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  • Question 1 - What is the term used to describe the area between the vocal cords?...

    Incorrect

    • What is the term used to describe the area between the vocal cords?

      Your Answer: Glottis

      Correct Answer: Rima glottidis

      Explanation:

      The narrowest part of the laryngeal cavity is known as the rima glottidis.

      Anatomy of the Larynx

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

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

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      4.3
      Seconds
  • Question 2 - A 24-year-old man is being evaluated at the respiratory clinic for possible bronchiectasis....

    Correct

    • A 24-year-old man is being evaluated at the respiratory clinic for possible bronchiectasis. He has a history of recurrent chest infections since childhood and has difficulty maintaining a healthy weight. Despite using inhalers, he has not experienced any significant improvement. Genetic testing has been ordered to investigate the possibility of cystic fibrosis.

      What is the typical role of the cystic fibrosis transmembrane conductance regulator?

      Your Answer: Chloride channel

      Explanation:

      The chloride channel, specifically a cyclic-AMP regulated chloride channel, is the correct answer. Cystic fibrosis can be caused by various mutations, but they all affect the same gene, the cystic fibrosis transmembrane conductance regulator gene. This gene encodes a chloride channel that, when dysfunctional, results in increased viscosity of secretions and the development of cystic fibrosis.

      Understanding Cystic Fibrosis

      Cystic fibrosis is a genetic disorder that causes thickened secretions in the lungs and pancreas. It is an autosomal recessive condition that occurs due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which regulates a chloride channel. In the UK, 80% of CF cases are caused by delta F508 on chromosome 7, and the carrier rate is approximately 1 in 25.

      CF patients are at risk of colonization by certain organisms, including Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia (previously known as Pseudomonas cepacia), and Aspergillus. These organisms can cause infections and exacerbate symptoms in CF patients. It is important for healthcare providers to monitor and manage these infections to prevent further complications.

      Overall, understanding cystic fibrosis and its associated risks can help healthcare providers provide better care for patients with this condition.

    • This question is part of the following fields:

      • Respiratory System
      18.7
      Seconds
  • Question 3 - A 50-year-old female presents to her GP with complaints of shortness of breath...

    Correct

    • A 50-year-old female presents to her GP with complaints of shortness of breath and weakness during mild-moderate exercise. She reports that these episodes have been getting progressively worse and now often result in dizziness. The patient has no significant medical history but was a previous smoker for 15 years, smoking 15 cigarettes per day. Spirometry testing reveals a restrictive lung pattern. What is the most probable diagnosis?

      Your Answer: Myasthenia gravis

      Explanation:

      Myasthenia gravis can result in a restrictive pattern of lung disease due to weakness of the respiratory muscles, which causes difficulty in breathing air in. Asthma and COPD are incorrect as they cause an obstructive pattern on spirometry, with asthma being characterized by small bronchiole obstruction from inflammation and increased mucus production, and COPD causing small airway inflammation and emphysema that restricts outward airflow. Alpha-1 antitrypsin deficiency also leads to an obstructive pattern, as it results in pulmonary tissue degradation and panlobular emphysema.

      Understanding the Differences between Obstructive and Restrictive Lung Diseases

      Obstructive and restrictive lung diseases are two distinct categories of respiratory conditions that affect the lungs in different ways. Obstructive lung diseases are characterized by a reduction in the flow of air through the airways due to narrowing or blockage, while restrictive lung diseases are characterized by a decrease in lung volume or capacity, making it difficult to breathe in enough air.

      Spirometry is a common diagnostic tool used to differentiate between obstructive and restrictive lung diseases. In obstructive lung diseases, the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is less than 80%, indicating a reduced ability to exhale air. In contrast, restrictive lung diseases are characterized by an FEV1/FVC ratio greater than 80%, indicating a reduced ability to inhale air.

      Examples of obstructive lung diseases include chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema, while asthma and bronchiectasis are also considered obstructive. Restrictive lung diseases include intrapulmonary conditions such as idiopathic pulmonary fibrosis, extrinsic allergic alveolitis, and drug-induced fibrosis, as well as extrapulmonary conditions such as neuromuscular diseases, obesity, and scoliosis.

      Understanding the differences between obstructive and restrictive lung diseases is important for accurate diagnosis and appropriate treatment. While both types of conditions can cause difficulty breathing, the underlying causes and treatment approaches can vary significantly.

    • This question is part of the following fields:

      • Respiratory System
      34.4
      Seconds
  • Question 4 - A 24-year-old female arrives at the emergency department in a state of panic...

    Incorrect

    • A 24-year-old female arrives at the emergency department in a state of panic following a recent breakup with her partner. She complains of chest tightness and dizziness, fearing that she may be experiencing a heart attack. Upon examination, her vital signs are stable except for a respiratory rate of 34 breaths per minute. What compensatory mechanism is expected in response to the change in her oxyhaemoglobin dissociation curve, and what is the underlying cause?

      Your Answer: Left shift, respiratory acidosis

      Correct Answer: Left shift, respiratory alkalosis

      Explanation:

      The patient’s oxygen dissociation curve has shifted to the left, indicating respiratory alkalosis. This is likely due to the patient experiencing a panic attack and hyperventilating, leading to a decrease in carbon dioxide levels and an increase in the affinity of haemoglobin for oxygen. Respiratory acidosis, hypercapnia, and a right shift of the curve are not appropriate explanations for this patient’s condition.

      Understanding the Oxygen Dissociation Curve

      The oxygen dissociation curve is a graphical representation of the relationship between the percentage of saturated haemoglobin and the partial pressure of oxygen in the blood. It is not influenced by the concentration of haemoglobin. The curve can shift to the left or right, indicating changes in oxygen delivery to tissues. When the curve shifts to the left, there is increased saturation of haemoglobin with oxygen, resulting in decreased oxygen delivery to tissues. Conversely, when the curve shifts to the right, there is reduced saturation of haemoglobin with oxygen, leading to enhanced oxygen delivery to tissues.

