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  • Question 1 - A 35-year-old man arrives at the emergency department following an assault with a...

    Incorrect

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

      Your Answer: Nasal cavity

      Correct Answer: Maxillary sinus

      Explanation:

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

      Paranasal Air Sinuses and Carotid Sinus

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      46.5
      Seconds
  • Question 2 - A 35-year-old pregnant woman presents for an ultrasound scan. The results reveal foetal...

    Incorrect

    • A 35-year-old pregnant woman presents for an ultrasound scan. The results reveal foetal macrosomia and polyhydramnios. Given her unremarkable medical history, what is the probable cause of these findings?

      Your Answer: Fetal heart failure

      Correct Answer: Gestational diabetes

      Explanation:

      Gestational diabetes is the correct answer as it can result in foetal macrosomia, which is caused by insulin resistance promoting fat storage, and polyhydramnios, which is caused by foetal polyuria.

      While maternal obesity may cause macrosomia, it does not necessarily lead to polyhydramnios.

      Foetal gut atresia is a condition where part of the intestine is narrowed or absent, which can make it difficult for the foetus to ingest substances like amniotic fluid. This can result in excess amniotic fluid and polyhydramnios, but not macrosomia.

      Hydrops fetalis may cause polyhydramnios, but it does not necessarily lead to macrosomia. However, it can cause hepatosplenomegaly.

      Maternal hypercalcaemia may cause polyhydramnios, but it does not necessarily lead to macrosomia.

      Gestational diabetes is a common medical disorder that affects around 4% of pregnancies. It can develop during pregnancy or be a pre-existing condition. According to NICE, 87.5% of cases are gestational diabetes, 7.5% are type 1 diabetes, and 5% are type 2 diabetes. Risk factors for gestational diabetes include a BMI of > 30 kg/m², previous gestational diabetes, a family history of diabetes, and family origin with a high prevalence of diabetes. Screening for gestational diabetes involves an oral glucose tolerance test (OGTT), which should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

      To diagnose gestational diabetes, NICE recommends using the following thresholds: fasting glucose is >= 5.6 mmol/L or 2-hour glucose is >= 7.8 mmol/L. Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose. Advice about diet and exercise should be given, and if glucose targets are not met within 1-2 weeks of altering diet/exercise, metformin should be started. If glucose targets are still not met, insulin should be added to the treatment plan.

      For women with pre-existing diabetes, weight loss is recommended for those with a BMI of > 27 kg/m^2. Oral hypoglycaemic agents, apart from metformin, should be stopped, and insulin should be commenced. Folic acid 5 mg/day should be taken from pre-conception to 12 weeks gestation, and a detailed anomaly scan at 20 weeks, including four-chamber view of the heart and outflow tracts, should be performed. Tight glycaemic control reduces complication rates, and retinopathy should be treated as it can worsen during pregnancy.

      Targets for self-monitoring of pregnant women with diabetes include a fasting glucose level of 5.3 mmol/l and a 1-hour or 2-hour glucose level after meals of 7.8 mmol/l or 6.4 mmol/l, respectively. It is important to manage gestational diabetes and pre-existing diabetes during pregnancy to reduce the risk of complications for both the mother and baby.

    • This question is part of the following fields:

      • Reproductive System
      20.1
      Seconds
  • Question 3 - A 75-year-old woman with a history of type 2 diabetes mellitus and atrial...

    Incorrect

    • A 75-year-old woman with a history of type 2 diabetes mellitus and atrial fibrillation visits her GP complaining of a rash on her arm. The rash has been present for two days and she has been feeling generally unwell with a mild fever. Upon examination, the GP observes a well-defined, raised, reddish patch on her left forearm that is most red at the border. Additionally, there is associated axillary lymphadenopathy. The GP orders a full blood count, CRP, and a swab of the lesion. What is the most likely pathogen responsible for this condition?

      Your Answer: Trichophyton rubrum

      Correct Answer: Streptococcus pyogenes

      Explanation:

      Erysipelas is a skin infection that is localized and caused by Streptococcus pyogenes. It is often seen in elderly patients with weakened immune systems, such as those with diabetes mellitus. Symptoms include a raised, painful rash with clear boundaries.

      Ringworm is commonly caused by Trichophyton rubrum. This results in a circular, scaly, and itchy rash that is red in color.

      While Staphylococcus epidermidis is a normal part of the skin’s flora, it is more commonly associated with infections of foreign devices and endocarditis rather than skin infections.

      Understanding Erysipelas: A Superficial Skin Infection

      Erysipelas is a skin infection that is caused by Streptococcus pyogenes. It is a less severe form of cellulitis, which is a more widespread skin infection. Erysipelas is a localized infection that affects the skin’s upper layers, causing redness, swelling, and warmth. The infection can occur anywhere on the body, but it is most commonly found on the face, arms, and legs.

      The treatment of choice for erysipelas is flucloxacillin, an antibiotic that is effective against Streptococcus pyogenes. Other antibiotics may also be used, depending on the severity of the infection and the patient’s medical history.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.1
      Seconds
  • Question 4 - A 70-year-old male smoker complains of calf pain.

    The GP performs a clinical...

    Incorrect

    • A 70-year-old male smoker complains of calf pain.

      The GP performs a clinical test by raising the patient's legs and observing for the angle at which there is blanching. After one minute, the legs are lowered over the side of the couch so that they are fully dependent with feet on the floor. Reactive hyperaemia is observed.

      Which clinical test does this describe?

      Your Answer: Trendelenburg's test

      Correct Answer: Buerger's test

      Explanation:

      Tests for Assessing Arterial and Venous Circulation, Hip Dysfunction, and Meniscal Tear

      Buerger’s test is a method used to evaluate the arterial circulation of the lower limb. The test involves observing the angle at which blanching occurs, with a lower angle indicating a higher likelihood of arterial insufficiency. Additionally, the degree of reactive hyperaemia on dependency of the limb after one minute is another positive sign of arterial insufficiency during the test.

      Another test used to assess circulation is the Ankle-Brachial Pressure Index (ABPI), which involves using blood pressure cuffs to determine the degree of claudication. McMurray’s test, on the other hand, is used to evaluate for a meniscal tear within the knee joint.

      Perthe’s test is a method used to assess the patency of the deep femoral vein prior to varicose vein surgery. Lastly, Trendelenburg’s test is used to evaluate hip dysfunction. These tests are important in diagnosing and treating various conditions related to circulation and joint function.

