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  • Question 1 - A senior woman with a history of chronic obstructive pulmonary disease (COPD) arrives...

    Correct

    • A senior woman with a history of chronic obstructive pulmonary disease (COPD) arrives at the hospital complaining of worsening shortness of breath and a productive cough. As part of the initial evaluation, a chest X-ray is requested.

      What radiographic feature would you anticipate observing on her chest X-ray?

      Your Answer: Flattened diaphragm

      Explanation:

      The diaphragm of patients with COPD often appears flattened on a chest X-ray due to the chronic expiratory airflow obstruction causing dynamic hyperinflation of the lungs. Pleural effusions are commonly associated with infection, malignancy, or heart failure, while empyema is a result of pus accumulation in the pleural space caused by an infection.

      Understanding COPD: Symptoms and Diagnosis

      Chronic obstructive pulmonary disease (COPD) is a common medical condition that includes chronic bronchitis and emphysema. Smoking is the leading cause of COPD, and patients with mild disease may only need occasional use of a bronchodilator, while severe cases may result in frequent hospital admissions due to exacerbations. Symptoms of COPD include a productive cough, dyspnea, wheezing, and in severe cases, right-sided heart failure leading to peripheral edema.

      To diagnose COPD, doctors may recommend post-bronchodilator spirometry to demonstrate airflow obstruction, a chest x-ray to check for hyperinflation, bullae, and flat hemidiaphragm, and to exclude lung cancer. A full blood count may also be necessary to exclude secondary polycythemia, and body mass index (BMI) calculation is important. The severity of COPD is categorized using the FEV1, with a ratio of less than 70% indicating airflow obstruction. The grading system has changed following the 2010 NICE guidelines, with Stage 1 – mild now including patients with an FEV1 greater than 80% predicted but with a post-bronchodilator FEV1/FVC ratio of less than 0.7. Measuring peak expiratory flow is of limited value in COPD, as it may underestimate the degree of airflow obstruction.

      In summary, COPD is a common condition caused by smoking that can result in a range of symptoms and severity. Diagnosis involves various tests to check for airflow obstruction, exclude lung cancer, and determine the severity of the disease.

    • This question is part of the following fields:

      • Respiratory System
      11.2
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  • Question 2 - A 30-year-old female complains of weakness, weight gain, and cold intolerance. You suspect...

    Correct

    • A 30-year-old female complains of weakness, weight gain, and cold intolerance. You suspect hypothyroidism. What vocal change would you anticipate to have occurred, increasing the probability of this potential diagnosis?

      Your Answer: Hoarse voice

      Explanation:

      Hoarseness is a symptom that can be caused by hypothyroidism.

      When a patient presents with hoarseness, it can be difficult to determine the underlying cause. However, if the hoarseness is accompanied by other symptoms commonly associated with hypothyroidism, it can help narrow down the diagnosis.

      The reason for the voice change in hypothyroidism is due to the thickening of the vocal cords caused by the accumulation of mucopolysaccharide. This substance, also known as glycosaminoglycans, is found throughout the body in mucus and joint fluid. When it builds up in the vocal cords, it can lower the pitch of the voice. The thyroid hormone plays a role in preventing this buildup.

      Hoarseness can be caused by various factors such as overusing the voice, smoking, viral infections, hypothyroidism, gastro-oesophageal reflux, laryngeal cancer, and lung cancer. It is important to investigate the underlying cause of hoarseness, and a chest x-ray may be necessary to rule out any apical lung lesions.

      If laryngeal cancer is suspected, it is recommended to refer the patient to an ENT specialist through a suspected cancer pathway. This referral should be considered for individuals who are 45 years old and above and have persistent unexplained hoarseness or an unexplained lump in the neck. Early detection and treatment of laryngeal cancer can significantly improve the patient’s prognosis.

    • This question is part of the following fields:

      • Respiratory System
      162.2
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  • Question 3 - A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During...

    Correct

    • A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During examination, granulation tissue is observed in the external auditory meatus. What is the probable causative agent of the infection?

