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  • Question 1 - Which of the following structures is in danger of direct harm after a...

    Incorrect

    • Which of the following structures is in danger of direct harm after a femoral condyle fracture dislocation in an older adult?

      Your Answer: Tibial nerve

      Correct Answer: Popliteal artery

      Explanation:

      The fracture segment can be pulled backwards by the contraction of the gastrocnemius heads, which may result in damage or compression of the popliteal artery that runs adjacent to the bone.

      Anatomy of the Popliteal Fossa

      The popliteal fossa is a diamond-shaped space located at the back of the knee joint. It is bound by various muscles and ligaments, including the biceps femoris, semimembranosus, semitendinosus, and gastrocnemius. The floor of the popliteal fossa is formed by the popliteal surface of the femur, posterior ligament of the knee joint, and popliteus muscle, while the roof is made up of superficial and deep fascia.

      The popliteal fossa contains several important structures, including the popliteal artery and vein, small saphenous vein, common peroneal nerve, tibial nerve, posterior cutaneous nerve of the thigh, genicular branch of the obturator nerve, and lymph nodes. These structures are crucial for the proper functioning of the lower leg and foot.

      Understanding the anatomy of the popliteal fossa is important for healthcare professionals, as it can help in the diagnosis and treatment of various conditions affecting the knee joint and surrounding structures.

    • This question is part of the following fields:

      • Cardiovascular System
      39.5
      Seconds
  • Question 2 - What is the mechanism of action of dipyridamole when prescribed alongside aspirin for...

    Incorrect

    • What is the mechanism of action of dipyridamole when prescribed alongside aspirin for a 70-year-old man who has had an ischaemic stroke?

      Your Answer: Agonist of thromboxane synthase

      Correct Answer: Phosphodiesterase inhibitor

      Explanation:

      Although Dipyridamole is commonly referred to as a non-specific phosphodiesterase inhibitor, it has been found to have a strong effect on PDE5 (similar to sildenafil) and PDE6. Additionally, it reduces the uptake of adenosine by cells.

      Understanding the Mechanism of Action of Dipyridamole

      Dipyridamole is a medication that is commonly used in combination with aspirin to prevent the formation of blood clots after a stroke or transient ischemic attack. The drug works by inhibiting phosphodiesterase, which leads to an increase in the levels of cyclic adenosine monophosphate (cAMP) in platelets. This, in turn, reduces the levels of intracellular calcium, which is necessary for platelet activation and aggregation.

      Apart from its antiplatelet effects, dipyridamole also reduces the cellular uptake of adenosine, a molecule that plays a crucial role in regulating blood flow and oxygen delivery to tissues. By inhibiting the uptake of adenosine, dipyridamole can increase its levels in the bloodstream, leading to vasodilation and improved blood flow.

      Another mechanism of action of dipyridamole is the inhibition of thromboxane synthase, an enzyme that is involved in the production of thromboxane A2, a potent platelet activator. By blocking this enzyme, dipyridamole can further reduce platelet activation and aggregation, thereby preventing the formation of blood clots.

      In summary, dipyridamole exerts its antiplatelet effects through multiple mechanisms, including the inhibition of phosphodiesterase, the reduction of intracellular calcium levels, the inhibition of thromboxane synthase, and the modulation of adenosine uptake. These actions make it a valuable medication for preventing thrombotic events in patients with a history of stroke or transient ischemic attack.

    • This question is part of the following fields:

      • Cardiovascular System
      45.4
      Seconds
  • Question 3 - A 89-year-old diabetic man with known vascular dementia is reporting a loss of...

    Incorrect

    • A 89-year-old diabetic man with known vascular dementia is reporting a loss of sensation on the left side of his body to his caregivers.

      During his cranial nerve examination, no abnormalities were found. However, upon neurological examination of his upper and lower limbs, there is a significant sensory loss to light touch, vibration, and pain on the right side. Additionally, he is unable to detect changes in temperature and his joint position sense is impaired on the right side. A CT head scan reveals an infarction in the region of the lateral thalamus on the left side.

      Which specific lateral thalamic nucleus has been affected by this stroke?

      Your Answer: Ventral lateral

      Correct Answer: Ventral posterior

      Explanation:

      Injury to the lateral section of the ventral posterior nucleus located in the thalamus can impact the perception of bodily sensations such as touch, pain, proprioception, pressure, and vibration.

