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  • Question 1 - An elderly retired manual labourer in his late 60s presents to his GP...

    Incorrect

    • An elderly retired manual labourer in his late 60s presents to his GP with a complaint of gradual loss of extension in his 4th and 5th finger. During the examination, the doctor observes the presence of nodules between the affected fingers.

      What is the probable diagnosis for this patient?

      Your Answer: Osteoarthritis of the metacarpophalangeal joint

      Correct Answer: Dupuytren's contracture

      Explanation:

      Dupuytren’s contracture commonly affects the ring finger and little finger, particularly in older males. This condition causes nodules and cord development in the palmar fascia, resulting in flexion at the metacarpophalangeal and proximal interphalangeal joints.

      Trigger finger causes stiffness, pain, and a locking sensation when flexing, making it difficult to extend the finger.

      Ganglion cysts, also known as bible cysts, are typically soft and found in the dorsal and volar aspect of the wrist. Many cysts will disappear on their own.

      Flexor tendon rupture is usually caused by trauma to the flexor tendon, such as a sports injury. This condition is typically acute and results in a sudden loss of flexion in the affected finger, often requiring surgery.

      Understanding Dupuytren’s Contracture

      Dupuytren’s contracture is a condition that affects about 5% of the population. It is more common in older men and those with a family history of the condition. The causes of Dupuytren’s contracture include manual labor, phenytoin treatment, alcoholic liver disease, diabetes mellitus, and trauma to the hand.

      The condition typically affects the ring finger and little finger, causing them to become bent and difficult to straighten. In severe cases, the hand may not be able to be placed flat on a table.

      Surgical treatment may be necessary when the metacarpophalangeal joints cannot be straightened.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.3
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  • Question 2 - A 26-year-old medical student visits his doctor with a complaint of experiencing dry...

    Correct

    • A 26-year-old medical student visits his doctor with a complaint of experiencing dry mouth, particularly at night, which has been affecting his sleep. He has a medical history of allergic rhinitis and is currently taking chlorphenamine for it.

      What is the correct explanation for the mechanism of action of chlorphenamine?

      Your Answer: H1 receptor antagonist

      Explanation:

      Chlorphenamine is a medication.

      Antihistamines for Allergic Rhinitis and Urticaria

      Antihistamines, specifically H1 inhibitors, are effective in treating allergic rhinitis and urticaria. Sedating antihistamines like chlorpheniramine have antimuscarinic properties that can cause dry mouth and urinary retention. On the other hand, non-sedating antihistamines like loratadine and cetirizine are less likely to cause drowsiness. However, there is some evidence that cetirizine may still cause some level of drowsiness compared to other non-sedating antihistamines. Overall, antihistamines are a valuable treatment option for those suffering from allergic rhinitis and urticaria.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.9
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  • Question 3 - A father brings his 4-year-old son to a dermatologist concerned about his dry...

    Incorrect

    • A father brings his 4-year-old son to a dermatologist concerned about his dry skin. The child was also born via spontaneous vaginal delivery at term without any complications. He has always had dry skin, but it has become more severe lately. He has a past medical history of eczema.

      What clinical feature could have aided in the diagnosis of ichthyosis based on the history and examination?

      Your Answer: Raised, shiny, dome-shaped nodule

      Correct Answer: 'fish-scale' skin

      Explanation:

      Ichthyosis is characterized by the presence of dry, scaly skin resembling fish scales.

      Understanding Acquired Ichthyosis

      Acquired ichthyosis is a skin condition characterized by dry and scaly skin, often referred to as crocodile skin. Unlike congenital ichthyosis, which is present at birth, acquired ichthyosis develops later in life and can be caused by various factors. Some of the known causes of acquired ichthyosis include lymphoma, particularly Hodgkin’s lymphoma, other malignancies such as Kaposi’s sarcoma, leprosy, and malnutrition.

      It is important to note that acquired ichthyosis is a rare condition and is often associated with underlying medical conditions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      23.5
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  • Question 4 - Which one of the following is not a content of the posterior triangle...

    Incorrect

    • Which one of the following is not a content of the posterior triangle of the neck?

      Your Answer: Submandibular gland

      Correct Answer: Phrenic nerve

      Explanation:

      The contents of the posterior triangle include the phrenic nerve, while the carotid sheath and its contents are found in the anterior triangle.

      The Anterior Triangle of the Neck: Boundaries and Contents

      The anterior triangle of the neck is a region that is bounded by the anterior border of the sternocleidomastoid muscle, the lower border of the mandible, and the anterior midline. It is further divided into three sub-triangles by the digastric muscle and the omohyoid muscle. The muscular triangle contains the neck strap muscles, while the carotid triangle contains the carotid sheath, which houses the common carotid artery, the vagus nerve, and the internal jugular vein. The submandibular triangle, located below the digastric muscle, contains the submandibular gland, submandibular nodes, facial vessels, hypoglossal nerve, and other structures.

      The digastric muscle, which separates the submandibular triangle from the muscular triangle, is innervated by two different nerves. The anterior belly of the digastric muscle is supplied by the mylohyoid nerve, while the posterior belly is supplied by the facial nerve.

      Overall, the anterior triangle of the neck is an important anatomical region that contains many vital structures, including blood vessels, nerves, and glands. Understanding the boundaries and contents of this region is essential for medical professionals who work in this area.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 5 - A 65-year-old man visits his doctor with complaints of a painful rash on...

    Correct

    • A 65-year-old man visits his doctor with complaints of a painful rash on his face after experiencing lethargy and headache for 3 days. The man's vital signs are within normal limits. Upon examination, a distinct line of blisters is observed on the upper left side of his face.

