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Question 1
Incorrect
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A 60-year-old patient visits the GP with symptoms indicative of a rotator cuff injury. The GP intends to assess the subscapularis muscle. What is the most suitable special test to examine the subscapularis muscle?
Your Answer: Empty can test
Correct Answer: Lift-off test
Explanation:If a lift-off test shows abnormal results, it suggests that the subscapularis muscle may be involved.
Rotator cuff injuries are a common cause of shoulder problems and can be classified into four types of disease: subacromial impingement, calcific tendonitis, rotator cuff tears, and rotator cuff arthropathy. The symptoms of a rotator cuff injury include shoulder pain that worsens during abduction. The signs of a rotator cuff injury include tenderness over the anterior acromion and a painful arc of abduction. The painful arc of abduction is typically between 60 and 120 degrees for subacromial impingement, while for rotator cuff tears, the pain may be in the first 60 degrees. Proper diagnosis and treatment are essential to prevent further damage and improve shoulder function.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 2
Incorrect
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In which part of the gastrointestinal system is water mainly taken up?
Your Answer: Descending colon
Correct Answer: Small intestine
Explanation:The Function of the Large Intestine
Although many people believe that the primary function of the large intestine is to absorb water, this is not entirely accurate. In fact, the majority of water and fluids that are ingested or secreted are actually reabsorbed in the small intestine, which is located before the large intestine in the digestive tract. While the large intestine does play a role in absorbing some water and electrolytes, its primary function is to store and eliminate waste products from the body. This is achieved through the formation of feces, which are then eliminated through the rectum and anus. Overall, while the large intestine is an important part of the digestive system, its function is more complex than simply absorbing water.
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This question is part of the following fields:
- Clinical Sciences
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Question 3
Correct
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A 67-year-old woman visits the oncology clinic after being diagnosed with non-metastatic breast cancer. She is started on neoadjuvant chemotherapy using docetaxel.
What is the mechanism of action for this form of chemotherapy?Your Answer: Prevents microtubule depolymerisation and disassembly
Explanation:Docetaxel, a taxane chemotherapy agent, works by reducing the amount of free tubulin through the prevention of microtubule depolymerisation and disassembly during the metaphase stage of cell division, ultimately hindering mitosis.
Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and potential adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.
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This question is part of the following fields:
- Haematology And Oncology
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Question 4
Correct
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A 38-year-old woman presents with symptoms of irritability and changes in bowel habits. During examination, a smooth enlargement of the thyroid gland is noted. Thyroid function tests are ordered and the results are as follows:
TSH 0.1 mug/l
Free T4 35 pmol/l
What is the most likely underlying diagnosis?Your Answer: Graves disease
Explanation:When TSH receptor antibodies are present, they stimulate the thyroid to produce T4. This results in a decrease in TSH levels due to negative feedback on the pituitary. However, in cases where hyperthyroidism is caused by pregnancy, the TSH levels are usually elevated.
Understanding Thyroid Disease and its Management
Thyroid disease can present with various manifestations, which can be classified based on the presence or absence of clinical signs of thyroid dysfunction and the presence of a mass. To assess thyroid disease, a thorough history and examination, including ultrasound, are necessary. If a nodule is identified, it should be sampled through an image-guided fine needle aspiration. Radionucleotide scanning is not very useful.
Thyroid tumors can be papillary, follicular, anaplastic, medullary, or lymphoma. Multinodular goitre is a common reason for presentation, and if the patient is asymptomatic and euthyroid, they can be reassured. However, if they have compressive symptoms, surgery is required, and total thyroidectomy is the best option. Patients with endocrine dysfunction are initially managed by physicians, and surgery may be offered alongside radioiodine for those with Graves disease that fails with medical management or in patients who prefer not to be irradiated. Patients with hypothyroidism do not generally get offered a thyroidectomy.
Complications following surgery include anatomical damage to the recurrent laryngeal nerve, bleeding, and damage to the parathyroid glands resulting in hypocalcaemia. For further information, the Association of Clinical Biochemistry guidelines for thyroid function tests and the British Association of Endocrine Surgeons website can be consulted.
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This question is part of the following fields:
- Endocrine System
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Question 5
Correct
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As a young medical trainee participating in the ward round for diabetic foot, your consultant requests you to evaluate the existence of the posterior tibial pulse. Can you identify its location?
Your Answer: Behind and below the medial ankle
Explanation:The lower limb has 4 primary pulse points, which include the femoral pulse located 2-3 cm below the mid-inguinal point, the popliteal pulse that can be accessed by partially flexing the knee to loosen the popliteal fascia, the posterior tibial pulse located behind and below the medial ankle, and the dorsal pedis pulse found on the dorsum of the foot.
