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  • Question 1 - A 25-year-old male visits his primary care physician complaining of shoulder pain. He...

    Correct

    • A 25-year-old male visits his primary care physician complaining of shoulder pain. He denies any history of shoulder dislocation and regularly attends the gym for five days a week, performing overhead pressing movements. He is a first-year physiotherapy student and has a good understanding of shoulder anatomy.

      During the examination, the patient exhibits a positive 'empty can' test, indicating supraspinatus tendonitis. A focused ultrasound scan of the shoulder joint confirms inflammation at the point of insertion of the supraspinatus tendon.

      What is the precise location of the inflammation?

      Your Answer: Superior facet of the greater tubercle of the humerus

      Explanation:

      The insertion site of the supraspinatus tendon is the superior facet of the greater tubercle of the humerus, while the teres major and coracobrachialis muscles insert into the medial border. The subscapularis muscle inserts into the lesser tubercle, and the infraspinatus muscle inserts into the middle facet of the greater tubercle. The teres minor muscle’s insertion site is not specified.

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      68.1
      Seconds
  • Question 2 - You are a third year medical student assisting a plastic surgeon in theatre....

    Correct

    • You are a third year medical student assisting a plastic surgeon in theatre. The plastic surgeon hands you a surgical retractor and asks you to retract the latissimus dorsi muscle. Once you have successfully done so, the surgeon inquires about the nerve responsible for innervating this muscle.

      What is the nerve that innervates the latissimus dorsi muscle?

      Your Answer: Thoracodorsal nerve

      Explanation:

      The Functions of Different Nerves in the Brachial Plexus

      The brachial plexus is a network of nerves that originate from the spinal cord and provide innervation to the upper limb. Each nerve in the brachial plexus has a specific function and innervates a particular muscle or group of muscles. the functions of these nerves is essential for diagnosing and treating various neurological conditions.

      One of the nerves in the brachial plexus is the thoracodorsal nerve, which originates from the posterior cord of the brachial plexus. Its primary function is to provide somatic innervation to the latissimus dorsi muscle, which is a large muscle in the posterior thorax involved in shoulder joint movement.

      Another nerve in the brachial plexus is the upper subscapular nerve, which innervates the subscapularis muscle. The long thoracic nerve, on the other hand, innervates the serratus anterior muscle, and damage to this nerve can cause a winging effect on the scapula.

      The axillary nerve is another nerve in the brachial plexus that originates from the posterior cord. Its primary motor supply is to the deltoid muscle, which is involved in shoulder abduction.

      Lastly, the lateral pectoral nerve is a branch of the lateral cord and innervates the pectoralis major muscle. The pectoralis major muscle also receives innervation from the medial pectoral nerve, which is a branch of the median cord of the brachial plexus.

      In summary, each nerve in the brachial plexus has a specific function and innervates a particular muscle or group of muscles. the functions of these nerves is crucial for diagnosing and treating various neurological conditions.

    • This question is part of the following fields:

      • Clinical Sciences
      23.6
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  • Question 3 - A 35-year-old male patient is feeling impatient as he waits in a crowded...

    Correct

    • A 35-year-old male patient is feeling impatient as he waits in a crowded Emergency Room (ER) waiting area. He snaps at his daughter in annoyance.

      What ego defence mechanism is he utilizing?

      Your Answer: Displacement

      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.

    • This question is part of the following fields:

      • Psychiatry
      12.3
      Seconds
  • Question 4 - The emergency buzzer is activated for a 32-year-old woman in labour. Despite gentle...

    Incorrect

    • The emergency buzzer is activated for a 32-year-old woman in labour. Despite gentle traction, the midwife is unable to deliver the foetal shoulders after the head is delivered during a vaginal cephalic delivery. What is the most probable risk factor for this labour complication?

      Your Answer: Previous caesarean section

      Correct Answer: Foetal macrosomia

      Explanation:

      Shoulder dystocia is the labour complication discussed in this case, and it is more likely to occur in cases of foetal macrosomia. This is because larger babies have a greater shoulder diameter, making it more difficult for the shoulders to pass through the pelvic outlet.

      Maternal pre-eclampsia is a risk factor for small for gestational age (SGA) pregnancies, but it is not directly linked to shoulder dystocia.

      Obstetric cholestasis is a liver disorder that can occur during pregnancy, but it does not increase the risk of shoulder dystocia.