      What is the most frequent complication associated with this condition in the elderly population?

      Your Answer: Neuralgia

      Explanation:

      The most common complication of shingles is post-herpetic neuralgia, which is characterized by a burning pain in the affected dermatome. This condition is likely to occur in older individuals, who are also at risk of experiencing more severe and prolonged pain. While bacterial superinfection of cutaneous lesions can occur, it is typically caused by Staphylococcus aureus or group A streptococcal species. Shingles can also lead to complications such as pneumonia, meningoencephalitis, hepatitis, and acute retinal necrosis if it affects internal organs.

      Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 6 - A 75-year-old man falls and injures his left hip. He is given paracetamol...

    Correct

    • A 75-year-old man falls and injures his left hip. He is given paracetamol by a junior doctor and sent home. After a few months, he returns with persistent pain and discomfort in the hip. The doctors suspect avascular necrosis of the femoral head. Which of the following features is least likely to be present?

      Your Answer: Apoptosis of osteoblasts

      Explanation:

      Necrotic cell death does not involve apoptosis. Instead, the body typically attempts to repair the damage by promoting angiogenesis and the proliferation of fibroblasts. These cells may even differentiate into osteoblasts, which can then lay down new matrix.

      Avascular necrosis (AVN) is a condition where bone tissue dies due to a loss of blood supply, resulting in bone destruction and joint dysfunction. This commonly affects the femur’s epiphysis, which is a long bone. The causes of AVN include long-term steroid use, chemotherapy, alcohol excess, and trauma. Initially, AVN may not show any symptoms, but pain in the affected joint may develop over time. Plain x-rays may not show any abnormalities at first, but osteopenia and microfractures may be visible early on. The crescent sign may appear due to the collapse of the articular surface. MRI is the preferred diagnostic tool as it is more sensitive than radionuclide bone scanning. Joint replacement may be necessary for management.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 7 - From which of the following structures does the posterior cruciate ligament originate? ...

    Incorrect

    • From which of the following structures does the posterior cruciate ligament originate?

      Your Answer: Posterolateral aspect of the medial femoral condyle

      Correct Answer: Anterior intercondylar area of tibia

      Explanation:

      The attachment point of the anterior cruciate ligament is the anterior intercondylar area of the tibia. From there, it extends in a posterolateral direction and inserts into the posteromedial aspect of the lateral femoral condyle.

      The knee joint is the largest and most complex synovial joint in the body, consisting of two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The degree of congruence between the tibiofemoral articular surfaces is improved by the presence of the menisci, which compensate for the incongruence of the femoral and tibial condyles. The knee joint is divided into two compartments: the tibiofemoral and patellofemoral compartments. The fibrous capsule of the knee joint is a composite structure with contributions from adjacent tendons, and it contains several bursae and ligaments that provide stability to the joint. The knee joint is supplied by the femoral, tibial, and common peroneal divisions of the sciatic nerve and by a branch from the obturator nerve, while its blood supply comes from the genicular branches of the femoral artery, popliteal, and anterior tibial arteries.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      20.1
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  • Question 8 - A 68-year-old woman arrives at the emergency department with a complaint of a...

    Correct

    • A 68-year-old woman arrives at the emergency department with a complaint of a painful, red toe. The pain began a few hours ago and has been getting worse. Upon examination, her 1st metatarsophalangeal joint is inflamed, erythematous, and tender to the touch.

      What are the joint aspiration findings that would confirm a gout flare diagnosis?

      Your Answer: Negatively birefringent needle-shaped monosodium urate crystals

      Explanation:

      Joint aspiration is a valuable diagnostic tool for differentiating between various causes of joint swelling, including septic arthritis and pseudogout. In the case of gout, joint aspiration will reveal needle-shaped monosodium urate crystals that are negatively birefringent under polarised light. These crystals form when uric acid levels remain persistently high and deposit in tissues, leading to the characteristic inflammatory response seen in gout.

      It is important to note that a green-colored aspirate with a positive gram stain for Staphylococcus aureus is not indicative of gout, but rather suggests septic arthritis. In this case, the aspirate may have a raised white cell count and appear yellow or green.

      Similarly, the presence of negatively birefringent needle-shaped calcium oxalate crystals is not associated with gout, but rather with kidney stones. These crystals form when there are high concentrations of calcium oxalate in the urine and are typically octahedral or envelope-shaped.

      Finally, positively birefringent rhomboid-shaped calcium pyrophosphate crystals are not seen in gout, but rather in pseudogout. Pseudogout presents with similar symptoms to gout and more commonly affects the knee joint.

      Understanding Gout: Symptoms and Diagnosis

      Gout is a type of arthritis that causes inflammation and pain in the joints. Patients experience episodes of intense pain that can last for several days, followed by periods of no symptoms. The acute episodes usually reach their peak within 12 hours and can affect various joints, with the first metatarsophalangeal joint being the most commonly affected. Swelling and redness are also common symptoms of gout.

      If left untreated, repeated acute episodes of gout can lead to joint damage and chronic joint problems. To diagnose gout, doctors may perform synovial fluid analysis to look for needle-shaped, negatively birefringent monosodium urate crystals under polarised light. Uric acid levels may also be checked once the acute episode has subsided, as they can be high, normal, or low during the attack.

