00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A teenage girl and her mother come to the doctor's office with concerns...

    Incorrect

    • A teenage girl and her mother come to the doctor's office with concerns about ambiguous genitalia. Upon conducting a thorough medical history and various tests, the doctor diagnoses the girl with congenital adrenal hyperplasia. What is the reason for adrenal hyperplasia being a characteristic of this condition?

      Your Answer: Increased testosterone synthesis

      Correct Answer: Inefficient cortisol synthesis

      Explanation:

      Low cortisol production and compensatory adrenal hyperplasia are caused by 21-hydroxylase deficiency, leading to increased androgen production and ambiguous genitalia. The enzymes 11-beta hydroxylase and 17-hydroxylase are also involved. Testosterone and estrogen synthesis is not affected as they are produced in the testes and ovaries, respectively. Congenital adrenal hyperplasia is not caused by aldosterone synthesis, despite it occurring in the adrenal cortex.

      Congenital adrenal hyperplasia is a genetic condition that affects the adrenal glands and can result in various symptoms depending on the specific enzyme deficiency. One common form is 21-hydroxylase deficiency, which can cause virilization of female genitalia, precocious puberty in males, and a salt-losing crisis in 60-70% of patients during the first few weeks of life. Another form is 11-beta hydroxylase deficiency, which can also cause virilization and precocious puberty, as well as hypertension and hypokalemia. A third form is 17-hydroxylase deficiency, which typically does not cause virilization in females but can result in intersex characteristics in boys and hypertension.

      Overall, congenital adrenal hyperplasia can have significant impacts on a person’s physical development and health, and early diagnosis and treatment are important for managing symptoms and preventing complications.

    • This question is part of the following fields:

      • Endocrine System
      59
      Seconds
  • Question 2 - A 85-year-old man is brought to the emergency department after collapsing at home....

    Correct

    • A 85-year-old man is brought to the emergency department after collapsing at home. He has a history of hypertension and poorly controlled type 2 diabetes. During examination, he complains of right-sided facial pain and left-sided arm pain, and mentions that the room appears to be spinning. The patient also has reduced temperature sensation on the right side of his face and the left side of his body, an ataxic gait, and vomits during the examination. Which artery is the most likely to be affected?

      Your Answer: Posterior inferior cerebellar artery

      Explanation:

      The correct diagnosis for a patient presenting with sudden onset vertigo and vomiting, dysphagia, ipsilateral facial pain and temperature loss, contralateral limb pain and temperature loss, and ataxia is posterior inferior cerebellar artery. This constellation of symptoms is consistent with lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by ischemia of the lateral medulla. This condition is associated with involvement of the trigeminal nucleus, lateral spinothalamic tract, cerebellum, and nucleus ambiguus, resulting in the aforementioned symptoms.

      The anterior spinal artery, basilar artery, middle cerebral artery, and posterior cerebral artery are not associated with lateral medullary syndrome and would present with different symptoms.

      Stroke can affect different parts of the brain depending on which artery is affected. If the anterior cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the lower extremities being more affected than the upper. If the middle cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the upper extremities being more affected than the lower. They may also experience vision loss and difficulty with language. If the posterior cerebral artery is affected, the person may experience vision loss and difficulty recognizing objects.

      Lacunar strokes are a type of stroke that are strongly associated with hypertension. They typically present with isolated weakness or loss of sensation on one side of the body, or weakness with difficulty coordinating movements. They often occur in the basal ganglia, thalamus, or internal capsule.

    • This question is part of the following fields:

      • Neurological System
      45.3
      Seconds
  • Question 3 - A 24-year-old man has been admitted to the emergency department after falling off...

    Incorrect

    • A 24-year-old man has been admitted to the emergency department after falling off a roof and has been diagnosed with a Colles' fracture by the radiologist. The medical team plans to perform a closed reduction of the fracture, and they intend to use a haematoma block with lidocaine to facilitate a quick and painless reduction. What is a potential side effect that may occur after a haematoma block with lidocaine?

      Your Answer: Ventricular arrhythmia

      Correct Answer: Mental status change

      Explanation:

      Lidocaine has been known to affect mental status by crossing the blood-brain barrier quickly and blocking inhibitory neurons in the brain. This can lead to a decrease in seizure threshold and a decline in mental function. While hypertension is a recognized side effect of lidocaine, it does not cause hypotension. While constipation can be a side effect of lidocaine, it is not known to cause diarrhea. While there is no evidence to suggest that lidocaine causes sexual dysfunction, it is used in the treatment of premature ejaculation. Lidocaine is a class 1b anti-arrhythmic drug used to treat ventricular arrhythmias and does not cause them.

      Overview of Local Anaesthetic Agents

      Local anaesthetic agents are drugs that block nerve impulses and provide pain relief in a specific area of the body. Lidocaine is a commonly used amide local anaesthetic that is also used as an antiarrhythmic drug. It is metabolized in the liver, protein-bound, and excreted in the urine. Toxicity can occur with excessive administration or in patients with liver dysfunction or low protein states. Acidosis can also cause lidocaine to detach from protein binding. Treatment for local anaesthetic toxicity involves the use of IV 20% lipid emulsion. Drug interactions with lidocaine include beta blockers, ciprofloxacin, and phenytoin. Cocaine is another local anaesthetic agent that is rarely used in mainstream surgical practice. Bupivacaine has a longer duration of action than lidocaine and is useful for topical wound infiltration. However, it is cardiotoxic and contraindicated in regional blockage. Levobupivacaine is a less cardiotoxic alternative. Prilocaine is less cardiotoxic than other local anaesthetic agents and is preferred for intravenous regional anaesthesia. Adrenaline can be added to local anaesthetic drugs to prolong their duration of action and permit higher doses, but it is contraindicated in patients taking MAOI’s or tricyclic antidepressants. The maximum total doses of local anaesthetic agents depend on the type of drug and are based on ideal body weight.

    • This question is part of the following fields:

      • General Principles
      73.2
      Seconds
  • Question 4 - Which one of the following nerves conveys sensory information from the nasal mucosa?...

    Incorrect

    • Which one of the following nerves conveys sensory information from the nasal mucosa?

      Your Answer: Laryngeal branches of the trigeminal

      Correct Answer: Laryngeal branches of the vagus

      Explanation:

      The larynx receives sensory information from the laryngeal branches of the vagus.

      Anatomy of the Larynx

      The larynx is located in the front of the neck, between the third and sixth cervical vertebrae. It is made up of several cartilaginous segments, including the paired arytenoid, corniculate, and cuneiform cartilages, as well as the single thyroid, cricoid, and epiglottic cartilages. The cricoid cartilage forms a complete ring. The laryngeal cavity extends from the laryngeal inlet to the inferior border of the cricoid cartilage and is divided into three parts: the laryngeal vestibule, the laryngeal ventricle, and the infraglottic cavity.

