name": "Cardiology",
"typeId": 7
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"id": "19479",
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"learningPoint": "Anaemia can cause a soft, systolic murmur due to increased blood flow across heart valves in a hyperdynamic circulation.",
"likes": 3,
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"question": "A 24-year-old woman visits her GP with severe menorrhagia, which she has suffered from for a number of years. She feels tired all the time and is considering starting the combined oral contraceptive pill to help with her symptoms.\n\n\nShe has no other past medical history.\n\n\nOn examination, she looks pale. Her abdomen is soft and non-tender, and she declines a vaginal examination. Her chest is clear. A soft, non-radiating systolic murmur is heard on auscultation.\n\n\nBlood results:\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|90 g/L|(M) 130 - 170, (F) 115 - 155|\n|White Cell Count|9.2x10<sup>9</sup>/L|3.0 - 10.0|\n|Mean Cell Volume (MCV)|72 fL|80 - 96|\n\n\nWhich of the following is most likely causing her murmur?\n\n ",
"sbaAnswer": [
"a"
],
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} | MarksheetMark |
173,468,570 | false | 2 | null | 6,495,268 | null | false | [] | null | 19,480 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis C infection can be caused by intravenous drug use, which is a risk factor for endocarditis. However, hepatitis C infection alone is not a risk factor for developing endocarditis.",
"id": "10035386",
"label": "e",
"name": "Hepatitis C infection",
"picture": null,
"votes": 262
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This gentleman most likely has infective endocarditis given his presentation, new murmur, and splinter haemorrhages (a vasculitic complication of endocarditis). Previous valve surgery would place this patient at a high risk of developing infective endocarditis.",
"id": "10035382",
"label": "a",
"name": "Previous aortic valve replacement",
"picture": null,
"votes": 1622
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This gentleman most likely has infective endocarditis given his presentation, new murmur, and splinter haemorrhages (a vasculitic complication of endocarditis). Intravenous, rather than inhaled, drug use is a risk factor for infective endocarditis.",
"id": "10035383",
"label": "b",
"name": "Inhaling cocaine",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intravenous, rather than inhaled, drug use is a risk factor for infective endocarditis.",
"id": "10035384",
"label": "c",
"name": "Smoking cannabis",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alcohol use can place patients at risk of a multitude of infections, however, it is not a well-known risk factor for endocarditis.",
"id": "10035385",
"label": "d",
"name": "Alcohol consumption",
"picture": null,
"votes": 76
}
],
"comments": [],
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"__typename": "Concept",
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},
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"demo": null,
"entitlement": null,
"id": "3710",
"name": "Infective Endocarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
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"topicId": 134,
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"highlights": [],
"id": "19480",
"isLikedByMe": 0,
"learningPoint": "Previous heart valve surgery significantly increases the risk of developing infective endocarditis due to potential bacterial colonisation.",
"likes": 1,
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"pictures": [
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"id": "2787",
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"question": "A 54-year-old man has been referred to the emergency department by his GP. He has been experiencing recurrent fevers and has been feeling generally unwell for the past three weeks. He reports no other symptoms.\n\nHe is febrile, tachycardic, and hypotensive. On examination, he is pale and looks unwell. Auscultation of his chest reveals a pan-systolic murmur.\n\nExamination of his hands shows:\n\n[lightgallery]\n\nWhich of the following is a significant risk factor for the condition he has developed?",
"sbaAnswer": [
"a"
],
"totalVotes": 2030,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,571 | false | 3 | null | 6,495,268 | null | false | [] | null | 19,482 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest pain, hypoxia, and breathlessness should raise suspicions of myocardial infarction. However, in the absence of ischaemic changes and the presence of right heart strain make pulmonary embolism more likely.",
"id": "10035393",
"label": "b",
"name": "Non-ST elevation myocardial infarction (NSTEMI)",
"picture": null,
"votes": 400
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest pain, hypoxia, and breathlessness should raise suspicions of myocardial infarction. However, in the absence of ischaemic changes (such as ST-segment elevation) and the presence of right heart strain make pulmonary embolism more likely.",
"id": "10035394",
"label": "c",
"name": "ST-elevation myocardial infarction (STEMI)",
"picture": null,
"votes": 231
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The ECG shows right bundle branch block and right axis deviation, suggestive of right heart strain. This, combined with the patient's hypoxia, chest pain, and recent surgery, makes pulmonary embolism the most likely diagnosis.",
"id": "10035392",
"label": "a",
"name": "Pulmonary embolism",
"picture": null,
"votes": 1264
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pneumonia is an important differential, however, this does not account for the ECG features of right heart strain or the lack of examination findings; pneumonia would usually cause focal crackles. Pulmonary embolism is the most likely diagnosis.",
"id": "10035396",
"label": "e",
"name": "Hospital-acquired pneumonia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While atelectasis can cause post-operative hypoxia, this is usually present earlier in the postoperative course and is milder/less acute. The ECG findings of right heart strain, along with chest pain and hypoxia, make pulmonary embolism the most likely diagnosis.",
"id": "10035395",
"label": "d",
"name": "Atelectasis",
"picture": null,
"votes": 94
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "looked at this and thought it was S1Q3T3. Right answer for wrong reason",
"createdAt": 1717528724,
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"id": "51934",
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{
"__typename": "QuestionComment",
"comment": "i think it's both",
