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  • Question 1 - A 68-year-old man visits his doctor accompanied by his daughter, reporting a recent...

    Correct

    • A 68-year-old man visits his doctor accompanied by his daughter, reporting a recent onset of tremors and slower movements. During the examination, the doctor observes a shuffling gait, slower movements, and a resting pill-rolling tremor of the right hand with cogwheel rigidity. As part of the neurological examination for Parkinson's disease, the doctor assesses the coordination of the lower limbs by instructing the patient to place his left foot on his right knee and slide it down his leg.

      Which muscle is the most crucial for this movement?

      Your Answer: Sartorius

      Explanation:

      The sartorius muscle is crucial in assisting with medial rotation of the tibia on the femur. It performs multiple actions such as flexion, abduction, and lateral rotation of the thigh, as well as flexion of the knee. These functions are particularly important when crossing the legs or placing the heel of the foot onto the opposite knee.

      Although the gastrocnemius muscle also flexes the knee and plantarflexes the foot at the ankle joint, the sartorius muscle is more significant in this scenario due to its ability to perform the necessary limb movement.

      While the psoas major muscle may aid in this action as a hip joint flexor and lateral rotator, it is not as effective as the sartorius muscle in lateral rotation.

      The tibialis anterior muscle is responsible for dorsiflexion and inversion of the foot at the ankle joint, while the soleus muscle is responsible for plantarflexion of the foot at the ankle joint.

      The Sartorius Muscle: Anatomy and Function

      The sartorius muscle is the longest strap muscle in the human body and is located in the anterior compartment of the thigh. It is the most superficial muscle in this region and has a unique origin and insertion. The muscle originates from the anterior superior iliac spine and inserts on the medial surface of the body of the tibia, anterior to the gracilis and semitendinosus muscles. The sartorius muscle is innervated by the femoral nerve (L2,3).

      The primary action of the sartorius muscle is to flex the hip and knee, while also slightly abducting the thigh and rotating it laterally. It also assists with medial rotation of the tibia on the femur, which is important for movements such as crossing one leg over the other. The middle third of the muscle, along with its strong underlying fascia, forms the roof of the adductor canal. This canal contains important structures such as the femoral vessels, the saphenous nerve, and the nerve to vastus medialis.

      In summary, the sartorius muscle is a unique muscle in the anterior compartment of the thigh that plays an important role in hip and knee flexion, thigh abduction, and lateral rotation. Its location and relationship to the adductor canal make it an important landmark for surgical procedures in the thigh region.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      44.5
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  • Question 2 - Which of the muscles below does not cause lateral rotation of the hip?...

    Correct

    • Which of the muscles below does not cause lateral rotation of the hip?

      Your Answer: Pectineus

      Explanation:

      P-GO-GO-Q is a mnemonic for remembering the lateral hip rotators in order from top to bottom: Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, Obturator externus, and Quadratus femoris.

      Anatomy of the Hip Joint

      The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

      There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

      The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      42.7
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  • Question 3 - During a soccer match, a young player is tackled and suffers a twisting...

    Incorrect

    • During a soccer match, a young player is tackled and suffers a twisting injury to their knee. They are diagnosed with a soft tissue knee injury. What is the name of the structure that originates from the medial surface of the lateral femoral condyle and inserts onto the anterior intercondylar area of the tibial plateau?

      Your Answer: Medial meniscus

      Correct Answer: Anterior cruciate ligament

      Explanation:

      To recall the attachments of the ACL, one can imagine placing their hand in their pocket and moving from the superolateral to inferomedial direction. Conversely, for the PCL, the movement would be from inferolateral to superomedial.

      The ACL originates from the medial surface of the lateral condyle, while the PCL originates from the lateral surface of the medial condyle.

      Located in the medial compartment of the knee, beneath the medial condyle of the femur, is the medial meniscus.

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      30
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  • Question 4 - A 25-year-old female experiences repeated anterior dislocations of her left shoulder and a...

    Correct

    • A 25-year-old female experiences repeated anterior dislocations of her left shoulder and a CT scan shows a Bankart lesion. What is the name of the rotator cuff muscle tendon located at the front of the shoulder capsule?

      Your Answer: Subscapularis tendon

      Explanation:

      The tendon of the subscapularis runs in front of the shoulder capsule, while the supraspinatus tendon runs above it. The tendons of the infraspinatus and teres minor run behind the shoulder capsule, with the infraspinatus tendon positioned above the teres minor tendon. It should be noted that the teres major muscle is not part of the rotator cuff. A Bankart lesion refers to a tear in the front part of the glenoid labrum and is commonly seen in cases of anterior shoulder dislocation.