      Your Answer: Pseudomonas aeruginosa

      Explanation:

      The primary cause of malignant otitis externa is typically Pseudomonas aeruginosa. Symptoms of this condition include intense pain, headaches, and the presence of granulation tissue in the external auditory meatus. Individuals with diabetes mellitus are at a higher risk for developing this condition.

      Malignant Otitis Externa: A Rare but Serious Infection

      Malignant otitis externa is a type of ear infection that is uncommon but can be serious. It is typically found in individuals who are immunocompromised, with 90% of cases occurring in diabetics. The infection starts in the soft tissues of the external auditory meatus and can progress to involve the soft tissues and bony ear canal, eventually leading to temporal bone osteomyelitis.

      Key features in the patient’s history include diabetes or immunosuppression, severe and persistent ear pain, temporal headaches, and purulent otorrhea. In some cases, patients may also experience dysphagia, hoarseness, and facial nerve dysfunction.

      Diagnosis is typically done through a CT scan, and non-resolving otitis externa with worsening pain should be referred urgently to an ENT specialist. Treatment involves intravenous antibiotics that cover pseudomonal infections.

      In summary, malignant otitis externa is a rare but serious infection that requires prompt diagnosis and treatment. Patients with diabetes or immunosuppression should be particularly vigilant for symptoms and seek medical attention if they experience persistent ear pain or other related symptoms.

    • This question is part of the following fields:

      • Respiratory System
      7.1
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  • Question 4 - A 55-year-old woman comes to your clinic seeking help to quit smoking. She...

    Correct

    • A 55-year-old woman comes to your clinic seeking help to quit smoking. She has been using nicotine patches for 6 months but has not been successful in her attempts. You decide to prescribe bupropion.

      What is a typical side effect of bupropion?

      Your Answer: Gastrointestinal disturbance

      Explanation:

      Side Effects of Buproprion

      Buproprion is a medication that can cause aggression and hallucination in some patients. However, the more common side effects are gastrointestinal disturbances such as diarrhoea, nausea, and dry mouth. These side effects are often experienced by patients taking buproprion. It is important to be aware of the potential side effects of any medication and to speak with a healthcare provider if any concerns arise. Additional information on buproprion and its potential side effects can be found in the electronic Medicines Compendium and Medicines Complete.

    • This question is part of the following fields:

      • Respiratory System
      13.7
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  • Question 5 - During a radical neck dissection, at what age would division of which of...

    Incorrect

    • During a radical neck dissection, at what age would division of which of the following fascial layers expose the ansa cervicalis?

      Your Answer: Investing layer of fascia

      Correct Answer: Pretracheal fascia

      Explanation:

      To access the ansa cervicalis, one must cut through the pretracheal fascia on the posterolateral side of the thyroid gland. This nerve is located in front of the carotid sheath. However, it should be noted that the pre vertebral fascia is situated further back and cannot be reached by dividing the investing layer of fascia.

      The ansa cervicalis is a nerve that provides innervation to the sternohyoid, sternothyroid, and omohyoid muscles. It is composed of two roots: the superior root, which branches off from C1 and is located anterolateral to the carotid sheath, and the inferior root, which is derived from the C2 and C3 roots and passes posterolateral to the internal jugular vein. The inferior root enters the inferior aspect of the strap muscles, which are located in the neck, and should be divided in their upper half when exposing a large goitre. The ansa cervicalis is situated in front of the carotid sheath and is an important nerve for the proper functioning of the neck muscles.

    • This question is part of the following fields:

      • Respiratory System
      6.1
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  • Question 6 - How many fissures can be found in the right lung?

    At what age...

    Incorrect

    • How many fissures can be found in the right lung?

      At what age do these fissures typically develop?

      Your Answer: Three

      Correct Answer: Two

      Explanation:

      The oblique and horizontal fissures are present in the right lung. The lower lobe is separated from the middle and upper lobes by the upper oblique fissure. The superior and middle lobes are separated by the short horizontal fissure.

      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
      4.3
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  • Question 7 - A 9-year-old boy is rushed to the emergency department following a fish bone...

    Incorrect

    • A 9-year-old boy is rushed to the emergency department following a fish bone choking incident during dinner. The patient is not experiencing any airway obstruction and has been given sufficient pain relief.