      While a previous caesarean section may increase the likelihood of placenta praevia, placenta accreta, or uterine rupture, it is not a direct risk factor for shoulder dystocia.

      A previous post-term delivery may increase the likelihood of future post-term deliveries, but it does not directly increase the risk of shoulder dystocia.

      Shoulder dystocia is a complication that can occur during vaginal delivery when the body of the fetus cannot be delivered after the head has already been delivered. This is usually due to the anterior shoulder of the fetus becoming stuck on the mother’s pubic bone. Shoulder dystocia can cause harm to both the mother and the baby.

      There are several risk factors that increase the likelihood of shoulder dystocia, including fetal macrosomia (large baby), high maternal body mass index, diabetes mellitus, and prolonged labor.

      If shoulder dystocia is identified, it is important to call for senior medical assistance immediately. The McRoberts’ maneuver is often used to help deliver the baby. This involves flexing and abducting the mother’s hips to increase the angle of the pelvis and facilitate delivery. An episiotomy may be performed to provide better access for internal maneuvers, but it will not relieve the bony obstruction. Symphysiotomy and the Zavanelli maneuver are not recommended as they can cause significant harm to the mother. Oxytocin administration is not effective in treating shoulder dystocia.

      Complications of shoulder dystocia can include postpartum hemorrhage and perineal tears for the mother, and brachial plexus injury or neonatal death for the baby. It is important to manage shoulder dystocia promptly and effectively to minimize these risks.

    • This question is part of the following fields:

      • Reproductive System
      60.4
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  • Question 5 - A 25-year-old patient who works as a graphic designer presents with symptoms and...

    Incorrect

    • A 25-year-old patient who works as a graphic designer presents with symptoms and signs of appendicitis. She is adamant that she does not want surgery as she fears the potential complications and risks associated with it. Despite being informed of the potential consequences of not having surgery, she remains firm in her decision and provides a written declaration to this effect. She consents to hospital admission for intravenous antibiotics.

      However, three hours after admission, her condition worsens and she begins to exhibit signs of peritonitis. She becomes delirious while still conscious. The high dependency unit is currently experiencing a high volume of patients, and the intensive care consultants are hesitant to accept a patient who has declined optimal treatment.

      What is the appropriate course of action in this situation?

      Your Answer: Her wishes should be respected and she should receive the best possible non-surgical treatment. However, as she has declined surgery, this should be limited to what can be provided on the ward in order to prevent other patients from being denied a high dependency bed.

      Correct Answer: Her wishes should be respected and she should receive the best possible non-surgical treatment, including admission to the high dependency unit for monitoring if appropriate.

      Explanation:

      Advance Decision and Medical Best Interests

      The Mental Capacity Act 2005 requires doctors to consider a patient’s previously known wishes when making decisions in their best interests. If a patient has made an advance decision to refuse surgery, doctors must respect this decision even if the patient loses the capacity to make decisions. In such cases, doctors cannot act solely in what they deem to be the patient’s ‘medical’ best interests.

      A psychiatric assessment is not necessary if the patient’s lack of capacity has an organic cause and there were no previous indicators of mental illness. In situations where a patient’s autonomy and view that surgery will do long-term harm outweigh the medical view that not operating will be more harmful, it is important to seek legal advice to ensure compliance with the law.

      Once a decision has been made that surgery is not possible due to the patient withholding consent, the patient should receive the best possible medical care. Decisions about admitting the patient to the high dependency unit should be based on clinical need rather than compliance with medical advice. It is crucial to prioritize the patient’s well-being and respect their autonomy in making decisions about their own medical care.

    • This question is part of the following fields:

      • Ethics And Law
      43.1
      Seconds
  • Question 6 - A physician informs a recently pregnant woman about the typical physiological alterations that...

    Incorrect

    • A physician informs a recently pregnant woman about the typical physiological alterations that occur during pregnancy. He clarifies that her cardiac output will rise. What is the primary cause of this?

      Your Answer: Increased heart rate

      Correct Answer: Increased stroke volume

      Explanation:

      During pregnancy, the main contributor to the increased cardiac output is the increased stroke volume, which is caused by the activation of the renin-angiotensin system and the subsequent increase in plasma volume. Although the heart rate also increases slightly, it is not as significant as the increase in stroke volume. Therefore, the major contributor to the increased cardiac output is the stroke volume.