      Understanding the Rotator Cuff Muscles

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

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

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.7
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  • Question 5 - Mrs. Smith presents to the clinic with a newly noticed lesion on her...

    Incorrect

    • Mrs. Smith presents to the clinic with a newly noticed lesion on her leg. Upon examination, concerning characteristics of malignancy are observed.

      What signs would be most indicative of an in situ malignant melanoma in Mrs. Smith, who is in her early 50s?

      Your Answer: A diameter of 4mm

      Correct Answer: Having multiple colours

      Explanation:

      When assessing a pigmented lesion, it is important to consider the ‘ABCDE’ criteria: Asymmetry, Border, Colour, Diameter, and Evolution. The British Association of Dermatologists (BAD) provides guidance on this assessment. According to BAD, a diameter of over 6mm is more indicative of a melanoma than a diameter of 4mm. A lesion’s color alone does not determine malignancy, as highly pigmented lesions can be benign. Rolled edges are more commonly associated with basal cell carcinoma than melanoma. However, the presence of multiple colors within a lesion, including different shades of black, brown, and pink, is a significant indicator of melanoma.

      Skin cancer is a type of cancer that affects the skin. There are three main types of skin cancer: basal cell cancer, squamous cell cancer, and malignant melanoma. The risk factors for skin cancer include sun exposure, iatrogenic factors such as PUVA and UVB phototherapy, exposure to arsenic, and immunosuppression following renal transplant. People who have undergone renal transplant are at a higher risk of developing squamous cell cancer and basal cell cancer, and this may be linked to human papillomavirus.

      Skin cancer is a type of cancer that affects the skin. It can be classified into three main types: basal cell cancer, squamous cell cancer, and malignant melanoma. The risk factors for skin cancer include exposure to the sun, iatrogenic factors such as PUVA and UVB phototherapy, exposure to arsenic, and immunosuppression following renal transplant. People who have undergone renal transplant are at a higher risk of developing squamous cell cancer and basal cell cancer, and this may be linked to human papillomavirus.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      7
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  • Question 6 - Which bone is not part of the carpal bones? ...

    Incorrect

    • Which bone is not part of the carpal bones?

      Your Answer: Trapezium

      Correct Answer: Trapezius

      Explanation:

      Trapezius is not related to the mnemonic for the carpal bones.

      Carpal Bones: The Wrist’s Building Blocks

      The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

      In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      33
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  • Question 7 - A 75-year-old man sustains a scaphoid bone fracture that is displaced. The medical...

    Incorrect

    • A 75-year-old man sustains a scaphoid bone fracture that is displaced. The medical team decides to use a screw to fix the fracture. What structure is located directly medial to the scaphoid?

      Your Answer: None of the above

      Correct Answer: Lunate

      Explanation:

      The lunate is positioned towards the middle in the anatomical plane. Injuries that involve high velocity and result in scaphoid fractures may also lead to dislocation of the lunate.

      The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      90
      Seconds
  • Question 8 - A 4-year-old boy is presented to the GP by his father. He has...

    Correct

    • A 4-year-old boy is presented to the GP by his father. He has developed a rash around his mouth and nose over the past few days. It started as a flat red patch at the corner of his mouth but quickly progressed to a blistering rash that oozes fluid. During today's examination, the rash appears to have a crusty, golden appearance on the surface. The child is healthy otherwise and has no prior history of skin problems. Based on this history and examination, what is the most probable diagnosis?

      Your Answer: Impetigo

      Explanation:

      The most likely diagnosis based on the history and examination is impetigo or eczema herpeticum, which can have similar presentations and are difficult to differentiate clinically. However, since the child has no prior history of skin conditions, eczema herpeticum is less probable. Therefore, option 2 is the correct answer.

      Option 1: Atopic eczema would not manifest with a yellowish crust.

      Option 3: Chickenpox would not exhibit this particular progression.

      Understanding Impetigo: Causes, Symptoms, and Management

      Impetigo is a common bacterial skin infection that is caused by either Staphylococcus aureus or Streptococcus pyogenes. It can occur as a primary infection or as a complication of an existing skin condition such as eczema. Impetigo is most common in children, especially during warm weather. The infection can develop anywhere on the body, but it tends to occur on the face, flexures, and limbs not covered by clothing.

      The infection spreads through direct contact with discharges from the scabs of an infected person. The bacteria invade the skin through minor abrasions and then spread to other sites by scratching. Infection is spread mainly by the hands, but indirect spread via toys, clothing, equipment, and the environment may occur. The incubation period is between 4 to 10 days.

      Symptoms of impetigo include ‘golden’, crusted skin lesions typically found around the mouth. It is highly contagious, and children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment.