      After being referred for laryngoscopy, a fish bone is discovered in the piriform recess. What is the potential structure that could be harmed due to the location of the fish bone?

      Your Answer: External laryngeal nerve

      Correct Answer: Internal laryngeal nerve

      Explanation:

      Foreign objects lodged in the piriform recess can cause damage to the internal laryngeal nerve, which is in close proximity to this area. The internal laryngeal nerve is responsible for providing sensation to the laryngeal mucosa. The ansa cervicalis, external laryngeal nerve, glossopharyngeal nerve, and superior laryngeal nerve are not at high risk of injury from foreign bodies in the piriform recess.

      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
      14.6
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  • Question 8 - A 6-year-old girl is playing with some small ball bearings. Regrettably, she inhales...

    Incorrect

    • A 6-year-old girl is playing with some small ball bearings. Regrettably, she inhales one. In which of the following lung regions is the ball expected to settle?

      Your Answer: Right upper lobe

      Correct Answer: Right lower lobe

      Explanation:

      Due to the angle of the right main bronchus from the trachea, small objects are more likely to get stuck in the most dependent part of the right lung. This makes the right lung the preferred location for most objects to enter.

      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
      3
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  • Question 9 - A 70-year-old man is admitted to the respiratory ward with an exacerbation of...

    Incorrect

    • A 70-year-old man is admitted to the respiratory ward with an exacerbation of COPD. He has been experiencing increased breathlessness and a productive cough for the past week. He is currently on day three of his rescue medication regimen consisting of amoxicillin and prednisolone. According to his previous discharge summary, this patient has a history of carbon dioxide retention. He is currently receiving controlled oxygen therapy via a 28% venturi mask. What is the target oxygen saturation level for this patient?

      Your Answer:

      Correct Answer: 88%-92%

      Explanation:

      As a junior doctor, you will often encounter patients who retain carbon dioxide and depend on their hypoxic drive to breathe. When using Venturi masks to deliver controlled oxygen, it is important to set a target that balances the patient’s need for oxygen with their reliance on hypoxia to stimulate breathing. Answer 4 is the correct choice in this scenario. Providing too much oxygen, as in answers 2 and 3, can cause the patient to lose their hypoxic drive and become drowsy or confused. Answer 5 does not provide enough oxygen to properly perfuse the tissues. Failing to set a target for these patients is not good clinical practice.

      Guidelines for Oxygen Therapy in Emergency Situations

      In 2017, the British Thoracic Society updated its guidelines for emergency oxygen therapy. The guidelines state that in critically ill patients, such as those experiencing anaphylaxis or shock, oxygen should be administered through a reservoir mask at a rate of 15 liters per minute. However, certain conditions, such as stable myocardial infarction, are excluded from this recommendation.

      The guidelines also provide specific oxygen saturation targets for different patient populations. Acutely ill patients should have a saturation level between 94-98%, while patients at risk of hypercapnia, such as those with COPD, should have a saturation level between 88-92%. Oxygen levels should be reduced in stable patients with satisfactory oxygen saturation.

      For COPD patients, a 28% Venturi mask at 4 liters per minute should be used prior to the availability of blood gases. The target oxygen saturation level for these patients should be 88-92% if they have risk factors for hypercapnia but no prior history of respiratory acidosis. If the patient’s pCO2 is normal, the target range should be adjusted to 94-98%.

      The guidelines also state that oxygen therapy should not be used routinely in certain situations where there is no evidence of hypoxia, such as in cases of myocardial infarction, acute coronary syndromes, stroke, obstetric emergencies, and anxiety-related hyperventilation.

      Overall, these guidelines provide important recommendations for the appropriate use of oxygen therapy in emergency situations, taking into account the specific needs of different patient populations.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 10 - A 65-year-old woman comes to the clinic complaining of fever and productive cough...

    Incorrect

    • A 65-year-old woman comes to the clinic complaining of fever and productive cough for the past two days. She spends most of her time at home watching TV and rarely goes outside. She has no recent travel history. The patient has a history of gastroesophageal reflux disease but has not been compliant with medication and follow-up appointments. Upon physical examination, crackles are heard on the left lower lobe, and her sputum is described as 'red-currant jelly.'

