0 [{"id":498306,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:06:24","updated_at":"2018-07-11 14:58:07","questionName":"A 55 year old male complains of blurred vision and painful eye movements. He attends the weekly DOTS clinic and his CXR is available to view (below). What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-2\/CXR1.png","position":1,"explanation":"DOTS standards for Directly Observed Treatment, Short-course and is a strategy used to reduce the number of tuberculosis (TB) cases. For this question you need to work out the patient has TB, then work out which drugs causes which side effects. Ethambutol affects the Eyes (remember by them both beginning with E), so you can rule out 3 of the choices. Retrobulbar neuritis is a form of optic neuritis in which the optic nerve becomes inflamed due to the drug. Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous and\/or vitreous humor), usually caused by infection.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498328,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:57:28","updated_at":"2018-07-11 14:58:07","questionName":"A 20 year old woman visits the GP after having intercourse during which the condom split last night. She is very concerned about becoming pregnant. Which of the following options would be most likely to prevent pregnancy?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":13,"explanation":"The morning after pills are very effective but the copper coil is most effective and can be fitted up to 5 days post intercourse. Two of the answers are commonly held beliefs about how to prevent pregnancy.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498324,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:51:31","updated_at":"2018-07-11 14:58:07","questionName":"A 37 year old woman visits the GP to discuss contraception. She has no relevant past medical history. On examination she is found to have a BMI of 36 and a blood pressure of 145\/90. Which of the following is probably not a suitable choice of contraceptive?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":9,"explanation":"The combined oral pill often increases BP (hers is already worryingly high for a 37 year old), she also has a high BMI (this alone may not entirely rule out the use of the CoCP)","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498326,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:53:40","updated_at":"2018-07-11 14:58:07","questionName":"A 50 year old man visits the GP complaining of a burning sensation when he urinates, he describes no other symptoms. He is currently taking metformin. Which of the following is most likely to be the cause of the burning sensation?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":11,"explanation":"He is not in the age group in which chlamydia and gonorrhoea are prevalent although his sexual history should be explored in the consultation. With kidney stones and balanitis we would probably expect additional symptoms such as pain\/ visible redness and swelling (in balanitis)","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498320,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:43:57","updated_at":"2018-07-11 14:58:07","questionName":"A 49 year old travel writer presents with a three week history of periodic low-grade fevers with nausea and vomiting. At onset she also experienced watery diarrhoea and joint pains which have since resolved. She recently returned from a two month stay in rural India, where she swam in the Ganges river and drank unfiltered water. She did not take malaria prophylaxis and received no pre-travel vaccinations. On examination her observations are normal and her temperature is 36.4\u00b0C. She has scleral jaundice and a palpable liver edge at the costal margin. Cardiovascular and respiratory examinations are unremarkable. \u000bWhat is the most important investigation to perform?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":7,"explanation":"You want to rule out Malaria by requesting a thick and thin blood film.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498305,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 08:57:54","updated_at":"2018-07-11 14:58:07","questionName":"A 33 year old male patient is admitted to hospital and investigated for a pyrexia of unknown origin. On examination he is unkempt, sweating and has track marks on his arms. You hear a pan-systolic murmur loudest over the left 4th intercostal space on the parasternal edge; his medical records show no such finding previously. \u000bGiven the most likely diagnosis, which organism is most likely isolated from his blood cultures?\u000b","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":0,"explanation":"Staph aureus is a common skin bacteria that has been introduced due to IV drug use, it can stick to the heart valves and cause infective endocarditis which causes the pan-systolic murmur (associated with Mitral valve regurgitation and tricuspid valve regurgitation).","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498308,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:15:07","updated_at":"2018-07-12 09:39:12","questionName":"A 45 year old lady presents to you 4 weeks after returning from a holiday to Turkey. She has come to your GP surgery because she feels hot and feverish with a cough. There is no mucus or blood, has not lost weight recently and has not had exposure to TB that she knows of. On further questioning she reveals she has aching muscles and a \u2018sniffly\u2019 nose but no chest pain.\u000bGiven the likely diagnosis, select the most likely causative organism?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":2,"explanation":"The question tries to lead you down the route of a poorly maintained A\/C unit at a hotel in Turkey (which would be Legionella) but the symptoms and time frame do not fit with legionella and are more in keeping with influenza. Symptoms of a headache, productive cough with blood and green mucus, GI symptoms (diarrhoea, N&V) and incubation period of 6-7days would point you in the direction of Legionella.