      The vocal folds, also known as the true vocal cords, control sound production. They consist of the vocal ligament and the vocalis muscle, which is the most medial part of the thyroarytenoid muscle. The glottis is composed of the vocal folds, processes, and rima glottidis, which is the narrowest potential site within the larynx.

      The larynx is also home to several muscles, including the posterior cricoarytenoid, lateral cricoarytenoid, thyroarytenoid, transverse and oblique arytenoids, vocalis, and cricothyroid muscles. These muscles are responsible for various actions, such as abducting or adducting the vocal folds and relaxing or tensing the vocal ligament.

      The larynx receives its arterial supply from the laryngeal arteries, which are branches of the superior and inferior thyroid arteries. Venous drainage is via the superior and inferior laryngeal veins. Lymphatic drainage varies depending on the location within the larynx, with the vocal cords having no lymphatic drainage and the supraglottic and subglottic parts draining into different lymph nodes.

      Overall, understanding the anatomy of the larynx is important for proper diagnosis and treatment of various conditions affecting this structure.

    • This question is part of the following fields:

      • Respiratory System
      24.4
      Seconds
  • Question 5 - A 25-year-old male has recently begun working in the textile industry and reports...

    Correct

    • A 25-year-old male has recently begun working in the textile industry and reports handling various materials and chemicals on a daily basis. He has come to you complaining of a burning and itchy rash that appeared on his hands two days ago. Upon examination, his hands appear red and inflamed, and are warm and tender to the touch.

      Which type of immune cell is primarily responsible for this patient's condition?

      Your Answer: T lymphocytes

      Explanation:

      The patient has contact dermatitis, a delayed hypersensitivity reaction caused by contact with allergens in the workplace. Contact allergens penetrate the skin and are engulfed by Langerhans cells, leading to activation of the innate immune system and T lymphocyte proliferation. This type of hypersensitivity is not antibody mediated and involves different cells than other types of hypersensitivity reactions.

    • This question is part of the following fields:

      • Clinical Sciences
      16.7
      Seconds
  • Question 6 - A 67-year-old woman complains of feeling tired and dizzy. During the examination, she...

    Correct

    • A 67-year-old woman complains of feeling tired and dizzy. During the examination, she appears pale and has an enlarged spleen and liver. She has been consuming a bottle of wine daily for the past 25 years.

      Her blood work reveals:

      Hemoglobin (Hb) level of 72 g/L (normal range for females: 115 - 160)
      Mean Cell Volume (MCV) of 73 fL (normal range: 80 - 100)
      Ferritin level of 410 ng/mL (normal range: 10 - 300)
      Blood film shows basophilic stippling of red blood cells

      What is the most probable diagnosis?

      Your Answer: Sideroblastic anaemia

      Explanation:

      The correct answer is sideroblastic anaemia, which is characterized by hypochromic microcytic anaemia, high levels of ferritin iron and transferrin saturation, and the presence of basophilic stippling in red blood cells. This condition occurs when haem formation is incomplete, leading to the accumulation of iron in the mitochondria and the formation of a ring sideroblast around the nucleus. Alcohol consumption is a common cause, and treatment is supportive.

      B12 deficiency is a type of megaloblastic anaemia, which results in a high mean corpuscular volume (MCV). It is typically caused by conditions that lead to vitamin B12 malabsorption, such as autoimmune gastritis.

      Iron deficiency is a type of microcytic anaemia, which is characterized by a low MCV. However, in iron deficiency, the ferritin level is typically low, and pencil-shaped cells may be present in the blood film.

      Sickle cell anaemia is a normochromic-normocytic haemolytic disorder, so the MCV should be normal. Patients often have a positive family history, and the blood film may show sickle cells and features of hyposplenism, such as target cells and Howell-Jolly bodies.

      Understanding Sideroblastic Anaemia

      Sideroblastic anaemia is a medical condition that occurs when red blood cells fail to produce enough haem, which is partly synthesized in the mitochondria. This results in the accumulation of iron in the mitochondria, forming a ring around the nucleus known as a ring sideroblast. The condition can be either congenital or acquired.

      The congenital cause of sideroblastic anaemia is delta-aminolevulinate synthase-2 deficiency. On the other hand, acquired causes include myelodysplasia, alcohol, lead, and anti-TB medications.

      To diagnose sideroblastic anaemia, doctors may conduct a full blood count, iron studies, and a blood film. The results may show hypochromic microcytic anaemia, high ferritin, high iron, high transferrin saturation, and basophilic stippling of red blood cells. A bone marrow test may also be done, and Prussian blue staining can reveal ringed sideroblasts.

      Management of sideroblastic anaemia is mainly supportive, and treatment focuses on addressing any underlying cause. Pyridoxine may also be prescribed to help manage the condition.

      In summary, sideroblastic anaemia is a condition that affects the production of haem in red blood cells, leading to the accumulation of iron in the mitochondria. It can be congenital or acquired, and diagnosis involves various tests. Treatment is mainly supportive, and addressing any underlying cause is crucial.

    • This question is part of the following fields:

      • Haematology And Oncology
      81.8
      Seconds
  • Question 7 - What grade of evidence does a randomized controlled trial provide, as per the...

    Correct

    • What grade of evidence does a randomized controlled trial provide, as per the guidance of the Oxford Centre for Evidence-Based Medicine (CEBM)?

      Your Answer: 1

      Explanation:

      Levels and Grades of Evidence in Evidence-Based Medicine

      In order to evaluate the quality of evidence in evidence-based medicine, levels or grades are often used to organize the evidence. Traditional hierarchies placed systematic reviews or randomized control trials at the top and case-series/report at the bottom. However, this approach is overly simplistic as certain research questions cannot be answered using RCTs. To address this, the Oxford Centre for Evidence-Based Medicine introduced their 2011 Levels of Evidence system which separates the type of study questions and gives a hierarchy for each. On the other hand, the GRADE system is a grading approach that classifies the quality of evidence as high, moderate, low, or very low. The process begins by formulating a study question and identifying specific outcomes. Outcomes are then graded as critical or important, and the evidence is gathered and criteria are used to grade the evidence. Evidence can be promoted or downgraded based on certain circumstances. The use of levels and grades of evidence helps to evaluate the quality of evidence and make informed decisions in evidence-based medicine.

    • This question is part of the following fields:

      • General Principles
      9.8
      Seconds
  • Question 8 - A 30-year-old female visits her GP complaining of visual disturbance that has been...

    Incorrect

    • A 30-year-old female visits her GP complaining of visual disturbance that has been ongoing for 2 days. She reports experiencing blurry vision in her left eye and pain when moving it. She denies having any signs of infection. About 4 months ago, she had a brief episode of weakness and tingling in her left arm that resolved on its own.