      What is the probable causative organism in this case?

      Your Answer:

      Correct Answer: Klebsiella pneumoniae

      Explanation:

      The patient’s history of severe gastro-oesophageal reflux disease (GORD) suggests that she may have aspiration pneumonia, particularly as she had not received appropriate treatment for it. Aspiration of gastric contents is likely to occur in the right lung due to the steep angle of the right bronchus. Klebsiella pneumoniae is a common cause of aspiration pneumonia and is known to produce ‘red-currant jelly’ sputum.

      Mycoplasma pneumoniae is a cause of atypical pneumonia, which typically presents with a non-productive cough and clear lung sounds on auscultation. It is more common in younger individuals.

      Burkholderia pseudomallei is the causative organism for melioidosis, a condition that is transmitted through exposure to contaminated water or soil, and is more commonly found in Southeast Asia. However, given the patient’s sedentary lifestyle and lack of travel history, it is unlikely to be the cause of her symptoms.

      Streptococcus pneumoniae is the most common cause of pneumonia, but it typically produces yellowish-green sputum rather than the red-currant jelly sputum seen in Klebsiella pneumoniae infections. It also presents with fever, productive cough, and crackles on auscultation.

      Understanding Klebsiella Pneumoniae

      Klebsiella pneumoniae is a type of bacteria that is commonly found in the gut flora of humans. However, it can also cause various infections such as pneumonia and urinary tract infections. It is more prevalent in individuals who have alcoholism or diabetes. Aspiration is a common cause of pneumonia caused by Klebsiella pneumoniae. One of the distinct features of this type of pneumonia is the production of red-currant jelly sputum. It usually affects the upper lobes of the lungs.

      The prognosis for Klebsiella pneumoniae infections is not good. It often leads to the formation of lung abscesses and empyema, which can be fatal. The mortality rate for this type of infection is between 30-50%.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 11 - A 60-year-old diabetic patient presents to the clinic with a chief complaint of...

    Incorrect

    • A 60-year-old diabetic patient presents to the clinic with a chief complaint of hearing loss. After conducting a Webber’s and Rinne’s test, the following results were obtained:

      - Webber’s test: lateralizes to the left ear
      - Rinne’s test (left ear): bone conduction > air conduction
      - Rinne’s test (right ear): air conduction > bone conduction

      Based on these findings, what is the probable cause of the patient's hearing loss?

      Your Answer:

      Correct Answer: Otitis media with effusion

      Explanation:

      The Weber test lateralises to the side with bone conduction > air conduction, indicating conductive hearing loss on that side. The options given include acoustic neuroma (sensorineural hearing loss), otitis media with effusion (conductive hearing loss), temporal lobe epilepsy (no conductive hearing loss), and Meniere’s disease (vertigo, tinnitus, and fluctuating hearing loss). The correct answer is otitis media with effusion.

      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
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  • Question 12 - A 44-year-old male singer visits his GP complaining of a hoarse voice that...

    Incorrect

    • A 44-year-old male singer visits his GP complaining of a hoarse voice that has persisted for a few weeks. He first noticed it after his thyroidectomy. Upon reviewing his post-thyroidectomy report, it was noted that he experienced a complication related to external laryngeal nerve injury. Which muscle's loss of innervation could be responsible for this patient's symptoms?

      Your Answer:

      Correct Answer: Cricothyroid

      Explanation:

      The external laryngeal nerve is responsible for innervating the cricothyroid muscle. If this nerve is injured, it can result in paralysis of the cricothyroid muscle, which is often referred to as the tuning fork of the larynx. This can cause hoarseness in the patient. However, over time, the other muscles will compensate for the paralysis, and the hoarseness will improve. It is important to note that the recurrent laryngeal nerve is responsible for innervating the rest of the muscles.

      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
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  • Question 13 - A 55-year-old woman comes to the clinic complaining of a persistent cough and...

    Incorrect

    • A 55-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 medical or family history and has never smoked.

      The healthcare provider suspects that bronchiectasis may be the underlying cause of her symptoms and orders appropriate tests, including a sputum sample.

      What is the most likely organism to be identified?