      The Thalamus: Relay Station for Motor and Sensory Signals

      The thalamus is a structure located between the midbrain and cerebral cortex that serves as a relay station for motor and sensory signals. Its main function is to transmit these signals to the cerebral cortex, which is responsible for processing and interpreting them. The thalamus is composed of different nuclei, each with a specific function. The lateral geniculate nucleus relays visual signals, while the medial geniculate nucleus transmits auditory signals. The medial portion of the ventral posterior nucleus (VML) is responsible for facial sensation, while the ventral anterior/lateral nuclei relay motor signals. Finally, the lateral portion of the ventral posterior nucleus is responsible for body sensation, including touch, pain, proprioception, pressure, and vibration. Overall, the thalamus plays a crucial role in the transmission of sensory and motor information to the brain, allowing us to perceive and interact with the world around us.

    • This question is part of the following fields:

      • Neurological System
      32.6
      Seconds
  • Question 4 - A 60-year-old male visits his doctor complaining of a lump on the side...

    Incorrect

    • A 60-year-old male visits his doctor complaining of a lump on the side of his neck. He reports feeling exhausted and experiencing night sweats. Following a needle core biopsy, the patient is diagnosed with follicular lymphoma. Which chromosomes are linked to this condition through translocation?

      Your Answer: 9 and 22

      Correct Answer: 14 and 18

      Explanation:

      The translocation of chromosomes is associated with various types of lymphoma and leukaemia. For example, the t(14;18) translocation causes follicular lymphoma by increasing BCL-2 transcription. Similarly, the t(8;14) translocation causes Burkitt lymphoma, while the t(9;22) translocation leads to the Philadelphia chromosome and chronic myeloid leukaemia. Mantle cell lymphoma is associated with the t(11;14) translocation. These translocations can help diagnose and classify these haematological malignancies.

      Genetics of Haematological Malignancies

      Haematological malignancies are cancers that affect the blood, bone marrow, and lymphatic system. These cancers are often associated with specific genetic abnormalities, such as translocations. Here are some common translocations and their associated haematological malignancies:

      – Philadelphia chromosome (t(9;22)): This translocation is present in more than 95% of patients with chronic myeloid leukaemia (CML). It results in the fusion of the Abelson proto-oncogene with the BCR gene on chromosome 22, creating the BCR-ABL gene. This gene codes for a fusion protein with excessive tyrosine kinase activity, which is a poor prognostic indicator in acute lymphoblastic leukaemia (ALL).

      – t(15;17): This translocation is seen in acute promyelocytic leukaemia (M3) and involves the fusion of the PML and RAR-alpha genes.

      – t(8;14): Burkitt’s lymphoma is associated with this translocation, which involves the translocation of the MYC oncogene to an immunoglobulin gene.

      – t(11;14): Mantle cell lymphoma is associated with the deregulation of the cyclin D1 (BCL-1) gene.

      – t(14;18): Follicular lymphoma is associated with increased BCL-2 transcription due to this translocation.

      Understanding the genetic abnormalities associated with haematological malignancies is important for diagnosis, prognosis, and treatment.

    • This question is part of the following fields:

      • Haematology And Oncology
      8.6
      Seconds
  • Question 5 - A passionate surgical resident attempts his first independent splenectomy. The procedure proves to...

    Incorrect

    • A passionate surgical resident attempts his first independent splenectomy. The procedure proves to be more challenging than expected and the resident places a tube drain in the splenic bed at the conclusion of the surgery. Within the next 24 hours, around 500ml of clear fluid drains into the tube. What is the most probable result of biochemical testing on the fluid?

      Elevated creatinine
      28%
      Elevated triglycerides
      10%
      Elevated glucagon
      9%
      Elevated amylase
      25%
      None of the above
      29%

      During a splenectomy, the tail of the pancreas may be harmed, causing the pancreatic duct to drain into the splenic bed, resulting in an increase in amylase levels. Glucagon is not produced in the pancreatic duct.

      Your Answer: Elevated glucagon

      Correct Answer: Elevated amylase

      Explanation:

      If the tail of the pancreas is damaged during splenectomy, the pancreatic duct may end up draining into the splenic bed. This can result in an increase in amylase levels, but there will be no secretion of glucagon into the pancreatic duct.

      Understanding the Anatomy of the Spleen

      The spleen is a vital organ in the human body, serving as the largest lymphoid organ. It is located below the 9th-12th ribs and has a clenched fist shape. The spleen is an intraperitoneal organ, and its peritoneal attachments condense at the hilum, where the vessels enter the spleen. The blood supply of the spleen is from the splenic artery, which is derived from the coeliac axis, and the splenic vein, which is joined by the IMV and unites with the SMV.