      What is the probable diagnosis for this patient, and which cells are likely to be targeted by her immune system in this condition?

      Your Answer: Schwann cells

      Correct Answer: Oligodendrocytes

      Explanation:

      The production of myelin in the CNS is the responsibility of oligodendrocytes.

      The nervous system is composed of various types of cells, each with their own unique functions. Oligodendroglia cells are responsible for producing myelin in the central nervous system (CNS) and are affected in multiple sclerosis. Schwann cells, on the other hand, produce myelin in the peripheral nervous system (PNS) and are affected in Guillain-Barre syndrome. Astrocytes provide physical support, remove excess potassium ions, help form the blood-brain barrier, and aid in physical repair. Microglia are specialised CNS phagocytes, while ependymal cells provide the inner lining of the ventricles.

      In summary, the nervous system is made up of different types of cells, each with their own specific roles. Oligodendroglia and Schwann cells produce myelin in the CNS and PNS, respectively, and are affected in certain diseases. Astrocytes provide physical support and aid in repair, while microglia are specialised phagocytes in the CNS. Ependymal cells line the ventricles. Understanding the functions of these cells is crucial in understanding the complex workings of the nervous system.

    • This question is part of the following fields:

      • Neurological System
      35.5
      Seconds
  • Question 9 - A 35-year-old woman has remarried and desires to have children with her new...

    Incorrect

    • A 35-year-old woman has remarried and desires to have children with her new Caucasian husband. However, she already has a 5-year-old child with cystic fibrosis from her previous marriage. She is concerned about the likelihood of having another affected child with her new partner. Can you provide an estimated risk?

      Your Answer: 1 in 4 chance

      Correct Answer: 1 in 100 chance

      Explanation:

      Cystic Fibrosis Inheritance

      Cystic fibrosis is a genetic disorder that is inherited in an autosomal recessive pattern. This means that both copies of the gene in each cell have mutations. Individuals with only one copy of the mutated gene are carriers and typically do not show signs or symptoms of the condition.

      In the case of a female carrier for the CF gene, there is a 1 in 2 chance of producing a gamete carrying the CF gene. If her new partner is also a carrier, he has a 1 in 25 chance of having the CF gene and a 1 in 50 chance of producing a gamete with the CF gene. Therefore, the chance of producing a child with cystic fibrosis is 1 in 100.

      It is important to understand the inheritance pattern of cystic fibrosis to make informed decisions about family planning and genetic testing. This knowledge can help individuals and families better understand the risks and potential outcomes of having children with this condition.

    • This question is part of the following fields:

      • Reproductive System
      64.2
      Seconds
  • Question 10 - You are on a post-take ward round with your consultant and review a...

    Correct

    • You are on a post-take ward round with your consultant and review a 50-year-old man who was admitted with sudden severe abdominal pain, confusion and pyrexia. He has a history of alcoholic cirrhosis and known asymptomatic ascites. An ascitic tap was performed overnight which revealed a neutrophil count of 375/mm³ and was sent for urgent microscopy & culture.

      What is the most probable organism to be cultured from the ascitic tap?

      Your Answer: E. coli

      Explanation:

      The most frequently isolated organism in ascitic fluid culture in cases of spontaneous bacterial peritonitis is E. coli. While Staphylococcus aureus, Klebsiella, and Streptococcus can also cause spontaneous bacterial peritonitis, they are not as commonly found as E. coli.

      Understanding Spontaneous Bacterial Peritonitis

      Spontaneous bacterial peritonitis (SBP) is a type of peritonitis that typically affects individuals with ascites caused by liver cirrhosis. The condition is characterized by symptoms such as abdominal pain, fever, and ascites. Diagnosis is usually made through paracentesis, which reveals a neutrophil count of over 250 cells/ul. The most common organism found on ascitic fluid culture is E. coli.

      Management of SBP typically involves the administration of intravenous cefotaxime. Antibiotic prophylaxis is recommended for patients with ascites who have had an episode of SBP or have fluid protein levels below 15 g/l and a Child-Pugh score of at least 9 or hepatorenal syndrome. NICE recommends prophylactic oral ciprofloxacin or norfloxacin until the ascites has resolved.

      Alcoholic liver disease is a significant predictor of poor prognosis in SBP. Understanding the symptoms, diagnosis, and management of SBP is crucial for healthcare professionals to provide appropriate care for patients with this condition. Proper management can help improve outcomes and prevent complications.

    • This question is part of the following fields:

      • Gastrointestinal System
      68
      Seconds
  • Question 11 - Which one of the following is not a direct branch of the facial...

    Incorrect

    • Which one of the following is not a direct branch of the facial nerve?

      Your Answer: Nerve to stapedius

      Correct Answer: Auriculotemporal

      Explanation:

      The mandibular nerve gives rise to several branches, including the auriculotemporal nerve, lingual nerve, inferior alveolar nerve, nerve to the mylohyoid, and mental nerve.

      The facial nerve is responsible for supplying the muscles of facial expression, the digastric muscle, and various glandular structures. It also contains a few afferent fibers that originate in the genicular ganglion and are involved in taste. Bilateral facial nerve palsy can be caused by conditions such as sarcoidosis, Guillain-Barre syndrome, Lyme disease, and bilateral acoustic neuromas. Unilateral facial nerve palsy can be caused by these conditions as well as lower motor neuron issues like Bell’s palsy and upper motor neuron issues like stroke.

      The upper motor neuron lesion typically spares the upper face, specifically the forehead, while a lower motor neuron lesion affects all facial muscles. The facial nerve’s path includes the subarachnoid path, where it originates in the pons and passes through the petrous temporal bone into the internal auditory meatus with the vestibulocochlear nerve. The facial canal path passes superior to the vestibule of the inner ear and contains the geniculate ganglion at the medial aspect of the middle ear. The stylomastoid foramen is where the nerve passes through the tympanic cavity anteriorly and the mastoid antrum posteriorly, and it also includes the posterior auricular nerve and branch to the posterior belly of the digastric and stylohyoid muscle.

    • This question is part of the following fields:

      • Neurological System
      7.3
      Seconds
  • Question 12 - A medical research lab is investigating new tests for diabetes in a group...

    Correct

    • A medical research lab is investigating new tests for diabetes in a group of 250 elderly patients. The results have been quite inconsistent, and you have been assigned the task of determining the likelihood ratio of a negative test result based on the following information.

      Sensitivity = 60%
      Specificity = 85%

      What is the correct value?

      Your Answer: 0.5

      Explanation:

      The correct formula for calculating the likelihood ratio for a negative test result is (1 – sensitivity) divided by specificity. This ratio helps determine how much the odds of having the disease decrease when the test is negative. For example, if the sensitivity is 0.55 and the specificity is 0.9, the likelihood ratio for a negative test result would be 0.5. It is important to remember to subtract the sensitivity from 1, not add it, when using this formula.

