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  • Question 1 - A 9-month-old girl is brought to the hospital due to recurrent episodes of...

    Correct

    • A 9-month-old girl is brought to the hospital due to recurrent episodes of breathing difficulties. She has been experiencing a gradual worsening of symptoms, including a wet cough and expiratory wheezing, for the past 4 days.

      During the examination, her temperature is recorded at 38.2°C, and her respiratory rate is 60 breaths per minute. Oxygen saturation levels are at 92% on air. Chest examination reveals mild intercostal retractions, scattered crackles, and expiratory wheezing in both lungs.

      What is the most probable causative agent responsible for the symptoms?

      Your Answer: Respiratory syncytial virus

      Explanation:

      Bronchiolitis is commonly caused by respiratory syncytial virus, which accounts for the majority of cases of serious lower respiratory tract infections in children under one.

      Understanding Bronchiolitis

      Bronchiolitis is a condition that is characterized by inflammation of the bronchioles. It is a serious lower respiratory tract infection that is most common in children under the age of one year. The pathogen responsible for 75-80% of cases is respiratory syncytial virus (RSV), while other causes include mycoplasma and adenoviruses. Bronchiolitis is more serious in children with bronchopulmonary dysplasia, congenital heart disease, or cystic fibrosis.

      The symptoms of bronchiolitis include coryzal symptoms, dry cough, increasing breathlessness, and wheezing. Fine inspiratory crackles may also be present. Children with bronchiolitis may experience feeding difficulties associated with increasing dyspnoea, which is often the reason for hospital admission.

      Immediate referral to hospital is recommended if the child has apnoea, looks seriously unwell to a healthcare professional, has severe respiratory distress, central cyanosis, or persistent oxygen saturation of less than 92% when breathing air. Clinicians should consider referring to hospital if the child has a respiratory rate of over 60 breaths/minute, difficulty with breastfeeding or inadequate oral fluid intake, or clinical dehydration.

      The investigation for bronchiolitis involves immunofluorescence of nasopharyngeal secretions, which may show RSV. Management of bronchiolitis is largely supportive, with humidified oxygen given via a head box if oxygen saturations are persistently < 92%. Nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth, and suction is sometimes used for excessive upper airway secretions.

    • This question is part of the following fields:

      • Respiratory System
      69.8
      Seconds
  • Question 2 - As a medical student attending an endocrine clinic, you encounter a 56-year-old man...

    Incorrect

    • As a medical student attending an endocrine clinic, you encounter a 56-year-old man who has been referred to the clinic by his family physician due to complaints of pins and needles. The patient has a medical history of thyroidectomy. During the examination, you observe a positive Chovstek's sign. Upon reviewing his blood results, you note that he has hypocalcaemia. The endocrinologist supervising your work asks you to identify the two primary regulators of calcium in the body. What is your response?

      Your Answer: Calcitonin and PTH

      Correct Answer: PTH and calcitriol

      Explanation:

      PTH and calcitriol are the primary hormones that regulate calcium metabolism, while calcitonin plays a secondary role. ACTH, on the other hand, does not directly impact calcium metabolism as it primarily stimulates the release of cortisol from the adrenal glands.

      Hormones Controlling Calcium Metabolism

      Calcium metabolism is primarily controlled by two hormones, parathyroid hormone (PTH) and 1,25-dihydroxycholecalciferol (calcitriol). Other hormones such as calcitonin, thyroxine, and growth hormone also play a role. PTH increases plasma calcium levels and decreases plasma phosphate levels. It also increases renal tubular reabsorption of calcium, osteoclastic activity, and renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol. On the other hand, 1,25-dihydroxycholecalciferol increases plasma calcium and plasma phosphate levels, renal tubular reabsorption and gut absorption of calcium, osteoclastic activity, and renal phosphate reabsorption. It is important to note that osteoclastic activity is increased indirectly by PTH as osteoclasts do not have PTH receptors. Understanding the actions of these hormones is crucial in maintaining proper calcium metabolism in the body.

    • This question is part of the following fields:

      • General Principles
      38.2
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  • Question 3 - A 16-year-old girl comes to the doctor with a cellulitic infection in her...

    Correct

    • A 16-year-old girl comes to the doctor with a cellulitic infection in her leg. The infection was caused by a pathogen that triggered an immune response from T cells. Where did the T cells develop?

      Your Answer: Thymus

      Explanation:

      The bone marrow sends T cells to the thymus, where they mature in organized zones within multi-lobar structures. During thymic education, they acquire a functional TCR and express either CD4 or CD8 molecules.

