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Question 1
Incorrect
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A 25-year-old woman is stabbed in the buttock and receives sutures in the emergency department. When she visits the clinic eight weeks later, she presents with a waddling gait and difficulty with thigh abduction. Upon examination, she exhibits buttock muscle wasting. Which nerve was damaged in the injury?
Your Answer: Sciatic nerve
Correct Answer: Superior gluteal nerve
Explanation:If the superior gluteal nerve is damaged, it will cause a Trendelenburg gait.
The Trendelenburg Test: Assessing Gluteal Nerve Function
The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.
When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.
To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.
It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 2
Correct
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A 45-year-old patient has a cardiac output of 6 L/min and a heart rate of 60/min. Her end-diastolic left ventricular volume is 200ml. What is her left ventricular ejection fraction (LVEF)?
Your Answer: 50%
Explanation: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.
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This question is part of the following fields:
- Cardiovascular System
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Question 3
Correct
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An 80-year-old man is admitted to the acute medical ward after experiencing a myocardial infarction. During examination, it is discovered that his heart rate is 40 beats per minute. The consultant explains that this is due to damage to the conduction pathways between the sinoatrial and atrioventricular (AV) node, resulting in the AV node pacing his ventricles exclusively.
In most patients, what is the blood supply to the AV node?Your Answer: Right coronary artery
Explanation:The AV node is typically supplied by the right coronary artery in right-dominant hearts, while in left-dominant hearts it is supplied by the left circumflex artery. The left circumflex artery also supplies the left atrium and some of the left ventricle, while the right marginal artery supplies the right ventricle, the posterior descending artery supplies the posterior third of the interventricular septum, and the left anterior descending artery supplies the left ventricle.
The walls of each cardiac chamber are made up of the epicardium, myocardium, and endocardium. The heart and roots of the great vessels are related anteriorly to the sternum and the left ribs. The coronary sinus receives blood from the cardiac veins, and the aortic sinus gives rise to the right and left coronary arteries. The left ventricle has a thicker wall and more numerous trabeculae carnae than the right ventricle. The heart is innervated by autonomic nerve fibers from the cardiac plexus, and the parasympathetic supply comes from the vagus nerves. The heart has four valves: the mitral, aortic, pulmonary, and tricuspid valves.
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This question is part of the following fields:
- Cardiovascular System
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Question 4
Incorrect
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A 45-year-old man presents to the physician complaining of fatigue, dark urine, and swelling in his lower extremities that has been ongoing for the past two weeks. He has no significant medical history and is not taking any medications. He denies using tobacco, alcohol, or drugs. During the physical examination, symmetric pitting oedema is observed in his lower extremities, and his blood pressure is 132/83 mmHg with a pulse of 84/min.
Laboratory results reveal a urea level of 4mmol/L (2.0 - 7.0) and a creatinine level of 83 µmol/L (55 - 120). Urinalysis shows 4+ proteinuria and microscopic hematuria. Electron microscopy of the kidney biopsy specimen reveals dense deposits within the glomerular basement membrane, and immunofluorescence microscopy is positive for C3, not immunoglobulins.
What is the most likely pathophysiologic mechanism underlying this patient's condition?Your Answer: Circulating immune complexes
Correct Answer: Persistent activation of alternate complement pathway
Explanation:The cause of membranoproliferative glomerulonephritis, type 2, is persistent activation of the alternative complement pathway, which leads to kidney damage. This condition is characterized by IgG antibodies, known as C3 nephritic factor, that target C3 convertase. In contrast, Goodpasture’s syndrome is associated with anti-GBM antibodies, while rapidly progressive glomerulonephritis may involve cell-mediated injury. Immune complex-mediated glomerulopathies, such as SLE and post-streptococcal glomerulonephritis, are caused by circulating immune complexes, while non-immunologic kidney damage is seen in diabetic nephropathy and hypertensive nephropathy.
Understanding Membranoproliferative Glomerulonephritis
Membranoproliferative glomerulonephritis, also known as mesangiocapillary glomerulonephritis, is a kidney disease that can present as nephrotic syndrome, haematuria, or proteinuria. Unfortunately, it has a poor prognosis. There are three types of this disease, with type 1 accounting for 90% of cases. It is caused by cryoglobulinaemia and hepatitis C, and can be diagnosed through a renal biopsy that shows subendothelial and mesangium immune deposits of electron-dense material resulting in a ‘tram-track’ appearance under electron microscopy.
Type 2, also known as ‘dense deposit disease’, is caused by partial lipodystrophy and factor H deficiency. It is characterized by persistent activation of the alternative complement pathway, low circulating levels of C3, and the presence of C3b nephritic factor in 70% of cases. This factor is an antibody to alternative-pathway C3 convertase (C3bBb) that stabilizes C3 convertase. A renal biopsy for type 2 shows intramembranous immune complex deposits with ‘dense deposits’ under electron microscopy.
Type 3 is caused by hepatitis B and C. While steroids may be effective in managing this disease, it is important to note that the prognosis for all types of membranoproliferative glomerulonephritis is poor. Understanding the different types and their causes can help with diagnosis and management of this serious kidney disease.
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This question is part of the following fields:
- Renal System
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Question 5
Incorrect
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A 44-year-old man was admitted to the emergency department with facial swelling and difficulty breathing. Stridor and dilated neck veins were observed on examination. A CT scan revealed a mass obstructing the superior vena cava, which was later confirmed to be non-Hodgkin lymphoma. The patient received initial chemotherapy treatment for the lymphoma.