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • General Principles
      94.7
      Seconds
  • Question 13 - A 50-year-old man presents to the emergency department with acute chest pain. His...

    Correct

    • A 50-year-old man presents to the emergency department with acute chest pain. His ECG reveals ST depression in leads II, III, & aVF, and his troponin levels are elevated. He is diagnosed with NSTEMI and prescribed ticagrelor as part of his treatment plan.

      What is the mechanism of action of ticagrelor?

      Your Answer: Inhibits ADP binding to platelet receptors

      Explanation:

      Clopidogrel and ticagrelor have a similar mechanism of action in that they both inhibit the binding of ADP to platelet receptors. Heparin activates antithrombin III, which in turn inhibits factor Xa and IIa. DOACs like rivaroxaban directly inhibit factor Xa that is bound to the prothrombinase complex and associated with clots. Aspirin works by inhibiting the production of prostaglandins, while warfarin inhibits VKORC1, which is responsible for the activation of vitamin K.

      ADP receptor inhibitors, such as clopidogrel, prasugrel, ticagrelor, and ticlopidine, work by inhibiting the P2Y12 receptor, which leads to sustained platelet aggregation and stabilization of the platelet plaque. Clinical trials have shown that prasugrel and ticagrelor are more effective than clopidogrel in reducing short- and long-term ischemic events in high-risk patients with acute coronary syndrome or undergoing percutaneous coronary intervention. However, ticagrelor may cause dyspnea due to impaired clearance of adenosine, and there are drug interactions and contraindications to consider for each medication. NICE guidelines recommend dual antiplatelet treatment with aspirin and ticagrelor for 12 months as a secondary prevention strategy for ACS.

    • This question is part of the following fields:

      • Cardiovascular System
      46.9
      Seconds
  • Question 14 - A 28-year-old female patient presents to her GP with concerns about the appearance...

    Incorrect

    • A 28-year-old female patient presents to her GP with concerns about the appearance of lumps in her lower abdomen. She has been diagnosed with type 1 diabetes and has been using insulin for more than a decade. The lumps have developed in the areas where she administers her insulin injections.

      What is the probable cause of the lumps?

      Your Answer: Lipoma

      Correct Answer: Lipodystrophy

      Explanation:

      Small subcutaneous lumps at injection sites, known as lipodystrophy, can be caused by insulin.

      The type and location of the lump suggest that lipodystrophy is the most probable cause.

      Deposits of insulin and glucose are not responsible for the formation of these lumps.

      While a lipoma could also cause similar lumps, it is less likely than lipodystrophy, which is a known complication of insulin injections, especially at the injection site. These lumps can occur in multiple locations.

      Insulin therapy can have side-effects that patients should be aware of. One of the most common side-effects is hypoglycaemia, which can cause sweating, anxiety, blurred vision, confusion, and aggression. Patients should be taught to recognize these symptoms and take 10-20g of a short-acting carbohydrate, such as a glass of Lucozade or non-diet drink, three or more glucose tablets, or glucose gel. It is also important for every person treated with insulin to have a glucagon kit for emergencies where the patient is not able to orally ingest a short-acting carbohydrate. Patients who have frequent hypoglycaemic episodes may develop reduced awareness, and beta-blockers can further reduce hypoglycaemic awareness.

      Another potential side-effect of insulin therapy is lipodystrophy, which typically presents as atrophy or lumps of subcutaneous fat. This can be prevented by rotating the injection site, as using the same site repeatedly can cause erratic insulin absorption. It is important for patients to be aware of these potential side-effects and to discuss any concerns with their healthcare provider. By monitoring their blood sugar levels and following their treatment plan, patients can manage the risks associated with insulin therapy and maintain good health.

    • This question is part of the following fields:

      • Endocrine System
      33.7
      Seconds
  • Question 15 - An 88-year-old woman has presented to the GP for a review of her...

    Correct

    • An 88-year-old woman has presented to the GP for a review of her type 2 diabetes. She has gained weight since starting dapagliflozin, and her BMI is now 53 kg/m². During the consultation, she mentions experiencing 'skin issues' on her leg. Upon examination, a 5cm diameter area of erythematous skin is visible on her shin. This area contains multiple small blisters and is warm and painful. What is the most probable organism responsible for this presentation?

      Your Answer: Gram positive cocci

      Explanation:

      The most common causative organisms in cellulitis are Staphylococcus aureus and Streptococcus pyogenes, both of which are gram positive cocci. The patient’s clinical presentation is likely due to cellulitis, which is exacerbated by their obesity and immunodeficiency from diabetes.

      Treatment for mild/moderate cellulitis typically involves flucloxacillin, while patients allergic to penicillin may be given clarithromycin, erythromycin (in pregnancy), or doxycycline. Severe cellulitis may require co-amoxiclav, cefuroxime, clindamycin, or ceftriaxone.

      Examples of gram-negative bacilli include E. coli, Salmonella, Klebsiella, and Campylobacter. E. coli can cause severe food poisoning via ingestion of uncooked meat, while Salmonella is transmitted through contaminated food. Klebsiella pneumonia can cause pneumonia in alcoholics, while Campylobacter is the most common cause of food poisoning in the UK.

      Double-stranded DNA viruses include HSV, VZV, adenovirus, and HPV. HSV-1 and HSV-2 cause oral and genital herpes, respectively, while VZV causes chickenpox. Adenovirus typically causes respiratory tract infections, and HPV is the leading cause of cervical cancer.

      Gram-negative cocci include Neisseria meningitidis, Neisseria gonorrhoeae, and Moraxella catarrhalis. Neisseria meningitidis causes meningococcal disease, Neisseria gonorrhoeae causes gonorrhoeae, and Moraxella catarrhalis causes respiratory tract infections.

      Double-stranded RNA viruses include rotavirus and coltivirus. Rotavirus is the most common cause of gastroenteritis in children, while coltivirus causes colorado tick fever.

      Understanding Cellulitis: Symptoms, Diagnosis, and Treatment

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

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

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

    • This question is part of the following fields:

      • General Principles
      28.3
      Seconds
  • Question 16 - A middle-aged woman with severe refractory psoriasis, a chronic inflammatory skin condition, has...

    Incorrect

    • A middle-aged woman with severe refractory psoriasis, a chronic inflammatory skin condition, has been prescribed cyclosporin by her dermatologist.

      What is the mechanism of action of this drug as an immunosuppressant?