      The spleen is derived from mesenchymal tissue during embryology. It weighs between 75-150g and has several relations with other organs. The diaphragm is superior to the spleen, while the gastric impression is anterior, the kidney is posterior, and the colon is inferior. The hilum of the spleen is formed by the tail of the pancreas and splenic vessels. The spleen also forms the apex of the lesser sac, which contains short gastric vessels.

      In conclusion, understanding the anatomy of the spleen is crucial in comprehending its functions and the role it plays in the human body. The spleen’s location, weight, and relations with other organs are essential in diagnosing and treating spleen-related conditions.

    • This question is part of the following fields:

      • Gastrointestinal System
      49
      Seconds
  • Question 6 - A routine ECG is performed on a 24-year-old man. Which segment of the...

    Incorrect

    • A routine ECG is performed on a 24-year-old man. Which segment of the tracing obtained indicates the repolarization of the atria?

      Your Answer: T wave

      Correct Answer: None of the above

      Explanation:

      During the QRS complex, the process of atrial repolarisation is typically not discernible on the ECG strip.

      Understanding the Normal ECG

      The electrocardiogram (ECG) is a diagnostic tool used to assess the electrical activity of the heart. The normal ECG consists of several waves and intervals that represent different phases of the cardiac cycle. The P wave represents atrial depolarization, while the QRS complex represents ventricular depolarization. The ST segment represents the plateau phase of the ventricular action potential, and the T wave represents ventricular repolarization. The Q-T interval represents the time for both ventricular depolarization and repolarization to occur.

      The P-R interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization. The duration of the QRS complex is normally 0.06 to 0.1 seconds, while the duration of the P wave is 0.08 to 0.1 seconds. The Q-T interval ranges from 0.2 to 0.4 seconds depending upon heart rate. At high heart rates, the Q-T interval is expressed as a ‘corrected Q-T (QTc)’ by taking the Q-T interval and dividing it by the square root of the R-R interval.

      Understanding the normal ECG is important for healthcare professionals to accurately interpret ECG results and diagnose cardiac conditions. By analyzing the different waves and intervals, healthcare professionals can identify abnormalities in the electrical activity of the heart and provide appropriate treatment.

    • This question is part of the following fields:

      • Cardiovascular System
      11.8
      Seconds
  • Question 7 - Which receptor is predominantly targeted by noradrenaline? ...

    Incorrect

    • Which receptor is predominantly targeted by noradrenaline?

      Your Answer: α 2 receptors

      Correct Answer: α 1 receptors

      Explanation:

      Adrenaline is derived from noradrenaline and has a potent effect on α 1 receptors, although it can also increase myocardial contractility. When administered through infusions, it causes vasoconstriction and a rise in overall peripheral resistance. Noradrenaline is the preferred inotrope for treating septic shock.

      Inotropes are drugs that primarily increase cardiac output and are different from vasoconstrictor drugs that are used for peripheral vasodilation. Catecholamine type agents are commonly used in inotropes and work by increasing cAMP levels through adenylate cyclase stimulation. This leads to intracellular calcium ion mobilisation and an increase in the force of contraction. Adrenaline works as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses. Dopamine causes dopamine receptor-mediated renal and mesenteric vascular dilatation and beta 1 receptor agonism at higher doses, resulting in increased cardiac output. Dobutamine is a predominantly beta 1 receptor agonist with weak beta 2 and alpha receptor agonist properties. Noradrenaline is a catecholamine type agent and predominantly acts as an alpha receptor agonist and serves as a peripheral vasoconstrictor. Milrinone is a phosphodiesterase inhibitor that acts specifically on the cardiac phosphodiesterase and increases cardiac output.

      The cardiovascular receptor action of inotropes varies depending on the drug. Adrenaline and noradrenaline act on alpha and beta receptors, with adrenaline acting as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses. Dobutamine acts predominantly on beta 1 receptors with weak beta 2 and alpha receptor agonist properties. Dopamine acts on dopamine receptors, causing renal and spleen vasodilation and beta 1 receptor agonism at higher doses. The minor receptor effects are shown in brackets. The effects of receptor binding include vasoconstriction for alpha-1 and alpha-2 receptors, increased cardiac contractility and heart rate for beta-1 receptors, and vasodilation for beta-2 receptors. D-1 receptors cause renal and spleen vasodilation, while D-2 receptors inhibit the release of noradrenaline. Overall, inotropes are a class of drugs that increase cardiac output through various receptor actions.

    • This question is part of the following fields:

      • General Principles
      5.9
      Seconds
  • Question 8 - A 49-year-old female has a history of B12 deficiency and is now presenting...