Lower Limb Pulse Points
The lower limb has four main pulse points that are important to check for proper circulation. These pulse points include the femoral pulse, which can be found 2-3 cm below the mid-inguinal point. The popliteal pulse can be found with a partially flexed knee to lose the popliteal fascia. The posterior tibial pulse can be found behind and below the medial ankle, while the dorsal pedis pulse can be found on the dorsum of the foot. It is important to check these pulse points regularly to ensure proper blood flow to the lower limb. By doing so, any potential circulation issues can be detected early on and treated accordingly. Proper circulation is essential for maintaining healthy lower limbs and overall physical well-being.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Incorrect
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What is the structure utilized by bacteria to penetrate dense mucus?
Your Answer: Fimbriae
Correct Answer: Flagella
Explanation:Cell Surface Projections
Flagella, fimbriae, and pili are all types of cell surface projections found in bacteria. Flagella are composed of flagellin and have a motor pump at the base that propels the filamentous structure to allow bacteria to move. This movement is important for bacteria such as Helicobacter pylori to penetrate through gastric mucus. Fimbriae and pili are short projections that aid in attachment. They can be used to attach to an epithelial layer, which increases virulence, or to attach to other bacteria, which facilitates the exchange of genetic material.
In contrast, microvilli are cell surface projections found on the apical surfaces of human epithelial cells, such as enterocytes. They increase the surface area for absorption, allowing for more efficient nutrient uptake. Overall, these cell surface projections play important roles in bacterial movement, attachment, and nutrient absorption in human cells.
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This question is part of the following fields:
- Microbiology
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Question 7
Incorrect
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A 26-year-old woman comes to her GP complaining of low back pain. She is in good health otherwise. She reports several finger and wrist fractures during her childhood. Her father and sister have also experienced multiple fractures throughout their lives. On examination, she displays paralumbar tenderness and scoliosis. Her sclera is blue-grey. What type of collagen mutation is likely responsible for her condition?
Your Answer: Type 2
Correct Answer: Type 1
Explanation:Osteogenesis imperfecta is caused by an abnormality in type 1 collagen, which is the primary component of bone, skin, and tendons. The diagnosis is based on a combination of factors, including a history of fractures, scoliosis, family history, and physical examination findings. In contrast, mutations in type 2 collagen can lead to chondrodysplasias, while mutations in type 3 collagen may cause a type of Ehlers-Danlos syndrome. Additionally, mutations in type 4 collagen can result in Alport’s syndrome and Goodpasture’s syndrome, as this type of collagen forms the basal lamina.
Understanding Osteogenesis Imperfecta
Osteogenesis imperfecta, also known as brittle bone disease, is a group of disorders that affect collagen metabolism, leading to bone fragility and fractures. The most common type of osteogenesis imperfecta is type 1, which is inherited in an autosomal dominant manner and is caused by decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides.
This condition typically presents in childhood, with individuals experiencing fractures following minor trauma. Other common features include blue sclera, deafness secondary to otosclerosis, and dental imperfections. Despite these symptoms, adjusted calcium, phosphate, parathyroid hormone, and ALP results are usually normal in individuals with osteogenesis imperfecta.
Overall, understanding the symptoms and underlying causes of osteogenesis imperfecta is crucial for proper diagnosis and management of this condition.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 8
Incorrect
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A 29-year-old man presents to the hospital with sudden chest pain while playing football. He reports no prior history of such pain but is concerned as one of his uncles died young due to a heart problem. On examination, the doctor notes that his fingers are longer than normal and that his little finger and thumb overlap when he holds his opposite wrist. He has no significant medical or surgical history and denies illicit drug use but has been smoking half a pack of cigarettes daily since he was 17. What is the most likely disease mechanism in this patient?
Your Answer: Overactive elastase enzyme leading to an excessive breakdown of collagen
Correct Answer: A defect of the glycoprotein structure which usually wraps around elastin
Explanation:The patient is exhibiting signs and symptoms of aortic dissection, which occurs when there is a tear in the inner wall of the aorta. This can be caused by chronic uncontrolled hypertension or a weakening of the aortic wall. However, in this case, the patient has a family history of Marfan syndrome, a genetically inherited condition that affects the glycoprotein fibrillin and leads to a range of symptoms such as joint hypermobility and chest deformities. Menkes disease, on the other hand, is a genetically inherited condition that involves an accumulation of copper in some body tissues and is inherited in an X-linked recessive pattern. Alpha-1-antitrypsin deficiency is characterized by a deficiency of the enzyme alpha-1-antitrypsin, which normally inhibits elastase and can lead to pan-acinar emphysema and liver impairment. Wrinkles and decreased skin elasticity in the elderly population are a result of normal aging, while scurvy is caused by vitamin C deficiency.
