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  • Question 1 - Which of the following cancers is not linked to human papillomavirus? ...

    Correct

    • Which of the following cancers is not linked to human papillomavirus?

      Your Answer: Tracheal cancer

      Explanation:

      HPV is linked to the following conditions:
      1. The most common type of cervical cancer (HPV 16/18)
      2. Anal cancer
      3. (missing information)

      Understanding Oncoviruses and Their Associated Cancers

      Oncoviruses are viruses that have the potential to cause cancer. These viruses can be detected through blood tests and prevented through vaccination. There are several types of oncoviruses, each associated with a specific type of cancer.

      The Epstein-Barr virus, for example, is linked to Burkitt’s lymphoma, Hodgkin’s lymphoma, post-transplant lymphoma, and nasopharyngeal carcinoma. Human papillomavirus 16/18 is associated with cervical cancer, anal cancer, penile cancer, vulval cancer, and oropharyngeal cancer. Human herpes virus 8 is linked to Kaposi’s sarcoma, while hepatitis B and C viruses are associated with hepatocellular carcinoma. Finally, human T-lymphotropic virus 1 is linked to tropical spastic paraparesis and adult T cell leukemia.

      It is important to understand the link between oncoviruses and cancer so that appropriate measures can be taken to prevent and treat these diseases. Vaccination against certain oncoviruses, such as HPV, can significantly reduce the risk of developing associated cancers. Regular screening and early detection can also improve outcomes for those who do develop cancer as a result of an oncovirus.

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      • General Principles
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  • Question 2 - A 45-year-old male presents to his primary care physician with blood in his...

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    • A 45-year-old male presents to his primary care physician with blood in his urine and increased frequency of urination for the past two weeks. He denies experiencing any abdominal or pelvic pain, fever, or discharge. Despite taking nitrofurantoin as prescribed two weeks ago, his symptoms have not improved. The patient has a history of traveling to Africa with his girlfriend a year ago and is sexually active with multiple partners while consistently using condoms. Urinalysis confirms the presence of haematuria, but the diagnosis remains unclear. An ELISA test was ordered due to his travel history, which revealed a schistosome infection.

      What is the most likely cause of the patient's symptoms?

      Your Answer: Schistosoma haematobium

      Explanation:

      Haematuria is a common symptom of Schistosoma haematobium infection.

      Schistosomiasis is a disease that is caused by parasitic blood flukes and is most prevalent in sub-Saharan Africa. The parasites responsible for schistosomiasis live in freshwater snails, and the infectious form of the parasite, known as cercariae, contaminates water. People can become infected with schistosomiasis when their skin comes into contact with cercariae. While most people with schistosomiasis are asymptomatic, acute infection can cause an itchy rash (known as swimmer’s itch) or acute schistosomiasis syndrome, which includes symptoms such as fever, urticaria, chills, myalgias, arthralgia, headache, and abdominal pain.

      Chronic infection with Schistosoma haematobium can lead to inflammation of the bladder, resulting in symptoms such as dysuria, frequency, haematuria, fibrosis, and bladder calcification. Schistosoma intercalatum is another type of blood fluke that can cause schistosomiasis.

      Schistosomiasis, also known as bilharzia, is a type of parasitic flatworm infection caused by three main species of schistosome: S. mansoni, S. japonicum, and S. haematobium. Acute symptoms usually occur in individuals who travel to endemic areas and have no immunity to the worms. These symptoms may include fever, cough, urticaria/angioedema, eosinophilia, and acute schistosomiasis syndrome (Katayama fever). Chronic infections caused by S. haematobium can lead to bladder inflammation and calcification, which can cause an obstructive uropathy and kidney damage. Schistosoma mansoni and Schistosoma japonicum can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion, as well as complications of liver cirrhosis, variceal disease, and cor pulmonale. Schistosoma intercalatum and Schistosoma mekongi are less common but can cause intestinal schistosomiasis. Diagnosis is typically done through urine or stool microscopy to look for eggs, and treatment involves a single oral dose of praziquantel.

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  • Question 3 - During your placement on a urology ward, you receive a call from microbiology...