After five weeks, he returned to the emergency department complaining of a tingling and painful sensation in his hands and feet bilaterally. Additionally, he was observed to have a high steppage gait. What is the most likely cause of his symptoms during his second visit to the emergency department?Your Answer: Prednisolone
Correct Answer: Vincristine
Explanation:The standard chemotherapy regimen for non-Hodgkin lymphoma is R-CHOP, which includes Rituximab (in certain patients), cyclophosphamide, hydroxydaunorubicin, Oncovin (vincristine), and prednisolone. However, one of the significant side effects of vincristine is chemotherapy-induced peripheral neuropathy, which can cause tingling or numbness starting from the extremities. It can also lead to severe neuropathic pain and distal weakness, such as foot drop.
While Rituximab can cause adverse effects such as cardiotoxicity and infections, it is not commonly associated with neurological effects. Cyclophosphamide, on the other hand, can cause chemotherapy-induced nausea and vomiting, bone marrow suppression, and haemorrhagic cystitis due to its toxicity to the bladder epithelium.
Hydroxydaunorubicin is known to cause dilated cardiomyopathy, which can lead to heart failure and has a high mortality rate.
Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and potential adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.
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This question is part of the following fields:
- Haematology And Oncology
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Question 6
Correct
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A 50-year-old male complains of stiffness and joint pains in his hands and feet for the past month, which is worse in the morning. He has no significant medical history and is not taking any medication. Upon examination, there is some mild swelling in the proximal interphalangeal joints of both hands, metacarpo-phalangeal joints, and wrist. No other abnormalities are detected. What would be the most suitable investigation for this patient?
Your Answer: Rheumatoid factor
Explanation:Rheumatoid Factor and Diagnostic Markers for Rheumatoid Arthritis
The clinical scenario presented is a common manifestation of rheumatoid arthritis, with a positive rheumatoid factor found in approximately 70% of cases. This factor is an IgM antibody directed against IgG, and while false positives can occur, its presence is highly supportive of the diagnosis and carries prognostic significance. In addition to rheumatoid factor, non-specific markers of inflammation such as erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) are expected to be elevated in patients with rheumatoid arthritis. These diagnostic markers can aid in the diagnosis and management of the disease. Proper interpretation and utilization of these markers can lead to earlier diagnosis and better outcomes for patients with rheumatoid arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 7
Correct
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A 35-year-old man visits his GP complaining of a painful, erythematous, vesicular rash on the anteromedial aspect of his left arm and a small area of his left chest. The patient reports that he first experienced pain in the affected area three days ago and noticed the rash yesterday morning. He attributes his current stressful state to work-related issues, which were exacerbated by a recent COVID-19 infection that required him to take 10 days off. The patient confirms that he had chickenpox during his childhood. Based on this information, where is the virus responsible for his symptoms most likely to have been dormant in his nervous system?
Your Answer: T1 dorsal root ganglion
Explanation:After the primary infection (usually chickenpox during childhood), the herpes zoster virus remains inactive in the dorsal root or cranial nerve ganglia. The patient’s rash, which appears in the left T1 dermatome, indicates that the virus has been dormant in the T1 dorsal root ganglion. Although herpes zoster can reactivate at any time, it is more commonly associated with older age, recent viral infections, periods of stress, or immunosuppression.
Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 8
Incorrect
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A 10-year-old male presents with recurrent swollen joints which are painful. His parents have noticed this is usually precipitated by minor accidents while playing on the playground. A plasma factor assay is requested which reveals a diagnosis of haemophilia A.
Which of the following tests is most likely to be normal in this patient?Your Answer: Haemoglobin
Correct Answer: Bleeding time
Explanation:Bleeding time is typically unaffected by haemophilia as it is a disorder of secondary haemostasis and does not impact platelets. However, APTT is likely to be prolonged due to a deficiency in factor VIII, which is reduced in haemophilia A. The disruption of the coagulation cascade is a result of this factor VIII deficiency. In cases of severe haemophilia A with significant blood loss, haemoglobin levels may be low.
Haemophilia is a genetic disorder that affects blood coagulation and is inherited in an X-linked recessive manner. It is possible for up to 30% of patients to have no family history of the condition. Haemophilia A is caused by a deficiency of factor VIII, while haemophilia B, also known as Christmas disease, is caused by a lack of factor IX.
The symptoms of haemophilia include haemoarthroses, haematomas, and prolonged bleeding after surgery or trauma. Blood tests can reveal a prolonged APTT, while the bleeding time, thrombin time, and prothrombin time are normal. However, up to 10-15% of patients with haemophilia A may develop antibodies to factor VIII treatment.
Overall, haemophilia is a serious condition that can cause significant bleeding and other complications. It is important for individuals with haemophilia to receive appropriate medical care and treatment to manage their symptoms and prevent further complications.
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This question is part of the following fields:
- Haematology And Oncology
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Question 9
Incorrect
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A 15-year-old girl is brought to the clinic by her mother due to complaints of severe abdominal cramps and heavy menstrual bleeding.
Which term accurately describes an excessive amount of menstrual bleeding?Your Answer: Dysmenorrhoea
Correct Answer: Menorrhagia
Explanation:Menstrual Disorders
Menstrual disorders are common among women and can cause discomfort and inconvenience. Menorrhagia is a condition where women experience prolonged and heavy periods at regular intervals. On the other hand, metrorrhagia, also known as spotting, is characterized by vaginal bleeding that is not in line with a regular menstrual cycle. Cryptomenorrhoea is a condition where menstruation occurs but is concealed, such as in the case of an imperforate hymen. Dysmenorrhoea, which often coexists with menorrhagia, refers to severe uterine pain experienced by some women during and around the time of menstruation.