      Cell Surface Proteins and Their Functions

      Cell surface proteins play a crucial role in identifying and distinguishing different types of cells. The table above lists the most common cell surface markers associated with particular cell types, such as CD34 for haematopoietic stem cells and CD19 for B cells. Meanwhile, the table below describes the major clusters of differentiation (CD) molecules and their functions. For instance, CD3 is the signalling component of the T cell receptor (TCR) complex, while CD4 is a co-receptor for MHC class II and is used by HIV to enter T cells. CD56, on the other hand, is a unique marker for natural killer cells, while CD95 acts as the FAS receptor and is involved in apoptosis.

      Understanding the functions of these cell surface proteins is crucial in various fields, such as immunology and cancer research. By identifying and targeting specific cell surface markers, researchers can develop more effective treatments for diseases and disorders.

    • This question is part of the following fields:

      • General Principles
      31.3
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  • Question 4 - While taking a patient's medical history, you discover that there is a significant...

    Incorrect

    • While taking a patient's medical history, you discover that there is a significant family history of a particular disease. Diseases that are inherited in an autosomal dominant manner typically manifest in early adulthood due to structural gene abnormalities, with both males and females being affected equally. Which of the following diseases does not follow an autosomal dominant inheritance pattern?

      Your Answer: von Hippel-Lindau disease

      Correct Answer: Haemochromatosis

      Explanation:

      Abnormal Binding Proteins Resulting in Iron Deposition and Multiple Organ Dysfunction

      Iron deposition due to an abnormality in binding proteins can lead to various health complications. This condition is characterized by the deposition of iron in different organs, including the heart, liver, pancreas, and skin. The abnormality in binding proteins results in the accumulation of iron in these organs, leading to cardiomyopathy, cirrhosis, pancreatic failure, and skin pigmentation.

      This condition is inherited in an autosomal recessive pattern, meaning that an individual must inherit two copies of the mutated gene, one from each parent, to develop the condition. The recessive form of this condition is also known as infantile polycystic kidney disease, which predominantly affects children.

      Overall, iron deposition due to an abnormality in binding proteins can cause multiple organ dysfunction and can be inherited in an autosomal recessive pattern. Early diagnosis and management of this condition are crucial to prevent further complications and improve the quality of life of affected individuals.

    • This question is part of the following fields:

      • Clinical Sciences
      51
      Seconds
  • Question 5 - A 75-year-old woman presents with a five-day history of difficulty initiating abduction of...

    Correct

    • A 75-year-old woman presents with a five-day history of difficulty initiating abduction of her right arm. She denies any pain or previous shoulder issues and has not experienced any trauma. During examination, her passive range of motion is normal, but she is unable to begin abduction from a neutral position. However, if she uses her left arm to lift her right arm to approximately 15 degrees, she is then able to continue abduction without difficulty. Which muscle is responsible for initiating shoulder abduction?

      Your Answer: Supraspinatus

      Explanation:

      The Supraspinatus muscle is responsible for starting the process of lifting the arm away from the body, up to a point of about 15 degrees. After this point, the Deltoid muscle takes over as the primary muscle responsible for continuing the arm’s upward movement. When the arm is lifted beyond 90 degrees, the Trapezius muscle comes into play, elevating the shoulder and rotating the scapula. Finally, the Infraspinatus muscle is responsible for producing lateral rotation of the arm at the shoulder.

      Understanding the Rotator Cuff Muscles

      The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

      The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

      Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.8
      Seconds
  • Question 6 - A 35-year-old man is brought to the emergency department by ambulance after being...

    Incorrect

    • A 35-year-old man is brought to the emergency department by ambulance after being found unresponsive at his home. He is vomiting, confused, and drowsy with pinpoint pupils. The patient is only responsive to pain, has a respiratory rate of 6/min with shallow breaths, a blood pressure of 65/90mmHg, and a heart rate of 50bpm. It is suspected that he has overdosed. What receptor does the drug class likely agonize?

      Your Answer: Beta adrenoreceptors

      Correct Answer: Mu, delta and kappa receptors

      Explanation:

      Understanding Opioids: Types, Receptors, and Clinical Uses

      Opioids are a class of chemical compounds that act upon opioid receptors located within the central nervous system (CNS). These receptors are G-protein coupled receptors that have numerous actions throughout the body. There are three clinically relevant groups of opioid receptors: mu (µ), kappa (κ), and delta (δ) receptors. Endogenous opioids, such as endorphins, dynorphins, and enkephalins, are produced by specific cells within the CNS and their actions depend on whether µ-receptors or δ-receptors and κ-receptors are their main target.