    • This question is part of the following fields:

      • Basic Sciences
      22.9
      Seconds
  • Question 5 - A febrile 5-day-old boy with surfactant deficient lung disease presents with a seizure....

    Incorrect

    • A febrile 5-day-old boy with surfactant deficient lung disease presents with a seizure. Subsequently, he exhibits variable consciousness and decreased limb tone. His blood glucose level is within normal limits. What is the most suitable initial test to establish the diagnosis?

      Your Answer: CT head

      Correct Answer: USS cranium

      Explanation:

      Intraventricular Haemorrhage and Neonatal Seizures

      Ultrasound is the primary diagnostic tool used to investigate intraventricular haemorrhage (IVH), a common cause of neonatal seizures. IVH occurs when the blood vessels in the ventricle walls rupture, which is more likely to happen in neonates who require ventilation for lung disease. This condition can lead to hydrocephalus and damage to the surrounding neural tissue, resulting in temporary changes in tone and conscious level. The most severe complication of IVH is periventricular leukomalacia, which can progress to spastic diplegic cerebral palsy.

      To diagnose IVH, an ultrasound scan through the anterior fontanelle is a quick and effective method of examining for blood in the ventricles or hydrocephalus. Blood cultures may also be taken to rule out sepsis, another cause of neonatal seizures. However, chest x-rays may be necessary if there are changes in ventilation pressures or hypoxia due to chest infection or pneumothorax.

      It is important to avoid CT head scans if possible due to the radiation exposure to the neonate. Instead, MRI may be a reasonable investigation at a later date to determine the extent of the damage. Overall, early detection and management of IVH is crucial in preventing long-term complications such as cerebral palsy.

    • This question is part of the following fields:

      • Paediatrics
      28.9
      Seconds
  • Question 6 - A 25-year-old male patient visits his physician complaining of a rash that has...

    Incorrect

    • A 25-year-old male patient visits his physician complaining of a rash that has been present for two weeks. Upon examination, the doctor observes multiple oval-shaped lesions with a fine-scale on the outer aspects of the lesions. The rash has spread across the patient's trunk and back, resembling a fir tree. The patient reports feeling generally well. The doctor suspects pityriasis rosea and wonders which organism has been linked to its development.

      Your Answer: Parvovirus B-19

      Correct Answer: Herpes hominis virus 7 (HHV-7)

      Explanation:

      Herpes hominis virus 7 (HHV-7) is believed to be involved in the development of pityriasis rosea, while the other choices are not linked to this condition. Slapped cheek syndrome is associated with Parvovirus B-19, while Coxsackie B virus is an enterovirus that is associated with aseptic meningitis, Bornholm disease, pericarditis, and myocarditis.

      Understanding Pityriasis Rosea

      Pityriasis rosea is a rash that typically affects young adults and is characterized by an acute, self-limiting nature. While the exact cause is not fully understood, it is believed that herpes hominis virus 7 (HHV-7) may play a role. Most patients do not experience any warning signs, but some may report a recent viral infection. The rash begins with a herald patch on the trunk, followed by oval, scaly patches that follow a distinct pattern with the longitudinal diameters running parallel to the line of Langer, creating a fir-tree appearance.

      The condition is self-limiting and usually disappears within 6-12 weeks. There is no specific treatment for pityriasis rosea, but topical agents used for psoriasis may be helpful. UVB phototherapy may also be an option. It is important to differentiate pityriasis rosea from guttate psoriasis, which is characterized by tear-drop shaped, scaly papules on the trunk and limbs. Guttate psoriasis is often preceded by a streptococcal sore throat, while pityriasis rosea may be associated with recent respiratory tract infections. Both conditions typically resolve spontaneously within a few months.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      19.2
      Seconds
  • Question 7 - Which of the following statements about the ankle joint is false? ...

    Incorrect

    • Which of the following statements about the ankle joint is false?

      Your Answer: The flexor hallucis longus tendon is the most posterior structure at the medial malleolus

      Correct Answer: The sural nerve lies medial to the Achilles tendon at its point of insertion

      Explanation:

      The distal fibula is located in front of the sural nerve. Subtalar movements involve inversion and eversion. When passing behind the medial malleolus from front to back, the structures include the tibialis posterior, flexor digitorum longus, posterior tibial vein, posterior tibial artery, nerve, and flexor hallucis longus.

      Anatomy of the Ankle Joint

      The ankle joint is a type of synovial joint that is made up of the tibia and fibula superiorly and the talus inferiorly. It is supported by several ligaments, including the deltoid ligament, lateral collateral ligament, and talofibular ligaments. The calcaneofibular ligament is separate from the fibrous capsule of the joint, while the two talofibular ligaments are fused with it. The syndesmosis is composed of the antero-inferior tibiofibular ligament, postero-inferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous ligament.

      The ankle joint allows for plantar flexion and dorsiflexion movements, with a range of 55 and 35 degrees, respectively. Inversion and eversion movements occur at the level of the sub talar joint. The ankle joint is innervated by branches of the deep peroneal and tibial nerves.

      Reference:
      Golano P et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):557-69.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.8
      Seconds
  • Question 8 - A 75-year-old man presents to the emergency department following a syncopal episode. He...

    Correct

    • A 75-year-old man presents to the emergency department following a syncopal episode. He has no significant medical history and denies any loss of bladder or bowel control or tongue biting.

      During examination, an ejection systolic murmur is detected at the right sternal edge in the second intercostal space. The murmur is heard radiating to the carotids.

      What intervention can be done to decrease the intensity of the murmur heard during auscultation?

      Your Answer: Valsalva manoeuvre

      Explanation:

      The intensity of the ejection systolic murmur heard in aortic stenosis can be decreased by performing the Valsalva manoeuvre. On the other hand, the intensity of the murmur can be increased by administering amyl nitrite, raising legs, expiration, and squatting. These actions increase the volume of blood flow through the valve.

      Aortic stenosis is a condition characterized by the narrowing of the aortic valve, which can lead to various symptoms. These symptoms include chest pain, dyspnea, syncope or presyncope, and a distinct ejection systolic murmur that radiates to the carotids. Severe aortic stenosis can cause a narrow pulse pressure, slow rising pulse, delayed ESM, soft/absent S2, S4, thrill, duration of murmur, and left ventricular hypertrophy or failure. The condition can be caused by degenerative calcification, bicuspid aortic valve, William’s syndrome, post-rheumatic disease, or subvalvular HOCM.

