Mixed SBA for 3rd Year Quiz 1 (73 Questions)

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0 [{"id":488752,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:16:20","updated_at":"2018-07-11 14:58:40","questionName":"Mr. A, 40, comes into the GP with his wife, complaining about feeling generally unwell with fatigue and malaise. He is currently under investigations with an hepatologist for alcohol-related liver problems. \r\nHe tells you that he knows his alcohol intake is causing his liver problems but he still can\u2019t stop excessively drinking. He feels he needs to drink every night, but occasionally manages to stop for a week or two, during which time he feels fine. Over recent months he has noticed that he needs to drink more alcohol to feel the same effect. How many features of alcohol dependence dose Mr. A have?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":4,"explanation":"Persistence - knows his alcohol intake is causing his liver problems but he still can\u2019t stop.\r\nCompulsion - needs to drink every night.\r\nTolerance - needs to drink more alcohol to feel the same effect.\r\nRed hearing \u2013 No Withdrawal (occasionally manages to stop for a week or two, during which time he feels fine).\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488757,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:41:16","updated_at":"2018-07-11 14:58:40","questionName":"Which of these is most likely to be the cause of a hepatic jaundice?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":9,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488754,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:31:36","updated_at":"2018-07-11 14:58:40","questionName":"A mild rise in alanine aminotransferase (ALT) of <300 could suggest which kind of pathology?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":6,"explanation":"An ALT rise of <300 can also be seen in NAFLD, cirrhosis and haemochromatosis.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":494923,"quiz_id":"24891","answer_id":null,"answerType_id":"2","created_at":"2018-06-29 07:47:50","updated_at":"2018-07-11 14:58:40","questionName":"Match the normal values of respiratory rate to the correct age group.","questionTimeSeconds":"0","questionTimeMinutes":"4","questionImagePath":null,"position":12,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488755,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:33:50","updated_at":"2018-07-11 14:58:40","questionName":"A moderate rise in alanine aminotransferase (ALT) to 300-500 could suggest which pathology?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":7,"explanation":"Other causes of a moderate rise in ALT include: chronic liver disease and autoimmune hepatitis","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488758,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:52:27","updated_at":"2018-07-11 14:58:40","questionName":"You're an FY1 working in urgent care and you are asked to see a 52 year old male who's complaining of a constant dull ache in his RUQ and epigastric region. It started 2 days ago and is worse after eating (particularly fatty foods) and at night when led flat. The pain radiates to his right shoulder and he also complains of nausea. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":10,"explanation":"The most common cause of biliary colic is a gall stone stuck at the neck of a gallbladder","question_score_id":null,"lang":"","questionAudioPath":null},{"id":494925,"quiz_id":"24891","answer_id":null,"answerType_id":"2","created_at":"2018-06-29 07:50:58","updated_at":"2018-07-11 14:58:40","questionName":"Match the normal values of systolic blood pressure to the correct age group.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":14,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488753,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:28:24","updated_at":"2018-07-11 14:58:40","questionName":"Mrs C is a 42 year old female who came to A&E presenting with worsening RUQ pain for 2 days. She also complains of a fever and fatigue. On examination you notice that she has sign of icterus in her eyes and abdomen is soft and non tender with no palpable masses or distension. Bloods show: Raised Bilirubin, Significantly raised ALP, Raised ALT. What is the most appropriate initial investigation?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":5,"explanation":"Significantly raised ALP is likely to be a post hepatic problem (biliary). She has worsening RUQ pain, fever and fatigue. Icterus is the technical term for jaundice and her bilirubin in raised. This points to either: biliary colic or ascending cholangitis.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488751,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:13:26","updated_at":"2018-07-11 14:58:40","questionName":"Mr. P is a 29 year old man who was brought in by ambulance after being found semi-conscious in the street, surrounded by empty bottles of vodka. He is haemodynamically stable but his GCS is 9 (M5, V2, E2). His wife comes in and reports that he has not had any long term medical conditions or recently been ill, however he has been a heavy drinker for 10 years now but no other illicit drugs. He's blood test can be seen below. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-1\/Liver Q2.png","position":3,"explanation":"He's had a massive rise of >1000 in ALT which indicates toxin\/drug induced hepatitis. Acute viral hepatitis can also cause an ALT rise like this but the history doesn't show any sign of recent infection. Liver ischaemia can also cause this massive rise. ","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488749,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 17:58:33","updated_at":"2018-07-11 14:58:40","questionName":"Mr. G consumes 1 pint of 4% lager every day except for Friday when he has 8 shots of 25ml of 40% vodka. How many units does he have in a week?