      Drugs targeted at opioid receptors are the largest group of analgesic drugs and form the second and third steps of the WHO pain ladder of managing analgesia. The choice of which opioid drug to use depends on the patient’s needs and the clinical scenario. The first step of the pain ladder involves non-opioids such as paracetamol and non-steroidal anti-inflammatory drugs. The second step involves weak opioids such as codeine and tramadol, while the third step involves strong opioids such as morphine, oxycodone, methadone, and fentanyl.

      The strength, routes of administration, common uses, and significant side effects of these opioid drugs vary. Weak opioids have moderate analgesic effects without exposing the patient to as many serious adverse effects associated with strong opioids. Strong opioids have powerful analgesic effects but are also more liable to cause opioid-related side effects such as sedation, respiratory depression, constipation, urinary retention, and addiction. The sedative effects of opioids are also useful in anesthesia with potent drugs used as part of induction of a general anesthetic.

    • This question is part of the following fields:

      • Neurological System
      47.5
      Seconds
  • Question 7 - A 30-year-old bartender complains of discomfort on the outer part of his elbow....

    Incorrect

    • A 30-year-old bartender complains of discomfort on the outer part of his elbow. He mentions that he has had this issue in the past and was diagnosed with lateral epicondylitis, commonly known as tennis elbow.
      Assuming that this current episode is due to tennis elbow, which specific movement would you anticipate to be the most painful?

      Your Answer: Elbow flexion

      Correct Answer: Wrist extension

      Explanation:

      Tennis Elbow and Wrist Extension

      Wrist extension is the motion that is commonly linked to discomfort in tennis elbow. This is due to the fact that the lateral epicondyle of the humerus is connected to the tendinous common origin of several extensor muscles. When performing activities such as pouring water from a jug, patients frequently report experiencing pain in the outer part of their elbow.

      In summary, tennis elbow is caused by the overuse of the extensor muscles that attach to the lateral epicondyle of the humerus. This results in pain and discomfort in the outer part of the elbow, particularly during activities that involve wrist extension.

    • This question is part of the following fields:

      • Clinical Sciences
      45.6
      Seconds
  • Question 8 - You are requested to evaluate a 25-year-old woman who was brought in by...

    Correct

    • You are requested to evaluate a 25-year-old woman who was brought in by the emergency medical services after reporting a bee sting. She has no known allergies but experienced sudden breathlessness and observed swelling of her lips.

      Currently, the patient is feeling improved and can converse with you without difficulty. She believes that the medication administered to her during transportation is responsible for her progress.

      What is the probable reason for the prompt amelioration of this patient's condition?

      Your Answer: Intramuscular 0.5ml 1:1000 adrenaline

      Explanation:

      The most crucial drug to administer in cases of anaphylaxis is adrenaline. Hydrocortisone and chlorphenamine are no longer prescribed. It is probable that the patient experienced an anaphylactic reaction due to the bee sting, which is a common trigger for susceptible individuals.

      The correct dosage in this scenario is 0.5ml of 1:1000 adrenaline via the intramuscular route. Adrenaline is essential in reducing mast cell degranulation and facilitating bronchodilation and blood pressure maintenance by acting on alpha and beta receptors.

      Administering 1ml of 1:10,000 adrenaline subcutaneously is incorrect as this dosage is intended for cardiac arrest and the delivery method is not appropriate.

      1ml of 1:1000 adrenaline via the intravenous route is also incorrect as the dosage is excessive, and intramuscular injection is the preferred method.

      Chlorphenamine and hydrocortisone are no longer recommended for emergency anaphylaxis management due to insufficient evidence supporting their efficacy.

      Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically develop suddenly and progress rapidly, affecting the airway, breathing, and circulation. Swelling of the throat and tongue, hoarse voice, and stridor are common airway problems, while respiratory wheeze and dyspnea are common breathing problems. Hypotension and tachycardia are common circulation problems. Skin and mucosal changes, such as generalized pruritus and widespread erythematous or urticarial rash, are also present in around 80-90% of patients.

      The most important drug in the management of anaphylaxis is intramuscular adrenaline, which should be administered as soon as possible. The recommended doses of adrenaline vary depending on the patient’s age, with the highest dose being 500 micrograms for adults and children over 12 years old. Adrenaline can be repeated every 5 minutes if necessary. If the patient’s respiratory and/or cardiovascular problems persist despite two doses of IM adrenaline, IV fluids should be given for shock, and expert help should be sought for consideration of an IV adrenaline infusion.