Oligomenorrhoea, on the other hand, is a condition where menstrual bleeding occurs infrequently, with periods of non-menstruation for more than 35 days. When menstruation does not occur at all, this is called amenorrhoea. It is important for women to be aware of these conditions and seek medical attention if they experience any abnormal menstrual symptoms. Proper diagnosis and treatment can help manage these conditions and improve the quality of life for women.
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This question is part of the following fields:
- Clinical Sciences
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Question 10
Correct
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What stage of cellular respiration is responsible for the production of pyruvic acid?
Your Answer: Glycolysis
Explanation:The Versatility of Pyruvic Acid in Cellular Metabolism
Pyruvic acid is a simple alpha-keto acid that plays a crucial role in several metabolic pathways within the cell. It serves as a central intersection where different pathways converge and diverge. One of the primary ways pyruvic acid is produced is through glycolysis, where glucose is broken down into pyruvic acid. Depending on the cell’s needs, pyruvic acid can be converted back into glucose through gluconeogenesis or used to synthesize fatty acids through the acetyl-CoA pathway. Additionally, pyruvic acid can be used to produce the amino acid alanine.
Pyruvic acid is also involved in respiration, where it enters the Krebs cycle under aerobic conditions. This cycle produces energy in the form of ATP, which is used by the cell for various functions. Under anaerobic conditions, pyruvic acid can ferment into lactic acid, which is used by some organisms as a source of energy.
In summary, pyruvic acid is a versatile molecule that plays a critical role in cellular metabolism. Its ability to be converted into different molecules depending on the cell’s needs makes it an essential component of many metabolic pathways.
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This question is part of the following fields:
- Basic Sciences
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Question 11
Incorrect
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During which stage of the cell cycle does the replication of DNA occur?
Your Answer: M phase
Correct Answer: S phase
Explanation:The Five Phases of the Cell Cycle
The cell cycle is a complex process that is divided into five main phases, each with its unique cellular events. The first phase is the G0 phase, which is a resting phase where the cell has stopped dividing and is out of the cell cycle. The second phase is the G1 phase, also known as interphase Gap 1, where cells increase in size, and a checkpoint control mechanism prepares the cell for DNA synthesis.
The third phase is the S phase, where DNA replication occurs. The fourth phase is the G2 phase, also known as Gap 2, which is a gap between DNA synthesis and the onset of mitosis. During this phase, the cell continues to grow until it is ready to enter mitosis. Finally, the fifth phase is the M phase, also known as mitosis, where cell growth stops, and the cell focuses its energy to divide into two daughter cells.
A checkpoint in the middle of mitosis, known as the metaphase checkpoint, ensures that the cell is prepared to complete division. the five phases of the cell cycle is crucial in how cells divide and grow.
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This question is part of the following fields:
- Basic Sciences
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Question 12
Incorrect
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A 32-year-old man presents to the emergency department complaining of abdominal pain and persistent diarrhoea. He recently returned from a trip to Brazil and noticed the symptoms a few days after his return. He initially thought it was food-related, but he also developed an urticarial rash on his abdomen and papulovesicular lesions on the soles of his feet. Stool cultures are ordered to determine the most likely causative agent.
What is the probable cause of the patient's symptoms?Your Answer: Shigella
Correct Answer: Strongyloides stercoralis
Explanation:The patient in the vignette is likely infected with Strongyloides stercoralis, as he presents with diarrhoea and abdominal pain, along with papulovesicular lesions on the soles of his feet and an urticarial rash. S. stercoralis is a parasitic roundworm that resides in the small intestine and is commonly found in areas with poor sanitation. The other options in the vignette do not match the patient’s symptoms, as they do not involve papulovesicular lesions.
Helminths are a group of parasitic worms that can infect humans and cause various diseases. Nematodes, also known as roundworms, are one type of helminth. Strongyloides stercoralis is a type of roundworm that enters the body through the skin and can cause symptoms such as diarrhea, abdominal pain, and skin lesions. Treatment for this infection typically involves the use of ivermectin or benzimidazoles. Enterobius vermicularis, also known as pinworm, is another type of roundworm that can cause perianal itching and other symptoms. Diagnosis is made by examining sticky tape applied to the perianal area. Treatment typically involves benzimidazoles.
Hookworms, such as Ancylostoma duodenale and Necator americanus, are another type of roundworm that can cause gastrointestinal infections and anemia. Treatment typically involves benzimidazoles. Loa loa is a type of roundworm that is transmitted by deer fly and mango fly and can cause red, itchy swellings called Calabar swellings. Treatment involves the use of diethylcarbamazine. Trichinella spiralis is a type of roundworm that can develop after eating raw pork and can cause fever, periorbital edema, and myositis. Treatment typically involves benzimidazoles.
Onchocerca volvulus is a type of roundworm that causes river blindness and is spread by female blackflies. Treatment involves the use of ivermectin. Wuchereria bancrofti is another type of roundworm that is transmitted by female mosquitoes and can cause blockage of lymphatics and elephantiasis. Treatment involves the use of diethylcarbamazine. Toxocara canis, also known as dog roundworm, is transmitted through ingestion of infective eggs and can cause visceral larva migrans and retinal granulomas. Treatment involves the use of diethylcarbamazine. Ascaris lumbricoides, also known as giant roundworm, can cause intestinal obstruction and occasionally migrate to the lung. Treatment typically involves benzimidazoles.