      Your Answer: It inhibits calcineurin activity, inhibiting a rise in cytokines that stimulates proliferation of B lymphocytes

      Correct Answer: It inhibits calcineurin activity, preventing a rise in IL-2 levels and proliferation of T lymphocytes

      Explanation:

      Cyclosporine and tacrolimus work by inhibiting calcineurin, which reduces the levels of IL-2 and suppresses the cell-mediated immune response. This is different from targeting the humoral immune response associated with B lymphocytes. It is important to note that cyclosporin is not a TNF-alpha inhibitor, which is a different group of biologic agents used to treat severe psoriasis. Methotrexate works by inhibiting dihydrofolate reductase, not by the same mechanism as ciclosporin. Ciclosporin does not affect the proliferation of keratinocytes, which are targeted by vitamin D analogues commonly used in psoriasis treatment, such as calcitriol.

      Understanding Ciclosporin: An Immunosuppressant Drug

      Ciclosporin is a medication that is used as an immunosuppressant. It works by reducing the clonal proliferation of T cells by decreasing the release of IL-2. The drug binds to cyclophilin, forming a complex that inhibits calcineurin, a phosphatase that activates various transcription factors in T cells.

      Despite its effectiveness, Ciclosporin has several adverse effects. It can cause nephrotoxicity, hepatotoxicity, fluid retention, hypertension, hyperkalaemia, hypertrichosis, gingival hyperplasia, tremors, impaired glucose tolerance, hyperlipidaemia, and increased susceptibility to severe infection. However, it is interesting to note that Cyclosporin is virtually non-myelotoxic, which means it does not affect the bone marrow.

      Ciclosporin is used to treat various conditions such as following organ transplantation, rheumatoid arthritis, psoriasis, ulcerative colitis, and pure red cell aplasia. It has a direct effect on keratinocytes and modulates T cell function, making it an effective treatment for psoriasis.

      In conclusion, Ciclosporin is a potent immunosuppressant drug that can effectively treat various conditions. However, it is essential to monitor patients for adverse effects and adjust the dosage accordingly.

    • This question is part of the following fields:

      • General Principles
      36.7
      Seconds
  • Question 17 - A 50-year-old smoker visits his doctor complaining of a persistent mouth ulcer that...

    Correct

    • A 50-year-old smoker visits his doctor complaining of a persistent mouth ulcer that has been present for the last 2 months. The ulcer is located on the base of the tip of his tongue. Upon biopsy, it is revealed that the ulcer is a squamous cell carcinoma. Further testing is conducted to determine if there is any lymphatic spread.

      What are the primary regional lymph nodes that this tumor is likely to spread to?

      Your Answer: Submental

      Explanation:

      The submental lymph nodes are the primary site of lymphatic drainage from the tip of the tongue. The lymph will then spread to the deep cervical lymph nodes.

      Lymphatic Drainage of the Tongue

      The lymphatic drainage of the tongue varies depending on the location of the tumour. The anterior two-thirds of the tongue have minimal communication of lymphatics across the midline, resulting in metastasis to the ipsilateral nodes being more common. On the other hand, the posterior third of the tongue has communicating networks, leading to early bilateral nodal metastases being more common in this area.

      The tip of the tongue drains to the submental nodes and then to the deep cervical nodes, while the mid portion of the tongue drains to the submandibular nodes and then to the deep cervical nodes. If mid tongue tumours are laterally located, they will usually drain to the ipsilateral deep cervical nodes. However, those from more central regions may have bilateral deep cervical nodal involvement. Understanding the lymphatic drainage of the tongue is crucial in determining the spread of tumours and planning appropriate treatment.

    • This question is part of the following fields:

      • Haematology And Oncology
      19.3
      Seconds
  • Question 18 - A 35-year-old motorcyclist is in a road traffic collision resulting in a severely...

    Incorrect

    • A 35-year-old motorcyclist is in a road traffic collision resulting in a severely displaced humerus fracture. During surgical repair, the surgeon observes an injury to the radial nerve. Which of the following muscles is most likely to be unaffected by this injury?

      Your Answer: Abductor pollicis longus

      Correct Answer: None of the above

      Explanation:

      BEST

      The Radial Nerve: Anatomy, Innervation, and Patterns of Damage

      The radial nerve is a continuation of the posterior cord of the brachial plexus, with root values ranging from C5 to T1. It travels through the axilla, posterior to the axillary artery, and enters the arm between the brachial artery and the long head of triceps. From there, it spirals around the posterior surface of the humerus in the groove for the radial nerve before piercing the intermuscular septum and descending in front of the lateral epicondyle. At the lateral epicondyle, it divides into a superficial and deep terminal branch, with the deep branch crossing the supinator to become the posterior interosseous nerve.

      The radial nerve innervates several muscles, including triceps, anconeus, brachioradialis, and extensor carpi radialis. The posterior interosseous branch innervates supinator, extensor carpi ulnaris, extensor digitorum, and other muscles. Denervation of these muscles can lead to weakness or paralysis, with effects ranging from minor effects on shoulder stability to loss of elbow extension and weakening of supination of prone hand and elbow flexion in mid prone position.

      Damage to the radial nerve can result in wrist drop and sensory loss to a small area between the dorsal aspect of the 1st and 2nd metacarpals. Axillary damage can also cause paralysis of triceps. Understanding the anatomy, innervation, and patterns of damage of the radial nerve is important for diagnosing and treating conditions that affect this nerve.

    • This question is part of the following fields:

      • Neurological System
      36.2
      Seconds
  • Question 19 - A 45-year-old woman arrives at the emergency department complaining of a sudden headache....

    Correct

    • A 45-year-old woman arrives at the emergency department complaining of a sudden headache. The doctor is evaluating her condition. Her BMI is 33 kgm2.

      During the cranial nerve examination, the doctor observes papilloedema on fundoscopy. The patient also reports a loss of taste in the back third of her tongue. Which of the following nerves could be responsible for this loss?

      Your Answer: Glossopharyngeal nerve

      Explanation:

      The glossopharyngeal nerve mediates taste and sensation from the posterior one-third of the tongue, while the anterior two-thirds of the tongue receive taste input from the chorda tympani branch of the facial nerve and sensation input from the lingual branch of the mandibular division of the trigeminal nerve. The base of the tongue receives taste and sensation input from the internal branch of the superior laryngeal nerve, which is a branch of the vagus nerve.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      50
      Seconds
  • Question 20 - A 51-year-old woman has just had a right hemiarthroplasty and is now experiencing...

    Correct

    • A 51-year-old woman has just had a right hemiarthroplasty and is now experiencing sudden onset of shortness of breath and sharp pleuritic pain on the right side of her chest. A chest x-ray is done as part of the initial evaluation, revealing a wedge-shaped opacification. What is the probable diagnosis?

      Your Answer: Pulmonary embolism

      Explanation:

      Symptoms and Signs of Pulmonary Embolism

      Pulmonary embolism is a medical condition that can be difficult to diagnose due to its varied symptoms and signs. While chest pain, dyspnoea, and haemoptysis are commonly associated with pulmonary embolism, only a small percentage of patients present with this textbook triad. The symptoms and signs of pulmonary embolism can vary depending on the location and size of the embolism.