      The L rule is a helpful mnemonic to remember the factors that cause a shift to the left, resulting in lower oxygen delivery. These factors include low levels of hydrogen ions (alkali), low partial pressure of carbon dioxide, low levels of 2,3-diphosphoglycerate, and low temperature. On the other hand, the mnemonic ‘CADET, face Right!’ can be used to remember the factors that cause a shift to the right, leading to raised oxygen delivery. These factors include carbon dioxide, acid, 2,3-diphosphoglycerate, exercise, and temperature.

      Understanding the oxygen dissociation curve is crucial in assessing the oxygen-carrying capacity of the blood and the delivery of oxygen to tissues. By knowing the factors that can shift the curve to the left or right, healthcare professionals can make informed decisions in managing patients with respiratory and cardiovascular diseases.

    • This question is part of the following fields:

      • Respiratory System
      50.9
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  • Question 5 - During a neck dissection, a nerve is observed to pass behind the medial...

    Correct

    • During a neck dissection, a nerve is observed to pass behind the medial aspect of the second rib. Which nerve from the list below is the most probable?

      Your Answer: Phrenic nerve

      Explanation:

      The crucial aspect to note is that the phrenic nerve travels behind the inner side of the first rib. Towards the top, it is situated on the exterior of scalenus anterior.

      The Phrenic Nerve: Origin, Path, and Supplies

      The phrenic nerve is a crucial nerve that originates from the cervical spinal nerves C3, C4, and C5. It supplies the diaphragm and provides sensation to the central diaphragm and pericardium. The nerve passes with the internal jugular vein across scalenus anterior and deep to the prevertebral fascia of the deep cervical fascia.

      The right phrenic nerve runs anterior to the first part of the subclavian artery in the superior mediastinum and laterally to the superior vena cava. In the middle mediastinum, it is located to the right of the pericardium and passes over the right atrium to exit the diaphragm at T8. On the other hand, the left phrenic nerve passes lateral to the left subclavian artery, aortic arch, and left ventricle. It passes anterior to the root of the lung and pierces the diaphragm alone.

      Understanding the origin, path, and supplies of the phrenic nerve is essential in diagnosing and treating conditions that affect the diaphragm and pericardium.

    • This question is part of the following fields:

      • Respiratory System
      21.6
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  • Question 6 - A patient in their 60s presents to surgical outpatients with diffuse abdominal pain....

    Incorrect

    • A patient in their 60s presents to surgical outpatients with diffuse abdominal pain. As a second-line imaging investigation, a CT scan is requested. The radiologist looks through the images to write the report. Which of the following would they expect to find at the level of the transpyloric plane (L1)?

      Your Answer: Adrenal glands

      Correct Answer: Hila of the kidneys

      Explanation:

      The hila of the kidneys are at the level of the transpyloric plane, with the left kidney slightly higher than the right. The adrenal glands sit just above the kidneys at the level of T12. The neck of the pancreas, not the body, is at the level of the transpyloric plane. The coeliac trunk originates at the level of T12 and the inferior mesenteric artery originates at L3.

      The Transpyloric Plane and its Anatomical Landmarks

      The transpyloric plane is an imaginary horizontal line that passes through the body of the first lumbar vertebrae (L1) and the pylorus of the stomach. It is an important anatomical landmark used in clinical practice to locate various organs and structures in the abdomen.

      Some of the structures that lie on the transpyloric plane include the left and right kidney hilum (with the left one being at the same level as L1), the fundus of the gallbladder, the neck of the pancreas, the duodenojejunal flexure, the superior mesenteric artery, and the portal vein. The left and right colic flexure, the root of the transverse mesocolon, and the second part of the duodenum also lie on this plane.

      In addition, the upper part of the conus medullaris (the tapered end of the spinal cord) and the spleen are also located on the transpyloric plane. Knowing the location of these structures is important for various medical procedures, such as abdominal surgeries and diagnostic imaging.

      Overall, the transpyloric plane serves as a useful reference point for clinicians to locate important anatomical structures in the abdomen.

    • This question is part of the following fields:

      • Respiratory System
      92.6
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  • Question 7 - A 50-year-old man with laryngeal cancer is undergoing a challenging laryngectomy. During the...

    Incorrect

    • A 50-year-old man with laryngeal cancer is undergoing a challenging laryngectomy. During the procedure, the surgeons cut the thyrocervical trunk. What vessel does this structure typically originate from?

      Your Answer: External carotid artery

      Correct Answer: Subclavian artery

      Explanation:

      The subclavian artery gives rise to the thyrocervical trunk, which emerges from the first part of the artery located between the inner border of scalenus anterior and the subclavian artery. The thyrocervical trunk branches off from the subclavian artery after the vertebral artery.

      Thoracic Outlet: Where the Subclavian Artery and Vein and Brachial Plexus Exit the Thorax

      The thoracic outlet is the area where the subclavian artery and vein and the brachial plexus exit the thorax and enter the arm. This passage occurs over the first rib and under the clavicle. The subclavian vein is the most anterior structure and is located immediately in front of scalenus anterior and its attachment to the first rib. Scalenus anterior has two parts, and the subclavian artery leaves the thorax by passing over the first rib and between these two portions of the muscle. At the level of the first rib, the lower cervical nerve roots combine to form the three trunks of the brachial plexus. The lowest trunk is formed by the union of C8 and T1, and this trunk lies directly posterior to the artery and is in contact with the superior surface of the first rib.

      Thoracic outlet obstruction can cause neurovascular compromise.

    • This question is part of the following fields:

      • Respiratory System
      15.4
      Seconds
  • Question 8 - A 10-year-old boy comes to your clinic with a complaint of ear pain...

    Correct

    • A 10-year-old boy comes to your clinic with a complaint of ear pain that started last night and kept him awake. He missed school today because of the pain and reports muffled sounds on the affected side. During otoscopy, you observe a bulging tympanic membrane with visible fluid behind it, indicating a middle ear infection. Can you identify which nerves pass through the middle ear?

      Your Answer: Chorda tympani

      Explanation:

      The chorda tympani is the correct answer. It is a branch of the seventh cranial nerve, the facial nerve, and carries parasympathetic and taste fibers. It passes through the middle ear before exiting and joining with the lingual nerve to reach the tongue and salivary glands.