      Radiological features of gout include joint effusion, well-defined punched-out erosions with sclerotic margins, and eccentric erosions. Unlike rheumatoid arthritis, gout does not cause periarticular osteopenia. Soft tissue tophi may also be visible.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      10.9
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  • Question 9 - A 25-year-old patient was recently admitted to hospital with symptoms of diarrhoea, weight...

    Incorrect

    • A 25-year-old patient was recently admitted to hospital with symptoms of diarrhoea, weight loss and abdominal pain. Upon blood tests, a raised C-reactive protein (CRP) and anaemia were observed. A stool test for faecal calprotectin was significantly raised. A colonoscopy was performed, revealing deep ulceration and skip lesions. The patient was diagnosed with Crohn's disease without complications and was promptly started on glucocorticoids to induce remission. Subsequently, the gastroenterologist prescribed a drug called azathioprine to maintain remission of symptoms.

      What is the correct mechanism of action for azathioprine?

      Your Answer: It forms radicals which disrupt the DNA of anaerobic bacteria

      Correct Answer: Its metabolite inhibits purine synthesis

      Explanation:

      Azathioprine is an immunosuppressant that is commonly used to maintain remission in Crohn’s disease. It is metabolized into mercaptopurine, which inhibits purine synthesis and helps to control inflammation.

      Infliximab is a monoclonal antibody that is sometimes used to induce remission in refractory or fistulating Crohn’s disease. It works by binding to and neutralizing tumor necrosis factor, a key mediator of inflammation.

      Mesalazine is a second-line drug that is used to induce remission in Crohn’s disease after glucocorticoids. It belongs to the 5-aminosalicylate class of drugs and works by inhibiting prostaglandin secretion. It is also considered for use in maintaining remission in post-surgical Crohn’s patients.

      Methotrexate is another immunosuppressant that is used as a second-line treatment for Crohn’s disease. It works by disrupting folic acid metabolism and accumulating the anti-inflammatory molecule adenosine.

      Metronidazole is an antibiotic that is used to treat isolated peri-anal Crohn’s disease. It works by forming radicals that disrupt the DNA of anaerobic bacteria.

      Azathioprine is a medication that is converted into mercaptopurine, which is an active compound that inhibits the production of purine. To determine if someone is at risk for azathioprine toxicity, a test for thiopurine methyltransferase (TPMT) may be necessary. Adverse effects of this medication include bone marrow depression, nausea and vomiting, pancreatitis, and an increased risk of non-melanoma skin cancer. If infection or bleeding occurs, a full blood count should be considered. It is important to note that there may be a significant interaction between azathioprine and allopurinol, so lower doses of azathioprine should be used. However, azathioprine is generally considered safe to use during pregnancy.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.6
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  • Question 10 - A 75-year-old woman with a history of type 2 diabetes mellitus and atrial...

    Incorrect

    • A 75-year-old woman with a history of type 2 diabetes mellitus and atrial fibrillation visits her GP complaining of a rash on her arm. The rash has been present for two days and she has been feeling generally unwell with a mild fever. Upon examination, the GP observes a well-defined, raised, reddish patch on her left forearm that is most red at the border. Additionally, there is associated axillary lymphadenopathy. The GP orders a full blood count, CRP, and a swab of the lesion. What is the most likely pathogen responsible for this condition?

      Your Answer: Staphylococcus epidermidis

      Correct Answer: Streptococcus pyogenes

      Explanation:

      Erysipelas is a skin infection that is localized and caused by Streptococcus pyogenes. It is often seen in elderly patients with weakened immune systems, such as those with diabetes mellitus. Symptoms include a raised, painful rash with clear boundaries.

      Ringworm is commonly caused by Trichophyton rubrum. This results in a circular, scaly, and itchy rash that is red in color.

      While Staphylococcus epidermidis is a normal part of the skin’s flora, it is more commonly associated with infections of foreign devices and endocarditis rather than skin infections.

      Understanding Erysipelas: A Superficial Skin Infection

      Erysipelas is a skin infection that is caused by Streptococcus pyogenes. It is a less severe form of cellulitis, which is a more widespread skin infection. Erysipelas is a localized infection that affects the skin’s upper layers, causing redness, swelling, and warmth. The infection can occur anywhere on the body, but it is most commonly found on the face, arms, and legs.

      The treatment of choice for erysipelas is flucloxacillin, an antibiotic that is effective against Streptococcus pyogenes. Other antibiotics may also be used, depending on the severity of the infection and the patient’s medical history.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.4
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  • Question 11 - A 15-year-old girl presents with a painful swelling in her distal femur. After...

    Correct

    • A 15-year-old girl presents with a painful swelling in her distal femur. After diagnosis, it is revealed that she has osteoblastic sarcoma. What is the most probable site for metastasis of this lesion?

      Your Answer: Lung

      Explanation:

      Sarcomas that exhibit lymphatic metastasis can be remembered using the acronym ‘RACE For MS’, which stands for Rhabdomyosarcoma, Angiosarcoma, Clear cell sarcoma, Epithelial cell sarcoma, Fibrosarcoma, Malignant fibrous histiocytoma, and Synovial cell sarcoma. Alternatively, the acronym ‘SCARE’ can be used to remember Synovial sarcoma, Clear cell sarcoma, Angiosarcoma, Rhabdomyosarcoma, and Epithelioid sarcoma. While sarcomas typically metastasize through the bloodstream and commonly spread to the lungs, lymphatic metastasis is less common but may occur in some cases. The liver and brain are typically spared from initial metastasis.