      Management of impetigo depends on the extent of the disease. Limited, localized disease can be treated with hydrogen peroxide 1% cream or topical antibiotic creams such as fusidic acid or mupirocin. MRSA is not susceptible to either fusidic acid or retapamulin, so topical mupirocin should be used in this situation. Extensive disease may require oral flucloxacillin or oral erythromycin if penicillin-allergic. The use of hydrogen peroxide 1% cream was recommended by NICE and Public Health England in 2020 to cut antibiotic resistance. The evidence base shows it is just as effective at treating non-bullous impetigo as a topical antibiotic.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      14.4
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  • Question 9 - Which one of the following forms the floor of the anatomical snuffbox? ...

    Incorrect

    • Which one of the following forms the floor of the anatomical snuffbox?

      Your Answer: Extensor pollicis brevis

      Correct Answer: Scaphoid bone

      Explanation:

      The anatomical snuffbox is situated above the scaphoid bone. The radial nerve’s cutaneous branch is located closer to the surface and closer to the center.

      The Anatomical Snuffbox: A Triangle on the Wrist

      The anatomical snuffbox is a triangular depression located on the lateral aspect of the wrist. It is bordered by tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscles, as well as the styloid process of the radius. The floor of the snuffbox is formed by the trapezium and scaphoid bones. The apex of the triangle is located distally, while the posterior border is formed by the tendon of the extensor pollicis longus. The radial artery runs through the snuffbox, making it an important landmark for medical professionals.

      In summary, the anatomical snuffbox is a small triangular area on the wrist that is bordered by tendons and bones. It is an important landmark for medical professionals due to the presence of the radial artery.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      42.9
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  • Question 10 - A 48-year-old woman presents to her GP with complaints of tiredness, increased urinary...

    Incorrect

    • A 48-year-old woman presents to her GP with complaints of tiredness, increased urinary frequency, constipation, and low back pain for the past 3 months. She has a 20-year history of smoking 1 pack of cigarettes per day and drinks socially. Her family is concerned about depression. On examination, her pulse is 72/min, and her blood pressure is 160/90 mmHg.

      The following are her lab results:

      - Na+ 140 mmol/L (135 - 145)
      - K+ 4.5 mmol/L (3.5 - 5.0)
      - Urea 2.5 mmol/L (2.0 - 7.0)
      - Creatinine 75 µmol/L (55 - 120)
      - PTH 19 pmol/L (0.8 - 8.5)
      - Vitamin D 35 nmol/L (> 25)
      - Serum calcium (corrected) X mmol/L (2.1-2.6)
      - Serum phosphate Y mmol/L (0.8-1.4)
      - Alkaline phosphatase Z umol/L (30-100)

      What are the possible values for X, Y, and Z in this patient?

      Your Answer: X = 2.5; Y = 1.1; Z = 45

      Correct Answer: X = 3.7; Y = 0.4; Z = 175

      Explanation:

      Primary hyperparathyroidism is indicated by elevated levels of serum calcium, decreased levels of serum phosphate, increased levels of ALP, and increased levels of PTH.

      Lab Values for Bone Disorders

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      12.4
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  • Question 11 - Mr. Johnson is a 65-year-old man who has had rheumatoid arthritis for 20...

    Incorrect

    • Mr. Johnson is a 65-year-old man who has had rheumatoid arthritis for 20 years. During his yearly check-up, he mentions experiencing difficulty while eating as his food feels very dry. Additionally, he has received comments about his cheeks appearing larger. Mr. Johnson has also developed a dry cough and a CT scan of his chest reveals early signs of bronchiectasis.

      What could be the possible reason for these new symptoms?

      Your Answer: Side effects of methotrexate

      Correct Answer: Sjogren's syndrome

      Explanation:

      Sjogren’s syndrome is the most appropriate answer as it can affect multiple systems of the body, including the lacrimal and salivary glands, which can lead to xerophthalmia and xerostomia. Additionally, it can predispose individuals to conditions such as COPD and bronchiectasis due to mucosal dryness. Early stages of bronchiectasis, early COPD, and parotitis are not the most appropriate answers as they do not fully explain the oral symptoms and other systemic manifestations associated with Sjogren’s syndrome.

      Understanding Sjogren’s Syndrome

      Sjogren’s syndrome is a medical condition that affects the exocrine glands, leading to dry mucosal surfaces. It can either be primary or secondary to other connective tissue disorders, such as rheumatoid arthritis. The condition is more common in females, with a ratio of 9:1. Patients with Sjogren’s syndrome have a higher risk of developing lymphoid malignancy, which is 40-60 times more likely than the general population.

