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"explanation": "Whilst the preparation of the HRT (containing both oestrogen and progesterone for patients with a uterus) is appropriate, patients who are post menopausal should be prescribed continuous rather than cyclical preparations.\nThis patient has been amenorrhoic for over 12 months.",
"id": "62416",
"label": "d",
"name": "Combined cyclical oral HRT",
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"votes": 291
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"explanation": "Vaginal oestrogen gel can be prescribed to patients with a uterus without also prescribing progesterone as systemic absorption of the oestrogen is minimal. As the systemic absorption is minimal, this route does not help with systemic symptoms such as the hot flushes experienced by this patient. Topical oestrogen helps locally with symptoms such as vaginal dryness.",
"id": "62415",
"label": "c",
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"explanation": "Patients can be reffered for cognitive behaviour therapy (CBT) to help with the symptoms of low mood and stress associated with menopause.\nHowever, it would also be appropriate to offer hormonal HRT to this patient to help with the symptoms she has presented with hot flushes, lethargy and loss of libido.",
"id": "62417",
"label": "e",
"name": "Referral for cognitive behaviour therapy",
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"votes": 10
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"explanation": "Transdermal oestrogen patches can be prescribed for those who have had troublesome side effects with oral HRT.\nThe oestrogen patch is only suitable for those without a uterus. Oestrogen without progesterone ('unopposed oestrogen) causes hyperplasia of the endometrium, increasing the risk of endometrial cancer. If the patient has a intrauterine system with progesterone in situ then an oestrogen only HRT can be prescribed.",
"id": "62414",
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"explanation": "# Summary \n \n \nHormone Replacement Therapy (HRT) is a treatment strategy used to alleviate menopausal symptoms by replacing diminishing hormones. It typically involves small doses of oestrogen and progestogen (if the woman has a uterus) to reduce endometrial cancer risk. HRT may be administered systemically or vaginally and can help manage symptoms such as flushing, insomnia, headaches, vaginal atrophy, and dryness. However, it may also have side effects including breast tenderness, leg cramps, bloating, nausea, and headaches. Key investigations involve assessing the history and physical examination of the patient to decide the need for HRT. Management strategies include careful dose regulation and monitoring for side effects.\n \n \n# Definition \n \n \nHormone replacement therapy (HRT) is a treatment to relieve symptoms of menopause by replacing hormones that decrease as a woman approaches the menopause. It typically involves small doses of oestrogen combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer.\n \n \n \n# Indications \n \n \n - Symptomatic relief of vasomotor symptoms such as flushing, insomnia, headaches, vaginal atrophy and dryness\n - Decreases the risk of osteoporosis and colorectal cancer\n - In premature ovarian insufficiency, HRT should be continued until the age of 50. This is to help prevent the development of osteoporosis\n \n \n# Contraindications\n \n \n - Undiagnosed vaginal bleeding\n - Pregnancy\n - Breastfeeding\n - Oestrogen receptor-positive breast cancer\n - Acute liver disease\n - Uncontrolled hypertension\n - History of breast cancer or venous thromboembolism (VTE)\n - Recent stroke, myocardial infarction or angina\n\n\n# Types\n\n\nHRT can be given systemically, either via oral tablets, transdermal patches or gels, or can be given vaginally for urogenital atrophy, in the form of tablets, creams, pessaries or vaginal rings. Transdermal is the preferred route if the woman is at risk of VTE.\n\n\nHormones that can be given as part of HRT are:\n\n\n - **Oestrogens:** oestradiol, estrone and conjugated oestrogen are generally used.\n - **Progestogens:** Medroxyprogesterone, norethisterone, levonorgestrel and drospirenone are typically used. A levonorgestrel-releasing intrauterine system (e.g. Mirena coil) may be used as part of the progestogen component of HRT, so the woman may just take oral oestrogen and have endometrial protection via the intrauterine system\n - **Tibolone:** this is a synthetic compound containing oestrogen, progestogen and androgens.\n\n\nAll women require a combination of oestrogen and progesterone as part of their HRT, unless they have had a hysterectomy, in which case oestrogen-only is enough. This is due to risk of endometrial cancer if oestrogen is given alone. \n\nHRT can be given continuously (for postmenopausal women not having periods) or cyclically (for perimenopausal women still having some periods). Cyclical can include:\n\n- Monthly: Oestrogen every day of the month + progesterone for the last 14 days \n- Every three months: Oestrogen every day for 3 months + progesterone for the last 14 days\n\n\n# Side Effects\n\n\n - Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches\n - Progestogen: premenstrual syndrome-like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain\n - Cholestatic jaundice\n - Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease\n\n \n# NICE Guidelines\n\n[CLick here for NICE guidelines on HRT](https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/)\n\n# References\n\n\n[Primary Care Women's Health Forum](https://pcwhf.co.uk/resources/hrt-types-doses-and-regimens/#)\n\n[Hickey & Davison 2012, The BMJ](https://www.bmj.com/content/344/bmj.e763.long)\n\n[NHS Website](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)",
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"question": "A 55 year old female attends her GP surgery to discuss her menopausal symptoms. Her last period was 18 months ago. She has noticed that she is having hot flushes, lethargy and loss of libido.\n\nHer past medical history is of asthma.\n\nWhich of the following is the best next step in the management of this patient?",
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"explanation": "This patient can be prescribed oestrogen without progesterone ('unopposed oestrogen') as she has had a hysterectomy. Unopposed oestrogen causes hyperplasia of the endometrium, increasing the risk of endometrial cancer. Oestrogen can be prescribed as a tablet or a transdermal patch.\nFirst line treatment would be oral oestrogen.",
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"explanation": "Whilst this could be offered to help with the symptoms of anxiety, the patient also presents with hot flushes.\nA trial of HRT would be the first step, referral for CBT could be offered concurrently.",
"id": "62422",
"label": "e",
"name": "Refer for cognitive behavioural therapy (CBT)",
"picture": null,
"votes": 35
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"explanation": "As this patient has had a hysterectomy she does not require progesterone alongside the oestrogen. Preparations of combined HRT are required when the patient has a uterus. This is because oestrogen on its own (unopposed) causes hypertrophy of the endometrium, leading to a risk of endometrial cancer.",
"id": "62419",
"label": "b",
"name": "Combined oral HRT",
"picture": null,
"votes": 387
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "FSH levels are not required to diagnose menopause in patients over the age of 45.\nPatients between the age of 40 and 45 with menstrual cycle changes can have their FSH levels checked to confirm menopause. Patients under the age of 40 with menopausal symptoms can have their FSH levels checked to diagnose premature ovarian failure.",
"id": "62420",
"label": "c",
"name": "A blood test for FSH levels before commencing HRT",
"picture": null,
"votes": 240
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"explanation": "Gabapentin can be prescribed for hot flushes, however, this patient has presented with anxiety and lethargy as well. Therefore, an HRT option would be most suitable.",
"id": "62421",
"label": "d",
"name": "Gabapentin",
"picture": null,
"votes": 9
}
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"comment": "Hang on a minute, surely patch which reduces VTE risk would be first line no?",
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"comment": "I think that prescribing patch HRT is more for women with h/o VTE/DVT or have a high risk of having a clot later on\n",
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"comment": "Patient might prefer not to have a patch if sensitive skin (eczema)? ",
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"comment": "So I think transdermal delivery is preferable regardless of baseline VTE risk, but its more expensive than oral. In specialist services they tend to prescribe transdermal first-line but I think in a GP setting they are more guided by money sadly so oral would be first-line?",
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"explanation": "# Summary \n \n \nHormone Replacement Therapy (HRT) is a treatment strategy used to alleviate menopausal symptoms by replacing diminishing hormones. It typically involves small doses of oestrogen and progestogen (if the woman has a uterus) to reduce endometrial cancer risk. HRT may be administered systemically or vaginally and can help manage symptoms such as flushing, insomnia, headaches, vaginal atrophy, and dryness. However, it may also have side effects including breast tenderness, leg cramps, bloating, nausea, and headaches. Key investigations involve assessing the history and physical examination of the patient to decide the need for HRT. Management strategies include careful dose regulation and monitoring for side effects.\n \n \n# Definition \n \n \nHormone replacement therapy (HRT) is a treatment to relieve symptoms of menopause by replacing hormones that decrease as a woman approaches the menopause. It typically involves small doses of oestrogen combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer.\n \n \n \n# Indications \n \n \n - Symptomatic relief of vasomotor symptoms such as flushing, insomnia, headaches, vaginal atrophy and dryness\n - Decreases the risk of osteoporosis and colorectal cancer\n - In premature ovarian insufficiency, HRT should be continued until the age of 50. This is to help prevent the development of osteoporosis\n \n \n# Contraindications\n \n \n - Undiagnosed vaginal bleeding\n - Pregnancy\n - Breastfeeding\n - Oestrogen receptor-positive breast cancer\n - Acute liver disease\n - Uncontrolled hypertension\n - History of breast cancer or venous thromboembolism (VTE)\n - Recent stroke, myocardial infarction or angina\n\n\n# Types\n\n\nHRT can be given systemically, either via oral tablets, transdermal patches or gels, or can be given vaginally for urogenital atrophy, in the form of tablets, creams, pessaries or vaginal rings. Transdermal is the preferred route if the woman is at risk of VTE.\n\n\nHormones that can be given as part of HRT are:\n\n\n - **Oestrogens:** oestradiol, estrone and conjugated oestrogen are generally used.\n - **Progestogens:** Medroxyprogesterone, norethisterone, levonorgestrel and drospirenone are typically used. A levonorgestrel-releasing intrauterine system (e.g. Mirena coil) may be used as part of the progestogen component of HRT, so the woman may just take oral oestrogen and have endometrial protection via the intrauterine system\n - **Tibolone:** this is a synthetic compound containing oestrogen, progestogen and androgens.\n\n\nAll women require a combination of oestrogen and progesterone as part of their HRT, unless they have had a hysterectomy, in which case oestrogen-only is enough. This is due to risk of endometrial cancer if oestrogen is given alone. \n\nHRT can be given continuously (for postmenopausal women not having periods) or cyclically (for perimenopausal women still having some periods). Cyclical can include:\n\n- Monthly: Oestrogen every day of the month + progesterone for the last 14 days \n- Every three months: Oestrogen every day for 3 months + progesterone for the last 14 days\n\n\n# Side Effects\n\n\n - Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches\n - Progestogen: premenstrual syndrome-like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain\n - Cholestatic jaundice\n - Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease\n\n \n# NICE Guidelines\n\n[CLick here for NICE guidelines on HRT](https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/)\n\n# References\n\n\n[Primary Care Women's Health Forum](https://pcwhf.co.uk/resources/hrt-types-doses-and-regimens/#)\n\n[Hickey & Davison 2012, The BMJ](https://www.bmj.com/content/344/bmj.e763.long)\n\n[NHS Website](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)",
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"question": "A 52 year old female attends her GP surgery to discuss Her menopausal symptoms. Her last period was 18 months ago. She has been more anxious and lethargic as of recently with episodes of hot flushes.\nHer past medical history include eczema and fibroids for which she has had a hysterectomy.\n\nWhich of the following is the best next step in the management of this patient?",
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"explanation": "The QRISK2 is a score used to estimate the 10-year risk of cardiovascular disease in patients under the age of 85 years who do not have heart disease.\nThe risk score helps guide **primary prevention** of cardiovascular disease with lifestyle and pharmacological intervention. Patients with a **QRISK2 score of 10% or more** should be **offered a statin** to reduce the risk of cardiovascular disease. First line choice is atorvastatin 20mg.",
"id": "62423",
"label": "a",
"name": "Atorvastatin 20mg",
"picture": null,
"votes": 1280
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"explanation": "The patient shoukd be offered lifestyle advice such as increased exercise, stopping smoking and decreased alcohol intake as part of the primary prevention of cardiovascular disease. However, the patient should also be offered a statin.",
"id": "62425",
"label": "c",
"name": "Recommend an increase in weekly exercise only",
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"explanation": "The QRISK2 is a score used to estimate the 10-year risk of cardiovascular disease in patients under the age of 85 years who do not have heart disease.\nThe risk score helps guide primary prevention of cardiovascular disease with lifestyle and pharmacological intervention. Patients with a 10% or more QRISK2 score should be offered a statin to reduce the risk of cardiovascular disease. First line choice is atorvastatin 20mg.\nIf atorvastatin 20mg is commenced and there has not been a 40% or greater reduction in non-HDL cholesterol, then the dose can be increased up to 80mg. For **secondary prevention**, atorvastatin 80mg would be appropriate.",
"id": "62428",
"label": "f",
"name": "Atorvastatin 80mg",
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"explanation": "This patient should be offered a statin and lifestyle advice as part of primary prevention of cardiovascular disease. There is no need to recalculate his QRISK2 score.",
"id": "62426",
"label": "d",
"name": "Recalculate QRISK2 score in 3 months time",
"picture": null,
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"answer": false,
"explanation": "Whilst a statin is recommended for this patient, atorvastatin is now the first line choice. Atorvastatin is more effective at lowering cholesterol than simvastatin.",
"id": "62424",
"label": "b",
"name": "Simvastatin 40mg",
"picture": null,
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"comment": "this question has 6 options :o",
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"comment": "do i get extra points for getting it right",
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"comment": "People at quesmed be trippin",
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"explanation": "# Definition\n\nHypercholesterolaemia is the term used to denote raised serum levels of one or more of total cholesterol.\n\n# Causes\n\nCauses can primary or secondary.\n\nSecondary causes include:\n\n- Familial dyslipidaemias\n- Familial hypercholesterolaemia\n- Apoprotein disorders\n- Medical conditions\n\t- Hypothyroidism\n\t- Obstructive jaundice\n\t- Cushings syndrome\n\t- Nephrotic syndrome\n\t- Chronic Kidney Disease\n- Drugs e.g. thiazide diuretics, glucocorticoids, ciclosporin\n- Pregnancy\n- Obesity \n- Alcohol abuse\n\n\n# Physicial signs\n\nDiagnosis is usually biochemical. \n\nThere are two key physical signs which may indicate familial hypercholesterolaemia\n\n - Premature arcus senilis\n - Tendon xanthomata\n\n# Investigations\n\n- Lipid profile \n- Fasting blood glucose\n- Renal function\n- Liver function tests\n- Thyroid function tests\n\n# Management\n\n\n## Statins\n\n- Statins are the first line treatment of high cholesterol. \n- They are HMG-CoA reductase inhibitors. \n- This enzyme plays a key role in the production of cholesterol, so inhibiting it reduces the cholesterol in the body.\n- In patients with high cholesterol, the QRISK score is used to see if they would benefit from statins as primary prevention against cardiovascular disease. \n- If an adult is under 80 years old and their QRISK is greater than 10% then a statin should be offered. \n- For primary prevention of CVD aim for a greater than 40% reduction in non-HDL cholesterol\n- For secondary prevention of CVD, aim for low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less.\n\n## Doses\n\n- Atorvastatin 20mg is the usual starting dose for primary prevention.\n- For patients who need a statin as secondary prevention, e.g following a stroke, heart attack, peripheral arterial disease or angina, atorvastatin at 80mg starting dose should be used.\n\n## Side effects of statins\n\n\nCommon side effects of statins include muscle pain, abdominal pain, constipation and headache.\n\nIf a patient is struggling with significant myalgia, this may indeed indicate a myositis. Creatinine Kinase can be measured and if it is 5-10 times the upper limit of normal, the statin should be stopped. \n\nStatins can also cause abnormal liver function so this should be monitored with a repeat blood test in 4-6 weeks time. If the transaminases (ALT, AST) are 3 times the upper limit the statin should be stopped.\n\nOffer ezetimibe instead of a statin to people for whom statins are contraindicated/cause abnormal blood test results.\n\n# NICE Guidelines\n\n[NICE Guidelines - Cardiovascular disease: risk assessment and reduction, including lipid modification ](https://www.nice.org.uk/guidance/ng238/chapter/Recommendations)",
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"question": "A 65 year old male presents to his GP for a general health check. As part of this, the GP calculates the patient's QRISK2 score, which is 20%.\n\nHe has no past medical history.\n\nWhich of the following is the best next step in the management of this patient?",
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"explanation": "This is a type 3 and type 4 immune-mediated hypersensitivity reaction and is a form of pulmonary fibrosis. Clubbing of the fingers is commonly seen in pulmonary fibrosis. The answer is specifically hypersensitivity pneumonitis as this patient has a pet bird, from which antigens can be inhaled in the air from their faeces.",
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"explanation": "Chronic obstructive pulmonary disease (COPD) is an obstructive lung condition typically comprising of chronic bronchitis and/or emphysema. It often occurs in smokers although does not present with finger clubbing.",
"id": "10000002",
"label": "b",
"name": "COPD",
"picture": null,
"votes": 344
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pneumothorax is the accumulation of air within the pleural space. It can be spontaneous, typically occurring in young men, or may be due to an underlying lung condition like COPD or tuberculosis.",
"id": "10000005",
"label": "e",
"name": "Pneumothorax",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pleural effusion is the accumulation of fluid in the pleural space of the lungs and can be categorised as transudative or exudative. The patient may be asymptomatic or have pleuritic chest pain. Stony dull percussion and decreased breath sounds would be present on examination but finger clubbing is not seen in this condition.",
"id": "10000004",
"label": "d",
"name": "Pleural Effusion",
"picture": null,
"votes": 65
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an acute lower respiratory tract infection that can arise from the community, hospital or aspiration among other causes. The patient would present with fever, cough and occasionally pleuritic chest pain. It does not present with finger clubbing.",
"id": "10000003",
"label": "c",
"name": "Pneumonia",
"picture": null,
"votes": 65
}
],
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"id": "3693",
"name": "Pulmonary Fibrosis",
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"id": "132",
"name": "Respiratory",
"typeId": 7
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"topicId": 132,
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"question": "A 68-year-old male attends the GP practice complaining of an irritating dry cough and fever. He has been a smoker for 55 years and has a pet parrot.\n\nIn which of the following conditions would you expect to find clubbing of the fingers?",
"sbaAnswer": [
"a"
],
"totalVotes": 991,
"typeId": 1,
"userPoint": null
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173,459,523 | false | 2 | null | 6,494,999 | null | false | [] | null | 12,548 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
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"explanation": "COPD is an obstructive lung disease, typically occurring in smokers and is a combination of chronic bronchitis and emphysema.",
"id": "10000006",
"label": "a",
"name": "COPD",
"picture": null,
"votes": 880
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a form of lung malignancy often occurring due to asbestos exposure. It is important in this instance to ask about occupation. It can present with a restrictive picture.",
"id": "10000009",
"label": "d",
"name": "Mesothelioma",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Sarcoidosis is an example of a restrictive lung disease. It is a multisystem disorder characterised by widespread non-caseating granulomas and inflammation.",
"id": "10000007",
"label": "b",
"name": "Sarcoidosis",
"picture": null,
"votes": 4
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This occurs due to fluid buildup in the pleural space and may be classified as transudative or exudative. The buildup fluid can present as a restrictive picture.",
"id": "10000010",
"label": "e",
"name": "Pleural Effusion",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pulmonary fibrosis is a restrictive lung disease where there is scarring of the lung tissue. This makes the tissue less compliant and therefore presents with a restrictive picture.",
"id": "10000008",
"label": "c",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 36
}
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"name": "Sarcoidosis",
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"question": "Which of the following is an example of a obstructive lung disease?",
"sbaAnswer": [
"a"
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173,459,524 | false | 3 | null | 6,494,999 | null | false | [] | null | 12,549 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Liver failure can be a side effect of taking amiodarone, not kidney failure.",
"id": "10000012",
"label": "b",
"name": "Kidney failure",
"picture": null,
"votes": 88
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Corneal deposits may be seen as a side effect of amiodarone. However, xanthelasma refers to lipid deposits around the eyelids and may occur in those with hyperlipidaemia.",
"id": "10000015",
"label": "e",
"name": "Xanthelasma",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Grey skin discolouration can be quite profound in patients who experience side effects of amiodarone.",
"id": "10000014",
"label": "d",
"name": "Purple skin discolouration",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Eczema is often associated with atopy and is not typically a side effect of amiodarone. Stevens-Johnson syndrome (SJS) may arise, however.",
"id": "10000013",
"label": "c",
"name": "Eczema",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hypothyroidism can develop as a result of taking amiodarone. Amiodarone can also cause hyperthyroidism. In both cases, a goitre may develop in patients.",
"id": "10000011",
"label": "a",
"name": "Hypothyroidism",
"picture": null,
"votes": 672
}
],
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"name": "Side effects of amiodarone",
"status": null,
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"id": "133",
"name": "Endocrinology",
"typeId": 5
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"question": "A patient is being treated for supraventricular tachycardia with amiodarone. They notice they've developed a large lump in the front of their neck and attend their GP.\n\nWhich of the following is a side effect of amiodarone?",
"sbaAnswer": [
"a"
],
"totalVotes": 889,
"typeId": 1,
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173,459,525 | false | 4 | null | 6,494,999 | null | false | [] | null | 12,550 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically seen in first-degree heart block.",
"id": "10000020",
"label": "e",
"name": "PR interval >200ms",
"picture": null,
"votes": 181
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is seen in atrial flutter and is an example of a narrow complex tachycardia.",
"id": "10000019",
"label": "d",
"name": "Sawtooth pattern",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "QRS complexes alternate in height across the ECG. This occurs due to the heart moving back and forth in excessive fluid in\nthe pericardium.",
"id": "10000016",
"label": "a",
"name": "Electrical alternans",
"picture": null,
"votes": 349
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tall tented T-waves are present in hyperkalaemia.",
"id": "10000018",
"label": "c",
"name": "Tall tented T waves",
"picture": null,
"votes": 150
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These occur in Wolff-Parkinson-White syndrome and look like upstroke QRS complexes. A short PR interval and broad QRS would also be present.",
"id": "10000017",
"label": "b",
"name": "Delta waves",
"picture": null,
"votes": 123
}
],
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"id": "3696",
"name": "Cardiac Tamponade",
"status": null,
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"id": "134",
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"typeId": 7
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"question": "Which of the following is an ECG sign of cardiac tamponade?",
"sbaAnswer": [
"a"
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173,459,526 | false | 5 | null | 6,494,999 | null | false | [] | null | 12,551 | {
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a bacteria which can cause respiratory illnesses like pneumonia or epiglottitis, however, does not cause tuberculosis.",
"id": "10000025",
"label": "e",
"name": "*Haemophilus influenza*",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a bacteria which can cause tuberculosis (TB), a respiratory illness. TB often presents with fever, malaise, weight loss and night sweats. It is also important to ask about travel history, especially in endemic areas.",
"id": "10000021",
"label": "a",
"name": "*Mycobacterium tuberculosis*",
"picture": null,
"votes": 735
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a fungus which acts as an opportunistic pathogen, commonly affecting those who are immunocompromised, for example, patients with HIV/AIDS.",
"id": "10000023",
"label": "c",
"name": "*Pneumocystis jirovecii*",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a yeast-like fungus which can be opportunistic and causes conditions like vaginal candidiasis.",
"id": "10000024",
"label": "d",
"name": "*Candida albicans*",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a gram-negative bacteria which often causes pneumonia in patients with alcoholism.",
"id": "10000022",
"label": "b",
"name": "*Klebsiella pneumoniae*",
"picture": null,
"votes": 28
}
],
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"id": "3697",
"name": "Tuberculosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
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"question": "A 48-year-old male presents to his GP because he has been experiencing profound night sweats and fever after recently returning from a trip to India. He has also experienced unintentional weight loss.\n\nGiven the most likely diagnosis, which of the following is the most likely causative pathogen?",
"sbaAnswer": [
"a"
],
"totalVotes": 863,
"typeId": 1,
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173,459,527 | false | 6 | null | 6,494,999 | null | false | [] | null | 12,552 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Cystic fibrosis (CF) is an autosomal recessive inheritance pattern caused by inheriting 2 recessive alleles from the parents. CF is caused by a mutation on chromosome 7 affecting the CFTR gene. Chloride is therefore secreted abnormally and there is increased sodium absorption resulting in thick mucus lining the airways causing cilia impairment.",
"id": "10000026",
"label": "a",
"name": "Autosomal recessive",
"picture": null,
"votes": 775
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cystic fibrosis is an autosomal recessive disease. An example of an x-linked recessive disorder would be Duchenne muscular dystrophy.",
"id": "10000028",
"label": "c",
"name": "X-linked recessive",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cystic fibrosis is an autosomal recessive disease. An example of autosomal dominant inheritance would be Huntington's disease.",
"id": "10000027",
"label": "b",
"name": "Autosomal dominant",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cystic fibrosis is an autosomal recessive disease. An example of a mitochondrial inherited disorder would be chronic progressive external ophthalmoplegia (CPEO) characterised by weak eye muscles.",
"id": "10000030",
"label": "e",
"name": "Mitochondrial",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cystic fibrosis is an autosomal recessive disease. An example of an x-linked dominant disorder would be Fragile X syndrome resulting in issues with brain development.",
"id": "10000029",
"label": "d",
"name": "X-linked dominant",
"picture": null,
"votes": 11
}
],
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"demo": null,
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"id": "3698",
"name": "Cystic Fibrosis",
"status": null,
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"id": "132",
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"typeId": 7
},
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"question": "What is the inheritance pattern of cystic fibrosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 882,
"typeId": 1,
"userPoint": null
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173,459,528 | false | 7 | null | 6,494,999 | null | false | [] | null | 12,553 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a narrow complex tachycardia with atrial activity >300bpm. A 'saw-tooth' pattern would be seen on ECG.",
"id": "10000035",
"label": "e",
"name": "Atrial flutter",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is 3rd degree or complete heart block whereby atrial impulses do not pass to the ventricles. Patients require a permanent pacemaker as definitive management due to the severity of this condition.",
"id": "10000034",
"label": "d",
"name": "Complete heart block",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mobitz type I (Wenckebach phenomenon) is a type of 2nd-degree heart block due to a block in conduction through the AV node. This would present as **progressive PR interval lengthening** and then would drop off, failing to conduct a QRS complex.",
"id": "10000032",
"label": "b",
"name": "Mobitz type I",
"picture": null,
"votes": 94
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of 2nd-degree heart block where P waves fail to be conducted. The PR interval remains at a constant length however it is not consistently conducted and may or may not show a fixed ratio e.g. 2:1.",
"id": "10000033",
"label": "c",
"name": "Mobitz type II",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Electrical activity is being prolonged through the AV node and therefore causes a prolonged PR interval (>200ms). 1st-degree heart block can occur in those with a high vagal tone e.g. athletes.",
"id": "10000031",
"label": "a",
"name": "1st-degree heart block",
"picture": null,
"votes": 628
}
],
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"name": "Heart Block",
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"question": "An athlete is having a routine health screening check including routine blood tests and an ECG. The findings on ECG show a PR interval of >200ms.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 833,
"typeId": 1,
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173,459,529 | false | 8 | null | 6,494,999 | null | false | [] | null | 12,554 | {
"__typename": "QuestionSBA",
"choices": [
