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"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient remains in status epilepticus despite two doses of IV lorazepam. Therefore, she requires a second-line treatment in the form of phenytoin.",
"id": "10025080",
"label": "a",
"name": "Phenytoin",
"picture": null,
"votes": 81
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is in status epilepticus and has already had two doses of lorazepam. This patient therefore requires a second-line treatment in the form of phenytoin.",
"id": "10025081",
"label": "b",
"name": "A further dose of lorazepam",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient requires a second-line drug for treatment of her status epilepticus. Sodium valproate would not be an appropriate drug to give in this scenario. This is for stabilising patients with epilepsy, not for use in the acute phase.",
"id": "10025083",
"label": "d",
"name": "Sodium valproate",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diazepam can be given instead of lorazepam in the initial treatment of status epilepticus. It is usually given if there is no intravenous access as it can be given rectally.",
"id": "10025084",
"label": "e",
"name": "Diazepam",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Midazolam can be given instead of lorazepam in the initial treatment of status epilepticus. It is usually given if there is no intravenous access as it can be given via the buccal route.",
"id": "10025082",
"label": "c",
"name": "Midazolam",
"picture": null,
"votes": 7
}
],
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"id": "3749",
"name": "Epilepsy",
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"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"question": "You are called to see a 17-year-old girl who has been having a seizure for nine minutes. She has been given two doses of IV lorazepam, but her seizures have not stopped.\n\nWhich of the following is the next best step in management?",
"sbaAnswer": [
"a"
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173,470,945 | false | 25 | null | 6,495,349 | null | false | [] | null | 17,415 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Pancreatic cancer would be the most important diagnosis to exclude in this case. It presents with the classic symptoms of painless jaundice and a palpable gallbladder.",
"id": "10025085",
"label": "a",
"name": "Pancreatic cancer",
"picture": null,
"votes": 117
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect pancreatitis to present with symptoms like epigastric pain radiating to the back, pain relived by sitting forward and associated symptoms like nausea and vomiting. Bloods may show an extremely high amylase level. This patient does not present with any pain, nausea or vomiting. Therefore, acute pancreatitis is not a likely diagnosis. This patient's symptoms are more likely to be due to pancreatic cancer.",
"id": "10025087",
"label": "c",
"name": "Acute pancreatitis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect Gilbert’s syndrome to cause intermitted jaundice in relation to stress, infection or exercise. It would not account for the palpable gallbladder and therefore is not the most likely diagnosis in this case.",
"id": "10025089",
"label": "e",
"name": "Gilbert's syndrome",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Colorectal cancer would be an important diagnosis to exclude if the patient was over 60 and reported a change in bowel habit. However, this patient's symptoms are more suggestive of pancreatic cancer, so this would be the most important diagnosis to exclude.",
"id": "10025086",
"label": "b",
"name": "Colorectal Cancer",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gastric cancer would present with symptoms such as persistent reflux, bloating and weight loss. This patient is more likely to be suffering from pancreatic cancer.",
"id": "10025088",
"label": "d",
"name": "Gastric Cancer",
"picture": null,
"votes": 0
}
],
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"demo": null,
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"id": "3734",
"name": "Pancreatic Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
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"topicId": 136,
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"question": "A 40-year-old male presents to his GP with yellowing of his eyes. The GP conducts a thorough abdominal examination in which he notes a palpable gallbladder. The patient does not complain of any pain.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 161,
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173,470,946 | false | 26 | null | 6,495,349 | null | false | [] | null | 17,416 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bisoprolol is not the most likely drug to have caused this patient's presentation. Amiodarone is most likely to be the cause of this patients symptoms as their symptoms are are suggestive of hypothyroidism. Bisoprolol can cause symptoms such as bradycardia, diarrhoea and erectile dysfunction.",
"id": "10025093",
"label": "d",
"name": "Bisoprolol",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Amiodarone is most likely to be the cause of this patients symptoms as they are suggestive of hypothyroidism. Amiodarone can also less commonly cause patients to present with hyperthyroidism.",
"id": "10025090",
"label": "a",
"name": "Amiodarone",
"picture": null,
"votes": 71
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Omeprazole is not a cause of hypothyroidism. The most likely drug that has caused this patients symptoms is amiodarone.",
"id": "10025094",
"label": "e",
"name": "Omeprazole",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's symptoms are most likely to be caused by amiodarone. An important side effect of carbamazepine is agranulocytosis.",
"id": "10025092",
"label": "c",
"name": "Carbamazepine",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Simvastatin is not the most likely cause of this patients symptoms. The most likely cause of this patients hypothyroidism is amiodarone. Simvastatin can cause symptoms such as arthralgia and muscle pain.",
"id": "10025091",
"label": "b",
"name": "Simvastatin",
"picture": null,
"votes": 5
}
],
"comments": [],
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5821",
"name": "Metronidazole",
"status": null,
"topic": {
"__typename": "Topic",
"id": "223",
"name": "Antibiotic pharmacology",
"typeId": 7
},
"topicId": 223,
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"question": "A 55-year-old man attends his GP with constipation and tiredness. He also reports gaining some weight recently and feeling low in mood. His thyroid function tests show a high thyroid-stimulating hormone (TSH) and low T4.\n\nWhich of the following drugs is most likely to have caused this presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 157,
"typeId": 1,
"userPoint": null
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173,470,947 | false | 27 | null | 6,495,349 | null | false | [] | null | 17,417 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The proximal left anterior descending artery would cause changed in leads V1-6 as well as leads I and AVL. The ECG changes in this question correlate to the right coronary artery.",
"id": "10025099",
"label": "e",
"name": "Proximal left anterior descending artery",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An occlusion in the left circumflex artery would cause changes in leads I and aVL.",
"id": "10025097",
"label": "c",
"name": "Left circumflex artery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The ECG changes described represent an occlusion in the right coronary artery, not the right marginal artery.",
"id": "10025098",
"label": "d",
"name": "Right marginal artery",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An occlusion in the left anterior descending artery would cause changes in leads V1-V4.",
"id": "10025096",
"label": "b",
"name": "Left anterior descending artery",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "An occlusion in the right coronary artery correspond to leads II,III and aVF. These leads represent the inferior region of the heart.",