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498322,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:45:48","updated_at":"2018-07-11 14:58:07","questionName":"A 32 year old woman presents to the Emergency Department with her husband complaining of fever and abnormal behaviour of four days duration. She returned 24 days ago from rural Nigeria, where she was visiting relatives. On examination, she has a heart rate of 96 bpm, BP 130\/80 mmHg and saturations 94% RA. Her temperature is 37.9\u00b0C and she is confused with GCS 14\/15 (E4 V4 M6). She is mildly jaundiced but has no rash, lymphadenopathy or hepatomegaly. There are fine crepitations at both lung bases. The local laboratory has alerted you that they cannot process her blood results, as the area she visited is known to have an endemic viral haemorrhagic fever (Lassa). \u000bWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":8,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498319,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:42:18","updated_at":"2018-07-11 14:58:07","questionName":"A 49 year old travel writer presents with a three week history of periodic low-grade fevers with nausea and vomiting. At onset she also experienced watery diarrhoea and joint pains which have since resolved. She recently returned from a two month stay in rural India, where she swam in the Ganges river and drank unfiltered water. She did not take malaria prophylaxis and received no pre-travel vaccinations. On examination her observations are normal and her temperature is 36.4\u00b0C. She has scleral jaundice and a palpable liver edge at the costal margin. Cardiovascular and respiratory examinations are unremarkable. Her FBC is within normal limits and her LFTs show elevated bilirubin (6.0 mg\/dL), ALT (3682 IU\/L) and GGT (174 IU\/L). \u000bWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":6,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498325,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:52:53","updated_at":"2018-07-11 14:58:07","questionName":"A 19 year old male visits the GP complaining of a burning sensation when he urinates. He states that it has recently been fresher\u2019s week and during that period he had several new sexual partners and that he always uses condoms. Which of the following is most likely to be causing the burning sensation?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":10,"explanation":"Chlamydia is more common than gonorrhoea. He has had numerous sexual partners so his chance of being exposed to an STI is high. He may not be being truthful about condom use and even so it only reduces transmission rates of chlamydia and gonorrhoea by 50%. Both of these infections are very common in 18-25 year olds.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498327,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:55:20","updated_at":"2018-07-11 14:58:07","questionName":"A 16 year old girl visits her GP. She is distraught after noticing several lumps near her vagina. On inspection, the lumps are small, hard and painless. She states she recently became sexually active with a new boyfriend after he told her he was \u2018clean\u2019. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":12,"explanation":"Vulval cancer is very rare, particularly in this age group. Bartholin\u2019s cysts and genital herpes would be painful. Molluscs contagiosum has a very specific \u2018pearly white\u2019 appearance that would definitely be mentioned in an SBA.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498318,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:39:26","updated_at":"2018-07-11 14:58:07","questionName":"A 19 year old student presents to the Emergency Department with a five day history of high fevers, headache, lethargy and joint pains. She first noticed the symptoms on her return journey from Bangkok, where she had been visiting family. She vomited three times today, and reported bleeding gums after brushing her teeth. On examination her blood pressure is 94\/62 mmHg, her heart rate is 88 bpm, and her temperature is 37.4\u00b0C. There is mild abdominal tenderness with a fading maculopapular rash over the trunk. Cardiovascular and respiratory examination are unremarkable. \u000bWhat is the most likely causative organism?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":5,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498311,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:17:53","updated_at":"2018-07-11 14:58:07","questionName":"A 7 year old girl presents to her local GP with a limp. She developed a cold about 6 days ago and is now struggling to weight bear on her left leg. Examination of her legs reveals no signs of any skin changes. Passive movement of the left lower limb is limited by pain which the child says is in her knee. Apart from a diagnosis of atopic asthma, her past medical history completely unremarkable. Which of the following diagnoses is most important to exclude in this patient?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":3,"explanation":"It's always important to exclude Septic arthritis from a joint pain history.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498334,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 11:15:42","updated_at":"2018-07-11 14:58:07","questionName":"A 65 year old woman presents to her GP with low mood. She cannot be bothered to any gardening anymore, claiming she is always tired and low on energy. She complains of problems with her memory which started 8 months ago but have become so bad recently that she caused a fire in her kitchen after forgetting to turn the oven off. Many of the GP\u2019s questions are quickly met with the reply: \u201cI don\u2019t know\u201d. On examination, she appears unkempt and is wearing a black top, with black trousers and black shoes. Her clothes are clearly too big for her. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":14,"explanation":"Pseudodementia is a situation where a person who has depression also has cognitive impairment that looks like dementia.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498316,"quiz_id":"25644","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 09:34:16","updated_at":"2018-07-11 14:58:07","questionName":"A 51 year old man presents to A\/E with new onset headache and fever. Brudzinski\u2019s sign is positive and he feels very nauseous and has vomited 3 times since admission. His has a history of COPD and he suffered an infective exacerbation 2 weeks ago. He is still a little \u201cchesty\u201d since his exacerbation. A lumbar puncture is performed (see results below). What is the most likely infective organism?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-2\/Results1.png","position":4,"explanation":"From the information given that patient has a positive Brudzi\u0144ski's sign - a clinical sign in which forced flexion of the neck elicits a reflex flexion of the hips. It is found in patients with meningitis. The LP is also turbid has reduced glucose, increased protein and a high white cell count - pointing to a bacterial infection. NG and NM are both gram negative diplococci (2 small spheres joined); Streptococcus is gram positive and forms chains of spheres; and haemophilus influzenzae is a gram negative coccobacillus (somewhere between a sphere and a rod). The only organism that fits the description is Listeria which is a gram positive long thin rod.","question_score_id":null,"lang":"","questionAudioPath":null}]