      The vestibulocochlear nerve is the eighth cranial nerve and carries balance and hearing information.

      The maxillary nerve is the second division of the fifth cranial nerve and carries sensation from the upper teeth, nasal cavity, and skin.

      The mandibular nerve is the third division of the fifth cranial nerve and carries sensation from the lower teeth, tongue, mandible, and skin. It also carries motor fibers to certain muscles.

      The glossopharyngeal nerve is the ninth cranial nerve and carries taste and sensation from the posterior one-third of the tongue, as well as sensation from various areas. It also carries motor and parasympathetic fibers.

      The patient in the question has ear pain, likely due to otitis media, as evidenced by a bulging tympanic membrane and fluid level on otoscopy.

      Anatomy of the Ear

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

    • This question is part of the following fields:

      • Respiratory System
      17.3
      Seconds
  • Question 9 - A 35-year-old man arrives at the emergency department following an assault with a...

    Incorrect

    • A 35-year-old man arrives at the emergency department following an assault with a baseball bat. He has significant swelling around his eye, which has caused him to lose vision in that eye. A CT scan reveals a fracture in the floor of the orbit. This type of fracture creates an unusual connection between the orbit and which of the following facial regions?

      Your Answer: Frontal sinus

      Correct Answer: Maxillary sinus

      Explanation:

      The correct answer is the maxillary sinus, which is the largest of the paranasal air sinuses found in the maxillary bone below the orbit. Fractures of the orbit’s floor can lead to herniation of the orbital contents into the maxillary sinus. The ethmoidal air cells are smaller air cells in the ethmoid bone, separated from the orbit by a thin plate of bone called the lamina papyracea. Fractures of the medial wall of the orbit can lead to communication between the ethmoidal air cells and the orbit. The frontal sinuses are located in the frontal bones above the orbits and fractures of the roof of the orbit can lead to communication between the frontal sinus and orbit. The sphenoid sinuses are found in the sphenoid bone and are located in the posterior portion of the roof of the nasal cavity. The nasal cavity is located more medial and inferior than the orbits and is not adjacent to the orbit.

      Paranasal Air Sinuses and Carotid Sinus

      The paranasal air sinuses are air-filled spaces found in the bones of the skull. They are named after the bone in which they are located and all communicate with the nasal cavity. The four paired paranasal air sinuses are the frontal sinuses, maxillary sinuses, ethmoid air cells, and sphenoid sinuses. The frontal sinuses are located above each eye on the forehead, while the maxillary sinuses are the largest and found in the maxillary bone below the orbit. The ethmoidal air cells are a collection of smaller air cells located lateral to the anterior superior nasal cavity, while the sphenoid sinuses are found in the posterior portion of the roof of the nasal cavity.

      On the other hand, the carotid sinus is not a paranasal air sinus. It is a dilatation of the internal carotid artery, located just beyond the bifurcation of the common carotid artery. It contains baroreceptors that enable it to detect changes in arterial pressure.

      Overall, understanding the location and function of these sinuses and the carotid sinus is important in various medical procedures and conditions.

    • This question is part of the following fields:

      • Respiratory System
      42.5
      Seconds
  • Question 10 - A 35-year-old man is stabbed in the right chest and requires a thoracotomy....

    Incorrect

    • A 35-year-old man is stabbed in the right chest and requires a thoracotomy. During the procedure, the right lung is mobilized and the pleural reflection at the lung hilum is opened. Which of the following structures is not located in this area?

      Your Answer: Pulmonary artery

      Correct Answer: Azygos vein

      Explanation:

      The pulmonary ligament extends from the pleural reflections surrounding the hilum of the lung and covers the pulmonary vessels and bronchus. However, it does not contain the azygos vein.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      17.4
      Seconds
  • Question 11 - A 68-year-old man arrives at the Emergency Department complaining of sharp and stabbing...

    Incorrect

    • A 68-year-old man arrives at the Emergency Department complaining of sharp and stabbing central chest pain that radiates to his back, neck, and left shoulder. He reports feeling feverish and states that sitting forward relieves the pain while lying down worsens it. The patient also mentions a recent hospitalization for a heart attack three weeks ago. During auscultation at the left sternal border, a scratchy sound is heard while the patient leans forward and holds his breath. His ECG shows widespread ST-segment saddle elevation and PR-segment depression. Can you identify the nerve responsible for his shoulder pain?

      Your Answer: Vagus nerve

      Correct Answer: Phrenic nerve

      Explanation:

      The referred pain to the shoulder in this case is likely caused by Dressler’s syndrome, a type of pericarditis that occurs after a heart attack. The scratchy sound heard during auscultation is a pericardial friction rub, which is a common characteristic of pericarditis. The phrenic nerve, which supplies the pericardium, travels from the neck down through the thoracic cavity and can cause referred pain to the shoulder in cases of pericarditis.

      The axillary nerve is responsible for innervating the teres minor and deltoid muscles, and dysfunction of this nerve can result in loss of sensation or movement in the shoulder area.

      While the accessory nerve does innervate muscles in the neck that attach to the shoulder, it has a purely motor function and is not responsible for sensory input. Additionally, the referred pain in this case is not typical of musculoskeletal pain, but rather a result of pericarditis.

      Injuries involving the long thoracic nerve often result in winging of the scapula and are commonly caused by axillary surgery.

      Although the vagus nerve does supply parasympathetic innervation to the heart, it is not responsible for the referred pain in this case, as the pericardium is innervated by the phrenic nerve.

      The Phrenic Nerve: Origin, Path, and Supplies

      The phrenic nerve is a crucial nerve that originates from the cervical spinal nerves C3, C4, and C5. It supplies the diaphragm and provides sensation to the central diaphragm and pericardium. The nerve passes with the internal jugular vein across scalenus anterior and deep to the prevertebral fascia of the deep cervical fascia.