"createdAt": 1738331131,
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"displayName": "Vaccine Complement",
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}
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"id": 17972
}
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"id": "5916",
"name": "Right heart strain",
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"name": "Cardiology",
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"learningPoint": "Pulmonary embolism should be suspected in post-operative patients presenting with hypoxia, chest pain, and signs of right heart strain on ECG.",
"likes": 1,
"multiAnswer": null,
"pictures": [
{
"__typename": "Picture",
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"createdAt": 1713535060,
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"thumbhash": "OwgCBICUppiAiHiKd3kAAAAAAA==",
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"updatedAt": 1713535060
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"question": "A medical emergency team attends to a patient with breathlessness a week after surgery. They report feeling very unwell and complain of central chest pain. Examination is unremarkable.\n\nObservations:\n* Heart rate: 134 beats/minute\n* Blood pressure: 102/69 mmHg\n* Respiratory rate: 17 breaths/minute\n* Temperature: 36.7 degrees\n* Oxygen saturations (room air): 89%\n\nECG:\n\n[lightgallery]",
"sbaAnswer": [
"a"
],
"totalVotes": 1992,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,572 | false | 4 | null | 6,495,268 | null | false | [] | null | 19,483 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Digoxin may help to control symptoms, however it does not provide a prognostic (i.e. mortality) benefit.",
"id": "10035398",
"label": "b",
"name": "Add digoxin",
"picture": null,
"votes": 354
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be considered but is mostly used in African-Caribbean patients. From the options provided, cardiac resynchronisation therapy is the best intervention to choose that would provide a mortality benefit.",
"id": "10035400",
"label": "d",
"name": "Add hydralazine and nitrate",
"picture": null,
"votes": 420
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is clearly experiencing significant symptoms of dyspnoea due to heart failure with reduced ejection fraction. It would be inappropriate to leave her management unchanged unless the patient wished for this to be the case.",
"id": "10035399",
"label": "c",
"name": "No changes to current management",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not appropriate; sacubitril-valsartan (Entresto) is recommended INSTEAD of an ACE inhibitor/ARB in patients with an ejection fraction of less than 35%. The formulation includes an angiotensin receptor blocker (valsartan).",
"id": "10035401",
"label": "e",
"name": "Substitute sacubitril-valsartan for an ACE inhibitor",
"picture": null,
"votes": 280
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is clearly experiencing significant symptoms of dyspnoea due to heart failure with reduced ejection fraction. She is now at maximal medical therapy, including a beta blocker, mineralocorticoid receptor antagonist, and sacubitril-valsartan (which contains an angiotensin receptor blocker). The next step to improve her prognosis would addition of an SGLT-2 inhibitor such as empagliflozin or dapagliflozin, which are known to reduce mortality in patients with heart failure with reduced ejection fraction.",
"id": "10035397",
"label": "a",
"name": "Add dapagliflozin",
"picture": null,
"votes": 852
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3798",
"name": "Heart Failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3798,
"conditions": [],
"difficulty": 1,
"dislikes": 10,
"explanation": null,
"highlights": [],
"id": "19483",
"isLikedByMe": 0,
"learningPoint": "Cardiac resynchronization therapy (CRT) is used in heart failure with reduced ejection fraction (EF) to improve ventricular coordination, enhance cardiac output, and reduce symptoms in patients with dyssynchrony.",
"likes": 5,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 67-year-old Caucasian woman with heart failure due to ischaemic heart disease is seen in an outpatient clinic. Her most recent echocardiogram shows an ejection fraction of 32% and an ECG shows sinus rhythm with broad QRS complexes.\n\nHer current cardiac medications include:\n* Bisoprolol 5mg PO OD\n* Sacubitril-valsartan 24/26 mg PO OD\n* Eplerenone 25mg PO OD\n* Furosemide 20mg PO OD\n\nOn examination, she is visibly breathless on mobilising to the clinic room and has mild pitting oedema to both calves. Her observations are normal and her pulse is regular at 70 bpm.\n\nWhat is the most appropriate next step to improve her prognosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 1970,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,573 | false | 5 | null | 6,495,268 | null | false | [] | null | 19,484 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has acute cholecystitis. As per NICE Guidelines, they should have a 'hot' cholecystectomy; i.e. gallbladder removal within a week of diagnosis. Delayed or 'interval' cholecystectomies are sometimes carried out as 'hot' cholecystectomies are more technically challenging and require more expertise. This may also be required if the patient requires medical stabilisation (e.g. if they are in septic shock), or optimisation of other comorbidities.",
"id": "10035403",
"label": "b",
"name": "Cholecystectomy in 2 months' time",
"picture": null,
"votes": 100
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These will be required, however, the question asks what the definitive management for acute cholecystitis is, which is a cholecystectomy.",
"id": "10035406",
"label": "e",
"name": "Antibiotics, fluids, and analgesia",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ERCP is a useful diagnostic and therapeutic procedure for disorders of the biliary tree, e.g. ascending cholangitis. This patient has acute cholecystitis, which an ERCP will not be able to treat. They require a cholecystectomy.",
"id": "10035405",
"label": "d",
"name": "Endoscopic retrograde cholangiopancreatography (ERCP)",
"picture": null,
"votes": 238
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has acute cholecystitis. Cholecystostomy (a drain placed into the gallbladder) can be considered in patients who are not fit for surgery and do not respond to conservative management (e.g. antibiotics). This patient has no contraindications to having a cholecystectomy, and therefore this would be the best definitive management.",
"id": "10035404",
"label": "c",
"name": "Cholecystostomy",
"picture": null,
"votes": 252