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    • During your placement on a urology ward, you receive a call from microbiology regarding the bacteria found in a urine sample from an older male patient you are managing for urosepsis. What is the most frequent bacteria that causes a urinary tract infection?

      Your Answer: Escherichia coli

      Explanation:

      Urinary tract infections (UTIs) are common in adults and can affect different parts of the urinary tract. Lower UTIs are more common and can be managed with antibiotics. For non-pregnant women, local antibiotic guidelines should be followed, and a urine culture should be sent if they are aged over 65 years or have visible or non-visible haematuria. Trimethoprim or nitrofurantoin for three days are recommended by NICE Clinical Knowledge Summaries. Pregnant women with symptoms should have a urine culture sent, and first-line treatment is nitrofurantoin, while amoxicillin or cefalexin can be used as second-line treatment. Asymptomatic bacteriuria in pregnant women should also be treated with antibiotics. Men with UTIs should be offered antibiotics for seven days, and a urine culture should be sent before starting treatment. Catheterised patients should not be treated for asymptomatic bacteria, but if they are symptomatic, a seven-day course of antibiotics should be given, and the catheter should be removed or changed if it has been in place for more than seven days. For patients with signs of acute pyelonephritis, hospital admission should be considered, and local antibiotic guidelines should be followed. The BNF recommends a broad-spectrum cephalosporin or a quinolone for 10-14 days for non-pregnant women.

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  • Question 4 - A 52-year-old woman comes to your GP clinic with a 3 day history...

    Incorrect

    • A 52-year-old woman comes to your GP clinic with a 3 day history of leg pain, fever and nausea. She suspects that a scratch she got from a thorn bush while picking blackberries might have caused it and is worried as the redness seems to be spreading. She has not been immobile recently. Upon further questioning, she mentions having a similar incident a few years ago after a long flight.

      During the examination, you observe that the woman is overweight and calculate her body mass index to be 33kg/m². Her vital signs are all within normal limits, except for a temperature of 38.2ºC. The woman's left leg appears to be swollen and red compared to the right. There is a small cluster of scratches in the middle of the lesion.

      What is the initial treatment for this condition?

      Your Answer: Amoxicillin & clarithromycin

      Correct Answer: Flucloxacillin

      Explanation:

      Understanding Cellulitis: Symptoms, Diagnosis, and Treatment

      Cellulitis is a common skin infection caused by Streptococcus pyogenes or Staphylococcus aureus. It is characterized by inflammation of the skin and subcutaneous tissues, usually on the shins, accompanied by erythema, pain, swelling, and sometimes fever. The diagnosis of cellulitis is based on clinical features, and no further investigations are required in primary care. However, bloods and blood cultures may be requested if the patient is admitted and septicaemia is suspected.

      To guide the management of patients with cellulitis, NICE Clinical Knowledge Summaries recommend using the Eron classification. Patients with Eron Class III or Class IV cellulitis, severe or rapidly deteriorating cellulitis, very young or frail patients, immunocompromised patients, patients with significant lymphoedema, or facial or periorbital cellulitis (unless very mild) should be admitted for intravenous antibiotics. Patients with Eron Class II cellulitis may not require admission if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the patient.

      The first-line treatment for mild/moderate cellulitis is flucloxacillin, while clarithromycin, erythromycin (in pregnancy), or doxycycline is recommended for patients allergic to penicillin. Patients with severe cellulitis should be offered co-amoxiclav, cefuroxime, clindamycin, or ceftriaxone. Understanding the symptoms, diagnosis, and treatment of cellulitis is crucial for effective management and prevention of complications.

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  • Question 5 - Which of the following is true of correlation in relation to age? ...

    Incorrect

    • Which of the following is true of correlation in relation to age?

      Your Answer: Negative correlation disproves causation

      Correct Answer: Complete absence of correlation is expressed by a value of 0

      Explanation:

      Understanding Correlation and Linear Regression

      Correlation and linear regression are two statistical methods used to analyze the relationship between variables. While they are related, they are not interchangeable. Correlation is used to determine if there is a relationship between two variables, while regression is used to predict the value of one variable based on the value of another variable.