      Sarcomas: Types, Features, and Assessment

      Sarcomas are malignant tumors that originate from mesenchymal cells. They can either be bone or soft tissue in origin. Bone sarcomas include osteosarcoma, Ewing’s sarcoma, and chondrosarcoma, while soft tissue sarcomas are a more diverse group that includes liposarcoma, rhabdomyosarcoma, leiomyosarcoma, and synovial sarcomas. Malignant fibrous histiocytoma is a sarcoma that can arise in both soft tissue and bone.

      Certain features of a mass or swelling should raise suspicion for a sarcoma, such as a large (>5cm) soft tissue mass, deep tissue or intra-muscular location, rapid growth, and a painful lump. Imaging of suspicious masses should utilize a combination of MRI, CT, and USS. Blind biopsy should not be performed prior to imaging, and where required, should be done in such a way that the biopsy tract can be subsequently included in any resection.

      Ewing’s sarcoma is more common in males, with an incidence of 0.3/1,000,000 and onset typically between 10 and 20 years of age. Osteosarcoma is more common in males, with an incidence of 5/1,000,000 and peak age 15-30. Liposarcoma is rare, with an incidence of approximately 2.5/1,000,000, and typically affects an older age group (>40 years of age). Malignant fibrous histiocytoma is the most common sarcoma in adults and is usually treated with surgical resection and adjuvant radiotherapy.

      In summary, sarcomas are a diverse group of malignant tumors that can arise from bone or soft tissue. Certain features of a mass or swelling should raise suspicion for a sarcoma, and imaging should utilize a combination of MRI, CT, and USS. Treatment options vary depending on the type and location of the sarcoma.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 12 - Which one of the following structures is not closely related to the adductor...

    Incorrect

    • Which one of the following structures is not closely related to the adductor longus muscle? Also, can you provide information on the relationship between the adductor longus muscle and nearby structures for a 12-year-old student?

      Your Answer: Long saphenous vein

      Correct Answer: Tendon of iliacus

      Explanation:

      The femoral triangle is bordered by the Adductor longus medially, Inguinal ligament superiorly, and Sartorius muscle laterally. The Adductor longus muscle is located along the medial border of the femoral triangle and is closely associated with the long saphenous vein and the profunda branch of the femoral artery. The femoral nerve is located inferiorly to the Adductor longus muscle. However, the tendon of iliacus inserts proximally and does not come into contact with the Adductor longus muscle.

      Adductor Longus Muscle

      The adductor longus muscle originates from the anterior body of the pubis and inserts into the middle third of the linea aspera. Its main function is to adduct and flex the thigh, as well as medially rotate the hip. This muscle is innervated by the anterior division of the obturator nerve, which originates from the spinal nerves L2, L3, and L4. The adductor longus is one of the adductor muscles, which are a group of muscles located in the thigh that work together to bring the legs towards the midline of the body. The schematic image below illustrates the relationship of the adductor muscles.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      19.4
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  • Question 13 - A 25-year-old male is having a full anterior cruciate ligament reconstruction procedure in...

    Incorrect

    • A 25-year-old male is having a full anterior cruciate ligament reconstruction procedure in the primary orthopaedic operating room. While performing the surgery, the orthopaedic surgeon requests his assistant to locate the blood vessel that is being ligated to prevent bleeding and supplies oxygenated blood to the ACL.

      Your Answer: Lateral femoral circumflex artery

      Correct Answer: Middle genicular artery

      Explanation:

      The middle genicular artery is responsible for providing blood supply to the anterior cruciate ligament, while the lateral femoral circumflex artery supplies certain muscles located on the lateral side of the thigh.

      The knee joint is the largest and most complex synovial joint in the body, consisting of two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The degree of congruence between the tibiofemoral articular surfaces is improved by the presence of the menisci, which compensate for the incongruence of the femoral and tibial condyles. The knee joint is divided into two compartments: the tibiofemoral and patellofemoral compartments. The fibrous capsule of the knee joint is a composite structure with contributions from adjacent tendons, and it contains several bursae and ligaments that provide stability to the joint. The knee joint is supplied by the femoral, tibial, and common peroneal divisions of the sciatic nerve and by a branch from the obturator nerve, while its blood supply comes from the genicular branches of the femoral artery, popliteal, and anterior tibial arteries.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 14 - A 47-year-old man is undergoing a block dissection of the groin for a...

    Correct

    • A 47-year-old man is undergoing a block dissection of the groin for a malignant melanoma. During the surgery, the femoral triangle is being explored to control intraoperative bleeding. What structure forms the medial border of the femoral triangle?

      Your Answer: Adductor longus

      Explanation:

      The adductor canal is bordered laterally by the vastus medialis and its roof is formed by the sartorius muscle. The adductor longus muscle forms the medial boundary of the femoral triangle.

      The Adductor Canal: Anatomy and Contents

      The adductor canal, also known as Hunter’s or the subsartorial canal, is a structure located in the middle third of the thigh, immediately distal to the apex of the femoral triangle. It is bordered laterally by the vastus medialis muscle and posteriorly by the adductor longus and adductor magnus muscles. The roof of the canal is formed by the sartorius muscle. The canal terminates at the adductor hiatus.

      The adductor canal contains three important structures: the saphenous nerve, the superficial femoral artery, and the superficial femoral vein. The saphenous nerve is a sensory nerve that supplies the skin of the medial leg and foot. The superficial femoral artery is a major artery that supplies blood to the lower limb. The superficial femoral vein is a large vein that drains blood from the lower limb.

      In order to expose the contents of the adductor canal, the sartorius muscle must be removed. Understanding the anatomy and contents of the adductor canal is important for medical professionals who perform procedures in this area, such as nerve blocks or vascular surgeries.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 15 - A 25-year-old male visits his primary care physician complaining of shoulder pain. He...

