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Question 1
Correct
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For a healthy adult, how much moderate-intensity physical activity is recommended per week by the World Health Organization?
Your Answer: > 150 minutes
Explanation:WHO Physical Activity Recommendations for Adults
The World Health Organization (WHO) recommends that adults aged 18-64 engage in a minimum of 150 minutes of moderate-intensity physical activity per week. This can be achieved through 30 minutes of exercise on at least 5 days per week. However, additional health benefits can be gained by increasing the amount of exercise beyond this minimum level.
The recommended physical activity can be achieved through either moderate-intensity aerobic activity, vigorous-intensity aerobic activity, or a combination of both. Aerobic activity should be performed in bouts of at least 10 minutes duration. For even greater health benefits, adults should aim for 300 minutes of moderate-intensity aerobic activity per week, or 150 minutes of vigorous-intensity aerobic activity per week, or a combination of both.
In addition to aerobic activity, adults should also engage in muscle-strengthening activities involving major muscle groups on two or more days per week. By following these recommendations, adults can improve their overall health and reduce the risk of chronic diseases.
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This question is part of the following fields:
- Clinical Sciences
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Question 2
Correct
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What is the most accurate definition of evidence-based medicine (EBM)?
Your Answer: EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients
Explanation:Evidence-Based Medicine
Evidence-based medicine (EBM) is a widely accepted approach to healthcare decision-making that involves the conscientious, explicit, and judicious use of current best evidence. This approach integrates the best available evidence with individual patient preferences to make informed decisions about patient care. While economic analyses can help allocate resources in a cost-effective manner, critical appraisal of clinical research is also an essential element of EBM.
EBM recognizes that high-quality randomized controlled trials and systematic reviews are valuable sources of evidence, but they are not the only sources. Practicing according to guidelines can be beneficial if the guidelines are evidence-based, but this is not always the case. Ultimately, the goal of EBM is to provide patients with the best possible care by using the most current and reliable evidence available while taking into account individual patient preferences and characteristics. By doing so, healthcare providers can make informed decisions that lead to better patient outcomes.
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This question is part of the following fields:
- Clinical Sciences
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Question 3
Incorrect
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Which nerve provides the motor supply to the brachialis muscle?
Your Answer: Median and musculocutaneous nerve
Correct Answer: Radial and musculocutaneous nerve
Explanation:The Brachialis Muscle: Anatomy and Innervation
The brachialis muscle is responsible for flexing the forearm and is located in the anterior half of the humerus and intermuscular septa. It attaches to the coronoid process and tuberosity of the ulna at the elbow joint. The main nerve supply for the brachialis muscle is the musculocutaneous nerve, with C6 and radial nerve also playing a role. Additionally, the lateral part of the brachialis muscle is supplied by branches from the C7 root. Overall, the brachialis muscle is an important muscle for forearm flexion and is innervated by multiple nerves.
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This question is part of the following fields:
- Clinical Sciences
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Question 4
Incorrect
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While taking a patient's medical history, you discover that there is a significant family history of a particular disease. Diseases that are inherited in an autosomal dominant manner typically manifest in early adulthood due to structural gene abnormalities, with both males and females being affected equally. Which of the following diseases does not follow an autosomal dominant inheritance pattern?
Your Answer: Adult polycystic kidney disease
Correct Answer: Haemochromatosis
Explanation:Abnormal Binding Proteins Resulting in Iron Deposition and Multiple Organ Dysfunction
Iron deposition due to an abnormality in binding proteins can lead to various health complications. This condition is characterized by the deposition of iron in different organs, including the heart, liver, pancreas, and skin. The abnormality in binding proteins results in the accumulation of iron in these organs, leading to cardiomyopathy, cirrhosis, pancreatic failure, and skin pigmentation.
This condition is inherited in an autosomal recessive pattern, meaning that an individual must inherit two copies of the mutated gene, one from each parent, to develop the condition. The recessive form of this condition is also known as infantile polycystic kidney disease, which predominantly affects children.
Overall, iron deposition due to an abnormality in binding proteins can cause multiple organ dysfunction and can be inherited in an autosomal recessive pattern. Early diagnosis and management of this condition are crucial to prevent further complications and improve the quality of life of affected individuals.
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This question is part of the following fields:
- Clinical Sciences
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Question 5
Incorrect
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What is the main role of cholecystokinin?
Your Answer: Increases stomach acid production
Correct Answer: Triggers gallbladder contraction
Explanation:Hormones and their Functions in Digestion
Cholecystokinin is a hormone that helps in digestion by neutralizing the partially digested food. It does this by stimulating the gallbladder to contract and the pancreas to release alkaline pancreatic fluid. This fluid helps to neutralize the acidic food and aids in the digestion process.