      The PIOPED study conducted in 2007 found that tachypnea, or a respiratory rate greater than 16/min, was the most common clinical sign in patients diagnosed with pulmonary embolism, occurring in 96% of cases. Other common signs included crackles in the chest (58%), tachycardia (44%), and fever (43%). Interestingly, the Well’s criteria for diagnosing a PE uses tachycardia rather than tachypnea. It is important for healthcare professionals to be aware of the varied symptoms and signs of pulmonary embolism to ensure prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Cardiovascular System
      64.9
      Seconds
  • Question 21 - Which one of the following structures is not closely related to the piriformis...

    Incorrect

    • Which one of the following structures is not closely related to the piriformis muscle?

      Your Answer: Inferior gluteal nerve

      Correct Answer: Medial femoral circumflex artery

      Explanation:

      The lateral hip rotators have different nerve supplies. The piriformis muscle is supplied by the ventral rami of S1 and S2, while the obturator internus and superior gemellus are supplied by the nerve to obturator internus. The inferior gemellus and quadrator femoris are supplied by the nerve to quadratus femoris.

      The piriformis muscle is an important landmark in the gluteal region and is closely related to the sciatic nerve, inferior gluteal artery and nerve, and superior gluteal artery and nerve.

      The medial femoral circumflex artery runs deep to the quadratus femoris muscle.

      The gluteal region is composed of various muscles and nerves that play a crucial role in hip movement and stability. The gluteal muscles, including the gluteus maximus, medius, and minimis, extend and abduct the hip joint. Meanwhile, the deep lateral hip rotators, such as the piriformis, gemelli, obturator internus, and quadratus femoris, rotate the hip joint externally.

      The nerves that innervate the gluteal muscles are the superior and inferior gluteal nerves. The superior gluteal nerve controls the gluteus medius, gluteus minimis, and tensor fascia lata muscles, while the inferior gluteal nerve controls the gluteus maximus muscle.

      If the superior gluteal nerve is damaged, it can result in a Trendelenburg gait, where the patient is unable to abduct the thigh at the hip joint. This weakness causes the pelvis to tilt down on the opposite side during the stance phase, leading to compensatory movements such as trunk lurching to maintain a level pelvis throughout the gait cycle. As a result, the pelvis sags on the opposite side of the lesioned superior gluteal nerve.

    • This question is part of the following fields:

      • Neurological System
      28.4
      Seconds
  • Question 22 - A 29-year-old male presents to his primary care physician complaining of lower back...

    Incorrect

    • A 29-year-old male presents to his primary care physician complaining of lower back pain. He reports that he has been experiencing this pain for the past year and has found little relief from over-the-counter ibuprofen and paracetamol. The pain is worse in the morning and he has noticed that swimming helps to alleviate his symptoms. He denies any history of trauma and works as a tax analyst, preferring to run for exercise rather than engage in heavy lifting. He has no significant medical history and no known drug allergies.

      What is the most probable radiographic finding in this patient?

      Your Answer: Osteophytes

      Correct Answer: Sacroiliitis

      Explanation:

      Ankylosing spondylitis is a chronic inflammatory disease that typically affects young men and presents with lower back pain and stiffness that is worse in the mornings. The condition is associated with HLA B27 and is characterized by a progressive loss of spinal movement. While radiological features may not be present initially, sacroiliitis is the earliest feature seen on x-ray and will show erosion and sclerosis of the sacroiliac joints. In contrast, psoriatic arthritis is characterized by skin plaques, dactylitis, and nail pitting, as well as a ‘pencil in cup’ deformity in severe cases. Osteophytes, on the other hand, are a hallmark feature of osteoarthritis, which is unlikely to occur in a young man. Finally, the bamboo spine appearance is a very late x-ray characteristic in ankylosing spondylitis and is due to calcification of the ligaments.

      Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in young males, with a sex ratio of 3:1, and typically presents with lower back pain and stiffness that develops gradually. The stiffness is usually worse in the morning and improves with exercise, while the patient may experience night pain that improves upon getting up.

      Clinical examination of patients with ankylosing spondylitis may reveal reduced lateral and forward flexion, as well as reduced chest expansion. The Schober’s test, which involves drawing a line 10 cm above and 5 cm below the back dimples and measuring the distance between them when the patient bends forward, may also be used to assess the condition. Other features associated with ankylosing spondylitis include apical fibrosis, anterior uveitis, aortic regurgitation, Achilles tendonitis, AV node block, amyloidosis, cauda equina syndrome, and peripheral arthritis (which is more common in females).

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      38.9
      Seconds
  • Question 23 - A 62-year-old man visited his primary care physician after his family noticed a...

    Incorrect

    • A 62-year-old man visited his primary care physician after his family noticed a significant weight loss over the past few months. The man confirms the weight loss and denies intentionally trying to lose weight or any changes in his appetite. He also reports experiencing night sweats and a fever, which he attributes to a cold. The patient has a history of well-controlled hypertension and no surgical history. He has not traveled recently and does not smoke or drink alcohol. During the physical examination, an enlarged lymph node in the armpit and splenomegaly were noted. The most likely diagnosis was confirmed through fluorescent in-situ hybridization (FISH), which revealed a translocation of the heavy-chain immunoglobulin and cyclin D1. What is the most likely translocation found in this patient?

      Your Answer: t(11;18)

      Correct Answer: t(11;14)

      Explanation:

      Understanding Mantle Cell Lymphoma

      Mantle cell lymphoma is a type of B-cell lymphoma that is characterized by the over-expression of the cyclin D1 (BCL-1) gene due to a translocation (11;14). This cancer is identified by the presence of CD5+, CD19+, CD22+, and CD23- markers. Unfortunately, mantle cell lymphoma has a poor prognosis and is often associated with widespread lymphadenopathy.

      In summary, mantle cell lymphoma is a type of cancer that affects B-cells and is caused by a specific genetic translocation. It is identified by certain markers and is known for its poor prognosis and widespread lymphadenopathy. Understanding the basics of this disease can help with early detection and treatment.

    • This question is part of the following fields:

      • Haematology And Oncology
      41.4
      Seconds
  • Question 24 - A 10-year-old boy comes to the clinic with his mother. He complained of...

    Correct

    • A 10-year-old boy comes to the clinic with his mother. He complained of ear pain during the night, but there is no discharge, hearing loss, or other symptoms. Upon examination, he has no fever. The pinna of his ear appears red and swollen, and pressing on the tragus causes pain. Otoscopy reveals a healthy tympanic membrane, but the external auditory canal is inflamed. The external auditory canal consists of a cartilaginous outer part and a bony inner part. Which bone does the bony external canal pass through?