Cestodes, also known as tapeworms, are another type of helminth. Echinococcus granulosus is a tapeworm that is transmitted through ingestion of eggs in dog feces and can cause liver cysts and anaphylaxis if the cyst ruptures
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This question is part of the following fields:
- General Principles
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Question 13
Incorrect
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Infusion with which of the following blood products is most likely to result in an urticarial reaction?
Rewritten: Infusion of which blood product is most likely to cause urticarial reactions?Your Answer: Cryoprecipitate
Correct Answer: Fresh frozen plasma
Explanation:Transfusion of packed red cells is frequently associated with pyrexia as an adverse event, while infusion of FFP often leads to urticaria as the most common adverse event.
Blood product transfusion complications can be categorized into immunological, infective, and other complications. Immunological complications include acute haemolytic reactions, non-haemolytic febrile reactions, and allergic/anaphylaxis reactions. Infective complications may arise due to transmission of vCJD, although measures have been taken to minimize this risk. Other complications include transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), hyperkalaemia, iron overload, and clotting.
Non-haemolytic febrile reactions are thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage. These reactions may occur in 1-2% of red cell transfusions and 10-30% of platelet transfusions. Minor allergic reactions may also occur due to foreign plasma proteins, while anaphylaxis may be caused by patients with IgA deficiency who have anti-IgA antibodies.
Acute haemolytic transfusion reaction is a serious complication that results from a mismatch of blood group (ABO) which causes massive intravascular haemolysis. Symptoms begin minutes after the transfusion is started and include a fever, abdominal and chest pain, agitation, and hypotension. Treatment should include immediate transfusion termination, generous fluid resuscitation with saline solution, and informing the lab. Complications include disseminated intravascular coagulation and renal failure.
TRALI is a rare but potentially fatal complication of blood transfusion that is characterized by the development of hypoxaemia/acute respiratory distress syndrome within 6 hours of transfusion. On the other hand, TACO is a relatively common reaction due to fluid overload resulting in pulmonary oedema. As well as features of pulmonary oedema, the patient may also be hypertensive, a key difference from patients with TRALI.
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This question is part of the following fields:
- Haematology And Oncology
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Question 14
Incorrect
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A 10-year-old girl comes to the clinic with a painful left ankle following a fall. An x-ray reveals a fracture that runs through the tibial growth plate and metaphysis. What Salter-Harris fracture classification does this injury fall under?
Your Answer: V
Correct Answer: II
Explanation:Type II Salter-Harris Fractures
The Salter-Harris classification system is a way to categorize fractures that involve the growth plate or physis. These types of fractures are common in children and teenagers whose growth plates are still open. Type II Salter-Harris fractures are the most common, accounting for 75% of all growth plate fractures. This type of fracture involves a defect that runs through the growth plate and then the metaphysis.
To put it simply, a Type II Salter-Harris fracture occurs when a bone breaks through the growth plate and into the surrounding bone tissue. This type of fracture is often caused by a sudden impact or trauma to the affected area. It is important to diagnose and treat Type II fractures promptly to prevent any long-term complications, such as growth abnormalities or joint problems.
In summary, Type II Salter-Harris fractures are a common type of growth plate fracture that involves a defect running through the growth plate and then the metaphysis. These fractures can have long-term consequences if not treated properly, making prompt diagnosis and treatment essential.
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This question is part of the following fields:
- Rheumatology
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Question 15
Incorrect
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A 75-year-old woman has been referred to the haematology clinic due to intermittent lymphadenopathy affecting her neck for the past 18 months. Following a biopsy, the histology report suggests a possible diagnosis of follicular lymphoma. To assist with the diagnosis, genetic analysis is conducted.
What is the most probable genomic alteration that will be detected?Your Answer: T(8;14) causing c-myc gene translocation
Correct Answer: T(14;18) causing increased BCL-2 transcription
Explanation:Genetics of Haematological Malignancies
Haematological malignancies are cancers that affect the blood, bone marrow, and lymphatic system. These cancers are often associated with specific genetic abnormalities, such as translocations. Here are some common translocations and their associated haematological malignancies:
– Philadelphia chromosome (t(9;22)): This translocation is present in more than 95% of patients with chronic myeloid leukaemia (CML). It results in the fusion of the Abelson proto-oncogene with the BCR gene on chromosome 22, creating the BCR-ABL gene. This gene codes for a fusion protein with excessive tyrosine kinase activity, which is a poor prognostic indicator in acute lymphoblastic leukaemia (ALL).
– t(15;17): This translocation is seen in acute promyelocytic leukaemia (M3) and involves the fusion of the PML and RAR-alpha genes.
– t(8;14): Burkitt’s lymphoma is associated with this translocation, which involves the translocation of the MYC oncogene to an immunoglobulin gene.
– t(11;14): Mantle cell lymphoma is associated with the deregulation of the cyclin D1 (BCL-1) gene.
– t(14;18): Follicular lymphoma is associated with increased BCL-2 transcription due to this translocation.
Understanding the genetic abnormalities associated with haematological malignancies is important for diagnosis, prognosis, and treatment.
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This question is part of the following fields:
- Haematology And Oncology
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Question 16
Incorrect
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A 65-year-old man visits his doctor with complaints of a painful rash on his face after experiencing lethargy and headache for 3 days. The man's vital signs are within normal limits. Upon examination, a distinct line of blisters is observed on the upper left side of his face.