      The statements ‘decreased heart rate’ and ‘increased peripheral resistance’ are incorrect. In fact, peripheral resistance decreases due to progesterone, which contributes to the normal decrease in blood pressure during pregnancy. Peripheral resistance is more concerned with blood pressure.

      Pregnancy also causes various physiological changes, including increased uterine size, cervical ectropion, reduced cervical collagen, and increased vaginal discharge. Cardiovascular and haemodynamic changes include increased plasma volume, anaemia, increased white cell count, platelets, ESR, cholesterol, and fibrinogen, as well as decreased albumin, urea, and creatinine. Progesterone-related effects, such as muscle relaxation, can cause decreased blood pressure, constipation, ureteral dilation, bladder relaxation, biliary stasis, and increased tidal volume.

      During pregnancy, a woman’s body undergoes various physiological changes. The cardiovascular system experiences an increase in stroke volume, heart rate, and cardiac output, while systolic blood pressure remains unchanged and diastolic blood pressure decreases in the first and second trimesters before returning to normal levels by term. The enlarged uterus may cause issues with venous return, leading to ankle swelling, supine hypotension, and varicose veins.

      The respiratory system sees an increase in pulmonary ventilation and tidal volume, with oxygen requirements only increasing by 20%. This can lead to a sense of dyspnea due to over-breathing and a fall in pCO2. The basal metabolic rate also increases, potentially due to increased thyroxine and adrenocortical hormones.

      Maternal blood volume increases by 30%, with red blood cells increasing by 20% and plasma increasing by 50%, leading to a decrease in hemoglobin levels. Coagulant activity increases slightly, while fibrinolytic activity decreases. Platelet count falls, and white blood cell count and erythrocyte sedimentation rate rise.

      The urinary system experiences an increase in blood flow and glomerular filtration rate, with elevated sex steroid levels leading to increased salt and water reabsorption and urinary protein losses. Trace glycosuria may also occur.

      Calcium requirements increase during pregnancy, with gut absorption increasing substantially due to increased 1,25 dihydroxy vitamin D. Serum levels of calcium and phosphate may fall, but ionized calcium levels remain stable. The liver experiences an increase in alkaline phosphatase and a decrease in albumin levels.

      The uterus undergoes significant changes, increasing in weight from 100g to 1100g and transitioning from hyperplasia to hypertrophy. Cervical ectropion and discharge may increase, and Braxton-Hicks contractions may occur in late pregnancy. Retroversion may lead to retention in the first trimester but usually self-corrects.

    • This question is part of the following fields:

      • Reproductive System
      50.7
      Seconds
  • Question 7 - Sophie presents acutely to the hospital with severe epigastric pain that is radiating...

    Correct

    • Sophie presents acutely to the hospital with severe epigastric pain that is radiating to the back, nausea and vomiting. Upon questioning, she has suffered from several episodes of biliary colic in the past. A blood test reveals a lipase level of 1000U/L.

      What is the underlying pathophysiology of Sophie's condition?

      Your Answer: Pancreatic enzymes released as a result of inflammation autodigest the pancreatic tissue

      Explanation:

      The cause of acute pancreatitis is the autodigestion of pancreatic tissue by pancreatic enzymes, which results in tissue necrosis. The patient is experiencing typical symptoms of acute pancreatitis, including epigastric pain that radiates to the back, nausea, and vomiting. The presence of elevated lipase levels, which are more than three times the upper limit of normal, is also indicative of acute pancreatitis. The patient’s history of biliary colic suggests that gallstones may be the underlying cause of this condition.

      During acute pancreatitis, inflammation of the pancreas triggers the release and activation of pancreatic enzymes, which then begin to digest the pancreatic tissue. This process is known as autodigestion. Autodigestion of fat can lead to tissue necrosis, while autodigestion of blood vessels can cause retroperitoneal hemorrhage, which can be identified by the presence of Grey Turner’s sign and Cullen’s sign.

      Understanding Acute Pancreatitis

      Acute pancreatitis is a condition that is commonly caused by alcohol or gallstones. It occurs when the pancreatic enzymes start to digest the pancreatic tissue, leading to necrosis. The most common symptom of acute pancreatitis is severe epigastric pain that may radiate through to the back. Vomiting is also common, and examination may reveal epigastric tenderness, ileus, and low-grade fever. Although rare, periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) may also be present.