      The degree of correlation is measured by the correlation coefficient, which can range from -1 to +1. A coefficient of 1 indicates a strong positive correlation, while a coefficient of -1 indicates a strong negative correlation. A coefficient of 0 indicates no correlation between the variables. However, correlation coefficients do not provide information on how much the variable will change or the cause and effect relationship between the variables.

      Linear regression, on the other hand, can be used to predict how much one variable will change when another variable is changed. A regression equation can be formed to calculate the value of the dependent variable based on the value of the independent variable. The equation takes the form of y = a + bx, where y is the dependent variable, a is the intercept value, b is the slope of the line or regression coefficient, and x is the independent variable.

      In summary, correlation and linear regression are both useful tools for analyzing the relationship between variables. Correlation determines if there is a relationship, while regression predicts the value of one variable based on the value of another variable. Understanding these concepts can help in making informed decisions and drawing accurate conclusions from data analysis.

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  • Question 6 - A 35-year-old woman presents to the emergency department with seizures. She reports experiencing...

    Incorrect

    • A 35-year-old woman presents to the emergency department with seizures. She reports experiencing headaches, nausea, vomiting, and fevers for the past week. She was diagnosed with HIV 3 years ago but has been noncompliant with her medication due to forgetfulness. On lumbar puncture, her CSF shows a high opening pressure and India ink staining. A head CT reveals cerebral edema.

      What is the probable cause of her symptoms?

      Your Answer: Encephalitis

      Correct Answer: Cryptococcus neoformans

      Explanation:

      Cryptococcus neoformans is a fungal infection that commonly affects the central nervous system and is often associated with HIV. This patient is at risk of developing neurological complications due to non-compliance with medication. Symptoms of Cryptococcus neoformans infection include seizures, headache, nausea, vomiting, and focal neurological deficits. A lumbar puncture will reveal high opening pressure and a positive India ink test.

      AIDS dementia complex typically has a more gradual onset than the acute symptoms seen in this patient. Patients with AIDS dementia complex may experience behavioral changes and motor impairment over a longer period of time.

      Encephalitis is a potential differential diagnosis for patients with neurological symptoms suggestive of infection, but the findings on lumbar puncture in this patient make Cryptococcus neoformans infection more likely.

      PML is caused by JC virus infection of oligodendrocytes. Patients with PML typically experience subacute onset of symptoms such as behavioral changes, speech impairment, motor impairment, or visual impairment. CT scans may show single or multiple lesions, but the CSF will not stain with India ink.

      Neurological complications are common in patients with HIV. Focal neurological lesions such as toxoplasmosis, primary CNS lymphoma, and tuberculosis can cause symptoms such as headache, confusion, and drowsiness. Toxoplasmosis is the most common cause of cerebral lesions in HIV patients and is treated with sulfadiazine and pyrimethamine. Primary CNS lymphoma, which is associated with the Epstein-Barr virus, is treated with steroids, chemotherapy, and whole brain irradiation. Differentiating between toxoplasmosis and lymphoma is important for proper treatment. Generalized neurological diseases such as encephalitis, cryptococcus, progressive multifocal leukoencephalopathy (PML), and AIDS dementia complex can also occur in HIV patients. Encephalitis may be due to CMV or HIV itself, while cryptococcus is the most common fungal infection of the CNS. PML is caused by infection of oligodendrocytes by JC virus, and AIDS dementia complex is caused by the HIV virus itself. Proper diagnosis and treatment of these neurological complications is crucial for improving outcomes in HIV patients.

      Neurological Complications in HIV Patients
      Introduction to the common neurological complications in HIV patients, including focal neurological lesions such as toxoplasmosis, primary CNS lymphoma, and tuberculosis.
      Details on the diagnosis and treatment of toxoplasmosis and primary CNS lymphoma, including the importance of differentiating between the two.
      Overview of generalized neurological diseases in HIV patients, including encephalitis, cryptococcus, PML, and AIDS dementia complex.
      Importance of proper diagnosis and treatment for improving outcomes in HIV patients with neurological complications.

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      • General Principles
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  • Question 7 - In a research facility, the replication of a heat-sensitive strain of Streptococcus pyogenes...

    Incorrect

    • In a research facility, the replication of a heat-sensitive strain of Streptococcus pyogenes is being investigated. An inhibitor was introduced during gel electrophoresis to target an enzyme involved in DNA replication on the lagging strand. The results showed that replication on the leading strand proceeded without interruption, while replication on the lagging strand was fragmented.