      Management of aortic stenosis depends on the severity of the condition and the presence of symptoms. Asymptomatic patients are usually observed, while symptomatic patients require valve replacement. Surgical AVR is the preferred treatment for young, low/medium operative risk patients, while TAVR is used for those with a high operative risk. Balloon valvuloplasty may be used in children without aortic valve calcification and in adults with critical aortic stenosis who are not fit for valve replacement. If the valvular gradient is greater than 40 mmHg and there are features such as left ventricular systolic dysfunction, surgery may be considered even if the patient is asymptomatic.

    • This question is part of the following fields:

      • Cardiovascular System
      6.4
      Seconds
  • Question 9 - A 75-year-old woman has been diagnosed with hyperaldosteronism. What is the source of...

    Incorrect

    • A 75-year-old woman has been diagnosed with hyperaldosteronism. What is the source of aldosterone release?

      Your Answer: Juxtaglomerular apparatus of the kidney

      Correct Answer: Zona glomerulosa of the adrenal cortex

      Explanation:

      The production of aldosterone takes place in the zona glomerulosa of the adrenal cortex and its function is to preserve water and sodium.

      Aldosterone is a hormone that is primarily produced by the adrenal cortex in the zona glomerulosa. Its main function is to stimulate the reabsorption of sodium from the distal tubules, which results in the excretion of potassium. It is regulated by various factors such as angiotensin II, potassium, and ACTH, which increase its secretion. However, when there is an overproduction of aldosterone, it can lead to primary hyperaldosteronism, which is a common cause of secondary hypertension. This condition can be caused by an adrenal adenoma, which is also known as Conn’s syndrome. It is important to note that spironolactone, an aldosterone antagonist, can cause hyperkalemia.

    • This question is part of the following fields:

      • Renal System
      30.5
      Seconds
  • Question 10 - An 80-year-old man comes to the emergency department with abrupt onset weakness of...

    Incorrect

    • An 80-year-old man comes to the emergency department with abrupt onset weakness of his left arm and leg along with double vision. During the examination, you observe that his right eye is held in a 'down-and-out' position and his pupil is dilated and unresponsive to light.

      Which artery would most plausibly account for this presentation?

      Your Answer: Right posterior inferior cerebellar artery

      Correct Answer: Right posterior cerebral artery

      Explanation:

      The correct answer is the right posterior cerebral artery. When branches of this artery that supply the midbrain are affected by a stroke, it can result in ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremities. This explains the right-sided oculomotor palsy and left-sided weakness of the arm and leg mentioned in the stem.

      The left posterior cerebral artery is incorrect because it would cause left-sided oculomotor palsy and right-sided weakness of the upper and lower extremities.

      The left posterior inferior cerebellar artery is also incorrect because it would cause left-sided facial pain and temperature loss, right-sided limb/torso pain and temperature loss, vertigo, vomiting, dysphagia, ataxia, and nystagmus.

      The right middle cerebral artery is incorrect because it would cause contralateral hemiparesis and sensory loss (with the upper extremity being more affected than the lower), contralateral homonymous hemianopia, and aphasia. This would not explain the left oculomotor palsy mentioned in the stem.

      Stroke can affect different parts of the brain depending on which artery is affected. If the anterior cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the lower extremities being more affected than the upper. If the middle cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the upper extremities being more affected than the lower. They may also experience vision loss and difficulty with language. If the posterior cerebral artery is affected, the person may experience vision loss and difficulty recognizing objects.

      Lacunar strokes are a type of stroke that are strongly associated with hypertension. They typically present with isolated weakness or loss of sensation on one side of the body, or weakness with difficulty coordinating movements. They often occur in the basal ganglia, thalamus, or internal capsule.

    • This question is part of the following fields:

      • Neurological System
      11.2
      Seconds
  • Question 11 - A 32-year old woman with asthma presents to the Emergency department with difficulty...

    Correct

    • A 32-year old woman with asthma presents to the Emergency department with difficulty breathing. Upon examination, you observe that she is utilizing accessory muscles for respiration. Can you identify which muscle is considered an accessory muscle of respiration?

      Your Answer: Serratus anterior

      Explanation:

      Accessory Muscles of Respiration

      The accessory muscles of respiration are utilized during deep inspiration and consist of several muscles. These muscles include the sternocleidomastoid, scalenus anterior, medius, and posterior, serratus anterior, and pectoralis major and minor. However, there is no consensus on the exact number of muscles that can be classified as ‘accessory’. Some lists include any muscle that can impact chest expansion. It is important to note that the trapezius muscle cannot be considered an accessory muscle of respiration as it is not connected to the ribs. Overall, the accessory muscles of respiration play a crucial role in deep breathing and chest expansion.

    • This question is part of the following fields:

      • Clinical Sciences
      22.4
      Seconds
  • Question 12 - A 30-year-old male pedestrian is struck by a van while on a busy...

    Correct

    • A 30-year-old male pedestrian is struck by a van while on a busy road and is transported to the Emergency Department via ambulance. Despite receiving high flow 100% oxygen, he remains dyspneic and hypoxic. His blood pressure is 110/70 mmHg and his pulse rate is 115 bpm. Upon examination, the right side of his chest is hyper-resonant on percussion and has decreased breath sounds. Additionally, the trachea is deviated to the left. What is the most probable underlying diagnosis?

      Your Answer: Tension pneumothorax

      Explanation:

      A flap-like defect on the lung surface caused by chest trauma, whether blunt or penetrating, can lead to a tension pneumothorax. Symptoms may include difficulty breathing, worsening oxygen levels, a hollow sound upon tapping the chest, and the trachea being pushed to one side. The recommended course of action is to perform needle decompression and insert a chest tube.

      Thoracic Trauma: Types and Management

      Thoracic trauma refers to injuries that affect the chest area, including the lungs, heart, and blood vessels. There are several types of thoracic trauma, each with its own set of symptoms and management strategies. Tension pneumothorax, for example, occurs when pressure builds up in the thorax due to a laceration in the lung parenchyma. This condition is often caused by mechanical ventilation in patients with pleural injury. Flail chest, on the other hand, occurs when the chest wall disconnects from the thoracic cage due to multiple rib fractures. This condition is associated with pulmonary contusion and abnormal chest motion.