"id": "10025095",
"label": "a",
"name": "Right coronary artery",
"picture": null,
"votes": 129
}
],
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"chapterId": 2693,
"demo": null,
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"id": "4542",
"name": "Myocardial infarction and Acute Coronary Syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
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"question": "An 80-year-old male presents to the emergency department with central crushing chest pain. An ECG shows ST elevation in leads II,III and aVF.\n\nWhich coronary artery is the most likely site of occlusion?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,948 | false | 28 | null | 6,495,349 | null | false | [] | null | 17,418 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with the typical signs and symptoms of Addison's disease: fatigue, weakness, weight loss, bronze skin pigmentation, and low sodium and high potassium on blood results.",
"id": "10025100",
"label": "a",
"name": "Addison's disease",
"picture": null,
"votes": 121
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is presenting with the typical signs and symptoms of Addison's disease: fatigue, weakness, weight loss and bronze skin pigmentation. Blood tests also show a low sodium and high potassium which is typical of Addison's disease.",
"id": "10025104",
"label": "e",
"name": "Anxiety",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cushing's disease would present with symptoms such as depression, proximal myopathy and central obesity. Furthermore, Cushing's disease would show a hypokalaemia, rather than hyperkalaemia. The patient in this question is more likely to have Addison's disease.",
"id": "10025101",
"label": "b",
"name": "Cushing's disease",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes insipidus usually presents with producing large volumes of dilute urine, nocturia and excessive thirst.",
"id": "10025102",
"label": "c",
"name": "Diabetes Insipidus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pheochromocytoma usually presents as episodes of hypertension, anxiety, palpitations headaches, as well as signs like tremor and hypertensive retinopathy.",
"id": "10025103",
"label": "d",
"name": "Pheochromocytoma",
"picture": null,
"votes": 27
}
],
"comments": [],
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"id": "3835",
"name": "Adrenal insufficiency and Addison's Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "133",
"name": "Endocrinology",
"typeId": 5
},
"topicId": 133,
"totalCards": null,
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},
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"question": "A 23-year-old female presents to her GP with a one-month history of tiredness and weight loss. On closer inspection, you notice her skin looks bronze in colour. Her blood tests results show low sodium and high potassium levels.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,949 | false | 29 | null | 6,495,349 | null | false | [] | null | 17,419 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Malaria would be accompanied with symptoms such as fevers, headache, muscle aches and tiredness. This patient has more specific symptoms of right upper quadrant pain and jaundice which fits better with a diagnosis of hepatitis.",
"id": "10025107",
"label": "c",
"name": "Malaria",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Infective endocarditis usually presents with a new heart murmur, fever, tachycardia and specific nail signs like splinter haemorrhages. This patient is more likely to have hepatitis given the position of his abdominal pain, his jaundice, and pale stools and dark urine.",
"id": "10025108",
"label": "d",
"name": "Infective endocarditis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Yellow fever usually presents with a sudden onset fever, followed by a headache, muscle aches, vomiting and tiredness. This patient's symptoms fit more with a diagnosis of hepatitis.",
"id": "10025109",
"label": "e",
"name": "Yellow fever",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with classic symptoms of hepatitis: right upper quadrant pain, jaundice, dark urine and pale stools. Hepatitis A is the most common type of hepatitis in the world, but is quite rare in the UK.",
"id": "10025105",
"label": "a",
"name": "Hepatitis A",
"picture": null,
"votes": 136
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Coeliac Disease is a possible differential for a presentation of abdominal pain and weight loss. However, this patient has a typical presentation of hepatitis with right upper quadrant pain, jaundice, pale stools and dark urine.",
"id": "10025106",
"label": "b",
"name": "Coeliac Disease",
"picture": null,
"votes": 8
}
],
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},
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"demo": null,
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"id": "4039",
"name": "Hepatitis viruses",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 25-year-old male presents to the emergency department with right upper quadrant pain for the last six hours. On further questioning, he tells you his urine has looked quite dark and his stools are pale. You notice yellowing of the eyes. On examination, he looks jaundice and has a temperature of 37.4 degree Celsius.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,950 | false | 30 | null | 6,495,349 | null | false | [] | null | 17,420 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This medication would not be an appopiate first-line choice for a urinary tract infection. Pivmecillinam may be an option there is no improvement with a first choice antimicrobial or if a first choice is not suitable.",
"id": "10025112",
"label": "c",
"name": "Pivmecillinam for three days",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "For a male with a suspected urinary tract infection, the correct treatment would be treatment with nitrofurantoin for seven days. A single dose of Nitrofurantoin is not enough.",
"id": "10025114",
"label": "e",
"name": "Single dose of nitrofurantoin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is presenting with symptoms of a urinary tract infection. IV cephalosporin would be the appropriate management if the patient was presenting with symptoms of pyelonephritis, such as pyrexia and loin or flank tenderness.",
"id": "10025113",
"label": "d",
"name": "IV cephalosporin for five days",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days, not five days.",
"id": "10025111",
"label": "b",
"name": "Nitrofurantoin for five days",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with a suspected urinary tract infection. The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days.",
"id": "10025110",
"label": "a",
"name": "Nitrofurantoin for seven days",
"picture": null,
"votes": 103
}
],
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"name": "Urinary tract infection",
"status": null,
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"__typename": "Topic",
"id": "162",
"name": "General practice",
"typeId": 5
},
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"question": "A 21-year-old male attends his GP with dysuria that began eight days ago. He also reports some increased urinary frequency and foul smelling urine. A urine dipstick is positive for nitrites and leucocytes. All other observations are within the normal range.\n\nWhich of the following is the most appropriate management?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
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173,470,951 | false | 31 | null | 6,495,349 | null | false | [] | null | 17,421 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an asymptomatic patient with a HbA1c above diagnostic level. In order to be diagnosed with diabetes, this patient requires a second HbA1c reading above 48mmol/mol in one weeks time.",
"id": "10025117",
"label": "c",
"name": "Commence pioglitazone",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gliclazide is an option in the management of diabetes. However, in order to be diagnosed with diabetes and to commence treatment, patients with no symptoms need to have to at least two separate HbA1c readings above 48mmol/mol a week apart. This patient therefore requires a second HbA1c in one weeks time to confirm a diagnosis.",