    Incorrect

    • A 49-year-old female has a history of B12 deficiency and is now presenting symptoms of subacute combined degeneration of the spinal cord that affects her dorsal columns. Which types of sensation will be impacted by this condition?

      Your Answer: Proprioception, temperature and vibration

      Correct Answer: Light touch, vibration and proprioception

      Explanation:

      The spinal cord’s classic metabolic disorder is subacute combined degeneration, which results from a deficiency in vitamin B12. Folate deficiency can also cause this disorder. The damage specifically affects the posterior columns and corticospinal tracts, but peripheral nerve damage often develops early on, making the clinical picture complex. The dorsal columns are responsible for transmitting sensations of light touch, vibration, and proprioception.

      Spinal cord lesions can affect different tracts and result in various clinical symptoms. Motor lesions, such as amyotrophic lateral sclerosis and poliomyelitis, affect either upper or lower motor neurons, resulting in spastic paresis or lower motor neuron signs. Combined motor and sensory lesions, such as Brown-Sequard syndrome, subacute combined degeneration of the spinal cord, Friedrich’s ataxia, anterior spinal artery occlusion, and syringomyelia, affect multiple tracts and result in a combination of spastic paresis, loss of proprioception and vibration sensation, limb ataxia, and loss of pain and temperature sensation. Multiple sclerosis can involve asymmetrical and varying spinal tracts and result in a combination of motor, sensory, and ataxia symptoms. Sensory lesions, such as neurosyphilis, affect the dorsal columns and result in loss of proprioception and vibration sensation.

    • This question is part of the following fields:

      • Neurological System
      14.9
      Seconds
  • Question 9 - A 56-year-old male with a history of hypertension presents with symptoms of a...

    Incorrect

    • A 56-year-old male with a history of hypertension presents with symptoms of a stroke. Upon examination, he exhibits weakness on the right side of his face and arm, as well as expressive dysphasia. The diagnosis is confirmed, and thrombolysis is scheduled. Which artery is the most probable site of occlusion?

      Your Answer: Left anterior cerebral

      Correct Answer: Left middle cerebral

      Explanation:

      The patient is experiencing weakness and loss of sensation on the opposite side of their body, with the upper limb being more affected than the lower limb. They also have vision loss on the opposite side and difficulty with speech. These symptoms suggest that the middle cerebral artery on the left side of the brain is affected. It is important to have a good understanding of the circle of Willis and its cerebral associations to visualize the affected area. The left middle cerebral artery supplies the left temporal and parietal lobes of the brain, including the area responsible for speech, which explains the patient’s aphasia.

      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
      24.4
      Seconds
  • Question 10 - As a Foundation Year 2 doctor on placement in general practice, you visit...

    Incorrect

    • As a Foundation Year 2 doctor on placement in general practice, you visit a 49-year-old man with schizophrenia at a local nursing home for individuals with severe mental illness. The patient is staying at the nursing home voluntarily and currently believes he is the Lord of the Manor, with all staff and residents serving him. He occasionally hears voices that reinforce this belief. The patient has been detained under the Mental Health Act five times and has attempted suicide twice during acute psychotic episodes. Your task is to conduct his annual medication review. However, you discover that the patient dislikes taking his antipsychotic medication, and your GP colleagues have authorized hiding these medications in his food. What should you do about his medication?

      Your Answer: Tell the patient what has been going on and advise your GP colleagues that concealing the patient's medications is not acceptable and you will not be party to this practice. Ask them to immediately cease the practice and indicate that you will discuss the matter with the General Medical Council and the local area team for general practice if they do not speedily review the arrangement with the nursing home.

      Correct Answer: Reassess the patient's mental capacity. Check with your supervisor that local procedures for covert administration of medicines are being followed. If the patient does not have capacity and you consider it to be in the patient's best interests to receive antipsychotic medication and that local procedures are being following, reauthorise ongoing covert administration.

      Explanation:

      Covert Administration of Psychiatric Medication for Patients with Mental Illness

      Covert administration of psychiatric medication is sometimes necessary for patients with serious and enduring mental illness who lack the mental capacity to make decisions about their care. This practice is considered acceptable as long as it is in the patient’s best interests, taking into account their values and beliefs as well as their medical needs. It is important to note that this is only applicable to patients who are not detained under the Mental Health Act.

      To ensure patient safety, healthcare providers must establish arrangements to share information about the patient’s medications in case of complications or emergencies. Mental capacity should also be regularly reassessed, as it may vary with the patient’s mental health and cognitive ability. This can be done during the patient’s regular medication review or as circumstances change.