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mobitz type I (Wenckebach phenomenon) is a type of 2nd-degree heart block due to a block in conduction through the AV node. This would present as **progressive PR interval lengthening** and then would drop off, failing to conduct a QRS complex.",
"id": "10000038",
"label": "c",
"name": "Mobitz type I",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients would present with crushing chest pain and show ST elevation in leads V3-4. ST depression in inferior leads may also be seen (II, III and aVF).",
"id": "10000040",
"label": "e",
"name": "Anterior STEMI",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of 2nd-degree heart block where P waves fail to be conducted. The PR interval remains at a constant length however it is not consistently conducted and may or may not show a fixed ratio e.g. 2:1.",
"id": "10000039",
"label": "d",
"name": "Mobitz type II",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Complete (3rd degree) heart block occurs due to atrial impulses failing to pass to the ventricles. Patients can present with syncope or cardiac arrest and have bradycardia on ECG. There is no relationship between P and QRS complexes.",
"id": "10000036",
"label": "a",
"name": "Complete heart block",
"picture": null,
"votes": 703
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Electrical activity is being prolonged through the AV node and therefore causes a prolonged PR interval (>200ms). 1st-degree heart block can occur in those with a high vagal tone, after an acute inferior MI, hyperkalaemia and drugs e.g. digoxin.",
"id": "10000037",
"label": "b",
"name": "1st-degree heart block",
"picture": null,
"votes": 46
}
],
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"name": "Heart Block",
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"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 66-year-old male patient presents to A&E with syncope. An ECG is performed showing a rate of 34 bpm and no relationship between the P and QRS complexes.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 817,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,530 | false | 9 | null | 6,494,999 | null | false | [] | null | 12,555 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of cardiac tamponade due to the heart moving back and forth in excessive fluid in the pericardial space.",
"id": "10000044",
"label": "d",
"name": "Electrical alternans",
"picture": null,
"votes": 33
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Congenital long QT syndrome is autosomal dominant although long QT can also be acquired due to certain drugs e.g. antibiotics like erythromycin.",
"id": "10000045",
"label": "e",
"name": "Long QT interval",
"picture": null,
"votes": 139
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of hyperkalaemia. Sinus bradycardia and conduction blocks may also be present.",
"id": "10000043",
"label": "c",
"name": "Tall T waves",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of 1st-degree heart block whereby electrical activity is prolonged through the AV node.",
"id": "10000042",
"label": "b",
"name": "PR interval >200ms",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Delta waves appear as an upstroke QRS complex and are a feature of WPW syndrome. A short PR interval (<120ms) and broad QRS complexes may also be seen.",
"id": "10000041",
"label": "a",
"name": "Delta waves",
"picture": null,
"votes": 552
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
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"id": "3700",
"name": "Wolff-Parkinson-White syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "Which of the following is an ECG feature of Wolff-Parkinson-White (WPW) syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 798,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,531 | false | 10 | null | 6,494,999 | null | false | [] | null | 12,556 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Hypertension is the leading cause of stroke. Hypertension results from reduced elasticity in arteries due to older age and atheroma and calcification build up in the arteries.",
"id": "10000046",
"label": "a",
"name": "Hypertension",
"picture": null,
"votes": 623
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes mellitus type 2 is linked to other co-morbidities like hypertension and obesity, however, it is not the leading cause of stroke.",
"id": "10000049",
"label": "d",
"name": "Diabetes mellitus type 2",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Obesity is linked to hypertension and other co-morbidities like type 2 diabetes mellitus and atherosclerosis, however, hypertension is still the leading cause of stroke.",
"id": "10000048",
"label": "c",
"name": "Obesity",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst smoking can lead to hypertension, smoking itself is not the biggest cause of stroke.",
"id": "10000047",
"label": "b",
"name": "Smoking",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Depression has been linked to stroke, however, it is more common to have depression after a stroke occurs. Hypertension is the leading cause of stroke.",
"id": "10000050",
"label": "e",
"name": "Depression",
"picture": null,
"votes": 3
}
],
"comments": [],
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"id": "3701",
"name": "Hypertension",
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"topic": {
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"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "Which of the following is the most likely cause of a stroke?",
"sbaAnswer": [
"a"
],
"totalVotes": 845,
"typeId": 1,
"userPoint": null
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173,459,532 | false | 11 | null | 6,494,999 | null | false | [] | null | 12,557 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Red flag symptoms for lung cancer are weight loss and haemoptysis. The patient is not particularly old, however, he is a smoker which increases his risk of lung cancer and is displaying clinical features (unintentional weight loss) which require urgent investigation.",
"id": "10000051",
"label": "a",
"name": "Lung cancer",
"picture": null,
"votes": 796
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this can present with haemoptysis and cough, unintentional weight loss is more concerning for malignancy and must be explored. Patients with bronchiectasis would also likely have purulent sputum.",
"id": "10000052",
"label": "b",
"name": "Bronchiectasis",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A patient with asthma would not typically present with haemoptysis and weight loss. A cough may be present although other symptoms such as wheeze, dyspnoea and chest tightness would often be present.",
"id": "10000053",
"label": "c",
"name": "Asthma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haemoptysis and cough can be present in pneumonia, however, the unintentional weight loss and smoking history are more concerning for malignancy.",
"id": "10000054",
"label": "d",
"name": "Pneumonia",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is often a more acute presentation and would present with sudden onset dyspnoea and pleuritic chest pain. Patients with a pulmonary embolism can have haemoptysis although in this case, the symptoms are more gradual and the weight loss is more indicative of malignancy.",
"id": "10000055",
"label": "e",
"name": "Pulmonary embolism",
"picture": null,
"votes": 1
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3702",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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"question": "A 50-year-old man presents to his GP with haemoptysis and a cough which he has had for 10 weeks. He is a smoker and has been for 29 years. The GP also notes unintentional weight loss of 6kg in the last 2 months.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 822,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,533 | false | 12 | null | 6,494,999 | null | false | [] | null | 12,558 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a shockable rhythm alongside ventricular fibrillation. Non-shockable rhythms include asystole and pulseless electrical activity.",
"id": "10000056",
"label": "a",
"name": "Ventricular tachycardia",
"picture": null,
"votes": 590
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a normal part of the cardiac cycle where the ventricles are contracting.",
"id": "10000059",
"label": "d",
"name": "Systole",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a non-shockable rhythm.",
"id": "10000057",
"label": "b",
"name": "Asystole",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a normal part of the cardiac cycle where the chambers are filling with blood in a relaxed state.",
"id": "10000060",
"label": "e",
"name": "Diastole",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a non-shockable rhythm.",
"id": "10000058",
"label": "c",
"name": "Pulseless electrical activity",
"picture": null,
"votes": 99
}
],
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"demo": null,
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"id": "3703",
"name": "Broad Complex Tachycardias",
"status": null,
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"id": "134",
"name": "Cardiology",
"typeId": 7
},
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"question": "Which of the following is a shockable heart rhythm in cardiac arrest?",
"sbaAnswer": [
"a"
],
"totalVotes": 805,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,534 | false | 13 | null | 6,494,999 | null | false | [] | null | 12,559 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pulmonary stenosis is often congenital and associated with Noonan syndrome.",
"id": "10000061",
"label": "a",
"name": "Noonan syndrome",
"picture": null,
"votes": 348
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Klinefelter Syndrome is where males have an extra X chromosome and have the karyotype of XXY. These patient's are often tall and have small genitalia.",
"id": "10000063",
"label": "c",
"name": "Klinefelter syndrome",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is trisomy 21 and up to 15% of these patients have an atrioventricular septal defect.",
"id": "10000064",
"label": "d",
"name": "Down syndrome",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Marfan syndrome can be associated with an aortic aneurysm and also affects the skeleton and eyes.",
"id": "10000062",
"label": "b",
"name": "Marfan syndrome",
"picture": null,
"votes": 224
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Patients have a karyotype of 45X0 and present with coarctation of the aorta, short stature and gonadal dysgenesis.",
"id": "10000065",
"label": "e",
"name": "Turner syndrome",
"picture": null,
"votes": 105
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": null,
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},
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"demo": null,
"entitlement": null,
"id": "3704",
"name": "Pulmonary Stenosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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},
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"question": "Which of the following conditions is associated with pulmonary stenosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 791,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,535 | false | 14 | null | 6,494,999 | null | false | [] | null | 12,560 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "There is an increased risk of aortic stenosis due to a bicuspid valve abnormality. Aortic dissection is also a potential complication.",
"id": "10000066",
"label": "a",
"name": "Aortic stenosis",
"picture": null,
"votes": 342
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Aortic stenosis is a complication of Turner's syndrome, not mitral. Mitral stenosis is commonly caused by rheumatic heart disease.",
"id": "10000070",
"label": "e",
"name": "Mitral stenosis",
"picture": null,
"votes": 126
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This often occurs in patients with Noonan syndrome.",
"id": "10000067",
"label": "b",
"name": "Pulmonary stenosis",
"picture": null,
"votes": 127
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is inflammation of the pericardium which can be caused by numerous things including infection, malignancy and rheumatic disease and is not associated with Turner's syndrome.",
"id": "10000069",
"label": "d",
"name": "Pericarditis",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This often occurs in patients with Marfan syndrome.",
"id": "10000068",
"label": "c",
"name": "Aortic aneurysm",
"picture": null,
"votes": 136
}
],
"comments": [],
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"__typename": "Concept",
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"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3705",
"name": "Turner's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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},
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"explanation": null,
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"question": "Which of the following is a complication of Turner's syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 785,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,536 | false | 15 | null | 6,494,999 | null | false | [] | null | 12,561 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an abnormal build-up of fluid in the pleural cavity and can be caused by exudative or transudative causes like infection or congestive heart failure respectively.",
"id": "10000073",
"label": "c",
"name": "Pleural effusion",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would present as snoring when asleep, lack of concentration, irritability and excessive daytime sleepiness.",
"id": "10000075",
"label": "e",
"name": "Obstructive sleep apnoea",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the dilatation of bronchi due to chronic infection. Patients would display similar symptoms to those mentioned above, however, purulent sputum, productive cough and haemoptysis would be more indicative of bronchiectasis. Also, given that this patient is a retired construction worker, it is important to consider asbestos exposure.",
"id": "10000074",
"label": "d",
"name": "Bronchiectasis",
"picture": null,
"votes": 91
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of lung malignancy and is associated with asbestos exposure. However, this patient is not displaying any red flag signs of malignancy at this stage such as weight loss or haemoptysis.",
"id": "10000072",
"label": "b",
"name": "Mesothelioma",
"picture": null,
"votes": 251
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a diffuse interstitial lung fibrosis with pleural plaques present due to excessive asbestos exposure. This patient is a retired construction worker who would likely have been exposed to asbestos.",
"id": "10000071",
"label": "a",
"name": "Asbestosis",
"picture": null,
"votes": 420
}
],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
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"id": "3706",
"name": "Asbestosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
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},
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"question": "An 84-year-old male who is a retired construction worker develops dyspnoea and a cough. On examination, he has finger clubbing and reduced chest expansion. He is also a smoker.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 808,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,537 | false | 16 | null | 6,494,999 | null | false | [] | null | 12,562 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Aortic dissection is when a tear in the tunica intima of the aorta occurs thereby letting blood flow in between the inner and outer layers of the aorta walls. Risk factors include hypertension and a classical presentation is a man typically >50 years old with sudden onset chest pain that radiates to the back.",
"id": "10000076",
"label": "a",
"name": "Aortic dissection",
"picture": null,
"votes": 605
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chest pain in this case is often centralised and radiates down the left arm or up the jaw. It is classically a 'crushing' chest pain rather than 'tearing' as seen in aortic dissection.",
"id": "10000080",
"label": "e",
"name": "Non-ST-elevated Myocardial Infarction",
"picture": null,
"votes": 151
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Atrial fibrillation is when there is uncoordinated atrial contraction. Patients would often have chest pain, palpitations, and dyspnoea and on examination, an irregularly irregular pulse would be felt.",
"id": "10000078",
"label": "c",
"name": "Atrial fibrillation",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Fluid or blood can accumulate in the pericardial space causing chest pain and dyspnoea. This is a medical emergency, however, as the chest pain, in this case, radiates to the back, it is more indicative of aortic dissection.",
"id": "10000079",
"label": "d",
"name": "Cardiac tamponade",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Marfan's syndrome is a connective tissue disorder and is a risk factor for aortic dissection, however, there are no features in this question which indicate Marfan's syndrome.",
"id": "10000077",
"label": "b",
"name": "Marfan's syndrome",
"picture": null,
"votes": 5
}
],
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},
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"id": "3707",
"name": "Aortic Dissection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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},
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"question": "A 57-year-old male presents to A&E with severe sudden onset chest pain that radiates to his back. He has a past medical history of hypertension and type 2 diabetes mellitus.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 793,
"typeId": 1,
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173,459,538 | false | 17 | null | 6,494,999 | null | false | [] | null | 12,563 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Congenital long QT syndrome is autosomal dominant, although a long QT interval can also be acquired due to certain drugs e.g. antibiotics like erythromycin.",
"id": "10000085",
"label": "e",
"name": "Long QT interval",
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"__typename": "QuestionChoice",
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"explanation": "This is a feature of 1st-degree heart block whereby electrical activity is prolonged through the AV node.",
"id": "10000083",
"label": "c",
"name": "PR interval >200ms",
"picture": null,
"votes": 47
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Delta waves appear as an upstroke QRS complex and are a feature of WPW syndrome. A short PR interval (<120ms) and broad QRS complexes may also be seen.",
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"label": "b",
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"votes": 20
},
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"__typename": "QuestionChoice",
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"explanation": "Inflammation of the pericardium can occur for many reasons including infection, malignancy and drug side effects. A classic presentation is pleuritic chest pain that is worse when lying flat and on ECG a saddle-shaped ST elevation would be seen alongside PR depression.",
"id": "10000081",
"label": "a",
"name": "Saddle-shaped ST elevation",
"picture": null,
"votes": 513
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a feature of hyperkalaemia. Sinus bradycardia and conduction blocks may also be present.",
"id": "10000084",
"label": "d",
"name": "Tall Tented T waves",
"picture": null,
"votes": 64
}
],
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"id": "134",
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"question": "A 59-year-old patient presents to A&E with severe chest pain. He reports the pain is worse lying down and when he breathes in. He had a cold last week.\n\nWhich of the following would be the most likely finding on ECG?",
"sbaAnswer": [
"a"
],
"totalVotes": 768,
"typeId": 1,
"userPoint": null
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173,459,539 | false | 18 | null | 6,494,999 | null | false | [] | null | 12,564 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of cancer that often affects the lungs and is related to asbestos exposure, although is not the most common type.",
"id": "10000089",
"label": "d",
"name": "Mesothelioma",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Lung cancers can be divided into 2 groups, small-cell and non-small-cell. Adenocarcinoma is a non-small cell lung cancer (NSCLC) and the most common sub-type of the NSCLCs.",
"id": "10000086",
"label": "a",
"name": "Adenocarcinoma",
"picture": null,
"votes": 500
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the most common type in the UK. It is often associated with paraneoplastic endocrine disorders like Cushing's disease or Addison's. It typically has a poor prognosis and is most common in patients who smoke.",
"id": "10000087",
"label": "b",
"name": "Small cell carcinoma",
"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of non-small cell lung cancer but is not the most common in the UK. It often presents with obstruction to the bronchi causing infection.",
"id": "10000088",
"label": "c",
"name": "Squamous cell carcinoma",
"picture": null,
"votes": 171
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a type of non-small cell lung cancer but is not the most common in the UK>",
"id": "10000090",
"label": "e",
"name": "Large cell carcinoma",
"picture": null,
"votes": 25
}
],
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"id": "3702",
"name": "Lung Cancer",
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"id": "132",
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"question": "Which of the following lung cancers is the most common in the UK?",
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"a"
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173,459,540 | false | 19 | null | 6,494,999 | null | false | [] | null | 12,565 | {
"__typename": "QuestionSBA",
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"__typename": "QuestionChoice",
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"explanation": "This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 1 gives a 3.2% chance of mortality.",
"id": "10000092",
"label": "b",
"name": "1",
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},
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"__typename": "QuestionChoice",
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"explanation": "This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 2 gives a 13% chance of mortality.",
"id": "10000093",
"label": "c",
"name": "2",
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},
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"__typename": "QuestionChoice",
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"explanation": "This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 5 gives a 57% chance of mortality.",
"id": "10000094",
"label": "d",
"name": "5",
"picture": null,
"votes": 30
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 4 gives a 41.5% chance of morality.",
"id": "10000095",
"label": "e",
"name": "4",
"picture": null,
"votes": 170
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is >65 years old, confused and has a respiratory rate of >30. This gives a score of 3. His blood pressure is above 90 systolic and above 60 diastolic and his urea is < 7 mmol/L. A score of 3 gives a 17% chance of mortality.",
"id": "10000091",
"label": "a",
"name": "3",
"picture": null,
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}
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"name": "Pneumonia",
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"typeId": 7
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"question": "A 76-year-old male patient presents to A&E as he is acutely confused, has a fever and reports pleuritic chest pain. His partner mentions he has been coughing up blood and 'green phlegm' over the last few days. On examination, he is tachypnoeic with a respiratory rate of 32 and a BP of 96/62. His urea was measured at 6.8 mmol/L (normal range 2.5-7.8 mmol/L).\n\n\nWhich of the following is this patient's CURB-65 score?",
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"a"
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173,459,541 | false | 20 | null | 6,494,999 | null | false | [] | null | 12,566 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most common pathogen seen in IVDU with infective endocarditis due to potential contamination of needles and skin sites.",
"id": "10000096",
"label": "a",
"name": "*Staphylococcus aureus*",
"picture": null,
"votes": 574
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathogen is often seen in patients with colonic lesions as seen in inflammatory bowel disease or colorectal carcinoma.",
"id": "10000099",
"label": "d",
"name": "*Streptococcus bovis*",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a fungus which acts as an opportunistic pathogen and is not typically associated with infective endocarditis. It commonly affects those who are immunocompromised, for example, patients with HIV/AIDS.",
"id": "10000100",
"label": "e",
"name": "*Pneumocystis jirovecii*",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is also a common pathogen causing infective endocarditis. However, it is more commonly seen in patients with poor dentition or dental infections.",
"id": "10000097",
"label": "b",
"name": "*Streptococcus viridans*",
"picture": null,
"votes": 108
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is part of the HACEK organism group which can cause infective endocarditis, however, it is not as common as *Staphylococcus aureus* in IVDU.",
"id": "10000098",
"label": "c",
"name": "*Haemophilus influenzae*",
"picture": null,
"votes": 28
}
],
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"id": "134",
"name": "Cardiology",
"typeId": 7
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"question": "A 32-year-old female patient who is a known IV drug user (IVDU) presents to A&E with a high fever. On examination, splinter haemorrhages and Janeway lesions are noted.\n\nWhich of the following pathogens is the most likely cause of this diagnosis?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
"userPoint": null
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173,459,542 | false | 21 | null | 6,494,999 | null | false | [] | null | 12,567 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an NSAID and has no place in treating croup here. Dexamethasone is necessary to treat mild cases of croup.",
"id": "10000104",
"label": "d",
"name": "Ibuprofen",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Croup is typically an upper respiratory tract infection that needs to be treated with dexamethasone.",
"id": "10000102",
"label": "b",
"name": "Rest and reassurance",
"picture": null,
"votes": 267
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this may alleviate fever due to its anti-pyretic properties, croup needs to be treated with dexamethasone.",
"id": "10000103",
"label": "c",
"name": "Paracetamol",
"picture": null,
"votes": 49
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with croup, a common illness that affects babies and young children. Most cases are caused by the parainfluenza virus and can be treated with a single dose of dexamethasone.",
"id": "10000101",
"label": "a",
"name": "Dexamethasone",
"picture": null,
"votes": 408
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oxygen may be required in severe cases of croup, however, as this patient’s dyspnoea has resolved and he is saturating appropriately he can be managed in primary care with dexamethasone.",
"id": "10000105",
"label": "e",
"name": "Oxygen",
"picture": null,
"votes": 12
}
],
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},
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"question": "A 3-year-old boy presents to his GP with his parent. He has a barking cough and fever. His parent says he has been struggling to breathe at times over the last 2 days although this has resolved now. He is saturating appropriately on room air.\n\nGiven the likely diagnosis, which of the following is the most appropriate treatment?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,459,543 | false | 22 | null | 6,494,999 | null | false | [] | null | 12,568 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an abnormal build-up of fluid in the pleural cavity and would present with dyspnoea, chest pain and reduced exercise tolerance.",
"id": "10000109",
"label": "d",
"name": "Pleural effusion",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autosomal recessive condition caused by a mutation in chromosome 7. It is present from birth and would have respiratory symptoms like sinusitis, cough and recurrent respiratory tract infections.",
"id": "10000108",
"label": "c",
"name": "Cystic fibrosis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The patient may have a Pancoast tumour in his lung, however, these symptoms correlate with Horner’s syndrome which is the direct diagnosis at this time. It cannot be confirmed yet whether the underlying cause of Horner’s syndrome is due to a Pancoast tumour.",
"id": "10000107",
"label": "b",
"name": "Pancoast tumour",
"picture": null,
"votes": 289
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is air within the pleural space and may come on suddenly. Patients may experience sudden onset pleuritic chest pain and shortness of breath.",
"id": "10000110",
"label": "e",
"name": "Pneumothorax",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is characterised by ptosis, miosis and anhidrosis due to sympathetic chain ganglion disruption. Given that the patient is a smoker, he may have a Pancoast tumour at the lung apex which can affect the sympathetic chain and cause Horner’s syndrome, however, further testing and investigation would be necessary to determine this.",
"id": "10000106",
"label": "a",
"name": "Horner’s syndrome",
"picture": null,
"votes": 439
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "having a cough with Horners syndrome, you would suspect a pan coast tumour no? surely that would be the diagnosis?",
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"question": "A 67-year-old male patient presents to his GP with a chronic cough and drooping eyelid. The GP notes he has a constricted pupil in his right eye. The patient is a known smoker and has been for 40 years.\n\nWhich of the following is the most likely diagnosis for this presentation?",
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"a"
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} | MarksheetMark |
173,459,544 | false | 23 | null | 6,494,999 | null | false | [] | null | 12,569 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used to predict how soon a pregnant woman will be in labour.",
"id": "10000112",
"label": "b",
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},
{
"__typename": "QuestionChoice",
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"explanation": "This is used as a diagnostic guide for infective endocarditis. It can be split into major and minor criteria.",
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"picture": null,
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},
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"__typename": "QuestionChoice",
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"id": "10000113",
"label": "c",
"name": "CURB-65",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
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"id": "10000114",
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},
{
"__typename": "QuestionChoice",
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"explanation": "This is the scoring system for calculating stroke risk in patients with atrial fibrillation.",
"id": "10000115",
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"name": "CHA2DS2-VASC",
"picture": null,
"votes": 63
}
],
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"question": "Which of the following is the scoring system used for infective endocarditis?",
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"a"
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} | MarksheetMark |
173,459,545 | false | 24 | null | 6,494,999 | null | false | [] | null | 12,570 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would show ST elevation in leads V5-6 and/or I and aVL.",
"id": "10000118",
"label": "c",
"name": "Left circumflex",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is an inferior ST-elevation myocardial infarction showing ST elevation in leads II, III and aVF.",
"id": "10000116",
"label": "a",
"name": "Right coronary artery",
"picture": null,
"votes": 541
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would be an anterior ST-elevation myocardial infarction showing ST elevation in leads V3-4 and/or leads V5-6.",
"id": "10000117",
"label": "b",
"name": "Left anterior descending artery",
"picture": null,
"votes": 167
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is typically used as a graft in coronary artery bypass graft surgery (CABG) when coronary arteries are severely occluded.",
"id": "10000119",
"label": "d",
"name": "Left internal mammary artery",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can be used as a graft in coronary artery bypass graft surgery (CABG).",
"id": "10000120",
"label": "e",