block

A 55 year old male complains of blurred vision and painful eye movements. He attends the weekly DOTS clinic and his CXR is available to view (below). What is the most likely diagnosis?

Select the correct answer(s).  

(0/0)

Explanation

DOTS standards for Directly Observed Treatment, Short-course and is a strategy used to reduce the number of tuberculosis (TB) cases. For this question you need to work out the patient has TB, then work out which drugs causes which side effects. Ethambutol affects the Eyes (remember by them both beginning with E), so you can rule out 3 of the choices. Retrobulbar neuritis is a form of optic neuritis in which the optic nerve becomes inflamed due to the drug. Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor), usually caused by infection.

---

Intra-ocular TB

Blepharitis secondary to Isoniazid

Endophthalmitis secondary to Ethambutol

Retrobulbar neuritis secondary to Rifampicin

Retrobulbar neuritis secondary to Ethambutol

none

A 20 year old woman visits the GP after having intercourse during which the condom split last night. She is very concerned about becoming pregnant. Which of the following options would be most likely to prevent pregnancy?

Select the correct answer(s).  

(0/0)

Explanation

The morning after pills are very effective but the copper coil is most effective and can be fitted up to 5 days post intercourse. Two of the answers are commonly held beliefs about how to prevent pregnancy.

---

Inserting a tampon to soak up any rogue sperm

Inserting a copper coil

Not lying down for 5 days so that gravity stops the sperm swimming to the ovaries.

The morning after pill

Inserting a Mirena coil

none

A 37 year old woman visits the GP to discuss contraception. She has no relevant past medical history. On examination she is found to have a BMI of 36 and a blood pressure of 145/90. Which of the following is probably not a suitable choice of contraceptive?

Select the correct answer(s).  

(0/0)

Explanation

The combined oral pill often increases BP (hers is already worryingly high for a 37 year old), she also has a high BMI (this alone may not entirely rule out the use of the CoCP)

---

Mirena coil

Condom

Copper coil

Mini-pill

Combined oral pill

none

A 50 year old man visits the GP complaining of a burning sensation when he urinates, he describes no other symptoms. He is currently taking metformin. Which of the following is most likely to be the cause of the burning sensation?

Select the correct answer(s).  