      The symptoms of Sjogren’s syndrome include dry eyes, dry mouth, vaginal dryness, arthralgia, Raynaud’s, myalgia, sensory polyneuropathy, recurrent episodes of parotitis, and subclinical renal tubular acidosis. To diagnose the condition, doctors may perform a Schirmer’s test to measure tear formation, as well as check for the presence of rheumatoid factor, ANA, anti-Ro (SSA) antibodies, and anti-La (SSB) antibodies.

      Management of Sjogren’s syndrome involves the use of artificial saliva and tears, as well as medications like pilocarpine to stimulate saliva production. It is important for patients with Sjogren’s syndrome to receive regular medical care and monitoring to manage their symptoms and reduce the risk of complications.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      6.1
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  • Question 12 - Which nerve is in danger during removal of the submandibular gland? ...

    Incorrect

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

      Your Answer: Maxillary nerve

      Correct Answer: Marginal mandibular nerve

      Explanation:

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

      Anatomy of the Submandibular Gland

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

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

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      229.7
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  • Question 13 - A 6-year-old girl is brought to the clinic by her mother who is...

    Incorrect

    • A 6-year-old girl is brought to the clinic by her mother who is worried about her daughter's hearing loss. The girl has a history of frequent bone fractures. During the examination, the doctor observes that the external ear canal and tympanic membrane appear normal and there is no discharge or swelling. However, the girl's sclera has a bluish tint. What type of collagen is most likely affected in this case?

      Your Answer: Type 3

      Correct Answer: Type 1

      Explanation:

      Osteogenesis imperfecta is caused by a defect in type 1 collagen, which is found in the skin, tendons, vasculature, and bones. This abnormality results in fragile bones, leading to multiple fractures, as seen in a child with deafness, blue sclera, and fractures. Type 2 collagen is present in cartilage and is not typically affected in osteogenesis imperfecta. Type 3 collagen is the primary component of reticular fibers, which are also not typically affected in this condition. Type 4 collagen makes up basement membranes, which are also not typically affected in osteogenesis imperfecta.

      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.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      35.4
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  • Question 14 - Which of the following statements regarding psoriasis is inaccurate? ...

    Incorrect

    • Which of the following statements regarding psoriasis is inaccurate?

      Your Answer: Psoriatic arthropathy may occur prior to the development of skin lesions

      Correct Answer: Mediated by type 2 helper T cells

      Explanation:

      Psoriasis is caused by type 1 helper T cells that participate in the cellular immune response, as opposed to type 2 helper T cells.

      Psoriasis: A Chronic Skin Disorder with Various Subtypes and Complications

      Psoriasis is a prevalent chronic skin disorder that affects around 2% of the population. It is characterized by red, scaly patches on the skin, but it is now known that patients with psoriasis are at an increased risk of arthritis and cardiovascular disease. The pathophysiology of psoriasis is multifactorial and not yet fully understood. It is associated with genetic factors such as HLA-B13, -B17, and -Cw6, and abnormal T cell activity that stimulates keratinocyte proliferation. Environmental factors such as skin trauma, stress, streptococcal infection, and sunlight exposure can worsen, trigger, or improve psoriasis.

      There are several recognized subtypes of psoriasis, including plaque psoriasis, flexural psoriasis, guttate psoriasis, and pustular psoriasis. Each subtype has its own unique characteristics and affects different areas of the body. Psoriasis can also cause nail signs such as pitting and onycholysis, as well as arthritis.

      Complications of psoriasis include psoriatic arthropathy, metabolic syndrome, cardiovascular disease, venous thromboembolism, and psychological distress. It is important for patients with psoriasis to receive proper management and treatment to prevent these complications and improve their quality of life.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.8
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  • Question 15 - A 9-year-old child has been brought to the emergency department after falling onto...

    Incorrect

    • A 9-year-old child has been brought to the emergency department after falling onto their shoulder during a soccer game. They are experiencing pain across their shoulder and upper chest, which is most severe when the clavicular area is palpated. A visible bony deformity is present in the clavicular area. The physician suspects a fracture and orders an x-ray.

      What is the most probable location of the fracture?

      Your Answer: Distal third of the clavicle

      Correct Answer: Middle third of the clavicle

      Explanation:

      The most frequent location for clavicle fractures is the middle third, which is the weakest part of the bone and lacks any ligaments or muscles. This is especially common in young children. Fractures in the proximal and distal thirds are less frequent and therefore incorrect answers. While sternum fractures can occur in high-force trauma, the mechanism of injury and visible bony deformity in this case suggest a clavicular fracture. Acromion fractures are rare and would not result in the observed bony injury.