      Overall, covert administration of psychiatric medication should only be considered as a last resort and must be carefully evaluated on a case-by-case basis. The patient’s best interests and safety should always be the top priority.

    • This question is part of the following fields:

      • Ethics And Law
      51.3
      Seconds
  • Question 11 - A 2-year-old child is evaluated for inability to pass stool. After further testing,...

    Incorrect

    • A 2-year-old child is evaluated for inability to pass stool. After further testing, a rectal biopsy confirms a diagnosis of Hirschsprung's disease.

      Can you explain the pathophysiology behind this condition?

      Your Answer: Prolapse of bowel back into itself

      Correct Answer: Failure of the development of the parasympathetic plexuses

      Explanation:

      Hirschsprung’s disease is caused by a failure in the development of the parasympathetic plexuses, which are responsible for allowing the distal part of the large intestine to relax. Without these plexuses, the colon remains tightly sealed, preventing the passage of stool and leading to symptoms such as failure to pass meconium and constipation.

      Understanding Hirschsprung’s Disease

      Hirschsprung’s disease is a rare condition that affects 1 in 5,000 births. It is caused by a developmental failure of the parasympathetic Auerbach and Meissner plexuses, resulting in an aganglionic segment of bowel. This leads to uncoordinated peristalsis and functional obstruction, which can present as constipation and abdominal distension in older children or failure to pass meconium in the neonatal period.

      Hirschsprung’s disease is three times more common in males and is associated with Down’s syndrome. Diagnosis is made through a rectal biopsy, which is considered the gold standard. Treatment involves initial rectal washouts or bowel irrigation, followed by surgery to remove the affected segment of the colon.

      In summary, Hirschsprung’s disease is a rare but important differential diagnosis in childhood constipation. Understanding its pathophysiology, associations, possible presentations, and management is crucial for healthcare professionals to provide appropriate care for affected individuals.

    • This question is part of the following fields:

      • Gastrointestinal System
      11.7
      Seconds
  • Question 12 - A 67-year-old man with peripheral vascular disease is scheduled for a below knee...

    Incorrect

    • A 67-year-old man with peripheral vascular disease is scheduled for a below knee amputation. Can you identify the compartment in the lower leg where peroneus brevis is located?

      Your Answer: Deep posterior compartment

      Correct Answer: Lateral compartment

      Explanation:

      The deep transverse fascia divides the leg into anterior and posterior compartments, while the interosseous membrane separates them. The lateral compartment includes the peroneus brevis muscle.

      Fascial Compartments of the Leg

      The leg is divided into compartments by fascial septae, which are thin layers of connective tissue. In the thigh, there are three compartments: the anterior, medial, and posterior compartments. The anterior compartment contains the femoral nerve and artery, as well as the quadriceps femoris muscle group. The medial compartment contains the obturator nerve and artery, as well as the adductor muscles and gracilis muscle. The posterior compartment contains the sciatic nerve and branches of the profunda femoris artery, as well as the hamstrings muscle group.

      In the lower leg, there are four compartments: the anterior, posterior (divided into deep and superficial compartments), lateral, and deep posterior compartments. The anterior compartment contains the deep peroneal nerve and anterior tibial artery, as well as the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius muscles. The posterior compartment contains the tibial nerve and posterior tibial artery, as well as the deep and superficial muscles. The lateral compartment contains the superficial peroneal nerve and peroneal artery, as well as the peroneus longus and brevis muscles. The deep posterior compartment contains the tibial nerve and posterior tibial artery, as well as the flexor hallucis longus, flexor digitorum longus, tibialis posterior, and popliteus muscles.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      9.2
      Seconds
  • Question 13 - A 74-year-old woman has been brought to the emergency department by her husband...

    Correct

    • A 74-year-old woman has been brought to the emergency department by her husband after a fall at home. Upon assessment by the orthopaedics team, it is observed that she is holding her right arm adducted to her side and there is deformity of the proximal arm and shoulder with overlying skin ecchymosis and swelling. Neurovascular examination reveals palpable distal pulses and some paraesthesia over the deltoid region, but loss of active shoulder abduction is noted. What structure is likely to have been affected by this patient's injury?

      Your Answer: Axillary nerve

      Explanation:

      The correct nerve that is likely injured in a patient with difficulty abducting their arm following a humeral neck fracture is the axillary nerve. This nerve provides motor function to the deltoid muscle, which is responsible for arm abduction at the shoulder joint, and cutaneous sensation to the deltoid region. Proximal humerus fractures, which are common in individuals of the patient’s age and gender, can often result in injury to the axillary nerve.

