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25.01.2022 Clinical Conundrum 23 Do you remember your embryology? A 35 year old G2P1 woman presents at 24 weeks gestation for routine evaluation, on a background of a normal pregnancy and no medical conditions. Fetal morphology ultrasound reveals a cardiac defect resulting from abnormal development of the endocardial cushions. This defect is most likely to result in which of the following?... a) Teratology of Fallot b) Atrioventricular septal defect c) Patent foramen ovale d) Transposition of the great vessels e) Dextrocardia

25.01.2022 Pre-clinical Conundrum #6 A 46-year-old female presents to the pre-admission clinic and is found to have a 3cm anterolateral firm painless neck mass along with a minor decrease in calcium serum levels. What is the most likely diagnosis?... A. Anaplastic carcinoma B. Medullary carcinoma C. Follicular carcinoma D. Papillary carcinoma Comment below with your answer so that you can go into the running to win the mystery prizes!!!

25.01.2022 Clinical Conundrum #4 Regarding targeted temperature management (TTM) after cardiac arrest: A: TTM should be implemented for at least 72 hours after arrest... B: Target temperature should be between 32 and 36 degrees C: Rapid infusion of 60ml/kg of IV iced normal saline should be used after ROSC D: Once TTM period is finished, there is no guide on what temperatures should be kept at if a patient remains comatosed Comment below with your answer so that you can go into the running to win the mystery prizes!!!

25.01.2022 Clinical Conundrum 15: A 37 year old women is concerned about growths around her anus which developed over the past four weeks. They are not painful and she does not have blood in her stools. She is sexually active with two male partners and uses condoms inconsistently. Examination reveals nontender, irregular hyperkeratotic sessile lesions in the perianal area around 4-7mm in diameter. There is no lymphadenopathy. The application of a dilute solution of acetic acid turns the... lesions white. Which of the following is the most likely cause? 1. Poxvirus 2. Treponema pallidum 3. Malignant transformation 4. Benign fibroepithelial growth 5. Human papilloma virus

25.01.2022 Clinical Conundrum 11: A 64 year old woman presents to the GP with a two day history of right sided headache and pain when eating. What is your immediate management plan, and what investigation is required to confirm the most likely diagnosis?

24.01.2022 Pre-Clinical Question #1 A 70-year-old woman presents with the inability to extend her right wrist. Which of the following neural structures is most likely to have been damaged? A: Median nerve... B: Ulnar nerve C: Radial nerve D: T1 nerve root Comment below with your answer so that you can go into the running to win the mystery prizes!!!

23.01.2022 Clinical conundrum 16 Which of the following statements regarding pleural effusion is/are correct? 1. Bronchial breathing is heard over the upper margin of the effusion 2. Vocal fremitus is increased over the fremitus... 3. Trachea is deviated to the same side 4. Breath sounds are diminished A) 1 only B) 3 only C) 2 and 3 D) 1 and 4 E) 1,2,3 and 4

23.01.2022 Clinical Conundrum #3 A couple brings their 3-year-old son to the emergency department, reporting that he fell down the stairs and broke his arm. The boy has a tearful face and gingerly holds his right arm by the elbow, but refuses to look the physician in the eye or to answer any questions. An x-ray of the boys arm is performed. Which of the following types of fracture is most likely to suggest an aetiology of child abuse? A: Bowing fracture ... B: Buckle fracture C: Greenstick fracture D: Spiral fracture Comment below with your answer so that you can go into the running to win the mystery prizes!!!

22.01.2022 Spot diagnoses #2 (Name the sign edition) A 19 year old patient presents with head ache, diplopia and nausea and vomiting. Upon examination with an opthalmoscope you see the following: What does this image show? What are the differential diagnoses for this patient?

22.01.2022 Clinical Conundrum #6 Regarding acid and base compensation, which is correct: a) Correlation between venous and arterial pH is poor especially in DKA... b) Compensation in chronic respiratory alkalosis may be efficient enough to normalise pH c) A patient cannot have a normal pH if there is a disease process causing metabolic acidosis d) In an ABG with a high pH, acidosis can be excluded Comment below with your answer so that you can go into the running to win the mystery prizes!!!