      The right phrenic nerve runs anterior to the first part of the subclavian artery in the superior mediastinum and laterally to the superior vena cava. In the middle mediastinum, it is located to the right of the pericardium and passes over the right atrium to exit the diaphragm at T8. On the other hand, the left phrenic nerve passes lateral to the left subclavian artery, aortic arch, and left ventricle. It passes anterior to the root of the lung and pierces the diaphragm alone.

      Understanding the origin, path, and supplies of the phrenic nerve is essential in diagnosing and treating conditions that affect the diaphragm and pericardium.

    • This question is part of the following fields:

      • Respiratory System
      96.2
      Seconds
  • Question 12 - A 35-year-old pregnant woman undergoes an ABG test. What is the anticipated outcome...

    Incorrect

    • A 35-year-old pregnant woman undergoes an ABG test. What is the anticipated outcome for a healthy pregnant woman?

      Your Answer: Compensated metabolic acidosis

      Correct Answer: Compensated respiratory alkalosis

      Explanation:

      During pregnancy, a woman’s increased tidal volume leads to a decrease in carbon dioxide levels, resulting in alkalosis. This is because carbon dioxide generates acid, and reduced levels of it lead to a decrease in acid. The kidneys eventually adapt to this change by reducing the amount of alkaline bicarbonate in the body. Therefore, pregnancy causes a compensated respiratory alkalosis.

      If a woman’s bicarbonate levels remain normal, she would have simple respiratory alkalosis.

      On the other hand, if a woman produces excess acid, she would have metabolic acidosis, which is the opposite of what occurs during pregnancy.

      Arterial Blood Gas Interpretation: A 5-Step Approach

      Arterial blood gas interpretation is a crucial aspect of patient care, particularly in critical care settings. The Resuscitation Council (UK) recommends a 5-step approach to interpreting arterial blood gas results. The first step is to assess the patient’s overall condition. The second step is to determine if the patient is hypoxaemic, with a PaO2 on air of less than 10 kPa. The third step is to assess if the patient is acidaemic (pH <7.35) or alkalaemic (pH >7.45).

      The fourth step is to evaluate the respiratory component of the arterial blood gas results. A PaCO2 level greater than 6.0 kPa suggests respiratory acidosis, while a PaCO2 level less than 4.7 kPa suggests respiratory alkalosis. The fifth step is to assess the metabolic component of the arterial blood gas results. A bicarbonate level less than 22 mmol/l or a base excess less than -2mmol/l suggests metabolic acidosis, while a bicarbonate level greater than 26 mmol/l or a base excess greater than +2mmol/l suggests metabolic alkalosis.

      To remember the relationship between pH, PaCO2, and bicarbonate, the acronym ROME can be used. Respiratory acidosis or alkalosis is opposite to the pH level, while metabolic acidosis or alkalosis is equal to the pH level. This 5-step approach and the ROME acronym can aid healthcare professionals in interpreting arterial blood gas results accurately and efficiently.

    • This question is part of the following fields:

      • Respiratory System
      82.5
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  • Question 13 - A 25-year-old female presents to the emergency department with complaints of shortness of...

    Incorrect

    • A 25-year-old female presents to the emergency department with complaints of shortness of breath that started 2 hours ago. She has no medical history. The results of her arterial blood gas (ABG) test are as follows:

      Normal range
      pH: 7.49 (7.35 - 7.45)
      pO2: 12.2 (10 - 14)kPa
      pCO2: 3.4 (4.5 - 6.0)kPa
      HCO3: 22 (22 - 26)mmol/l
      BE: +2 (-2 to +2)mmol/l

      Her temperature is 37ºC, and her pulse is 98 beats/minute and regular. Based on this information, what is the most likely diagnosis?

      Your Answer: Cerebrovascular accident

      Correct Answer: Anxiety hyperventilation

      Explanation:

      The patient is exhibiting symptoms and ABG results consistent with respiratory alkalosis. However, it is important to conduct a thorough history and physical examination to rule out any underlying pulmonary pathology or infection. Based on the patient’s history, anxiety-induced hyperventilation is the most probable cause of her condition.

      Respiratory Alkalosis: Causes and Examples

      Respiratory alkalosis is a condition that occurs when the blood pH level rises above the normal range due to excessive breathing. This can be caused by various factors, including anxiety, pulmonary embolism, CNS disorders, altitude, and pregnancy. Salicylate poisoning can also lead to respiratory alkalosis, but it may also cause metabolic acidosis in the later stages. In this case, the respiratory centre is stimulated early, leading to respiratory alkalosis, while the direct acid effects of salicylates combined with acute renal failure may cause acidosis later on. It is important to identify the underlying cause of respiratory alkalosis to determine the appropriate treatment. Proper management can help prevent complications and improve the patient’s overall health.

    • This question is part of the following fields:

      • Respiratory System
      19.7
      Seconds
  • Question 14 - A 75-year-old man presents to the Emergency Department with acute shortness of breath...

    Incorrect

    • A 75-year-old man presents to the Emergency Department with acute shortness of breath following a 4-day febrile illness. On initial assessment, his oxygen saturation is 70% on room air with a PaO2 of 4.2kpa on an arterial blood gas.

      What would be the anticipated physiological response in this patient?

      Your Answer: Increased tidal volume with decreased respiratory rate

      Correct Answer: Pulmonary artery vasoconstriction

      Explanation:

      When faced with hypoxia, the pulmonary arteries undergo vasoconstriction, which redirects blood flow away from poorly oxygenated areas of the lungs and towards well-oxygenated regions. In cases where patients remain hypoxic despite optimal mechanical ventilation, inhaled nitric oxide can be used to induce pulmonary vasodilation and reverse this response.

      The statement that increased tidal volume with decreased respiratory rate is a response to hypoxia is incorrect. While an increase in tidal volume may occur, it is typically accompanied by an increase in respiratory rate.

      Pulmonary artery vasodilation is also incorrect. Hypoxia actually induces vasoconstriction in the pulmonary vasculature, as explained above.

      Similarly, reduced tidal volume with increased respiratory rate is not a direct response to hypoxia. While respiratory rate may increase, tidal volumes typically increase in response to hypoxia.

      In contrast to the pulmonary vessels, the systemic vasculature vasodilates in response to hypoxia.