"id": "10025118",
"label": "d",
"name": "Commence gliclazide",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and therefore cannot be diagnosed based on this one HbA1c reading.",
"id": "10025116",
"label": "b",
"name": "Commence metformin",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and this reading was found incidentally. Therefore, this patient requires a repeat HbA1c in one weeks time in order to confirm a diagnosis of diabetes.",
"id": "10025115",
"label": "a",
"name": "Repeat HbA1c in 1 week",
"picture": null,
"votes": 132
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes. Therefore, this patient cannot be diagnosed based on this HbA1c reading. The HbA1c needs to be repeated in one weeks time to confirm diagnosis.",
"id": "10025119",
"label": "e",
"name": "Commence Insulin",
"picture": null,
"votes": 4
}
],
"comments": [
{
"__typename": "QuestionComment",
"comment": "Not sure if this is right but what different is it gonig to make to retake the HbA1c after 1 weeks when this value only really changes every 3 months due to the RBC turnover? If someone could clarify, that's be great :)",
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"__typename": "QuestionComment",
"comment": "Completely agree",
"createdAt": 1708346033,
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"name": "Diabetes Mellitus",
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"question": "A 30-year-old female is incidentally found to have an HbA1c of 58mmol/mol. She has no previous diagnosis of Type 2 diabetes. She does not report experiencing any polyuria or polydipsia.\n\nWhich of the following is the most appropriate next step?",
"sbaAnswer": [
"a"
],
"totalVotes": 156,
"typeId": 1,
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173,470,952 | false | 32 | null | 6,495,349 | null | false | [] | null | 17,422 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Seizures that affect the occipital lobe of the brain are often associated with visual symptoms. This can include seeing flashes of colour or shapes before a seizure occurs.",
"id": "10025122",
"label": "c",
"name": "Occipital lobe",
"picture": null,
"votes": 2
},
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"__typename": "QuestionChoice",
"answer": true,
"explanation": "Seizures that originate in the Parietal Lobe can cause sensory symptoms such as numbness and weakness.",
"id": "10025120",
"label": "a",
"name": "Parietal lobe",
"picture": null,
"votes": 59
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{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The frontal lobe is associated with motor symptoms, including a type of seizure called a Jacksonian march. This is a seizure where shaking or tingling begins in one area of the body and gradually spreads its way to another area.",
"id": "10025121",
"label": "b",
"name": "Frontal Lobe",
"picture": null,
"votes": 48
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Seizures that originate in the temporal lobe are associated with emotional disturbances such as sudden terror or déjà vu. Temporal lobe seizures can also involve auditory or olfactory hallucinations.",
"id": "10025124",
"label": "e",
"name": "Temporal lobe",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The seizure in this question is most likely to originate in the parietal lobe as this is most associated with sensory symptoms like numbness and weakness.",
"id": "10025123",
"label": "d",
"name": "Cerebellum",
"picture": null,
"votes": 16
}
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"name": "Epilepsy",
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"question": "You are called to the neurology ward to review a 60-year-old male who has had a seizure. Before his seizure began, he complained of numbness and weakness in the right side of his body.\n\nIn which of the following brain regions did his seizure most likely originate?",
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"a"
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173,470,953 | false | 33 | null | 6,495,349 | null | false | [] | null | 17,423 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Polymyalgia rheumatica would typically present with shoulder and hip girdle stiffness. It can also be associated with more systemic symptoms such as fever, anorexia, muscle pains and tiredness.",
"id": "10025129",
"label": "e",
"name": "Polymyalgia rheumatica",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cauda equina syndrome can cause bilateral sciatica symptoms, as well as other symptoms like perianal anaesthesia, urinary incontinence or sexual dysfunction. This would be an important differential to rule out in all patients with back pain. However, this is not the most likely diagnosis in this patient's case.",
"id": "10025126",
"label": "b",
"name": "Cauda equina syndrome",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This clinical picture makes sciatica the most likely diagnosis in this patient. The unilateral shooting pain down the leg associated with tingling and weakness is typical of sciatica. Patients can often have back pain alongside this, but it is not typically as bad as the pain in their legs or feet.",
"id": "10025125",
"label": "a",
"name": "Sciatica",
"picture": null,
"votes": 143
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Myeloma can present with back pain, but the patient describes the pain going down the back of his leg. This is more typical of sciatica.",
"id": "10025127",
"label": "c",
"name": "Multiple myeloma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This option would be more likely with a history of trauma, such as involvement in a road traffic collision. This patient is more likely to be experiencing symptoms of sciatica.",
"id": "10025128",
"label": "d",
"name": "Vertebral fracture",
"picture": null,
"votes": 0
}
],
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"id": "4247",
"name": "Back Pain",
"status": null,
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"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
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"question": "A 25-year-old builder presents to the GP with leg pain for the last two months. He describes a unilateral shooting pain that travels down the back of his left leg below the knee. He also has pins and needles in this area.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 157,
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173,470,954 | false | 34 | null | 6,495,349 | null | false | [] | null | 17,424 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Septic arthritis will produce similar symptoms to the ones described: joint pain, swelling, redness and warmth. However, individuals with septic arthritis will be be systemically unwell and have a fever, tachycardic or be hypotensive. Additionally, the joint fluid analysis results are more suggestive of pseudogout.",
"id": "10025132",
"label": "c",
"name": "Septic arthritis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Rheumatoid arthritis can produce an inflammatory joint effusion that gives patients warm, swollen joints. These effusions would consist of mainly neutrophils and the gram-stain would be negative.",
"id": "10025134",
"label": "e",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of pseudogout: a single red, hot swollen joint, most commonly affecting the wrist or the shoulder. Pseudogout causes rhomboid-shaped crystals that are positively birefringent to be seen on aspiration.",
"id": "10025130",
"label": "a",
"name": "Pseudogout",
"picture": null,
"votes": 125
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paget's disease of the bone would usually present as an isolated rise in alkaline phosphatase (ALP) levels alongside bone pain. This description of a single hot and swollen joint with rhomboid-shaped crystals on joint fluid analysis is more typical of pseudogout.",
"id": "10025133",
"label": "d",