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has acute cholecystitis. As per NICE Guidelines, they should have a 'hot' cholecystectomy; i.e. gallbladder removal within a week of diagnosis.",
"id": "10035402",
"label": "a",
"name": "Cholecystectomy within 1 week",
"picture": null,
"votes": 1332
}
],
"comments": [],
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5978",
"name": "Cholecystitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 4,
"explanation": null,
"highlights": [],
"id": "19484",
"isLikedByMe": 0,
"learningPoint": "Laparoscopic cholecystectomy should be performed within 1 week of acute cholecystitis diagnosis; if not possible, surgery should be delayed until the acute episode resolves, usually more than 4 weeks after diagnosis.",
"likes": 2,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 56-year-old man is admitted to hospital with right upper quadrant pain and fevers. An ultrasound is performed which shows multiple gallstones present within a thickened gallbladder. Has localised peritonism in the right upper quadrant and is Murphy's sign positive.\n\nWhat is the most appropriate definitive management for this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 1956,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,574 | false | 6 | null | 6,495,268 | null | false | [] | null | 19,485 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has developed an appendiceal mass; a contained area of small bowel and omentum which has become inflamed and encases the appendix. He should undergo an appendectomy, but it is unsafe to attempt this until the inflammation of the appendix has resolved. He should receive antibiotics and then have an appendectomy in 6-8 weeks' time.",
"id": "10035409",
"label": "c",
"name": "Proceed to appendectomy",
"picture": null,
"votes": 1333
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inappropriate; the patient requires definitive management.",
"id": "10035411",
"label": "e",
"name": "Observation in hospital",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has developed an appendiceal mass; a contained area of small bowel and omentum which has become inflamed and encases the appendix. He should undergo an appendectomy, but it is unsafe to attempt this until the inflammation of the appendix has resolved. He should receive antibiotics and then have an appendectomy in 6-8 weeks' time.",
"id": "10035407",
"label": "a",
"name": "Interval appendectomy in 6-8 weeks' time",
"picture": null,
"votes": 370
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Antibiotics will be required, however the patient will still likely require an appendectomy.",
"id": "10035408",
"label": "b",
"name": "A 2-week course of antibiotics",
"picture": null,
"votes": 126
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If an associated abscess was present, drainage may have been an option to control the source of infection. In this case, there is no drainable collection. The patient should receive antibiotics until the inflammation settles, and then can proceed to an appendectomy.",
"id": "10035410",
"label": "d",
"name": "Ultrasound-guided drainage",
"picture": null,
"votes": 52
}
],
"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": "4486",
"name": "Appendicitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
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"userNote": null,
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},
"conceptId": 4486,
"conditions": [],
"difficulty": 1,
"dislikes": 29,
"explanation": null,
"highlights": [],
"id": "19485",
"isLikedByMe": 0,
"learningPoint": "In cases of appendiceal mass, initial management includes antibiotics followed by interval appendectomy after inflammation resolves, typically within 6-8 weeks.",
"likes": 8,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 7-year-old boy is admitted to hospital with persistent fevers. His parents report him experiencing an episode of severe right iliac fossa pain lasting four days that ended a week ago.\n\nHe is started on antibiotics and an ultrasound scan is carried out, which shows an appendix mass but no associated abscess.\n\nWhat is the most appropriate course of management?",
"sbaAnswer": [
"a"
],
"totalVotes": 1965,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,575 | false | 7 | null | 6,495,268 | null | false | [] | null | 19,486 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has a femoral hernia based on examination findings. While imaging will likely be required, arranging this will delay a surgical opinion which is urgently needed due to the risk of strangulation. If further imaging is required, the surgical team can arrange this.",
"id": "10035416",
"label": "e",
"name": "Arrange CT abdomen/pelvis",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has a femoral hernia. These are very prone to strangulation, so observation and follow-up is inappropriate.",
"id": "10035414",
"label": "c",
"name": "Careful observation and follow-up",
"picture": null,
"votes": 429
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has a femoral hernia based on examination findings. While an abdominal ultrasound will likely be required, arranging this will delay a surgical opinion which is urgently needed due to the risk of strangulation. If further imaging is required, the surgical team can arrange this.",
"id": "10035415",
"label": "d",
"name": "Arrange an urgent abdominal ultrasound",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient likely has a femoral hernia - clinical examination findings are suggestive of this, and she has multiple risk factors (constipation causing increased intra-abdominal pressure, female sex, increasing age, and COPD potentially causing a chronic cough). She should be referred urgently, as these hernias are prone to strangulation and therefore require prompt investigation and management.",
"id": "10035412",
"label": "a",
"name": "Urgent referral to surgical team",
"picture": null,
"votes": 1361
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has a femoral hernia. A referral to the emergency department for emergency surgery should be made if there are features of incarceration, strangulation, or obstruction. These would include an irreducible hernia, pain, features of bowel obstruction, or other clinical concerns. At present, an urgent referral to the surgical team is sufficient.",
"id": "10035413",
"label": "b",
"name": "Refer to the emergency department",
"picture": null,
"votes": 19
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5880",
"name": "Femoral hernias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 5880,
"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "19486",
"isLikedByMe": 0,