      The Effects of Hypoxia on Pulmonary Arteries

      When the partial pressure of oxygen in the blood decreases, the pulmonary arteries undergo vasoconstriction. This means that the blood vessels narrow, allowing blood to be redirected to areas of the lung that are better aerated. This response is a natural mechanism that helps to improve the efficiency of gaseous exchange in the lungs. By diverting blood to areas with more oxygen, the body can ensure that the tissues receive the oxygen they need to function properly. Overall, hypoxia triggers a physiological response that helps to maintain homeostasis in the body.

    • This question is part of the following fields:

      • Respiratory System
      63.8
      Seconds
  • Question 15 - A 29-year-old man visits his GP with a complaint of a persistent cough....

    Incorrect

    • A 29-year-old man visits his GP with a complaint of a persistent cough. He reports coughing up large amounts of yellow sputum and occasionally blood on a daily basis for the past few years. Lately, he has noticed that his clothes seem loose on him and he frequently feels fatigued.

      What is the most probable underlying condition responsible for this patient's symptoms?

      Your Answer: Goodpasture's disease

      Correct Answer: Kartagener's syndrome

      Explanation:

      Kartagener’s syndrome is a condition that can lead to bronchiectasis due to a defect in the cilia, which impairs the lungs’ ability to clear mucus. Bronchiectasis is diagnosed when a person produces large amounts of sputum daily, experiences haemoptysis, and loses weight. While other conditions may cause tiredness, weight loss, or haemoptysis, they are not typically associated with bronchiectasis.

      Understanding Kartagener’s Syndrome

      Kartagener’s syndrome, also known as primary ciliary dyskinesia, is a rare genetic disorder that was first described in 1933. It is often associated with dextrocardia, which can be detected through quiet heart sounds and small volume complexes in lateral leads during examinations. The pathogenesis of Kartagener’s syndrome is caused by a dynein arm defect, which results in immotile cilia.

      The features of Kartagener’s syndrome include dextrocardia or complete situs inversus, bronchiectasis, recurrent sinusitis, and subfertility. The latter is due to diminished sperm motility and defective ciliary action in the fallopian tubes. It is important to note that Kartagener’s syndrome is a rare disorder, and diagnosis can be challenging. However, early detection and management can help improve the quality of life for those affected by this condition.

    • This question is part of the following fields:

      • Respiratory System
      37.1
      Seconds
  • Question 16 - A 35-year-old woman presents with sudden chest pain and difficulty breathing. She recently...

    Incorrect

    • A 35-year-old woman presents with sudden chest pain and difficulty breathing. She recently returned from a trip to Italy with her family. She has no significant medical history but takes oral contraceptives. On examination, her pulse is 100 bpm, temperature is 37°C, oxygen saturation is 95%, respiratory rate is 28/min, and blood pressure is 116/76 mmHg. Chest examination is unremarkable and chest x-ray is normal. What is the most appropriate diagnostic test to confirm the diagnosis?

      Your Answer: Blood cultures

      Correct Answer: CT pulmonary angiogram (CTPA)

      Explanation:

      Diagnosis of Pulmonary Embolism in a Woman with Chest Pain and Dyspnoea

      This woman is experiencing chest pain and difficulty breathing, with a rapid heart rate and breathing rate. However, there are no visible signs on chest examination and her chest x-ray appears normal. Despite having no fever, her oxygen levels are lower than expected for a healthy person. To rule out a pulmonary embolism, doctors must consider risk factors such as recent air travel and use of oral contraceptives.

      The gold standard for diagnosing a pulmonary embolism is a CT pulmonary angiogram, as it can detect even large saddle embolus near the pulmonary arteries. While VQ scanning was previously used, it can miss these larger emboli. Additionally, doctors may perform Doppler ultrasounds of the venous system to check for deep vein thrombosis.

      This presentation is not indicative of atypical pneumonia, such as Legionella, as the patient’s temperature would be expected to be high and chest signs would be present. Overall, a thorough evaluation is necessary to accurately diagnose and treat a pulmonary embolism in a patient with chest pain and dyspnoea.

    • This question is part of the following fields:

      • Respiratory System
      81.6
      Seconds
  • Question 17 - A 25-year-old man is shot in the chest during a robbery. The right...

    Incorrect

    • A 25-year-old man is shot in the chest during a robbery. The right lung is lacerated and is bleeding. An emergency thoracotomy is performed. The surgeons place a clamp over the hilum of the right lung. Which one of the following structures lies most anteriorly at this level?

      Your Answer: Azygos vein

      Correct Answer: Phrenic nerve

      Explanation:

      At this location, the phrenic nerve is situated in front. The vagus nerve runs in front and then curves backwards just above the base of the left bronchus, releasing the recurrent laryngeal nerve as it curves.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      44.3
      Seconds
  • Question 18 - A 43-year-old woman comes to the respiratory clinic for an outpatient appointment. She...

    Incorrect

    • A 43-year-old woman comes to the respiratory clinic for an outpatient appointment. She has been experiencing increased breathlessness, particularly at night. Her medical history includes long-standing COPD, heart failure, and previous breast cancer that was treated with a mastectomy and radiotherapy. She used to smoke 20 cigarettes a day for 22 years but has since quit.

      During the examination, her respiratory rate is 23/min, oxygen saturation is 93%, blood pressure is 124/98mmHg, and temperature is 37.2ºC. A gas transfer test is performed, and her transfer factor is found to be low.

      What is the most likely diagnosis?

      Your Answer: Asthma

      Correct Answer: Pulmonary oedema

      Explanation:

      TLCO, also known as transfer factor, is a measurement of how quickly gas can move from a person’s lungs into their bloodstream. To test TLCO, a patient inhales a mixture of carbon monoxide and a tracer gas, holds their breath for 10 seconds, and then exhales forcefully. The exhaled gas is analyzed to determine how much tracer gas was absorbed during the 10-second period.

      A high TLCO value is associated with conditions such as asthma, pulmonary hemorrhage, left-to-right cardiac shunts, polycythemia, hyperkinetic states, male gender, and exercise. Conversely, most other conditions result in a low TLCO value, including pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary edema, emphysema, and anemia.