      What enzyme inhibitor was utilized in this study?

      Your Answer: RNase H

      Correct Answer: Ligase

      Explanation:

      Ligase is responsible for connecting Okazaki fragments on the lagging strand to create a continuous strand during DNA replication. While the leading strand undergoes continuous replication, the lagging strand is replicated in fragments known as Okazaki fragments. DNA ligase is an enzyme that joins these fragments together to form a complete section of DNA on the lagging strand.

      Helicase is a type of enzyme found in eukaryotes that unwinds double-stranded DNA during replication.

      Primase is an RNA polymerase that creates RNA primers, which are necessary for DNA replication to begin.

      RNase H is an enzyme that breaks down RNA primers during DNA replication.

      DNA Replication in Prokaryotes vs Eukaryotes

      DNA replication is the process by which genetic information is copied and passed on to the next generation of cells. In prokaryotes, DNA replication occurs in the cytoplasm, while in eukaryotes, it occurs in the nucleus. Additionally, prokaryotes have a single origin of replication, while eukaryotes have multiple origins.

      During DNA replication, the double helix is unzipped by DNA helicase, creating a replication fork. Single-stranded binding proteins prevent the DNA from reannealing. DNA polymerase III elongates the leading strand in a 5′-3′ direction, while DNA polymerase I removes RNA primers and replaces them with DNA. DNA ligase seals up the fragments.

      While the basic mechanisms of DNA replication are similar in prokaryotes and eukaryotes, there are some differences in the process. Understanding these differences can help researchers better understand the genetic processes of different organisms.

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  • Question 8 - A 53-year-old man comes to the emergency department complaining of chest discomfort. He...

    Incorrect

    • A 53-year-old man comes to the emergency department complaining of chest discomfort. He has no significant medical history and is generally healthy.

      Upon examination, the patient is found to have tachycardia and an ECG confirms supraventricular tachycardia. The on-call cardiologist is consulted and, after further evaluation, suggests starting flecainide.

      What is the mechanism of action of flecainide?

      Your Answer: Blockage of the Kv11.1 potassium channel

      Correct Answer: Blockage of the Nav1.5 sodium channel

      Explanation:

      Flecainide method of action is the blockage of Nav1.5 sodium channels in the heart. It is classified as a class Ic antiarrhythmic drug, which has the strongest effect on the initiation phase of depolarisation.

      Verapamil and diltiazem, which are class IV antiarrhythmic drugs, block L-type calcium channels, specifically the Cav1.2 unit. Amiodarone, on the other hand, exhibits some calcium-channel blocking effects, among other effects, and blocks the Kv11.1 potassium channel.

      Flecainide does not block the Cav2.3 calcium channel, which refers to R-type calcium channels that are poorly understood and sparsely found in the body.

      Flecainide: A Sodium Channel Blocker for Cardiac Arrhythmias

      Flecainide is a type of antiarrhythmic drug that belongs to the Vaughan Williams class 1c. It works by blocking the Nav1.5 sodium channels, which slows down the conduction of the action potential. This can cause the QRS complex to widen and the PR interval to prolong. Flecainide is commonly used to treat atrial fibrillation and supraventricular tachycardia associated with accessory pathways like Wolff-Parkinson-White syndrome.

      However, it is important to note that flecainide is contraindicated in certain situations. For instance, it should not be used in patients who have recently experienced a myocardial infarction or have structural heart disease like heart failure. It is also not recommended for those with sinus node dysfunction or second-degree or greater AV block, as well as those with atrial flutter.

      Like any medication, flecainide can cause adverse effects. It may have a negative inotropic effect, which means it can weaken the heart’s contractions. It can also cause bradycardia, proarrhythmic effects, oral paraesthesia, and visual disturbances. Therefore, it is important to use flecainide only under the guidance of a healthcare professional and to report any unusual symptoms immediately.

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  • Question 9 - A 26-year-old, first-time pregnant woman visits her doctor with worries about her baby's...