"learningPoint": "Femoral hernias are more common in elderly women and can lead to strangulation, requiring urgent surgical referral.",
"likes": 2,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 74-year-old woman visits her GP as she has noticed a painless lump in her groin, which she has not experienced before. She has a history of chronic constipation and COPD.\n\nOn examination, she has a soft, reducible lump below and lateral to the pubic tubercle. It is not tender to palpation and has a cough impulse.\n\nWhat is the most appropriate next step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 1951,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,576 | false | 8 | null | 6,495,268 | null | false | [] | null | 19,487 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most important differential diagnosis to rule out. However, these endoscopy findings make colorectal carcinoma unlikely; no tumours are seen. The endoscopy image shows multiple outpouchings of the intestinal wall, consistent with diverticular disease. Constipation is a risk factor for this.",
"id": "10035418",
"label": "b",
"name": "Colorectal carcinoma",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Angioectasias are common vascular lesions of the digestive tract and may cause chronic, recurrent lower GI bleeding. These appear as red 'coral reef' structures on endoscopy, and may be associated with aortic stenosis (this is called Heyde's syndrome). In this case, the endoscopy shows outpouchings of the intestinal wall, consistent with diverticular disease.",
"id": "10035419",
"label": "c",
"name": "Angioectasia (angiodysplasia)",
"picture": null,
"votes": 161
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no polyps demonstrated in this image. The endoscopy image shows multiple outpouchings of the intestinal wall, consistent with diverticular disease.",
"id": "10035421",
"label": "e",
"name": "Bleeding polyp",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The endoscopy image shows multiple outpouchings of the intestinal wall, consistent with diverticular disease. Constipation is a risk factor for this. #",
"id": "10035417",
"label": "a",
"name": "Diverticular disease",
"picture": null,
"votes": 1575
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inflammatory bowel disease would be a good differential in this case, however, the absence of systemic features makes this less likely. Endoscopy would show mucosal inflammation. In this case, the endoscopy image shows multiple outpouchings of the intestinal wall, consistent with diverticular disease.",
"id": "10035420",
"label": "d",
"name": "Inflammatory bowel disease",
"picture": null,
"votes": 103
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6129",
"name": "Diverticular disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
"conceptId": 6129,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "19487",
"isLikedByMe": 0,
"learningPoint": "Diverticular disease is characterised by the formation of outpouchings in the colon, often associated with constipation and rectal bleeding.",
"likes": 1,
"multiAnswer": null,
"pictures": [
{
"__typename": "Picture",
"caption": null,
"createdAt": 1713535060,
"id": "2791",
"index": 0,
"name": "3.png",
"overlayPath": null,
"overlayPath256": null,
"overlayPath512": null,
"path": "images/9280ye7k1713535059219.jpg",
"path256": "images/9280ye7k1713535059219_256.jpg",
"path512": "images/9280ye7k1713535059219_512.jpg",
"thumbhash": "11gKFYYgOlqadXiRd3iHhwSdMbAo",
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"topicId": null,
"updatedAt": 1713535060
}
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"prescribeAnswer": null,
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"qaAnswer": null,
"question": "A 56-year-old man with multiple episodes of rectal bleeding undergoes a colonoscopy under the 2-week wait pathway. He reports a history of long-standing irritable bowel syndrome with constipation.\n\nThe following appearance is seen in the sigmoid colon:\n\n[lightgallery]\n\nWhat is the most likely cause of his symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 1931,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,577 | false | 9 | null | 6,495,268 | null | false | [] | null | 19,488 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transverse colectomies are not often undertaken due to this being a complex surgery, as the colon has a complicated blood supply. An extended right hemicolectomy is the best option.",
"id": "10035423",
"label": "b",
"name": "Transverse colectomy",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This would be the most appropriate option. A right hemicolectomy involves the resection of a portion of the distal ileum, caecum, ascending colon, and proximal to mid-transverse colon. As the tumour is at the hepatic flexure, this would be resected. A primary anastomosis between the ileum and remaining colon is often made unless there are surgical complications necessitating temporary stoma formation.",
"id": "10035422",
"label": "a",
"name": "Right hemicolectomy with ileocolic anastamosis",
"picture": null,
"votes": 1266
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "While an extended right hemicolectomy would remove the tumour (this is the same as a right hemicolectomy but extended to the splenic flexure), this would be more extensive than required as the patient's tumour is at the hepatic flexure, and therefore be a higher risk procedure. Formation of an ileostomy would not be ideal unless a surgical complication meant that a primary anastomosis was not possible.",
"id": "10035424",
"label": "c",
"name": "Extended right hemicolectomy and temporary ileostomy",
"picture": null,
"votes": 558
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no indication to remove the whole colon, which is a higher-risk procedure. The tumour is confined to the hepatic flexure, and therefore a right hemicolectomy would suffice.",
"id": "10035426",
"label": "e",
"name": "Total colectomy",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Hartmann's procedure involves surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. This is typically an emergency procedure performed due to a sigmoid perforation (e.g. due to diverticulitis) or an obstructing sigmoid tumour. It is not suitable for right-sided colon cancer.",
"id": "10035425",
"label": "d",
"name": "Hartmann's procedure",
"picture": null,
"votes": 47
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4239",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4239,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "19488",
"isLikedByMe": 0,
"learningPoint": "Right hemicolectomy is the standard surgical treatment for tumours located at the hepatic flexure of the colon.",