      Understanding Transfer Factor in Lung Function Testing

      The transfer factor is a measure of how quickly a gas diffuses from the alveoli into the bloodstream. This is typically tested using carbon monoxide, and the results can be given as either the total gas transfer (TLCO) or the transfer coefficient corrected for lung volume (KCO). A raised TLCO may be caused by conditions such as asthma, pulmonary haemorrhage, left-to-right cardiac shunts, polycythaemia, hyperkinetic states, male gender, or exercise. On the other hand, a lower TLCO may be indicative of pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary oedema, emphysema, anaemia, or low cardiac output.

      KCO tends to increase with age, and certain conditions may cause an increased KCO with a normal or reduced TLCO. These conditions include pneumonectomy/lobectomy, scoliosis/kyphosis, neuromuscular weakness, and ankylosis of costovertebral joints (such as in ankylosing spondylitis). Understanding transfer factor is important in lung function testing, as it can provide valuable information about a patient’s respiratory health and help guide treatment decisions.

    • This question is part of the following fields:

      • Respiratory System
      22.8
      Seconds
  • Question 19 - A 20-year-old female presented to the hospital with a complaint of a sore...

    Correct

    • A 20-year-old female presented to the hospital with a complaint of a sore throat. She reported having a high-grade fever and severe pain on the right side of her throat for the past four days. The patient also experienced difficulty in swallowing and had restricted mouth opening. Additionally, she complained of bilateral ear pain and headache. Despite receiving oral antibiotics, her symptoms had worsened.

      Upon examination, the patient had a fever of 38.5ºC and prominent cervical lymphadenopathy. Swelling of the right soft palate was observed, and the uvula was deviated to the left.

      What is the most probable diagnosis?

      Your Answer: Peritonsillar abscess (quinsy)

      Explanation:

      Trismus, which is difficulty in opening the mouth, is a common symptom of peritonsillar abscess (also known as quinsy). It is important to note that quinsy is a complication of tonsillitis, not acute tonsillitis itself. Epiglottitis may present with muffled voice, drooling, and difficulty in breathing, while infectious mononucleosis is associated with other symptoms such as weight loss, fatigue, and enlarged lymph nodes and organs.

      Peritonsillar Abscess: Symptoms and Treatment

      A peritonsillar abscess, also known as quinsy, is a complication that can arise from bacterial tonsillitis. This condition is characterized by severe throat pain that is localized to one side, along with difficulty opening the mouth and reduced neck mobility. Additionally, the uvula may be deviated to the unaffected side. It is important to seek urgent medical attention from an ENT specialist if these symptoms are present.

      The treatment for a peritonsillar abscess typically involves needle aspiration or incision and drainage, along with intravenous antibiotics. In some cases, a tonsillectomy may be recommended to prevent recurrence of the abscess. It is important to follow the recommended treatment plan and attend all follow-up appointments to ensure proper healing and prevent complications.

    • This question is part of the following fields:

      • Respiratory System
      44.6
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  • Question 20 - A 70-year-old man with lung cancer is having a left pneumonectomy. The left...

    Incorrect

    • A 70-year-old man with lung cancer is having a left pneumonectomy. The left main bronchus is being divided. Which thoracic vertebrae is located behind this structure?

      Your Answer: T1

      Correct Answer: T6

      Explanation:

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      35.8
      Seconds
  • Question 21 - Which one of the following would cause a rise in the carbon monoxide...

    Correct

    • Which one of the following would cause a rise in the carbon monoxide transfer factor (TLCO)?

      Your Answer: Pulmonary haemorrhage

      Explanation:

      When alveolar haemorrhage takes place, the TLCO typically rises as a result of the increased absorption of carbon monoxide by haemoglobin within the alveoli.

      Understanding Transfer Factor in Lung Function Testing

      The transfer factor is a measure of how quickly a gas diffuses from the alveoli into the bloodstream. This is typically tested using carbon monoxide, and the results can be given as either the total gas transfer (TLCO) or the transfer coefficient corrected for lung volume (KCO). A raised TLCO may be caused by conditions such as asthma, pulmonary haemorrhage, left-to-right cardiac shunts, polycythaemia, hyperkinetic states, male gender, or exercise. On the other hand, a lower TLCO may be indicative of pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary oedema, emphysema, anaemia, or low cardiac output.

      KCO tends to increase with age, and certain conditions may cause an increased KCO with a normal or reduced TLCO. These conditions include pneumonectomy/lobectomy, scoliosis/kyphosis, neuromuscular weakness, and ankylosis of costovertebral joints (such as in ankylosing spondylitis). Understanding transfer factor is important in lung function testing, as it can provide valuable information about a patient’s respiratory health and help guide treatment decisions.

    • This question is part of the following fields:

      • Respiratory System
      57.7
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  • Question 22 - A 56-year-old woman comes to the clinic complaining of a persistent cough and...

    Incorrect

    • A 56-year-old woman comes to the clinic complaining of a persistent cough and increased production of sputum over the past year. She also reports feeling fatigued and experiencing shortness of breath. The patient mentions having had four chest infections in the last 12 months, all of which were treated with antibiotics. She has no personal or family history of lung issues and has never smoked.

      The healthcare provider suspects that bronchiectasis may be the underlying cause of her symptoms and orders appropriate tests.

      Which test is most likely to provide a definitive diagnosis?

      Your Answer: Chest radiography

      Correct Answer: High-resolution computerised tomography

      Explanation:

      Bronchiectasis can be diagnosed through various methods, including chest radiography, histopathology, and pulmonary function tests.

      Chest radiography can reveal thickened bronchial walls, cystic lesions with fluid levels, collapsed areas with crowded pulmonary vasculature, and scarring, which are characteristic features of bronchiectasis.

      Histopathology, which is a more invasive investigation often done through autopsy or surgery, can show irreversible dilation of bronchial airways and bronchial wall thickening.

      However, high-resolution computerised tomography is a more favorable imaging technique as it is less invasive than histopathology.