      The brachial plexus is an incorrect answer as injuries to this nerve bundle are rare and would likely result in neurological dysfunction beyond the shoulder. The musculocutaneous nerve is also an incorrect answer as it provides motor function to the anterior compartment of the arm and sensation to the lateral forearm, but not to the deltoid region. The radial nerve is also an incorrect answer as it is typically injured in humeral shaft fractures and would result in wrist drop and paresthesia over the dorsal hand and wrist. The suprascapular nerve is also an incorrect answer as it provides motor innervation to different muscles and sensation to different joints than those affected in this case.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      26.2
      Seconds
  • Question 14 - Sophie is a 22-year-old woman who was diagnosed with hypertrophic cardiomyopathy 4 years...

    Correct

    • Sophie is a 22-year-old woman who was diagnosed with hypertrophic cardiomyopathy 4 years ago. Since then she has developed pulmonary hypertension which has added to her symptom load. To alleviate this, Sophie's doctor considers prescribing ambrisentan, an endothelin receptor antagonist. By inhibiting the mediator, endothelin, the doctor hopes to improve Sophie's symptoms until she receives a heart transplant.

      What are the main physiological impacts of this mediator?

      Your Answer: Vasoconstriction and bronchoconstriction

      Explanation:

      Endothelin is a potent vasoconstrictor and bronchoconstrictor that is secreted by endothelial cells and plays a crucial role in vascular homeostasis. However, excessive production of endothelin has been linked to various pathologies, including primary pulmonary hypertension. Inhibiting endothelin receptors can help lower pulmonary blood pressure.

      It’s important to note that endothelin does not affect systemic vascular resistance or sodium excretion, which are regulated by atrial and ventricular natriuretic peptides. Aldosterone, on the other hand, is responsible for increasing sodium reabsorption in the kidneys, and it’s believed that endothelin and aldosterone may work together to regulate sodium homeostasis.

      While endothelin causes vasoconstriction, it does not cause bronchodilation. Adrenaline, on the other hand, causes both vasoconstriction and bronchodilation, allowing for improved oxygen absorption from the lungs while delivering blood to areas of the body that require it for action.

      Finally, endothelin does not increase endovascular permeability, which is a function of histamine released by mast cells in response to noxious stimuli. Histamine enhances the recruitment of leukocytes to an area of inflammation by causing vascular changes.

      Understanding Endothelin and Its Role in Various Diseases

      Endothelin is a potent vasoconstrictor and bronchoconstrictor that is secreted by the vascular endothelium. Initially, it is produced as a prohormone and later converted to ET-1 by the action of endothelin converting enzyme. Endothelin interacts with a G-protein linked to phospholipase C, leading to calcium release. This interaction is thought to be important in the pathogenesis of many diseases, including primary pulmonary hypertension, cardiac failure, hepatorenal syndrome, and Raynaud’s.

      Endothelin is known to promote the release of angiotensin II, ADH, hypoxia, and mechanical shearing forces. On the other hand, it inhibits the release of nitric oxide and prostacyclin. Raised levels of endothelin are observed in primary pulmonary hypertension, myocardial infarction, heart failure, acute kidney injury, and asthma.

      In recent years, endothelin antagonists have been used to treat primary pulmonary hypertension. Understanding the role of endothelin in various diseases can help in the development of new treatments and therapies.

    • This question is part of the following fields:

      • Cardiovascular System
      32.7
      Seconds
  • Question 15 - A 30-year-old woman presents with an absent corneal reflex on cranial nerve examination....

    Incorrect

    • A 30-year-old woman presents with an absent corneal reflex on cranial nerve examination. The examining neurologist suspects a lesion affecting either the afferent or efferent limb of this reflex. Which two cranial nerves should be considered as potential culprits?

      Your Answer: Oculomotor and facial nerve

      Correct Answer: Trigeminal and facial nerve

      Explanation:

      The trigeminal nerve’s ophthalmic branch serves as the input or arriving limb in the corneal reflex, while the facial nerve acts as the output or exiting limb.

      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
      17.8
      Seconds
  • Question 16 - Which is least likely to cause hyperuricaemia? ...

    Incorrect

    • Which is least likely to cause hyperuricaemia?