(0/0)

Explanation

He is not in the age group in which chlamydia and gonorrhoea are prevalent although his sexual history should be explored in the consultation. With kidney stones and balanitis we would probably expect additional symptoms such as pain/ visible redness and swelling (in balanitis)

---

Kidney stones

Gonorrhoea

UTI

Balanitis

Chlamydia

none

A 49 year old travel writer presents with a three week history of periodic low-grade fevers with nausea and vomiting. At onset she also experienced watery diarrhoea and joint pains which have since resolved. She recently returned from a two month stay in rural India, where she swam in the Ganges river and drank unfiltered water. She did not take malaria prophylaxis and received no pre-travel vaccinations. On examination her observations are normal and her temperature is 36.4°C. She has scleral jaundice and a palpable liver edge at the costal margin. Cardiovascular and respiratory examinations are unremarkable. What is the most important investigation to perform?

Select the correct answer(s).  

(0/0)

Explanation

You want to rule out Malaria by requesting a thick and thin blood film.

---

Stool culture

Thick and thin blood films

Haemolysis screen

Hepatitis serology

Blood culture

none

A 33 year old male patient is admitted to hospital and investigated for a pyrexia of unknown origin. On examination he is unkempt, sweating and has track marks on his arms. You hear a pan-systolic murmur loudest over the left 4th intercostal space on the parasternal edge; his medical records show no such finding previously. Given the most likely diagnosis, which organism is most likely isolated from his blood cultures?

Select the correct answer(s).  

(0/0)

Explanation

Staph aureus is a common skin bacteria that has been introduced due to IV drug use, it can stick to the heart valves and cause infective endocarditis which causes the pan-systolic murmur (associated with Mitral valve regurgitation and tricuspid valve regurgitation).

---

Adenovirus

E. Coli

Staph Aureus

Haemophillus Influenza

Candida

none

A 45 year old lady presents to you 4 weeks after returning from a holiday to Turkey. She has come to your GP surgery because she feels hot and feverish with a cough. There is no mucus or blood, has not lost weight recently and has not had exposure to TB that she knows of. On further questioning she reveals she has aching muscles and a ‘sniffly’ nose but no chest pain.Given the likely diagnosis, select the most likely causative organism?

Select the correct answer(s).  

(0/0)

Explanation

The question tries to lead you down the route of a poorly maintained A/C unit at a hotel in Turkey (which would be Legionella) but the symptoms and time frame do not fit with legionella and are more in keeping with influenza. Symptoms of a headache, productive cough with blood and green mucus, GI symptoms (diarrhoea, N&V) and incubation period of 6-7days would point you in the direction of Legionella.

---

Influenza Virus

Eikenella Corrodens

Legionella Pneumoniae

Streptococcus Pneumoniae

Burkholderia

none

A 32 year old woman presents to the Emergency Department with her husband complaining of fever and abnormal behaviour of four days duration. She returned 24 days ago from rural Nigeria, where she was visiting relatives. On examination, she has a heart rate of 96 bpm, BP 130/80 mmHg and saturations 94% RA. Her temperature is 37.9°C and she is confused with GCS 14/15 (E4 V4 M6). She is mildly jaundiced but has no rash, lymphadenopathy or hepatomegaly. There are fine crepitations at both lung bases. The local laboratory has alerted you that they cannot process her blood results, as the area she visited is known to have an endemic viral haemorrhagic fever (Lassa). What is the most likely diagnosis?

Select the correct answer(s).  

(0/0)

---

HSV encephalitis

HIV seroconversion

Malaria

Dengue

Typhoid

none

A 49 year old travel writer presents with a three week history of periodic low-grade fevers with nausea and vomiting. At onset she also experienced watery diarrhoea and joint pains which have since resolved. She recently returned from a two month stay in rural India, where she swam in the Ganges river and drank unfiltered water. She did not take malaria prophylaxis and received no pre-travel vaccinations. On examination her observations are normal and her temperature is 36.4°C. She has scleral jaundice and a palpable liver edge at the costal margin. Cardiovascular and respiratory examinations are unremarkable. Her FBC is within normal limits and her LFTs show elevated bilirubin (6.0 mg/dL), ALT (3682 IU/L) and GGT (174 IU/L). What is the most likely diagnosis?

Select the correct answer(s).  

(0/0)

---

Dengue

E. Coli

Hepatitis A

Typhoid

Malaria

none

A 19 year old male visits the GP complaining of a burning sensation when he urinates. He states that it has recently been fresher’s week and during that period he had several new sexual partners and that he always uses condoms. Which of the following is most likely to be causing the burning sensation?