      Other types of thoracic trauma include pneumothorax, haemothorax, cardiac tamponade, pulmonary contusion, blunt cardiac injury, aorta disruption, diaphragm disruption, and mediastinal traversing wounds. Each of these conditions has its own set of symptoms and management strategies. For example, patients with traumatic pneumothorax should never be mechanically ventilated until a chest drain is inserted. Haemothoraces large enough to appear on CXR are treated with a large bore chest drain, and surgical exploration is warranted if >1500ml blood is drained immediately. In cases of cardiac tamponade, Beck’s triad (elevated venous pressure, reduced arterial pressure, reduced heart sounds) and pulsus paradoxus may be present. Early intubation within an hour is recommended for patients with significant hypoxia due to pulmonary contusion. Overall, prompt and appropriate management of thoracic trauma is crucial for improving patient outcomes.

    • This question is part of the following fields:

      • Gastrointestinal System
      22
      Seconds
  • Question 13 - A 25-year-old man is struck with a hammer on the right side of...

    Incorrect

    • A 25-year-old man is struck with a hammer on the right side of his head. He passes away upon arrival at the emergency department. What is the most probable finding during the post mortem examination?

      Your Answer: Subdural haematoma

      Correct Answer: Laceration of the middle meningeal artery

      Explanation:

      The given scenario involves a short delay before death, which is not likely to result in a supratentorial herniation. The other options are also less severe.

      Patients with head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. Different types of traumatic brain injury include extradural hematoma, subdural hematoma, and subarachnoid hemorrhage. Primary brain injury may be focal or diffuse, while secondary brain injury occurs when cerebral edema, ischemia, infection, tonsillar or tentorial herniation exacerbates the original injury. Management may include IV mannitol/furosemide, decompressive craniotomy, and ICP monitoring. Pupillary findings can provide information on the location and severity of the injury.

    • This question is part of the following fields:

      • Neurological System
      59.3
      Seconds
  • Question 14 - What type of cell is found in higher quantities in the blood sample...

    Correct

    • What type of cell is found in higher quantities in the blood sample of an individual who has a viral infection?

      Your Answer: Lymphocytes

      Explanation:

      Blood Cell Types and Their Presence in Various Disorders

      Lymphocytes are a type of blood cell that can be found in higher numbers during viral infections. Eosinophils, on the other hand, are present in response to allergies, drug reactions, or infections caused by flatworms and strongyloides. Monocytes are another type of blood cell that can be found in disorders such as EBV infection, CMML, and other atypical infections. Neutrophils are present in bacterial infections or in disorders such as CML or AML where their more immature blastoid form is seen. Lastly, platelets can be increased in infections, iron deficiency, or myeloproliferative disorders.

      In summary, different types of blood cells can indicate various disorders or infections. By analyzing the presence of these cells in the blood, doctors can better diagnose and treat patients. It is important to note that the presence of these cells alone is not enough to make a diagnosis, and further testing may be necessary.

    • This question is part of the following fields:

      • Haematology And Oncology
      30.3
      Seconds
  • Question 15 - A previously healthy 30-year-old man has returned from a trip to Spain where...

    Incorrect

    • A previously healthy 30-year-old man has returned from a trip to Spain where he used spa pools. He is now experiencing a cough, fever, and flu-like symptoms for the past 10 days. What is the probable cause of his illness?

      Your Answer: Streptococcus pneumonia

      Correct Answer: Legionella pneumophila

      Explanation:

      Causes and Transmission of Legionella Infection

      In a healthy individual, infection can be caused by a virulent organism such as Legionella pneumophila, which can lead to atypical pneumonia. However, Legionella can also cause a less severe flu-like illness known as Pontiac fever. influenzae A is another possibility, but it typically lasts for only four to five days and is not associated with water facilities. TB is unlikely, as it rarely presents with flu-like symptoms. Streptococcus pneumoniae is a form of typical pneumonia that is less likely to occur in a fit and healthy young man, while Staphylococcus aureus pneumonia is usually acquired in a hospital setting.

      Legionella is transmitted through inhalation of aerosols from contaminated water sources, such as spa pools. The bacteria thrives in water temperatures between 20°C and 40°C. It is important to note that Legionella is a notifiable disease, and clinicians should inform Public Health England (previously the Health Protection Agency) in their locality when a case is diagnosed. By the causes and transmission of Legionella infection, individuals can take steps to prevent its spread and protect their health.

    • This question is part of the following fields:

      • Infectious Diseases
      56.5
      Seconds
  • Question 16 - A 9-month-old baby is presented to the emergency department by their mother with...

    Incorrect

    • A 9-month-old baby is presented to the emergency department by their mother with recurrent seizures and an increasing head circumference. The infant has been experiencing excessive sleeping, vomiting, and irritability. An MRI scan of the brain reveals an enlarged posterior fossa and an absent cerebellar vermis. Which structure is anticipated to be in a raised position in this infant?

      Your Answer: Falx cerebri

      Correct Answer: Tentorium cerebelli

      Explanation:

      The Dandy-Walker malformation causes an enlargement of the posterior fossa, resulting in an accumulation of cerebrospinal fluid that pushes the tentorium cerebelli upwards. This can lead to symptoms due to the mass effect. The falx cerebri, pituitary gland, sphenoid sinus, and superior cerebellar peduncle are unlikely to be significantly affected by this condition.

      The Three Layers of Meninges

      The meninges are a group of membranes that cover the brain and spinal cord, providing support to the central nervous system and the blood vessels that supply it. These membranes can be divided into three distinct layers: the dura mater, arachnoid mater, and pia mater.

      The outermost layer, the dura mater, is a thick fibrous double layer that is fused with the inner layer of the periosteum of the skull. It has four areas of infolding and is pierced by small areas of the underlying arachnoid to form structures called arachnoid granulations. The arachnoid mater forms a meshwork layer over the surface of the brain and spinal cord, containing both cerebrospinal fluid and vessels supplying the nervous system. The final layer, the pia mater, is a thin layer attached directly to the surface of the brain and spinal cord.

      The meninges play a crucial role in protecting the brain and spinal cord from injury and disease. However, they can also be the site of serious medical conditions such as subdural and subarachnoid haemorrhages. Understanding the structure and function of the meninges is essential for diagnosing and treating these conditions.