"likes": 3,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 68-year-old previously fit and well woman is diagnosed with colorectal cancer at the hepatic flexure during a colonoscopy performed due to a positive bowel cancer screening (FIT) test.\n\nSubsequent investigations show that the tumour has not metastasised or breached the intestinal wall.\n\nWhich of the following is the most suitable surgical approach?",
"sbaAnswer": [
"a"
],
"totalVotes": 1933,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,578 | false | 10 | null | 6,495,268 | null | false | [] | null | 19,489 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The clinical history and image are suggestive of a chalazion, caused by the blockage of an oil-secreting (Meibomian) gland. The first step in managing this condition is encouraging massage and using warm compresses.",
"id": "10035427",
"label": "a",
"name": "Warm compresses and massage",
"picture": null,
"votes": 1530
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Intralesional steroid injections are considered in persistent, recurrent chalazia. As this has only been present for a day, conservative management should be tried first. Incision and drainage may be preferred to steroid injections in the first instance.",
"id": "10035431",
"label": "e",
"name": "Triamcinolone injection",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chalazia that do not respond to conservative management may require incision and drainage.",
"id": "10035428",
"label": "b",
"name": "Incision and drainage",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chalazia are usually caused by non-infective processes (in contrast to styes). Although topical antibiotics are commonly used (especially for styes), the first line management to encourage the gland to unblock is massage and use of warm compresses.",
"id": "10035430",
"label": "d",
"name": "Topical chloramphenicol",
"picture": null,
"votes": 180
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chalazia are usually caused by non-infective processes (in contrast to styes). There are currently no indications for oral antibiotics. Flucloxacillin may be required if an infection develops.",
"id": "10035429",
"label": "c",
"name": "Oral flucloxacillin",
"picture": null,
"votes": 188
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Why can't this be peri-orbital cellulitis",
"createdAt": 1719149456,
"dislikes": 0,
"id": "53613",
"isLikedByMe": 0,
"likes": 4,
"parentId": null,
"questionId": 19489,
"replies": [
{
"__typename": "QuestionComment",
"comment": "There's not much in terms of risk factors for peri-orbital cellulitis, and the picture of the eyelid is mainly contained to the edge of the lid where the meibomian glands lie. The two differentials for chalazion are stye and blepharitis - and all these would be treated with warm compresses first line afaik.",
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"id": "4637",
"name": "Styes and chalazions",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
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"learningPoint": "A chalazion is managed initially with warm compresses and massage to promote drainage of the blocked Meibomian gland.",
"likes": 1,
"multiAnswer": null,
"pictures": [
{
"__typename": "Picture",
"caption": "The typical appearance of a chalazion.",
"createdAt": 1665036193,
"id": "781",
"index": 0,
"name": "Chalazion.jpeg",
"overlayPath": null,
"overlayPath256": null,
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"path": "images/s407pqrz1665036171706.jpg",
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"thumbhash": "oGkKFYQAVmd2dol5iHd4dwFmCFGG",
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"updatedAt": 1708373886
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"question": "A 19-year-old man attends the eye emergency department with a swelling of his eyelid. He is concerned that he has an eye infection as he admits to wearing his contact lenses in the shower. He has no visual disturbances.\n\nOn examination, his observations are within normal range, visual acuity (corrected) is normal, and eye movements are normal, as is fundoscopy. The following appearance is seen:\n\n[lightgallery]\n\nWhat is the most appropriate initial step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 1919,
"typeId": 1,
"userPoint": null
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173,468,579 | false | 11 | null | 6,495,268 | null | false | [] | null | 19,490 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chemotherapy can be considered in bilateral retinoblastoma or small tumours, however as this patient has advanced disease, enucleation is the best option.",
"id": "10035433",
"label": "b",
"name": "Systemic chemotherapy",
"picture": null,
"votes": 173
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anti-VEGF therapy is usually used in patients with vaso-proliferative retinopathies, e.g. diabetic retinopathy. It is not indicated in retinoblastoma.",
"id": "10035435",
"label": "d",
"name": "Intravitreal anti-vascular endothelial growth factor therapy",
"picture": null,
"votes": 211
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Radiotherapy may be used to treat small tumours, or when the disease is bilateral, the most involved eye is enucleated and the less involved eye is irradiated. There are no indications for bilateral irradiation in this case. Enucleation of the left eye is the most appropriate choice.",
"id": "10035436",
"label": "e",
"name": "Bilateral irradiation of the eyes",
"picture": null,
"votes": 166
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Removal of the eye (and as little of the optic nerve as possible) and insertion of a prosthesis is recommended in cases of retinoblastoma that is confined to the eye.",
"id": "10035432",
"label": "a",
"name": "Enucleation",
"picture": null,
"votes": 1217
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Laser photocoagulation may be used to manage small tumours, however as this patient has advanced disease, the eye should be removed to prevent metastases and resect the diseased areas.",
"id": "10035434",
"label": "c",
"name": "Photocoagulation",
"picture": null,
"votes": 145
}
],
"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": "6130",
"name": "Retinoblastoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
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},
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"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "19490",
"isLikedByMe": 0,
"learningPoint": "Enucleation is a surgical procedure in which the entire eyeball is removed to treat conditions like advanced retinoblastoma confined to the eye, aiming to prevent metastasis and preserve surrounding structures.",