"name": "Radial artery",
"picture": null,
"votes": 6
}
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"question": "A 48-year-old male presents to A&E with sudden onset chest pain that radiates down his left arm. An ECG was performed which showed ST elevation in leads II, III and aVF.\n\nWhich of the following vessels is most likely affected causing this presentation?",
"sbaAnswer": [
"a"
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"totalVotes": 750,
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173,459,546 | false | 25 | null | 6,494,999 | null | false | [] | null | 12,571 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This condition is characterised by uncoordinated atrial contraction at a rate of around 300-600 bpm. Patients may have palpitations, dyspnoea, chest pain or dizziness and an irregularly irregular pulse in atrial fibrillation.",
"id": "10000121",
"label": "a",
"name": "Atrial fibrillation",
"picture": null,
"votes": 649
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{
"__typename": "QuestionChoice",
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"explanation": "This is a genetic disorder of sodium channelopathies. It tends to occur in male Southeast Asian patients who may have sudden cardiac death.",
"id": "10000125",
"label": "e",
"name": "Brugada syndrome",
"picture": null,
"votes": 11
},
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"__typename": "QuestionChoice",
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"explanation": "This is the backflow of blood across the mitral valve. Patients often present with dyspnoea, fatigue and weakness.",
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"label": "d",
"name": "Mitral regurgitation",
"picture": null,
"votes": 13
},
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"explanation": "This is a common valvular pathology where the aortic valve becomes narrowed. It is associated with a classic triad of heart failure, syncope and angina. A slow rising pulse and narrow pulse pressure are other typical features.",
"id": "10000123",
"label": "c",
"name": "Aortic stenosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a narrow complex tachycardia with atrial activity of > 300 bpm. Symptoms include palpitations, dizziness and chest pain, however, on ECG, a saw-tooth pattern is seen.",
"id": "10000122",
"label": "b",
"name": "Atrial flutter",
"picture": null,
"votes": 69
}
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"question": "A 70-year-old female presents to her GP as she feels a ‘fluttering’ in her chest and has been feeling dizzy more regularly. She has a past medical history of hypertension and on examination, her pulse was irregularly irregular. An ECG shows an irregularly irregular rhythm with no P waves.\n\nWhich of the following is the most likely diagnosis?",
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"a"
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173,459,547 | false | 26 | null | 6,494,999 | null | false | [] | null | 12,572 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can cause mitral regurgitation due to abnormal left ventricle structure.",
"id": "10000129",
"label": "d",
"name": "Hypertrophic cardiomyopathy",
"picture": null,
"votes": 167
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myxomas are benign and are composed of unspecialised mesenchymal cells. They are the most common type of primary cardiac tumour.",
"id": "10000128",
"label": "c",
"name": "Cardiac myxoma",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a genetic condition which can cause pulmonary stenosis.",
"id": "10000130",
"label": "e",
"name": "Noonan syndrome",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This has an increased risk of aortic stenosis and aortic dissection due to a bicuspid aortic valve and coarctation of the aorta respectively.",
"id": "10000127",
"label": "b",
"name": "Turner's syndrome",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Marfan syndrome is a genetic cause of aortic root dilatation which can lead to incomplete aortic valve closure, therefore allowing the regurgitation of blood back into the left atrium.",
"id": "10000126",
"label": "a",
"name": "Marfan syndrome",
"picture": null,
"votes": 421
}
],
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"a"
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173,459,548 | false | 27 | null | 6,494,999 | null | false | [] | null | 12,573 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a beta-blocker, however, is not used for initial first line treatment for rate control in patients with AF. Sotalol has additional action in antagonising potassium channels.",
"id": "10000135",
"label": "e",
"name": "Sotalol",
"picture": null,
"votes": 10
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{
"__typename": "QuestionChoice",
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"explanation": "This can be used for rate and rhythm control although has a large side effect profile so is generally avoided where possible unless the patient is elderly and more sedentary.",
"id": "10000133",
"label": "c",
"name": "Amiodarone",
"picture": null,
"votes": 130
},
{
"__typename": "QuestionChoice",
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"explanation": "This is a beta-blocker which can be used in initial rate control for patients with AF. A rate-limiting calcium channel blocker like diltiazem can also be used.",
"id": "10000131",
"label": "a",
"name": "Bisoprolol",
"picture": null,
"votes": 455
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not used for initial rate control due to a large side effect profile. It is often used as a second line in conjunction with a beta-blocker.",
"id": "10000134",
"label": "d",
"name": "Digoxin",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is used to achieve rhythm control rather than rate.",
"id": "10000132",
"label": "b",
"name": "Electrical cardioversion",
"picture": null,
"votes": 66
}
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"question": "Which of the following can be used initially to achieve rate control in atrial fibrillation (AF)?",
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"a"
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173,459,549 | false | 28 | null | 6,494,999 | null | false | [] | null | 12,574 | {
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"__typename": "QuestionChoice",
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"explanation": "Aortic stenosis has a classic triad of symptoms - heart failure, syncope and angina. The patient may also have exertional dyspnoea and a slow rising pulse, narrow pulse pressure and ejection systolic murmur may be present.",
"id": "10000136",
"label": "a",
"name": "Aortic stenosis",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "This is an impaired opening of the mitral valve. The most common cause is rheumatic heart disease and it can present with exertional dyspnoea and reduced exercise tolerance.",
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"label": "e",
"name": "Mitral stenosis",
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"__typename": "QuestionChoice",
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"explanation": "This is the backflow of blood into the left atrium and can present differently in acute vs chronic cases. Acute cases can present with sudden collapse, pulmonary oedema and sweating whilst chronic cases may present with exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea. A Corrigan's pulse may be felt on examination and an early diastolic murmur will be heard.",
"id": "10000138",
"label": "c",
"name": "Aortic regurgitation",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
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"explanation": "Patients with atrial flutter may present with symptoms such as palpitations, dizziness or chest pain. The patient may also be asymptomatic. On ECG, a saw-tooth pattern is seen with narrow QRS complexes and a heart rate > 300 bpm.",
"id": "10000137",
"label": "b",
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},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the backflow of blood across the mitral valve. It may present with dyspnoea, fatigue and weakness in acute cases or may be asymptomatic in chronic cases.",
"id": "10000139",
"label": "d",
"name": "Mitral regurgitation",
"picture": null,
"votes": 89
}
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"question": "A 47-year-old male presents to his GP after experiencing multiple episodes of syncope recently. He has a past medical history of angina. On examination, an ejection systolic murmur is heard. An ECG is performed which shows increased QRS complex voltages.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
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173,459,550 | false | 29 | null | 6,494,999 | null | false | [] | null | 12,575 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature and must be present.",
"id": "10000142",
"label": "b",
"name": "Chronic productive cough lasting over 2 months in at least 2 consecutive years",
"picture": null,
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},
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"__typename": "QuestionChoice",
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"explanation": "A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.",
"id": "10000143",
"label": "c",
"name": "Chronic productive cough lasting over 1 month in at least 1 consecutive year",
"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature of COPD. Purulent sputum, hypoxia and hypercapnia may also be present.",
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"label": "a",
"name": "Chronic productive cough lasting over 3 months in at least 2 consecutive years",
"picture": null,
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},
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"__typename": "QuestionChoice",
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"explanation": "A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.",
"id": "10000145",
"label": "e",
"name": "Chronic productive cough lasting over 2 months in at least 2 consecutive years",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.",
"id": "10000144",
"label": "d",
"name": "Chronic productive cough lasting over 2 months in at least 1 consecutive year",
"picture": null,
"votes": 73
}
],
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"id": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
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"id": "132",
"name": "Respiratory",
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"question": "Which of the following is a key clinical feature of chronic obstructive pulmonary disease (COPD)?",
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} | MarksheetMark |
173,459,551 | false | 30 | null | 6,494,999 | null | false | [] | null | 12,576 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This bacterium primarily infects younger patients who may present with a flu-like illness.",
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"label": "b",
"name": "*Mycoplasma pneumoniae*",
"picture": null,
"votes": 125
},
{
"__typename": "QuestionChoice",
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"picture": null,
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},
{
"__typename": "QuestionChoice",
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"explanation": "*Klebsiella pneumoniae* often infects patients who are elderly, and have alcoholism or diabetes due to a weakened immune system.",
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"explanation": "This pathogen often occurs in patients who are immunosuppressed because of malignancy, chemotherapy or who are HIV positive.",
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"label": "e",
"name": "*Pneumocystis jirovecii*",
"picture": null,
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}
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"question": "Which of the following pathogens is most likely to be found in a patient with known alcoholism who has developed pneumonia?",
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"a"
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173,459,552 | false | 31 | null | 6,494,999 | null | false | [] | null | 12,577 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a useful investigation to track heart rate and activity, however, polysomnography is more useful to diagnose obstructive sleep apnoea as it measures heart rate, oxygen levels and breathing.",
"id": "10000154",
"label": "d",
"name": "ECG",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the gold standard and would not be necessary to determine whether the patient has obstructive sleep apnoea at this time.",
"id": "10000153",
"label": "c",
"name": "CT",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be necessary at this time to determine whether the patient has obstructive sleep apnoea.",
"id": "10000152",
"label": "b",
"name": "MRI",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the gold-standard investigation for obstructive sleep apnoea, measuring physiological parameters while the patient sleeps. This patient has risk factors of being overweight, male and has a smoking history.",
"id": "10000151",
"label": "a",
"name": "Polysomnography",
"picture": null,
"votes": 565
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This imaging technique would not be necessary at this time to determine if the patient has obstructive sleep apnoea.",
"id": "10000155",
"label": "e",
"name": "X-ray",
"picture": null,
"votes": 51
}
],
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"question": "A 65-year-old man presents to his GP as he is finding it difficult to sleep well and is struggling to concentrate at work. He has a BMI of 40 and a 50-pack-year history.\n\nWhich of the following is the gold-standard diagnostic investigation for the most likely diagnosis?",
"sbaAnswer": [
"a"
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"typeId": 1,
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173,459,553 | false | 32 | null | 6,494,999 | null | false | [] | null | 12,578 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a reversible obstruction of the airways resulting in bronchoconstriction. It would be less commonly diagnosed for the first time in a 76-year-old patient and would not typically present with haemoptysis. It is not associated with finger clubbing.",
"id": "10000157",
"label": "b",
"name": "Asthma",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This often presents with sudden onset pleuritic chest pain, dyspnoea and haemoptysis. The patient would be acutely unwell and may have tachypnoea and tachycardia.",
"id": "10000160",
"label": "e",
"name": "Pulmonary embolism",
"picture": null,
"votes": 59
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autosomal recessive condition often diagnosed in childhood. Patients may develop bronchiectasis as a result of cystic fibrosis (CF) however CF is less likely to be diagnosed at this age.",
"id": "10000159",
"label": "d",
"name": "Cystic fibrosis",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a restrictive lung condition characterised by granuloma formation and inflammation. It may present with dry cough and dyspnoea. It is important to look out for erythema nodosum and bilateral hilar lymphadenopathy.",
"id": "10000158",
"label": "c",
"name": "Sarcoidosis",
"picture": null,
"votes": 106
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a permanent dilatation of the bronchi due to chronic infection. A productive cough, purulent sputum and haemoptysis would be symptoms of bronchiectasis. Finger clubbing, inspiratory crepitations, dyspnoea and wheeze may be signs found on examination.",
"id": "10000156",
"label": "a",
"name": "Bronchiectasis",
"picture": null,
"votes": 531
}
],
"comments": [],
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"question": "A 76-year-old female has a productive cough and haemoptysis. She also has an audible wheeze and finger clubbing on examination.\n\nWhich of the following is the likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 749,
"typeId": 1,
"userPoint": null
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173,459,554 | false | 33 | null | 6,494,999 | null | false | [] | null | 12,579 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a progressive and restrictive lung disease. It often presents in male patients around the age of 70 and is more common in smokers. Dry cough, shortness of breath and fatigue are classic symptoms alongside cyanosis and end-inspiratory crackles as signs.",
"id": "10000161",
"label": "a",
"name": "Idiopathic pulmonary fibrosis",
"picture": null,
"votes": 567
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autosomal recessive condition often detected in neonates. It is a multisystem disorder although respiratory features including chronic sinusitis and thick mucus are common.",
"id": "10000163",
"label": "c",
"name": "Cystic fibrosis",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lung cancer usually presents with red-flag symptoms such as weight loss and haemoptysis, however, it is always important to consider malignancy as a differential diagnosis.",
"id": "10000164",
"label": "d",
"name": "Lung cancer",
"picture": null,
"votes": 15
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an abnormal build-up of fluid in the pleural cavity and patients may present with dyspnoea, reduced exercise tolerance and chest pain.",
"id": "10000165",
"label": "e",
"name": "Pleural effusion",
"picture": null,
"votes": 135
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an infection of the upper airway and is more common in children. It presents with a seal-bark cough.",
"id": "10000162",
"label": "b",
"name": "Croup",
"picture": null,
"votes": 21
}
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"a"
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173,459,555 | false | 34 | null | 6,494,999 | null | false | [] | null | 12,580 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an infection of the heart valves, however, patients may have predisposing factors like intravenous drug use, poor dentition or dental infections which cause IE. IE does not typically cause mitral stenosis.",
"id": "10000167",
"label": "b",
"name": "Infective endocarditis (IE)",
"picture": null,
"votes": 136
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an acute inflammation of the pericardium around the heart. Complications include cardiac tamponade or pericardial effusion. It is not associated with mitral stenosis.",
"id": "10000168",
"label": "c",
"name": "Pericarditis",
"picture": null,
"votes": 29
},
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"__typename": "QuestionChoice",
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"explanation": "This is a genetic condition which can often result in aortic stenosis or aortic dissection as a complication.",
"id": "10000169",
"label": "d",
"name": "Turner's syndrome",
"picture": null,
"votes": 34
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"__typename": "QuestionChoice",
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"explanation": "This is the most common cause of mitral stenosis. Streptococcal antigens secondary to bacterial infection can cause damage to the mitral valve.",
"id": "10000166",
"label": "a",
"name": "Rheumatic heart disease",
"picture": null,
"votes": 519
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a genetic condition caused by sodium channelopathies and can result in arrhythmias, typically AV nodal re-entrant tachycardias, ventricular fibrillation or ventricular tachycardia. It is not associated with mitral stenosis.",
"id": "10000170",
"label": "e",
"name": "Brugada syndrome",
"picture": null,
"votes": 20
}
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"name": "Mitral stenosis",
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"name": "Cardiology",
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173,459,556 | false | 35 | null | 6,494,999 | null | false | [] | null | 12,581 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a conservative measure and is used first line, however, the scenario mentions the patient is already undertaking a change in lifestyle measures to help the condition. This would not result in the alleviation of symptoms rapidly.",
"id": "10000175",
"label": "e",
"name": "Smoking cessation",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "GTN spray can be used sublingually to quickly relieve symptoms of angina such as chest pain that occurs from physical activity. This works in minutes and is useful as a 1st line management option to relieve symptoms.",
"id": "10000171",
"label": "a",
"name": "Glyceryl trinitrate (GTN) spray",
"picture": null,
"votes": 685
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is often used second-line in the management of angina. Examples include nifedipine or felodipine.",
"id": "10000172",
"label": "b",
"name": "Long-acting calcium channel blockers",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CABG operations can be used for those with more complex cases of angina which are not adequately managed by medical treatment for example if they have complex 3-vessel disease or left main stem stenosis.",
"id": "10000173",
"label": "c",
"name": "Coronary artery bypass graft (CABG)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Digoxin is often used in patients with atrial fibrillation and heart failure or hypotension. It inhibits the Na/K ATPase pump in the myocardium.",
"id": "10000174",
"label": "d",
"name": "Digoxin",
"picture": null,
"votes": 7
}
],
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"name": "Stable angina",
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"id": "134",
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"typeId": 7
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"question": "A 68-year-old male patient was recently diagnosed with angina by his GP.\n\nHe has been following lifestyle advice from his GP to help reduce his risk factors for cardiovascular disease.\n\nWhich of the following management options would be useful to relieve symptoms of angina quickly?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
"userPoint": null
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173,459,557 | false | 36 | null | 6,494,999 | null | false | [] | null | 12,582 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of a class 3 anti-arrhythmic like amiodarone which delays repolarisation by blocking potassium channels and is used to treat arrhythmias such as ventricular fibrillation.",
"id": "10000180",
"label": "e",
"name": "Inhibiting K+ channels",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an example of beta-blockers like atenolol or bisoprolol. They block the sympathetic action of the heart by agonising beta-1 receptors and therefore slowing the AV conduction in the heart.",
"id": "10000179",
"label": "d",
"name": "Activate beta-1 receptors to block sympathetic stimulation of the heart",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This describes the mechanism of a sodium channel blocker such as flecainide used to reduce depolarisation and action potential amplitude in arrhythmias like atrial fibrillation.",
"id": "10000178",
"label": "c",
"name": "Inhibit Na+ thus reducing the amplitude of action potentials",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The pericardium is the sac around the heart. Whilst the Na/K ATPase pump is inhibited by digoxin, this occurs in the myocardium, not the pericardium.",
"id": "10000177",
"label": "b",
"name": "Inhibition of Na/K ATPase ion pumps in the pericardium",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Digoxin is used for patients with atrial fibrillation, heart failure and hypotension and works by inhibiting the Na/K ATPase pump in the myocardium resulting in negative chronotropy and positive ionotropy.",
"id": "10000176",
"label": "a",
"name": "Inhibition of Na/K ATPase ion pumps in the myocardium",
"picture": null,
"votes": 521
}
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"name": "Digoxin",
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"question": "Which of the following accurately described the mechanism of digoxin?",
"sbaAnswer": [
"a"
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173,459,558 | false | 37 | null | 6,494,999 | null | false | [] | null | 12,583 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an infection of the upper airway and is common in children. It presents with a seal-bark cough and fever, typically in the winter months.",
"id": "10000184",
"label": "d",
"name": "Croup",
"picture": null,
"votes": 9
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an autosomal recessive condition often diagnosed in childhood. Patients would present with cough, excessive sputum/mucus and recurrent lower respiratory tract infections.",
"id": "10000183",
"label": "c",
"name": "Cystic fibrosis",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a permanent dilatation of the bronchi and often presents in older patients as a productive cough, haemoptysis and purulent sputum.",
"id": "10000182",
"label": "b",
"name": "Bronchiectasis",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an upper respiratory tract infection most often resulting in a sore throat as the primary symptom. It may be viral or bacterial and a throat swab may be necessary to determine this.",
"id": "10000185",
"label": "e",
"name": "Tonsillitis",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In children, asthma can present with cough, breathlessness, wheezing and chest tightness. Risk factors include a family history of asthma and atopy including hayfever, asthma and eczema.",
"id": "10000181",
"label": "a",
"name": "Asthma",
"picture": null,
"votes": 711
}
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"question": "A 4-year-old girl is seen by her GP. Her mum describes that she struggles to catch her breath sometimes and has been coughing more. The mum mentions that her daughter has had eczema in the past and that her husband suffers from hay fever.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
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"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,559 | false | 38 | null | 6,494,999 | null | false | [] | null | 12,584 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the best diagnostic investigation for bronchiectasis. On CT, dilated bronchi, 'signet' ring sign and opacities may be seen indicating possible infection.",
"id": "10000186",
"label": "a",
"name": "CT",
"picture": null,
"votes": 212
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a useful investigation to determine the pattern of respiratory illness i.e. whether it is obstructive or restrictive, however, it does not necessarily determine what specific disease is present.",
"id": "10000187",
"label": "b",
"name": "Spirometry",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "X-ray is a useful imaging modality to detect lung nodules, effusion and consolidation and is usually done 1st line, however, CT gives a more detailed image and in this case, is a more useful diagnostic imaging tool.",
"id": "10000190",
"label": "e",
"name": "X-ray",
"picture": null,
"votes": 305
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a useful investigation to determine whether a patient has cystic fibrosis, however, it is more often carried out in younger children rather than elderly patients.",
"id": "10000189",
"label": "d",
"name": "Sweat test",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is useful to determine potential infection and pathogens present which can therefore guide specific treatment options like antibiotics, however, CT is the best for diagnosis of bronchiectasis.",
"id": "10000188",
"label": "c",
"name": "Sputum culture",
"picture": null,
"votes": 172
}
],
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"name": "Bronchiectasis",
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"typeId": 7
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"question": "An 89-year-old male presents to his GP with a chronic productive cough. Yesterday, he has an episode of haemoptysis with a large amount of blood-stained sputum.\n\nWhich of the following investigations is the most appropriate diagnostic investigation for the underlying condition?",
"sbaAnswer": [
"a"
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"totalVotes": 744,
"typeId": 1,
"userPoint": null
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173,459,560 | false | 39 | null | 6,494,999 | null | false | [] | null | 12,585 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a non-specific test, however, if negative it can be useful to rule out a pulmonary embolism. It is not completely diagnostic and a CTPA or a lower limb duplex in the case of pregnant patients are needed. There are many causes of a raised D Dimer, including pregnancy.",
"id": "10000194",
"label": "d",
"name": "D-dimer",
"picture": null,
"votes": 159
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A lower limb duplex is the diagnostic test for a pulmonary embolism in a pregnant patient. This patient likely developed deep vein thrombosis due to her hypercoagulable state with pregnancy and the clot embolised and travelled to her lung.",
"id": "10000191",
"label": "a",
"name": "Lower limb duplex",
"picture": null,
"votes": 250
},
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is often normal in a pulmonary embolism although may be useful at a later stage to rule out other differentials like an infection.",
"id": "10000193",
"label": "c",
"name": "Chest x-ray",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ECG can be useful to check for right heart strain as a complication of pulmonary embolism, however, it is not diagnostic of a pulmonary embolism.",
"id": "10000195",
"label": "e",
"name": "ECG",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "CT pulmonary angiogram is usually the first line investigation to determine the diagnosis of a pulmonary embolism, however, this patient is pregnant and so a lower limb duplex is the first line investigation, especially if a DVT is thought to be the cause.",
"id": "10000192",
"label": "b",
"name": "CT pulmonary angiogram",
"picture": null,
"votes": 276
}
],
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"__typename": "QuestionComment",
"comment": "confirm the diagnosis of a PE for breathlessness or DVT for the swollen leg?",
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"name": "Pulmonary Embolism",
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"id": "132",
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"question": "A 24-year-old pregnant female presents to A&E with sudden dyspnoea and pleuritic chest pain. She has very swollen ankles due to her pregnancy but her left ankle and lower leg, in particular, are very tender and red.\n\nWhich of the following investigations would be useful to confirm the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 740,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,561 | false | 40 | null | 6,494,999 | null | false | [] | null | 12,586 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This bacterium is a common organism causing hospital-acquired pneumonia. Other common organisms to consider include Enterobacteria.",
"id": "10000196",
"label": "a",
"name": "*Pseudomonas aeruginosa*",
"picture": null,
"votes": 432
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a commensal fungus which more often causes vaginal candidiasis or oral thrush.",
"id": "10000199",
"label": "d",
"name": "*Candida albicans*",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathogen most commonly causes pneumonia in patients who are alcoholics, diabetics or elderly patients.",
"id": "10000197",
"label": "b",
"name": "*Klebsiella pneumoniae*",
"picture": null,
"votes": 156
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathogen often causes infection in patients who are severely immunocompromised such as HIV-positive patients.",
"id": "10000198",
"label": "c",
"name": "*Pneumocystis jirovecii*",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a bacterium that often causes psittacosis. It is acquired from contact with birds and cattle.",
"id": "10000200",
"label": "e",
"name": "*Chlamydophila psittaci*",
"picture": null,
"votes": 24
}
],
"comments": [],
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"id": "3709",
"name": "Pneumonia",
"status": null,
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"id": "132",
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"typeId": 7
},
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"question": "A 79-year-old female is recovering from a cardiac bypass operation in the hospital and has not been mobile for 3 days. She develops a fever of 39 degrees, is tachypnoeic and is coughing up purulent sputum.\n\nWhich of the following pathogens is most likely to be causing this diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 733,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,562 | false | 41 | null | 6,494,999 | null | false | [] | null | 12,587 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is step 4 of the BTS guidelines for managing chronic asthma and would not be appropriate yet. An inhaled corticosteroid would be the next appropriate step.",
"id": "10000203",
"label": "c",
"name": "Add oral leukotriene receptor antagonist",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is step 3 of the BTS guidelines for managing chronic asthma. It is more appropriate in the first instance to trial an inhaled corticosteroid.",