      Your Answer:

      Correct Answer:

      Explanation:

      Bronchiectasis patients may have various bacteria present in their respiratory system, with Haemophilus influenzae and Pseudomonas aeruginosa being the most common. Staphylococcus aureus has also been found but not as frequently. Respiratory syncytial virus has not been detected in acute exacerbations of bronchiectasis. It is crucial to identify the specific bacteria causing exacerbations as antibiotic sensitivity patterns differ, and sputum culture results can impact the effectiveness of treatment. These findings are outlined in the British Thoracic Society’s guideline for non-CF bronchiectasis and a study by Metaxas et al. on the role of atypical bacteria and respiratory syncytial virus in bronchiectasis exacerbations.

      Bronchiectasis is a condition where the airways become permanently dilated due to chronic inflammation or infection. Before treatment, it is important to identify any underlying causes that can be addressed, such as immune deficiencies. Management of bronchiectasis includes physical training, such as inspiratory muscle training, which has been shown to be effective for patients without cystic fibrosis. Postural drainage, antibiotics for exacerbations, and long-term rotating antibiotics for severe cases are also recommended. Bronchodilators may be used in selected cases, and immunizations are important to prevent infections. Surgery may be considered for localized disease. The most common organisms isolated from patients with bronchiectasis include Haemophilus influenzae, Pseudomonas aeruginosa, Klebsiella spp., and Streptococcus pneumoniae.

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      • Respiratory System
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  • Question 14 - A 20-year-old female presented to the hospital with a complaint of a sore...

    Incorrect

    • 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:

      Correct 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.

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      • Respiratory System
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  • Question 15 - 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:

      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
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  • Question 16 - A 25-year-old woman visits the outpatient department with concerns of eyelid drooping, double...

    Incorrect

    • A 25-year-old woman visits the outpatient department with concerns of eyelid drooping, double vision, shortness of breath, and rapid breathing. These symptoms typically occur in the evening or after physical activity.

      What respiratory condition could be causing her symptoms?

      Your Answer:

      Correct Answer: Restrictive lung disease

      Explanation:

      The presence of myasthenia gravis can result in a restrictive pattern of lung disease due to weakened chest wall muscles, leading to incomplete expansion during inhalation.

      Occupational lung disease, also known as pneumoconioses, is caused by inhaling specific types of dust particles in the workplace, resulting in a restrictive pattern of lung disease. However, symptoms such as drooping eyelids and double vision are typically not associated with this condition.

      Pneumonia is an infection of the lung tissue that typically presents with symptoms such as coughing, chest pain, fever, and difficulty breathing.

      Pulmonary embolism is an acute condition that presents with symptoms such as chest pain, shortness of breath, and coughing up blood.

      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.

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      • Respiratory System
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  • Question 17 - A 29-year-old man comes to your clinic with a complaint of ear pain...

    Incorrect

    • A 29-year-old man comes to your clinic with a complaint of ear pain that has been bothering him for the past 2 days. He reports no hearing loss or discharge and feels generally healthy. During the physical examination, you observe that he has no fever. When you palpate the tragus of the affected ear, he experiences pain. Upon otoscopy, you notice that the external auditory canal is red. The tympanic membrane is not bulging, and there is no visible fluid level. Which bone can you see pressing against the tympanic membrane?

      Your Answer:

      Correct Answer: Malleus

      Explanation:

      The ossicle that is in contact with the tympanic membrane is called the malleus. The middle ear contains three bones known as ossicles, which are arranged from lateral to medial. The malleus is the most lateral ossicle and its handle and lateral process attach to the tympanic membrane, making it visible during otoscopy. The head of the malleus articulates with the incus. The incus is located between the other two ossicles and articulates with both. The body of the incus articulates with the malleus, while the long limb of the bone articulates with the stapes. The Latin word for ‘hammer’ is used to describe the malleus, while the Latin word for ‘anvil’ is used to describe the incus.

      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.

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  • Question 18 - Which one of the following is not a cause of increased anion gap...

    Incorrect

    • Which one of the following is not a cause of increased anion gap acidosis?