      Your Answer: Temporal bone

      Explanation:

      The temporal bone is the correct answer. It contains the bony external auditory canal and middle ear, which are composed of a cartilaginous outer third and a bony inner two-thirds. The temporal bone articulates with the parietal, occipital, sphenoid, zygomatic, and mandible bones.

      The sphenoid bone is a complex bone that articulates with 12 other bones. It is divided into four parts: the body, greater wings, lesser wings, and pterygoid plates.

      The zygomatic bone is located on the anterior and lateral aspects of the face and articulates with the frontal, sphenoid, temporal, and maxilla bones.

      The parietal bone forms the sides and roof of the cranium and articulates with the parietal on the opposite side, as well as the frontal, temporal, occipital, and sphenoid bones.

      The occipital bone is situated at the rear of the cranium and articulates with the temporal, sphenoid, parietals, and the first cervical vertebrae.

      The patient’s symptoms of ear pain, erythematous pinna and external auditory canal, and tender tragus on palpation are consistent with otitis externa, which has numerous possible causes. The patient is not febrile and has no loss of hearing or dizziness.

      Anatomy of the Ear

      The ear is divided into three distinct regions: the external ear, middle ear, and internal ear. The external ear consists of the auricle and external auditory meatus, which are innervated by the greater auricular nerve and auriculotemporal branch of the trigeminal nerve. The middle ear is the space between the tympanic membrane and cochlea, and is connected to the nasopharynx by the eustachian tube. The tympanic membrane is composed of three layers and is approximately 1 cm in diameter. The middle ear is innervated by the glossopharyngeal nerve. The ossicles, consisting of the malleus, incus, and stapes, transmit sound vibrations from the tympanic membrane to the inner ear. The internal ear contains the cochlea, which houses the organ of corti, the sense organ of hearing. The vestibule accommodates the utricule and saccule, which contain endolymph and are surrounded by perilymph. The semicircular canals, which share a common opening into the vestibule, lie at various angles to the petrous temporal bone.

    • This question is part of the following fields:

      • Respiratory System
      31.9
      Seconds
  • Question 25 - A 55-year-old Caucasian man visits his primary care physician complaining of heartburn that...

    Correct

    • A 55-year-old Caucasian man visits his primary care physician complaining of heartburn that has been bothering him for the past 3 months. He reports experiencing gnawing pain in his upper abdomen that worsens between meals but improves after eating. The pain does not spread to other areas and is relieved by taking antacids that can be purchased over-the-counter.

      The patient undergoes a gastroscopy, which reveals a bleeding ulcer measuring 2x3cm in the first part of his duodenum.

      What is the probable cause of this patient's ulcer?

      Your Answer: Helicobacter pylori infection

      Explanation:

      The most likely cause of the patient’s duodenal ulcer is Helicobacter pylori infection, which is responsible for the majority of cases. Diagnosis can be made through serology, microbiology, histology, or CLO testing. The patient’s symptoms of gnawing epigastric pain and improvement with food are consistent with a duodenal ulcer. Adenocarcinoma is an unlikely cause as duodenal ulcers are typically benign. Alcohol excess and NSAIDs are not the most common causes of duodenal ulcers, with Helicobacter pylori being the primary culprit.

      Helicobacter pylori: A Bacteria Associated with Gastrointestinal Problems

      Helicobacter pylori is a type of Gram-negative bacteria that is commonly associated with various gastrointestinal problems, particularly peptic ulcer disease. This bacterium has two primary mechanisms that allow it to survive in the acidic environment of the stomach. Firstly, it uses its flagella to move away from low pH areas and burrow into the mucous lining to reach the epithelial cells underneath. Secondly, it secretes urease, which converts urea to NH3, leading to an alkalinization of the acidic environment and increased bacterial survival.

      The pathogenesis mechanism of Helicobacter pylori involves the release of bacterial cytotoxins, such as the CagA toxin, which can disrupt the gastric mucosa. This bacterium is associated with several gastrointestinal problems, including peptic ulcer disease, gastric cancer, B cell lymphoma of MALT tissue, and atrophic gastritis. However, its role in gastro-oesophageal reflux disease (GORD) is unclear, and there is currently no role for the eradication of Helicobacter pylori in GORD.

      The management of Helicobacter pylori infection involves a 7-day course of treatment with a proton pump inhibitor, amoxicillin, and either clarithromycin or metronidazole. For patients who are allergic to penicillin, a proton pump inhibitor, metronidazole, and clarithromycin are used instead.

    • This question is part of the following fields:

      • Gastrointestinal System
      18.5
      Seconds
  • Question 26 - A 55-year-old man visits his general practitioner complaining of pain in the back...

    Correct

    • A 55-year-old man visits his general practitioner complaining of pain in the back of his leg. The doctor suspects a sciatic nerve injury.

      During the examination, which reflexes are expected to be absent?

      Your Answer: Ankle reflex

      Explanation:

      When the sciatic nerve is damaged, the reflexes in the ankle and plantar areas are lost, but the knee jerk reflex remains intact. This can cause pain and numbness in the back of the leg. If the damage occurs at the pelvic outlet, the ability to flex the knee may be lost, but the knee jerk reflex will still be present. During a neurological examination of the upper limb, the reflexes in the biceps, brachioradialis, and triceps are tested. Additionally, the sural and tibial nerve reflexes are cutaneous reflexes that are activated during walking.

      Understanding Sciatic Nerve Lesion

      The sciatic nerve is a major nerve that is supplied by the L4-5, S1-3 vertebrae and divides into the tibial and common peroneal nerves. It is responsible for supplying the hamstring and adductor muscles. When the sciatic nerve is damaged, it can result in a range of symptoms that affect both motor and sensory functions.

      Motor symptoms of sciatic nerve lesion include paralysis of knee flexion and all movements below the knee. Sensory symptoms include loss of sensation below the knee. Reflexes may also be affected, with ankle and plantar reflexes lost while the knee jerk reflex remains intact.

      There are several causes of sciatic nerve lesion, including fractures of the neck of the femur, posterior hip dislocation, and trauma.

    • This question is part of the following fields:

      • Neurological System
      31.4
      Seconds
  • Question 27 - Which infection has the longest incubation period among the following options? ...

    Incorrect

    • Which infection has the longest incubation period among the following options?

      Your Answer: Dengue fever

      Correct Answer: Chickenpox

      Explanation:

      Understanding Incubation Periods of Diseases

      Incubation periods refer to the time between exposure to a disease-causing agent and the onset of symptoms. Knowing the incubation period of a disease is important in diagnosing and managing it. Some diseases have short incubation periods of less than a week, such as meningococcus, diphtheria, influenzae, and scarlet fever. Others have an incubation period of 1-2 weeks, including malaria, dengue fever, typhoid, and measles. Diseases with an incubation period of 2-3 weeks include mumps, rubella, and chickenpox. On the other hand, infectious mononucleosis, cytomegalovirus, viral hepatitis, and HIV have longer incubation periods of more than 3 weeks.