      Anatomy of the Clavicle

      The clavicle is a bone that runs from the sternum to the acromion and plays a crucial role in preventing the shoulder from falling forwards and downwards. Its inferior surface is marked by ligaments at each end, including the trapezoid line and conoid tubercle, which provide attachment to the coracoclavicular ligament. The costoclavicular ligament attaches to the irregular surface on the medial part of the inferior surface, while the subclavius muscle attaches to the intermediate portion’s groove.

      The superior part of the clavicle’s medial end has a raised surface that gives attachment to the clavicular head of sternocleidomastoid, while the posterior surface attaches to the sternohyoid. On the lateral end, there is an oval articular facet for the acromion, and a disk lies between the clavicle and acromion. The joint’s capsule attaches to the ridge on the margin of the facet.

      In summary, the clavicle is a vital bone that helps stabilize the shoulder joint and provides attachment points for various ligaments and muscles. Its anatomy is marked by distinct features that allow for proper function and movement.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      56.1
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  • Question 16 - A 78-year-old man complains of heartburn and indigestion for the past 3 weeks,...

    Incorrect

    • A 78-year-old man complains of heartburn and indigestion for the past 3 weeks, which he attributes to a new medication he started taking a few days ago. He has a medical history of hypertension, diabetes mellitus, osteoarthritis, right hip replacement, and recurrent falls. Which of the following medications could be causing his symptoms?

      Your Answer: Metformin

      Correct Answer: Alendronic acid

      Explanation:

      Oesophageal problems can be caused by bisphosphonates, which are commonly used to prevent and treat osteoporosis. These drugs can lead to gastrointestinal issues, including oesophagitis, which should prompt discontinuation of the medication. Long-term use of bisphosphonates can also result in atypical femoral fractures and osteonecrosis of the jaw. Therefore, patients should be periodically re-evaluated to assess the benefits and risks of continuing treatment, especially after five or more years of use. Before starting bisphosphonate treatment, patients should have a dental check-up and any necessary dental work should be performed.

      Gliclazide, a sulfonylurea drug, can cause hypoglycemia symptoms such as dizziness, lack of energy, drowsiness, headache, and sweating.

      Metformin is associated with lactic acidosis and gastrointestinal problems.

      Bisoprolol can cause erectile dysfunction, cold hands and feet, bradycardia, and hypotension.

      Paracetamol, unlike NSAIDs, is not known to cause indigestion.

      Bisphosphonates: Uses, Adverse Effects, and Patient Counselling

      Bisphosphonates are drugs that mimic the action of pyrophosphate, a molecule that helps prevent bone demineralization. They work by inhibiting osteoclasts, the cells responsible for breaking down bone tissue. Bisphosphonates are commonly used to prevent and treat osteoporosis, hypercalcemia, Paget’s disease, and pain from bone metastases.

      However, bisphosphonates can cause adverse effects such as oesophageal reactions, osteonecrosis of the jaw, and an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate. Patients may also experience an acute phase response, which includes fever, myalgia, and arthralgia following administration. Hypocalcemia may also occur due to reduced calcium efflux from bone, but this is usually clinically unimportant.

      To minimize the risk of adverse effects, patients taking oral bisphosphonates should swallow the tablets whole with plenty of water while sitting or standing. They should take the medication on an empty stomach at least 30 minutes before breakfast or another oral medication and remain upright for at least 30 minutes after taking the tablet. Hypocalcemia and vitamin D deficiency should be corrected before starting bisphosphonate treatment. However, calcium supplements should only be prescribed if dietary intake is inadequate when starting bisphosphonate treatment for osteoporosis. Vitamin D supplements are usually given.

      The duration of bisphosphonate treatment varies depending on the level of risk. Some experts recommend stopping bisphosphonates after five years if the patient is under 75 years old, has a femoral neck T-score of more than -2.5, and is at low risk according to FRAX/NOGG.

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  • Question 17 - A 65-year-old man is scheduled for a revisional total hip replacement via a...

    Correct

    • A 65-year-old man is scheduled for a revisional total hip replacement via a posterior approach. During the procedure, upon dividing the gluteus maximus along its fiber line, there is sudden arterial bleeding. Which vessel is most likely the source of the bleeding?

      Your Answer: Inferior gluteal artery

      Explanation:

      The internal iliac artery gives rise to the inferior gluteal artery, which travels along the deep side of the gluteus maximus muscle. This artery is often separated when using the posterior approach to the hip joint.

      Anatomy of the Hip Joint

      The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

      There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

      The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

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      • Musculoskeletal System And Skin
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  • Question 18 - A 23-year-old man is stabbed in the chest at the level of the...

    Correct

    • A 23-year-old man is stabbed in the chest at the level of the junction between the sternum and manubrium. What is the structure that is most vulnerable?