    • This question is part of the following fields:

      • Neurological System
      86.9
      Seconds
  • Question 17 - Mrs. Smith presents to the clinic with a newly noticed lesion on her...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Having multiple colours

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      0
      Seconds
  • Question 18 - What is the final product of glucose breakdown in the absence of oxygen?...

    Incorrect

    • What is the final product of glucose breakdown in the absence of oxygen?

      Your Answer:

      Correct Answer: Lactate

      Explanation:

      Anaerobic Metabolism and Lactic Acidosis

      During anaerobic metabolism, glucose can be broken down through the glycolysis pathway without the need for oxygen. This process generates pyruvate, but without oxygen, it cannot be further metabolized through the Kreb cycle or electron transfer chain to produce energy. Instead, pyruvate is converted into lactate, which yields two molecules of ATP. While small periods of anaerobic respiration are tolerable, excessive accumulation of lactate can lead to lactic acidosis, which reduces cellular pH. This reduction in pH can cause enzyme dysfunction, compromising cell function and ultimately leading to cell death.

      During intense exercise, muscle tissue relies on lactate as a quick source of ATP. The lactate produced can diffuse out of the cells and into the bloodstream, where it is taken up by other cells that can regenerate pyruvate from it. This pyruvate can then enter the Kreb cycle to produce more energy.

      However, in patients with serious illnesses where oxygen delivery to the body’s tissues is compromised, lactic acidosis can occur. This includes conditions such as pneumonia, heart failure, and chronic obstructive pulmonary disease. In these cases, the body may rely more heavily on anaerobic metabolism, leading to an accumulation of lactate and a decrease in cellular pH, which can have serious consequences for cell function and survival.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 19 - A 50-year-old male is admitted with sepsis caused by a urinary tract infection...

    Incorrect

    • A 50-year-old male is admitted with sepsis caused by a urinary tract infection from Escherichia coli. Despite taking trimethoprim for six days as prescribed by his doctor, he has not shown any improvement. He assures that he has followed the treatment regimen. What could be the probable reason for this lack of response?

      Your Answer:

      Correct Answer: The strain of the likely causative agent has developed extrinsic (acquired) resistance to the antibiotic

      Explanation:

      Understanding Trimethoprim: Mechanism of Action, Adverse Effects, and Use in Pregnancy

      Trimethoprim is an antibiotic that is commonly used to treat urinary tract infections. Its mechanism of action involves interfering with DNA synthesis by inhibiting dihydrofolate reductase. This may cause an interaction with methotrexate, which also inhibits dihydrofolate reductase. However, the use of trimethoprim may also lead to adverse effects such as myelosuppression and a transient rise in creatinine. The drug competitively inhibits the tubular secretion of creatinine, resulting in a temporary increase that reverses upon stopping the medication. Additionally, trimethoprim blocks the ENaC channel in the distal nephron, causing a hyperkalaemic distal RTA (type 4). It also inhibits creatinine secretion, which often leads to an increase in creatinine by around 40 points, but not necessarily causing AKI.

      When it comes to the use of trimethoprim in pregnancy, caution is advised. The British National Formulary (BNF) warns of a teratogenic risk in the first trimester due to its folate antagonist properties. Manufacturers advise avoiding the use of trimethoprim during pregnancy. It is important to consult with a healthcare provider before taking any medication, especially during pregnancy, to ensure the safety of both the mother and the developing fetus.

    • This question is part of the following fields:

      • General Principles
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  • Question 20 - A 16-year-old girl presents to the emergency department with anaphylaxis after unintentionally ingesting...

    Incorrect

    • A 16-year-old girl presents to the emergency department with anaphylaxis after unintentionally ingesting peanuts, to which she has a documented allergy.

      Which immune cell type is primarily responsible for orchestrating this type of allergic reaction?

      Your Answer:

      Correct Answer: Mast cells

      Explanation:

      IgE antibodies play a role in allergic, hypersensitivity, and anaphylactic responses by binding to Fc receptors on mast cells.

      Immunoglobulins, also known as antibodies, are proteins produced by the immune system to help fight off infections and diseases. There are five types of immunoglobulins found in the body, each with their own unique characteristics.

      IgG is the most abundant type of immunoglobulin in blood serum and plays a crucial role in enhancing phagocytosis of bacteria and viruses. It also fixes complement and can be passed to the fetal circulation.

      IgA is the most commonly produced immunoglobulin in the body and is found in the secretions of digestive, respiratory, and urogenital tracts and systems. It provides localized protection on mucous membranes and is transported across the interior of the cell via transcytosis.

      IgM is the first immunoglobulin to be secreted in response to an infection and fixes complement, but does not pass to the fetal circulation. It is also responsible for producing anti-A, B blood antibodies.

      IgD’s role in the immune system is largely unknown, but it is involved in the activation of B cells.

      IgE is the least abundant type of immunoglobulin in blood serum and is responsible for mediating type 1 hypersensitivity reactions. It provides immunity to parasites such as helminths and binds to Fc receptors found on the surface of mast cells and basophils.

    • This question is part of the following fields:

      • General Principles
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  • Question 21 - A 28-year-old woman comes to the pharmacy seeking advice on supplements or foods...

    Incorrect

    • A 28-year-old woman comes to the pharmacy seeking advice on supplements or foods to take while trying to conceive with her partner. She has no history of pregnancy complications or birth defects and is looking for ways to support a healthy pregnancy. The practitioner informs her that while there is limited evidence to support most pregnancy supplements, there is one in particular that they recommend.

      What supplement could the practitioner be suggesting?

      Your Answer:

      Correct Answer: 400 micrograms folic acid

      Explanation:

      To promote a healthy pregnancy, it is recommended that women take 400mcg of folic acid daily for three months before conception and up to 12 weeks into gestation. However, pregnant women should avoid vitamin A supplements and liver-based products as they can be harmful to the developing fetus. While iron supplements may be recommended for those with iron deficiency anemia, they are not necessary for this patient. It is important for pregnant women to avoid all types of pâté, including vegetable pâtés, as they may contain listeria bacterium.

      Antenatal Care: Lifestyle Advice for Pregnant Women

      During antenatal care, healthcare providers should provide pregnant women with lifestyle advice to ensure a healthy pregnancy. The National Institute for Health and Care Excellence (NICE) has made several recommendations regarding the advice that pregnant women should receive. These recommendations include nutritional supplements, alcohol consumption, smoking, food-acquired infections, work, air travel, prescribed medicines, over-the-counter medicines, complimentary therapies, exercise, and sexual intercourse.