22.01.2022 Clinical Conundrum 12: A 35 year old female presents to her GP with a 8 month history of fatigue, diarrhea and intermittent crampy abdominal pain. Blood tests reveal a macrocytic anemia. What is the most likely diagnosis? A) Uterine leiomyoma... B) Crohns disease C) Hypothyroidism D) Irritable bowel syndrome E) Folate deficiency See more

21.01.2022 Clinical Conundrum #5 Which of the following is incorrect in describing renal handling of acid base balance? A) Renal tubular acidosis type 1 distal inhibits H+ extrusion and serum bicarb decreases to a... steady state level B) 15% of bicarbonate reclamation occurs in the distal tubule C) If serum is acidotic, formation of new bicarbonate in the distal tubule to may take up to 4 -5 days to reach equilibrium D) Ammonia has no effect on acid excretion Comment below with your answer so that you can go into the running to win the mystery prizes!!!

20.01.2022 Clinical Conundrum #7 When calculating the anion gap: a) Measured values of K is always needed to accurately calculate anion gap... b) Anion gap > 12 is always abnormal c) Most of the normal anion gap in healthy individuals consists of albumin d) Anion gap cannot be normal if there is an elevated lactate Comment below with your answer so that you can go into the running to win the mystery prizes!!!

19.01.2022 Clinical conundrum 20 LAST PRE-CLINICAL Q FOR THE WEEK! (also on genetics :)) In termination of translation, the STOP codon enters the _ site and the release factor binds to the _ site, triggering the releasing of the polypeptide chain from tRNA at the _ site via peptidyl transferase.... a. P, E, A b. A, P, E c. P, P, A d. A, A, P e. P, A, A See more

18.01.2022 Clinical Conundrum 25 A 34-year-old woman presents to her GP with a 3-month history of fatigue and a 4.5kg weight loss despite eating more than usual. Her pulse is 115/min and blood pressure 140/60mmHg. Physical examination shows warm, moist skin, and a diffuse, non-tender swelling over the anterior neck. Ophthalmologic examination shows swelling of the eyelids and proptosis bilaterally. Which of the following is the most likely cause of this patients symptoms? A. nongranulo...matous thyroid inflammation B. thyrotropin receptor autoantibodies C. granulomatous thyroid inflammation D. parafollicular cell hyperplasia E. thyroid peroxidase autoantibodies F. constitutively active TSH receptor See more

18.01.2022 Pre-Clinical Conundrum #2 A patient presents with severe abdominal pain. Over the last few weeks, the patient comments that they have been finding it very hard to pass stool. They do not recount any instances of haematemesis, but noticed that their stool has streaks of bright-red blood coating it, and that the blood has not been mixed in. The patient described it as one of the most excruciating pains they have ever experienced. What is the most likely diagnosis? A: Peptic Ulc...er B: Coeliac Disease C: Gastroenteritis D: Crohns Disease E: Anal Fissure Comment below with your answer so that you can go into the running to win the mystery prizes!!!

17.01.2022 Pre-clinical Conundrum #7 The most correct sequence of early development following fertilization is: A. zygote, blastomeres, morula, blastocyst... B. oocyte, zygote, morula, blastocyst C. zygote, conceptus, blastocyst D. polar bodies, zygote, conceptus, blastocyst Comment below with your answer so that you can go into the running to win the mystery prizes!!!

16.01.2022 Clinical Conundrum #8 Which of the following is not a cause for a high anion gap metabolic acidosis? a) Renal tubular acidosis... b) Methanol consumption c) Uremia d) Infections Comment below with your answer so that you can go into the running to win the mystery prizes!!!