      Pulmonary function tests are commonly used to diagnose bronchiectasis, but they should be used in conjunction with other investigations as they are not sensitive or specific enough to provide sufficient diagnostic evidence on their own. An obstructive pattern is the most common pattern encountered, but a restrictive pattern is also possible.

      Understanding the Causes of Bronchiectasis

      Bronchiectasis is a condition characterized by the permanent dilation of the airways due to chronic inflammation or infection. There are various factors that can lead to this condition, including post-infective causes such as tuberculosis, measles, pertussis, and pneumonia. Cystic fibrosis, bronchial obstruction caused by lung cancer or foreign bodies, and immune deficiencies like selective IgA and hypogammaglobulinaemia can also contribute to bronchiectasis. Additionally, allergic bronchopulmonary aspergillosis (ABPA), ciliary dyskinetic syndromes like Kartagener’s syndrome and Young’s syndrome, and yellow nail syndrome are other potential causes. Understanding the underlying causes of bronchiectasis is crucial in developing effective treatment plans for patients.

    • This question is part of the following fields:

      • Respiratory System
      15.5
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  • Question 23 - A 7-year-old boy is brought to the clinic by his father, who is...

    Incorrect

    • A 7-year-old boy is brought to the clinic by his father, who is worried about his son's hearing. The father has noticed that his son frequently asks him to repeat himself and tends to turn up the volume on the TV. During Weber's test, the patient indicates that the sound is louder on the right side. What conclusion can be drawn from this finding?

      Your Answer: Conductive hearing loss of left ear.

      Correct Answer: Can not tell which side is affected.

      Explanation:

      The Weber test alone cannot determine which side of the patient’s hearing is affected. The test involves placing a tuning fork on the forehead and asking the patient to report if the sound is symmetrical or louder on one side. If the sound is louder on the left side, it could indicate a conductive hearing loss on the left or a sensorineural hearing loss on the right. To obtain more information, the Weber test should be performed in conjunction with the Rinne test, which involves comparing air conduction and bone conduction.

      Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

      Rinne’s and Weber’s tests are used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test indicates that BC is better than AC, suggesting conductive deafness.

      Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking the patient which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

      The table below summarizes the interpretation of Rinne and Weber tests. A normal result indicates that AC is greater than BC bilaterally and the sound is midline. Conductive hearing loss is indicated by BC being greater than AC in the affected ear and AC being greater than BC in the unaffected ear, with the sound lateralizing to the affected ear. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, with the sound lateralizing to the unaffected ear.

      Overall, Rinne’s and Weber’s tests are useful tools for differentiating between conductive and sensorineural deafness, allowing for appropriate management and treatment.

    • This question is part of the following fields:

      • Respiratory System
      20.3
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  • Question 24 - A 33-year-old male presents to the ED with coughing and wheezing following an...

    Incorrect

    • A 33-year-old male presents to the ED with coughing and wheezing following an episode of alcohol intoxication. Upon examination, decreased breath sounds are noted on one side. Imaging reveals a foreign body obstructing an airway structure. What is the most probable location for this foreign body to be lodged?

      Your Answer: Left mainstem bronchus

      Correct Answer: Right mainstem bronchus

      Explanation:

      It is rare for a foreign object to become lodged in the left mainstem bronchus due to its greater angle compared to the right mainstem bronchus. A tracheal obstruction would cause reduced breath sounds bilaterally, not just on one side. The right superior lobar bronchus is also unlikely to be affected due to its angle and direction. Therefore, foreign bodies typically get stuck in the right mainstem bronchus in adults because of its wider diameter and lesser angle.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      80.1
      Seconds
  • Question 25 - Which one of the following is true regarding the phrenic nerves? ...

    Correct

    • Which one of the following is true regarding the phrenic nerves?

      Your Answer: They both lie anterior to the hilum of the lungs

      Explanation:

      The phrenic nerves, located in the anterior region of the lung’s hilum, play a crucial role in keeping the diaphragm functioning properly. These nerves have both sensory and motor functions, and any issues in the sub diaphragmatic area may result in referred pain in the shoulder.

      The Phrenic Nerve: Origin, Path, and Supplies

      The phrenic nerve is a crucial nerve that originates from the cervical spinal nerves C3, C4, and C5. It supplies the diaphragm and provides sensation to the central diaphragm and pericardium. The nerve passes with the internal jugular vein across scalenus anterior and deep to the prevertebral fascia of the deep cervical fascia.

      The right phrenic nerve runs anterior to the first part of the subclavian artery in the superior mediastinum and laterally to the superior vena cava. In the middle mediastinum, it is located to the right of the pericardium and passes over the right atrium to exit the diaphragm at T8. On the other hand, the left phrenic nerve passes lateral to the left subclavian artery, aortic arch, and left ventricle. It passes anterior to the root of the lung and pierces the diaphragm alone.

      Understanding the origin, path, and supplies of the phrenic nerve is essential in diagnosing and treating conditions that affect the diaphragm and pericardium.

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      • Respiratory System
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  • Question 26 - A 52-year-old woman visited her family physician with complaints of pain in her...

    Incorrect

    • A 52-year-old woman visited her family physician with complaints of pain in her wrist and small joints of the hand. She mentioned that her joints felt stiff in the morning but improved throughout the day. The doctor prescribed glucocorticoids and methotrexate, which helped alleviate her symptoms. After a year, she returned to her doctor with a dry cough and shortness of breath that had been bothering her for a month. She denied any recent weight loss or coughing up blood. She is a non-smoker and drinks alcohol moderately. The woman has no significant medical or surgical history and has been a homemaker while her husband works in a shipyard. Her father died of a heart attack at the age of 77. What is the most likely finding on her chest X-ray?