"id": "10000202",
"label": "b",
"name": "Add long-acting beta-2 agonist",
"picture": null,
"votes": 104
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is step 2 of the BTS guidelines for the pharmacological management of chronic asthma. The first step, a short-acting beta-2 agonist e.g. salbutamol, is not working for this patient and so the next best step is to add an inhaled corticosteroid.",
"id": "10000201",
"label": "a",
"name": "Add low-dose inhaled corticosteroid",
"picture": null,
"votes": 604
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is useful in managing acute and severe asthma attacks. This patient is not experiencing an acute asthma attack and requires management of her chronic symptoms. An inhaled corticosteroid is more appropriate.",
"id": "10000204",
"label": "d",
"name": "Give IV magnesium sulphate",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the first step in managing an acute asthma attack. The patient has come to her GP to discuss management options and does not show symptoms or signs of an acute asthma attack.",
"id": "10000205",
"label": "e",
"name": "Ensure a patent airway",
"picture": null,
"votes": 15
}
],
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"id": "3725",
"name": "Asthma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
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"question": "A 22-year-old female with a known history of asthma and eczema presents to her GP as she feels that her 'blue' inhaler is not working as it used to.\n\nWhich of the following would be the next best management step for this patient's asthma?",
"sbaAnswer": [
"a"
],
"totalVotes": 744,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,563 | false | 42 | null | 6,494,999 | null | false | [] | null | 12,588 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The total duration for tuberculosis antibiotic therapy is 6 months.",
"id": "10000207",
"label": "b",
"name": "Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and rifampicin for 2 further months",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct form of antibiotic therapy for tuberculosis. The total regimen is 6 months of antibiotics but this may be extended if there are complications of meningitis or pericarditis or spinal TB.",
"id": "10000206",
"label": "a",
"name": "Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and rifampicin for 4 further months",
"picture": null,
"votes": 480
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.",
"id": "10000210",
"label": "e",
"name": "Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then pyrazinamide and ethambutol for 2 further months",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.",
"id": "10000208",
"label": "c",
"name": "Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and ethambutol for 4 further months",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.",
"id": "10000209",
"label": "d",
"name": "Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then pyrazinamide and ethambutol for 4 further months",
"picture": null,
"votes": 58
}
],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3697",
"name": "Tuberculosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
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"question": "A 57-year-old female returns from India after visiting family. She presents to her GP with night sweats, fever and a cough with haemoptysis.\n\nWhich of the following is the best management option for the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 725,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,564 | false | 43 | null | 6,494,999 | null | false | [] | null | 12,589 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This can be used as a 3rd line investigation if there are inconclusive results from non-invasive tests like ECG.",
"id": "10000213",
"label": "c",
"name": "Coronary angiogram",
"picture": null,
"votes": 91
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would not be useful unless there are other indicators which may suggest a different diagnosis rather than angina.",
"id": "10000214",
"label": "d",
"name": "Chest x-ray",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a 2nd line investigation for angina and would only be used after the less invasive 1st line investigations are done first.",
"id": "10000212",
"label": "b",
"name": "Stress ECHO",
"picture": null,
"votes": 131
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a useful investigation, however, it is very invasive and therefore would be after initial investigations such as an ECG and stress echo.",
"id": "10000215",
"label": "e",
"name": "CT coronary angiography",
"picture": null,
"votes": 160
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Anginal pain is suspected in this patient and so it is useful to do an ECG to check if there are any other abnormalities.",
"id": "10000211",
"label": "a",
"name": "ECG",
"picture": null,
"votes": 335
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3721",
"name": "Stable angina",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "A 55-year-old male struggles with chest pain when walking with his dog. This is relieved by sitting on the park bench. The patient recalls his father had a similar problem and used 'some sort of spray in the mouth' to help.\n\nWhat is the most appropriate initial investigation to do?",
"sbaAnswer": [
"a"
],
"totalVotes": 741,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,565 | false | 44 | null | 6,494,999 | null | false | [] | null | 12,590 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a triad which can indicate increased intracranial pressure. It consists of bradycardia, irregular respirations and a wide pulse pressure.",
"id": "10000217",
"label": "b",
"name": "Cushing's triad",
"picture": null,
"votes": 88
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a triad to determine venous thrombosis risk, consisting of stasis, hypercoagulability and vessel injury.",
"id": "10000220",
"label": "e",
"name": "Virchow's triad",
"picture": null,
"votes": 124
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The patient is experiencing a cardiac tamponade which is a medical emergency. Beck's triad is classic of cardiac tamponade with hypotension, raised JVP and muffled, quiet heart sounds.",
"id": "10000216",
"label": "a",
"name": "Beck's triad",
"picture": null,
"votes": 503
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This consists of bronchial asthma, nasal polyps and aspirin sensitivity and is also known as aspirin exacerbated respiratory disease (AERD).",
"id": "10000219",
"label": "d",
"name": "Samter's triad",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a triad consisting of interstitial keratitis, malformed teeth and deafness which is a common pattern of presentations for congenital syphilis.",
"id": "10000218",
"label": "c",
"name": "Hutchinson's triad",
"picture": null,
"votes": 14
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3696",
"name": "Cardiac Tamponade",
"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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},
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"question": "A patient presents to A&E with severe shortness of breath, confusion and tachycardia. On examination, the patient is hypotensive, and has a raised jugular venous pressure (JVP) and muffled heart sounds.\n\nGiven the likely diagnosis, which of the following describes this triad of signs?",
"sbaAnswer": [
"a"
],
"totalVotes": 735,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,566 | false | 45 | null | 6,494,999 | null | false | [] | null | 12,591 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a thiazide-like diuretic which is typically used as the next step after CCBs for a patient >55 and/or of African or Caribbean ethnicity.",
"id": "10000224",
"label": "d",
"name": "Indapamide",
"picture": null,
"votes": 84
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an ACE-inhibitor the 1st line treatment for patients who are <55 years old and not of Afro-Caribbean ethnicity.",
"id": "10000222",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an aldosterone receptor antagonist and would be used as step 4 of pharmacological management for hypertension.",
"id": "10000223",
"label": "c",
"name": "Spironolactone",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an angiotensin receptor blocker, often used for patients who are unable to tolerate ACE-I due to the side effects such as dry cough.",
"id": "10000225",
"label": "e",
"name": "Candesartan",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is >55 years old and of Caribbean ethnicity, therefore she requires a calcium channel blocker as 1st line pharmacological management for her hypertension.",
"id": "10000221",
"label": "a",
"name": "Nifedipine",
"picture": null,
"votes": 480
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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"userNote": null,
"videos": []
},
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"dislikes": 0,
"explanation": null,
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"id": "12591",
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"multiAnswer": null,
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"question": "A 56-year-old female of Caribbean ethnicity goes to her GP for a routine blood pressure check. Her blood pressure was measured and found to be 155/95 mmHg.\n\nWhich of the following is the first-line treatment for hypertension in this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 736,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,567 | false | 46 | null | 6,494,999 | null | false | [] | null | 12,592 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions like pulmonary fibrosis.",
"id": "10000228",
"label": "c",
"name": "0.85",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions whereas a ratio <0.7 indicates an obstructive condition.",
"id": "10000230",
"label": "e",
"name": "0.90",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a normal FEV1/FVC ratio.",
"id": "10000227",
"label": "b",
"name": "0.70",
"picture": null,
"votes": 98
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is likely to be an obstructive illness like asthma due to the age of the patient and its symptoms. An FEV1/FVC <0.7 is seen in obstructive conditions where the airways are narrowed or obstructed.",
"id": "10000226",
"label": "a",
"name": "0.65",
"picture": null,
"votes": 549
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions and neuromuscular conditions.",
"id": "10000229",
"label": "d",
"name": "0.75",
"picture": null,
"votes": 41
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3726",
"name": "Spirometry",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
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},
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"dislikes": 0,
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"highlights": [],
"id": "12592",
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"question": "A 17-year-old male notices he gets short of breath more quickly than normal when playing football. He also has to take more breaks compared to his peers. He goes to his GP who performs spirometry tests.\n\nGiven the likely diagnosis, which of the following is the most likely FEV1/FVC ratio?",
"sbaAnswer": [
"a"
],
"totalVotes": 741,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,568 | false | 47 | null | 6,494,999 | null | false | [] | null | 12,593 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a common side effect of the antibiotic rifampicin, used for tuberculosis.",
"id": "10000234",
"label": "d",
"name": "Red/orange urine",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a common side effect of calcium channel blockers.",
"id": "10000235",
"label": "e",
"name": "Ankle oedema",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a common side effect of ACE-I and patients who cannot tolerate these side effects often switch to an angiotensin receptor blocker like candesartan.",
"id": "10000231",
"label": "a",
"name": "Dry cough",
"picture": null,
"votes": 702
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is can be a common side effect of sulphonylureas which are an anti-diabetic drug class.",
"id": "10000233",
"label": "c",
"name": "Weight gain",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a common side effect of amiodarone which is used for rhythm control in atrial fibrillation.",
"id": "10000232",
"label": "b",
"name": "Hypothyroidism",
"picture": null,
"votes": 6
}
],
"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": "3701",
"name": "Hypertension",
"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": 3701,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12593",
"isLikedByMe": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "Which of the following is a common side effect of ACE-inhibitors?",
"sbaAnswer": [
"a"
],
"totalVotes": 742,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,569 | false | 48 | null | 6,494,999 | null | false | [] | null | 12,594 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an obstructive lung condition with reversible bronchoconstriction. It would be less common to see a presentation of asthma for the first time in a 78-year-old. The spirometry would show an obstructive pattern with an FEV1/FVC ratio of <0.7.",
"id": "10000238",
"label": "c",
"name": "Asthma",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "COPD is a chronic irreversible obstruction to the airways. This patient fits the typical presentation for COPD. He is a smoker and has a chronic cough productive of phlegm and dyspnoea. A common aetiology of COPD is smoking alongside air pollutants. The spirometry would show an obstructive pattern with an FEV1/FVC ratio of <0.7.",
"id": "10000236",
"label": "a",
"name": "Chronic obstructive pulmonary disease (COPD)",
"picture": null,
"votes": 667
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a restrictive lung condition and so the FEV1/FVC ratio would appear normal (0.7) despite the individual values being lower. Patients also exhibit a dry cough rather than productive, dyspnoea and fatigue.",
"id": "10000240",
"label": "e",
"name": "Pulmonary fibrosis",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is a permanent dilatation of the bronchi due to chronic infection. A productive cough, purulent sputum and haemoptysis would be symptoms of bronchiectasis. Bronchiectasis would show an obstructive type spirometry of <0.7.",
"id": "10000239",
"label": "d",
"name": "Bronchiectasis",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an inflammatory condition caused by infection and often caused by streptococcus pneumonia in the community. It can also be hospital-acquired or due to aspiration. Pneumonia can show a restrictive type pattern in spirometry with a normal FEV1/FVC ratio.",
"id": "10000237",
"label": "b",
"name": "Pneumonia",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3717,
"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12594",
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"question": "A 78-year-old male presented to his GP with a chronic productive cough and difficulty breathing. He has been a smoker for 50 years. Spirometry shows an FEV1/FVC ratio of 0.5.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 743,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,570 | false | 49 | null | 6,494,999 | null | false | [] | null | 12,595 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an accumulation of fluid, blood, pus or air in the pericardial space. It is a medical emergency and patients will present with tachycardia, confusion, chest pain and shortness of breath. In this case, given the absence of trauma and acute presentation, hypertrophic obstructive cardiomyopathy is more likely.",
"id": "10000244",
"label": "d",
"name": "Cardiac tamponade",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The heart is non-dilated and non-hypertrophied however has impaired ventricular filling. Patients may experience heart failure and many have atrial fibrillation.",
"id": "10000243",
"label": "c",
"name": "Restrictive cardiomyopathy",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Mitral regurgitation is the backflow of blood across the mitral valve during systole due to an incompetent valve. It can be acute or chronic and presents with dyspnoea, exertional dyspnoea, fatigue and weakness.",
"id": "10000245",
"label": "e",
"name": "Mitral regurgitation",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is an autosomal dominant inherited condition and can often result in sudden death in young people and athletes. It is the commonest genetic heart condition whereby there is septal hypertrophy obstructing the left ventricular outflow tract and anterior movement of the mitral valve in systole. Many patients will be asymptomatic throughout their life.",
"id": "10000241",
"label": "a",
"name": "Hypertrophic obstructive cardiomyopathy (HOCM)",
"picture": null,
"votes": 561
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common type of cardiomyopathy and is defined by dilatation and poor contraction of the ventricles. It often presents first in those between 30-60 years of age with exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea.",
"id": "10000242",
"label": "b",
"name": "Dilated cardiomyopathy",
"picture": null,
"votes": 46
}
],
"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": "3727",
"name": "Hypertrophic cardiomyopathy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
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"userNote": null,
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},
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"question": "A 35-year-old male was playing tennis with his friend when he suddenly he developed severe chest pain and breathlessness.\n\nUnfortunately the man died before the ambulance arrived. He was generally fit and well and did not have any health issues before this incident.\n\nGiven the above information, which of the following is the most likely underlying health condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 731,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,571 | false | 50 | null | 6,494,999 | null | false | [] | null | 12,596 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This presentation is likely to be that of a lung abscess due to the presence of fever, dyspnoea and green sputum. As this is infective, inflammatory markers like CRP and ESR will likely be raised.",
"id": "10000246",
"label": "a",
"name": "Raised CRP and ESR",
"picture": null,
"votes": 536
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is likely to be a lung abscess based on the presentation and history of recurrent pneumonia. The bloods would likely show raised CRP and ESR.",
"id": "10000247",
"label": "b",
"name": "Normal bloods",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Thyroid function tests would not be necessary to take here as the patient is not displaying symptoms of an abnormal thyroid condition such as Hashimoto's or Grave's disease. A full blood work up is useful if the differential diagnoses are unclear.",
"id": "10000249",
"label": "d",
"name": "Raised TFTs",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Glucose is unlikely to be measured here as the patient is not displaying features of a condition that may show raised glucose. However, a full blood workup is useful if the differential diagnoses are unclear.",
"id": "10000250",
"label": "e",
"name": "Raised glucose",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Leukocytes are likely to be raised in this presentation of a lung abscess due to the infective nature of the disease.",
"id": "10000248",
"label": "c",
"name": "Low leukocytes",
"picture": null,
"votes": 85
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3728",
"name": "Lung abscess",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3728,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12596",
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"question": "A 45-year-old female presents to her GP with a fever, productive cough with green sputum and dyspnoea. She is a long-term smoker of 30 years and often gets chest infections. On examination she has finger clubbing and dull notes on percussion. Bronchial breathing is heard on auscultation. The GP suggests blood tests should be taken.\n\nWhich of the following blood results would be the most pertinent to this case?",
"sbaAnswer": [
"a"
],
"totalVotes": 726,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,602 | false | 1 | null | 6,495,002 | null | false | [] | null | 12,597 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A barium enema may be used in large bowel obstruction but is unlikely to be used in the investigation of small bowel obstruction, as barium is unlikely to reach the small bowel. Furthermore, barium studies are contraindicated in perforation so it is important to rule this out first.",
"id": "10000255",
"label": "e",
"name": "Barium enema",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a case of small bowel obstruction as indicated by the bilious vomiting, total constipation and abdominal pain. The BMJ and American College of Radiology both state that abdominal CT scans are the investigation of choice for a definitive diagnosis of small bowel obstruction. This is due to superior sensitivity as well as the ability to detect aetiology.",
"id": "10000251",
"label": "a",
"name": "Abdominal CT scan",
"picture": null,
"votes": 356
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an abdominal X-Ray is a good initial investigation, plain radiographs lack sensitivity, especially in the early stages of bowel obstruction.",
"id": "10000252",
"label": "b",
"name": "Abdominal X-Ray",
"picture": null,
"votes": 206
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A colonoscopy may be used as part of therapeutic management but is unlikely to feature in the acute phase of investigation.",
"id": "10000254",
"label": "d",
"name": "Colonoscopy",
"picture": null,
"votes": 82
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although MRI scans can provide strong soft tissue contrast and do not expose the patient to radiation, in the acute setting these investigations are too time-consuming to be appropriate.",
"id": "10000253",
"label": "c",
"name": "Abdominal MRI",
"picture": null,
"votes": 56
}
],
"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": "3729",
"name": "Small Bowel Obstruction",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3729,
"conditions": [],
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12597",
"isLikedByMe": 0,
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"likes": 1,
"multiAnswer": null,
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"psaSectionId": null,
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"question": "A 61-year-old male presents to the emergency department with a 4-hour history of diffuse central abdominal pain and bilious vomiting. He has not passed stool or flatus in 3 days.\n\nWhich of the following is the best diagnostic investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 738,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,603 | false | 2 | null | 6,495,002 | null | false | [] | null | 12,598 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute appendicitis is an important acute abdomen differential but classically presents with acute diffuse abdominal pain that localises to the right iliac fossa, not epigastric pain.",
"id": "10000258",
"label": "c",
"name": "Acute appendicitis",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Acute pancreatitis classically presents with severe epigastric pain and vomiting. Pain in acute pancreatitis may also radiate to the back. The recent ERCP is a major risk factor for iatrogenic acute pancreatitis. Other causes of acute pancreatitis include gallstones, alcohol abuse, and autoimmune aetiologies amongst others.",
"id": "10000256",
"label": "a",
"name": "Acute pancreatitis",
"picture": null,
"votes": 537
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a history of gallstones may indicate acute cholecystitis, this condition typically presents with right upper quadrant pain and fever. Furthermore, the recent ERCP is an important risk factor for iatrogenic acute pancreatitis.",
"id": "10000257",
"label": "b",
"name": "Gallstones",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Biliary colic typically presents with intermittent right upper quadrant pain, and patients are typically systemically well. This makes biliary colic an unlikely diagnosis in this case.",
"id": "10000260",
"label": "e",
"name": "Biliary colic",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Small bowel obstruction is another important differential, though a history may include total constipation and vomiting is often bilious.",
"id": "10000259",
"label": "d",
"name": "Small bowel obstruction",
"picture": null,
"votes": 35
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3730",
"name": "Acute Pancreatitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
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"id": "12598",
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"learningPoint": null,
"likes": 1,
"multiAnswer": null,
"pictures": [],
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"question": "A 54-year-old female on the general surgery ward is assessed for severe epigastric abdominal pain that radiates to the back and vomiting. An abdominal exam reveals epigastric tenderness and abdominal distension. She underwent an ERCP for gallstones 4 hours ago.\n\nWhat is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 687,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,604 | false | 3 | null | 6,495,002 | null | false | [] | null | 12,599 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The retrocaval lymph nodes receive lymph from the posterior abdominal wall.",
"id": "10000264",
"label": "d",
"name": "Retrocaval lymph nodes",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The coeliac lymph nodes receive lymph from other nodes that drain the stomach.",
"id": "10000263",
"label": "c",
"name": "Coeliac group",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The inferior mesenteric nodes receive lymph from the descending and sigmoid colon.",
"id": "10000261",
"label": "a",
"name": "Inferior mesenteric nodes",
"picture": null,
"votes": 576
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The superior mesenteric nodes receive lymph from the ascending and transverse colon.",
"id": "10000262",
"label": "b",
"name": "Superior mesenteric group",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The internal iliac nodes receive lymph from the pelvic organs and perineum.",
"id": "10000265",
"label": "e",
"name": "Internal iliac nodes",
"picture": null,
"votes": 37
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3731",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3731,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12599",
"isLikedByMe": null,
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"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 60-year-old man has recently been diagnosed with colorectal cancer. A CT scan indicates he has a tumour of the descending colon.\n\nWhich of the following lymph node groups drain this area of the colon?",
"sbaAnswer": [
"a"
],
"totalVotes": 670,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,605 | false | 4 | null | 6,495,002 | null | false | [] | null | 12,600 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Non-caseating granulomas are another hallmark of Crohn's disease. Ulcerative colitis does not feature granulomas, indeed the BMJ cite the absence of granulomas as an indication of ulcerative colitis over Crohn's disease.",
"id": "10000269",
"label": "d",
"name": "Presence of granulomas",
"picture": null,
"votes": 67
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cobblestone inflammation is not a histopathological sign but an endoscopic sign found in Crohn's disease that occurs when fissures/ulceration leaves elevated patches of mucosa.",
"id": "10000270",
"label": "e",
"name": "Cobblestone inflammation",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Skip lesions are a classic histopathological sign of Crohn's disease. Ulcerative colitis on the other hand manifests as continuous inflammation extending proximally from the rectum.",
"id": "10000268",
"label": "c",
"name": "Skip lesions",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diverticula are a hallmark of diverticulosis and occur when pouches of colonic mucosa herniate through the muscular layer of the colon wall. They are often asymptomatic but can become problematic in diverticular disease and diverticulitis.",
"id": "10000267",
"label": "b",
"name": "Diverticula",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In ulcerative colitis, inflammation is typically limited to the mucosa and submucosa unless in fulminant disease. This is different from Crohn's disease which typically involves transmural inflammation. Other histopathological hallmarks of ulcerative colitis include continuous inflammation, goblet cell depletion, and crypt abscesses.",
"id": "10000266",
"label": "a",
"name": "Inflammation is limited to mucosa and submucosa",
"picture": null,
"votes": 477
}
],
"comments": [],
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"__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": "3732",
"name": "Ulcerative Colitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3732,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12600",
"isLikedByMe": null,
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"likes": 0,
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"psaSectionId": null,
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"question": "A 24-year-old female presents to clinic and reports a 5-week history of bloody diarrhoea and weight loss. You suspect inflammatory bowel disease and request a colonoscopy and biopsy.\n\nWhich histopathological sign would be most indicative of ulcerative colitis?",
"sbaAnswer": [
"a"
],
"totalVotes": 666,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,606 | false | 5 | null | 6,495,002 | null | false | [] | null | 12,601 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin B3 (niacin) is absorbed throughout the small intestine and stomach therefore loss of the terminal ileum will not drastically affect absorption. A deficiency of vitamin B3 causes Pellagra.",
"id": "10000273",
"label": "c",
"name": "Vitamin B3",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Vitamin B12 is actively absorbed in the terminal ileum bound to intrinsic factor. Resection of the terminal ileum can therefore result in a deficiency. A deficiency of vitamin B12 can cause megaloblastic anaemia and peripheral neuropathy.",
"id": "10000271",
"label": "a",
"name": "Vitamin B12",
"picture": null,
"votes": 636
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin B6 (pyridoxine) is primarily absorbed in the jejunum so would be unaffected by this surgery. A deficiency of vitamin B6 can cause anaemia and neuropathy. Although individuals with IBD are more likely to suffer pyridoxine deficiency, resection of the terminal ileum is a major risk factor for vitamin B12 deficiency.",
"id": "10000274",
"label": "d",
"name": "Vitamin B6",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin B9 (folic acid) is absorbed in the duodenum and jejunum. A deficiency of folic acid results in megaloblastic anaemia and can cause neural tube defects in the foetus.",
"id": "10000275",
"label": "e",
"name": "Vitamin B9",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Vitamin B1 (thiamine) is absorbed in the ileum and jejunum. As resection of the terminal ileum leaves the remainder of the ileum intact, this patient is unlikely to struggle to absorb vitamin B1. A deficiency of vitamin B1 can cause polyneuropathy, Wernicke-Korsakoff syndrome, and heart failure.",
"id": "10000272",
"label": "b",
"name": "Vitamin B1",
"picture": null,
"votes": 13
}
],
"comments": [],
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"__typename": "Concept",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3733",
"name": "Vitamin Deficiency Syndromes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "137",
"name": "Gastrointestinal",
"typeId": 7
},
"topicId": 137,
"totalCards": null,
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"question": "A 35-year-old male has recently had surgery to treat severe Crohn's disease. This surgery involved the resection of his terminal ileum.\n\nWhich of the following vitamins is he at risk of becoming deficient in?",
"sbaAnswer": [
"a"
],
"totalVotes": 669,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,607 | false | 6 | null | 6,495,002 | null | false | [] | null | 12,602 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "In Scotland, bowel cancer screening takes the form of the faecal immunochemical test (FIT) which is offered to everyone between the ages of 50-74.",
"id": "10000276",
"label": "a",
"name": "50 - 74 years old",
"picture": null,
"votes": 349
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals aged 75 and over can still request FIT testing every 2 years but are not invited to screening.",
"id": "10000279",
"label": "d",
"name": "50 - 79 years old",
"picture": null,
"votes": 110
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the age range for screening in England.",
"id": "10000280",
"label": "e",
"name": "60 - 74 years old",
"picture": null,
"votes": 113