Gastrin is another hormone that plays a crucial role in digestion. It increases the production of stomach acid and also increases the rate of gastric emptying. This helps to break down the food more efficiently and move it through the digestive system.
Secretin is a hormone that reduces the production of stomach acid. It is released by the small intestine in response to the acidic food passing through it. This helps to prevent the stomach from becoming too acidic and causing discomfort.
Leptin is a hormone that helps to regulate appetite. It is produced by fat cells and acts on the brain to suppress appetite. This helps to maintain a healthy weight and prevent overeating.
In summary, hormones play a vital role in digestion by regulating the production of stomach acid, neutralizing acidic food, and suppressing appetite.
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This question is part of the following fields:
- Clinical Sciences
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Question 6
Incorrect
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What is the muscle located posterior to the initial segment of the axillary nerve?
Your Answer: Teres minor
Correct Answer: Subscapularis
Explanation:Anatomy of the Axillary Nerve
The axillary nerve is located behind the axillary artery and in front of the subscapularis muscle. It travels downwards to the lower border of the subscapularis before winding backward with the posterior humeral circumflex artery and vein. This occurs through a quadrilateral space that is bounded by the subscapularis muscle above, the teres minor muscle below, the teres major muscle, and the long head of the triceps brachii muscle medially and laterally by the surgical neck of the humerus.
The axillary nerve then divides into two branches: the anterior branch supplies the deltoid muscle, while the posterior branch supplies the teres minor muscle, the posterior part of the deltoid muscle, and the upper lateral cutaneous nerve of the arm. the anatomy of the axillary nerve is crucial in diagnosing and treating injuries or conditions that affect this nerve.
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This question is part of the following fields:
- Clinical Sciences
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Question 7
Correct
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How would a CT scan show the structure located posteriorly to the first part of the duodenum?
Your Answer: Portal vein
Explanation:Anatomy of the Duodenum
The duodenum, which is the first part of the small intestine, can be divided into four sections. The posterior relations of the first part of the duodenum include the portal vein, common bile duct, and gastroduodenal artery, with the inferior vena cava located behind them. The third part of the duodenum is crossed by the abdominal aorta, while the superior mesenteric vessels are an anterior relation of this section. The second part of the duodenum is where the main pancreatic duct opens, and it is also crossed by the transverse colon.
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This question is part of the following fields:
- Clinical Sciences
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Question 8
Correct
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A 45-year-old female patient complains of symptoms suggestive of thyroid disease that have been ongoing for six months. These symptoms include weight loss, diarrhea, heat intolerance, and irritability. Upon examination, a small goiter and exophthalmos are observed. What is the most probable cause of these symptoms?
Your Answer: Grave's disease
Explanation:Thyrotoxicosis and Its Causes
Thyrotoxicosis is a medical condition characterized by symptoms such as weight loss, diarrhoea, heat intolerance, and irritability. These symptoms suggest an overactive thyroid gland, which produces too much thyroid hormone. The most common cause of thyrotoxicosis is Graves’ disease, an autoimmune disorder in which the body’s immune system produces autoantibodies that stimulate the thyroid TSH receptor. This leads to an overproduction of thyroid hormone, resulting in thyrotoxicosis.
While Hashimoto’s thyroiditis can also cause thyrotoxic symptoms in its early stages, it is important to note that all symptoms except those caused by Graves’ disease are recognized as symptoms of thyroid insufficiency rather than thyrotoxicosis. In Hashimoto’s thyroiditis, the immune system attacks the thyroid gland, leading to inflammation and damage. This can cause the thyroid gland to release excess thyroid hormone, leading to thyrotoxicosis. However, as the disease progresses, the thyroid gland becomes damaged and unable to produce enough thyroid hormone, leading to hypothyroidism.
In summary, the causes of thyrotoxicosis is important in diagnosing and treating this condition. While Graves’ disease is the most common cause, it is important to consider other potential causes such as Hashimoto’s thyroiditis. Proper diagnosis and treatment can help manage symptoms and prevent complications.
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This question is part of the following fields:
- Clinical Sciences
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Question 9
Incorrect
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A neonatal hearing screening program screened 10,000 newborns by measuring otoacoustic emissions (OAE). Out of these, 200 newborns failed the screening test and were invited for a test of brainstem auditory evoked potential (BAEP), which is considered the gold standard for diagnosing hearing impairment in newborns. Among these 200 newborns, 100 were confirmed to have hearing impairment by BAEP. What is the correct statement regarding this scenario?