      Your Answer: Aortic arch

      Explanation:

      The aortic arch can be located at the Angle of Louis (Manubriosternal angle) on the surface. The oesophagus is situated at the back and is less susceptible to damage.

      The sternal angle is a significant anatomical landmark located at the level of the upper sternum and manubrium. It is characterized by several structures, including the upper part of the manubrium, left brachiocephalic vein, brachiocephalic artery, left common carotid, left subclavian artery, lower part of the manubrium, and costal cartilages of the 2nd ribs. Additionally, the sternal angle marks the transition point between the superior and inferior mediastinum, and is also associated with the arch of the aorta, tracheal bifurcation, union of the azygos vein and superior vena cava, and the crossing of the thoracic duct to the midline. Overall, the sternal angle is a crucial anatomical structure that serves as a reference point for various medical procedures and diagnoses.

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      • Musculoskeletal System And Skin
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  • Question 19 - A 25-year-old male patient is diagnosed with appendicitis and requires an appendicectomy. The...

    Incorrect

    • A 25-year-old male patient is diagnosed with appendicitis and requires an appendicectomy. The surgical procedure begins with a 5cm incision at McBurney's point. What is the first structure that will be encountered during the dissection?

      Your Answer: Transversalis fascia

      Correct Answer: External oblique aponeurosis

      Explanation:

      The rectus sheath is located more medially than the external oblique, which is encountered first. The external oblique muscle is the most superficial muscle of the abdominal wall and originates from the 5th to 12th ribs. It inserts into the linea alba, pubic tubercle, and anterior half of the iliac crest by passing inferomedially. The muscle is innervated by the thoracoabdominal nerves (T7-T11) and subcostal nerves.

      Muscles and Layers of the Abdominal Wall

      The abdominal wall is composed of various muscles and layers that provide support and protection to the organs within the abdominal cavity. The two main muscles of the abdominal wall are the rectus abdominis and the quadratus lumborum. The rectus abdominis is located anteriorly, while the quadratus lumborum is located posteriorly.

      The remaining abdominal wall is made up of three muscular layers, each passing from the lateral aspect of the quadratus lumborum to the lateral margin of the rectus sheath. These layers are muscular posterolaterally and aponeurotic anteriorly. The external oblique muscle lies most superficially and originates from the 5th to 12th ribs, inserting into the anterior half of the outer aspect of the iliac crest, linea alba, and pubic tubercle. The internal oblique arises from the thoracolumbar fascia, the anterior 2/3 of the iliac crest, and the lateral 2/3 of the inguinal ligament, while the transversus abdominis is the innermost muscle, arising from the inner aspect of the costal cartilages of the lower 6 ribs, the anterior 2/3 of the iliac crest, and the lateral 1/3 of the inguinal ligament.

      During abdominal surgery, it is often necessary to divide either the muscles or their aponeuroses. It is desirable to divide the aponeurosis during a midline laparotomy, leaving the rectus sheath intact above the arcuate line and the muscles intact below it. Straying off the midline can lead to damage to the rectus muscles, particularly below the arcuate line where they may be in close proximity to each other. The nerve supply for these muscles is the anterior primary rami of T7-12.

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  • Question 20 - Bob, a 52-year-old male, is recuperating on the orthopaedic ward after undergoing internal...

    Incorrect

    • Bob, a 52-year-old male, is recuperating on the orthopaedic ward after undergoing internal fixation of a tibia fracture. He suddenly reports a surge in pain in his lower limb.

      Given his recent medical history and the presence of a cast on his leg, the ward physician suspects the onset of compartment syndrome. Upon removing the cast, it is discovered that the intracompartmental pressure in the anterior compartment exceeds 30mmHg (a critical level).

      Considering the specific fascial compartment that is affected, which nerve is most likely to be at risk if emergency management is not promptly initiated?

      Your Answer: Tibial nerve

      Correct Answer: Deep peroneal nerve

      Explanation:

      The deep peroneal nerve is responsible for supplying the muscles in the anterior compartment of the lower leg. The superficial peroneal nerve, on the other hand, innervates the muscles in the lateral compartment of the lower leg, while the tibial nerve is responsible for innervating the muscles in the posterior compartment of the lower leg. Lastly, the lateral cutaneous nerve is responsible for innervating the skin in the lower leg.

      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.

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  • Question 21 - A 25-year-old male visits his primary care physician complaining of shoulder pain. He...

    Incorrect

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

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

      What is the precise location of the inflammation?

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

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

      Explanation:

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

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

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      • Musculoskeletal System And Skin
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  • Question 22 - A 36-year-old woman visits her GP complaining of a severe, itchy, red rash...