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals under the age of 50 are not offered bowel screening. Individuals aged 75 and over can still request FIT testing every 2 years but are not invited to screening.",
"id": "10000278",
"label": "c",
"name": "45 - 75 years old",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals aged 75 and over can still request FIT testing every 2 years but are not invited to screening.",
"id": "10000277",
"label": "b",
"name": "60 - 79 years old",
"picture": null,
"votes": 45
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
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"id": "3731",
"name": "Colorectal Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
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"question": "A 36-year-old male attends a GP appointment asking for advice. His father has recently passed away from colorectal cancer aged 72. The man would like some information regarding colorectal cancer screening.\n\nWhich of the following is the correct age range for bowel cancer screening in Scotland?",
"sbaAnswer": [
"a"
],
"totalVotes": 645,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,608 | false | 7 | null | 6,495,002 | null | false | [] | null | 12,603 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatocellular carcinoma is another important differential but is unlikely in this case. HCC classically presents with signs of liver cirrhosis. These include jaundice, right upper quadrant pain, ascites, pruritis, and splenomegaly. Furthermore, the double duct sign is not seen in hepatocellular cancer.",
"id": "10000282",
"label": "b",
"name": "Hepatocellular carcinoma",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic pancreatitis is an important differential but is not the diagnosis in this case. Chronic pancreatitis is most commonly caused by alcohol abuse which is not present in this patient's history. Dull epigastric pain is also present in 80% of chronic pancreatitis cases and is typically worst after a meal or on sitting forward. Finally, a CT scan would likely reveal pancreatic calcifications that are not present in this case.",
"id": "10000284",
"label": "d",
"name": "Chronic pancreatitis",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acute cholangitis is an infection of the biliary tree and is an unlikely diagnosis in this case. Acute cholangitis often presents with fever, jaundice, and right upper quadrant pain. The absence of pain and fever and the 5-week history are strong factors against this diagnosis.",
"id": "10000283",
"label": "c",
"name": "Acute cholangitis",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Choledocholithiasis is the presence of gallstones in the bile ducts and is an important differential for obstructive jaundice. This condition presents with colicky right upper quadrant/epigastric pain often worse after a meal. As there is no pain in this presentation and the double duct sign is present, pancreatic cancer is the most likely diagnosis.",
"id": "10000285",
"label": "e",
"name": "Choledocholithiasis",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is suffering from pancreatic cancer. Painless obstructive jaundice is a classical presentation of this disease. Smoking is also an important risk factor. Combined with dilatation of the common bile duct and pancreatic duct (double duct sign), these factors indicate a diagnosis of pancreatic cancer.",
"id": "10000281",
"label": "a",
"name": "Pancreatic Cancer",
"picture": null,
"votes": 397
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3734",
"name": "Pancreatic Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3734,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12603",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A 57-year-old female presents to General Practice with a 5-week history of painless jaundice, pale stools, and dark urine. She is referred for an abdominal CT scan which reveals the \"double duct\" sign. She reports a smoking history of 25 pack years.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 633,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,609 | false | 8 | null | 6,495,002 | null | false | [] | null | 12,604 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis B is not transmitted through respiratory droplets. Classically respiratory airborne diseases include conditions such as influenza.",
"id": "10000287",
"label": "b",
"name": "Respiratory droplets",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hepatitis B is not transmitted through any respiratory means but can be transmitted through blood-to-blood contact.",
"id": "10000290",
"label": "e",
"name": "Droplet, Aerosol, Bloodborne",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although hepatitis B can be spread by both sexual transmission and blood-blood contact, it is not typically transmitted by the faecal-oral route. This method of transmission is more typical of hepatitis A which is a hepatic virus spread through faecal-oral exposure such as ingesting contaminated food or water.",
"id": "10000288",
"label": "c",
"name": "Faecal-oral, Sexual transmission, Bloodborne",
"picture": null,
"votes": 302
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although hepatitis B can be transmitted through both vertical and sexual means, it is not transmitted faecal-orally. This is more typical of hepatitis A which is a hepatic virus spread through faecal-oral exposure such as ingesting contaminated food or water.",
"id": "10000289",
"label": "d",
"name": "Faecal-oral, Vertical, Sexual transmission",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This man is suffering from Hepatitis B. Hepatitis B typically presents with fever, right upper quadrant pain, jaundice, fatigue, and malaise. A prodromal illness may occur ~2 weeks before the onset of jaundice. Hepatitis B is a viral infection transmitted through infected bodily fluids and is therefore transmitted through blood-to-blood contact (e.g. needle sharing), sexual transmission, and vertical transmission from mother to baby perinatally.",
"id": "10000286",
"label": "a",
"name": "Bloodborne, Sexual transmission, Vertical transmission",
"picture": null,
"votes": 205
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3735",
"name": "Hepatic viruses",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3735,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12604",
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"learningPoint": null,
"likes": 1,
"multiAnswer": null,
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"question": "A 32-year-old male presents to General Practice with right upper quadrant pain, malaise and fatigue. On examination, he is jaundiced and has right upper quadrant tenderness. He also reported experiencing a flu-like illness 2 weeks ago.\n\nWhich of the following are the transmission methods of the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 628,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,610 | false | 9 | null | 6,495,002 | null | false | [] | null | 12,605 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This child is suffering from cystic fibrosis, as indicated by the history of recurrent chest infections, short stature, and pancreatic insufficiency (causing steatorrhoea). The BMJ and NICE recommend the use of pancreatic enzyme replacement as well as a high-fat, high-calorie diet.",
"id": "10000291",
"label": "a",
"name": "Pancreatic enzyme supplementation",
"picture": null,
"votes": 339
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This child is suffering from cystic fibrosis, as indicated by the history of recurrent chest infections, short stature, and pancreatic insufficiency (causing steatorrhoea). Antibiotic therapy may feature in the management of respiratory cystic fibrosis but would not be used in pancreatic insufficiency.",
"id": "10000293",
"label": "c",
"name": "Antibiotic therapy",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reassurance is not appropriate management of cystic fibrosis.",
"id": "10000295",
"label": "e",
"name": "Reassurance",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This child is suffering from cystic fibrosis, as indicated by the history of recurrent chest infections, short stature, and pancreatic insufficiency (causing steatorrhoea). Steroid therapy is not indicated in the management of pancreatic insufficiency in cystic fibrosis.",
"id": "10000292",
"label": "b",
"name": "Prednisolone",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A gluten-free diet may be useful to manage coeliac disease but would not feature in cystic fibrosis management. Instead, a high-calorie, high-fat diet is recommended to treat pancreatic insufficiency, as well as pancreatic enzymes.",
"id": "10000294",
"label": "d",
"name": "Gluten-free diet",
"picture": null,
"votes": 240
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3736",
"name": "Pancreatic activity in cystic fibrosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "137",
"name": "Gastrointestinal",
"typeId": 7
},
"topicId": 137,
"totalCards": null,
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"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "12605",
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"learningPoint": null,
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"question": "An 8-year-old female is brought to General Practice by her mother who reports a history of pale, oily, foul-smelling stool. The mother also mentions her daughter has suffered from recurrent chest infections. You note the child is of short stature.\n\nWhich of the following is the most appropriate management of this child's gastrointestinal symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 630,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,611 | false | 10 | null | 6,495,002 | null | false | [] | null | 12,606 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a presentation of viral labyrinthitis (inflammation of the membranous labyrinth of the inner ear). Labyrinthitis may present with vertigo, sensorineural hearing loss, tinnitus, and nausea. Viral labyrinthitis is classically preceded by a recent history of a viral illness. Labyrinthitis can be differentiated from vestibular neuronitis as the latter does not feature hearing loss.",
"id": "10000296",
"label": "a",
"name": "Labyrinthitis",
"picture": null,
"votes": 319
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Acoustic neuromas are benign tumours of the vestibular portion of the vestibulocochlear nerve and typically manifest in the cerebellopontine angle. They can present with vertigo, unilateral sensorineural hearing loss, tinnitus, and even facial palsy if the facial nerve is compressed. An acoustic neuroma is less likely here as these tumours typically present with gradual onset of symptoms and hearing loss is unilateral, whereas this patient suffers from bilateral symptoms.",
"id": "10000298",
"label": "c",
"name": "Acoustic neuroma (vestibular schwannoma)",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another important vertigo differential, Meniere's disease is an idiopathic inner ear condition. It is characterized by repeat acute episodes of vertigo, hearing loss, tinnitus, and a sensation of ear fullness. This diagnosis cannot be made here as this is a single isolated episode of vertigo and hearing loss.",
"id": "10000299",
"label": "d",
"name": "Meniere's disease",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this is an important differential, it is not the case here. Vestibular neuronitis is an inflammation of the vestibular portion of the vestibulocochlear nerve and presents with vertigo but not hearing loss. It may also feature a recent history of viral illness.",
"id": "10000297",
"label": "b",
"name": "Vestibular neuronitis",
"picture": null,
"votes": 161
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A common vestibular disorder but unlikely in this case. Benign paroxysmal positional vertigo (BPPV) is characterised by vertigo caused by head movement, however, does not feature hearing loss and is therefore unlikely to be involved here. Diagnosis can be confirmed by a positive Dix-Hallpike manoeuvre (recreation of symptoms and rotational nystagmus) and BPPV can be treated with the Epley manoeuvre.",
"id": "10000300",
"label": "e",
"name": "Benign paroxysmal positional vertigo",
"picture": null,
"votes": 25
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3737",
"name": "Vertigo & Dizziness",
"status": null,
"topic": {
"__typename": "Topic",
"id": "138",
"name": "Ear, Nose & Throat",
"typeId": 7
},
"topicId": 138,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3737,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12606",
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"multiAnswer": null,
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"question": "A 40-year-old female presents to General Practice with a 1 week history of vertigo that is worse on movement. She also complains of hearing loss. Examination reveals bilateral sensorineural hearing loss. She has no relevant past medical history but does report recently recovering from an upper respiratory tract infection.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 613,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,612 | false | 11 | null | 6,495,002 | null | false | [] | null | 12,607 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Also known as malignant otitis externa, this is an unlikely cause of this young boy's symptoms. Malignant otitis externa typically occurs in immunocompromised patients (most commonly in diabetics). It is characterised by severe ear pain, and purulent discharge, and may feature osteomyelitis of the temporal bone. It is not the most likely diagnosis due to the absence of immunosuppression and no ear pain in the history.",
"id": "10000303",
"label": "c",
"name": "Benign necrotising otitis externa",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Chronic suppurative otitis media (CSOM) is a complication of unresolved acute otitis media with perforation of the tympanic membrane. Classically CSOM presents with persistent ear discharge and conductive hearing loss. Although an important differential, CSOM would not reveal a crusting cholesteatoma in the tympanic membrane attic.",
"id": "10000302",
"label": "b",
"name": "Chronic suppurative otitis media",
"picture": null,
"votes": 122
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A common ear condition but not the most likely one in this case. Otitis externa classically presents with otalgia, ear pruritis, and ear discharge. Hearing loss is possible but uncommon in otitis externa. Otoscopy typically reveals ear canal erythema and swelling. A cholesteatoma in the tympanic membrane attic would not be observed in otitis externa and hearing loss is uncommon in this condition.",
"id": "10000305",
"label": "e",
"name": "Otitis externa",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tympanosclerosis is scarring/calcification of the tympanic membrane. It presents with conductive hearing loss and calcification of the tympanic membrane is visualized on otoscopy. It is an unlikely diagnosis here due to the history of discharge and absence of tympanic membrane calcification.",
"id": "10000304",
"label": "d",
"name": "Tympanosclerosis",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This young boy has a cholesteatoma, which is a benign accumulation of squamous epithelium and keratin within the middle ear or mastoid air cell spaces. Symptoms include purulent discharge from the external acoustic meatus and hearing loss and/or tinnitus from the affected ear. Examination may reveal conductive hearing loss and the otoscopy typically reveals a crust of keratin in the attic of the tympanic membrane.",
"id": "10000301",
"label": "a",
"name": "Cholesteatoma",
"picture": null,
"votes": 313
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3738",
"name": "Cholesteatoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "139",
"name": "Ear, Nose, and Throat",
"typeId": 7
},
"topicId": 139,
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"question": "A 10-year-old boy presents with his father to General Practice. He has a 3-week history of left-sided hearing loss and has been experiencing unpleasant discharge from the left ear. On examination, you note malodorous, purulent discharge from the left ear which has not responded to antibiotics. Rinne's test is negative in the left ear and positive in the right ear. Weber's test lateralizes to the left ear. Otoscopy reveals crusting at the top of the left tympanic membrane.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 589,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,613 | false | 12 | null | 6,495,002 | null | false | [] | null | 12,608 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE states that any adult experiencing a sudden-onset sensorineural hearing loss (SSNHL) manifesting over 3 days or less should be immediately (less than 24 hours) referred to ENT or the emergency department. This is because SSNHL carries a major risk of progressing to permanent deafness without prompt expert intervention. ENT typically treat with oral corticosteroids but these should not be prescribed in general practice for SSNHL.",
"id": "10000306",
"label": "a",
"name": "Immediate referral to ENT",
"picture": null,
"votes": 479
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Due to the risk of permanent hearing loss if left untreated, SSNHL warrants an immediate referral (less than 24 hours). A routine referral is therefore incorrect due to the increased risk of permanent disability.",
"id": "10000310",
"label": "e",
"name": "Routine referral to ENT",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although oral corticosteroids form the basis of treatment for SSNHL, the setting is important in this question. In general practice, all cases of SSNHL should be urgently referred to the nearest emergency department or ENT department. SSNHL should only be treated by hospital specialists.",
"id": "10000307",
"label": "b",
"name": "Prescribe an oral corticosteroid",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "ENT may decide to perform audiology testing but a referral should be made to them first. Audiology testing should not be arranged by general practice in the case of SSNHL.",
"id": "10000309",
"label": "d",
"name": "Arrange outpatient audiology testing",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. NSAIDs have no place in the management of SSNHL. In general practice, an immediate referral to ENT or ED should be made where the patient is likely to be managed with oral corticosteroids.",
"id": "10000308",
"label": "c",
"name": "Prescribe a non-steroidal anti-inflammatory",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3739",
"name": "Sensorineural Hearing Loss",
"status": null,
"topic": {
"__typename": "Topic",
"id": "139",
"name": "Ear, Nose, and Throat",
"typeId": 7
},
"topicId": 139,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
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"question": "A 24-year-old female presents to General Practice after experiencing sudden onset hearing loss in her left ear over the last 24 hours. On examination, Rinne's test is positive in both ears and Weber's test lateralizes to the right side. Otoscopy is unremarkable. She has never experienced anything like this before and has no relevant past medical or family history.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 578,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,614 | false | 13 | null | 6,495,002 | null | false | [] | null | 12,609 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A very important consideration in any neck swelling but in this case is highly unlikely to be malignant. The most likely malignant cause of lymphadenopathy in a 12-year-old would be acute lymphoblastic leukaemia (ALL). This is not the case here as the patient is otherwise asymptomatic and, most importantly, blood tests are normal. Furthermore, fine needle aspiration reveals acellular fluid with cholesterol crystals which would not be found in a malignant node.",
"id": "10000315",
"label": "e",
"name": "Malignancy",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Branchial cleft cysts are common developmental defects of the branchial arches (most commonly the second branchial arch). They present in late childhood/adolescence and early adulthood and characteristically contain acellular fluid with cholesterol crystals.",
"id": "10000311",
"label": "a",
"name": "Branchial cleft cyst",
"picture": null,
"votes": 314
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another important \"neck lump\" differential, cervical lymphadenopathy is an important diagnosis to consider but this is not the case here. Cervical lymphadenopathy is characteristically firm and rubbery whereas this swelling is soft and fluctuant. Furthermore, an enlarged lymph node would not be acellular on fine needle aspiration.",
"id": "10000314",
"label": "d",
"name": "Cervical lymphadenopathy",
"picture": null,
"votes": 83
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A cystic hygroma is a type of lymphangioma that forms in children. This example is unlikely to be a cystic hygroma as these masses typically present in the first 2 years of life. Additionally, although they can manifest anywhere on the body, the posterior triangle (i.e. posterior to the sternocleidomastoid muscle) is the most common location, whereas this mass is located anterior to the SCM muscle.",
"id": "10000313",
"label": "c",
"name": "Cystic hygroma",
"picture": null,
"votes": 82
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an important differential, this case is not a thyroglossal cyst. Thyroglossal cysts classically move on swallowing whereas this mass does not. Furthermore, thyroglossal cysts are typically midline masses whereas this mass lies laterally, on the left side.",
"id": "10000312",
"label": "b",
"name": "Thyroglossal cyst",
"picture": null,
"votes": 91
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3740",
"name": "Branchial cyst",
"status": null,
"topic": {
"__typename": "Topic",
"id": "139",
"name": "Ear, Nose, and Throat",
"typeId": 7
},
"topicId": 139,
"totalCards": null,
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"question": "A 12-year-old female presents to the ENT clinic with a unilateral, left-sided neck swelling that has been slowly increasing in size over the past 10 days. On examination, there is a left-sided neck swelling lying anterior to the sternocleidomastoid muscle that does not move on swallowing. On palpation, you identify a 4cm well-circumscribed, soft, non-tender, smooth, and fluctuant swelling. Fine needle aspiration reveals acellular fluid with cholesterol crystals. Blood results are normal.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 575,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,615 | false | 14 | null | 6,495,002 | null | false | [] | null | 12,610 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These are the classical fundoscopy findings of central retinal artery occlusion. The retina is pale due to oedema from ischaemia and the cherry red spot represents the fovea, which remains red as it is the thinnest part of the retina and therefore is spared the oedematous whitening.",
"id": "10000317",
"label": "b",
"name": "Pale retina and a central cherry-red spot",
"picture": null,
"votes": 165
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Central retinal vein occlusion occurs when blood flow in the central retinal vein is obstructed, disrupting venous drainage of the eye. This results in congestion of blood within the retinal venous system which results in veins becoming dilated and tortuous. These veins can rupture, resulting in retinal haemorrhages.",
"id": "10000316",
"label": "a",
"name": "Severe, widespread retinal haemorrhages and venous tortuosity",
"picture": null,
"votes": 196
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These findings are most associated with proliferative diabetic retinopathy. Microaneurysms are tiny aneurysms of the retinal capillaries. Dot and blot haemorrhages arise from bleeding capillaries. Cotton wool spots represent ischaemia of the retinal nerve fibres, which, in diabetic retinopathy, occurs due to vessel wall dysfunction. Proliferative diabetic retinopathy is defined by the formation of new vessels (neovascularisation) which occurs due to the increased retinal production of vascular endothelial growth factor, which is the retina's response to insufficient perfusion.",
"id": "10000319",
"label": "d",
"name": "Microaneurysms, dot and blot haemorrhages, cotton wool spots, neovascularisation",
"picture": null,
"votes": 112
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These findings would be most typical of dry age-related macular degeneration. Drusen are deposits of lipid and protein underneath the retina that occurs with age. Geographic atrophy represents the degeneration of the retina, which appears as localized, sharply demarcated atrophy on fundoscopy.",
"id": "10000320",
"label": "e",
"name": "Drusen and geographic atrophy",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These fundoscopy findings would indicate hypertensive retinopathy. Arteriovenous nipping occurs due to the compression of veins at arteriovenous crossing sites. Flame haemorrhages represent bleeding in the superficial layer and occur as a result of vessel wall breakdown due to increased pressure. Cotton wool spots occur as a result of ischaemia of the nerve fibre layer.",
"id": "10000318",
"label": "c",
"name": "Arteriovenous nipping, flame haemorrhages, cotton wool spots",
"picture": null,
"votes": 76
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3741",
"name": "Central retinal vein occlusion",
"status": null,
"topic": {
"__typename": "Topic",
"id": "140",
"name": "Ophthalmology",
"typeId": 7
},
"topicId": 140,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12610",
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"question": "A 66-year-old man presents to the emergency department with painless complete vision loss in his right eye. This occurred spontaneously 2 hours ago and has not resolved. After further investigation, you diagnose central retinal vein occlusion.\n\nWhich of the following best describes fundoscopy findings in this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 561,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,616 | false | 15 | null | 6,495,002 | null | false | [] | null | 12,611 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE tonsillectomy guidelines indicate at least 7 episodes in 1 year are required to justify a tonsillectomy.",
"id": "10000324",
"label": "d",
"name": "5 episodes in 1 year",
"picture": null,
"votes": 130
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE guidelines indicate that for a tonsillectomy to be indicated, the following criteria must be met: sore throats must be due to tonsillitis AND there have been 7 episodes in 1 year OR 5 episodes per year for 2 years OR 3 episodes per year for 3 years.",
"id": "10000321",
"label": "a",
"name": "5 episodes per year for 2 years",
"picture": null,
"votes": 286
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "NICE guidelines on tonsillectomy indicate that 3 episodes per year for 3 years would be an indication for tonsillectomy, but 2 per year for 3 years does not meet the criteria for surgical intervention.",
"id": "10000325",
"label": "e",
"name": "2 episodes per year for 3 years",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although NICE tonsillectomy criteria require recurrent episodes of tonsillitis, 3 episodes per year for 2 years is inadequate to justify surgical intervention. 5 episodes per year for 2 years would be an indication.",
"id": "10000323",
"label": "c",
"name": "3 episodes per year for 2 years",
"picture": null,
"votes": 142
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The first episode of tonsillitis is not an indication for tonsillectomy due to the risks of complications (including haemorrhage and pain). Therefore there must be a history of recurrent episodes of tonsillitis to justify surgery: 7 in 1 year, 5 per year for 2 years, or 3 per year for 3 years.",
"id": "10000322",
"label": "b",
"name": "First episode of tonsillitis",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3742",
"name": "Tonsillitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "139",
"name": "Ear, Nose, and Throat",
"typeId": 7
},
"topicId": 139,
"totalCards": null,
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"userChapter": null,
"userNote": null,
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},
"conceptId": 3742,
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"highlights": [],
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"isLikedByMe": 0,
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"psaSectionId": null,
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"question": "A 17-year-old male presents to the ENT clinic with a history of recurrent tonsillitis. He wants to know more about tonsillectomy and if this would be an option for him.\n\nWhich of the following is an indication for tonsillectomy?",
"sbaAnswer": [
"a"
],
"totalVotes": 573,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,617 | false | 16 | null | 6,495,002 | null | false | [] | null | 12,612 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this man meets the criteria for a TACS, it is left-sided (most likely left middle or anterior cerebral artery). We know this because his hemiparesis is right-sided and the left hemisphere is responsible for right-sided motor control. Furthermore, the homonymous hemianopia described is right-sided, and the right visual fields are processed by the left hemisphere. Lastly, he suffers from Broca's aphasia which occurs due to damage to the Broca's area, which is located in the left frontal lobe in most people.",
"id": "10000327",
"label": "b",
"name": "Right Total Anterior Circulation Stroke",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has suffered a left total anterior circulation stroke (TACS). There are three criteria to diagnose a TACS: unilateral hemiparesis (+/- a sensory deficit) AND a homonymous hemianopia AND evidence of higher cerebral dysfunction (e.g. dysphasia or visuospatial dysfunction). This man has all three. Furthermore, his symptoms are right-sided (right hemiparesis, right homonymous hemianopia) and he suffers damage to Broca's area which is located in the dominant hemisphere. Therefore we know this man has had a left TACS.",
"id": "10000326",
"label": "a",
"name": "Left Total Anterior Circulation Stroke",
"picture": null,
"votes": 277
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is suffering from neither a right-sided stroke nor a PACS. This patient meets all 3 criteria for diagnosis of a TACS, whereas a PACS would be diagnosed if only 2 criteria were met. Additionally, this patient's hemiparesis is right-sided and the left hemisphere is responsible for right-sided motor control. Furthermore, the homonymous hemianopia described is right-sided, and the right visual fields are processed by the left hemisphere. Lastly, he suffers from Broca's aphasia which occurs due to damage to the Broca's area, which is located in the left frontal lobe in most people.",
"id": "10000329",
"label": "d",
"name": "Right Partial Anterior Circulation Stroke",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this man has suffered a left-sided stroke, he meets all criteria for diagnosis of a TACS, not a posterior circulation stroke (POCS). A POCS would be diagnosed if one of the following is present: cranial nerve palsy with contralateral motor/sensory deficit, bilateral motor/sensory deficit, conjugate eye movement disorder, evidence of cerebellar dysfunction, or isolated homonymous hemianopia.",
"id": "10000330",
"label": "e",
"name": "Left Posterior Circulation Stroke",
"picture": null,
"votes": 89
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this man has suffered a left-sided stroke, it involves the total anterior circulation, not partial anterior circulation. A partial anterior circulation stroke (PACS) features 2 of the 3 criteria for TACS. This patient features all criteria to diagnose a TACS however, so PACS is incorrect.",
"id": "10000328",
"label": "c",
"name": "Left Partial Anterior Circulation Stroke",
"picture": null,
"votes": 142
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3743",
"name": "Ischaemic Stroke",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 3743,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12612",
"isLikedByMe": null,
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"question": "A 67-year-old male presents to the emergency department with a 2-hour history of sudden onset right-sided weakness, difficulty forming words, and vision loss in both eyes. On examination, you identify right-sided hemiparesis, loss of the temporal visual fields in his right eye and nasal visual fields in his left eye. You also note that he has difficulty forming words, but the meaning is preserved. After further investigation, you diagnose an ischaemic stroke.\n\nWhich of the following stroke classifications has this patient suffered?",
"sbaAnswer": [
"a"
],
"totalVotes": 575,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,618 | false | 17 | null | 6,495,002 | null | false | [] | null | 12,613 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "In an acute ischaemic stroke setting, 300mg of aspirin is used rather than 1g. Furthermore, the provision of aspirin must be delayed until haemorrhagic stroke has been ruled out with brain imaging.",
"id": "10000333",
"label": "c",