Your Answer: The prevalence of hearing impairment in the described neonatal cohort is 1%
Correct Answer: The accuracy of the screening test cannot be determined
Explanation:Limitations of Screening Test Results
In the study, 200 out of 10,000 subjects were found to have hearing impairment through a screening test. However, for the 9,800 subjects who tested negative, no further testing was conducted to confirm if they truly did not have hearing impairment. This means that we cannot determine the accuracy of the screening test from the data provided, nor can we calculate the sensitivity, specificity, or negative predictive values. The only value that can be calculated is the positive predictive value, which is 50%. It is important to note the limitations of screening test results and the need for further testing to confirm diagnoses.
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This question is part of the following fields:
- Clinical Sciences
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Question 10
Incorrect
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What is a correct statement regarding meta-analysis?
Your Answer: Individual data need to be obtained in order to perform meta-analysis
Correct Answer: The weight of each study should depend on the sample size
Explanation:Factors Considered in Meta-Analysis
Meta-analysis is a statistical technique used to combine the results of multiple studies on a particular topic. When conducting a meta-analysis, the sample size of each study is taken into account for weighting purposes. This means that studies with larger sample sizes will have a greater impact on the final result than studies with smaller sample sizes.
It is possible to perform a meta-analysis on aggregate data, as long as there is enough information available. However, it is not necessary to exclude studies with missing data. The effect size of each study should not affect its weight in the meta-analysis, but it will impact the overall result.
In the past, trial quality was often incorporated into meta-analysis weightings. However, this practice has become less common as it can be subjective and arbitrary. Overall, the sample size of each study is the most important factor to consider when conducting a meta-analysis.
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This question is part of the following fields:
- Clinical Sciences
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Question 11
Correct
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What blood test result indicates hypoglycaemia?
Your Answer: A young child with a plasma glucose concentration of 2.2 mmol/L
Explanation:Hypoglycaemia
Hypoglycaemia occurs when the blood glucose level falls below the typical fasting level. This condition is common and may not always require treatment, especially if it is mild and asymptomatic. However, the diagnosis of true hypoglycaemia requires the satisfaction of Whipple’s triad, which includes the presence of hypoglycaemia, symptoms/signs consistent with hypoglycaemia, and resolution of symptoms/signs when blood glucose level normalises.
Symptoms of hypoglycaemia are caused by sympathetic activity and disrupted central nervous system function due to inadequate glucose. Infants may experience hypotonia, jitteriness, seizures, poor feeding, apnoea, and lethargy. On the other hand, adults and older children may experience tremor, sweating, nausea, lightheadedness, hunger, and disorientation. Severe hypoglycaemia can cause confusion, aggressive behaviour, and reduced consciousness.
In summary, hypoglycaemia is important to recognise its symptoms and provide appropriate treatment. While mild hypoglycaemia may not always require intervention, true hypoglycaemia should be diagnosed based on Whipple’s triad. Symptoms of hypoglycaemia vary depending on age, and severe hypoglycaemia can cause serious complications.
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This question is part of the following fields:
- Clinical Sciences
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Question 12
Correct
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Which organ is in direct contact with the left kidney's anterior surface without being separated by peritoneum?
Your Answer: Pancreas
Explanation:Retroperitoneal Structures in Proximity to the Left Kidney
The retroperitoneal structures that are in direct contact with the anterior surface of the left kidney include the pancreas, adrenal gland, and colon. While the pancreas is the only structure commonly listed as retroperitoneal, it is important to note that the adrenal gland and colon also share this classification and are located in close proximity to the left kidney.
According to Gray’s Anatomy of the Human Body, which focuses on the urinary organs, the location and relationship of these structures is important for medical professionals. By knowing the retroperitoneal structures in proximity to the left kidney, doctors can better diagnose and treat conditions that may affect these organs.
In summary, while the pancreas is commonly listed as the only retroperitoneal structure in contact with the left kidney, it is important to also consider the adrenal gland and colon in this classification. the location and relationship of these structures is crucial for medical professionals in providing effective care for their patients.
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This question is part of the following fields:
- Clinical Sciences
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Question 13
Correct
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A 50-year-old male patient presents at the clinic with a confirmed diagnosis of type 2 diabetes. He has also been diagnosed with liver cirrhosis and has a history of pseudogout. Based on his medical history, you suspect that he may be suffering from haemochromatosis. Can you identify the most frequently occurring genetic abnormality associated with this condition?