      To diagnose acute pancreatitis, doctors typically measure the levels of serum amylase and lipase in the blood. While amylase is raised in 75% of patients, it does not correlate with disease severity. Lipase, on the other hand, is more sensitive and specific than amylase and has a longer half-life, making it useful for late presentations. Imaging, such as ultrasound or contrast-enhanced CT, may also be necessary to assess the aetiology of the condition.

      Scoring systems, such as the Ranson score, Glasgow score, and APACHE II, are used to identify cases of severe pancreatitis that may require intensive care management. Factors indicating severe pancreatitis include age over 55 years, hypocalcaemia, hyperglycaemia, hypoxia, neutrophilia, and elevated LDH and AST. However, the actual amylase level is not of prognostic value.

      In summary, acute pancreatitis is a condition that can cause severe pain and discomfort. It is important to diagnose and manage it promptly to prevent complications.

    • This question is part of the following fields:

      • Gastrointestinal System
      37
      Seconds
  • Question 8 - From which embryological structure is the ureter derived? ...

    Correct

    • From which embryological structure is the ureter derived?

      Your Answer: Mesonephric duct

      Explanation:

      The ureter originates from the mesonephric duct, which is linked to the metanephric duct located in the metenephrogenic blastema. The ureteric bud emerges from the metanephric duct and separates from the mesonephric duct, forming the foundation of the ureter.

      Anatomy of the Ureter

      The ureter is a muscular tube that measures 25-35 cm in length and is lined by transitional epithelium. It is surrounded by a thick muscular coat that becomes three muscular layers as it crosses the bony pelvis. This retroperitoneal structure overlies the transverse processes L2-L5 and lies anterior to the bifurcation of iliac vessels. The blood supply to the ureter is segmental and includes the renal artery, aortic branches, gonadal branches, common iliac, and internal iliac. It is important to note that the ureter lies beneath the uterine artery.

      In summary, the ureter is a vital structure in the urinary system that plays a crucial role in transporting urine from the kidneys to the bladder. Its unique anatomy and blood supply make it a complex structure that requires careful consideration in any surgical or medical intervention.

    • This question is part of the following fields:

      • Gastrointestinal System
      6.9
      Seconds
  • Question 9 - A 67-year-old female presents to a medical facility with a chief complaint of...

    Correct

    • A 67-year-old female presents to a medical facility with a chief complaint of tremors. Upon examination, the physician observes that the tremors are most noticeable when the patient is at rest. The patient does not display any specific neurological deficits, but does exhibit arm rigidity throughout the full range of motion and takes some time to initiate movements. Given the probable diagnosis, what histological finding would be anticipated?

      Your Answer: Lewy bodies

      Explanation:

      When a patient presents with tremor, rigidity, and bradykinesia, Parkinson’s Disease should be considered as a possible diagnosis. The presence of Lewy Bodies, which are clumps of proteins within neurons, is a characteristic histological finding. These bodies are often found in the substantia nigra and have a cytoplasm that is rich in eosin.

      In males with Klinefelter syndrome, Barr bodies, which are inactivated X chromosomes, may be observed.

      Cholesterol clefts are a result of cholesterol emboli, which occur when material from an atherosclerotic plaque becomes dislodged and deposited elsewhere. This can happen during procedures such as angiography.

      Keratin pearls are a feature of squamous cell lung cancer, where squamous cells form concentric layers around keratin.

      The term kidney bean-shaped nuclei refers to the appearance of neutrophils.

      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
      30.7
      Seconds
  • Question 10 - A patient on the geriatrics ward has symptoms consistent with hypoparathyroidism. A blood...

    Correct

    • A patient on the geriatrics ward has symptoms consistent with hypoparathyroidism. A blood test is requested to check PTH levels, serum calcium, phosphate and vitamin D.

      Which of the following levels also need to be specifically checked?

      Your Answer: Magnesium

      Explanation:

      The correct answer is magnesium, as it is necessary for the secretion and function of parathyroid hormone. Adequate magnesium levels are required for the hormone to have its desired effects. CRP, urea, and platelets are not relevant to this situation and do not need to be tested.

      Understanding Parathyroid Hormone and Its Effects

      Parathyroid hormone is a hormone produced by the chief cells of the parathyroid glands. Its main function is to increase the concentration of calcium in the blood by stimulating the PTH receptors in the kidney and bone. This hormone has a short half-life of only 4 minutes.