What is the most frequent complication associated with this condition in the elderly population?Your Answer: Bacterial superinfection
Correct Answer: Neuralgia
Explanation:The most common complication of shingles is post-herpetic neuralgia, which is characterized by a burning pain in the affected dermatome. This condition is likely to occur in older individuals, who are also at risk of experiencing more severe and prolonged pain. While bacterial superinfection of cutaneous lesions can occur, it is typically caused by Staphylococcus aureus or group A streptococcal species. Shingles can also lead to complications such as pneumonia, meningoencephalitis, hepatitis, and acute retinal necrosis if it affects internal organs.
Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 17
Incorrect
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A 6-year-old boy is brought to the paediatrician by his parents due to a fever and sore throat that has been bothering him for the past 24 hours. The boy is experiencing significant discomfort in his throat and has been refusing to eat or drink. He does not report having a cough or a runny nose. The boy was delivered via spontaneous vaginal delivery and has been developing normally. He has two healthy older siblings. During the examination, the doctor observes that the boy's tonsils are inflamed and enlarged, with some white exudates, as well as enlarged cervical lymph nodes. The boy's temperature is 38.2 °C. The doctor informs the parents that the boy requires antibiotics to treat the current infection and prevent the risk of a severe complication commonly associated with this particular infection. What complication can be prevented with prompt antibiotic treatment?
Your Answer: Septicaemia
Correct Answer: Acute rheumatic fever
Explanation:Pharyngitis is the likely diagnosis for this patient based on their presenting symptoms. Group A streptococcus, also known as Streptococcus pyogenes, is a common cause of pharyngitis in young patients. One of the most concerning complications of this infection is acute rheumatic fever, which can lead to damage to the heart valves. Early antibiotic treatment can prevent the development of this serious condition.
1: Septicemia can result from various bacterial infections, but it is not typically associated with Group A streptococcal pharyngitis. Additionally, septicemia is rare in patients with this type of pharyngitis, as the condition usually resolves on its own without treatment.
2: Acute rheumatic fever is a serious complication of Group A streptococcal pharyngitis. It is an immune system reaction that damages the heart valves, particularly the mitral valve. Mitral valve regurgitation is common in the early stages of the disease, followed by mitral stenosis later on.
3: Post-streptococcal glomerulonephritis is another possible complication of Group A streptococcal pharyngitis. Unlike acute rheumatic fever, however, prompt antibiotic treatment does not prevent its development.
4: While Group A streptococcus can cause cellulitis, this is a separate condition from pharyngitis and is not a complication of the same bacterial infection.
5:
Rheumatic fever is a condition that occurs as a result of an immune response to a recent Streptococcus pyogenes infection, typically occurring 2-4 weeks after the initial infection. The pathogenesis of rheumatic fever involves the activation of the innate immune system, leading to antigen presentation to T cells. B and T cells then produce IgG and IgM antibodies, and CD4+ T cells are activated. This immune response is thought to be cross-reactive, mediated by molecular mimicry, where antibodies against M protein cross-react with myosin and the smooth muscle of arteries. This response leads to the clinical features of rheumatic fever, including Aschoff bodies, which are granulomatous nodules found in rheumatic heart fever.
To diagnose rheumatic fever, evidence of recent streptococcal infection must be present, along with 2 major criteria or 1 major criterion and 2 minor criteria. Major criteria include erythema marginatum, Sydenham’s chorea, polyarthritis, carditis and valvulitis, and subcutaneous nodules. Minor criteria include raised ESR or CRP, pyrexia, arthralgia, and prolonged PR interval.
Management of rheumatic fever involves antibiotics, typically oral penicillin V, as well as anti-inflammatories such as NSAIDs as first-line treatment. Any complications that develop, such as heart failure, should also be treated. It is important to diagnose and treat rheumatic fever promptly to prevent long-term complications such as rheumatic heart disease.
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This question is part of the following fields:
- Cardiovascular System
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Question 18
Correct
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An 80-year-old man visits his GP complaining of progressive breathlessness that has been worsening over the past 6 months. During the examination, the GP observes pitting oedema in the mid-shins. The patient has a medical history of type 2 diabetes mellitus and a myocardial infarction that occurred 5 years ago. The GP orders a blood test to investigate the cause of the patient's symptoms.
The blood test reveals a B-type natriuretic peptide (BNP) level of 907 pg/mL, which is significantly higher than the normal range (< 100). Can you identify the source of BNP secretion?Your Answer: Ventricular myocardium
Explanation:BNP is primarily secreted by the ventricular myocardium in response to stretching, making it a valuable indicator of heart failure. While it can be used for screening and prognostic scoring, it is not secreted by the atrial endocardium, distal convoluted tubule, pulmonary artery endothelium, or renal mesangial cells.
B-type natriuretic peptide (BNP) is a hormone that is primarily produced by the left ventricular myocardium in response to strain. Although heart failure is the most common cause of elevated BNP levels, any condition that causes left ventricular dysfunction, such as myocardial ischemia or valvular disease, may also raise levels. In patients with chronic kidney disease, reduced excretion may also lead to elevated BNP levels. Conversely, treatment with ACE inhibitors, angiotensin-2 receptor blockers, and diuretics can lower BNP levels.
BNP has several effects, including vasodilation, diuresis, natriuresis, and suppression of both sympathetic tone and the renin-angiotensin-aldosterone system. Clinically, BNP is useful in diagnosing patients with acute dyspnea. A low concentration of BNP (<100 pg/mL) makes a diagnosis of heart failure unlikely, but elevated levels should prompt further investigation to confirm the diagnosis. Currently, NICE recommends BNP as a helpful test to rule out a diagnosis of heart failure. In patients with chronic heart failure, initial evidence suggests that BNP is an extremely useful marker of prognosis and can guide treatment. However, BNP is not currently recommended for population screening for cardiac dysfunction.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Incorrect
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The arrangement of amphipathic phospholipids in the mammalian cell membrane, what is it like?