      Your Answer: Diabetic ketoacidosis

      Correct Answer: Amiodarone

      Explanation:

      The drugs that cause hyperuricaemia due to reduced urate excretion can be remembered using the mnemonic Can’t leap, which stands for Ciclosporin, Alcohol, Nicotinic acid, Thiazides, Loop diuretics, Ethambutol, Aspirin, and Pyrazinamide. Additionally, decreased tubular secretion of urate can occur in patients with acidosis, such as those with diabetic ketoacidosis, ethanol or salicylate intoxication, or starvation ketosis, as the organic acids that accumulate in these conditions compete with urate for tubular secretion.

      Understanding Hyperuricaemia

      Hyperuricaemia is a condition characterized by elevated levels of uric acid in the blood. This can be caused by an increase in cell turnover or a decrease in the excretion of uric acid by the kidneys. While some individuals with hyperuricaemia may not experience any symptoms, it can be associated with other health conditions such as hyperlipidaemia, hypertension, and the metabolic syndrome.

      There are several factors that can contribute to the development of hyperuricaemia. Increased synthesis of uric acid can occur in conditions such as Lesch-Nyhan disease, myeloproliferative disorders, and with a diet rich in purines. On the other hand, decreased excretion of uric acid can be caused by drugs like low-dose aspirin, diuretics, and pyrazinamide, as well as pre-eclampsia, alcohol consumption, renal failure, and lead exposure.

      It is important to understand the underlying causes of hyperuricaemia in order to properly manage and treat the condition. Regular monitoring of uric acid levels and addressing any contributing factors can help prevent complications such as gout and kidney stones.

    • This question is part of the following fields:

      • Renal System
      10.4
      Seconds
  • Question 17 - A 25-year-old man presents with acute appendicitis and undergoes an appendectomy with complete...

    Incorrect

    • A 25-year-old man presents with acute appendicitis and undergoes an appendectomy with complete resolution. What pathological process is unlikely to be observed in the inflamed tissues?

      Your Answer: Altered Starlings forces.

      Correct Answer: Formation of granulomas

      Explanation:

      Acute inflammation is characterized by the presence of neutrophil polymorphs, which are transported to the affected tissues through a series of three phases. The first phase involves changes in blood vessel and flow, resulting in a flush, flare, and wheal. The second phase involves the production of fluid exudates that are rich in protein, including Ig and coagulation factors, due to increased vascular permeability. In the third phase, cellular exudates containing mainly neutrophil polymorphs pass into the extravascular space. Neutrophils are then transported to the tissues through a process that involves margination, pavementing, and emigration. Margination refers to the movement of neutrophils to the peripheral plasmatic of the vessel rather than the central axial stream, while pavementing involves the adhesion of neutrophils to endothelial cells in venules at the site of acute inflammation. Finally, emigration occurs when neutrophils pass between endothelial cells and enter the tissue. In contrast, chronic inflammation is characterized by the formation of granulomas.

      Acute inflammation is a response to cell injury in vascularized tissue. It is triggered by chemical factors produced in response to a stimulus, such as fibrin, antibodies, bradykinin, and the complement system. The goal of acute inflammation is to neutralize the offending agent and initiate the repair process. The main characteristics of inflammation are fluid exudation, exudation of plasma proteins, and migration of white blood cells.

      The vascular changes that occur during acute inflammation include transient vasoconstriction, vasodilation, increased permeability of vessels, RBC concentration, and neutrophil margination. These changes are followed by leukocyte extravasation, margination, rolling, and adhesion of neutrophils, transmigration across the endothelium, and migration towards chemotactic stimulus.

      Leukocyte activation is induced by microbes, products of necrotic cells, antigen-antibody complexes, production of prostaglandins, degranulation and secretion of lysosomal enzymes, cytokine secretion, and modulation of leukocyte adhesion molecules. This leads to phagocytosis and termination of the acute inflammatory response.

    • This question is part of the following fields:

      • General Principles
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  • Question 18 - A 59-year-old man with a known history of type-2 diabetes comes for a...

    Incorrect

    • A 59-year-old man with a known history of type-2 diabetes comes for a check-up. He is currently on metformin only for his diabetes and reports compliance with the prescribed regimen.

      His HbA1c is 63 mmol/mol (target = 53mmol/mol) and the patient and clinician agree to initiate a sulfonylurea along with his metformin.

      What is the primary mode of action of the new treatment?

      Your Answer: Inhibits the principal enzyme that breaks down GLP-1 - an incretin hormone that increases insulin secretion and suppresses glucagon secretion

      Correct Answer: Increases stimulation of insulin secretion by pancreatic B-cells and decreases hepatic clearance of insulin

      Explanation:

      Sulfonylureas are a type of oral hypoglycemic agent that stimulate insulin secretion by pancreatic B-cells and reduce the clearance of insulin by the liver. They are known as insulin secretagogues.