Your Answer: C282Y mutation
Explanation:Genetic Mutations and Their Effects
HFE is a gene responsible for binding to transferrin, and when a mutation occurs in this gene, it can lead to haemochromatosis. The most common mutation in this gene is the C282Y allele, which is a point mutation resulting in the replacement of a cysteine residue with a tyrosine amino acid. On the other hand, the delta-F508 mutation is a deletion mutation that causes the loss of phenylalanine at position 508 in the CFTR protein, leading to the development of cystic fibrosis. Trinucleotide repeats are another type of mutation that can cause inherited neurological disorders, such as Huntington’s disease and spinocerebellar ataxia. Duchenne’s muscular dystrophy is caused by a mutation in the XP-21 gene, while phenylketonuria is caused by a mutation in phenylalanine hydroxylase (PAH).
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This question is part of the following fields:
- Clinical Sciences
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Question 14
Incorrect
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What is the primary cell-cell interaction necessary for the development of granulomas?
Your Answer: NK cells and macrophages
Correct Answer: Th1 CD4+ T cell and macrophages
Explanation:The Formation of Granulomas
Granulomas are formed when bacteria that cannot be killed are ingested by macrophages. These macrophages, which are filled with resistant bacteria such as Mycobacterium tuberculosis or Mycobacterium leprae, receive assistance from Th1 CD4+ T cells in the form of IFN-gamma. The macrophage then releases IL-12 to maintain its association with the T cell, and IFN-gamma helps activate the macrophage’s killing mechanisms. However, if this fails to clear the bacteria, the response moves to a more protective role. Fibroblasts seal off the area, forming a capsule that may become calcified. In TB infection, it is common for the macrophages within to undergo necrosis.
FDC and B cells interact to produce high-affinity antibody, while NK cells and macrophages do not directly interact with any particular response. Th2 CD4+ T cells provide stimulatory signals to B cells for the production of antibody. Th2 CD4+ T cells and CD8+ T cells do not directly interact for any specific response. Th1 CD4+ cells are part of the antiviral response, along with CD8+ T cells.
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This question is part of the following fields:
- Clinical Sciences
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Question 15
Correct
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A 75-year-old man comes to the clinic with a complaint of experiencing severe dizziness upon standing quickly. He is currently taking atenolol 100 mg OD for hypertension. Upon measuring his blood pressure while lying down and standing up, the readings were 146/88 mmHg and 108/72 mmHg, respectively. What is the main cause of his postural hypotension?
Your Answer: Impaired baroreceptor reflex
Explanation:Postural Hypotension and the Sympathetic Response
Postural hypotension is a common occurrence, especially in the elderly and those with refractory hypertension. When standing up, blood tends to pool in the lower limbs, causing temporary hypotension. However, the baroreceptors in the aortic arch and carotid sinus detect this change and trigger a sympathetic response. This response includes a rapid generalised venoconstriction, an increase in heart rate, and an increase in stroke volume, all working together to restore cardiac output and blood pressure. In most people, this response occurs before any awareness of hypotension, but a delay in this response can cause giddiness and pre-syncope.
However, in some cases, the reflex is partially impaired by the action of beta blockers. This means that the sympathetic response may not be as effective in restoring blood pressure. Increased adrenaline release, decreased pH (via chemoreceptors), or pain (via a sympathetic response) can all lead to an increase in blood pressure rather than a decrease. It is important to be aware of these factors and to monitor blood pressure regularly, especially in those who are at higher risk for postural hypotension.
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This question is part of the following fields:
- Clinical Sciences
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Question 16
Correct
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A 35-year-old man arrives at the emergency department with chest pain. He confesses to using cocaine. Upon examination, his heart rate is 110 bpm and his blood pressure is 118/76 mmHg. An ECG reveals T wave inversion in leads V3-V6. What part of his heart has been impacted?
Your Answer: Anterolateral
Explanation:ECG Leads and Myocardial Infarction
The T wave inversion on an electrocardiogram (ECG) can indicate a non-ST elevation myocardial infarction (MI) caused by cocaine abuse. The ECG has different leads that correspond to different areas of the heart. The septal leads are V1-V2, the anterior leads are V3-V4, the lateral leads are V5-V6, I, and aVL, and the inferior leads are II, III, and aVF. However, detecting posterior infarcts on a 12-lead ECG can be challenging. Some medical centers use additional ECG leads V7-9 to help identify posterior infarcts.
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This question is part of the following fields:
- Clinical Sciences
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Question 17
Correct
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In which part of the gastrointestinal system is water mainly taken up?
Your Answer: Small intestine
Explanation:The Function of the Large Intestine
Although many people believe that the primary function of the large intestine is to absorb water, this is not entirely accurate. In fact, the majority of water and fluids that are ingested or secreted are actually reabsorbed in the small intestine, which is located before the large intestine in the digestive tract. While the large intestine does play a role in absorbing some water and electrolytes, its primary function is to store and eliminate waste products from the body. This is achieved through the formation of feces, which are then eliminated through the rectum and anus. Overall, while the large intestine is an important part of the digestive system, its function is more complex than simply absorbing water.