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":2,"explanation":"Total volume of a drink x alcoholic strength (%) divided by 1000\r\nSo Mr G drinks 6 pints of beer and has 8 shots of vodka.\r\n6 pints = 568ml x 6 = (3408 x 4)\/1000 = 13.6 units. Or if you know there are 2.3 units in a 4% beer you can do 2.3x6=13.8\r\nVodka \u2013 8x25 = (200ml x 40)\/1000 = 8 units. Or a 25ml shot of a 40% spirit = 1 unit so 8 shots = 8 units\r\nTotal = 13.8+8=21.8 ~ 22units","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488747,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 17:30:03","updated_at":"2018-07-12 10:12:54","questionName":"Which of these liver functions tests is a more specific marker to hepatic issues when raised?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":0,"explanation":"Alanine transaminase (ALT); Aspartate aminotransferase (AST); Alkaline phosphatase (ALP); Gamma-Glutamyltransferase (GGT). ALT is found in high concentrations within hepatocytes and enters the blood following hepatocellular injury. It is, therefore, a useful marker of hepatocellular injury. ALP is concentrated in the liver, bile duct and bone tissues. ALP is often raised in liver pathology due to increased synthesis in response to cholestasis. As a result, ALP is a useful indirect marker of cholestasis.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488762,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 19:06:24","updated_at":"2018-07-11 14:58:40","questionName":"You are a FY2 doctor working in A&E, you are asked to see a 40 year old female who is presenting with jaundice, fever and right upper quadrant pain. On examination she has a fever of 38.6\u02daC, is tachycardic, has RUQ tenderness but no signs of peritonism. Her lab results show a slight elevated ALT, a markedly raised ALP and a raised CRP and WBCC. What is the likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":11,"explanation":"50-70% of patients present with classic Charcot's triad of jaundice, fever and right upper quadrant pain indicating ascending cholangitis. Physical signs may include fever, right upper quadrant tenderness, jaundice, mental status changes, hypotension and tachycardia. Puritanism is an unusual sign and should stimulate the search for an alternative diagnosis. Diagnostic criteria for acute cholangitis include: Fever and\/or shaking chills - temperature >38 \u00b0C. Laboratory data: evidence of inflammatory response - abnormal white blood cell counts, increase of serum C-reactive protein levels and other changes indicating inflammation, abnormal LFTs - increased serum ALP, \u03b3GTP (GGT), AST and ALT levels.\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488756,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 18:38:45","updated_at":"2018-07-11 14:58:40","questionName":"Which one of these is a pre-hepatic cause of jaundice? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":8,"explanation":"Pre-hepatic (unconjugated hyperbilirubinaemia):\r\nGilbert's syndrome is the most common inherited cause of unconjugated hyperbilirubinaemia. It is caused by underactivity of the conjugating enzyme system. It is found in 3-7% of the population.\r\nHaemolytic anaemias - eg, spherocytosis, pernicious anaemia.\r\nThalassaemia.\r\nTrauma.\r\nCrigler-Najjar syndrome is a rare autosomal recessive disorder of bilirubin metabolism, caused by deficient diphosphate glycosyltransferase.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":488748,"quiz_id":"24891","answer_id":null,"answerType_id":"0","created_at":"2018-06-12 17:50:16","updated_at":"2018-07-11 14:58:40","questionName":"Mrs T is a 61 year old lady admitted on the orthopaedic ward for an elective knee replacement for OA. She has T2DM (metformin controlled) and Hypertension and has a BMI of 33. She drinks 10 units of alcohol per week and doesn\u2019t smoke. On admission, her blood tests can be seen on the table below. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-1\/Liver Q1.png","position":1,"explanation":"NAFLD is a metabolite syndrome and is common in 3\/4 of obese people. There can be no symptoms present initially or fatigue and malaise. Symptoms normally only present in cirrhosis. On the LFT's the ALT will be greater than the AST with both being raised. Also look for clues in the history. The patient in this case has T2DM, hypertension and a BMI of 33 which makes her obese. She is also consumes less than the weekly recommended intake of alcohol.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":494924,"quiz_id":"24891","answer_id":null,"answerType_id":"2","created_at":"2018-06-29 07:49:39","updated_at":"2018-07-11 14:58:40","questionName":"Match the normal values of heart rate to the correct age group.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":13,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null}]
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Mr. A, 40, comes into the GP with his wife, complaining about feeling generally unwell with fatigue and malaise. He is currently under investigations with an hepatologist for alcohol-related liver problems. He tells you that he knows his alcohol intake is causing his liver problems but he still can’t stop excessively drinking. He feels he needs to drink every night, but occasionally manages to stop for a week or two, during which time he feels fine. Over recent months he has noticed that he needs to drink more alcohol to feel the same effect. How many features of alcohol dependence dose Mr. A have?

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