"name": "Paget's disease of the bone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gout would also present with a single red, hot swollen joint. However, on joint fluid analysis gout would show negatively birefringent crystals that are needle-shaped, rather than rhomboid-shaped.",
"id": "10025131",
"label": "b",
"name": "Gout",
"picture": null,
"votes": 22
}
],
"comments": [],
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"__typename": "Concept",
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},
"chapterId": 2693,
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"id": "3905",
"name": "pseudogout",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
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"question": "A 66-year-old male presents to his GP with a painful, swollen left knee. On examination, it feels hot to touch. Joint fluid analysis shows rhomboid-shaped crystals that are positively birefringent.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
"userPoint": null
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173,470,955 | false | 35 | null | 6,495,349 | null | false | [] | null | 17,425 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If this patient was presenting with bony metastases, the bone profile would look slightly different. Bony metastases would cause high levels of calcium and ALP, and low levels of PTH. The phosphate levels would remain in range. The biochemical results in this question suggest a diagnosis of osteomalacia.",
"id": "10025137",
"label": "c",
"name": "Bony metastases",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Osteoporosis would produce normal bone profile results. It would not explain the low calcium or phosphate levels or the rise in PTH.",
"id": "10025138",
"label": "d",
"name": "Osteoporosis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Osteomalacia is caused by low vitamin D levels and results in bone softening. Osteomalacia can cause normal or low levels of calcium or phosphate. It will cause a rise in the levels of alkaline phosphatase (ALP). It can cause normal or high levels of PTH.",
"id": "10025135",
"label": "a",
"name": "Osteomalacia",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paget's disease of the bone would present as an isolated rise in ALP levels. It would not explain the low calcium or phosphate, or the rise in PTH levels. Therefore, it is not the most likely diagnosis in this case.",
"id": "10025136",
"label": "b",
"name": "Paget's disease of the bone",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Primary hyperparathyroidism will cause high levels of calcium, ALP and PTH. It will cause low phosphate levels. The biochemical results in this question suggest a diagnosis of osteomalacia.",
"id": "10025139",
"label": "e",
"name": "Primary hyperparathyroidism",
"picture": null,
"votes": 66
}
],
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"name": "Osteomalacia",
"status": null,
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"__typename": "Topic",
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"name": "Endocrinology",
"typeId": 5
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"question": "A 20-year-old male comes into the GP for a routine blood test. He is found to have low calcium, low phosphate, low viatmin D levels, and high levels of parathyroid hormone (PTH).\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
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173,470,956 | false | 36 | null | 6,495,349 | null | false | [] | null | 17,426 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms this patient is describing is not likely to be a result of hydroxychloroquine. The dyspepsia and dysphagia described is more likely to be down to alendronic acid. Hydroxychloroquine can cause retinopathy or rashes, but dysphagia is not a known side effect of this medication.",
"id": "10025144",
"label": "e",
"name": "Hydroxychloroquine",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Phenytoin would not cause the symptoms this patient is experiencing. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.",
"id": "10025142",
"label": "c",
"name": "Phenytoin",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Amiodarone is a medication that can be used to treat atrial fibrillation. It would not cause the symptoms this patient is experiencing. However, amiodarone can cause hypothyroidism or hyperthyroidism, as well as corneal deposits and liver failure.",
"id": "10025141",
"label": "b",
"name": "Amiodarone",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The symptoms this patient is describing is not likely to be a result of ramipril. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.",
"id": "10025143",
"label": "d",
"name": "Ramipril",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Alendronic acid is an example of a bisphosphonate. Bisphosphonates can cause oesophagitis, oesophageal ulcers, dysphagia and dyspepsia. To reduce the risk of these side effects, there are guidelines surrounding these medications, including taking the tablets on an empty stomach and sitting upright for 30 minutes after taking these medications.",
"id": "10025140",
"label": "a",
"name": "Alendronic acid",
"picture": null,
"votes": 115
}
],
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"id": "5822",
"name": "Side effect of bisphosphonates",
"status": null,
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"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
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"question": "A 30-year-old female attends the GP with a 11-day history of dysphagia. On further questioning, she also describes having a burning sensation in her chest.\n\nWhich of the following medications is the most likely cause of her symptoms?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
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173,470,957 | false | 37 | null | 6,495,349 | null | false | [] | null | 17,427 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haemochromatosis is a disorder of iron metabolism where excessive iron builds up in the body and accumulates in the body. It is deposited in a number of sites including the liver, heart, joints, pancreas and skin. You would expect haemochromatosis to show deranged LFTs as well as a raised serum ferritin and raised transferrin saturation.",
"id": "10025146",
"label": "b",
"name": "Haemochromatosis",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Alpha-1 antitrypsin deficiency is an inherited condition that causes lung emphysema and liver cirrhosis. You would expect patients to present with shortness of breath and a raised ALP on blood results.",
"id": "10025148",
"label": "d",
"name": "Alpha-1 antitrypsin deficiency",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is presenting with intermittent jaundice and a high bilirubin which makes a diagnosis of Gilbert's syndrome the most likely diagnosis.",
"id": "10025149",
"label": "e",
"name": "Hepatitis E",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Wilson's disease would show a low serum ceruloplasmin and copper levels. Wilsons disease would not account for the high ALT.",
"id": "10025147",
"label": "c",
"name": "Wilson’s disease",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with the signs and symptoms of Gilbert's syndrome. This condition causes intermitted episodes of jaundice which often occur due to stress, infection, fasting or exercise. Gilbert's syndrome will cause a raised bilirubin level in an otherwise normal set of bloods.",
"id": "10025145",
"label": "a",
"name": "Gilbert's syndrome",
"picture": null,
"votes": 124
}
],
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"__typename": "Concept",
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"typeId": 7
},
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"demo": null,
"entitlement": null,
"id": "5823",
"name": "Gilbert's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
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"question": "A 17-year-old university student presents to the GP as he has noticed yellowing of the skin. On further questioning, he tells you this skin yellowing comes and goes. He undergoes blood tests which show a raised bilirubin. Alkaline phosphatase (ALP), alanine transaminase (ALT) and albumin are all within the normal range. He drinks two to three units of alcohol per week and his BMI is 21.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 154,