      Your Answer:

      Correct Answer: Acetazolamide

      Explanation:

      Causes of anion gap acidosis can be remembered using the acronym MUDPILES, which stands for Methanol, Uraemia, DKA/AKA, Paraldehyde/phenformin, Iron/INH, Lactic acidosis, Ethylene glycol, and Salicylates.

      Disorders of Acid-Base Balance

      The acid-base nomogram is a useful tool for categorizing the various disorders of acid-base balance. Metabolic acidosis is the most common surgical acid-base disorder, characterized by a reduction in plasma bicarbonate levels. This can be caused by a gain of strong acid or loss of base, and is classified according to the anion gap. A normal anion gap indicates hyperchloraemic metabolic acidosis, which can be caused by gastrointestinal bicarbonate loss, renal tubular acidosis, drugs, or Addison’s disease. A raised anion gap indicates lactate, ketones, urate, or acid poisoning. Metabolic alkalosis, on the other hand, is usually caused by a rise in plasma bicarbonate levels due to a loss of hydrogen ions or a gain of bicarbonate. It is mainly caused by problems of the kidney or gastrointestinal tract. Respiratory acidosis is characterized by a rise in carbon dioxide levels due to alveolar hypoventilation, while respiratory alkalosis is caused by hyperventilation resulting in excess loss of carbon dioxide. These disorders have various causes, such as COPD, sedative drugs, anxiety, hypoxia, and pregnancy.

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  • Question 19 - A 67-year-old man has been diagnosed with stage III lung cancer and is...

    Incorrect

    • A 67-year-old man has been diagnosed with stage III lung cancer and is concerned about potential complications. What are the risks he may face?

      Your Answer:

      Correct Answer: Pneumothorax

      Explanation:

      Pneumothorax is more likely to occur in individuals with lung cancer.

      Pneumothorax: Characteristics and Risk Factors

      Pneumothorax is a medical condition characterized by the presence of air in the pleural cavity, which is the space between the lungs and the chest wall. This condition can occur spontaneously or as a result of trauma or medical procedures. There are several risk factors associated with pneumothorax, including pre-existing lung diseases such as COPD, asthma, cystic fibrosis, lung cancer, and Pneumocystis pneumonia. Connective tissue diseases like Marfan’s syndrome and rheumatoid arthritis can also increase the risk of pneumothorax. Ventilation, including non-invasive ventilation, can also be a risk factor.

      Symptoms of pneumothorax tend to come on suddenly and can include dyspnoea, chest pain (often pleuritic), sweating, tachypnoea, and tachycardia. In some cases, catamenial pneumothorax can be the cause of spontaneous pneumothoraces occurring in menstruating women. This type of pneumothorax is thought to be caused by endometriosis within the thorax. Early diagnosis and treatment of pneumothorax are crucial to prevent complications and improve outcomes.

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  • Question 20 - A 55-year-old man is admitted to the ICU after emergency surgery for an...

    Incorrect

    • A 55-year-old man is admitted to the ICU after emergency surgery for an abdominal aortic aneurysm. He presents with abdominal pain and diarrhea and is in a critical condition. Despite the absence of peritonism, which of the following arterial blood gas patterns is most likely to be observed?

      Your Answer:

      Correct Answer: pH 7.20, pO2 9.0, pCO2 3.5, Base excess -10, Lactate 8

      Explanation:

      It is probable that this individual is experiencing metabolic acidosis as a result of a mesenteric infarction.

      Disorders of Acid-Base Balance

      The acid-base nomogram is a useful tool for categorizing the various disorders of acid-base balance. Metabolic acidosis is the most common surgical acid-base disorder, characterized by a reduction in plasma bicarbonate levels. This can be caused by a gain of strong acid or loss of base, and is classified according to the anion gap. A normal anion gap indicates hyperchloraemic metabolic acidosis, which can be caused by gastrointestinal bicarbonate loss, renal tubular acidosis, drugs, or Addison’s disease. A raised anion gap indicates lactate, ketones, urate, or acid poisoning. Metabolic alkalosis, on the other hand, is usually caused by a rise in plasma bicarbonate levels due to a loss of hydrogen ions or a gain of bicarbonate. It is mainly caused by problems of the kidney or gastrointestinal tract. Respiratory acidosis is characterized by a rise in carbon dioxide levels due to alveolar hypoventilation, while respiratory alkalosis is caused by hyperventilation resulting in excess loss of carbon dioxide. These disorders have various causes, such as COPD, sedative drugs, anxiety, hypoxia, and pregnancy.