Select the correct answer(s).  

(0/0)

Explanation

Chlamydia is more common than gonorrhoea. He has had numerous sexual partners so his chance of being exposed to an STI is high. He may not be being truthful about condom use and even so it only reduces transmission rates of chlamydia and gonorrhoea by 50%. Both of these infections are very common in 18-25 year olds.

---

Gonorrhoea

Chlamydia

Balanitis

UTI

Kidney stones

none

A 16 year old girl visits her GP. She is distraught after noticing several lumps near her vagina. On inspection, the lumps are small, hard and painless. She states she recently became sexually active with a new boyfriend after he told her he was ‘clean’. What is the most likely diagnosis?

Select the correct answer(s).  

(0/0)

Explanation

Vulval cancer is very rare, particularly in this age group. Bartholin’s cysts and genital herpes would be painful. Molluscs contagiosum has a very specific ‘pearly white’ appearance that would definitely be mentioned in an SBA.

---

Genital warts

Vulval cancer

Bartholin's cysts

Molluscum contagiosum

Genital herpes

none

A 19 year old student presents to the Emergency Department with a five day history of high fevers, headache, lethargy and joint pains. She first noticed the symptoms on her return journey from Bangkok, where she had been visiting family. She vomited three times today, and reported bleeding gums after brushing her teeth. On examination her blood pressure is 94/62 mmHg, her heart rate is 88 bpm, and her temperature is 37.4°C. There is mild abdominal tenderness with a fading maculopapular rash over the trunk. Cardiovascular and respiratory examination are unremarkable. What is the most likely causative organism?

Select the correct answer(s).  

(0/0)

---

Plasmodium falciparum

CMV

Legionella pneumophila

Dengue virus

Salmonella typhi

none

A 7 year old girl presents to her local GP with a limp. She developed a cold about 6 days ago and is now struggling to weight bear on her left leg. Examination of her legs reveals no signs of any skin changes. Passive movement of the left lower limb is limited by pain which the child says is in her knee. Apart from a diagnosis of atopic asthma, her past medical history completely unremarkable. Which of the following diagnoses is most important to exclude in this patient?

Select the correct answer(s).  

(0/0)

Explanation

It's always important to exclude Septic arthritis from a joint pain history.

---

Perches Disease

Slipped Capital Femoral Epiphysis

Septic Arthritis

Malignancy

Irritable Hip

none

A 65 year old woman presents to her GP with low mood. She cannot be bothered to any gardening anymore, claiming she is always tired and low on energy. She complains of problems with her memory which started 8 months ago but have become so bad recently that she caused a fire in her kitchen after forgetting to turn the oven off. Many of the GP’s questions are quickly met with the reply: “I don’t know”. On examination, she appears unkempt and is wearing a black top, with black trousers and black shoes. Her clothes are clearly too big for her. What is the most likely diagnosis?

Select the correct answer(s).  

(0/0)

Explanation

Pseudodementia is a situation where a person who has depression also has cognitive impairment that looks like dementia.

---

Pseudodementia

Depression

Alzheimer's disease

Alcohol dependency

Frontotemporal dementia

none

A 51 year old man presents to A/E with new onset headache and fever. Brudzinski’s sign is positive and he feels very nauseous and has vomited 3 times since admission. His has a history of COPD and he suffered an infective exacerbation 2 weeks ago. He is still a little “chesty” since his exacerbation. A lumbar puncture is performed (see results below). What is the most likely infective organism?

Select the correct answer(s).  

(0/0)

Explanation

From the information given that patient has a positive Brudziński's sign - a clinical sign in which forced flexion of the neck elicits a reflex flexion of the hips. It is found in patients with meningitis. The LP is also turbid has reduced glucose, increased protein and a high white cell count - pointing to a bacterial infection. NG and NM are both gram negative diplococci (2 small spheres joined); Streptococcus is gram positive and forms chains of spheres; and haemophilus influzenzae is a gram negative coccobacillus (somewhere between a sphere and a rod). The only organism that fits the description is Listeria which is a gram positive long thin rod.

---

Streptococcus pneumoniae

Haemophilus Influenzae

Neisseria Meningitides

Neisseria Gonorrhoea

Listeria Monocytogenes