"name": "Aspirin 1g",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE stroke and TIA guidelines state that a non-contrast CT head scan should be performed immediately for anyone suspected of an acute stroke who meets the following criteria:\n\n* Indications for thrombolysis/thrombectomy\n* On anticoagulant treatment\n* Known bleeding tendency\n* Depressed consciousness\n* Unexplained progressive or fluctuant symptoms\n* Papilloedema, neck stiffness or fever\n* Severe headache at symptom onset\n\nBrain imaging must be performed before the provision of aspirin as haemorrhagic stroke has to be ruled out.",
"id": "10000331",
"label": "a",
"name": "Non-contrast CT head",
"picture": null,
"votes": 356
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although aspirin forms an important part of stroke management, it is vital to rule out the presence of a haemorrhagic stroke before the provision of antiplatelet therapy. NICE and Royal College of Physician guidelines recommend the use of a non-contrast CT-head scan immediately to rule out bleeding before aspirin is prescribed.",
"id": "10000332",
"label": "b",
"name": "Aspirin 300mg",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this patient would fall under the time limit for thrombolysis, it is not the first step in the acute stroke management scenario. A non-contrast CT scan must be performed as soon as possible to rule out haemorrhage. After a diagnosis of haemorrhagic stroke has been ruled out and ischaemic stroke confirmed, other management options such as thrombolysis or thrombectomy can be considered and aspirin 300mg can be started.",
"id": "10000335",
"label": "e",
"name": "Thrombolysis",
"picture": null,
"votes": 93
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although brain imaging is vital to perform immediately to rule out haemorrhagic stroke, a non-contrast CT scan is performed and not an MRI. In the stroke management setting, time is vital and so the speed of a non-contrast CT makes it preferable to the slower MRI. CT scan also retains high sensitivity for haemorrhagic stroke so is a reliable rule-out tool.",
"id": "10000334",
"label": "d",
"name": "MRI head",
"picture": null,
"votes": 31
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3744",
"name": "Haemorrhagic Stroke",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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"question": "A 72-year-old female presents to the emergency department with a 1-hour history of sudden onset weakness of her right arm and leg, as well as facial drooping. On examination, you identify a right hemiparesis with sensory function intact. You suspect a diagnosis of stroke.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 582,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,619 | false | 18 | null | 6,495,002 | null | false | [] | null | 12,614 | {
"__typename": "QuestionSBA",
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diagnosis of multiple sclerosis requires the presence of white matter lesions disseminated in space and time. This requires the use of imaging, and an MRI has the highest sensitivity and positive predictive value. Although the presence of oligoclonal bands can be diagnostically useful, non-invasive investigations should be performed first.",
"id": "10000338",
"label": "c",
"name": "Lumbar puncture and CSF analysis",
"picture": null,
"votes": 115
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The most important diagnosis to rule out here is multiple sclerosis (MS). This patient has presented with optic neuritis and has previously experienced spontaneously remitting neurological abnormalities. A diagnosis of multiple sclerosis requires white matter lesions disseminated in space and time. The history has revealed symptoms disseminated in time. An MRI of the brain and spinal cord has the highest sensitivity for demyelinating white matter lesions disseminated in space and is therefore the best diagnostic investigation.",
"id": "10000336",
"label": "a",
"name": "MRI Brain and Spinal Cord",
"picture": null,
"votes": 371
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis in this patient is MS. This patient has presented with optic neuritis, which is a common first MS presentation and is characterized by reduced visual acuity and pain which is worse on eye movement. Ocular tonometry has no place in the diagnosis of MS and is much more likely to be used in the diagnosis of glaucoma.",
"id": "10000340",
"label": "e",
"name": "Ocular tonometry",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although evoked potential studies can be useful in the diagnosis of MS, the BMJ state they should typically be performed in patients for whom an MRI is contraindicated, which is not the case here. Evoked potential studies in a patient with MS typically demonstrate prolonged conduction.",
"id": "10000339",
"label": "d",
"name": "Evoked potential studies",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most likely diagnosis here is MS. Although imaging is required to confirm this diagnosis, CT scans have low positive predictive value for multiple sclerosis and are therefore much less suitable than an MRI.",
"id": "10000337",
"label": "b",
"name": "CT Head",
"picture": null,
"votes": 53
}
],
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"id": "3745",
"name": "Multiple Sclerosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"question": "A 31-year-old female presents to the outpatient neurology clinic with a 10-day history of vision loss in her left eye. She says that the eye is painful whenever she moves it. Upon taking her history, she reveals that 3 months ago she experienced a sensation of pins and needles in both legs that lasted 2 weeks and resolved spontaneously. Examination reveals no focal neurological abnormality but visual acuity in the left eye is reduced.\n\nWhich of the following is the best diagnostic investigation?",
"sbaAnswer": [
"a"
],
"totalVotes": 559,
"typeId": 1,
"userPoint": null
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173,459,620 | false | 19 | null | 6,495,002 | null | false | [] | null | 12,615 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is suffering from motor neuron disease which classically presents with both upper (UMN) and lower motor neuron (LMN) signs. In this patient, spastic weakness is a UMN sign and hyporeflexia is an LMN sign. Furthermore, motor neurone disease does not present with sensory signs or symptoms. Diagnosis is typically clinical and needs to be made by a specialist.",
"id": "10000341",
"label": "a",
"name": "Motor neuron disease",
"picture": null,
"votes": 303
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The diagnosis cannot be mononeuritis multiplex (MNM) for several reasons. Firstly, MNM is a peripheral nerve condition commonly caused by vasculitis and therefore presents only with LMN and sensory signs in the distribution of the affected nerve. This patient has UMN signs and so this is contrary to a diagnosis of MNM. Furthermore, MND does not present with sensory signs as it is characterised by progressive loss of motor, not sensory, neurons. Lastly, MNM commonly presents with neuropathic pain which is not present in this case.",
"id": "10000343",
"label": "c",
"name": "Mononeuritis multiplex",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has both UMN and LMN signs, which is pathognomonic of motor neuron disease. Multiple sclerosis typically only features UMN signs as it is a demyelinating disease of the central nervous system. Furthermore, MS is most common in females between the ages of 20-40, whereas the average age of MND diagnosis is ~57. Lastly, MS most commonly presents in a relapsing-remitting fashion though the less common subtype of primary progressive MS presents with progressive symptomatology.",
"id": "10000342",
"label": "b",
"name": "Multiple sclerosis",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Lumbosacral radiculopathy occurs as a result of nerve root compression or inflammation, commonly due to herniation of intervertebral discs. It commonly presents with back pain or radicular pain in the distribution of impinged nerve roots. This is an unlikely diagnosis as no pain is present in this case. Furthermore, because nerve roots are impinged, lumbosacral radiculopathy will only present with LMN signs, whereas both UMN and LMN signs are present in this case.",
"id": "10000345",
"label": "e",
"name": "Lumbosacral Radiculopathy",
"picture": null,
"votes": 148
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an important differential, myasthenia gravis (MG) cannot explain this presentation. MG is an autoimmune condition caused by antibodies against the acetylcholine receptors of the post-synaptic neuromuscular junction. The characteristic presentation of MG is fatigable weakness which is not described here. Furthermore, MG commonly affects the extra-ocular muscles due to their high concentration of ACh receptors, whereas MND classically spares these muscles. The BMJ also state that MG also does not present with specific UMN and LMN signs, which are present here.",
"id": "10000344",
"label": "d",
"name": "Myasthenia gravis",
"picture": null,
"votes": 69
}
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"name": "Motor neuron disease",
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"__typename": "Topic",
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"question": "A 56-year-old male presents to the clinic with a 6-week history of having difficulty climbing stairs which has gotten progressively worse. Examination reveals bilateral spastic leg weakness. Ankle jerk reflexes and patellar reflexes are absent but all other reflexes are present and normal. There are no identifiable sensory changes.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
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"totalVotes": 565,
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173,459,621 | false | 20 | null | 6,495,002 | null | false | [] | null | 12,616 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Parkinson's disease is a chronic neurological disorder characterised by the loss of dopaminergic neurons in the substantia nigra. This results in impairment of basal ganglia function and subsequent motor dysfunction. BMJ classify the classic triad of Parkinson's features as bradykinesia, rest tremor, and rigidity and these symptoms manifest as a consequence of basal ganglia impairment.",
"id": "10000346",
"label": "a",
"name": "Bradykinesia, rest tremor, rigidity",
"picture": null,
"votes": 541
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although these are all potential features of Parkinson's disease, these are atypical symptoms of early disease. Indeed, NICE suggest that symptoms such as recurrent falls and severe autonomic dysfunction may suggest a diagnosis of a different cause of parkinsonism, such as multiple system atrophy or progressive supranuclear palsy.",
"id": "10000347",
"label": "b",
"name": "Bradykinesia, autonomic dysfunction, recurrent falls",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "These symptoms indicate a \"Parkinson's plus\" diagnosis of Lewy body dementia. Lewy body dementia and Parkinson's disease have a close but complicated relationship and so it is important to differentiate the two. The BMJ recommend as a general rule that Parkinson's disease with dementia is diagnosed if Parkinson's was diagnosed at least 1 year before dementia onset and that Lewy body dementia should be diagnosed if dementia is present at symptom onset or within 1 year of parkinsonism onset.",
"id": "10000348",
"label": "c",
"name": "Cognitive impairment, bradykinesia, visual hallucinations",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the clinical triad of Wernicke's encephalopathy, a neurological condition caused by vitamin B1 (thiamine) deficiency.",
"id": "10000350",
"label": "e",
"name": "Altered mental status, gait ataxia, ophthalmoplegia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the classical clinical triad of normal pressure hydrocephalus, not Parkinson's disease. This is an important diagnosis to be aware of as it is one of the few reversible causes of dementia.",
"id": "10000349",
"label": "d",
"name": "Dementia, urinary incontinence, gait abnormalities",
"picture": null,
"votes": 7
}
],
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"name": "Parkinson's Disease",
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"typeId": 7
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"question": "A 66-year-old male presents to general practice as he has noticed changes in his movement. You suspect Parkinson's disease and refer him to neurology for specialist input.\n\nWhich of the following best characterises the classic triad of Parkinson's symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 567,
"typeId": 1,
"userPoint": null
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173,459,622 | false | 21 | null | 6,495,002 | null | false | [] | null | 12,617 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Astrocytes are one of the most populous cell types of the brain and central nervous system and maintain vital roles in CNS structure, neuronal metabolism, neurogenesis, maintenance of the blood-brain barrier and much more. They do not, however, produce myelin in the peripheral nervous system.",
"id": "10000354",
"label": "d",
"name": "Astrocytes",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Satellite glial cells are found within ganglia and are thought to play the role of the astrocyte within the PNS including support of neuronal metabolism. However, they are not involved in the production of myelin.",
"id": "10000355",
"label": "e",
"name": "Satellite glial cells",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Guillain-Barre syndrome is an acute inflammatory demyelinating disease of the peripheral nervous system (PNS). In the PNS, myelin is produced by Schwann cells.",
"id": "10000351",
"label": "a",
"name": "Schwann cells",
"picture": null,
"votes": 456
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The microglia cells are the immune cells of the central nervous system. Although they promote myelination by encouraging the differentiation of oligodendrocytes and clearing old myelin debris, they do not produce myelin themselves.",
"id": "10000353",
"label": "c",
"name": "Microglia",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Oligodendrocytes are the myelin-producing cells of the central nervous system (CNS). Therefore they are not involved in Guillain-Barre syndrome but do produce the myelin involved in multiple sclerosis.",
"id": "10000352",
"label": "b",
"name": "Oligodendrocytes",
"picture": null,
"votes": 95
}
],
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"name": "Guillain Barre",
"status": null,
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"__typename": "Topic",
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"name": "Neurology",
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"question": "A 45-year-old male presents with symmetrical ascending limb weakness which began in his legs and has progressed proximally. 2 weeks ago he suffered an episode of gastroenteritis. He is diagnosed with Guillain-Barre syndrome, an immune-mediated demyelinating disease.\n\nWhat cells produce the myelin involved in this disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 569,
"typeId": 1,
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173,459,623 | false | 22 | null | 6,495,002 | null | false | [] | null | 12,618 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A generalised tonic-clonic seizure is characterized by loss of consciousness followed by phases of limb stiffening (tonic) and limb jerking (clonic). Individuals suffering from generalised tonic-clonic seizures also suffer from aura and post-ictal symptoms. They may also experience urinary or bowel incontinence during the episode.",
"id": "10000358",
"label": "c",
"name": "Generalised tonic-clonic seizure",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an important differential, this patient is not suffering from absence seizures. Absence seizures can be differentiated from focal impaired awareness seizures through several factors: absence seizures typically last less than 60 seconds, focal impaired awareness seizures often have postictal states, and patients may have an aura before focal impaired awareness seizures. Absence seizures do not have an aura or postictal symptoms.",
"id": "10000357",
"label": "b",
"name": "Absence seizure",
"picture": null,
"votes": 311
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myoclonic seizures are characterised by brief, shock-like jerks of muscle groups. This patient does not express these muscle jerks, and so this is an unlikely diagnosis.",
"id": "10000360",
"label": "e",
"name": "Myoclonic seizure",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this individual is suffering from focal seizures, the history indicates a loss of awareness during seizure episodes. Therefore the diagnosis is unlikely to be focal aware seizures",
"id": "10000359",
"label": "d",
"name": "Focal aware seizure",
"picture": null,
"votes": 39
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This young patient is suffering from focal impaired awareness epilepsy. Focal seizures arise in one portion of the brain. Focal impaired awareness seizures are characterized by loss of awareness, memory loss, pre-seizure aura, and post-ictal symptoms, and individuals may express automatisms during the seizure.",
"id": "10000356",
"label": "a",
"name": "Focal impaired awareness seizure",
"picture": null,
"votes": 185
}
],
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"chapterId": 2693,
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"id": "3749",
"name": "Epilepsy",
"status": null,
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"topicId": 141,
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"question": "A 12-year-old female presents to general practice with her mother, who reports that teachers have mentioned her daughter has been losing awareness in class. These episodes last 90-120 seconds, during which she chews her lip. The girl states she can feel something is wrong beforehand but does not remember anything that happens during the episode. She always feels confused and disorientated afterwards. After referral to secondary care, she is diagnosed with epilepsy.\n\nWhich of the following most accurately describes her seizure classification?",
"sbaAnswer": [
"a"
],
"totalVotes": 559,
"typeId": 1,
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} | MarksheetMark |
173,459,624 | false | 23 | null | 6,495,002 | null | false | [] | null | 12,619 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hydrocephalus is another important differential, however, is not the most likely diagnosis here. Although hydrocephalus would present with evidence of raised ICP, localised prefrontal symptoms are unlikely to be present (though cognitive impairment may be). Furthermore, adult-onset hydrocephalus typically presents with gait disturbance and incontinence, which are not present in this presentation.",
"id": "10000365",
"label": "e",
"name": "Adult-onset hydrocephalus",
"picture": null,
"votes": 141
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an unlikely diagnosis here. Alzheimer's typically presents with early memory dysfunction and loss of executive function. Personality is typically preserved until later in the disease progression. Furthermore, Alzheimer's does not present with signs of raised intracranial pressure.",
"id": "10000364",
"label": "d",
"name": "Alzheimer's disease",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with evidence of raised intracranial pressure such as morning headaches and papilloedema. Other signs of raised ICP include nausea, vomiting, reduced consciousness and gait disturbance. This patient has also presented with personality change and emotional lability, which are both signs of a pre-frontal cortex involvement (situated in the frontal lobe).",
"id": "10000361",
"label": "a",
"name": "Frontal lobe tumour",
"picture": null,
"votes": 284
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an important differential as frontotemporal dementia can manifest as personality change and emotional lability, this patient has evidence of a space-occupying lesion due to papilloedema. As frontotemporal dementia does not result in raised ICP, it is not the correct diagnosis here.",
"id": "10000362",
"label": "b",
"name": "Frontotemporal dementia",
"picture": null,
"votes": 86
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A parietal lobe tumour would not result in personality change and emotional symptoms. Parietal lobe tumours typically present with sensory changes, visual field defects, and left-right neglect/confusion.",
"id": "10000363",
"label": "c",
"name": "Parietal lobe tumour",
"picture": null,
"votes": 34
}
],
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"id": "3750",
"name": "Space occupying lesion",
"status": null,
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"topicId": 141,
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"question": "A 68-year-old female presents to the clinic with her husband. She reports a recent history of morning headaches. Her husband also reports that she has become more aggressive and often swings from joy to anger suddenly and without provocation. Examination reveals no motor or sensory abnormalities but fundoscopy revealed papilloedema.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 555,
"typeId": 1,
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173,459,625 | false | 24 | null | 6,495,002 | null | false | [] | null | 12,620 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although streptococcus pneumoniae is one of the most common causes of bacterial meningitis, this patient is suffering from viral meningitis. CSF analysis of bacterial meningitis is characterised by:\n\n* Cloudy or turbid appearance\n* Low glucose\n* Elevated WCC, predominantly polymorphs\n* Elevated protein\n* Elevated opening pressure",
"id": "10000368",
"label": "c",
"name": "Streptococcus pneumoniae",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this young patient is indeed suffering from a case of viral meningitis, enteroviruses are the most common cause of viral meningitis and are therefore the most likely causative organism.",
"id": "10000367",
"label": "b",
"name": "Herpes simplex virus",
"picture": null,
"votes": 136
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cryptococcus neoformans is the most common cause of fungal meningitis. Fungal meningitis is an unlikely presentation in individuals with no history of immunosuppression and usually presents with systemic involvement. Furthermore, the CSF analysis does not support a diagnosis of fungal meningitis, which is characterised by:\n\n* Cloudy appearance\n* Low glucose\n* Elevated, predominantly lymphocytes\n* Elevated protein\n* Elevated opening pressure",
"id": "10000370",
"label": "e",
"name": "Cryptococcus neoformans",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another organism commonly implicated in meningitis, this bacteria is unlikely to be the cause due to the results of the CSF analysis which indicate viral meningitis.",
"id": "10000369",
"label": "d",
"name": "Neisseria meningitidis",
"picture": null,
"votes": 229
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This young patient is suffering from viral meningitis. Enteroviruses are the most common cause of viral meningitis. CSF analysis of viral meningitis is characterised by:\n\n* Clear appearance\n* Normal glucose\n* Elevated WCC, predominantly lymphocytes\n* Normal or raised protein\n* Normal or elevated opening pressure",
"id": "10000366",
"label": "a",
"name": "Enterovirus",
"picture": null,
"votes": 141
}
],
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"id": "3751",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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"question": "An 11-year-old male presents to the emergency department with a 6-hour history of gradual-onset severe headache and fever. On examination, you identify nuchal rigidity. You suspect meningitis and perform a lumbar puncture to obtain a CSF sample.\n\n\n||||\n|---------------------------------|:-------:|-------------------------|\n|Opening Pressure|normal|50 - 180|\n|Total Protein|0.54 g/L|0.15 - 0.45|\n|Glucose|3.4 mmol/L|3.2 - 4.4|\n|Lymphocyte Count|546/ µL|<5/ µL|\n|Plasma Glucose|4.9 mmol/L|3.5 - 5.5|\n\n\n * CSF Appearance: Clear\n\n\nWhich of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 564,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,626 | false | 25 | null | 6,495,002 | null | false | [] | null | 12,621 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Metformin is a very unlikely cause of AKI in this patient. Metformin is not inherently nephrotoxic so is not a cause of AKI. It is, however, important to be aware of metformin in AKI as most metformin excretion is performed by the kidneys, therefore the risk of toxicity is increased when kidney function is impaired.",
"id": "10000374",
"label": "d",
"name": "Metformin",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Nephrolithiasis is not a likely cause of AKI in this patient. Kidney stones classically present with acute renal colic which manifests as acute, severe loin-to-groin pain. There is no pain reported in this patient which makes obstructive nephrolithiasis an unlikely diagnosis. Furthermore, the presence of clinical fluid depletion and ongoing high volume vomiting should indicate an underlying cause of hypovolaemia.",
"id": "10000375",
"label": "e",
"name": "Nephrolithiasis",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although ACE inhibitors can cause AKI, it is not the most likely cause here. ACEis cause AKI by dilating the efferent renal arteriole, thereby reducing glomerular hydrostatic pressure. However, hypovolaemia is a far more likely underlying cause, given the acute history of fluid loss from vomiting and the subsequent clinical manifestation of hypovolaemia.",
"id": "10000372",
"label": "b",
"name": "Ramipril",
"picture": null,
"votes": 129
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another important risk factor for AKI, diabetic nephropathy is important to keep in mind. Diabetic nephropathy is a significant risk factor for chronic kidney disease, which in turn increases the risk of AKI. However, this patient's diabetes is well-controlled and CKD caused by diabetes would likely have been identified on admission blood tests. On top of this, the acute history of vomiting is a far more likely cause of AKI, given the clinical evidence of fluid depletion.",
"id": "10000373",
"label": "c",
"name": "Diabetic nephropathy",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient's acute kidney injury (AKI) has occurred secondary to hypovolaemia caused by her recent history of vomiting. Hypovolaemia and hypotension are common causes of pre-renal AKI and may be caused by sepsis, fluid loss, or poor fluid intake (especially in frail patients). AKI should be diagnosed in patients featuring any of the following:\n\n* Rise in serum creatinine of ≥26µmol/L within 48 hours\n* Rise in serum creatinine to ≥1.5x baseline within 7 days\n* A fall in urine output to <0.5ml/kg/hr for more than 6 hours",
"id": "10000371",
"label": "a",
"name": "Hypovolaemia",
"picture": null,
"votes": 315
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3752",
"name": "Acute Kidney Injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"question": "You are asked to assess a 44-year-old female patient on the ward who has not improved since admission. She was admitted 2 days ago with a 24-hour history of high volume vomiting. This has continued throughout her admission, for a total of 3 days.\n\n\nOn examination her mucosal membranes are dry and she has reduced skin turgor.\n\n\nAfter bedside observations, you note that she has a blood pressure of 98/71 mmHG, a heart rate of 132 bpm, and a temperature of 36.5C. Blood tests reveal that her creatinine has increased by 40µmol/L since admission (normal range 60-120 µmol/L).\n\n\nShe has a 2-year history of hypertension and well-controlled diabetes for which she takes ramipril and metformin respectively. Which of the following is the most likely cause of her acute kidney injury?",
"sbaAnswer": [
"a"
],
"totalVotes": 553,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,627 | false | 26 | null | 6,495,002 | null | false | [] | null | 12,622 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stage 5 CKD is diagnosed when eGFR = <15ml/min. This represents kidney failure and at this stage, patients require renal replacement therapy which takes the form of either dialysis or kidney transplant. Haemodialysis is the most common type of renal replacement therapy and involves the filtration of the patient's blood through a dialysis machine.",
"id": "10000380",
"label": "e",
"name": "Stage 5",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Stage 4 CKD covers an eGFR range of 15-29ml/min. This represents a severe reduction in kidney function. Typically CKD remains asymptomatic until the kidney function is severely reduced.",
"id": "10000376",
"label": "a",
"name": "Stage 4",
"picture": null,
"votes": 373
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stage 3a CKD is diagnosed when eGFR = 45-59ml/min and represents a mild to moderate reduction in kidney function.",
"id": "10000378",
"label": "c",
"name": "Stage 3a",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stage 1 CKD is indicated by an eGFR >90ml/min PLUS evidence of renal dysfunction on other tests. If there is no other evidence of renal dysfunction, CKD is not present as eGFR >90ml/min is an otherwise normal result.",
"id": "10000377",
"label": "b",
"name": "Stage 1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Stage 3b CKD is diagnosed when eGFR = 30-44ml/min and represents a moderate to severe reduction in kidney function.",
"id": "10000379",
"label": "d",
"name": "Stage 3b",
"picture": null,
"votes": 75
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3753",
"name": "Chronic kidney disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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},
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"question": "A 67-year-old male presents to General Practice with a 3-month history of lethargy and fatigue. His past medical history is significant for poorly controlled type 2 diabetes. You suspect he may be suffering from chronic kidney disease (CKD) as a consequence of his diabetes. After further investigation, you establish an eGFR of 25ml/min.\n\nWhich of the following best describes his classification of CKD?",
"sbaAnswer": [
"a"
],
"totalVotes": 515,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,628 | false | 27 | null | 6,495,002 | null | false | [] | null | 12,623 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, indeed the opposite is happening in this patient. ADH recruits aquaporin-2 channels in the distal tubule and collecting ducts of the kidney, thereby allowing water reabsorption. This patient's urine is too dilute, therefore the problem cannot be caused by increased secretion of ADH. Syndrome of inappropriate ADH secretion (SIADH) is a separate clinical entity characterised by increased ADH secretion causing excessive water retention and subsequently reduced serum osmolality.",
"id": "10000383",
"label": "c",
"name": "Increased secretion of ADH",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is suffering from cranial diabetes insipidus. Several factors point towards this diagnosis: polyuria, increased serum osmolality, low urine osmolality, and urine osmolality responsive to desmopressin. Cranial DI occurs due to decreased anti-diuretic hormone (ADH) secretion from the pituitary gland. This results in impaired recruitment of aquaporin-2 channels in the distal tubule and collecting duct, resulting in an inability to concentrate urine.",
"id": "10000381",
"label": "a",
"name": "Reduced anti-diuretic hormone secretion from the pituitary gland",
"picture": null,
"votes": 344
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary aldosteronism (AKA Conn's syndrome) is characterised by excess production of aldosterone, causing an excess exchange of potassium for sodium in the nephron. This results in hypernatraemia, hypertension, and hypokalaemia. However, this is unlikely to be the underlying cause as this patient demonstrates low urine osmolality which responds to desmopressin - a hallmark of cranial DI.",
"id": "10000384",
"label": "d",
"name": "Excess aldosterone production",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An important polyuria differential, though not the case here. T2DM is characterised by elevated plasma glucose. T2DM does not typically feature elevated serum osmolality combined with reduced urine osmolality and is therefore not the diagnosis.",
"id": "10000385",
"label": "e",
"name": "Type 2 diabetes mellitus",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this describes one potential mechanism of diabetes insipidus, impaired kidney response to ADH is the hallmark of nephrogenic DI. This patient is instead suffering from cranial DI. The two causes of diabetes insipidus can be differentiated by the desmopressin test. As this patient's kidneys have responded to desmopressin (an exogenous ADH analogue) as indicated by the subsequent significant increase in urine osmolality, renal response to ADH is intact. Therefore the pathology must lie elsewhere, confirming the diagnosis of cranial DI.",
"id": "10000382",
"label": "b",
"name": "Impaired kidney response to anti-diuretic hormone",