    Correct

    • A 26-year-old, first-time pregnant woman visits her doctor with worries about her baby's health. She is currently 30 weeks pregnant. After discovering that her paternal grandmother had galactosemia, she has been researching the condition online. Her primary concern is whether her child could also be affected.

      The doctor assures her that newborns are screened for galactosemia using a specific test, which can detect the condition early and allow for proper management.

      What is the test that the doctor is referring to?

      Your Answer: Heel-prick test

      Explanation:

      After birth, every baby undergoes a comprehensive physical examination to check for any potential health issues. This includes examining their eyes, heart, hips, and testicles (in boys). The examination is conducted within 72 hours of birth and again at six to eight weeks of age to detect any conditions that may require further testing or treatment. Galactosaemia is one of the disorders screened for using the ‘heel prick’ test, which is performed between 5-9 days of life. Other disorders screened for include hypothyroidism, phenylketonuria, maple syrup urine disease, and homocystinuria. It’s important to note that amniocentesis is a diagnostic test, not a screening test, and the combined test and quadruple test are used to screen for Down Syndrome.

      The Guthrie Test: Screening for Biochemical Disorders in Newborns

      The Guthrie test, also known as the heel-prick test, is a screening procedure that is typically performed on newborns between 5 to 9 days after birth. This test is designed to detect the presence of several biochemical disorders that can cause serious health problems if left untreated.

      The Guthrie test involves pricking the baby’s heel and collecting a small amount of blood on a special filter paper. The blood sample is then sent to a laboratory for analysis. The test screens for several disorders, including hypothyroidism, phenylketonuria, galactosaemia, maple syrup urine disease, and homocystinuria.

      Hypothyroidism is a condition in which the thyroid gland does not produce enough hormones, which can lead to developmental delays and other health problems. Phenylketonuria is a genetic disorder that affects the body’s ability to break down an amino acid called phenylalanine, which can cause brain damage if left untreated. Galactosaemia is a rare genetic disorder that affects the body’s ability to process galactose, a sugar found in milk. Maple syrup urine disease is a metabolic disorder that prevents the body from breaking down certain amino acids, which can cause seizures and other serious health problems. Homocystinuria is a genetic disorder that affects the body’s ability to break down certain amino acids, which can cause developmental delays and other health problems.

      Overall, the Guthrie test is an important screening tool that can help identify these and other biochemical disorders in newborns, allowing for early intervention and treatment to prevent serious health complications.

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  • Question 10 - A 65-year-old woman presents to the surgical clinic with iron deficiency anemia. She...

    Incorrect

    • A 65-year-old woman presents to the surgical clinic with iron deficiency anemia. She has a history of left hemicolectomy but no other medical conditions. Where in the body does dietary iron absorption primarily occur?

      Your Answer: Proximal ileum

      Correct Answer: Duodenum

      Explanation:

      The most efficient absorption of iron occurs in the duodenum and jejunum of the proximal small intestine when it is in the Fe 2+ state. A divalent membrane transporter protein facilitates the transportation of iron across the small intestine mucosa, resulting in better absorption of Fe 2+. Ferritin is the form in which the intestinal cells store the bound iron. When cells require iron, they absorb the complex as necessary.

      Iron Metabolism: Absorption, Distribution, Transport, Storage, and Excretion

      Iron is an essential mineral that plays a crucial role in various physiological processes. The absorption of iron occurs mainly in the upper small intestine, particularly the duodenum. Only about 10% of dietary iron is absorbed, and ferrous iron (Fe2+) is much better absorbed than ferric iron (Fe3+). The absorption of iron is regulated according to the body’s need and can be increased by vitamin C and gastric acid. However, it can be decreased by proton pump inhibitors, tetracycline, gastric achlorhydria, and tannin found in tea.

      The total body iron is approximately 4g, with 70% of it being present in hemoglobin, 25% in ferritin and haemosiderin, 4% in myoglobin, and 0.1% in plasma iron. Iron is transported in the plasma as Fe3+ bound to transferrin. It is stored in tissues as ferritin, and the lost iron is excreted via the intestinal tract following desquamation.

      In summary, iron metabolism involves the absorption, distribution, transport, storage, and excretion of iron in the body. Understanding these processes is crucial in maintaining iron homeostasis and preventing iron-related disorders.

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