      The effects of parathyroid hormone are mainly seen in the bone, kidney, and intestine. In the bone, PTH binds to osteoblasts, which then signal to osteoclasts to resorb bone and release calcium. In the kidney, PTH promotes the active reabsorption of calcium and magnesium from the distal convoluted tubule, while decreasing the reabsorption of phosphate. In the intestine, PTH indirectly increases calcium absorption by increasing the activation of vitamin D, which in turn increases calcium absorption.

      Overall, understanding the role of parathyroid hormone is important in maintaining proper calcium levels in the body. Any imbalances in PTH secretion can lead to various disorders such as hyperparathyroidism or hypoparathyroidism.

    • This question is part of the following fields:

      • Endocrine System
      32.4
      Seconds
  • Question 11 - A 30-year-old male presents with massive haematemesis and is diagnosed with splenomegaly. What...

    Correct

    • A 30-year-old male presents with massive haematemesis and is diagnosed with splenomegaly. What is the probable origin of the bleeding?

      Your Answer: Oesophageal varices

      Explanation:

      Portal Hypertension and its Manifestations

      Portal hypertension is a condition that often leads to splenomegaly and upper gastrointestinal (GI) bleeding. The primary cause of bleeding is oesophageal varices, which are dilated veins in the oesophagus. In addition to these symptoms, portal hypertension can also cause ascites, a buildup of fluid in the abdomen, and acute or chronic hepatic encephalopathy, a neurological disorder that affects the brain. Another common manifestation of portal hypertension is splenomegaly with hypersplenism, which occurs when the spleen becomes enlarged and overactive, leading to a decrease in the number of blood cells in circulation. the various symptoms of portal hypertension is crucial for early diagnosis and effective management of the condition.

    • This question is part of the following fields:

      • Gastrointestinal System
      18.8
      Seconds
  • Question 12 - A 36-year-old woman with a history of endometriosis is scheduled for adhesiolysis to...

    Correct

    • A 36-year-old woman with a history of endometriosis is scheduled for adhesiolysis to alleviate pain during micturition, defecation, and intercourse. Despite taking the combined oral contraceptive pill, the patient has not found relief. However, during the surgery, the surgeon mistakenly severs the ligament that connects the cervix to the lateral pelvic wall.

      Which ligament has been unintentionally cut during the procedure?

      Your Answer: Cardinal ligament

      Explanation:

      The correct answer is the cardinal ligament, which connects the cervix to the lateral pelvic wall. Pelvic surgery can damage this ligament, which may lead to cervical prolapse in severe cases.

      The broad ligament surrounds the fallopian tubes and ovaries, along with their respective neurovascular structures. However, it does not attach the cervix to the lateral pelvic wall.

      The pubocervical ligament anchors the cervix to the pubic symphysis. In severe cases, damage to this ligament may contribute to vaginal prolapse.

      The round ligament of the uterus maintains the anteverted position of the uterus. During pregnancy, stretching of the round ligament may cause round ligament pain.

      The uterosacral ligament anchors the uterus to the sacrum posteriorly, helping to maintain normal pelvic anatomy and prevent the descent of pelvic organs into the vaginal vault.

      Pelvic Ligaments and their Connections

      Pelvic ligaments are structures that connect various organs within the female reproductive system to the pelvic wall. These ligaments play a crucial role in maintaining the position and stability of these organs. There are several types of pelvic ligaments, each with its own unique function and connection.

      The broad ligament connects the uterus, fallopian tubes, and ovaries to the pelvic wall, specifically the ovaries. The round ligament connects the uterine fundus to the labia majora, but does not connect to any other structures. The cardinal ligament connects the cervix to the lateral pelvic wall and is responsible for supporting the uterine vessels. The suspensory ligament of the ovaries connects the ovaries to the lateral pelvic wall and supports the ovarian vessels. The ovarian ligament connects the ovaries to the uterus, but does not connect to any other structures. Finally, the uterosacral ligament connects the cervix and posterior vaginal dome to the sacrum, but does not connect to any other structures.

      Overall, pelvic ligaments are essential for maintaining the proper position and function of the female reproductive organs. Understanding the connections between these ligaments and the structures they support is crucial for diagnosing and treating any issues that may arise.

    • This question is part of the following fields:

      • Reproductive System
      27
      Seconds
  • Question 13 - A 70-year-old male with a 50 pack year history of smoking complains of...