      Your Answer: Central bronchial opacity around the hilar region

      Correct Answer: Intrapulmonary nodules

      Explanation:

      1. Caplan syndrome is a condition characterized by intrapulmonary nodules found peripherally and bilaterally in individuals with both pneumoconiosis and rheumatoid arthritis. The immune system changes associated with rheumatoid arthritis are thought to affect the body’s response to coal dust particles, leading to the development of nodules.
      2. A normal chest X-ray does not rule out the possibility of underlying respiratory disease. If there is a high clinical suspicion, further investigation should be pursued to confirm or rule out potential diagnoses, such as asthma.
      3. Chronic obstructive respiratory disease, which includes chronic bronchitis and emphysema, is characterized by hyperinflated lungs and a flattened diaphragm on chest X-ray. This is due to the loss of elastic recoil in the lungs and airway obstruction caused by inflammation of the bronchi.
      4. Silicosis is a restrictive lung disease that develops in individuals exposed to silica, such as sandblasters and those working in silica mines. Eggshell calcification of hilar lymph nodes is a characteristic finding on chest X-ray.
      5. Squamous cell carcinoma of the lungs, a non-small cell type of lung cancer, is associated with a central bronchial opacity around the hilar region on chest X-ray. This type of cancer is more common in smokers and may be accompanied by hypercalcemia as a paraneoplastic syndrome.

      Respiratory Manifestations of Rheumatoid Arthritis

      Patients with rheumatoid arthritis may experience a range of respiratory problems. These can include pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, and pleurisy. Additionally, drug therapy for rheumatoid arthritis, such as methotrexate, can lead to complications like pneumonitis. In some cases, patients may develop Caplan’s syndrome, which involves the formation of massive fibrotic nodules due to occupational coal dust exposure. Finally, immunosuppression caused by rheumatoid arthritis treatment can increase the risk of infection, including atypical infections. Overall, it is important for healthcare providers to be aware of these potential respiratory complications in patients with rheumatoid arthritis.

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      • Respiratory System
      14.3
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  • Question 27 - Which one of the following muscles is supplied by the external laryngeal nerve?...

    Correct

    • Which one of the following muscles is supplied by the external laryngeal nerve?

      Your Answer: Cricothyroid

      Explanation:

      Anatomy of the Larynx

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

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

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

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

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

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      • Respiratory System
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  • Question 28 - A 28-year-old female patient presents to your clinic seeking help to quit smoking....

    Incorrect

    • A 28-year-old female patient presents to your clinic seeking help to quit smoking. Despite several attempts in the past, she has been unsuccessful. She has a medical history of bipolar disorder and well-managed epilepsy, for which she takes lamotrigine. She currently smokes 15 cigarettes per day and is especially interested in the health benefits of quitting smoking since she has recently found out that she is pregnant. As her physician, you decide to prescribe a suitable medication to assist her in her efforts. What would be the most appropriate treatment option?

      Your Answer:

      Correct Answer: Nicotine gum

      Explanation:

      Standard treatments for nicotine dependence do not include amitriptyline, fluoxetine, or gabapentin. Nicotine replacement therapy (NRT) can be helpful for motivated patients, but it is not a cure for addiction and may require multiple attempts. Bupropion and varenicline are other smoking cessation aids, but they have multiple side effects and may not be suitable for all patients. NICE guidelines recommend discussing the best method of smoking cessation with the patient, but NRT is considered safer in pregnancy.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 29 - Sophie, a 4-year-old patient with Down's syndrome, is brought to the general practitioner...

    Incorrect

    • Sophie, a 4-year-old patient with Down's syndrome, is brought to the general practitioner by her father. He is worried as Sophie has been crying more than usual and has started holding her right ear. She is diagnosed with acute bacterial otitis media.

      What is the most probable bacteria responsible for this infection?

      Your Answer:

      Correct Answer: Haemophilus influenzae

      Explanation:

      Haemophilus influenzae is a frequent culprit behind bacterial otitis media, a common ear infection.

      The majority of cases of acute bacterial otitis media are caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella.

      Genital gonorrhoeae is caused by N. gonorrhoeae, a sexually transmitted infection that presents with discharge and painful urination.

      Meningococcal sepsis, a life-threatening condition, is caused by N. meningitides.

      Staph. aureus is responsible for superficial skin infections like impetigo.

      Syphilis, which typically manifests as a painless genital sore called a chancre, is caused by T. pallidum.

      Acute otitis media is a common condition in young children, often caused by bacterial infections following viral upper respiratory tract infections. Symptoms include ear pain, fever, and hearing loss, and diagnosis is based on criteria such as the presence of a middle ear effusion and inflammation of the tympanic membrane. Antibiotics may be prescribed in certain cases, and complications can include perforation of the tympanic membrane, hearing loss, and more serious conditions such as meningitis and brain abscess.

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      • Respiratory System
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  • Question 30 - A 19-year-old male is admitted with acute asthma. He has been treated with...

    Incorrect

    • A 19-year-old male is admitted with acute asthma. He has been treated with steroid, bronchodilators and 15 l/min of oxygen.

      His pulse rate is 125/min, oxygen saturation 89%, respiratory rate 24/min, blood pressure 140/88 mmHg and he has a peak flow rate of 150 l/min. On auscultation of his chest, he has bilateral wheezes.

      Arterial blood gas (ABG) result taken on 15 l/min oxygen shows:

      pH 7.42 (7.36-7.44)
      PaO2 8.4 kPa (11.3-12.6)
      PaCO2 5.3 kPa (4.7-6.0)
      Standard HCO3 19 mmol/L (20-28)
      Base excess −4 (+/-2)
      Oxygen saturation 89%

      What is the most appropriate action for this man?

      Your Answer:

      Correct Answer: Call ITU to consider intubation

      Explanation:

      Urgent Need for Ventilation in Life-Threatening Asthma

      This patient is experiencing life-threatening asthma with a dangerously low oxygen saturation level of less than 92%. Despite having a normal PaCO2 level, the degree of hypoxia is inappropriate and requires immediate consideration for ventilation. The arterial blood gas (ABG) result is consistent with the clinical presentation, making a venous blood sample unnecessary. Additionally, the ABG and bedside oxygen saturation readings are identical, indicating an arterialised sample.

      It is crucial to note that in cases of acute asthma, reducing the amount of oxygen below the maximum available is not recommended. Hypoxia can be fatal and must be addressed promptly. Therefore, urgent intervention is necessary to ensure the patient’s safety and well-being.

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      • Respiratory System
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SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory System (14/27) 52%
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