"typeId": 1,
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173,470,958 | false | 38 | null | 6,495,349 | null | false | [] | null | 17,428 | {
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{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with bone pain and an isolated rise in their ALP levels which is typical of a diagnosis of Paget's disease. Paget’s disease may also be diagnosed on X-ray where you may find osteolysis or an increase in bone size.",
"id": "10025150",
"label": "a",
"name": "Paget’s disease of the bone",
"picture": null,
"votes": 95
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Gout would normally present with a single red, hot and swollen joint. Gout would not account for a raise in ALP, so is not the most likely diagnosis in this case.",
"id": "10025152",
"label": "c",
"name": "Gout",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "If the patient had osteoporosis, this would produce a normal bone profile and would not account for the raised ALP. Paget's disease is more likely to account for the biochemical findings in this patient.",
"id": "10025154",
"label": "e",
"name": "Osteoporosis",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A presentation of ankylosing spondylitis would normally describe back pain that gets better with exercise. It would not account for the rise in ALP levels, and therefore Paget's disease is a more likely diagnosis in this case.",
"id": "10025153",
"label": "d",
"name": "Ankylosing spondylitis",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Pseudogout would present as a single inflamed joint, and it usually affects the wrist or shoulder joints. It would not account for this patient’s high ALP, so is not the most likely diagnosis in this case.",
"id": "10025151",
"label": "b",
"name": "Pseudogout",
"picture": null,
"votes": 3
}
],
"comments": [],
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"__typename": "Concept",
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},
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"demo": null,
"entitlement": null,
"id": "4617",
"name": "Paget's Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
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"question": "A 65-year-old female presents to the GP with bone pain that began eight months ago. A blood test reveals no abnormalities except for a raised alkaline phosphatase (ALP) level.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 154,
"typeId": 1,
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} | MarksheetMark |
173,470,959 | false | 39 | null | 6,495,349 | null | false | [] | null | 17,429 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with the typical symptoms of ankylosing spondylitis: back pain and stiffness worse in the morning that gets better with movement. This condition is also associated with anterior uveitis, which this patient experienced one month ago.",
"id": "10025155",
"label": "a",
"name": "Ankylosing Spondylitis",
"picture": null,
"votes": 97
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient's presentation is more typical of ankylosing spondylitis. The age and gender of this patient (a young man) also points towards this diagnosis.",
"id": "10025159",
"label": "e",
"name": "Mechanical back pain",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Polymyalgia rheumatica would typically cause shoulder and hip girdle stiffness alongside some systemic symptoms such as fever, anorexia, weight loss and malaise. Normally, there would be raised inflammatory markers.",
"id": "10025157",
"label": "c",
"name": "Polymyalgia Rheumatica",
"picture": null,
"votes": 41
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Paget's disease would present with bone pain and an isolated rise in alkaline phosphatase (ALP). It could also be picked up on X-ray where you may find osteolysis, increased bone size and sclerosis or pathological fractures.",
"id": "10025158",
"label": "d",
"name": "Paget’s disease of the bone",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cauda equina syndrome would present with symptoms such as saddle anaesthesia, serve sudden onset back pain and urinary incontinence. This patient is more likely to have ankylosing spondylitis.",
"id": "10025156",
"label": "b",
"name": "Cauda equina syndrome",
"picture": null,
"votes": 1
}
],
"comments": [],
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"id": "3911",
"name": "ankylosing spondylitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
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"question": "A 20-year-old male presents to the GP with worsening back pain for the past ten months. He tells you the pain is worse in the morning, but gets better on exercise. You note he had an episode of anterior uveitis a month ago.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 153,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,960 | false | 40 | null | 6,495,349 | null | false | [] | null | 17,430 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This classically presents as a temporal headache alongside jaw claudication (pain on chewing food) and scalp tenderness. It can also lead to blindness if not treated promptly. The patient may also describe a thickened tender temporal artery on examination. You should also look out for a patient with symmetrical proximal muscle weakness and oligoarthritis as giant cell arteritis is often associated with polymyalgia rheumatica.",
"id": "10025164",
"label": "e",
"name": "Giant cell arteritis",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Cluster headaches present as unilateral headaches that are worse around the eye. They occur in attacks, or clusters over time. Patients would typically describe associated symptoms such as a bloodshot eye, rhinorrhea, lid swelling and facial flushing. The length of attacks is a lot shorter than migraines, typically lasting between 15 minutes and three hours.",
"id": "10025162",
"label": "c",
"name": "Cluster headache",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This presents as short episodes of stabbing pain, affecting one side of the face, in the trigeminal nerve distribution. They are triggered by talking, eating or touching the face. The headache in this patient is not described as following the trigeminal nerve distribution, and no triggers are given that would indicate trigeminal neuralgia being the most likely diagnosis.",
"id": "10025163",
"label": "d",
"name": "Trigeminal Neuralgia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "You would expect a tension headache to present as a bilateral, non-pulsatile headache. They can feel tight, like around the head. They are not associated with aura’s or photophobia, and therefore do not fit this woman’s symptoms.",
"id": "10025161",
"label": "b",
"name": "Tension headache",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is a typical presentation of a migraine. The question describes a unilateral headache associated with photophobia and phonophobia. Migraines can last anything from four to 72 hours at a time. Episodes of migraine can be preceded by an aura, such as a visual aura, like in this patient, or can present with sensory symptoms like paraesthesia. Migraines can have various triggers, which include medications such as aspirin and naproxen and certain foods like cheese or chocolate.",
"id": "10025160",
"label": "a",
"name": "Migraine",
"picture": null,
"votes": 110
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
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"demo": null,
"entitlement": null,
"id": "5824",
"name": "Headache",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
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},
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"dislikes": 0,