    Correct

    • A 70-year-old male with a 50 pack year history of smoking complains of dyspnoea, cough and facial swelling that has been worsening for the past 8 weeks. The symptoms are aggravated by leaning forward. Venous collaterals are observed on the anterior chest wall during examination.

      What is the probable diagnosis?

      Your Answer: Superior vena cava obstruction

      Explanation:

      When bronchogenic carcinoma leads to SVC obstruction, patients usually experience dyspnea, cough, and swelling of the face.

      Understanding Superior Vena Cava Obstruction

      Superior vena cava obstruction is a medical emergency that occurs when the superior vena cava, a large vein that carries blood from the upper body to the heart, is compressed. This condition is commonly associated with lung cancer, but it can also be caused by other malignancies, aortic aneurysm, mediastinal fibrosis, goitre, and SVC thrombosis. The most common symptom of SVC obstruction is dyspnoea, but patients may also experience swelling of the face, neck, and arms, headache, visual disturbance, and pulseless jugular venous distension.

      The management of SVC obstruction depends on the underlying cause and the patient’s individual circumstances. Endovascular stenting is often the preferred treatment to relieve symptoms, but certain malignancies may require radical chemotherapy or chemo-radiotherapy instead. Glucocorticoids may also be given, although the evidence supporting their use is weak. It is important to seek advice from an oncology team to determine the best course of action for each patient.

    • This question is part of the following fields:

      • Haematology And Oncology
      609.4
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  • Question 14 - A 72-year-old woman is brought to the general practice by her son. The...

    Correct

    • A 72-year-old woman is brought to the general practice by her son. The son reports that his mother has been experiencing increasing forgetfulness and appears less alert. She has also been having repeated incidents of urinary incontinence and walks with a shuffling gait. A CT head scan is ordered, which reveals bilateral dilation of the lateral ventricles without any blockage of the interventricular foramina. What is the space that the interventricular foramen allows cerebrospinal fluid to flow from each lateral ventricle into?

      Your Answer: Third ventricle

      Explanation:

      The third ventricle is the correct answer as it is a part of the CSF system and is located in the midline between the thalami of the two hemispheres. It connects to the lateral ventricles via the interventricular foramina and to the fourth ventricle via the cerebral aqueduct (of Sylvius).

      CSF flows from the third ventricle to the fourth ventricle through the cerebral aqueduct (of Sylvius) and exits the fourth ventricle through one of four openings. These include the median aperture (foramen of Magendie), either of the two lateral apertures (foramina of Luschka), and the central canal at the obex.

      The lateral ventricles do not communicate directly with each other and drain into the third ventricle via individual interventricular foramina.

      The patient in the question is likely suffering from normal pressure hydrocephalus, which is characterized by gait abnormality, urinary incontinence, and dementia. This condition is caused by alterations in the flow and absorption of CSF, leading to ventricular dilation without raised intracranial pressure. Lumbar puncture typically shows normal CSF pressure.

      Cerebrospinal Fluid: Circulation and Composition

      Cerebrospinal fluid (CSF) is a clear, colorless liquid that fills the space between the arachnoid mater and pia mater, covering the surface of the brain. The total volume of CSF in the brain is approximately 150ml, and it is produced by the ependymal cells in the choroid plexus or blood vessels. The majority of CSF is produced by the choroid plexus, accounting for 70% of the total volume. The remaining 30% is produced by blood vessels. The CSF is reabsorbed via the arachnoid granulations, which project into the venous sinuses.

      The circulation of CSF starts from the lateral ventricles, which are connected to the third ventricle via the foramen of Munro. From the third ventricle, the CSF flows through the cerebral aqueduct (aqueduct of Sylvius) to reach the fourth ventricle via the foramina of Magendie and Luschka. The CSF then enters the subarachnoid space, where it circulates around the brain and spinal cord. Finally, the CSF is reabsorbed into the venous system via arachnoid granulations into the superior sagittal sinus.

      The composition of CSF is essential for its proper functioning. The glucose level in CSF is between 50-80 mg/dl, while the protein level is between 15-40 mg/dl. Red blood cells are not present in CSF, and the white blood cell count is usually less than 3 cells/mm3. Understanding the circulation and composition of CSF is crucial for diagnosing and treating various neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      47.3
      Seconds
  • Question 15 - As a medical student in general practice, a 37-year-old male with chronic back...