Your Answer: A lipid monolayer with hydrophobic heads linked with hydrophilic tails in an alternating chain
Correct Answer: A lipid bilayer with hydrophilic heads facing out and hydrophobic tails facing in
Explanation:The Function and Structure of the Mammalian Cell Membrane
The mammalian cell membrane serves as a protective barrier that separates the cytoplasm from the extracellular environment. It also acts as a filter for molecules that move across it. Unlike plant and prokaryotic cells, mammalian cells do not have a cell wall. The main component of the cell membrane is a bilayer of amphipathic lipids, which have a hydrophilic head and a hydrophobic tail. The phospholipids in the bilayer are oriented with their hydrophilic heads facing outward and their hydrophobic tails facing inward. This arrangement allows for the separation of the watery extracellular environment from the watery intracellular compartment.
It is important to note that the cell membrane is not a monolayer and the phospholipids are not linked head-to-tail. This is in contrast to DNA, which has a helical chain formation. Overall, the structure and function of the mammalian cell membrane are crucial for maintaining the integrity and proper functioning of the cell.
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This question is part of the following fields:
- Basic Sciences
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Question 20
Incorrect
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A 28-year-old patient arrives at the Emergency Department complaining of severe headache and abdominal pain that started 2 hours ago. Upon assessment, the patient's blood pressure is measured at 210/115 mmHg and heart rate at 140 beats per minute.
Further tests reveal elevated levels of urinary metanephrines and serum noradrenaline. A CT scan of the abdomen confirms the presence of a pheochromocytoma in the right adrenal gland.
In which part of the nervous system is this neurotransmitter secreted?Your Answer: preganglionic neurotransmitter of the sympathetic nervous system
Correct Answer: postganglionic neurotransmitter of the sympathetic nervous system
Explanation:The correct answer is that noradrenaline is the postganglionic neurotransmitter of the sympathetic nervous system. It is secreted by postsynaptic neurons of the sympathetic nervous system and acts on effector organs such as vascular smooth muscle and sweat glands. The other options provided are incorrect as they refer to different neurotransmitters and nervous systems.
Understanding Norepinephrine: Its Synthesis and Effects on Mental Health
Norepinephrine is a neurotransmitter that is synthesized in the locus ceruleus, a small region in the brainstem. This neurotransmitter plays a crucial role in the body’s fight or flight response, which is activated in response to stress or danger. When released, norepinephrine increases heart rate, blood pressure, and breathing rate, preparing the body to respond to a perceived threat.
In terms of mental health, norepinephrine levels have been linked to anxiety and depression. Elevated levels of norepinephrine have been observed in individuals with anxiety, which can lead to symptoms such as increased heart rate, sweating, and trembling. On the other hand, depleted levels of norepinephrine have been associated with depression, which can cause feelings of sadness, hopelessness, and low energy.
It is important to note that norepinephrine is just one of many neurotransmitters that play a role in mental health. However, understanding its synthesis and effects can provide insight into the complex interplay between brain chemistry and mental health. By studying neurotransmitters like norepinephrine, researchers can develop new treatments and therapies for individuals struggling with anxiety, depression, and other mental health conditions.
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This question is part of the following fields:
- General Principles
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Question 21
Incorrect
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A 23-year-old woman visits the clinic after discovering that her partner has been involved in another relationship. She expresses intense anger and reports struggling to concentrate on her upcoming college classes and track competition. She also shares that she is using her anger to fuel her training for the track meet.
What defense mechanism is she displaying?Your Answer: Reaction formation
Correct Answer: Sublimation
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 22
Incorrect
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Which virus is linked to Kaposi's sarcoma?
Your Answer: Human papillomavirus 16
Correct Answer: Human herpes virus 8
Explanation:Understanding Oncoviruses and Their Associated Cancers
Oncoviruses are viruses that have the potential to cause cancer. These viruses can be detected through blood tests and prevented through vaccination. There are several types of oncoviruses, each associated with a specific type of cancer.
The Epstein-Barr virus, for example, is linked to Burkitt’s lymphoma, Hodgkin’s lymphoma, post-transplant lymphoma, and nasopharyngeal carcinoma. Human papillomavirus 16/18 is associated with cervical cancer, anal cancer, penile cancer, vulval cancer, and oropharyngeal cancer. Human herpes virus 8 is linked to Kaposi’s sarcoma, while hepatitis B and C viruses are associated with hepatocellular carcinoma. Finally, human T-lymphotropic virus 1 is linked to tropical spastic paraparesis and adult T cell leukemia.
It is important to understand the link between oncoviruses and cancer so that appropriate measures can be taken to prevent and treat these diseases. Vaccination against certain oncoviruses, such as HPV, can significantly reduce the risk of developing associated cancers. Regular screening and early detection can also improve outcomes for those who do develop cancer as a result of an oncovirus.
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This question is part of the following fields:
- General Principles
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Question 23
Correct
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A 75-year-old man presents to the emergency department with sudden onset chest pain that started 3 hours ago and is radiating to his left shoulder. He reports feeling a heavy pressure over his sternum. The patient has a 40-year history of smoking one pack of cigarettes per day and was diagnosed with hyperlipidaemia 25 years ago. An initial ECG reveals ST elevation in V3 and V4. Despite resuscitative efforts, the patient passes away. Upon autopsy, a section of the left anterior descending artery stained with haematoxylin and eosin shows atheroma formation.