16.01.2022 Clinical Conundrum 13: A 54 year old man presents to your GP clinic complaining of pain in his right thigh. He is tender on deep palpation of his anterior thigh, but his examination is otherwise unremarkable. He does not report any further medical history or significant recent immobility. You find that he has a positive D-dimer. What is your next step in his management? A) Proximal leg vein ultrasound within 4 hours of presentation... B) Provide elastic graduated compression stockings and encourage regular mobilisation C) Commence warfarin within 24 hours of diagnosis and continue for 3 months D) Commence subcutaneous clexane injection for 5 days or until INR is 2+ for 24 hours, with concurrent warfarin for 3 months E) Commence subcutaneous clexane injection for 5 days or until INR is 2+ for 24 hours, with concurrent warfarin for 6 months See more

16.01.2022 Clinical Conundrum 24 A 4-year-old girl is brought to you by her parents because she is severely underweight. She is easily fatigued and has difficulty keeping up with other kids at the daycare centre. She has a good appetite and eats 3 full meals a day. She has 4-5 bowel movements daily with bulky, foul-smelling stools that float. She has had recuurent episodes of sinusitis since infancy. Her parent report that she has recently started to snore during her sleep. She is at th...e 15th percentile for height and 3rd percentile for weight. Her vitals re within normal limits. Examintation shows pale conjunctivae. A few scattered expiratory crackles are heard in the thorax and there is abdominal distention. Which of the following is the most likely cause of this patients failure to thrive? A. exocrine pancreatic insufficiency B. mucosal damage from excessive gastric acid C. small intestine bacterial overgrowth D. impaired intestinal amino acid transport E. intestinal inflammatory reaction to gluten F. whippelii infiltration of the intestinal villi See more

13.01.2022 Pre-clinical Conundrum #8 What are the characteristics of stable angina? A. Chest pain that occurs with exertion and/or emotional stress... B. Severe and crushing chest pain (>20 mins) C. Chest pain that occurs at rest D. Bradycardia Comment below with your answer so that you can go into the running to win the mystery prizes!!!

13.01.2022 Pre-clinical Conundrum #4 The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present? A. Ammonia... B. Urea C. Hydrochloric acid D. Carbon dioxide Comment below with your answer so that you can go into the running to win the mystery prizes!!!

13.01.2022 Clinical conundrum 17 A middle-aged female presented with bloody diarrhoea of 3 weeks duration. Possible causes are: 1. Hyperthyroidism 2. Rotavirus infection... 3. Diverticular disease 4. IBD 5. C. Difficile infection A) 1,2 and 3 B) 2,4 and 5 C) 1 and 5 D) 4 and 5 E) none of the above F) all of the above

12.01.2022 Clinical conundrum 19 MORE PRE-CLINICAL QS THIS WEEK THIS TIME ON GENETICS FOR OUR FIRST AND SECOND YEARS! Which genetic haplotype combination is most strongly associated with increased risk of Type 1 Diabetes in children?... a. HLA-DR1/DR2 b. HLA-DQ2/DQ8 c. HLA-DR3/DR4 d. HLA-DR2/DR3 e. HLA-DQ3/DQ3 See more

12.01.2022 Pre-clinical Conundrum #3 JC is a slender 17-year-old young man who arrives in your clinic with complaints of chronic fatigue, excessive thirst, frequent urination (5-6 times per night), and an unexpected 20 lb weight loss over the past two months. His prior medical history is unremarkable. His family history is negative for diabetes, and JC takes no other medications except for an antibiotic for acne. Lab results indicate: FPG 270 mg/dL (normal <110), HbA1c 13% (normal 4-6%).... Your presumptive diagnosis is Type 1 diabetes mellitus. What is the most appropriate therapy for controlling JCs hyperglycaemia? A. diet & exercise B. glucagon C. GLP-agonists D. insulin Comment below with your answer so that you can go into the running to win the mystery prizes!!!

11.01.2022 Congratulations to our winners for our Clinical Conundrums competition! We will be in touch with you shortly to arrange collection of prizes. Remember to keep an eye out for Part 2 later this week for more chances to win one of our prizes! Pre-Clin Winners: - Melody Hu - Shakya Sumanasekera... Clin Winners: - Charlie Mccafferty - Georgia McMillan - Yolanda Wang

10.01.2022 Clinical Conundrum 21 (yes we are back guys! with a vengeance) A 82-year-old woman is BIBA from her nursing home with complaints of "the worst" abdominal pain she has ever experienced. It began 3 hours ago whilst she was watching television and was accompanied by some nausea. Nil chest pain, shortness of breath, leg pain, fever or chills. Normal bowel movements up until today.... In terms of her medical history - she has poorly controlled hypertension and poorly controlled non-insulin-dependent diabetes (diet controlled). She does not drink but has smoked a pack a day since she was in her 20s. Nil allergies. When you examine her, however, she is only in mild distress, with no abnormal findings apart from hypertension (165/100), mild epigastric tenderness, markedly reduced bowel sounds and reduced peripheral pulses throughout. a) What is your differential diagnosis? b) What is the gold standard investigation? c) How can the issue be definitively treated?