      Following stabilisation, non-sedating oral antihistamines may be given to patients with persisting skin symptoms. Patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic, and an adrenaline injector should be given as an interim measure before the specialist allergy assessment. Patients should be prescribed two adrenaline auto-injectors, and training should be provided on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and have been given an adrenaline auto-injector and trained how to use it. Patients who require two doses of IM adrenaline or have had a previous biphasic reaction should be observed for a minimum of 6 hours after symptom resolution, while those who have had a severe reaction requiring more than two doses of IM adrenaline or have severe asthma should be observed for a minimum of 12 hours after symptom resolution. Patients who present late at night or in areas where access to emergency care may be difficult should also be observed for a minimum of 12

    • This question is part of the following fields:

      • General Principles
      33.9
      Seconds
  • Question 9 - A nephrologist is evaluating a 12-year-old boy who presented with general malaise and...

    Incorrect

    • A nephrologist is evaluating a 12-year-old boy who presented with general malaise and was found to have proteinuria and haematuria on urine dipstick by his primary care physician. Following a comprehensive assessment, the nephrologist orders a renal biopsy. The biopsy report reveals that the immunofluorescence of the sample showed a granular appearance. What is the probable diagnosis?

      Your Answer: Minimal change disease

      Correct Answer: Post-streptococcal glomerulonephritis

      Explanation:

      Post-streptococcal glomerulonephritis is a condition that typically occurs 7-14 days after an infection caused by group A beta-haemolytic Streptococcus, usually Streptococcus pyogenes. It is more common in young children and is caused by the deposition of immune complexes (IgG, IgM, and C3) in the glomeruli. Symptoms include headache, malaise, visible haematuria, proteinuria, oedema, hypertension, and oliguria. Blood tests may show a raised anti-streptolysin O titre and low C3, which confirms a recent streptococcal infection.

      It is important to note that IgA nephropathy and post-streptococcal glomerulonephritis are often confused as they both can cause renal disease following an upper respiratory tract infection. Renal biopsy features of post-streptococcal glomerulonephritis include acute, diffuse proliferative glomerulonephritis with endothelial proliferation and neutrophils. Electron microscopy may show subepithelial ‘humps’ caused by lumpy immune complex deposits, while immunofluorescence may show a granular or ‘starry sky’ appearance.

      Despite its severity, post-streptococcal glomerulonephritis carries a good prognosis.

    • This question is part of the following fields:

      • Renal System
      180.3
      Seconds
  • Question 10 - As a medical student on wards in the endocrinology department, you come across...

    Incorrect

    • As a medical student on wards in the endocrinology department, you come across a patient suffering from syndrome of inappropriate antidiuretic hormone secretion. During the ward round, the consultant leading the team decides to test your knowledge and asks about the normal release of antidiuretic hormone (ADH) in the brain.

      Can you explain the pathway that leads to the release of this hormone causing the patient's condition?

      Your Answer: ADH is released from the anterior pituitary gland via neural cells which extend from the hypothalamus

      Correct Answer: ADH is released from the posterior pituitary gland via neural cells which extend from the hypothalamus

      Explanation:

      The posterior pituitary gland is formed by neural cells’ axons that extend directly from the hypothalamus.

      In contrast to the anterior pituitary gland, which has separate hormone-secreting cells controlled by hormonal stimulation, the posterior pituitary gland only contains neural cells that extend from the hypothalamus. Therefore, the hormones (ADH and oxytocin) released from the posterior pituitary gland are released from the axons of cells extending from the hypothalamus.

      All anterior pituitary hormone release is controlled through hormonal stimulation from the hypothalamus.

      The adrenal medulla directly releases epinephrine, norepinephrine, and small amounts of dopamine from sympathetic neural cells.

      The pituitary gland is a small gland located within the sella turcica in the sphenoid bone of the middle cranial fossa. It weighs approximately 0.5g and is covered by a dural fold. The gland is attached to the hypothalamus by the infundibulum and receives hormonal stimuli from the hypothalamus through the hypothalamo-pituitary portal system. The anterior pituitary, which develops from a depression in the wall of the pharynx known as Rathkes pouch, secretes hormones such as ACTH, TSH, FSH, LH, GH, and prolactin. GH and prolactin are secreted by acidophilic cells, while ACTH, TSH, FSH, and LH are secreted by basophilic cells. On the other hand, the posterior pituitary, which is derived from neuroectoderm, secretes ADH and oxytocin. Both hormones are produced in the hypothalamus before being transported by the hypothalamo-hypophyseal portal system.

    • This question is part of the following fields:

      • Neurological System
      53.2
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SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory System (1/1) 100%
General Principles (2/3) 67%
Clinical Sciences (0/2) 0%
Musculoskeletal System And Skin (1/1) 100%
Neurological System (0/2) 0%
Renal System (0/1) 0%
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