    Incorrect

    • As a medical student in general practice, a 37-year-old male with chronic back pain comes in for a refill of his amitriptyline prescription. Can you explain the mechanism of action of this medication?

      Your Answer: Inhibits monoamine reuptake on postsynaptic membrane

      Correct Answer: Inhibits monoamine reuptake on the presynaptic membrane

      Explanation:

      Amitriptyline belongs to the class of tricyclic antidepressants (TCAs).

      TCAs primarily act on the presynaptic neuron rather than the postsynaptic neuron. Their main mode of action involves inhibiting the reuptake of monoamines at the presynaptic membrane. This is achieved by binding to the ATPase monoamine pump located within the presynaptic membrane.

      Tricyclic antidepressants (TCAs) are not commonly used for depression anymore due to their side-effects and potential for toxicity in overdose. However, they are still widely used for the treatment of neuropathic pain, where smaller doses are typically required. The common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of QT interval. When choosing a TCA, low-dose amitriptyline is commonly used for the management of neuropathic pain and the prevention of headaches. Lofepramine is preferred due to its lower incidence of toxicity in overdose, while amitriptyline and dosulepin are considered the most dangerous in overdose. The sedative effects of TCAs vary, with amitriptyline, clomipramine, dosulepin, and trazodone being more sedative, while imipramine and nortriptyline are less sedative. Trazodone is technically a ‘tricyclic-related antidepressant’.

    • This question is part of the following fields:

      • Psychiatry
      23
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  • Question 16 - A 42-year-old woman presents with symptoms of fatigue, palpitations, and shortness of breath...

    Incorrect

    • A 42-year-old woman presents with symptoms of fatigue, palpitations, and shortness of breath on exertion. She has recently been ill with an upper respiratory tract infection. During the examination, you observe that she has conjunctival pallor, and her sclera are icteric.

      After conducting investigations, a positive Coombs test leads to a diagnosis of autoimmune haemolytic anaemia. This condition results in the breakdown of red blood cells, causing an increase in free haemoglobin levels in the blood.

      What mechanisms will be involved in recycling the elevated levels of this substance?

      Your Answer: Bilirubin

      Correct Answer: Haptoglobins

      Explanation:

      Haptoglobins are responsible for binding free haemoglobin within the circulation, allowing for the complex to be removed from the circulation by the reticuloendothelial system. Therefore, the correct answer is 2 – haptoglobins. LDH, albumin, and bilirubin do not play a role in recycling free haemoglobin.

      Understanding Haemolytic Anaemias by Site

      Haemolytic anaemias can be classified by the site of haemolysis, either intravascular or extravascular. In intravascular haemolysis, free haemoglobin is released and binds to haptoglobin. As haptoglobin becomes saturated, haemoglobin binds to albumin forming methaemalbumin, which can be detected by Schumm’s test. Free haemoglobin is then excreted in the urine as haemoglobinuria and haemosiderinuria. Causes of intravascular haemolysis include mismatched blood transfusion, red cell fragmentation due to heart valves, TTP, DIC, HUS, paroxysmal nocturnal haemoglobinuria, and cold autoimmune haemolytic anaemia.

      On the other hand, extravascular haemolysis occurs when red blood cells are destroyed by macrophages in the spleen or liver. This type of haemolysis is commonly seen in haemoglobinopathies such as sickle cell anaemia and thalassaemia, hereditary spherocytosis, haemolytic disease of the newborn, and warm autoimmune haemolytic anaemia.

      It is important to understand the site of haemolysis in order to properly diagnose and treat haemolytic anaemias. While both intravascular and extravascular haemolysis can lead to anaemia, the underlying causes and treatment approaches may differ.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 17 - A 20-year-old man has a tonsillectomy due to recurrent acute tonsillitis. During recovery,...

    Incorrect

    • A 20-year-old man has a tonsillectomy due to recurrent acute tonsillitis. During recovery, he experiences a postoperative bleeding. Which vessel is the most probable cause of the bleeding?

      Your Answer: Facial vein

      Correct Answer: External palatine vein

      Explanation:

      If the external palatine vein is harmed during tonsillectomy, it can result in reactionary bleeding and is located adjacent to the tonsil.