      Nutritional supplements such as folic acid and vitamin D are recommended to reduce the risk of neural tube defects and ensure adequate bone health, respectively. However, iron supplementation should not be offered routinely, and vitamin A supplementation should be avoided due to its teratogenic effects. Pregnant women should also avoid alcohol consumption as it can lead to long-term harm to the baby. Smoking should also be avoided, and NRT may be used only after discussing the risks and benefits.

      Food-acquired infections such as listeriosis and salmonella should be avoided by avoiding certain foods. Pregnant women should also be informed of their maternity rights and benefits and consult with the Health and Safety Executive if there are any concerns about possible occupational hazards during pregnancy. Air travel during pregnancy should also be avoided after a certain gestational age, and prescribed medicines should be avoided unless the benefits outweigh the risks.

      Over-the-counter medicines should be used as little as possible during pregnancy, and few complementary therapies have been established as being safe and effective during pregnancy. Pregnant women should also be informed that moderate exercise is not associated with adverse outcomes, but certain activities should be avoided. Sexual intercourse is not known to be associated with any adverse outcomes. By following these recommendations, pregnant women can ensure a healthy pregnancy and reduce the risk of complications.

    • This question is part of the following fields:

      • Reproductive System
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  • Question 22 - A 78-year-old man is undergoing evaluation for a cognitive impairment and suspected movement...

    Incorrect

    • A 78-year-old man is undergoing evaluation for a cognitive impairment and suspected movement disorder. Various scans are ordered to aid in the assessment.

      The scan findings are as follows:

      MRI head reveals typical age-related alterations
      SPECT scan shows decreased dopaminergic activity in the substantia nigra

      Based on the above results, what is the probable diagnosis?

      Your Answer:

      Correct Answer: Parkinson's disease

      Explanation:

      Neurodegenerative diseases are a group of disorders that affect the nervous system and lead to progressive deterioration of its functions. Parkinson’s disease is a common example of a basal ganglia disorder, which is characterized by the loss of dopamine-producing neurons in the substantia nigra. This results in motor symptoms such as bradykinesia, muscle rigidity, tremor, and postural instability, as well as cognitive, mood, and behavioral changes.

      Alzheimer’s dementia, on the other hand, is not associated with a movement disorder but is characterized by atrophy of the medial temporal lobe and temporoparietal cortex, which can be seen on CT and MRI scans.

      Huntington’s disease is another basal ganglia disorder, but it primarily affects the striatum, leading to a loss of striatal volume on CT and MRI scans. The movement disorder seen in Huntington’s disease is chorea, which is characterized by jerky, uncontrollable limb movements.

      Multi-system atrophy is a rare neurodegenerative disease that affects the basal ganglia and cerebellum, leading to autonomic dysfunction, ataxia, and Parkinsonism. However, cognitive impairment is uncommon in this disorder.

      Parkinson’s disease is a progressive neurodegenerative disorder that occurs due to the degeneration of dopaminergic neurons in the substantia nigra. This leads to a classic triad of symptoms, including bradykinesia, tremor, and rigidity, which are typically asymmetrical. The disease is more common in men and is usually diagnosed around the age of 65. Bradykinesia is characterized by a poverty of movement, shuffling steps, and difficulty initiating movement. Tremors are most noticeable at rest and typically occur in the thumb and index finger. Rigidity can be either lead pipe or cogwheel, and other features include mask-like facies, flexed posture, and drooling of saliva. Psychiatric features such as depression, dementia, and sleep disturbances may also occur. Diagnosis is usually clinical, but if there is difficulty differentiating between essential tremor and Parkinson’s disease, 123I‑FP‑CIT single photon emission computed tomography (SPECT) may be considered.

    • This question is part of the following fields:

      • Neurological System
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  • Question 23 - A 57-year-old man has been diagnosed with motor neuron disease, which is caused...

    Incorrect

    • A 57-year-old man has been diagnosed with motor neuron disease, which is caused by dysregulation in RNA splicing. This dysregulation leads to the degeneration of both upper and lower motor neurons. In which cellular component does this dysregulation occur?

      Your Answer:

      Correct Answer: Nucleus

      Explanation:

      RNA splicing occurs in the nucleus.

      Functions of Cell Organelles

      The functions of major cell organelles can be summarized in a table. The rough endoplasmic reticulum (RER) is responsible for the translation and folding of new proteins, as well as the manufacture of lysosomal enzymes. It is also the site of N-linked glycosylation. Cells such as pancreatic cells, goblet cells, and plasma cells have extensive RER. On the other hand, the smooth endoplasmic reticulum (SER) is involved in steroid and lipid synthesis. Cells of the adrenal cortex, hepatocytes, and reproductive organs have extensive SER.

      The Golgi apparatus modifies, sorts, and packages molecules that are destined for cell secretion. The addition of mannose-6-phosphate to proteins designates transport to lysosome. The mitochondrion is responsible for aerobic respiration and contains mitochondrial genome as circular DNA. The nucleus is involved in DNA maintenance, RNA transcription, and RNA splicing, which removes the non-coding sequences of genes (introns) from pre-mRNA and joins the protein-coding sequences (exons).

      The lysosome is responsible for the breakdown of large molecules such as proteins and polysaccharides. The nucleolus produces ribosomes, while the ribosome translates RNA into proteins. The peroxisome is involved in the catabolism of very long chain fatty acids and amino acids, resulting in the formation of hydrogen peroxide. Lastly, the proteasome, along with the lysosome pathway, is involved in the degradation of protein molecules that have been tagged with ubiquitin.

    • This question is part of the following fields:

      • General Principles
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  • Question 24 - A 67-year-old woman visits her general practitioner complaining of pelvic pain, weight loss,...

    Incorrect

    • A 67-year-old woman visits her general practitioner complaining of pelvic pain, weight loss, and vaginal bleeding that has persisted for 3 months. She has been menopausal for 15 years and is not currently taking any medication. Upon examination, no abnormalities are found in her abdomen or pelvis, and she is referred to a gynaecologist for urgent evaluation. Unfortunately, the patient is diagnosed with endometrial cancer that has spread to the fundus of her uterus.

      Which lymph node region is most likely to be affected by metastatic spread in this patient?