What is the final step in the pathogenesis of the autopsy finding in this case?Your Answer: Smooth muscle migration from tunica media
Explanation:An elderly patient with typical anginal pain is likely suffering from ischaemic heart disease, which is commonly caused by atherosclerosis. This patient has risk factors for atherosclerosis, including smoking and hyperlipidaemia.
Atherosclerosis begins with thickening of the tunica intima, which is mainly composed of proteoglycan-rich extracellular matrix and acellular lipid pools. Fatty streaks, which are minimal lipid depositions on the luminal surface, can be seen in normal individuals and are not necessarily a part of the atheroma. They can begin as early as in the twenties.
As the disease progresses, fibroatheroma develops, characterized by infiltration of macrophages and T-lymphocytes, with the formation of a well-demarcated lipid-rich necrotic core. Foam cells appear early in the disease process and play a major role in atheroma formation.
Further progression leads to thin cap fibroatheroma, where the necrotic core becomes bigger and the fibrous cap thins out. Throughout the process, there is a progressive increase in the number of inflammatory cells. Finally, smooth muscle cells from the tunica media proliferate and migrate into the tunica intima, completing the formation of the atheroma.
Understanding Atherosclerosis and its Complications
Atherosclerosis is a complex process that occurs over several years. It begins with endothelial dysfunction triggered by factors such as smoking, hypertension, and hyperglycemia. This leads to changes in the endothelium, including inflammation, oxidation, proliferation, and reduced nitric oxide bioavailability. As a result, low-density lipoprotein (LDL) particles infiltrate the subendothelial space, and monocytes migrate from the blood and differentiate into macrophages. These macrophages that phagocytose oxidized LDL, slowly turning into large ‘foam cells’. Smooth muscle proliferation and migration from the tunica media into the intima result in the formation of a fibrous capsule covering the fatty plaque.
Once a plaque has formed, it can cause several complications. For example, it can form a physical blockage in the lumen of the coronary artery, leading to reduced blood flow and oxygen to the myocardium, resulting in angina. Alternatively, the plaque may rupture, potentially causing a complete occlusion of the coronary artery and resulting in a myocardial infarction. It is essential to understand the process of atherosclerosis and its complications to prevent and manage cardiovascular diseases effectively.
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This question is part of the following fields:
- Cardiovascular System
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Question 24
Incorrect
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A 21-year-old female is experiencing high levels of anxiety when she is in social situations. She often turns to alcohol to calm her nerves, which has resulted in a few embarrassing incidents where she has had to leave early due to being too intoxicated. As a result, she now avoids social events altogether and worries that others will view her as socially inept or strange. What is the most accurate way to describe her anxiety and fears?
Your Answer: Generalised anxiety disorder
Correct Answer: Social phobia
Explanation:Social Phobia
Social phobia is a condition where individuals experience intense fear and avoidance of social situations. They have a constant fear of being judged or scrutinized by others due to their behavior or physical appearance. To cope with their anxiety, some individuals may resort to excessive drinking, which can lead to further problems such as aggression and disinhibition.
Treatment for social phobia typically involves a combination of medication and psychotherapy. Medications such as antidepressants and anti-anxiety drugs can help alleviate symptoms, while psychotherapy can help individuals learn coping mechanisms and develop social skills. With proper treatment, individuals with social phobia can learn to manage their anxiety and improve their quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 25
Correct
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A 28-year-old woman presents to her GP with milky discharge from her breasts. Her periods have also become very irregular and she has not menstruated in the past 4 months. On further questioning, she reports not being sexually active since having a miscarriage 9 months ago which required surgical management. On examination, there are no palpable masses in her breasts bilaterally, she demonstrates a small amount of milky white discharge from her left nipple which is collected for microscopy, culture, and sensitivity. She has no focal neurological deficits, cardiac, and respiratory examination is unremarkable, and her abdominal examination is unremarkable.
What is the most likely diagnosis?Your Answer: Prolactinoma
Explanation:The likely cause of this patient’s amenorrhoea and galactorrhoea is a prolactinoma, which inhibits the secretion of GnRH and leads to low levels of oestrogen. Further tests, including a urinary pregnancy test and blood tests for various hormones, should be conducted to confirm the diagnosis. Asherman’s syndrome, intraductal papilloma, and pregnancy are less likely causes, as they do not present with the same symptoms or do not fit the patient’s reported history.
Understanding Amenorrhoea: Causes, Investigations, and Management
Amenorrhoea is a condition characterized by the absence of menstrual periods. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls with no secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.
The causes of amenorrhoea vary depending on the type. Primary amenorrhoea may be caused by gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, and thyrotoxicosis. Meanwhile, secondary amenorrhoea may be caused by stress, excessive exercise, PCOS, Sheehan’s syndrome, Asherman’s syndrome, and other underlying medical conditions.
To diagnose amenorrhoea, initial investigations may include pregnancy tests, full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels. Management of amenorrhoea involves treating the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause and treat the underlying cause accordingly. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis and other complications.
In conclusion, amenorrhoea is a condition that requires proper diagnosis and management. Understanding the causes and appropriate investigations can help in providing the necessary treatment and care for women experiencing this condition.
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This question is part of the following fields:
- Reproductive System
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Question 26
Incorrect
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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: 5 milligrams folic acid
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.
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This question is part of the following fields:
- Reproductive System
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Question 27
Incorrect
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A 58-year-old man is having a right nephrectomy. At what level does the renal artery typically branch off from the abdominal aorta during this procedure?