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  • Question 21 - A 36-year-old man presents to his GP with symptoms of vertigo. He reports...

    Incorrect

    • A 36-year-old man presents to his GP with symptoms of vertigo. He reports that he has been experiencing constant dizziness for the past 2 days, which has prevented him from going to work. He also reports hearing difficulties and tinnitus in his right ear, as well as nausea and difficulty with balance. He notes that these symptoms are not related to changes in position. He has no significant medical history, except for a recent bout of flu that resolved on its own.

      During the examination, the man is observed to sway to the right while attempting to walk in a straight line. He also has a positive head thrust test to the right side. A complete neurological examination is performed, and aside from mild sensorineural hearing loss in the right ear, his neurological function is normal.

      Which structures are most likely involved in this man's condition?

      Your Answer:

      Correct Answer: Vestibular nerve and labyrinth

      Explanation:

      The patient is displaying symptoms of labyrinthitis, which affects both the vestibular nerve and labyrinth, resulting in vertigo and hearing impairment. In contrast, pure vestibular neuritis only causes vestibular symptoms without affecting hearing. Benign paroxysmal positional vertigo (BPPV) involves otolith displacement and is triggered by head position changes, which is not the case for this patient’s constant vertigo. Facial nerve palsy primarily causes facial drooping and does not affect hearing or vestibular function, making it an unlikely diagnosis for this patient.

      Understanding Viral Labyrinthitis

      Labyrinthitis is a condition that affects the membranous labyrinth, which includes the vestibular and cochlear end organs. It can be caused by a viral or bacterial infection, or it may be associated with systemic diseases. Viral labyrinthitis is the most common form of the condition.

      It’s important to distinguish labyrinthitis from vestibular neuritis, which only affects the vestibular nerve and doesn’t cause hearing impairment. Labyrinthitis, on the other hand, affects both the vestibular nerve and the labyrinth, resulting in both vertigo and hearing loss.

      The condition typically affects people between the ages of 40 and 70 and is characterized by an acute onset of symptoms, including vertigo, nausea and vomiting, hearing loss, and tinnitus. Patients may also experience gait disturbance and fall towards the affected side.

      Diagnosis is based on a patient’s history and examination, which may reveal spontaneous unidirectional horizontal nystagmus towards the unaffected side, sensorineural hearing loss, and an abnormal head impulse test.

      While episodes of labyrinthitis are usually self-limiting, medications like prochlorperazine or antihistamines may help reduce the sensation of dizziness. Understanding the symptoms and management of viral labyrinthitis can help patients seek appropriate treatment and manage their condition effectively.

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  • Question 22 - A 10-year-old boy comes to your clinic with a complaint of ear pain...

    Incorrect

    • 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:

      Correct 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.

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  • Question 23 - 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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  • Question 24 - 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.

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  • Question 25 - A 67-year-old man visits the respiratory clinic for spirometry testing to investigate possible...

    Incorrect

    • A 67-year-old man visits the respiratory clinic for spirometry testing to investigate possible COPD. The clinician observes that his breathing appears to be shallow even at rest.

      What specific lung volume would accurately describe the clinician's observation?

      Your Answer:

      Correct Answer: Tidal volume (TV)

      Explanation:

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

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  • Question 26 - A 50-year-old man visits the GP clinic for a routine hearing examination. He...

    Incorrect

    • A 50-year-old man visits the GP clinic for a routine hearing examination. He reports no issues with his hearing and has no significant medical history or medication use. After conducting Rinne and Weber tests on the patient, you determine that his hearing is within normal limits.

      What are the test findings for this patient?

      Your Answer:

      Correct Answer: Rinne: air conduction > bone conduction bilaterally; Weber: equal in both ears

      Explanation:

      The patient’s hearing exam results indicate normal hearing. The Rinne test showed more air conduction than bone conduction in both ears, which is typical for normal hearing. The Weber test also showed equal results in both ears, indicating no significant difference in hearing between the ears.