      Your Answer:

      Correct Answer: Para-aortic nodes

      Explanation:

      The para-aortic lymph nodes are responsible for draining the uterine fundus. This is because the ovaries develop in the abdomen and move down the posterior abdominal wall during fetal development, and their lymphatic drainage comes from the para-aortic nodes. Therefore, lymphatic spread is most likely to occur in this location.

      The inferior mesenteric nodes are not responsible for draining the uterine fundus, as they primarily drain hindgut structures from the transverse colon down to the rectum.

      Similarly, the internal iliac nodes are not responsible for draining the uterine fundus, as they primarily drain the inferior portion of the rectum, the anal canal above the pectinate line, and the pelvic viscera.

      The posterior mediastinal chain is also not responsible for draining the uterine fundus, as it primarily drains the oesophagus, mediastinum, and posterior surface of the diaphragm.

      Lymphatic Drainage of Female Reproductive Organs

      The lymphatic drainage of the female reproductive organs is a complex system that involves multiple nodal stations. The ovaries drain to the para-aortic lymphatics via the gonadal vessels. The uterine fundus has a lymphatic drainage that runs with the ovarian vessels and may thus drain to the para-aortic nodes. Some drainage may also pass along the round ligament to the inguinal nodes. The body of the uterus drains through lymphatics contained within the broad ligament to the iliac lymph nodes. The cervix drains into three potential nodal stations; laterally through the broad ligament to the external iliac nodes, along the lymphatics of the uterosacral fold to the presacral nodes and posterolaterally along lymphatics lying alongside the uterine vessels to the internal iliac nodes. Understanding the lymphatic drainage of the female reproductive organs is important for the diagnosis and treatment of gynecological cancers.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 25 - Linda, a 68-year-old female, visits a shoulder clinic for a routine follow-up appointment...

    Incorrect

    • Linda, a 68-year-old female, visits a shoulder clinic for a routine follow-up appointment after undergoing a right shoulder replacement surgery for osteoarthritis. During the consultation, she reports limited movement in bending her elbow and shoulder.

      Upon examining her upper limb, the surgeon observes decreased flexion at the elbow and suspects nerve damage during the operation.

      Which nerve is most likely to have been affected based on the patient's symptoms and signs?

      Your Answer:

      Correct Answer: Musculocutaneous nerve

      Explanation:

      When the musculocutaneous nerve is injured, it can result in weakness when flexing the upper arm at the shoulder and elbow. This nerve is responsible for innervating the brachialis, biceps brachii, and coracobrachialis muscles. Other nerves, such as the axillary nerve, median nerve, and radial nerve, also play a role in muscle innervation and movement. The axillary nerve innervates the teres minor and deltoid muscles, while the median nerve innervates the majority of the flexor muscles in the forearm, the thenar muscles, and the two lateral lumbricals. The radial nerve innervates the triceps brachii and the muscles in the posterior compartment of the forearm, which generally cause extension of the wrist and fingers.

      The Musculocutaneous Nerve: Function and Pathway

      The musculocutaneous nerve is a nerve branch that originates from the lateral cord of the brachial plexus. Its pathway involves penetrating the coracobrachialis muscle and passing obliquely between the biceps brachii and the brachialis to the lateral side of the arm. Above the elbow, it pierces the deep fascia lateral to the tendon of the biceps brachii and continues into the forearm as the lateral cutaneous nerve of the forearm.

      The musculocutaneous nerve innervates the coracobrachialis, biceps brachii, and brachialis muscles. Injury to this nerve can cause weakness in flexion at the shoulder and elbow. Understanding the function and pathway of the musculocutaneous nerve is important in diagnosing and treating injuries or conditions that affect this nerve.

    • This question is part of the following fields:

      • Neurological System
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  • Question 26 - A 9-year-old boy comes to the GP after experiencing bloody diarrhoea for the...

    Incorrect

    • A 9-year-old boy comes to the GP after experiencing bloody diarrhoea for the past 6 days. He complains of abdominal pain and has been urinating very little. His mother has also noticed multiple bruises on his body without any known cause. What is the most probable organism responsible for his symptoms?

      Your Answer:

      Correct Answer: E. coli

      Explanation:

      The patient’s symptoms suggest that they may be suffering from haemolytic uraemic syndrome (HUS), which is often caused by an infection with E.coli 0157:H7.

      HUS is characterized by a combination of haemolytic anaemia, thrombocytopaenia, and acute kidney injury, which can ultimately lead to renal failure.

      The presence of bloody diarrhoea in the patient’s medical history is a significant indicator of HUS. Additionally, the reduced urine output is likely due to the acute kidney injury, while the bruising may be a result of the thrombocytopaenia associated with HUS.

      Understanding Haemolytic Uraemic Syndrome

      Haemolytic uraemic syndrome (HUS) is a condition that primarily affects young children and is characterized by a triad of symptoms, including acute kidney injury, microangiopathic haemolytic anaemia, and thrombocytopenia. The most common cause of HUS in children is Shiga toxin-producing Escherichia coli (STEC) 0157:H7, which accounts for over 90% of cases. Other causes of HUS include pneumococcal infection, HIV, systemic lupus erythematosus, drugs, and cancer.

      To diagnose HUS, doctors may perform a full blood count, check for evidence of STEC infection in stool culture, and conduct PCR for Shiga toxins. Treatment for HUS is supportive and may include fluids, blood transfusion, and dialysis if required. Antibiotics are not recommended, despite the preceding diarrhoeal illness in many patients. The indications for plasma exchange in HUS are complicated, and as a general rule, plasma exchange is reserved for severe cases of HUS not associated with diarrhoea. Eculizumab, a C5 inhibitor monoclonal antibody, has shown greater efficiency than plasma exchange alone in the treatment of adult atypical HUS.

      In summary, HUS is a serious condition that primarily affects young children and is characterized by a triad of symptoms. The most common cause of HUS in children is STEC 0157:H7, and diagnosis may involve various tests. Treatment is supportive, and antibiotics are not recommended. The indications for plasma exchange are complicated, and eculizumab may be more effective in treating adult atypical HUS.

    • This question is part of the following fields:

      • Renal System
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  • Question 27 - A 65-year-old woman visits her GP complaining of difficulty swallowing, altered taste, and...