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"question": "A 37-year-old female attends the GP practice complaining of episodes of throbbing pain on the left side of her head. Before these episodes, her vision can go funny. The episodes can last from 10- 24 hours at a time. She has a past medical history of osteoarthritis and is currently taking naproxen.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,961 | false | 41 | null | 6,495,349 | null | false | [] | null | 17,431 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is experiencing symptoms of acute stress reaction, which is a mental health condition that can occur up to a month after someone goes through a traumatic event.",
"id": "10025165",
"label": "a",
"name": "Acute stress reaction",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Schizotypal personality disorder is a personality disorder is characterized by bizarre or magical thinking. It causes individuals to have difficulty with social interactions.",
"id": "10025169",
"label": "e",
"name": "Schizotypal personality disorder",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "EUPD is characterized by individuals having sudden mood swings, unstable relationships, and an unstable sense of self and self-image. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.",
"id": "10025168",
"label": "d",
"name": "Emotionally unstable personality disorder (EUPD)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Bipolar disorder is diagnosed when someone has both a major depressive episode and an episode of mania or hypomania. Manic episodes involve elated mood or irritability, often involving people making dangerous decisions with little thought for consequences. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.",
"id": "10025167",
"label": "c",
"name": "Bipolar Disorder",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Post traumatic stress disorder can only be diagnosed when a person has symptoms for more than one month. Therefore, the correct answer to this question is acute stress reaction.",
"id": "10025166",
"label": "b",
"name": "Post-traumatic stress disorder",
"picture": null,
"votes": 88
}
],
"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": "4067",
"name": "Anxiety, Obsessions and Stress Reactions (including OCD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4067,
"conditions": [],
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"dislikes": 0,
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"highlights": [],
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"question": "A 25-year-old female presents to the GP with palpations and shortness of breath for the last two weeks. She describes several episodes of feeling hot and breathless before seeing vivid images. She says these episodes began after she was involved in a car crash two weeks ago.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 153,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,962 | false | 42 | null | 6,495,349 | null | false | [] | null | 17,432 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Thyrotoxicosis occurs when there is excess thyroid hormone action at the level of the tissues. The most common cause of this is Grave's disease. This patient is presenting with lots of the typical symptoms of thyrotoxicosis: weight loss, heat intolerance, tremor, palpitations, irritability and muscle weakness.",
"id": "10025170",
"label": "a",
"name": "Thyrotoxicosis",
"picture": null,
"votes": 101
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "An Addisonian crisis is a severe presentation of Addison's disease when it is left untreated. It can present with symptoms such as dizziness, fainting, abdominal pain, depression and muscle weakness. Patients will often describe a bronze hyperpigmentation to the skin. The key biochemical finding of hyponatremia.",
"id": "10025172",
"label": "c",
"name": "Addisonian crisis",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Diabetic ketoacidosis will often present with polyuria and polydipsia preceding unconsciousness. This patient is presenting with lots of the typical symptoms of thyrotoxicosis.",
"id": "10025173",
"label": "d",
"name": "Diabetic ketoacidosis (DKA)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hypothyroidism would present with weight gain, rather than weight loss. It would also cause symptoms like lethargy, anhydrosis, constipation and in some patients menorrhagia.",
"id": "10025171",
"label": "b",
"name": "Hypothyroidism",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Hyperosmolar hyperglycaemic state is a complication of untreated type 2 diabetes. Like DKA, it often presents with polyuria and polydipsia. It does not produce ketones, making it different to diabetic ketoacidosis.",
"id": "10025174",
"label": "e",
"name": "Hyperosmolar hyperglycaemic state (HHS)",
"picture": null,
"votes": 4
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5825",
"name": "Hyperthyroidism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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},
"conceptId": 5825,
"conditions": [],
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"highlights": [],
"id": "17432",
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"question": "A 50-year-old female is found collapsed in her home. She is found to have thin hair, and is hot and clammy to touch. Her wife tells you that she has lost some weight in the last month. On examination, you notice brisk reflexes and a heartrate of 144. A thyroid function test shows a low thyroid-stimulating hormone (TSH) and high T4.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 157,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,963 | false | 43 | null | 6,495,349 | null | false | [] | null | 17,433 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "IV fluids are not the most appropriate treatment for this patient. This patient has taken a staggered overdose, and therefore they require management with N-acetylcysteine.",
"id": "10025179",
"label": "e",
"name": "Give IV fluids",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has taken a staggered overdose, taking two doses over an hour apart. This means the patient should be treated with N-acetylcysteine. Other indications for N-acetylcysteine treatment include uncertainty over the timing of the overdose and the patient being unconscious.",
"id": "10025175",
"label": "a",
"name": "Give N-acetylcysteine",
"picture": null,
"votes": 116
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Activated charcoal should only be given to patients who are less than an hour post-overdose and have taken more than 75mg/kg. This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.",
"id": "10025176",
"label": "b",
"name": "Give activated charcoal",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.",
"id": "10025177",
"label": "c",
"name": "Take paracetamol levels at four hours after the second dose",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.",
"id": "10025178",
"label": "d",
"name": "Take paracetamol levels at one hour after the second dose",
"picture": null,
"votes": 6
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"demo": null,
"entitlement": null,
"id": "4620",
"name": "Paracetamol Overdose",
"status": null,
"topic": {
"__typename": "Topic",
"id": "161",
"name": "Emergency Medicine",
"typeId": 5
},
"topicId": 161,
"totalCards": null,
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},
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"question": "A 19-year-old male is brought into the emergency department by his flatmates after taking an overdose of paracetamol. He states that he took a total of 8g of paracetamol at around 6pm and another 6g of paracetamol an hour and a half later. It is now 9pm.\n\nWhich of the following is the most appropriate management of this patient?",
"sbaAnswer": [
"a"
],
"totalVotes": 158,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,964 | false | 44 | null | 6,495,349 | null | false | [] | null | 17,434 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A consequence of anorexia nervosa is hypercholesterolaemia, which is thought to be due to changes to metabolic pathways as a consequence of the conditon.",
"id": "10025182",
"label": "c",
"name": "Low cholesterol levels",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anorexia nervosa causes the levels of growth hormone to increase, rather than decrease.",