      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.

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  • Question 27 - A 55-year-old man comes to the hospital complaining of lethargy, headache, and shortness...

    Incorrect

    • A 55-year-old man comes to the hospital complaining of lethargy, headache, and shortness of breath. Upon examination, he is found to be cyanotic and hypoxic, and is admitted to the respiratory ward for oxygen therapy.

      Following some initial tests, the consultant informs the patient that his hemoglobin has a high affinity for oxygen, resulting in reduced oxygen delivery to the tissues.

      What is the probable reason for this alteration in the oxygen dissociation curve?

      Your Answer:

      Correct Answer: Low 2,3-DPG

      Explanation:

      The correct answer is low 2,3-DPG. The professor’s description refers to a left shift in the oxygen dissociation curve, which indicates that haemoglobin has a high affinity for oxygen and is less likely to release it to the tissues. Factors that cause a left shift include low temperature, high pH, low PCO2, and low 2,3-DPG. 2,3-DPG is a substance that helps release oxygen from haemoglobin, so low levels of it result in less oxygen being released, causing a left shift in the oxygen dissociation curve.

      The answer high temperature is incorrect because it causes a right shift in the oxygen dissociation curve, promoting oxygen delivery to the tissues. Hypercapnoea also causes a right shift in the curve, promoting oxygen delivery. Hyperglycaemia has no effect on haemoglobin’s ability to release oxygen, so it is also incorrect.

      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.

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  • Question 28 - A 26-year-old man has been experiencing a chronic cough and wheeze since starting...

    Incorrect

    • A 26-year-old man has been experiencing a chronic cough and wheeze since starting a new job. He has noticed that his peak flow measurements are significantly reduced while at work but improve on the weekends. What substance is commonly linked to this type of asthma?

      Your Answer:

      Correct Answer: Isocyanates

      Explanation:

      Occupational Asthma: Causes and Symptoms

      Occupational asthma is a type of asthma that is caused by exposure to certain chemicals in the workplace. Patients may experience worsening asthma symptoms while at work or notice an improvement in symptoms when away from work. The most common cause of occupational asthma is exposure to isocyanates, which are found in spray painting and foam moulding using adhesives. Other chemicals associated with occupational asthma include platinum salts, soldering flux resin, glutaraldehyde, flour, epoxy resins, and proteolytic enzymes.

      To diagnose occupational asthma, it is recommended to measure peak expiratory flow at work and away from work. If there is a significant difference in peak expiratory flow, referral to a respiratory specialist is necessary. Treatment may include avoiding exposure to the triggering chemicals and using medications to manage asthma symptoms. It is important for employers to provide a safe working environment and for employees to report any concerns about potential exposure to harmful chemicals.

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  • Question 29 - Which one of the following is not found in the anterior mediastinum? ...

    Incorrect

    • Which one of the following is not found in the anterior mediastinum?

      Your Answer:

      Correct Answer: Thoracic duct

      Explanation:

      The posterior and superior mediastinum contain the thoracic duct.

      The mediastinum is the area located between the two pulmonary cavities and is covered by the mediastinal pleura. It extends from the thoracic inlet at the top to the diaphragm at the bottom. The mediastinum is divided into four regions: the superior mediastinum, middle mediastinum, posterior mediastinum, and anterior mediastinum.

      The superior mediastinum is the area between the manubriosternal angle and T4/5. It contains important structures such as the superior vena cava, brachiocephalic veins, arch of aorta, thoracic duct, trachea, oesophagus, thymus, vagus nerve, left recurrent laryngeal nerve, and phrenic nerve. The anterior mediastinum contains thymic remnants, lymph nodes, and fat. The middle mediastinum contains the pericardium, heart, aortic root, arch of azygos vein, and main bronchi. The posterior mediastinum contains the oesophagus, thoracic aorta, azygos vein, thoracic duct, vagus nerve, sympathetic nerve trunks, and splanchnic nerves.

      In summary, the mediastinum is a crucial area in the thorax that contains many important structures and is divided into four regions. Each region contains different structures that are essential for the proper functioning of the body.

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  • Question 30 - 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:

      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.

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