Your Answer: L3
Correct Answer: L2
Explanation:The level with L2 is where the renal arteries typically branch off from the aorta.
Anatomy of the Renal Arteries
The renal arteries are blood vessels that supply the kidneys with oxygenated blood. They are direct branches off the aorta and enter the kidney at the hilum. The right renal artery is longer than the left renal artery. The renal vein, artery, and pelvis also enter the kidney at the hilum.
The right renal artery is related to the inferior vena cava, right renal vein, head of the pancreas, and descending part of the duodenum. On the other hand, the left renal artery is related to the left renal vein and tail of the pancreas.
In some cases, there may be accessory arteries, mainly on the left side. These arteries usually pierce the upper or lower part of the kidney instead of entering at the hilum.
Before reaching the hilum, each renal artery divides into four or five segmental branches that supply each pyramid and cortex. These segmental branches then divide within the sinus into lobar arteries. Each vessel also gives off small inferior suprarenal branches to the suprarenal gland, ureter, and surrounding tissue and muscles.
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This question is part of the following fields:
- Renal System
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Question 28
Correct
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A 26-year-old male presented with weight loss, cramping abdominal pain, and bloody diarrhea. During colonoscopy, a diffusely red and friable mucosa was observed in the rectum and sigmoid colon, while the mucosa was normal in the proximal region. Over time, the disease progressed to involve most of the colon, except for the ileum. After several years, a colonic biopsy revealed high grade epithelial dysplasia. What was the probable initial diagnosis?
Your Answer: Ulcerative colitis
Explanation:Ulcerative colitis advances from the distal to proximal regions in a progressive manner, leading to dysplastic changes over time. These endoscopic observations necessitate frequent endoscopic monitoring, and if a colonic mass is present, a pancproctocolectomy is typically recommended.
Understanding Ulcerative Colitis
Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation in the rectum and spreads continuously without going beyond the ileocaecal valve. It is most commonly seen in people aged 15-25 years and 55-65 years. The symptoms of ulcerative colitis are insidious and intermittent, including bloody diarrhea, urgency, tenesmus, abdominal pain, and extra-intestinal features. Diagnosis is done through colonoscopy and biopsy, but in severe cases, a flexible sigmoidoscopy is preferred to avoid the risk of perforation. The typical findings include red, raw mucosa that bleeds easily, widespread ulceration with preservation of adjacent mucosa, and inflammatory cell infiltrate in lamina propria. Extra-intestinal features of inflammatory bowel disease include arthritis, erythema nodosum, episcleritis, osteoporosis, uveitis, pyoderma gangrenosum, clubbing, and primary sclerosing cholangitis. Ulcerative colitis is linked with sacroiliitis, and a barium enema can show the whole colon affected by an irregular mucosa with loss of normal haustral markings.
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This question is part of the following fields:
- Gastrointestinal System
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Question 29
Correct
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A 15-year-old boy presents to his GP with a painless swelling in his neck. The mass is located centrally just below the hyoid bone and does not cause any difficulty in swallowing or breathing. Upon examination, the GP notes that the mass moves with protrusion of the tongue and with swallowing. The GP diagnoses the boy with a benign thyroglossal cyst, which is caused by a persistent thyroglossal duct, and advises surgical removal. Where is the thyroglossal duct attached to the tongue?
Your Answer: Foramen cecum
Explanation:The thyroglossal duct connects the thyroid gland to the tongue via the foramen caecum during embryonic development. The terminal sulcus, median sulcus, palatoglossal arch, and epiglottis are not connected to the thyroid gland.
Understanding Thyroglossal Cysts
Thyroglossal cysts are named after the thyroid and tongue, which are the two structures involved in their development. During embryology, the thyroid gland develops from the floor of the pharynx and descends into the neck, connected to the tongue by the thyroglossal duct. The foramen cecum is the point of attachment of the thyroglossal duct to the tongue. Normally, the thyroglossal duct atrophies, but in some people, it may persist and give rise to a thyroglossal duct cyst.
Thyroglossal cysts are more common in patients under 20 years old and are usually midline, between the isthmus of the thyroid and the hyoid bone. They move upwards with protrusion of the tongue and may be painful if infected. Understanding the embryology and presentation of thyroglossal cysts is important for proper diagnosis and treatment.
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This question is part of the following fields:
- Respiratory System
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Question 30
Correct
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A 5-day-old girl is currently intubated and ventilated in the neonatal unit due to surfactant deficient lung disease. However, her oxygen saturations have suddenly dropped and she now requires higher ventilation pressures. What is the probable complication that has arisen?
Your Answer: Pneumothorax
Explanation:Pneumothorax as a Common Complication of Neonatal Ventilation
Pneumothorax is a frequent complication of neonatal ventilation, particularly in cases where high pressures are required due to poor lung compliance in surfactant deficient lung disease. This condition occurs when air enters the interstitial space, increasing the risk of barotraumatic pneumothoraces. A sudden change in ventilation requirements is a sign of a physical process rather than a gradual inflammatory change, making it important to monitor neonates closely for this complication.
Acute pulmonary oedema is another potential complication, but it usually occurs secondary to heart failure in neonates with severe cardiac malformations. Aspiration pneumonitis is unlikely if an endotracheal tube is in place, and hypoglycaemia is more common in neonates but would not present with increased ventilation pressure requirements. Pneumonia, on the other hand, would present more gradually and would not be the most prominent feature in cases of sudden changes in ventilation requirements. Overall, it is crucial to be aware of the risks associated with neonatal ventilation and to monitor patients closely for potential complications.
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This question is part of the following fields:
- Paediatrics
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