      Understanding the incubation period of a disease can help healthcare professionals identify the possible cause of a patient’s symptoms and provide appropriate treatment. It can also help in preventing the spread of the disease by identifying and isolating infected individuals. Therefore, it is important to be aware of the incubation periods of common diseases and to seek medical attention if symptoms develop within the expected time frame.

    • This question is part of the following fields:

      • General Principles
      17.8
      Seconds
  • Question 28 - A 73-year-old man visits the urology clinic due to an elevated PSA level....

    Incorrect

    • A 73-year-old man visits the urology clinic due to an elevated PSA level. Despite undergoing a biopsy, there are no indications of cancer or benign prostatic hypertrophy.

      The patient has a medical history of diabetes mellitus, hypertension, scrotal varicocele, renal calculi, and acute urine retention.

      Out of his existing medical conditions, which one is the probable culprit for his increased PSA level?

      Your Answer: Scrotal varicocele

      Correct Answer: Urine retention

      Explanation:

      Urinary retention is a common cause of a raised PSA reading, as it can lead to bladder enlargement. Other conditions such as diabetes mellitus, hypertension, and renal calculi are not direct causes of elevated PSA levels.

      Understanding PSA Testing for Prostate Cancer

      Prostate specific antigen (PSA) is an enzyme produced by the prostate gland that has become an important marker for prostate cancer. However, there is still much debate about its usefulness as a screening tool. The NHS Prostate Cancer Risk Management Programme (PCRMP) has published guidelines on how to handle requests for PSA testing in asymptomatic men. While a recent European trial showed a reduction in prostate cancer deaths, there is also a high risk of over-diagnosis and over-treatment. As a result, the National Screening Committee has decided not to introduce a prostate cancer screening programme yet, but rather allow men to make an informed choice.

      PSA levels may be raised by various factors, including benign prostatic hyperplasia, prostatitis, ejaculation, vigorous exercise, urinary retention, and instrumentation of the urinary tract. However, PSA levels are not always a reliable indicator of prostate cancer. For example, around 20% of men with prostate cancer have a normal PSA level, while around 33% of men with a PSA level of 4-10 ng/ml will be found to have prostate cancer. To add greater meaning to a PSA level, age-adjusted upper limits and monitoring changes in PSA level over time (PSA velocity or PSA doubling time) are used. The PCRMP recommends age-adjusted upper limits for PSA levels, with a limit of 3.0 ng/ml for men aged 50-59 years, 4.0 ng/ml for men aged 60-69 years, and 5.0 ng/ml for men over 70 years old.

    • This question is part of the following fields:

      • Renal System
      47.6
      Seconds
  • Question 29 - A 59-year-old man presents to the emergency department with pleuritic thoracic pain and...

    Correct

    • A 59-year-old man presents to the emergency department with pleuritic thoracic pain and fever. His medical history includes an inferior STEMI that occurred 3 weeks ago. During auscultation, a pericardial rub is detected, and his ECG shows diffuse ST segment elevation and PR segment depression. What is the complication of myocardial infarction that the patient is experiencing?

      Your Answer: Dressler syndrome

      Explanation:

      The patient’s symptoms strongly suggest Dressler syndrome, which is an autoimmune-related inflammation of the pericardium that typically occurs 2-6 weeks after a heart attack. This condition is characterized by fever, pleuritic pain, and diffuse ST elevation and PR depression on an electrocardiogram. A pleural friction rub can also be heard during a physical exam.

      While another heart attack is a possibility, the absence of diffuse ST elevation and the presence of a pleural friction rub make this diagnosis less likely.

      A left ventricular aneurysm would present with persistent ST elevation but no chest pain.

      Ventricular free wall rupture typically occurs 1-2 weeks after a heart attack and would present with acute heart failure due to cardiac tamponade, which is characterized by raised jugular venous pressure, pulsus paradoxus, and diminished heart sounds.

      A ventricular septal defect usually occurs within the first week and would present with acute heart failure and a pansystolic murmur.

      Myocardial infarction (MI) can lead to various complications, which can occur immediately, early, or late after the event. Cardiac arrest is the most common cause of death following MI, usually due to ventricular fibrillation. Cardiogenic shock may occur if a large part of the ventricular myocardium is damaged, and it is difficult to treat. Chronic heart failure may result from ventricular myocardium dysfunction, which can be managed with loop diuretics, ACE-inhibitors, and beta-blockers. Tachyarrhythmias, such as ventricular fibrillation and ventricular tachycardia, are common complications. Bradyarrhythmias, such as atrioventricular block, are more common following inferior MI. Pericarditis is common in the first 48 hours after a transmural MI, while Dressler’s syndrome may occur 2-6 weeks later. Left ventricular aneurysm and free wall rupture, ventricular septal defect, and acute mitral regurgitation are other complications that may require urgent medical attention.

    • This question is part of the following fields:

      • Cardiovascular System
      62.2
      Seconds
  • Question 30 - What is the most powerful muscle for extending the hip? ...

    Correct

    • What is the most powerful muscle for extending the hip?

      Your Answer: Gluteus maximus

      Explanation:

      Muscles Acting on the Hip Joint

      The hip joint is a synovial ball and socket joint that allows for a wide range of movements. There are several muscles that act over the hip, each with their own primary movement and innervation. The hip extensors include the gluteus maximus and the hamstrings, which are responsible for extending the hip joint. The hip flexors include the psoas major, iliacus, rectus femoris, and pectineus, which are responsible for flexing the hip joint. The hip abductors include the gluteus medius and minimus, as well as the tensor fascia latae, which are responsible for abducting the hip joint. Finally, the hip adductors include the adductor magnus, brevis, and longus, as well as the gracilis, which are responsible for adducting the hip joint.

      The gluteus maximus is the strongest hip extensor, earning it the nickname of the power extensor of the hip. The hamstrings, while partially responsible for hip extension, are primarily responsible for knee flexion. However, their long course leaves them vulnerable to sports injuries. the muscles that act on the hip joint is important for both athletes and healthcare professionals in order to prevent and treat injuries.

    • This question is part of the following fields:

      • Clinical Sciences
      6.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrine System (0/2) 0%
Neurological System (3/7) 43%
General Principles (3/6) 50%
Respiratory System (1/2) 50%
Clinical Sciences (2/2) 100%
Haematology And Oncology (2/3) 67%
Reproductive System (0/1) 0%
Gastrointestinal System (2/2) 100%
Cardiovascular System (3/3) 100%
Musculoskeletal System And Skin (0/1) 0%
Renal System (0/1) 0%
Passmed