    Incorrect

    • 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: Topical emollient

      Correct 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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  • Question 23 - In pediatric patients with sickle cell disease, what is the most common causative...

    Incorrect

    • In pediatric patients with sickle cell disease, what is the most common causative organism of osteomyelitis?

      Your Answer: Group B Streptococcus species

      Correct Answer: Salmonella species

      Explanation:

      Salmonella is the most common infecting organism in children with osteomyelitis worldwide.

      Understanding Osteomyelitis: Types, Causes, and Treatment

      Osteomyelitis is a bone infection that can be classified into two types: haematogenous and non-haematogenous. Haematogenous osteomyelitis is caused by bacteria in the bloodstream and is usually monomicrobial. It is more common in children and can be caused by risk factors such as sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis is caused by the spread of infection from adjacent soft tissues or direct injury to the bone. It is often polymicrobial and more common in adults, with risk factors such as diabetic foot ulcers, pressure sores, diabetes mellitus, and peripheral arterial disease.

      Staphylococcus aureus is the most common cause of osteomyelitis, except in patients with sickle-cell anaemia where Salmonella species are more prevalent. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%.

      The treatment for osteomyelitis involves a course of antibiotics for six weeks. Flucloxacillin is the preferred antibiotic, but clindamycin can be used for patients who are allergic to penicillin. Understanding the types, causes, and treatment of osteomyelitis is crucial in managing this bone infection.

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      • Musculoskeletal System And Skin
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  • Question 24 - Which one of the following is not an intrinsic muscle of the foot?...

    Incorrect

    • Which one of the following is not an intrinsic muscle of the foot?

      Your Answer: Opponens pollicis

      Correct Answer: Palmaris longus

      Explanation:

      The origin of palmaris longus is in the forearm.

      Anatomy of the Hand: Fascia, Compartments, and Tendons

      The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

      The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

      The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

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      • Musculoskeletal System And Skin
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  • Question 25 - A 6-year-old girl falls and suffers a growth plate fracture in her left...

    Incorrect

    • A 6-year-old girl falls and suffers a growth plate fracture in her left wrist. What system is utilized to categorize the injury?

      Your Answer:

      Correct Answer: Salter - Harris system

      Explanation:

      The Salter-Harris system is widely utilized, but it can be problematic as Type 1 and Type 5 injuries may exhibit similar radiological indications. This is unfortunate because Type 5 injuries have poor outcomes and may go undetected.

      Genetic Conditions Causing Pathological Fractures

      Osteogenesis imperfecta and osteopetrosis are genetic conditions that can cause pathological fractures. Osteogenesis imperfecta is a congenital condition that results in defective osteoid formation, leading to a lack of intercellular substances like collagen and dentine. This can cause translucent bones, multiple fractures, particularly of the long bones, wormian bones, and a trefoil pelvis. There are four subtypes of osteogenesis imperfecta, each with varying levels of collagen quantity and quality.

      Osteopetrosis, on the other hand, causes bones to become harder and more dense. It is an autosomal recessive condition that is most common in young adults. Radiology can reveal a lack of differentiation between the cortex and the medulla, which is described as marble bone.

      It is important to consider these genetic conditions when evaluating paediatric fractures, especially if there is a delay in presentation, lack of concordance between the proposed and actual mechanism of injury, or injuries at sites not commonly exposed to trauma. Prompt diagnosis and management can help prevent further fractures and complications.

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  • Question 26 - A 32-year-old male patient visits his GP with a complaint of progressive weakness...

    Incorrect

    • A 32-year-old male patient visits his GP with a complaint of progressive weakness in his right arm for the past 3 months. He reports that he suffered a humerus fracture after a fall and has since experienced difficulty in straightening his arm, especially against resistance. Upon examination, his sensation is normal, but he exhibits significantly reduced extension in his forearm, wrist, and fingers.

      Which nerve is the most probable cause of the injury?

      Your Answer:

      Correct Answer: Radial nerve

      Explanation:

      The radial nerve supplies all the extensor muscles in the arm, and a recent humerus fracture in this patient may have caused damage to this nerve. Midshaft humeral fractures can put the radial nerve at risk as it travels down the arm in the radial groove on the surface of the humerus.

      In contrast, the axillary nerve is most commonly damaged in humeral head dislocations or fractures of the humeral neck, resulting in weakened shoulder abduction or reduced sensation in the inferior region of the deltoid muscle.

      The median nerve is typically affected at the wrist and is commonly injured in carpal tunnel syndrome. Symptoms of median nerve damage include weakened pronation (if injured at the elbow), paralysis of the thenar muscles (if injured at the wrist), or loss of sensation over the palmar aspect of the lateral 3½ fingers.

