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[{"id":498393,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:18:54","updated_at":"2018-07-13 15:56:14","questionName":"A 14 year old boy presents with his parents to his GP with a non-blanching rash over the torso and legs. 2 weeks ago, he had a sore throat and his recovery was unremarkable. The boy reported no signs of dyspnoea, chest pain, fever, cough or wheeze. The boy has not experienced any headaches. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":3,"explanation":"The rash is bruising\/blood vessel damage triggered by low platelets. The recent infection trigger ITP.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498390,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:09:59","updated_at":"2018-07-13 15:56:14","questionName":"A concerned mother takes a 9 month old child with an increased effort of breathing to her local GP. The baby is feverish and is more quiet than normal, according to the mother. During the consultation, the baby coughs several times, bringing up no sputum. On examination, the baby exhibits nasal flaring and some tracheal tug. The GP also elicits bilateral crackles in the lung fields. Which infective agent is most likely to cause the presentation above? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":1,"explanation":"Respiratory syncytial virus (RSV) is the most common pathogen, causing 50-90% of cases of Bronchiolitis. Widespread fine inspiratory crackles are considered a key finding in the UK, whilst high-pitched expiratory wheezing is commonly present.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498399,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:36:43","updated_at":"2018-07-13 15:56:14","questionName":"A concerned mother presents to her GP because her 12 day old baby keeps on vomiting. A more detailed history reveals the child vomits 3 times a day, occasionally after meals. The baby currently weighs 3kg.\r\nOn eliciting a feeding history, you discover that the mother feeds the child at least 8 times a day with 100ml feeds. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":9,"explanation":"By the end of the first week babies will take in 150-200ml\/kg\/day so a max of 600ml in a 3kg baby.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":500549,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-16 07:38:03","updated_at":"2018-07-16 07:38:03","questionName":"Mr. Ferrand is a 24-year-old man who came to see the psychiatrist on advice from his friend. His friend was concerned about Mr. Ferrand's way of thinking, as he always felt inferior to others and was convinced that nobody liked him. \r\n\r\nMr. Ferrand was a bright pupil at school, but he was afraid to ask questions and never volunteered to give answers, in case what he said was wrong. He was very shy, self-conscious and did not like being involved in group activities. When he was in secondary school, he took the first of his final exams, but because he was convinced that he had done poorly, he refused to take the remaining exams. He dropped out of school, and found a job, but kept having to go from job to job. He met his wife at one of his workplaces, but she filed for divorce two years later. She liked to go out with her friends, which he refused to join as he did not feel comfortable meeting other people. \r\n\r\nWhen seen by the psychiatrist, he appeared at first to be tense and apprehensive, but relaxed as the consultation went on. He explained that he felt awkward in social situations, and that he was afraid of criticism, disapproval or rejection. He expressed a need to feel safe and secure, and so he never went out with people, as he felt that they would not like him. He never experienced panic attacks \u2014 he felt uncomfortable in social situations, but it did not lead to any emotional distress.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":null,"explanation":"This patient demonstrates: feelings of tension and apprehension; insecurity and inferiority; hypersensitivity to rejection and criticism; restricted personal attachments; avoiding activities by exaggeration of potential dangers in everyday situations.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498396,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:32:25","updated_at":"2018-07-13 15:56:14","questionName":"A 2 day old boy born at 36 weeks gestation at a time 30 hours after membrane rupture. He has had an 8 hour history of poor feeding. He had been breastfeeding well but on admission he is now dehydrated, hypotonic and jaundiced. \u000bWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":6,"explanation":"Sepsis should always be on your differential of causes for a jaundiced baby. Though jaundice can be physiological, due to hepatic immaturity and a reduced RBC life span, the history of premature rupture of membranes (PROM) should alert you to the possibility of neonatal infection as a cause for this baby\u2019s change in behaviour and new onset jaundice. ","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498398,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:35:24","updated_at":"2018-07-13 15:56:14","questionName":"A baby born at 26 weeks (with a mass of 1.10kg) gestation develops bloody stools. His abdomen has become distended and tense after 2 weeks of life. Prior to his symptoms, he was on formula feed which he is now aspirating. He is currently bradycardic and lethargic. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":8,"explanation":"NEC is problem neonates are predisposed to. Classically, it develops after 2 weeks of life and can lead to abdominal distension, altered bowel habit(include bloody\/mucoid stools) and a palpable abdominal mass. There may also be decreased bowel sounds. Newborn babies may experience bilious vomiting. ","question_score_id":null,"lang":"","questionAudioPath":null},{"id":500548,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-16 07:33:55","updated_at":"2018-07-16 07:33:55","questionName":"Mr. Charpentier is a 19-year-old student who was referred to the psychiatrist by one of his professors. He is currently studying mathematics and computer science. Although his grades were very good, he did poorly in all activities that required teamwork and he is at risk of failing the year because of this. \r\n\r\nHe had never been one for socialising very much with others. As a teenager, he preferred solitary games and kept to himself most of the time. He did not seem to need or want anything other than his books and his computer. He did not have any friends, and he has never had a girlfriend. He never caused any trouble, never argued with others. He has never had drugs or alcohol. On the whole, he took pleasure in hardly anything but never complained of feeling bored. At university, he lives alone, looks after himself, and is generally a good student and works hard but without enthusiasm. \r\n\r\nWhen seen by the psychiatrist, he was calm and polite, and readily answered all questions coherently. He looked bored, and never smiled, get irritated or show any other emotion.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":null,"explanation":"The patient here shows: withdrawal from affectional, social and other contacts; preference for fantasy, solitary activities and introspection; limited capacity to express feelings and to experience pleasure.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":500547,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-16 07:30:58","updated_at":"2018-07-16 07:30:58","questionName":"Mrs. Emery is a 50-year-old woman who presented to the psychiatrist as she was requesting to be admitted into hospital. She said that she had seen a dozen psychiatrists over the years, and has decided that only the best professionals could help her. \r\n\r\nMrs. Emery was brought up in a town in Belgium, and she had a younger sister whom she said was her father's favourite. She did not understand why, as Mrs. Emery did better at school than her sister. When she was 25, she married her boss who was 50 at the time, even though she wasn't particularly in love with him. In the past, she had seen several specialists for a variety of complaints such as abdominal pain, headaches, dizziness, but she was told that there was no physical cause for any of these and was advised to see a psychiatrist. She told the physicians that she had already seen several psychiatrists and none of them were able to help her, and that she had enormous confidence in the physicians. \r\n\r\nWhen seen by the psychiatrist, she seemed to greatly enjoy the consultation. She was smiling, and spoke at great length, using dramatic gestures. She was dressed meticulously with impeccable make-up, although she apologised for not looking her best. She spoke of a previous psychiatric admission, where she complained that none of the staff had any time for her as they always paid more attention to the other patients. She always liked to tell other patients about herself, but was told once by a nurse that it appeared she liked being the centre of attention, to which she was very much taken aback.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":null,"explanation":"This patients shows the signs of: shallow and labile affectivity, self-dramatisation, theatricality, exaggerate expression of emotions, egocentricity, easily hurt feelings, continuous seeking for appreciation, excitement and attention.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":500017,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-15 20:50:43","updated_at":"2018-07-15 20:50:43","questionName":"A 72 year old woman presents to the Emergency Department with a three day history of abdominal pain and dysuria. Her initial assessment can be seen below. Her initial bloods show a leucocytosis with neutrophilia, normal lactate and evidence of an acute kidney injury. The F1 has commenced the patient on 15L high-flow O2 via a non-rebreather mask and 500ml normal saline. What is the next step in managing this patient?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-3\/Results3.png","position":null,"explanation":"This question stem is describing a patient with features of sepsis, likely secondary to pyelonephritis given the symptoms, renal angle tenderness (a good buzzword for pyelonephritis) and inflammatory urine dipstick result. In this question, the F1 has commenced their management of sepsis and you are expected to complete the remaining steps in an appropriate order. The sepsis 6 describes actions to be taken within one hour of identifying a patient with sepsis, and can be split into \u201cgive 3 and take 3\u201d: \r\n \r\nTake lactate (plus other necessary bloods)\r\nTake urine (monitor hourly urine output e.g. through urinary catheterisation) \r\nTake blood cultures \r\nGive intravenous fluids \r\nGive high-flow oxygen \r\nGive intravenous antibiotics (within one hour of identification of sepsis) \r\n \r\nIn this patient, the lactate has already been checked and fluids and oxygen have already been given. Urine output monitoring is not given as an option, leaving blood cultures and antibiotic therapy as the remaining options. Wherever possible, blood cultures should be taken before initiating intravenous antibiotic therapy, and so this is the best next step. Urine cultures are a very sensible option and would be performed, but given that the infection has progressed to sepsis the blood cultures should be prioritised. A CXR is useful in evaluation of sepsis of unclear source, but in this case the normal respiratory examination versus the obvious urinary symptoms\/signs makes this a low-priority investigation. Co-amoxiclav and gentamicin are both appropriate options for the management of suspected urosepsis. ","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498394,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:28:29","updated_at":"2018-07-13 15:56:14","questionName":"A 7 year old girl develops periorbital oedema which is worst in the morning. She currently has bilateral lower limb oedema and signs of shifting dullness in the abdomen. Her parents say she moans because her tummy is sore all the time. Below are some investigation results. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-3\/Results2.png","position":4,"explanation":"Nephrotic syndrome in children can present with facial swelling (common feature), with periorbital oedema often being the first evidence that something is wrong; oedema may progress to involve the whole body.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498395,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:30:34","updated_at":"2018-07-13 15:56:14","questionName":"A 7 year old girl develops periorbital oedema which is worst in the morning. She currently has bilateral lower limb oedema and signs of shifting dullness in the abdomen. Her parents say she moans because her tummy is sore all the time. Some investigation results are below. What is the most likely pattern of disease?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":"uploads\/mixed-sba-for-3rd-year-quiz-3\/Results2.png","position":5,"explanation":"Minimal Change Disease form of nephrotic syndrome seen most often in kids, should a renal biopsy be taken. Minimal change means no changes are seen on light microscopy. However, there are changes to see on electron microscopy, as there is some fusion of the podocyte foot processes at the glomerulus. Most time, kids with nephrotic syndrome do not require a biopsy as most will respond (i.e. resolution of proteinuria) to corticosteroids. Biopsies are reserved for children who don\u2019t respond to steroids (after 4-6 weeks) or those with atypical features (e.g. high blood pressure, haematuria).","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498397,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:33:49","updated_at":"2018-07-13 15:56:14","questionName":"9 hours after giving birth, a distressed mother reports that her baby\u2019s lips and fingers are going blue. The baby is tachypnoeic, tachycardic but normotensive. Further examination reveals palpable femoral pulses. Heart sounds are present with no evidence of any murmurs. On general inspection, the baby appears less interested in its surroundings. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":7,"explanation":"When you see a question about congenital heart defects, your differential is determined by the presence or absence of cyanosis: \r\n\r\nNo cyanosis\/just shortness of breath (left to right shunting; reduced blood for to systemic circulation): ASD, VSD, Coarctation of the Aorta, PDA\r\n\r\nCyanotic heart diseases (right to left shunting: cyanosis is due to blood bypassing lung): TOF, Transposition of the Great Arteries. \r\nTOF tends to present much later (around 6 months, but can present earlier) than TGA, which tends to present within the first few hours\/days of life, worsening when the ductus arteriosus closes. The worsening of symptoms with duct closure means these patients are \u201cduct dependent\u201d and their ductus arteriosus is maintained using prostaglandin E2. \r\n\r\nAortic\/pulmonary stenosis (in TOF) may present with ejection systolic murmurs. \r\nVSD presents classically presents with a pansystolic murmur on the left sternal edge.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498391,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:12:22","updated_at":"2018-07-13 15:56:14","questionName":"A 14 year old boy presents with his parents to his GP with abdominal pain and difficulty walking. Specs of blood were present in the last volume of urine he passed. 2 weeks ago, he had a sore throat and his recovery was unremarkable. On examination the boy has a palpable non-blanching petechial rash on the torso and legs (front and back). What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":2,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":498389,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-11 15:02:32","updated_at":"2018-07-13 15:56:14","questionName":"A 5 hour old newborn baby becomes tachypnoeic. On examination, the baby is tachycardic. He is apyrexial. An ejection systolic murmur is heard at the left sternal edge, and is more prominent in the interscapular region. Femoral pulses are weak bilaterally. There are no signs of either central or peripheral cyanosis. Air entry is good and equal in both lung fields. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":0,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":500546,"quiz_id":"25652","answer_id":null,"answerType_id":"0","created_at":"2018-07-16 07:26:27","updated_at":"2018-07-16 07:26:27","questionName":"Mr. Zanetta is a 35-year-old man who was referred for a psychiatric assessment by the police. He had thrown a pizza into the face of one of his customers and was arrested for this. Mr. Zanetta had no idea and could not understand why anybody was making a fuss about the situation, as the customer had clearly deserved what he got. The customer had told him that the pizza was inedible, which Mr. Zanetta knew could not be true as he made the best pizzas in town. \r\n\r\nAs a child, he had always been up to mischief, and used to skip classes, but always came up with the most plausible excuses when the teachers questioned him. When he was a teenager, he was caught shoplifting many times, but most of the time he managed to tell a heart-breaking story that convinced people to not tell the police. He was married at one stage and had a child, but his wife left him. He was sure that he probably had other children too, but he was not bothered to look into this. \r\n\r\nWhen seen by the psychiatrist, he was very polite and charming. It was difficult to tell to what extent he was telling the truth. He did not express and feelings of regret or guilt about any of his past behaviours, and he blamed others \u2014 the police, his wife, his family etc. for all the problems in his life.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":null,"explanation":"He has the unconcern for the feelings of others, a gross disparity between behaviour and the prevailing social norms, low tolerance to frustration and a low threshold of aggression, including violence, a tendency to blame others.","question_score_id":null,"lang":"","questionAudioPath":null}]