Understanding Marfan’s Syndrome
Marfan’s syndrome is a genetic disorder that affects the connective tissue in the body. It is caused by a defect in the FBN1 gene on chromosome 15, which codes for the protein fibrillin-1. This disorder is inherited in an autosomal dominant pattern and affects approximately 1 in 3,000 people.
Individuals with Marfan’s syndrome often have a tall stature with an arm span to height ratio greater than 1.05. They may also have a high-arched palate, arachnodactyly (long, slender fingers), pectus excavatum (sunken chest), pes planus (flat feet), and scoliosis (curvature of the spine). In addition, they may experience cardiovascular problems such as dilation of the aortic sinuses, mitral valve prolapse, and aortic aneurysm, which can lead to aortic dissection and aortic regurgitation. Other symptoms may include repeated pneumothoraces (collapsed lung), upwards lens dislocation, blue sclera, myopia, and ballooning of the dural sac at the lumbosacral level.
In the past, the life expectancy of individuals with Marfan’s syndrome was around 40-50 years. However, with regular echocardiography monitoring and medication such as beta-blockers and ACE inhibitors, the life expectancy has significantly improved. Despite this, cardiovascular problems remain the leading cause of death in individuals with Marfan’s syndrome.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 9
Incorrect
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A 67-year-old man is scheduled for open surgery to treat a popliteal artery aneurysm. What is the structure that forms the supero-lateral boundary of the popliteal fossa?
Your Answer: Lateral head of gastrocnemius
Correct Answer: Tendon of biceps femoris
Explanation:The Polpiteal Fossa and Sartorius Muscle
The area behind the knee is known as the polpiteal fossa. It is bordered by the tenodon of biceps femoris on the superolateral side, and the tendons of semimembranous and semitendinosus on the superomedial side. The medial head of gastrocnemius forms the inferomedial border, while the lateral head of gastrocnemius forms the inferolateral border.
The sartorius muscle is attached to the medial surface of the tibia. This muscle is located in the thigh and runs from the hip to the knee. It is responsible for flexing and rotating the hip joint, as well as flexing the knee joint. The sartorius muscle is one of the longest muscles in the body and is important for maintaining proper posture and movement. the anatomy of the polpiteal fossa and the sartorius muscle can be helpful in diagnosing and treating injuries or conditions in this area.
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This question is part of the following fields:
- Clinical Sciences
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Question 10
Correct
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A 36-year-old woman visits her GP complaining of a severe, itchy, red rash on her hands and arms that started a few days ago. The itching is so intense that it is affecting her sleep. She denies any family history of asthma, eczema, or hay fever and is otherwise healthy. During the consultation, she mentions that a colleague had a similar issue last week.
Upon examination, the GP observes a widespread erythematous rash on both hands, particularly in the interdigital web spaces and the flexor aspect of the wrists, with excoriation marks. There is no crusting, and the rash is not present anywhere else.
What is the recommended first-line treatment for this likely diagnosis?Your Answer: Permethrin 5% cream
Explanation:A cream containing steroids may be applied to address eczema.
As a second option for scabies, an insecticide lotion called Malathion is used.
For hyperkeratotic (‘Norwegian’) scabies, which is prevalent in immunosuppressed patients, oral ivermectin is the recommended treatment. However, this patient does not have crusted scabies and is in good health.
To alleviate dry skin in conditions such as eczema and psoriasis, a topical emollient can be utilized.
Scabies: Causes, Symptoms, and Treatment
Scabies is a skin condition caused by the mite Sarcoptes scabiei, which is spread through prolonged skin contact. It is most commonly seen in children and young adults. The mite burrows into the skin, laying its eggs in the outermost layer. The resulting intense itching is due to a delayed hypersensitivity reaction to the mites and eggs, which occurs about a month after infection. Symptoms include widespread itching, linear burrows on the fingers and wrists, and secondary features such as excoriation and infection.
The first-line treatment for scabies is permethrin 5%, followed by malathion 0.5% if necessary. Patients should be advised to avoid close physical contact until treatment is complete and to treat all household and close contacts, even if asymptomatic. Clothing, bedding, and towels should be laundered, ironed, or tumble-dried on the first day of treatment to kill off mites. The insecticide should be applied to all areas, including the face and scalp, and left on for 8-12 hours for permethrin or 24 hours for malathion before washing off. Treatment should be repeated after 7 days.
Crusted scabies, also known as Norwegian scabies, is a severe form of the condition seen in patients with suppressed immunity, particularly those with HIV. The skin is covered in hundreds of thousands of mites, and isolation is essential. Ivermectin is the treatment of choice.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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