    Correct

    • A 25-year-old male visits his primary care physician complaining of shoulder pain. He denies any history of shoulder dislocation and regularly attends the gym for five days a week, performing overhead pressing movements. He is a first-year physiotherapy student and has a good understanding of shoulder anatomy.

      During the examination, the patient exhibits a positive 'empty can' test, indicating supraspinatus tendonitis. A focused ultrasound scan of the shoulder joint confirms inflammation at the point of insertion of the supraspinatus tendon.

      What is the precise location of the inflammation?

      Your Answer: Superior facet of the greater tubercle of the humerus

      Explanation:

      The insertion site of the supraspinatus tendon is the superior facet of the greater tubercle of the humerus, while the teres major and coracobrachialis muscles insert into the medial border. The subscapularis muscle inserts into the lesser tubercle, and the infraspinatus muscle inserts into the middle facet of the greater tubercle. The teres minor muscle’s insertion site is not specified.

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 16 - A 32-year-old male visits the GP after a soccer injury. During the game,...

    Correct

    • A 32-year-old male visits the GP after a soccer injury. During the game, he received a blow to the lateral side of his left leg, causing valgus strain on the knee. The GP suspects an unhappy triad injury. What are the three injuries typically associated with this triad?

      Your Answer: Damage to the medial collateral ligament, medial meniscus and anterior cruciate ligament

      Explanation:

      The unhappy triad refers to a set of knee injuries that happen when the knee experiences a lateral impact causing Valgus stress. This stress leads to tears in the medial collateral ligament and the medial meniscus, which are closely connected. Additionally, the anterior cruciate ligament is also affected and traumatized. However, the lateral collateral ligament, lateral meniscus, and posterior cruciate ligament are not involved in this triad.

      Knee Injuries and Common Causes

      Knee injuries can be caused by a variety of factors, including twisting injuries, dashboard injuries, skiing accidents, and lateral blows to the knee. One common knee injury is the unhappy triad, which involves damage to the anterior cruciate ligament, medial collateral ligament, and meniscus. While the medial meniscus is classically associated with this injury, recent evidence suggests that the lateral meniscus is actually more commonly affected.

      When the anterior cruciate ligament is damaged, it may be the result of twisting injuries. Tests such as the anterior drawer test and Lachman test may be positive if this ligament is damaged. On the other hand, dashboard injuries may cause damage to the posterior cruciate ligament. Damage to the medial collateral ligament is often caused by skiing accidents or valgus stress, and can result in abnormal passive abduction of the knee. Isolated injury to the lateral collateral ligament is uncommon.

      Finally, damage to the menisci can also occur from twisting injuries. Common symptoms of meniscus damage include locking and giving way. Overall, understanding the common causes and symptoms of knee injuries can help individuals seek appropriate treatment and prevent further damage.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 17 - Sophie, a 35-year-old female, is brought to the Emergency Department by ambulance after...

    Correct

    • Sophie, a 35-year-old female, is brought to the Emergency Department by ambulance after being involved in a car accident.

      Upon conducting several tests, an X-ray reveals that she has sustained a mid shaft humeral fracture.

      What is the structure that is typically most vulnerable to injury in cases of mid shaft humeral fractures?

      Your Answer: Radial nerve

      Explanation:

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      16.1
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  • Question 18 - A 35-year-old man presents with sudden onset of severe lower back pain on...

    Incorrect

    • A 35-year-old man presents with sudden onset of severe lower back pain on the right side after lifting a heavy suitcase and twisting. He experiences some paraesthesia on the postero-lateral aspect of his right lower leg and foot.

      Upon examination, he appears to be in significant discomfort with his lower back and has a positive sciatic nerve street test. Additionally, there is evident weakness in plantar flexion (MRC grading 3/5) and a reduced ankle reflex.

      Based on these findings, it is suspected that the patient has a herniated intervertebral disc with radiculopathy. What is the level of nerve root compression in this case?

      Your Answer: L3

      Correct Answer: S1

      Explanation:

      The patient exhibits sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, a reduced ankle reflex, and a positive sciatic nerve stretch test. These features suggest compression of the S1 nerve root. Symptoms and signs associated with L3, L4, and L5 nerve root compression differ significantly and are not present in this patient.

      Understanding Prolapsed Disc and its Features

      A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

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  • Question 19 - A 79-year-old woman arrived at the hospital complaining of pain in her right...

    Correct

    • A 79-year-old woman arrived at the hospital complaining of pain in her right hip and thigh after falling from her bed. According to her, she fell while attempting to get up and go to the bathroom during the night. During the physical examination, the physician observed that her right leg was externally rotated and shorter than her left leg. What is the most probable pathological alteration present in this woman?

      Your Answer: Decreased cortical and trabecular bone mass with normal bone mineralization

      Explanation:

      The patient’s shortened and externally rotated right leg indicated a fracture of the neck of the femur, which was determined to be a fragility fracture due to osteoporosis. This condition is a common cause of fragility fractures in postmenopausal women, as decreased estrogen levels lead to increased bone resorption and decreased bone mass. Other bone-related conditions, such as osteopetrosis, osteomalacia, Paget disease of the bone, and osteosarcoma, have different underlying causes and presentations.