"picture": null,
"votes": 68
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3754",
"name": "Diabetes insipidus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3754,
"conditions": [],
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"dislikes": 0,
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"highlights": [],
"id": "12623",
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"question": "A 51-year-old female presents to general practice with a 3-week history of polyuria. She reports no other urinary symptoms. Examination is normal apart from slightly reduced skin turgor. Further investigation reveals:\n\n* Serum osmolality 312 mOsmol/kg (275-295 mOsmol/kg)\n* Urine osmolality 91 mOsmol/kg (50-1200 mOsmol/kg)\n* Urine osmolality 760 mOsmol/kg after administration of desmopressin\n\nWhich of the following best describes the pathophysiological mechanism behind this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 500,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,629 | false | 28 | null | 6,495,002 | null | false | [] | null | 12,624 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "There is no lateral zone of the prostate. The three recognised zones are central, transitional, and peripheral. The fibromuscular stroma of the prostate is sometimes considered the fourth zone.",
"id": "10000389",
"label": "d",
"name": "Lateral zone",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The fibromuscular stroma is sometimes considered to be the fourth zone of the prostate. It is situated at the anterior of the gland and merges with the urogenital diaphragm. Prostatic malignancy does not typically arise in the fibromuscular stroma.",
"id": "10000390",
"label": "e",
"name": "Stromal zone",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Prostate cancer most commonly arises in the peripheral zone of the prostate (70-80%). The prostate has three zones: central, transitional, and peripheral. The peripheral zone is the largest zone of the prostate, making up approximately 65% of the total volume and lies to the posterior of the gland, anterior to the rectum. Prostate malignancy is most commonly adenocarcinoma.",
"id": "10000386",
"label": "a",
"name": "Peripheral Zone",
"picture": null,
"votes": 327
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Only ~20% of prostate malignancies arise in the transitional zone. The transitional zone encircles the urethra. Although not the most common location for malignancy, the transitional zone is the most common zone for benign prostatic hyperplasia to arise.",
"id": "10000387",
"label": "b",
"name": "Transitional zone",
"picture": null,
"votes": 113
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This zone has the lowest occurrence of prostate malignancy, with only ~5% of malignancies occurring in this zone. The central zone surrounds the ejaculatory ducts.",
"id": "10000388",
"label": "c",
"name": "Central zone",
"picture": null,
"votes": 24
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3755",
"name": "Prostate cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "143",
"name": "Urology",
"typeId": 7
},
"topicId": 143,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"videos": []
},
"conceptId": 3755,
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"highlights": [],
"id": "12624",
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"question": "A 76-year-old male presents to General Practice with a 3-month history of urinary hesitancy and frequency. He does not report any other symptoms. Digital rectal examination reveals an asymmetrical, hard, nodular prostate. You suspect a diagnosis of prostate cancer and arrange an urgent referral to urology.\n\nWhich of the following zones of the prostate is most commonly involved in malignancy?",
"sbaAnswer": [
"a"
],
"totalVotes": 485,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,630 | false | 29 | null | 6,495,002 | null | false | [] | null | 12,625 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Loss of HCl (stomach acid) can occur through high volume vomiting and results in the depletion of the body's H+ ions. This can result in a metabolic alkalosis. However, this is an unlikely cause of this patient's presentation as he has presented with a respiratory alkalosis. The ABG results of a metabolic alkalosis appear as follows:\n\n* Elevated pH\n* Normal PaO2\n* Normal PaCO2 (or increased in compensation)\n* Elevated HCO3-\n* Elevated base excess",
"id": "10000393",
"label": "c",
"name": "Loss of hydrogen ions",
"picture": null,
"votes": 160
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Benzodiazepines suppress the respiratory centres, causing respiratory acidosis. This patient has presented with respiratory alkalosis caused by stimulation of the respiratory centres due to salicylate overdose. Respiratory suppression results in the retention of CO2, which causes acidosis. The ABG results of a respiratory acidosis appear as follows:\n\n* Elevated pH\n* Reduced PaO2\n* Elevated PaCO2\n* Elevated HCO3- if compensated\n* Elevated base excess if compensated",
"id": "10000394",
"label": "d",
"name": "Benzodiazepine overdose",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetic ketoacidosis (DKA) presents with metabolic acidosis, whereas this patient suffers from respiratory alkalosis, therefore DKA cannot be the cause of this patient's presentation. The ABG results of a metabolic acidosis typically appear as:\n\n* Reduced pH\n* PaO2 normal or may be increased if compensation\n* PaCO2 normal or may be decreased if compensated\n* Reduced HCO3-\n* Low base excess",
"id": "10000392",
"label": "b",
"name": "Diabetic ketoacidosis",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with a respiratory alkalosis secondary to salicylate poisoning. In the early stages of salicylate poisoning, stimulation of respiratory centres results in respiratory alkalosis as CO2 is blown off before metabolic acidosis manifests later due to the direct toxicity of salicylates. Salicylate poisoning presents with hyperventilation, nausea, vomiting, abdominal pain, tinnitus, confusion, and tachycardia. Severe poisoning can cause cerebral and pulmonary oedema, followed by death.",
"id": "10000391",
"label": "a",
"name": "Salicylate poisoning",
"picture": null,
"votes": 140
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Similarly to benzodiazepine overdose, opiates cause suppression of the respiratory centres. This results in hypoventilation and subsequent CO2 retention, which manifests as respiratory acidosis.",
"id": "10000395",
"label": "e",
"name": "Opiate overdose",
"picture": null,
"votes": 94
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3756",
"name": "ABG Analysis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
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"videos": []
},
"conceptId": 3756,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "12625",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 1,
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"question": "A 24-year-old male is brought to the emergency department by his flatmate. The flatmate reports that he found the patient vomiting and confused 40 minutes ago and immediately brought him to the hospital. On assessment, the patient is confused and is only able to report that he feels nauseous and unwell. You note that his respiratory rate is 27 and his heart rate is 92bpm. You perform further investigations, including an arterial blood gas. The results are as follows:\n\n* pH: 7.48 (7.35 - 7.45)\n* Pa02: 14kPa (11 - 13)\n* PaCO2: 3.1kPa (4.7 - 6.0)\n* HCO3-: 25 (22 - 26)\n* Base excess: +2 (-2 - +2)\n\nWhich of the following is the most likely cause of this patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 493,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,631 | false | 30 | null | 6,495,002 | null | false | [] | null | 12,626 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Staphylococcus saprophyticus is the second most common cause of urinary tract infection, accounting for 5-20% of cases.",
"id": "10000398",
"label": "c",
"name": "Staphylococcus saprophyticus",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Candida is an uncommon cause of lower urinary tract infections UTI). Candida UTI typically only occurs in individuals with indwelling catheters or who are immunosuppressed.",
"id": "10000399",
"label": "d",
"name": "Candida",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudomonas aeruginosa is another less common organism implicated in urinary tract infections and may be more likely to cause complicated infections.",
"id": "10000400",
"label": "e",
"name": "Pseudomonas aeruginosa",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Proteus mirabilis is an uncommon cause of urinary tract infection and is associated with renal tract abnormalities.",
"id": "10000397",
"label": "b",
"name": "Proteus mirabilis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a classical presentation of a lower urinary tract infection. NICE estimates that 70-95% of lower urinary tract infections are caused by Escherichia coli. Simple lower urinary tract infections are treated with trimethoprim or nitrofurantoin for 3 days in female patients or 7 days in male patients due to the longer male urethra.",
"id": "10000396",
"label": "a",
"name": "Escherichia coli",
"picture": null,
"votes": 438
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3757",
"name": "Urinary Tract Infection",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
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"highlights": [],
"id": "12626",
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"question": "A 32-year-old female presents to General Practice with a 5-day history of dysuria and urinary frequency. Examination reveals suprapubic tenderness.\n\nWhat is the most likely causative organism of this patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 498,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,632 | false | 31 | null | 6,495,002 | null | false | [] | null | 12,627 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has developed secondary hyperparathyroidism as a consequence of his chronic kidney disease. Vitamin D is synthesized in the kidneys and is vital in maintaining calcium homeostasis. When renal function is impaired, the body cannot adequately synthesize vitamin D and the body struggles to absorb sufficient calcium as a result. Furthermore, the dysfunctional kidney cannot excrete sufficient phosphate, which ionizes with calcium in the blood and reduces the amount of free calcium available. These two mechanisms result in low serum calcium, which leads to excess parathyroid hormone production. Secondary hyperparathyroidism is now established. Elevated PTH causes excess mobilization of calcium from bones and subsequent mineral bone disease.",
"id": "10000401",
"label": "a",
"name": "Elevated PTH, Low Ca2+, Elevated phosphate, Low vitamin D",
"picture": null,
"votes": 290
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This blood profile is characteristic of primary hypoparathyroidism. Deficient PTH secretion results in reduced calcium mobilization as well as reduced excretion of phosphate, which ionizes with calcium in the blood and further reduces the availability of free calcium. Primary hypoparathyroidism occurs due to impaired function of the parathyroid gland, for example as a result of iatrogenic causes such as thyroid surgery.",
"id": "10000404",
"label": "d",
"name": "Low PTH, Low Ca2+, Elevated phosphate, Normal vitamin D",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This profile of blood test results suggests inappropriately elevated calcium in absence of a parathyroid cause. Further investigation is required to rule out important diagnoses such as hypercalcaemia of malignancy.",
"id": "10000403",
"label": "c",
"name": "Low PTH, Elevated CA2+, Low phosphate, Normal vitamin D",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This combination of results is unlikely to occur in a patient suffering from CKD. Elevated PTH concurrent with elevated Ca2+ indicates primary hyperparathyroidism whilst elevated phosphate indicates renal dysfunction. An elevated vitamin D, however, is unlikely to occur in renal dysfunction as the kidney is responsible for synthesizing the vitamin. Therefore this combination of results would not occur in a stage 5 CKD patient.",
"id": "10000405",
"label": "e",
"name": "Elevated PTH, Elevated Ca2+, Elevated phosphate, Elevated vitamin D",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This profile suggests primary hyperparathyroidism, which most commonly occurs due to parathyroid adenoma rather than CKD. Primary hyperparathyroidism is characterised by inappropriately elevated PTH - i.e. in the presence of low calcium. This usually occurs due to the presence of an adenoma or carcinoma which uncontrollably excretes PTH.",
"id": "10000402",
"label": "b",
"name": "Elevated PTH, Elevated Ca2+, Low phosphate, Normal vitamin D",
"picture": null,
"votes": 77
}
],
"comments": [],
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"demo": null,
"entitlement": null,
"id": "3753",
"name": "Chronic kidney disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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"question": "A 67-year-old patient with stage 5 chronic kidney disease presents to the clinic for a scheduled check-up on his condition. He does not report any symptoms but his blood test results reveal that he has developed a complication of CKD and is at risk of developing renal osteodystrophy as a result. His previous check-up one year ago was normal.\n\nWhich of the following sets of results most accurately reflect this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 483,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,633 | false | 32 | null | 6,495,002 | null | false | [] | null | 12,628 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although potentially an alarming symptom, oozing or bleeding only constitutes a minor criterion on the weighted 7-point checklist of pigmented skin lesion assessment.",
"id": "10000408",
"label": "c",
"name": "Oozing or bleeding",
"picture": null,
"votes": 68
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A pigmented skin lesion should be assessed using the weighted 7-point checklist. Using this method, a diameter of >7mm is only a minor criterion and therefore less suggestive than major criteria such as a change in size.",
"id": "10000407",
"label": "b",
"name": "Diameter > 7mm",
"picture": null,
"votes": 90
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE recommend the use of the weighted 7-point checklist for the assessment of skin lesions. The checklist consists of 3 major criteria and 4 minor criteria.\n\nMajor criteria:\n* Change in size of the lesion\n* Irregular shape\n* Irregular colour\n\nMinor criteria:\n* Diameter > 7mm\n* Inflammation\n* Oozing or bleeding\n* Change in sensation\n\nOf the options, change in the size of the lesion is the only major criterion and is therefore most indicative of melanoma.",
"id": "10000406",
"label": "a",
"name": "Change in size",
"picture": null,
"votes": 302
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inflammation can be an alarming symptom but is only a minor criterion on the weighted 7-point checklist.",
"id": "10000409",
"label": "d",
"name": "Inflammation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Altered sensation (e.g. numbness or tingling) around the site of a lesion constitutes a minor criterion on the weighted 7-point checklist.",
"id": "10000410",
"label": "e",
"name": "Altered sensation on/around the lesion",
"picture": null,
"votes": 41
}
],
"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": "3758",
"name": "Malignant Melanoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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"question": "A 60-year-old female presents to General Practice with a suspicious mole on her back which she noticed 2 weeks ago. She is concerned about malignant melanoma.\n\nWhich of the following would be most suggestive of a malignant melanoma?",
"sbaAnswer": [
"a"
],
"totalVotes": 501,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,634 | false | 33 | null | 6,495,002 | null | false | [] | null | 12,629 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Guttate psoriasis is the second most common presentation of psoriasis in children (after chronic plaque psoriasis). It classically occurs 2-4 weeks after a streptococcal infection and manifests as multiple small papules which are pink, scaly, and teardrop shape in appearance. Guttate psoriasis is often the first presentation of psoriasis.",
"id": "10000411",
"label": "a",
"name": "Guttate psoriasis",
"picture": null,
"votes": 301
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Tinea corporis (also known as ringworm) is an unlikely diagnosis here. Tinea corporis is a fungal skin infection caused by *Trichophyton* species and presents with a well-defined ring-shaped lesion which may have pustules or papules. Guttate psoriasis on the other hand presents with multiple, small, tear-drop-shaped scales and characteristically is preceded by streptococcal infection.",
"id": "10000415",
"label": "e",
"name": "Tinea corporis",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An important differential, pityriasis rosea is a common skin condition characterised by oval-shaped scaly patches that commonly occur after an upper respiratory tract infection. One of the most important differentiating factors between pityriasis rosea and guttate psoriasis is the presence of a herald patch in pityriasis rosea. A herald patch is a single patch that appears in pityriasis rosea a few days before the onset of more widespread skin involvement.",
"id": "10000412",
"label": "b",
"name": "Pityriasis rosea",
"picture": null,
"votes": 87
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Generalized pustular psoriasis (GPP) is a life-threatening dermatological condition. It is a rare form of psoriasis characterized by acute-onset, widespread erythema and the subsequent appearance of non-follicular pustules. GPP also often presents with systemic features such as fever, fatigue, nausea, and tachycardia. Guttate psoriasis, on the other hand, is typically a self-resolving condition that often disappears after several weeks without intervention. Furthermore, GPP does not present with tear-drop lesions, but rather a widespread erythema. It is therefore not the most likely diagnosis.",
"id": "10000414",
"label": "d",
"name": "Generalized pustular psoriasis",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although chronic plaque psoriasis is the most common presentation of psoriasis, it is not the diagnosis here. Chronic plaque psoriasis classically presents with well-demarcated, scaly, erythematous plaques that most commonly manifest over extensor surfaces, the trunk, the scalp, and the buttocks. The tear-drop morphology of the lesions and the history of streptococcal infection suggest guttate psoriasis over chronic plaque psoriasis in this case.",
"id": "10000413",
"label": "c",
"name": "Chronic plaque psoriasis",
"picture": null,
"votes": 10
}
],
"comments": [],
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"__typename": "Chapter",
"explanation": null,
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3759",
"name": "Guttate psoriasis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
"totalCards": null,
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"__typename": "Picture",
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"createdAt": 1682079367,
"id": "1501",
"index": 0,
"name": "guttate_psoriasis.jpg",
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"id": "144",
"name": "Dermatology",
"typeId": 7
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"topicId": 144,
"updatedAt": 1708373886
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"question": "A 13-year-old boy presents to General Practise with his mother, who reports a 2-day history of spots across the back and chest. She also reports that he suffered from a sore throat 2 weeks ago which was treated with antibiotics. On examination, you note multiple small lesions across the boy's torso. They are teardrop-shaped, pink, and scaly in appearance.\n\n[lightgallery]\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 476,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,635 | false | 34 | null | 6,495,002 | null | false | [] | null | 12,630 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a very important differential for any suspicious skin lesion, this patient does not have a malignant melanoma. Melanomas have varied appearances which are dependent on classification. The most common type of melanoma is superficial spreading which presents as a flat, irregular pigmented lesion. Other types of melanoma include nodular, lentigo maligna, acral lentiginous, amelanotic and many others. This patient, however, has presented with a classic basal cell carcinoma which can be identified by its central depression, telangiectasia and pearly rolled border in an area of sun-exposed skin.",
"id": "10000418",
"label": "c",
"name": "Malignant melanoma",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Actinic keratosis is a premalignant skin condition characterised by the presence of a small, scaly lesion found in an area of sun-damaged skin. Although this patient has the sun exposure risk factor for actinic keratosis, the lesion is not scaled and instead has a central depression and pearly, rolled border which is characteristic of basal cell carcinoma.",
"id": "10000417",
"label": "b",
"name": "Actinic Keratosis",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cutaneous squamous cell carcinoma is a common skin malignancy arising from keratinocytes of the skin. As opposed to this patient's lesion, SCCs present as outwardly growing or sometimes ulcerated skin lesions which may be itchy or tender. SCCs sometimes grow from existing areas of skin trauma and commonly arise from areas of skin damage. However, this patient has presented with a centrally depressed skin lesion featuring a pearly rolled edge which is not found in SCC, therefore the diagnosis must be BCC.",
"id": "10000419",
"label": "d",
"name": "Cutaneous squamous cell carcinoma",
"picture": null,
"votes": 64
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A seborrhoeic keratosis (SK) is a common benign skin lesion which classically appears as a well-defined keratinous growth which is often described as having a \"stuck-on\" appearance. However, this patient has not presented with a keratinous growth, but rather with a centrally depressed lesion with a pearly-rolled border which is much more typical of basal cell carcinoma.",
"id": "10000420",
"label": "e",
"name": "Seborrheic Keratosis",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has a classical presentation of basal cell carcinoma (BCC). BCCs typically develop over sun-exposed skin such as the face and neck. There are several types of BCC. The most common is the nodular BCC which classically presents with a central depression with a pearly, rolled border. There may be telangiectasia across the centre. Other types of BCC include superficial, morphoeic, and basosquamous.",
"id": "10000416",
"label": "a",
"name": "Basal cell carcinoma",
"picture": null,
"votes": 344
}
],
"comments": [],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3760",
"name": "Basal cell carcinoma",
"status": null,
"topic": {
"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
},
"topicId": 144,
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"highlights": [],
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"__typename": "Picture",
"caption": null,
"createdAt": 1682079367,
"id": "1502",
"index": 0,
"name": "basal_cell_carcinoma.jpg",
"overlayPath": null,
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"overlayPath512": null,
"path": "images/isl37ybl1682079428853.jpg",
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"thumbhash": "4DgOFQSfeHaHWHZod3Z4h2B3ZWUG",
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"__typename": "Topic",
"id": "144",
"name": "Dermatology",
"typeId": 7
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"topicId": 144,
"updatedAt": 1708373886
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],
"prescribeAnswer": null,
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"qaAnswer": null,
"question": "A 60-year-old male presents to General Practice with a skin lesion on the back of his neck which he noticed 3 weeks ago. The patient recently returned to the UK after living and working in Spain for 20 years. On examination, you identify a 4mm skin lesion with a red central depression and a pearly rolled border.\n\n[lightgallery]\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 475,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,636 | false | 35 | null | 6,495,002 | null | false | [] | null | 12,631 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Reassurance and discharge are not appropriate in this setting. This patient has presented with an abnormal fasting blood glucose result (>7.0 mmol/L) which requires follow-up before a diagnosis of T2DM can be confirmed or excluded.",
"id": "10000423",
"label": "c",
"name": "Reassure and discharge",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this patient requires additional investigation before a diagnosis of T2DM can be made, NICE recommend the use of the original abnormal test. In this case, it is therefore recommended to perform an additional fasting blood glucose test.",
"id": "10000424",
"label": "d",
"name": "Arrange follow-up HbA1c testing in 2 weeks",
"picture": null,
"votes": 214
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "As this patient has presented without symptoms and only one abnormal blood test has been produced, NICE state it is inappropriate to diagnose T2DM in this patient. In asymptomatic patients, two abnormal blood tests are required. In symptomatic patients, only one abnormal blood test is required.",
"id": "10000422",
"label": "b",
"name": "Diagnose type 2 diabetes mellitus and discuss treatment options",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE recommend that type 2 diabetes mellitus (T2DM) should not be diagnosed in asymptomatic patients based on a single abnormal test. Diagnosis of T2DM requires either presence of symptoms and one abnormal test (i.e. random blood glucose, fasting blood glucose, HbA1c), or two abnormal tests if asymptomatic. This patient has presented asymptomatically and therefore requires an additional abnormal test result.",
"id": "10000421",
"label": "a",
"name": "Arrange a follow-up fasting blood glucose test in 2 weeks",
"picture": null,
"votes": 190
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although lifestyle modification is an important aspect of T2DM management and should be discussed with all patients, it is not the most appropriate next step in this case. This patient has presented with an elevated fasting blood glucose which requires swift follow-up to confirm or eliminate a diagnosis of type 2 diabetes mellitus.",
"id": "10000425",
"label": "e",
"name": "Provide lifestyle advice and follow up in 6 months",
"picture": null,
"votes": 57
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3761",
"name": "Type 2 Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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"conceptId": 3761,
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"difficulty": 1,
"dislikes": 3,
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"question": "A 51-year-old male attends a regular health check-up as part of his work. He reports no symptoms. Examination and observations are both normal, however, blood glucose testing reveals a fasting blood glucose of 8.2 mmol/L (normal range 3.5-5.5 mmol/L).\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 491,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,637 | false | 36 | null | 6,495,002 | null | false | [] | null | 12,632 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although this patient is indeed expressing signs and symptoms of hypovolaemic shock (tachycardia, hypotension), the underlying cause is an adrenal crisis which is therefore the most correct answer. Adrenal crisis is one of the most important and life-threatening complications of long-term steroid use and is most common following a gastrointestinal illness.",
"id": "10000430",
"label": "e",
"name": "Hypovolaemic shock",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a vital differential diagnosis in patients presenting with impaired consciousness, tachycardia, and hypotension, sepsis is not the underlying cause in this case. The two key clues lie in the absence of pyrexia and the history of long-term prednisolone use in the context of GI illness. Adrenal crisis secondary to steroid therapy is therefore the most likely cause in this case.",
"id": "10000427",
"label": "b",
"name": "Sepsis",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An unlikely underlying diagnosis in a patient with no history of thyroid disease, thyroid storm is very rarely the first presentation of thyrotoxicosis. There are also important differentiating factors in the clinical examination. Thyroid storm classically presents with fever, tachycardia, hypertension, and altered mental state. This patient is not pyrexic and is hypotensive, making thyroid storm an unlikely cause of their presentation.",
"id": "10000429",
"label": "d",
"name": "Thyroid storm",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another important differential in a patient presenting with cardiogenic symptoms. However, in a patient with a history of long-term steroid use who has been suffering from a gastrointestinal illness in the days preceding presentation, it is vital to rule out adrenal crisis.",
"id": "10000428",
"label": "c",
"name": "Myocardial infarction",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with circulatory collapse (indicated by loss of consciousness, hypotension, and tachycardia) which has occurred secondary to an adrenal crisis. Long-term steroid use suppresses the body's natural production of glucocorticoids by negatively feeding back on the hypothalamic-pituitary-adrenal axis. Adrenal crisis can then occur in the presence of additional physiological stress or if the patient is unable to take their medication. This patient should be urgently managed with IV hydrocortisone and fluid replacement.",
"id": "10000426",
"label": "a",
"name": "Adrenal crisis",
"picture": null,
"votes": 334
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3762",
"name": "Adrenal insufficiency & Addison's",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
"typeId": null,
"userChapter": null,
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},
"conceptId": 3762,
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"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 70-year-old female is brought to the emergency department by ambulance. Her husband reports that she has been unwell for the past 4 days with vomiting and diarrhoea. He found her this morning unconscious on the sofa and immediately dialled 999.\n\nOn examination, the patient is unresponsive, with a heart rate of 134 bpm, a blood pressure of 88/72 mmHg, and a temperature of 37.1 C. Her husband reports that she has a history of polymyalgia rheumatica for which she has taken prednisolone for 18 months. Which of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 487,
"typeId": 1,
"userPoint": null
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173,459,638 | false | 37 | null | 6,495,002 | null | false | [] | null | 12,633 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although intense exercise can increase the risk of hypoglycaemia, NICE recommend that patients should be counselled on self-monitoring and adjusting insulin doses for intense exercise, rather than avoiding it altogether. Physical activity is an important factor in improving T1DM prognosis.",
"id": "10000432",
"label": "b",
"name": "Avoid intense exercise",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "NICE guidelines suggest the provision of carbohydrate-counting courses as part of type 1 diabetes mellitus self-management. Carbohydrate counting is a meal planning method by which an individual manages blood glucose by approximating insulin doses with carbohydrate levels in each meal.",
"id": "10000431",
"label": "a",
"name": "Meal planning courses",
"picture": null,
"votes": 384
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the opposite of what is recommended for insulin-injecting patients. Patients regularly self-administrating insulin should regularly rotate insulin injection sites to avoid lipodystrophy and cutaneous amyloidosis.",
"id": "10000434",
"label": "d",
"name": "Avoid switching injection sites",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals self-managing type 1 diabetes with insulin should never omit insulin doses, especially when unwell. Stopping insulin self-administration increases the risk of diabetic ketoacidosis (DKA). If a patient does not know how to adjust insulin doses when unwell, they should be advised to contact their diabetes team. When unwell, blood glucose monitoring should be increased to every 1-2 hours. Patients should be counselled to seek urgent medical advice if they experience symptoms of DKA.",
"id": "10000435",
"label": "e",
"name": "Omit insulin doses when severely unwell",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although patients beginning insulin therapy that will last >3 months must inform the DVLA, he does not need to stop driving as long as he maintains hypoglycaemia awareness. If an individual has more than one episode of severe hypoglycaemia per year they must stop driving and inform the DVLA.",