"likes": 3,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "An 18-month-old girl is referred to the paediatric ophthalmology clinic after her GP noticed leukocoria in her left eye.\n\nOphthalmoscopy under general anaesthesia and an MRI confirm a likely diagnosis of advanced retinoblastoma, confined to the eye.\n\nWhat is the most likely next step in management?",
"sbaAnswer": [
"a"
],
"totalVotes": 1912,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,580 | false | 12 | null | 6,495,268 | null | false | [] | null | 19,491 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient's presentation of polygonal plaques with fine white lines (Wickham's striae), and the development of lesions at sites of injury describes Koebner's phenomenon, all keeping in line with a diagnosis of lichen planus, which is primarily a clinical diagnosis. This is managed with topical corticosteroids.",
"id": "10035438",
"label": "b",
"name": "Topical corticosteroids",
"picture": null,
"votes": 1571
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis is lichen planus. Intralesional injections may be considered if the disease is refractory to other treatments. The next most appropriate step, however, is to carry out a biopsy to confirm the diagnosis and exclude malignant changes.",
"id": "10035440",
"label": "d",
"name": "Intralesional steroid injections",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The clinical history and findings are suggestive of lichen planus, a chronic inflammatory skin condition. In people with coloured skin, lesions may appear dark rather than purple. The fine white lines on the lesions are Wickham's striae, and the development of lesions at sites of injury describes Koebner's phenomenon. This is primarily a clinical diagnosis and a skin biopsy would be undertaken to confirm the diagnosis and check for any malignant changes if there was any diagnostic uncertainty.",
"id": "10035437",
"label": "a",
"name": "Skin biopsy",
"picture": null,
"votes": 103
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oral immunosuppressants may be considered in lichen planus refractory to topical therapy. This is not the most appropriate next step. A skin biopsy should be obtained first to confirm the diagnosis and exclude malignancy.",
"id": "10035441",
"label": "e",
"name": "Oral azathioprine",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis is lichen planus. Tacrolimus may be commenced to spare steroid use, however this would not be the next most appropriate step.",
"id": "10035439",
"label": "c",
"name": "Topical tacrolimus",
"picture": null,
"votes": 104
}
],
"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": "6131",
"name": "Lichen planus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
"conceptId": 6131,
"conditions": [],
"difficulty": 1,
"dislikes": 31,
"explanation": null,
"highlights": [],
"id": "19491",
"isLikedByMe": 0,
"learningPoint": "A skin biopsy is often used to diagnose lichen planus by examining a sample of skin tissue for characteristic signs such as lymphocytic infiltration and basal cell degeneration.",
"likes": 3,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 45-year-old African man is referred to the dermatology clinic for investigation of skin lesions that have appeared over the past year. He describes these as intensely itchy and notices that new lesions sometimes form at sites of injury.\n\nOn examination, multiple dark, polygonal plaques are seen over the arms. They are crossed by fine white lines.\n\nWhat is the most appropriate next step?",
"sbaAnswer": [
"b"
],
"totalVotes": 1893,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,581 | false | 13 | null | 6,495,268 | null | false | [] | null | 19,492 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An antihistamine may help reduce the pruritus, but will not address the disease process. A topical antifungal should be prescribed.",
"id": "10035445",
"label": "d",
"name": "Cetirizine",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a treatment for seborrhoeic dermatitis in babies (cradle cap) as they have little hair. Antifungal preparations should be used in adults.",
"id": "10035443",
"label": "b",
"name": "Scalp massage with emollients",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This may be considered for seborrhoeic dermatitis affecting the skin, however, applying a shampoo is most appropriate to treat the scalp and hair.",
"id": "10035446",
"label": "e",
"name": "Clotrimazole cream",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The clinical history and findings are consistent with seborrhoeic dermatitis, an inflammatory skin condition thought to be caused by an overgrowth of Malassezia yeasts. Topical ketoconazole shampoo is recommended as a first-line treatment for diseases affecting the scalp. Topical steroids may be added to control pruritus.",
"id": "10035442",
"label": "a",
"name": "Ketoconazole shampoo",
"picture": null,
"votes": 1698
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There are no indications for systemic steroids in this case.",
"id": "10035444",
"label": "c",
"name": "A short course of oral steroids",
"picture": null,
"votes": 49
}
],
"comments": [],
"concept": {
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"__typename": "Chapter",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "6132",
"name": "Seborrhoeic Dermatitis: Adults",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
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"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "19492",
"isLikedByMe": 0,
"learningPoint": "Ketoconazole shampoo is an effective first-line treatment for seborrhoeic dermatitis, characterised by greasy scales and itching on the scalp.",
"likes": 1,
"multiAnswer": null,
"pictures": [],
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"question": "A university student visits his GP with severe scalp itching that he has experienced for a few months. He is becoming self-conscious as he is also experiencing large volumes of dandruff and flaking of the skin at his hairline.\n\nOn examination, greasy white scales are present on the scalp and at the hairline. He has a past medical history of asthma and has no drug allergies.\n\nWhich of the following will most likely improve his symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 1889,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,582 | false | 14 | null | 6,495,268 | null | false | [] | null | 19,493 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE recommends a delayed/backup antibiotic prescription if the FeverPAIN score is 2 or 3. This patient's FeverPAIN score is 1, making supportive management more appropriate.",