      Osteoporosis is a condition that is more prevalent in women and increases with age. However, there are many other risk factors and secondary causes of osteoporosis. Some of the most significant risk factors include a history of glucocorticoid use, rheumatoid arthritis, alcohol excess, parental hip fracture history, low body mass index, and current smoking. Other risk factors include a sedentary lifestyle, premature menopause, certain ethnicities, endocrine disorders, gastrointestinal disorders, chronic kidney disease, and certain genetic disorders. Additionally, certain medications such as SSRIs, antiepileptics, and proton pump inhibitors may worsen osteoporosis.

      If a patient is diagnosed with osteoporosis or has a fragility fracture, further investigations may be necessary to identify the cause of osteoporosis and assess the risk of subsequent fractures. Recommended investigations include a history and physical examination, blood tests such as a full blood count, urea and electrolytes, liver function tests, bone profile, CRP, and thyroid function tests. Other procedures may include bone densitometry, lateral radiographs, protein immunoelectrophoresis, and urinary Bence-Jones proteins. Additionally, markers of bone turnover and urinary calcium excretion may be assessed. By identifying the cause of osteoporosis and contributory factors, healthcare providers can select the most appropriate form of treatment.

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  • Question 20 - A 43-year-old man presents to his doctor with complaints of struggling to use...

    Incorrect

    • A 43-year-old man presents to his doctor with complaints of struggling to use the twist throttle on his motorcycle with his right hand. He sustained a mid-shaft fracture of his right humerus in a car accident 10 weeks ago, which was successfully treated with surgery. What is the most frequent nerve injury resulting from this type of fracture?

      Your Answer: Musculocutaneous nerve injury

      Correct Answer: Radial nerve injury

      Explanation:

      The most common nerve injury that occurs with a mid-shaft fracture of the humerus is radial nerve injury. This type of injury can cause a dropped wrist presentation, which is characterized by weakness in wrist extension and difficulty making a fist. The patient in the scenario describes difficulty accelerating on their motorcycle, which requires normal wrist extension and the ability to make a fist.

      Other nerve injuries that can occur include axillary nerve injury, which affects shoulder abduction and external rotation and is usually caused by anterior shoulder dislocation. Median nerve injury can result in weakness of forearm pronation, wrist flexion, and thumb flexion, and is associated with carpal tunnel syndrome. Musculocutaneous nerve injury, on the other hand, does not typically affect wrist movements and is responsible for elbow flexion and certain shoulder movements.

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

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  • Question 21 - A 20-year-old male has recently been diagnosed with an infectious episode that caused...

    Incorrect

    • A 20-year-old male has recently been diagnosed with an infectious episode that caused a sore throat. The illness was found to be caused by a gram-positive cocci in chains. Two weeks later, he developed teardrop erythematous lesions on his trunk and arms. What is the most probable diagnosis?

      Your Answer: Scarlet fever

      Correct Answer: Guttate psoriasis

      Explanation:

      Guttate psoriasis is frequently seen after a streptococcal infection, with group-A streptococcus being the likely culprit. The condition is characterized by the appearance of small, teardrop shaped red lesions. Scarlet fever, which is also caused by group-A streptococcus, presents with a rough rash, fever, swollen lymph nodes, and a red tongue. Pityriasis rosea, on the other hand, typically follows a viral infection and is identified by a single scaly patch followed by a widespread salmon-pink rash. Acne vulgaris and impetigo are not commonly associated with a streptococcal sore throat.

      Guttate psoriasis is a type of psoriasis that is more commonly seen in children and adolescents. It is often triggered by a streptococcal infection that occurred 2-4 weeks prior to the appearance of the lesions. The condition is characterized by the presence of tear drop-shaped papules on the trunk and limbs, along with pink, scaly patches or plaques of psoriasis. The onset of guttate psoriasis tends to be acute, occurring over a few days.

      In most cases, guttate psoriasis resolves on its own within 2-3 months. There is no clear evidence to support the use of antibiotics to treat streptococcal infections associated with the condition. Treatment options for guttate psoriasis include topical agents commonly used for psoriasis and UVB phototherapy. In cases where the condition recurs, a tonsillectomy may be necessary.

      It is important to differentiate guttate psoriasis from pityriasis rosea, which is another skin condition that can present with similar symptoms. Guttate psoriasis is typically preceded by a streptococcal sore throat, while pityriasis rosea may be associated with recent respiratory tract infections. The appearance of guttate psoriasis is characterized by tear drop-shaped, scaly papules on the trunk and limbs, while pityriasis rosea presents with a herald patch followed by multiple erythematous, slightly raised oval lesions with a fine scale. Pityriasis rosea is self-limiting and resolves after around 6 weeks.

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  • Question 22 - Which nerve is in danger during removal of the submandibular gland? ...

    Incorrect

    • Which nerve is in danger during removal of the submandibular gland?

      Your Answer: Buccal nerve

      Correct Answer: Marginal mandibular nerve

      Explanation:

      The depressor anguli oris and depressor labii inferioris muscles are supplied by the marginal mandibular nerve, which is located beneath the platysma muscle. Damage to this nerve can result in facial asymmetry and drooling.

      Anatomy of the Submandibular Gland

      The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

      The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

      The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

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  • Question 23 - In a confrontation, a 35-year-old woman was stabbed in the medial aspect of...

    Incorrect

    • In a confrontation, a 35-year-old woman was stabbed in the medial aspect of her left thigh. Upon examination, there is a noticeable decrease in knee extension. Additionally, there is a reduction in sensation over the anterior thigh.

      Which anatomical structure has been affected by the stabbing?