      Sulfonylureas are a type of medication used to treat type 2 diabetes mellitus. They work by increasing the amount of insulin produced by the pancreas, but only if the beta cells in the pancreas are functioning properly. Sulfonylureas bind to a specific channel on the cell membrane of pancreatic beta cells, known as the ATP-dependent K+ channel (KATP).

      While sulfonylureas can be effective in managing diabetes, they can also cause some adverse effects. The most common side effect is hypoglycemia, which is more likely to occur with long-acting preparations like chlorpropamide. Another common side effect is weight gain. However, there are also rarer side effects that can occur, such as hyponatremia (low sodium levels) due to inappropriate ADH secretion, bone marrow suppression, hepatotoxicity (liver damage), and peripheral neuropathy.

      It is important to note that sulfonylureas should not be used during pregnancy or while breastfeeding.

    • This question is part of the following fields:

      • Endocrine System
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  • Question 19 - A 78-year-old man arrives at the emergency department after his wife found him...

    Incorrect

    • A 78-year-old man arrives at the emergency department after his wife found him unresponsive this morning. According to her, he fell out of bed and hit his head on the bedside table during the night. Upon examination, the man responds to pain but not to voice. A CT scan of his head reveals an extradural hematoma, which is often caused by a rupture of the middle meningeal artery. What is the source of the middle meningeal artery?

      Your Answer: Internal carotid artery

      Correct Answer: Maxillary artery

      Explanation:

      The middle meningeal artery is a branch of the maxillary artery, which is one of two terminal branches of the external carotid artery. It supplies the dura and skin of the anterior face. Other branches of the maxillary artery include the inferior alveolar artery, buccal artery, deep temporal artery, and sphenopalatine artery. Extradural haemorrhage, which is bleeding into the space between the dura mater and the skull, is commonly caused by rupture of the middle meningeal artery following head trauma.

      The Middle Meningeal Artery: Anatomy and Clinical Significance

      The middle meningeal artery is a branch of the maxillary artery, which is one of the two terminal branches of the external carotid artery. It is the largest of the three arteries that supply the meninges, the outermost layer of the brain. The artery runs through the foramen spinosum and supplies the dura mater. It is located beneath the pterion, where the skull is thin, making it vulnerable to injury. Rupture of the artery can lead to an Extradural hematoma.

      In the dry cranium, the middle meningeal artery creates a deep indentation in the calvarium. It is intimately associated with the auriculotemporal nerve, which wraps around the artery. This makes the two structures easily identifiable in the dissection of human cadavers and also easily damaged in surgery.

      Overall, understanding the anatomy and clinical significance of the middle meningeal artery is important for medical professionals, particularly those involved in neurosurgery.

    • This question is part of the following fields:

      • Neurological System
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  • Question 20 - A 17-year-old female is seeking a termination and she is currently 16 weeks...

    Correct

    • A 17-year-old female is seeking a termination and she is currently 16 weeks pregnant.
      At what point in the pregnancy does the law impose more restrictions on obtaining a termination?

      Your Answer: 24 weeks

      Explanation:

      Abortion Law in the UK

      The Abortion Act 1967, which was amended by the Human Fertilisation and Embryology Act 1990, governs the law on abortion in the UK. According to this law, an abortion can be carried out until 24 weeks of pregnancy if two doctors agree that continuing with the pregnancy would pose a risk to the physical or psychological health of the mother or her existing children.

      If the pregnancy has progressed beyond 24 weeks, an abortion can only be carried out if two doctors agree that the woman’s health is gravely threatened by the pregnancy or if the infant is likely to be born with severe physical or mental abnormalities. It is important to note that there is no time limit on procuring an abortion if these criteria are met.

      In summary, the law on abortion in the UK allows for abortions to be carried out up to 24 weeks if there is a risk to the mother’s health or the health of her existing children. After 24 weeks, an abortion can only be carried out if the woman’s health is at risk or if the infant is likely to be born with severe physical or mental abnormalities.

    • This question is part of the following fields:

      • Clinical Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (1/4) 25%
Neurological System (0/5) 0%
Haematology And Oncology (0/1) 0%
Gastrointestinal System (0/2) 0%
General Principles (0/2) 0%
Ethics And Law (0/1) 0%
Musculoskeletal System And Skin (1/2) 50%
Renal System (0/1) 0%
Endocrine System (0/1) 0%
Clinical Sciences (1/1) 100%
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