09.01.2022 Pre-clinical Conundrum #5 What is the major protein expressed by the osteoblast precursors that stimulates osteoclast formation? A. RANK B. OPG... C. RANKL D. Calcitonin Comment below with your answer so that you can go into the running to win the mystery prizes!!!

08.01.2022 Want a chance to win prizes from the comfort of your own home? Need a chance to flex your neverending knowledge of diseases? Or just need a refresher on some high yield content? Introducing Clinical Conundrums! Every Thursday, WSPS will be posting a question with both a pre-clin and clin category! Everyone who answers has the chance to win one of several mystery prizes .

08.01.2022 Introducing our fun new series - Puzzling Predicaments! Coming your way will be fun little problems you might encounter in your medical career as "doctors in training" ;) (thats what you call yourselves, right?) Puzzling Predicament 1... Oh no! Your patients had an ischaemic stroke earlier today and just recorded a blood pressure of 154/90mmHg, will you give them an antihypertensive??

07.01.2022 WSPS is combining our Physicians Panel and Pathway to Paediatrics on the 24th of August at 5pm on Zoom! Join us to hear a range of inspiring paediatricians and physicians talk about their journeys and give useful tips and tricks to anyone considering a physician or paediatrician career. There will also be prizes up for grabs for attendees such as a Google Nest Mini, a Chromecast and a $50 gift card. Hit going on the event page to stay updated!

05.01.2022 Clinical conundrum 18 A 50 year old thin man presents complaining of recurrent abdominal pain radiating to the back and made worse by eating. Antacids relieve the pain. He smokes 20 cigarettes a day and is on indomethacin for arthritis. What is the most useful investigation? A) Endoscopy B) Double contrast barium meal... C) Helicobacter pylori breath test D) Abdominal xray E) Abdominal CT scan See more

04.01.2022 Clinical Question #1: A 26-year-old man presents with four days of progressive, bilateral, lower extremity weakness and dysesthesia. The patient denies any history of trauma, but states that he stayed home from work last week because of a fever accompanied by diarrhoea. Neurologic examination demonstrates the absence of reflexes in the lower extremities with no cranial nerve deficits. What is the best therapy for this patients condition? A: Plasmapheresis and immunoglobulin... B: Glucocorticoids C: Acetaminophen D: Radiation therapy Comment below with your answer so that you can go into the running to win the mystery prizes!!!

03.01.2022 Clinical Conundrum 14: A 25yo woman is brought into ED by her sister because of agitation, confusion and lethargy. This is on a background of one month of recurring headaches, and a seizure three days ago. She is hemodynamically stable. Bloodwork reveals the following abnormalities.... What is the most likely cause of the presentation? 1. Increased water intake 2. Increased ADH secretion 3. Decreased ADH receptor activity 4. Increased ACTH secretion 5. Decreased ADH secretion 6. Decreased ACTH secretion

02.01.2022 Clinical Conundrum #2 A 27-year-old man with a history of panic disorder and generalised anxiety disorder is brought to the emergency department after being found unconscious in his room by his parents. He is lethargic and can barely be aroused. He nods yes when asked if he has had any alcohol and yes when asked if he has taken any pills. His parents are sure the only pills in the house are those prescribed by his psychiatrist. His vital signs are normal, and his pupils a...re dilated to 2 mm and normally reactive. His blood alcohol level is 100 mg/dL. Results of the urine toxicology screen are pending. All of a sudden, his breathing slows and his oxygen saturation drops significantly. What should the physician give to treat this patients condition? A: Benztropine B: Flucytosine C: Flumazenil D: Naloxone E: Naltrexone Comment below with your answer so that you can go into the running to win the mystery prizes!!!

02.01.2022 Clinical Conundrum 22 a) What are your two most likely differentials for a patient presenting with the following? b) If an infective process is confirmed, what is the first line treatment?... c) What are three possible complications of this presentation?