      Your Answer: Quadriceps tendon

      Correct Answer: Femoral nerve

      Explanation:

      The femoral nerve is responsible for loss of knee extension and sensory loss to the anterior and medial aspect of the thigh following a stab injury. The muscles innervated by the femoral nerve are responsible for hip flexion and knee extension, while the nerve is responsible for sensation over the anterior thigh. Injury to the inferior gluteal nerve would result in loss of hip extension, while injury to the obturator nerve would result in a loss of sensation to the medial thigh and impaired hip adduction. Although the quadriceps tendon is vital to knee extension, it would not explain the sensory deficit and the location of the injury.

      Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

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  • Question 24 - A 48-year-old woman comes to the clinic complaining of chronic back pain. She...

    Incorrect

    • A 48-year-old woman comes to the clinic complaining of chronic back pain. She has no known medical conditions and was recently hospitalized for a wrist fracture sustained while playing frisbee. The hospital discharged her with conservative management. Her blood test results are as follows:

      Calcium 1.9 mmol/L (2.1-2.6)
      Phosphate 0.8 mmol/L (0.8-1.4)
      ALP 172 IU/L (44-147)
      Parathyroid Hormone 65 pg/mL (15-65)

      What is the probable diagnosis?

      Your Answer: Paget's disease

      Correct Answer: Osteomalacia

      Explanation:

      The patient’s lab results suggest that they have osteomalacia, a condition caused by vitamin D deficiency that results in weak and soft bones. This deficiency leads to poor absorption of calcium in the gastrointestinal tract, which causes low serum calcium levels. In response, the body produces more parathyroid hormone (PTH) to compensate, which lowers serum phosphate levels and increases alkaline phosphatase (ALP) due to increased osteoclast activity.

      Osteoporosis also causes weak bones, but it is not a metabolic disease and does not affect electrolyte and hormone levels. Paget’s disease, on the other hand, is characterized by bone pain and abnormal bone growth, but typically has normal calcium, phosphate, and PTH levels. Primary hyperparathyroidism causes high PTH levels, leading to high serum calcium and low serum phosphate levels, and can cause bone pain and fractures. Secondary hyperparathyroidism occurs in chronic kidney disease and is characterized by low serum calcium and high serum phosphate levels, with elevated PTH and ALP levels.

      Lab Values for Bone Disorders

      When it comes to bone disorders, certain lab values can provide important information about the condition. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically normal. However, in osteomalacia, calcium and phosphate levels are decreased while ALP and PTH levels are increased. Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels but decreased phosphate levels. Chronic kidney disease can result in secondary hyperparathyroidism, which is marked by decreased calcium levels and increased phosphate and PTH levels. Paget’s disease, on the other hand, typically shows normal calcium and phosphate levels but increased ALP levels. Finally, osteopetrosis is associated with normal levels of calcium, phosphate, ALP, and PTH. By analyzing these lab values, healthcare professionals can better diagnose and treat bone disorders.

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  • Question 25 - A 50-year-old woman comes to the emergency department complaining of crushing chest pain....

    Incorrect

    • A 50-year-old woman comes to the emergency department complaining of crushing chest pain. Her ECG shows no abnormalities. She has a medical history of rheumatoid arthritis managed with methotrexate, hypertension, and type II diabetes. Her BMI is 34 kg/m². As a healthcare provider, you initiate aspirin therapy.

      What is the most significant risk this patient is facing?

      Your Answer: Polymyositis

      Correct Answer: Bone marrow toxicity

      Explanation:

      Taking aspirin while on methotrexate treatment can be dangerous as it reduces the excretion of methotrexate, leading to an increased risk of toxicity and bone marrow problems. However, some studies suggest that methotrexate may be helpful in treating severe osteoarthritis and polymyositis. All other options are incorrect.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

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  • Question 26 - A mother brings her 3-year-old son to the GP worried about his motor...

    Incorrect

    • A mother brings her 3-year-old son to the GP worried about his motor development. Since he started walking 9 months ago, the child has been limping and avoiding weight bearing on the left leg. He has otherwise been healthy. He was born at term via a caesarean section, due to his breech position, and weighed 4.5kg. What is the probable reason for his limp?

      Your Answer: Perthes' disease

      Correct Answer: Developmental dysplasia of the hip

      Explanation:

      The condition is developmental dysplasia of the hip, which is typically observed in individuals under the age of 4.

      Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

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  • Question 27 - A 29-year-old male attends a dermatology clinic after being referred by his GP...

    Incorrect

    • A 29-year-old male attends a dermatology clinic after being referred by his GP for severe eczema. Despite treatment with both emollients and topical corticosteroids, the patient's eczema remains very severe and is causing him much psychological distress. As a result, the doctor decides to prescribe azathioprine.

      What are the necessary checks that must be done before starting the treatment?

      Your Answer: ECG

      Correct Answer: Thiopurine methyltransferase activity

      Explanation:

      Before starting treatment with azathioprine, it is important to check for thiopurine methyltransferase deficiency (TPMT) to avoid the risk of myelosuppression in patients with reduced enzyme activity. Azathioprine is commonly used as an immunosuppressant for conditions like IBD and severe refractory eczema. However, an ECG and lipid profile are not necessary before starting treatment with azathioprine. On the other hand, thyroid function tests are required before initiating treatment with amiodarone, while renal function and electrolytes should be checked before starting treatment with drugs like ACE inhibitors.

      Azathioprine is a medication that is converted into mercaptopurine, which is an active compound that inhibits the production of purine. To determine if someone is at risk for azathioprine toxicity, a test for thiopurine methyltransferase (TPMT) may be necessary. Adverse effects of this medication include bone marrow depression, nausea and vomiting, pancreatitis, and an increased risk of non-melanoma skin cancer. If infection or bleeding occurs, a full blood count should be considered. It is important to note that there may be a significant interaction between azathioprine and allopurinol, so lower doses of azathioprine should be used. However, azathioprine is generally considered safe to use during pregnancy.