"id": "10035450",
"label": "d",
"name": "Delayed antibiotic prescription",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has viral pharyngitis; his FeverPAIN score is 1 (for the absence of a cough), meaning that it is unlikely his symptoms are caused by a streptococcal infection. Clarithromycin would be a reasonable choice given his penicillin allergy if his FeverPAIN score was 4 or 5 (or his Centor score was 3 or 4)",
"id": "10035449",
"label": "c",
"name": "Clarithromycin",
"picture": null,
"votes": 145
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient likely has viral pharyngitis; his FeverPAIN score is 1 (for the absence of a cough), meaning that it is unlikely his symptoms are caused by a streptococcal infection. He should be advised to rest and use regular analgesia, but to seek medical advice if his symptoms worsen.",
"id": "10035447",
"label": "a",
"name": "Supportive management",
"picture": null,
"votes": 1543
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has viral pharyngitis; his FeverPAIN score is 1 (for the absence of a cough), meaning that it is unlikely his symptoms are caused by a streptococcal infection. Antibiotics are not currently indicated as per NICE guidelines. Phenoxymethylpenicillin would be an appropriate first choice in most cases, however this patient has an allergy to penicillin.",
"id": "10035448",
"label": "b",
"name": "Phenoxymethylpenicillin",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient likely has viral pharyngitis. There are no current indications for a referral to secondary care such as airway compromise or significant systemic upset.",
"id": "10035451",
"label": "e",
"name": "Referral to secondary care",
"picture": null,
"votes": 48
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "I swear everytime pharyngitis comes up it's a toss up as to whether they're gonna use FeverPAIN or CENTOR. Wish NICE would just recommend one and one only.",
"createdAt": 1734714273,
"dislikes": 0,
"id": "58659",
"isLikedByMe": 0,
"likes": 2,
"parentId": null,
"questionId": 19493,
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"__typename": "User",
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"displayName": "Relapse Retrograde",
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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": "4332",
"name": "Streptococcal sore throat",
"status": null,
"topic": {
"__typename": "Topic",
"id": "194",
"name": "Infectious Diseases",
"typeId": 7
},
"topicId": 194,
"totalCards": null,
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"conditions": [],
"difficulty": 1,
"dislikes": 2,
"explanation": null,
"highlights": [],
"id": "19493",
"isLikedByMe": 0,
"learningPoint": "Viral pharyngitis is common in adolescents; supportive management with rest and analgesia is typically sufficient, as antibiotics are ineffective.",
"likes": 0,
"multiAnswer": null,
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"question": "A 14-year-old male has had a sore throat for four days, which is causing him pain when eating. He visits his GP asking for antibiotics to treat his symptoms. He is allergic to penicillin and has a past medical history of recurrent otitis externa. He denies any other symptoms.\n\nOn examination, his pharynx is red and inflamed and there is no palpable lymphadenopathy. An ear examination is normal. Observations are within normal limits.\n\nWhat is the most appropriate course of action?",
"sbaAnswer": [
"a"
],
"totalVotes": 1896,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,583 | false | 15 | null | 6,495,268 | null | false | [] | null | 19,494 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis is meningitis. Local guidelines should always be referred to, but the BNF (and most hospital trusts) recommend empirical treatment with third-generation cephalosporins immediately, as these cover the most common bacteria that cause meningitis.",
"id": "10035452",
"label": "a",
"name": "Cefotaxime",
"picture": null,
"votes": 1490
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis is meningitis given the features of meningism. It is not uncommon for aciclovir to be given along with antibiotics to cover for viral encephalitis, however, this is not the most important drug to prescribe.",
"id": "10035455",
"label": "d",
"name": "Aciclovir",
"picture": null,
"votes": 185
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis is meningitis. Amoxicillin (or ampicillin) should be added to cephalosporin therapy in patients susceptible to listeria infections (children under the age of 1 and adults over the age of 60).",
"id": "10035453",
"label": "b",
"name": "Amoxicillin",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Most clinical guidelines recommend cephalosporin therapy for meningitis. Vancomycin can be used if there is a history of travel to an area with cephalosporin-resistant pneumococci, or if there is a history of prolonged antibiotic use that might make infection by a resistant organism more likely.",
"id": "10035456",
"label": "e",
"name": "Vancomycin",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis is meningitis. Benzylpenicillin is recommended in the pre-hospital (i.e. GP or ambulance) setting for patients with suspected meningococcal meningitis. This patient is in hospital and should therefore receive a cephalosporin.",
"id": "10035454",
"label": "c",
"name": "Benzylpenicillin",
"picture": null,
"votes": 182
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "i thought the absence of rash made it more likely to be viral?",
"createdAt": 1736257125,
"dislikes": 0,
"id": "59857",
"isLikedByMe": 0,
"likes": 2,
"parentId": null,
"questionId": 19494,
"replies": [],
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"__typename": "User",
"accessLevel": "subscriber",
"displayName": "Malignant Syndrome",
"id": 15952
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"__typename": "Concept",
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"__typename": "Chapter",
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"files": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4102",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "194",
"name": "Infectious Diseases",
"typeId": 7
},
"topicId": 194,
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"conditions": [],
"difficulty": 1,
"dislikes": 3,
"explanation": null,
"highlights": [],
"id": "19494",
"isLikedByMe": 0,
"learningPoint": "If meningitis is suspected, treatment should start with a third-generation cephalosporin, like cefotaxime, to target the most common bacterial causes.",
"likes": 1,
"multiAnswer": null,