"id": "10025183",
"label": "d",
"name": "Low growth hormone (GH) levels",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anorexia nervosa causes low potassium levels, not high.",
"id": "10025181",
"label": "b",
"name": "Hyperkalaemia",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Anorexia nervosa causes the levels of sex hormones to decrease, so it would be typical to find low levels of testosterone, rather than high.",
"id": "10025184",
"label": "e",
"name": "High testosterone levels",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A consequence of anorexia nervosa is low levels of lutenising hormone (LH) and FSH. It also causes lower levels of other sex hormones, including low oestrogen and testosterone levels.",
"id": "10025180",
"label": "a",
"name": "Low follicle stimulating hormone (FSH)",
"picture": null,
"votes": 84
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4469",
"name": "Anorexia nervosa",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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"question": "A 17-year-old female patient is currently detained under the Mental Health Act with anorexia nervosa.\n\nWhich of the following is a consequence of anorexia nervosa?",
"sbaAnswer": [
"a"
],
"totalVotes": 152,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,965 | false | 45 | null | 6,495,349 | null | false | [] | null | 17,435 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the most common cause of meningococcal sepsis in neonates, so is unlikely to be the cause of this patient's meningitis. The rash described in the question is more typical of *Neisseria meningitidis*, rather than Group B Streptococcus.",
"id": "10025186",
"label": "b",
"name": "Group B Streptococcus",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Herpes simplex virus 2 would cause a viral meningitis, meaning the cerebral spinal fluid would show a high glucose and low protein. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.",
"id": "10025188",
"label": "d",
"name": "Herpes simplex virus 2",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient is presenting with meningococcal disease. *Neisseria meningitidis* is the most likely causative organism. Typical features include fever, headache, neck stiffness and photophobia. The presence of a non-blanching rash indicates the infection has spread into the bloodstream.",
"id": "10025185",
"label": "a",
"name": "*Neisseria meningitidis*",
"picture": null,
"votes": 142
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Listeria monocytogenes* causes infections in immunosuppressed patients and can be found in patients at the extremes of age. The patient in question is more likely to be caused by *Neisseria meningitidis*.",
"id": "10025187",
"label": "c",
"name": "*Listeria monocytogenes*",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This would cause a viral meningitis, meaning the cerebral fluid analysis would show a high glucose and low protein content. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.",
"id": "10025189",
"label": "e",
"name": "Coxsackie Virus A",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3751",
"name": "Meningitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
"typeId": null,
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"question": "An 18-year-old female student presents to the GP with a fever. She also reports a headache and neck stiffness. On examination, she has a temperature of 39 degree Celsius and you notice a purpuric rash on her abdomen. Cerebral spinal fluid analysis shows low glucose levels, high protein levels and an increased white cell count.\n\nWhich of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 155,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,966 | false | 46 | null | 6,495,349 | null | false | [] | null | 17,436 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This patient has the typical findings of infective endocarditis: fevers (most common), weight loss, and chest pain. You may also find night sweats, muscle pains and lethargy as well as typical nail signs like splinter haemorrhages. The first two months after prosthetic valve surgery would put a patient at risk of infective endocarditis with *staph. epidermis*. Therefore, the most likely causative organism in this case is *staph. epidermis*.",
"id": "10025190",
"label": "a",
"name": "*Staphlococcus epidermis*",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "*Streptococcus viridans* is found in dental plaque and is a common cause of endocarditis in patients with poor dental hygiene. However, this patient is most likely to be colonised with *staph. epidermis* as he has had a prosthetic valve replacement a month ago.",
"id": "10025193",
"label": "d",
"name": "*Streptococcus viridans*",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The most common causative organism of infective endocarditis overall is *Staph. aureus*. However, this patient has had a prosthetic valve replacement a month ago and therefore is at risk of colonisation with *staph. epidermis*.",
"id": "10025191",
"label": "b",
"name": "*Staphylococcus aureus*",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This organism is associated with colorectal cancer. The question gives us no indications the patient has colorectal cancer. Therefore, *strep. bovis* is not a likely cause of this patient's infective endocarditis.",
"id": "10025192",
"label": "c",
"name": "*Streptococcus bovis*",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an uncommon cause of infective endocarditis and therefore is not the most likely causative organism of this patient’s infective endocarditis.",
"id": "10025194",
"label": "e",
"name": "*Coxiella burnetii*",
"picture": null,
"votes": 0
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
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},
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"demo": null,
"entitlement": null,
"id": "3710",
"name": "Infective Endocarditis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "A 55-year-old male presents to the emergency department with a three-week history of fevers, weight loss and chest pain. On examination, there are splinter haemorrhages on his nails and macules on his palms consistent with janeway lesions. He had a prosthetic valve replacement one month ago.\n\nGiven the most likely diagnosis, which of the following is the most likely causative organism?",
"sbaAnswer": [
"a"
],
"totalVotes": 153,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,967 | false | 47 | null | 6,495,349 | null | false | [] | null | 17,437 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The ventrolateral preorbital nucleus is the structure in the brain responsible for paralysis during sleep.",
"id": "10025195",
"label": "a",
"name": "Ventrolateral preorbital nucleus",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This structure stabilizes the sleep-wake switch. It does not control paralysis during sleep.",
"id": "10025199",
"label": "e",
"name": "Hypothalamic orexin",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is an excitatory neurotransmitter that interacts with nuclei in the midbrain during sleep. It does not control paralysis during sleep.",
"id": "10025198",
"label": "d",
"name": "Hypocretin",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This structure is located in the brainstem and is silenced during REM (rapid eye movement) atonia. The ventrolateral preorbital nucleus controls paralysis during sleep.",
"id": "10025197",
"label": "c",
"name": "Locus coeruleus",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The suprachiasmatic nucleus controls the circadian rhythm, meaning it controls the regulation of sleep across 24 hours. Circadian rhythm is affected by both light and melatonin. It does not control paralysis during sleep.",
"id": "10025196",
"label": "b",
"name": "Suprachiasmatic nucleus",
"picture": null,
"votes": 21
}
],
"comments": [],
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"__typename": "Chapter",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4310",
"name": "Phases of sleep",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