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  • Question 28 - During a thyroidectomy, at what age do surgeons typically ligate the inferior thyroid...

    Correct

    • During a thyroidectomy, at what age do surgeons typically ligate the inferior thyroid artery?

      Your Answer: Thyrocervical trunk

      Explanation:

      The thyrocervical trunk gives rise to the inferior thyroid artery, which is a derivative of the subclavian artery.

      Anatomy of the Thyroid Gland

      The thyroid gland is a butterfly-shaped gland located in the neck, consisting of two lobes connected by an isthmus. It is surrounded by a sheath from the pretracheal layer of deep fascia and is situated between the base of the tongue and the fourth and fifth tracheal rings. The apex of the thyroid gland is located at the lamina of the thyroid cartilage, while the base is situated at the fourth and fifth tracheal rings. In some individuals, a pyramidal lobe may extend from the isthmus and attach to the foramen caecum at the base of the tongue.

      The thyroid gland is surrounded by various structures, including the sternothyroid, superior belly of omohyoid, sternohyoid, and anterior aspect of sternocleidomastoid muscles. It is also related to the carotid sheath, larynx, trachea, pharynx, oesophagus, cricothyroid muscle, and parathyroid glands. The superior and inferior thyroid arteries supply the thyroid gland with blood, while the superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic veins.

      In summary, the thyroid gland is a vital gland located in the neck, responsible for producing hormones that regulate metabolism. Its anatomy is complex, and it is surrounded by various structures that are essential for its function. Understanding the anatomy of the thyroid gland is crucial for the diagnosis and treatment of thyroid disorders.

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  • Question 29 - During a lower limb examination, a 54-year-old female patient is observed by the...

    Incorrect

    • During a lower limb examination, a 54-year-old female patient is observed by the GP to have a right-sided pelvic drop while walking, which is identified as a positive Trendelenburg sign. Which specific muscle or group of muscles is weakened in this patient?

      Your Answer: Right gluteus maximus

      Correct Answer: Left gluteus medius and gluteus minimus

      Explanation:

      The Trendelenburg sign test evaluates the strength of the abductor muscles of the hip, specifically the gluteus medius and minimus. During the gait cycle, the contralateral abductor muscles are necessary to prevent the pelvis from dropping to the side of the stance leg when the patient stands on one leg. A positive Trendelenburg sign on the right side indicates weakness in the left gluteus medius and minimus, which are responsible for lifting the pelvis.

      The Trendelenburg sign test assesses the contralateral muscles that contract to maintain a straight pelvis. Therefore, if the pelvis tilts to the right, the left gluteus medius and gluteus minimus are likely weak.

      It’s important to note that the gluteus maximus is not involved in hip abduction and is not tested with this test. Additionally, the adductor muscles, including the adductor magnus, help stabilize the leg and prevent outward movement, and are not evaluated with the Trendelenburg sign test.

      The Trendelenburg Test: Assessing Gluteal Nerve Function

      The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.

      When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.

      To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.

      It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.

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  • Question 30 - A 50-year-old woman visits her doctor complaining of lower back pain. She has...

    Incorrect

    • A 50-year-old woman visits her doctor complaining of lower back pain. She has no notable medical history and is in good physical condition. Her mother was recently diagnosed with hip osteoarthritis. The patient is concerned that her lower back pain may be due to the same condition. She studied physiotherapy in college but never pursued it professionally due to family obligations.

      During the examination, the doctor notes tenderness in her lower back, indicating muscular pain.

      The doctor explains that given her age and lack of significant risk factors, it is unlikely that her pain is caused by hip osteoarthritis. The doctor also mentions that there are certain signs that typically appear first in hip osteoarthritis.

      The patient requests more information about these signs.

      What is the initial sign that is often observed in hip osteoarthritis?

      Your Answer:

      Correct Answer: Reduction in internal rotation

      Explanation:

      The initial indication of osteoarthritis is often a decrease in internal rotation. Bouchard’s nodes and Heberden’s nodes, which are hard knobs at the middle and farthest finger joints, respectively, are common in moderate to severe cases of osteoarthritis but are not typically the first sign. Morning pain that worsens with exercise is more characteristic of inflammatory conditions like rheumatoid arthritis and ankylosing spondylitis. In contrast, exercise can exacerbate pain in osteoarthritis.

      Understanding Osteoarthritis of the Hip

      Osteoarthritis (OA) of the hip is a common condition that affects many people, especially those who are older or overweight. It is characterized by chronic groin pain that is worsened by exercise and relieved by rest. Women are twice as likely to develop OA of the hip, and those with developmental dysplasia of the hip are also at increased risk.

      To diagnose OA of the hip, doctors typically rely on a patient’s symptoms and a physical exam. X-rays may be ordered if the diagnosis is uncertain. Treatment options include oral pain medication and injections, but total hip replacement is often necessary to provide long-term relief.

      While total hip replacement is generally safe and effective, there are some potential complications to be aware of. These include blood clots, fractures, nerve damage, infections, and dislocation of the prosthetic joint. Aseptic loosening is the most common reason for revision surgery, and prosthetic joint infections can also occur.

      Overall, understanding the risk factors, symptoms, and treatment options for OA of the hip can help patients make informed decisions about their care and improve their quality of life.

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