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"question": "A 48-year-old man is brought into hospital by ambulance feeling generally unwell. He provides minimal history, however, his wife describes a 3-day period of fevers, headaches, and drowsiness. She says he has no medical problems and only takes over-the-counter vitamins. He has no drug allergies.\n\nOn examination, he appears to be extremely photophobic, with nuchal rigidity and a positive Kernig's sign. No rashes are noted. He is also febrile and tachycardic.\n\nWhat is the most important medication to prescribe?",
"sbaAnswer": [
"a"
],
"totalVotes": 1902,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,468,584 | false | 16 | null | 6,495,268 | null | false | [] | null | 19,495 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most likely diagnosis is glandular fever; an infection caused by the Epstein-Barr Virus. This is a common infection in people aged 15-24 and can be transmitted through contact with saliva. Splenomegaly is extremely common, and patients should be advised to avoid contact sports for a month to reduce the risk of splenic rupture.",
"id": "10035457",
"label": "a",
"name": "Splenomegaly",
"picture": null,
"votes": 1326
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis given the clinical history and sore throat is glandular fever, an infection caused by the Epstein-Barr virus. Drenching night sweats would suggest a diagnosis of lymphoma, which is also possible given the lymphadenopathy but is less likely with the infectious symptoms. EBV infections may cause sweats but they would typically not be drenching.",
"id": "10035458",
"label": "b",
"name": "Drenching night sweats",
"picture": null,
"votes": 129
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis given the clinical history and sore throat is glandular fever, an infection caused by the Epstein-Barr virus. Significant weight loss would suggest a diagnosis of lymphoma, which is also possible given the lymphadenopathy but is less likely with the infectious symptoms.",
"id": "10035459",
"label": "c",
"name": "More than 10% weight loss in 1 month",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis given the clinical history and sore throat is glandular fever, an infection caused by the Epstein-Barr virus. A lymph node biopsy would not routinely be performed unless there is a high suspicion of lymphoma. 'Mirror image nuclei', also known as Reed-Sternberg cells, are seen in Hodgkin lymphoma.",
"id": "10035461",
"label": "e",
"name": "'Mirror-image nuclei' on lymph node biopsy",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis given the clinical history and sore throat is glandular fever, an infection caused by the Epstein-Barr virus. A lymph node biopsy would not routinely be performed unless there is a high suspicion of lymphoma. 'Owl's eye' inclusions are seen in cytomegalovirus infection, rather than EBV infection.",
"id": "10035460",
"label": "d",
"name": "'Owl's eye' inclusions seen on lymph node biopsy",
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"question": "An 18-year-old university student visits his GP feeling tired all the time. He describes a 2-week period of lethargy, myalgia, headache, and a sore throat.\n\nHe has bilateral posterior cervical lymphadenopathy and a red pharynx with some palatal petechiae. He is slightly tachycardic, but observations are otherwise normal.\n\nWhich feature would be most consistent with the most likely diagnosis?",
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173,468,585 | false | 17 | null | 6,495,268 | null | false | [] | null | 19,496 | {
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"question": "An 87-year-old care home resident is admitted to hospital after a fall. During her stay, she develops watery diarrhoea (type 7 on the Bristol Stool Chart) and a fever.\n\nShe feels mildly unwell but has no abdominal pain or other symptoms. A rectal examination is unremarkable and her abdomen is soft and non-tender.\n\nStool samples are positive for C.difficile toxin.\n\nWhat is the most appropriate antibiotic to prescribe?",
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},
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"explanation": "Whilst this is another important differential in any sudden onset dyspnoea, especially in a younger patient with a smoking history, the normal respiratory examination points away from this. Additionally, the elevated oxygen further suggests anxiety is a more likely cause.",
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"label": "c",
"name": "COPD",
"picture": null,
"votes": 29
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"__typename": "QuestionChoice",
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"id": "10035473",
"label": "b",
"name": "Pulmonary embolism",
"picture": null,
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}
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173,468,588 | false | 20 | null | 6,495,268 | null | false | [] | null | 19,499 | {
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"explanation": "In this case, the trachea would be central and the CXR changes would be bilateral. It would also present with an acute deterioration, as the name suggests.",
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This history is suggestive of a lung malignancy, This CXR shows a large white-out of the right lung with the trachea deviated away from the opacified side, suggesting a large malignant pleural effusion.",
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"picture": null,
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},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would result in a CXR with the trachea pulled towards the opacified side, rather than deviated away from the opacified side.",
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"label": "b",
"name": "Pneumonectomy",
"picture": null,
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},
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"__typename": "QuestionChoice",
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"label": "d",
"name": "Collapsed lung",
"picture": null,
"votes": 238
}
],
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"question": "A 68-year-old smoker has an 8-month history of weight loss. He states he noticed the weight loss as his trousers have become looser over this period, which he thinks might be due to his decreased appetite. He also mentions he is becoming increasingly breathless, both at rest and on exertion. On examination, he has greatly reduced breath sounds throughout the right lung.\n\nHis CXR is seen below:\n\n[lightgallery]\n\nWhat is the most likely diagnosis?",
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Subsets and Splits