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},
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"question": "Which structure control paralysis during sleep?",
"sbaAnswer": [
"a"
],
"totalVotes": 148,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,968 | false | 48 | null | 6,495,349 | null | false | [] | null | 17,438 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Haloperidol is associated with a reduced seizure threshold, rather than an increased seizure threshold.",
"id": "10025203",
"label": "d",
"name": "Increased seizure threshold",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Agranulocytosis is more likely to occur with second-generation antipsychotics like clozapine. Haloperidol is more likely to cause side effects like dystonia and akathisia.",
"id": "10025201",
"label": "b",
"name": "Agranulocytosis",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Haloperidol is a first-generation antipsychotic. Dystonia is a type of extra-pyramidal side effect that can occur with use of these medications. Other extra-pyramidal side effects include akathisia, parkinsonism and tardive dyskinesia.",
"id": "10025200",
"label": "a",
"name": "Dystonia",
"picture": null,
"votes": 53
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Dyslipidaemia is a side effect more likely to occur with the use of second-generation antipsychotics like clozapine and olanzapine, not first-generation antipsychotics like haloperidol.",
"id": "10025204",
"label": "e",
"name": "Dyslipidaemia",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Weight gain is more likely to occur with second-generation antipsychotics like olanzapine, rather than first-generation antipsychotics like haloperidol.",
"id": "10025202",
"label": "c",
"name": "Weight gain",
"picture": null,
"votes": 45
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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},
"chapterId": 2693,
"demo": null,
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"id": "3828",
"name": "Side effects of antipsychotics",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "17438",
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"question": "A 50-year-old female attends the GP for a medication review. She has recently been started on haloperidol by her psychiatrist.\n\nWhich of the following side effects is most likely to occur with this medication?",
"sbaAnswer": [
"a"
],
"totalVotes": 146,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,969 | false | 49 | null | 6,495,349 | null | false | [] | null | 17,439 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals with histrionic personality disorder often engage in attention-seeking behaviour, and can be flirtatious. The individual in this question is described as having a low self-esteem and unstable moods which fits in better with a diagnosis of emotionally unstable personality disorder. It is not common for these individuals to display self-harm or suicidal behaviours.",
"id": "10025209",
"label": "e",
"name": "Histrionic personality disorder",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Generalised anxiety disorder would not normally present in this manner. It can cause symptoms such as feeling restless or worried a lot of the time, having trouble concentrating or physical symptoms like palpations and shortness of breath.",
"id": "10025206",
"label": "b",
"name": "Generalised Anxiety disorder",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Individuals with schizoid personality disorder would present with a lack of interest in social relationships. They often have limited emotional expression, and can present as cold or detached from people. Unlike the individual in the question, they often have very few relationships and do not typically display heightened emotions.",
"id": "10025207",
"label": "c",
"name": "Schizoid personality disorder",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the most likely diagnosis in this patient. Although this condition is more common in women, it should not be ignored in the male population. Individuals often have unstable moods and difficulty in relationships.",
"id": "10025205",
"label": "a",
"name": "Emotionally unstable personality disorder (EUPD)",
"picture": null,
"votes": 130
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This often presents as intense fears of abandonment, excess reliance on caregivers and low self-esteem. They would find it difficult to make decisions or complete tasks without caregiver support.",
"id": "10025208",
"label": "d",
"name": "Dependant personality disorder",
"picture": null,
"votes": 11
}
],
"comments": [],
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"__typename": "Chapter",
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},
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"id": "4622",
"name": "Class B Personality Disorders",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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},
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"question": "A 24-year-old male presents to A+E after a paracetamol overdose. He reports a history of unstable relationships, and often alternates between isolating partners to believing 'they are the best thing to have ever happened to him'. He finds he can have difficulty controlling anger and acts impulsively.\n\nWhich of the following is the most likely diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 149,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,470,970 | false | 50 | null | 6,495,349 | null | false | [] | null | 17,440 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A Section 5(2) is used by doctors to detain a person for up to 72 hours. However, this patient is in a public place (A+E), and therefore require a Section 136 by the police to be detained.",
"id": "10025212",
"label": "c",
"name": "Section 5(2)",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This section can be used by police to enter private premises and remove a person to a place of safety. This can last up to 24 hours. Because this patient is in A+E, the police can use a section 136 to detain this patient.",
"id": "10025214",
"label": "e",
"name": "Section 135",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A section 5(4) can be used by nurses and means they can detain an individual for six hours if they believe this individual is suffering from a mental disorder. However, this patient is in a public place (A+E), and therefore require a Section 136 by the police to be detained.",
"id": "10025211",
"label": "b",
"name": "Section 5(4)",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This patient is in the emergency department which is classed as a public place, and therefore require a section 136 instead of a Section 5(3).",
"id": "10025213",
"label": "d",
"name": "Section 5(3)",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "A section 136 can be used by police to bring someone in from a public place if the police believe they are mentally unwell. This section can last up to 24hours, after which they should have a mental health act assessment. Because this patient is in A+E, this counts as a public place.",
"id": "10025210",
"label": "a",
"name": "Section 136",
"picture": null,
"votes": 55
}
],
"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": "4434",
"name": "The Mental Health Act",
"status": null,
"topic": {
"__typename": "Topic",
"id": "173",
"name": "Psychiatry",
"typeId": 5
},
"topicId": 173,
"totalCards": null,
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},
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"difficulty": 1,
"dislikes": 0,
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"question": "A 30-year-old female with known bipolar disorder has started shouting at staff in the emergency department. The police believe she is a risk to herself and others and wish to place her under a section of the mental health act.\n\nWhich of the following sections of the mental health act can be used by the police for this purpose?",
"sbaAnswer": [
"a"
],
"totalVotes": 145,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
Subsets and Splits