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This question is part of the following fields:
- Clinical Sciences
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Question 18
Correct
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A 24-year-old man has sustained a stab wound to his thigh caused by a broken bottle. What sign indicates damage to the femoral nerve?
Your Answer: Loss of knee reflex
Explanation:Lesion of the Femoral Nerve and its Effects on Sensation and Movement
A lesion of the femoral nerve, specifically at the L2-4 levels, can result in several noticeable effects. One of the most prominent is weakness of the quadriceps femoris muscle, which leads to difficulty extending the knee. Additionally, there may be a loss of sensation over the front of the thigh and a lack of knee jerk reflex. These symptoms can significantly impact a person’s ability to move and perform daily activities.
The lateral cutaneous nerve of the thigh, which originates from the L1-2 levels, is responsible for providing sensation to the lateral aspect of the thigh and knee, as well as the lower lateral quadrant of the buttock. Meanwhile, the obturator nerve, which also originates from the L2-4 levels, supplies the adductors of the hip and sensation to the inner part of the thigh. These nerves can also be affected by a lesion, leading to further sensory and motor deficits.
Overall, a lesion of the femoral nerve can have significant consequences for a person’s mobility and sensation. the specific nerves involved and their functions can help in diagnosing and treating these types of injuries.
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This question is part of the following fields:
- Clinical Sciences
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Question 19
Incorrect
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What is the primary function of vitamin B12 within the human body?
Your Answer: Production of serotonin
Correct Answer: Synthesis of DNA
Explanation:The Importance of Vitamin B12 in the Body
Vitamin B12, also known as cobalamin, is a compound that contains cobalt and is obtained from the diet. The body has limited ability to store B12, which is why it is important to consume it regularly. Vitamin B12 works closely with folate in the body and has several important roles. It is essential for the synthesis of DNA, which allows for cell replication and tissue growth. B12 and folate are both necessary for this process. Additionally, B12 is involved in the synthesis of the myelin sheath that covers nerves and speeds up nervous transmission. It also plays a role in the metabolism of amino acids to remove harmful homocysteine, the metabolism of fats, and has an antioxidant function in association with glutathione. B12 is required for bone marrow turnover to produce healthy blood cells and platelets, which means it has some role in immunity and coagulation.
However, a deficiency in vitamin B12 can lead to several signs and symptoms. These include megaloblastic anaemia, fatigue, breathlessness, abnormal bleeding due to reduced platelet production, impaired immune response due to reduced leucocyte production, poor function of tissues such as the skin and gut which require a high cell turnover to maintain function, and infertility. It is important to ensure that you are consuming enough vitamin B12 in your diet to avoid these deficiencies and maintain optimal health.
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This question is part of the following fields:
- Clinical Sciences
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Question 20
Incorrect
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A patient with familial hypercholesterolaemia who is 45 years old is undergoing treatment with high dose nicotinic acid, a derivative of vitamin B3 (niacin).
What are the primary side effects that can be anticipated with this therapy?Your Answer: Muscle aches
Correct Answer: Flushing
Explanation:The Functions and Uses of Nicotinic Acid
Nicotinic acid is a medication used to treat dyslipidaemia, a condition characterized by abnormal levels of lipids in the blood. It works by increasing high-density lipoprotein cholesterol (HDLc) and reducing low-density lipoprotein cholesterol (LDLc). However, high doses of nicotinic acid can cause flushing, a side effect that can be improved by co-administering laropiprant. On the other hand, niacin deficiency can lead to anxiety, diarrhea, and skin rashes on sun-exposed sites, while muscle aches are common with statins, another group of lipid-lowering agents.
Aside from its therapeutic uses, nicotinic acid and its derivatives have various functions within the body. It serves as a cofactor in cellular reactions, particularly in the metabolism of fatty acids and steroid hormones. It also acts as an antioxidant, protecting the liver against free radical damage. Moreover, niacin is required for DNA replication and repair, as well as for the synthesis of histone proteins that facilitate DNA storage, replication, and repair. Additionally, niacin plays a role in lipid metabolism and has been used as a lipid-lowering agent. Although poorly understood, niacin may also have a role in the regulation of blood sugar concentrations.
Overall, nicotinic acid is a versatile medication with various functions and uses in the body. Its therapeutic benefits in dyslipidaemia are significant, but its side effects should also be considered. the different roles of niacin in the body can provide insights into its potential uses in other conditions.
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This question is part of the following fields:
- Clinical Sciences
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