    Incorrect

    • A 65-year-old woman visits her GP complaining of difficulty swallowing, altered taste, and a recent weight loss of 6kg over the past 2 months. Upon examination, the patient appears pale and cachectic, with an absent gag reflex. A CT scan of the head and neck reveals a poorly defined hypodense lesion consistent with a skull base tumor that is compressing the sigmoid sinus. Which structure is most likely to have been invaded by this tumor?

      Your Answer:

      Correct Answer: Jugular foramen

      Explanation:

      The glossopharyngeal nerve travels through the jugular foramen, which is consistent with the patient’s absent gag reflex. The sigmoid sinus also passes through this canal, which is compressed in the patient’s CT. Therefore, the correct answer is the jugular foramen. The foramen ovale, foramen rotundum, and hypoglossal canal are not associated with the glossopharyngeal nerve and would not cause the patient’s symptoms.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
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  • Question 28 - A 25-year-old athlete is collaborating with the cardiovascular physiology department to enhance their...

    Incorrect

    • A 25-year-old athlete is collaborating with the cardiovascular physiology department to enhance their performance. They are observing their heart rate to optimize their training routine. After a rigorous treadmill test, their heart rate rises from 56 beats per minute (BPM) to 184 BPM, leading to an increase in their cardiac output.

      What is the most accurate description of the alterations in stroke volume during the treadmill test?

      Your Answer:

      Correct Answer: Increased venous return from the muscles, increases preload and increases stroke volume

      Explanation:

      When the body is exercising, the heart needs to increase its output to meet the increased demand for oxygen in the muscles. This is achieved by increasing the heart rate, but there is a limit to how much the heart rate can increase. To achieve a total increase in cardiac output, the stroke volume must also increase. This is done by increasing the preload, which is facilitated by an increase in venous return.

      Therefore, an increase in venous return will always result in an increase in preload and stroke volume. Conversely, a decrease in venous return will lead to a decrease in preload and stroke volume, as there is less blood returning to the heart from the rest of the body. It is important to note that an increase in venous return cannot result in a decrease in either stroke volume or preload.

      Cardiovascular physiology involves the study of the functions and processes of the heart and blood vessels. One important measure of heart function is the left ventricular ejection fraction, which is calculated by dividing the stroke volume (the amount of blood pumped out of the left ventricle with each heartbeat) by the end diastolic LV volume (the amount of blood in the left ventricle at the end of diastole) and multiplying by 100%. Another key measure is cardiac output, which is the amount of blood pumped by the heart per minute and is calculated by multiplying stroke volume by heart rate.

      Pulse pressure is another important measure of cardiovascular function, which is the difference between systolic pressure (the highest pressure in the arteries during a heartbeat) and diastolic pressure (the lowest pressure in the arteries between heartbeats). Factors that can increase pulse pressure include a less compliant aorta (which can occur with age) and increased stroke volume.

      Finally, systemic vascular resistance is a measure of the resistance to blood flow in the systemic circulation and is calculated by dividing mean arterial pressure (the average pressure in the arteries during a heartbeat) by cardiac output. Understanding these measures of cardiovascular function is important for diagnosing and treating cardiovascular diseases.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 29 - A 63-year-old woman with a longstanding history of type 2 diabetes mellitus, hypertension,...

    Incorrect

    • A 63-year-old woman with a longstanding history of type 2 diabetes mellitus, hypertension, and hypercholesterolemia experienced sudden weakness in her right lower leg while preparing breakfast. She had a similar episode two days ago, which resolved after an hour. Her son brought her to the emergency department, where she reported her symptoms to the attending physician. The patient can speak well and fully comprehend what the doctor tells her. Upon examination, the doctor noted decreased touch sensation in her right leg. A non-contrast computed tomography (CT) scan was unremarkable, but a repeat CT scan after 12 hours revealed an area of hypo-attenuation in a region of the brain. Which artery of the cerebral circulation is most likely to be occluded in this patient?

      Your Answer:

      Correct Answer: Anterior cerebral artery

      Explanation:

      The patient’s symptoms suggest a diagnosis of stroke, likely caused by their long history of diabetes, hypertension, and hypercholesterolemia, which are all risk factors for ischemic stroke. The absence of risk factors for hemorrhagic stroke, such as blood clotting disorders or warfarin use, supports this diagnosis. The CT scan performed upon admission may have been too early to detect the stroke, as ischemic strokes are typically visible on CT scans only after 6 hours. However, brain tissue swelling 12 hours later can produce an area of hypo-attenuation visible on CT scan.

      The patient’s contralateral hemiparesis and sensory loss, with greater impact on the lower extremity than the upper, suggest an ischemic stroke affecting the anterior cerebral artery. If the posterior cerebral artery were obstructed, the patient would experience contralateral hemianopia with macular sparing. An ischemic stroke affecting the middle cerebral artery would more likely affect the upper limbs and face, and could also impact language centers or cause hemineglect. An ischemic stroke affecting the basilar artery could result in severe neurological impairment, such as locked-in syndrome or quadriplegia. An occlusion of the posterior inferior cerebellar artery would cause swallowing impairment, hoarseness, and loss of the gag reflex.

      Stroke can affect different parts of the brain depending on which artery is affected. If the anterior cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the lower extremities being more affected than the upper. If the middle cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the upper extremities being more affected than the lower. They may also experience vision loss and difficulty with language. If the posterior cerebral artery is affected, the person may experience vision loss and difficulty recognizing objects.

      Lacunar strokes are a type of stroke that are strongly associated with hypertension. They typically present with isolated weakness or loss of sensation on one side of the body, or weakness with difficulty coordinating movements. They often occur in the basal ganglia, thalamus, or internal capsule.

    • This question is part of the following fields:

      • Neurological System
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  • Question 30 - A group of researchers and physicians are working on a novel screening method...

    Incorrect

    • A group of researchers and physicians are working on a novel screening method for detecting pancreatic cancer at an early stage. The trial for this test is underway, and initial findings regarding its accuracy have been released:

      Condition present Condition absent
      Positive test 70 25
      Negative test 10 60

      What is the sensitivity of the new test, rounded to two decimal places?

      Your Answer:

      Correct Answer: 0.84

      Explanation:

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • General Principles
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal System And Skin (1/3) 33%
Paediatrics (0/1) 0%
Renal System (0/2) 0%
Haematology And Oncology (1/2) 50%
Infectious Diseases (0/1) 0%
Clinical Sciences (1/1) 100%
General Principles (3/3) 100%
Reproductive System (0/1) 0%
Neurological System (1/2) 50%
Passmed