"id": "10000433",
"label": "c",
"name": "He must inform the DVLA and stop driving his car",
"picture": null,
"votes": 36
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3763",
"name": "Type 1 Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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"question": "A 24-year-old male presents to General Practice with a 3-week history of fatigue, malaise, and polyuria. After examination and further investigation, he is diagnosed with type 1 diabetes mellitus. He is due to begin insulin therapy after the consultation today and is interested in ways to improve his glycaemic control.\n\nWhich of the following advice is most appropriate to discuss with him?",
"sbaAnswer": [
"a"
],
"totalVotes": 490,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,639 | false | 38 | null | 6,495,002 | null | false | [] | null | 12,634 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although dexamethasone suppression tests are used first line to diagnose Cushing's, low dose (overnight) tests are used not high dose. Morning and midnight ACTH measurements are the gold standards for Cushing's localisation, but a high dose dexamethasone tests can also be used to localise Cushing's pathology:\n\n* Cortisol and ACTH suppressed: Pituitary pathology (Cushing's disease)\n* Cortisol not suppressed, ACTH suppressed: adrenal pathology\n* Neither cortisol nor ACTH suppressed: ectopic ACTH secretion (e.g. small cell lung cancer)",
"id": "10000439",
"label": "d",
"name": "High-dose dexamethasone suppression test",
"picture": null,
"votes": 45
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The aldosterone/renin ratio is the first line test for primary hyperaldosteronism, a condition characterised by excess production of the mineralocorticoid aldosterone by the adrenal gland. In individuals with hyperaldosteronism, the aldosterone/renin ratio is increased, due to elevated aldosterone production and the subsequent suppression of renin caused by sodium retention negatively feeding back.",
"id": "10000437",
"label": "b",
"name": "Aldosterone/renin ratio",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although a pituitary MRI may be used to identify the presence of a pituitary adenoma (Cushing's disease), it is not the first-line test to diagnose Cushing's syndrome. Instead, a low-dose dexamethasone suppression test should be used to establish the presence of excess cortisol production.",
"id": "10000440",
"label": "e",
"name": "Pituitary MRI",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is most likely suffering from Cushing's syndrome, a disease characterised by excess circulating cortisol which may have a range of causes including exogenous corticosteroid exposure or pituitary adenoma. Cushing's syndrome presents with features of glucocorticoid excess: hypertension, insulin insensitivity, central obesity, proximal muscle weakness, striae, moon facies, and menstrual irregularities. The low-dose dexamethasone suppression test is first line and assesses the body's response to exogenous glucocorticoid. In health, the body will suppress the morning cortisol spike due to the negative feedback effect. In individuals with Cushing's syndrome, the morning cortisol increase will still be present.",
"id": "10000436",
"label": "a",
"name": "Low-dose dexamethasone suppression test",
"picture": null,
"votes": 367
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ACTH stimulation test (also known as the short synacthen test) is the definitive investigation of Addison's disease, not Cushing's syndrome. Addison's disease is characterised by primary adrenal insufficiency, so the provision of exogenous ACTH does not stimulate cortisol production. ACTH measurement also plays a role in Cushing's syndrome diagnosis, but is not the first line investigation and is instead used to localise the pathology involved.",
"id": "10000438",
"label": "c",
"name": "ACTH stimulation test",
"picture": null,
"votes": 49
}
],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3764",
"name": "Cushing's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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"dislikes": 0,
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"highlights": [],
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"question": "A 43-year-old male presents to the clinic with a 2-month history of central weight gain and difficulty rising from chairs.\n\nOn examination, you note central obesity and proximal muscle weakness.\n\nFurthermore, you identify a blood pressure of 146/93 mmHg and a heart rate of 81 bpm. Which of the following investigations is first line for the most likely underlying condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 489,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,640 | false | 39 | null | 6,495,002 | null | false | [] | null | 12,635 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anxiety is not an appropriate diagnosis in patients presenting with symptoms of thyrotoxicosis and painful goitre.",
"id": "10000445",
"label": "e",
"name": "Anxiety",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hashimoto's thyroiditis is a common cause of hypothyroidism and is not the most likely causative factor here. Hashimoto's classically presents with symptoms of hypothyroidism (e.g. weight gain, low mood, fatigue etc) as well as a firm, non-tender goitre. This patient has presented with symptoms of thyrotoxicosis and a tender goitre, therefore the most likely diagnosis is De Quervain's thyroiditis.",
"id": "10000443",
"label": "c",
"name": "Hashimoto's thyroiditis",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although Grave's disease is the most common cause of hypothyroidism, it is not the most likely cause here. It is very uncommon for Grave's disease to present with a tender goitre, typically goitre in Grave's disease is diffuse but painless. De Quervain's thyroiditis is the most common cause of painful goitre and is therefore the most likely diagnosis here.",
"id": "10000442",
"label": "b",
"name": "Grave's disease",
"picture": null,
"votes": 224
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "De Quervain's thyroiditis (also known as subacute thyroiditis) is a transient inflammation of the thyroid gland. De Quervain's thyroiditis is characterised by three phases: initial thyrotoxicosis (due to the release of thyroglobulin during gland destruction) which is followed by hypothyroidism and finally a return to normal thyroid function. The initial phase of thyrotoxicosis classically presents with a painful goitre and symptoms of elevated thyroid hormone.",
"id": "10000441",
"label": "a",
"name": "De Quervain's thyroiditis",
"picture": null,
"votes": 179
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An important differential but not the most likely cause here. Toxic multinodular goitre occurs due to the development of individual thyroid nodules which develop the autonomous ability to secrete thyroid hormone. Toxic multinodular goitre classically presents with a more subtle, subclinical hyperthyroidism as well as the development of an irregular and nodular goitre. This patient has presented with more acute thyrotoxicosis and a painful goitre, therefore De Quervain's thyroiditis is a much more likely diagnosis.",
"id": "10000444",
"label": "d",
"name": "Toxic multinodular goitre",
"picture": null,
"votes": 55
}
],
"comments": [
{
"__typename": "QuestionComment",
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"name": "Hypothyroidism",
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"typeId": 5
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"question": "A 46-year-old female presents to General Practise with a 3-week history of anxiety, palpitations and restlessness. She has also noticed a painful neck swelling which is causing significant discomfort. On examination, you identify a tender, diffuse, firm neck goitre.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 491,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,641 | false | 40 | null | 6,495,002 | null | false | [] | null | 12,636 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient suffers from osteoarthritis. Osteoarthritis classically presents with joint pain worst on movement and improved by rest. Morning stiffness in osteoarthritis is characteristically short-lived, quite distinct from the lengthy morning stiffness of rheumatoid arthritis. Furthermore, crepitus is a classical finding of osteoarthritis on examination.\n\nThere are 4 key signs of osteoarthritis to be aware of on X-ray. They can be remembered by the acronym LOSS:\n\n* Loss of joint space\n* Osteophytes\n* Subchondral sclerosis\n* Subchondral cysts",
"id": "10000446",
"label": "a",
"name": "Loss of joint space",
"picture": null,
"votes": 416
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudo-fractures are a type of insufficiency fracture which describes the damage caused by normal stress on the dysfunctional bone. In this case, pseudo-fractures are a radiological hallmark of osteomalacia (vitamin D deficiency). Pseudo-fractures occur in osteomalacia due to impaired calcium homeostasis caused by vitamin d deficiency/malabsorption.",
"id": "10000449",
"label": "d",
"name": "Pseudo-fractures",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoporosis of bone that neighbours a joint is an X-ray sign of rheumatoid arthritis, rather than osteoarthritis. Loss of bone mineral density occurs as a result of inflammatory cytokines, which increase osteoclast activation and recruitment.",
"id": "10000447",
"label": "b",
"name": "Periarticular osteoporosis",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Soft tissue swelling is a radiological sign of rheumatoid arthritis which occurs due to the inflammatory nature of the disease.",
"id": "10000448",
"label": "c",
"name": "Soft tissue swelling",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Marginal erosions describe erosions that occur at areas of the bone within the joint capsule not covered by cartilage. Such erosions are often among the earliest radiological signs of rheumatoid arthritis and do not occur in osteoarthritis.",
"id": "10000450",
"label": "e",
"name": "Marginal erosions",
"picture": null,
"votes": 14
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3766",
"name": "Osteoarthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
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"question": "A 62-year-old female presents to General Practice with a 6-month history of bilateral knee pain which is worse on walking and alleviated by rest. She finds her joints are stiff in the morning but this lasts no longer than 10 minutes. On examination, there is crepitus and a limited range of motion in both knees. You refer the patient for an X-Ray.\n\nWhich of the following is most likely to be seen on X-ray?",
"sbaAnswer": [
"a"
],
"totalVotes": 478,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,642 | false | 41 | null | 6,495,002 | null | false | [] | null | 12,637 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, psoriatic arthritis has several different patterns of joint involvement. The most common is symmetrical joint involvement, but asymmetrical joint disease is present in up to 30% of patients.",
"id": "10000455",
"label": "e",
"name": "Joint involvement is always asymmetrical",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Psoriatic arthritis can occur before the onset of psoriasis or even in the absence of skin disease.",
"id": "10000452",
"label": "b",
"name": "Psoriatic skin lesions are always present",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Psoriatic arthritis is a seronegative inflammatory arthropathy, therefore rheumatoid factor is negative.",
"id": "10000454",
"label": "d",
"name": "Rheumatoid factor is positive",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Psoriatic arthritis is a chronic inflammatory seronegative arthritis which is associated with psoriasis. Psoriatic arthritis occurs in around 30% of individuals with psoriasis but can develop in absence of the skin condition, and, crucially, the severity of psoriasis does not correlate with the severity of psoriatic arthritis. Psoriatic arthritis can occur symmetrically or asymmetrically and distal interphalangeal joint involvement occurs in around 10% of patients. Psoriatic arthritis can be difficult to differentiate from rheumatoid arthritis but there are several key differentiating factors:\n\n* DIP joint involvement is more common in psoriatic arthritis\n* Dactylitis is more common in psoriatic arthritis\n* Psoriatic arthritis is rheumatoid factor negative\n* Psoriatic arthritis is associated with psoriatic skin lesions and nail changes\n* Psoriatic arthritis is more likely to be asymmetrical than rheumatoid arthritis",
"id": "10000451",
"label": "a",
"name": "Arthritis can involve the distal interphalangeal joints",
"picture": null,
"votes": 225
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although nail involvement is common in psoriatic arthritis, leukonychia is not a sign of psoriatic nail disease. Signs of psoriatic nail involvement include pitting, onycholysis, and nail hyperkeratosis.",
"id": "10000453",
"label": "c",
"name": "Nail leukonychia is a common finding",
"picture": null,
"votes": 172
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3767",
"name": "Psoriatic arthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "A 45-year-old male presents to the clinic after a recent diagnosis of psoriatic arthritis. He is enthusiastic about engaging with treatment and is seeking advice and further information on his condition.\n\nWhich of the following is true regarding psoriatic arthritis?",
"sbaAnswer": [
"a"
],
"totalVotes": 476,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,643 | false | 42 | null | 6,495,002 | null | false | [] | null | 12,638 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Corticosteroid use is not associated with an increased risk of gout. Predisposing factors that increase the risk of gout typically act through one of two mechanisms: increased production of uric acid or reduced excretion of uric acid. Corticosteroid use does not cause either of these to occur.",
"id": "10000460",
"label": "e",
"name": "Corticosteroid use",
"picture": null,
"votes": 74
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A vegetarian diet is not associated with an increased risk of gout. Red meat, on the other hand, is rich in purines and so results in elevated uric acid levels, thereby increasing the risk of gout.",
"id": "10000459",
"label": "d",
"name": "Vegetarian diet",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypouricaemia is decreased presence of uric acid within the blood and therefore reduces the risk of gout.",
"id": "10000457",
"label": "b",
"name": "Hypouricaemia",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has presented with an acute episode of gout. Gout occurs due to the accumulation of urate crystals within joints, causing acute crystal arthropathies. Gout presents with severe pain and most commonly affects the 1st metatarsophalangeal joint but affects other joints such as the knee, ankle, and wrist. Diuretics cause reduced excretion of uric acid and are therefore an important predisposing factor to the development of gout.",
"id": "10000456",
"label": "a",
"name": "Diuretic use",
"picture": null,
"votes": 333
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Non-Steroidal Anti-Inflammatory drugs (NSAIDs) do not increase the risk of gout. The BNF does not state gout as a recognized side-effect of NSAID use. Indeed, NSAIDs are actually used in the management of acute gout.",
"id": "10000458",
"label": "c",
"name": "Non-Steroidal Anti-Inflammatory drugs",
"picture": null,
"votes": 35
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3768",
"name": "Gout",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
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"question": "A 67-year-old male presents to the emergency department with a 10-hour history of excruciating pain in his big toe. The pain began in the morning and has worsened in intensity throughout the day. He is unable to walk on the affected foot due to the pain. On examination, you identify that the patient's left 1st metatarsophalangeal joint is erythematous and swollen.\n\nWhich of the following is a predisposing factor to this patient's condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 481,
"typeId": 1,
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} | MarksheetMark |
173,459,644 | false | 43 | null | 6,495,002 | null | false | [] | null | 12,639 | {
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"__typename": "QuestionChoice",
"answer": false,
"explanation": "Transient hip inflammation describes transient synovitis. Transient synovitis is an idiopathic inflammation of the synovium, causing self-limiting pain and a limp. Transient synovitis would not present as progressively worsening hip pain over 3 weeks, as transient synovitis typically resolves with rest after 7-10 days. This is therefore an unlikely underlying pathology.",
"id": "10000464",
"label": "d",
"name": "Transient hip inflammation",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathology describes septic arthritis, an infection of the joint space caused by the direct or haematogenous invasion. This is a very unlikely underlying cause in this patient. Septic arthritis typically presents with severe joint pain, joint swelling, extremely limited joint movement, non-weight bearing, and systemic illness. This patient is systemically healthy, without fever and can weight bear but with a limp. Septic arthritis is therefore a far less likely diagnosis than Perthes' disease.",
"id": "10000463",
"label": "c",
"name": "Infection of the hip joint",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathology describes a condition called slipped upper femoral epiphysis (SUFE) but is not the most likely diagnosis here. SUFE typically presents in a slightly older age group, with diagnosis most common in the 11-13 age group. SUFE occurs due to the weakening of the growth plate due to stressors such as obesity or a period of sudden growth. SUFE can present acutely or chronically, and typically presents with hip pain or pain referred to the knee or groin. The most important differentiating factor here is the age at presentation. This patient is too young to have undergone the growth spurts of puberty and is not obese, therefore SUFE is an unlikely diagnosis.",
"id": "10000462",
"label": "b",
"name": "Displacement of the upper femoral epiphysis",
"picture": null,
"votes": 121
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient suffers from Perthes' disease, which occurs due to impaired blood supply to the femoral head. This results in avascular necrosis and remodelling of the femoral head, which can lead to collapse and flattening. Perthes' disease is most common in males aged 4-8 and presents with progressively worsening hip pain and limited joint movement, which can lead to the wasting of leg muscles due to underuse. These three factors contribute towards the development of a limp.",
"id": "10000461",
"label": "a",
"name": "Avascular necrosis of the femoral head",
"picture": null,
"votes": 260
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This pathology describes developmental dysplasia of the hip (DDH), in which abnormal development of the hip joint results in an abnormal relationship between the femoral head and the acetabulum. This condition is usually picked up through the use of the Barlow and Ortolani tests in screening and then confirmed by ultrasound. In cases where DDH slips through screening, it typically presents in children under 3 years as leg length discrepancy, limited hip abduction and toe-walking. DDH would not present as a 3-week history of progressive hip pain in a previously fit and active child.",
"id": "10000465",
"label": "e",
"name": "Abnormal position and alignment of the femoral head",
"picture": null,
"votes": 59
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "too young?????? ave. 8-15",
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"question": "A 7-year-old male presents with his father to General Practice with a 3-week history of left-sided hip pain. His father states the pain has been progressively worsening since onset and the boy has now developed a limp.\n\nThe young patient is normally very active and plays football regularly, but has not been able to recently due to his hip problems.\n\nExamination of the hip reveals limited internal rotation, a limping gait and some wasting of the quadriceps and gluteal muscles.\n\nThe child is otherwise fit and well.\n\nWhich of the following is the most likely underlying pathology?",
"sbaAnswer": [
"a"
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} | MarksheetMark |
173,459,645 | false | 44 | null | 6,495,002 | null | false | [] | null | 12,640 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "SLE is a condition with a complex autoimmune background. There are many different antibodies implicated in SLE, but the most specific antibodies are those targeted against double-stranded DNA (anti-dsDNA). Although highly specific (>99%), anti-dsDNA is less sensitive (~70%).",
"id": "10000466",
"label": "a",
"name": "Anti-dsDNA",
"picture": null,
"votes": 282
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This antibody is typically associated with diffuse systemic sclerosis, though is sometimes also present in SLE patients. It is therefore not the most specific antibody test for the diagnosis of SLE.",
"id": "10000470",
"label": "e",
"name": "Anti-scl-70",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An extremely sensitive test but with poor specificity, anti-nuclear antibodies are positive in most SLE patients but are also positive in a range of other autoimmune conditions such as Sjögren's or systemic sclerosis.",
"id": "10000467",
"label": "b",
"name": "Anti-nuclear antibodies",
"picture": null,
"votes": 148
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although anti-ro antibodies may be positive in SLE, they are not a very specific test. Anti-ro antibodies are also positive in ~70% of Sjögren's patients, and so are not the most specific test here.",
"id": "10000468",
"label": "c",
"name": "Anti-Ro",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Another non-specific antibody which may be positive in SLE, rheumatoid factor is positive in a wide spectrum of autoimmune conditions including rheumatoid arthritis and Sjögren syndrome.",
"id": "10000469",
"label": "d",
"name": "Rheumatoid factor",
"picture": null,
"votes": 7
}
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"name": "Systemic lupus erythematosus",
"status": null,
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"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
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"question": "A 36-year-old female presents to the clinic with a 4-month history of fatigue, facial rash, and arthralgia. Examination reveals a malar rash and after further investigation, the patient is diagnosed with systemic lupus erythematosus (SLE).\n\nWhich of the following antibody tests is most specific for SLE?",
"sbaAnswer": [
"a"
],
"totalVotes": 483,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,459,646 | false | 45 | null | 6,495,002 | null | false | [] | null | 12,641 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Butterfly rash (aka malar rash) is a sign most commonly associated with systemic lupus erythematosus. Although facial skin sclerosis can occur in limited systemic sclerosis, it does not manifest as a butterfly rash.",
"id": "10000473",
"label": "c",
"name": "Butterfly rash",
"picture": null,
"votes": 92
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Inflammatory arthritis is an extremely uncommon presentation of systemic sclerosis and may instead suggest overlap with another autoimmune condition (or indeed a different diagnosis altogether). Although patients may experience arthralgia, an inflammatory arthritis is unlikely in limited systemic sclerosis.",
"id": "10000474",
"label": "d",
"name": "Inflammatory joint pain",
"picture": null,
"votes": 126
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient suffers from limited systemic sclerosis, as indicated by the presence of Raynaud's phenomenon as well as sclerotic skin changes limited to the face and distal limbs (i.e. below elbow/knee). Oesophageal dysmotility is a very common symptom of limited systemic sclerosis and typically manifests as heartburn, dysphagia, and gastro-oesophageal reflux. Patients with limited systemic sclerosis may also develop telangiectasia, calcifications, and sclerodactyly. Late in the disease patients may develop interstitial lung disease and pulmonary artery hypertension.",
"id": "10000471",
"label": "a",
"name": "Heartburn",
"picture": null,
"votes": 170
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Jaundice is not a typical symptom of limited systemic sclerosis. Although primary biliary cirrhosis (chronic inflammatory destruction of hepatic bile ducts) can uncommonly occur in diffuse systemic sclerosis, it does not occur in limited disease.",
"id": "10000472",
"label": "b",
"name": "Jaundice",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dry eyes are a classical symptom of Sjögren's syndrome. Dry eyes and mouth are two clinical hallmarks of this autoimmune disease but would not be found in systemic sclerosis (at least not without the presence of disease overlap).",
"id": "10000475",
"label": "e",
"name": "Dry eyes",
"picture": null,
"votes": 81
}
],
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"name": "Systemic sclerosis",
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"id": "146",
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"typeId": 7
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"question": "A 39-year-old female presents to the clinic. She reports a 2-month history of her fingers turning blue in the cold as well as some skin thickening in her hands. On examination, you identify the presence of digital ulcers as well as thickened, sclerotic skin that involves the hands and wrists bilaterally. There is also some sclerotic skin on her face.\n\nWhich of the following symptoms is the patient most likely to also experience?",
"sbaAnswer": [
"a"
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173,459,647 | false | 46 | null | 6,495,002 | null | false | [] | null | 12,642 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although an MRI is the imaging modality of choice for the investigation and assessment of cauda equina syndrome, a non-urgent MRI is inappropriate given the emergency nature of the condition. If cauda equina syndrome remains untreated, there is a risk of permanent neurological damage such as leg weakness, sensory changes, and incontinence.",
"id": "10000479",
"label": "d",
"name": "Non-urgent MRI lumbar spine",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient suffers from cauda equina syndrome, which occurs due to compression of the cauda equina lumbosacral nerve roots. This pathology is best assessed with an MRI due to the quality of soft tissue imaging and accurate aetiological assessment. The BMJ states that a CT lumbar spine should only be carried out if an MRI is unavailable or contraindicated.",
"id": "10000477",
"label": "b",
"name": "Urgent CT lumbar spine",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect for several reasons. Firstly, MRI lumbar spine is the imaging modality of choice due to superior soft tissue imaging. Secondly, cauda equina syndrome is a neurosurgical emergency and requires urgent investigation and intervention.",
"id": "10000480",
"label": "e",
"name": "Non-urgent CT lumbar spine",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is suffering from cauda equina syndrome, which is a neurosurgical emergency caused by compression of the cauda equina. This can occur due to disc prolapse, trauma, infection or malignancy. In this patient, bony metastases from his prostatic cancer are the most likely underlying cause. Cauda equina presents with lower back pain, sciatica, urinary and/or faecal incontinence, changes in perineal sensation, and reduced anal sphincter tone. The BMJ states that an urgent lumbar spine MRI is the best imaging modality due to soft tissue detail as well as the ability to examine the spinal canal, allowing accurate assessment of aetiology.",
"id": "10000476",
"label": "a",
"name": "Urgent MRI lumbar spine",
"picture": null,
"votes": 426
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A spinal radiograph is not an appropriate investigation in the assessment of cauda equina syndrome. Plain radiographs have extremely poor soft tissue image quality and are unlikely to delineate compression of the lumbosacral nerve roots of the cauda equina.",
"id": "10000478",
"label": "c",
"name": "Plain spinal radiograph",
"picture": null,
"votes": 3
}
],
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"demo": null,
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"id": "3772",
"name": "Cauda equina syndrome",
"status": null,
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"id": "145",
"name": "Orthopaedics",
"typeId": 7
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"question": "A 71-year-old male presents to the Emergency Department with sudden onset urinary incontinence and pins and needles across his perineum. He also notes a 4-week history of lower back pain. His past medical history includes prostate cancer for which he is currently receiving treatment.\n\nOn examination, you identify reduced sensation across his perineum as well as reduced anal tone on digital rectal examination.\n\nWhich of the following investigations is most likely to be diagnostic of the underlying condition?",
"sbaAnswer": [
"a"
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173,459,648 | false | 47 | null | 6,495,002 | null | false | [] | null | 12,643 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although the peroneal nerve is implicated in foot drop, the superficial branch is not. The superficial peroneal nerve supplies the lateral compartment of the lower leg and thus is responsible for eversion of the foot. The superficial peroneal nerve does not supply foot dorsiflexors, that function is fulfilled by fibres of the deep fibular nerve. Superficial peroneal nerve injury is therefore unlikely in this patient.",
"id": "10000485",
"label": "e",
"name": "Superficial peroneal nerve",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The tibial nerve is not implicated in foot drop presentations. The tibial nerve supplies the posterior muscle compartment of the lower leg which is responsible for plantarflexion of the foot. In this patient, dorsiflexion is impaired but plantarflexion is preserved. Furthermore, tibial nerve injury typically results in impaired sensation over the plantar aspect of the foot, not the dorsum. It is therefore unlikely this patient is experiencing tibial nerve damage.",
"id": "10000484",
"label": "d",
"name": "Tibial nerve injury",
"picture": null,
"votes": 35
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Damage to the L3 nerve root is unlikely to produce foot drop. Typically L3 radiculopathies present with weakness of knee extension (quadriceps) as well as sensory loss over the knee and anterior thigh.",
"id": "10000482",
"label": "b",
"name": "L3 radiculopathy",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Common peroneal nerve lesions are the most common cause of foot drop. The common peroneal nerve gives off the deep fibular nerve which innervates the muscles of the anterior compartment. The anterior compartment muscles are responsible for dorsiflexion of the foot, and impaired innervation produces foot drop. The common peroneal nerve provides sensation to the lateral lower leg and dorsum of the foot. Risk factors for common peroneal nerve injury include trauma, surgical positioning, and certain sports that may compress the nerve at the fibular neck.",
"id": "10000481",
"label": "a",
"name": "Common peroneal nerve injury",
"picture": null,
"votes": 392
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The common femoral nerve is the largest branch of the lumbar plexus and receives input from L2-4. Damage to the common femoral nerve results in impairment of the hip flexors and knee extenders but does not cause foot drop. Furthermore, common femoral nerve injury typically causes sensory impairment of the medial thigh, lower leg, and foot. It would not cause sensory impairment of the lateral aspect of the calf and dorsal foot.",
"id": "10000483",
"label": "c",
"name": "Common femoral nerve injury",
"picture": null,
"votes": 21
}
],
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"name": "Common peroneal nerve injury",
"status": null,
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"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
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"question": "A 30-year-old female presents to General Practice with a 2-week history of difficulty walking. On examination, you note weakness of foot dorsiflexion and eversion as well as a foot-dropping gait. You also note reduced sensation over the lateral calf and dorsal aspect of the foot. The patient is a keen skier and recently returned from a skiing trip.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 495,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
Subsets and Splits