      Damage to the musculocutaneous nerve is rare and usually occurs as part of a larger injury to the brachial plexus. Symptoms of musculocutaneous nerve damage include weakened elbow flexion or loss of sensation to the lateral part of the forearm.

      Finally, a medial epicondyle fracture can damage the ulnar nerve, resulting in weakness of the majority of the intrinsic hand muscles or loss of sensation to the medial 1½ fingers.

      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.

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  • Question 27 - A 23-year-old individual presents to the emergency department with a gym-related injury. While...

    Incorrect

    • A 23-year-old individual presents to the emergency department with a gym-related injury. While lifting a heavy barbell off the floor, they experienced a hamstring pull. Upon examination, the doctor notes weak knee flexion facilitated by the biceps femoris muscle. The doctor suspects nerve damage to the nerves innervating the short and long head of biceps femoris. Which nerve specifically provides innervation to the short head of biceps femoris?

      Your Answer:

      Correct Answer: Common peroneal branch of sciatic nerve

      Explanation:

      The short head of biceps femoris receives innervation from the common peroneal division of the sciatic nerve. The superior gluteal nerve supplies the gluteus medius and minimus, while the inferior gluteal nerve supplies the gluteus maximus. The perineum is primarily supplied by the pudendal nerve.

      The Biceps Femoris Muscle

      The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.

      On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.

      Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.

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  • Question 28 - Which one of the following muscles does not attach to the radius? ...

    Incorrect

    • Which one of the following muscles does not attach to the radius?

      Your Answer:

      Correct Answer: Brachialis

      Explanation:

      The ulna serves as the insertion point for the brachialis muscle, while the remaining muscles are inserted onto the radius.

      Anatomy of the Radius Bone

      The radius bone is one of the two long bones in the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. It has two expanded ends, with the distal end being the larger one. The upper end of the radius bone has articular cartilage that covers the medial to lateral side and articulates with the radial notch of the ulna by the annular ligament. The biceps brachii muscle attaches to the tuberosity of the upper end.

      The shaft of the radius bone has several muscle attachments. The upper third of the body has the supinator, flexor digitorum superficialis, and flexor pollicis longus muscles. The middle third of the body has the pronator teres muscle, while the lower quarter of the body has the pronator quadratus muscle and the tendon of supinator longus.

      The lower end of the radius bone is quadrilateral in shape. The anterior surface is covered by the capsule of the wrist joint, while the medial surface has the head of the ulna. The lateral surface ends in the styloid process, and the posterior surface has three grooves that contain the tendons of extensor carpi radialis longus and brevis, extensor pollicis longus, and extensor indicis. Understanding the anatomy of the radius bone is crucial in diagnosing and treating injuries and conditions that affect this bone.

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  • Question 29 - A 50-year-old woman visits the rheumatology clinic due to worsening joint pain caused...

    Incorrect

    • A 50-year-old woman visits the rheumatology clinic due to worsening joint pain caused by her longstanding rheumatoid arthritis. Her symptoms have progressed to the point where she can no longer perform her daily activities. She is interested in trying infliximab after hearing about it from a friend and reading about it online. She wants to know how the drug works and how it can potentially alleviate her symptoms.

      What is the mechanism of action of infliximab?

      Your Answer:

      Correct Answer: Anti-TNF

      Explanation:

      Infliximab targets TNF through its monoclonal antibody action, while rituximab targets CD20, cetuximab acts as an antagonist to epidermal growth factor receptor, alemtuzumab targets CD52, and OKT3 targets CD3.

      Understanding Tumour Necrosis Factor and its Inhibitors

      Tumour necrosis factor (TNF) is a cytokine that plays a crucial role in the immune system. It is mainly secreted by macrophages and has various effects on the immune system, such as activating macrophages and neutrophils, acting as a costimulator for T cell activation, and mediating the body’s response to Gram-negative septicaemia. TNF also has anti-tumour effects and binds to both the p55 and p75 receptor, inducing apoptosis and activating NFkB.

      TNF has endothelial effects, including increased expression of selectins and production of platelet activating factor, IL-1, and prostaglandins. It also promotes the proliferation of fibroblasts and their production of protease and collagenase. TNF inhibitors are used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Examples of TNF inhibitors include infliximab, etanercept, adalimumab, and golimumab.

      Infliximab is also used to treat active Crohn’s disease unresponsive to steroids. However, TNF blockers can have adverse effects such as reactivation of latent tuberculosis and demyelination. Understanding TNF and its inhibitors is crucial in the treatment of various inflammatory conditions.

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  • Question 30 - A 65-year-old man visits his doctor with complaints of a painful rash on...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Neuralgia

      Explanation:

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

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

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