      Tonsil Anatomy and Tonsillitis

      The tonsils are located in the pharynx and have two surfaces, a medial and lateral surface. They vary in size and are usually supplied by the tonsillar artery and drained by the jugulodigastric and deep cervical nodes. Tonsillitis is a common condition that is usually caused by bacteria, with group A Streptococcus being the most common culprit. It can also be caused by viruses. In some cases, tonsillitis can lead to the development of an abscess, which can distort the uvula. Tonsillectomy is recommended for patients with recurrent acute tonsillitis, suspected malignancy, or enlargement causing sleep apnea. The preferred technique for tonsillectomy is dissection, but it can be complicated by hemorrhage, which is the most common complication. Delayed otalgia may also occur due to irritation of the glossopharyngeal nerve.

    • This question is part of the following fields:

      • Cardiovascular System
      12.3
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  • Question 18 - A 25-year-old female presents to the emergency department with a 4-hour history of...

    Incorrect

    • A 25-year-old female presents to the emergency department with a 4-hour history of headache, confusion, and neck stiffness. In the department, she appears to become increasingly lethargic and has a seizure.

      She has no past medical history and takes no regular medications. Her friend reports that no one else in their apartment complex has been unwell recently.

      Her observations show heart rate 112/min, blood pressure of 98/78 mmHg, 98% oxygen saturations in room air, a temperature of 39.1ºC, and respiratory rate of 20/min.

      She has bloods including cultures sent and is referred to the medical team for further management.

      What is the most likely organism causing this patient's presentation?

      Your Answer: Staphylococcus aureus

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Aetiology of Meningitis in Adults

      Meningitis is a condition that can be caused by various infectious agents such as bacteria, viruses, and fungi. However, this article will focus on bacterial meningitis. The most common bacteria that cause meningitis in adults is Streptococcus pneumoniae, which can develop after an episode of otitis media. Another bacterium that can cause meningitis is Neisseria meningitidis. Listeria monocytogenes is more common in immunocompromised patients and the elderly. Lastly, Haemophilus influenzae type b is also a known cause of meningitis in adults. It is important to identify the causative agent of meningitis to provide appropriate treatment and prevent complications.

    • This question is part of the following fields:

      • Neurological System
      77.5
      Seconds
  • Question 19 - An injury to the spinal accessory nerve will impact which movements? ...

    Correct

    • An injury to the spinal accessory nerve will impact which movements?

      Your Answer: Upward rotation of the scapula

      Explanation:

      The spinal accessory nerve controls the trapezius muscle, which retracts the scapula and upwardly rotates it through the combined action of its upper and lower fibers.

      The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      33.4
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  • Question 20 - A 16-year-old presents to the Emergency Department with her father, who has noticed...

    Correct

    • A 16-year-old presents to the Emergency Department with her father, who has noticed a yellowish tint to her eyes. Upon further inquiry, she reports having a flu-like illness a few days ago, which has since resolved. She has no medical history and is not taking any medications. On examination, scleral icterus is the only significant finding. The following are her blood test results:

      Hb 130 g/L Male: (135-180) Female: (115 - 160)
      Platelets 320 * 109/L (150 - 400)
      WBC 6.0 * 109/L (4.0 - 11.0)

      Bilirubin 80 µmol/L (3 - 17)
      ALP 42 u/L (30 - 100)
      ALT 30 u/L (3 - 40)
      γGT 50 u/L (8 - 60)
      Albumin 45 g/L (35 - 50)

      What is the most probable cause of her symptoms?

      Your Answer: Gilbert's syndrome

      Explanation:

      Gilbert’s syndrome is characterized by an inherited deficiency of an enzyme used to conjugate bilirubin, resulting in elevated levels of unconjugated bilirubin in the blood. This can lead to isolated jaundice of the sclera or mouth during times of physiological stress.

      Crigler Najjar syndrome, on the other hand, is a rare genetic disorder that causes an inability to convert and clear bilirubin from the body, resulting in jaundice shortly after birth.

      Gallstones, which can be asymptomatic or present with right upper quadrant pain following a meal, are associated with risk factors such as being overweight, over 40 years old, female, or fertile.

      Primary sclerosing cholangitis (PSC) is characterized by scarring and fibrosis of the bile ducts inside and outside the liver, and may occur alone or in combination with inflammatory diseases such as ulcerative colitis. Symptoms of PSC include jaundice, right upper quadrant pain, itching, fatigue, and weight loss.

      Gilbert’s syndrome is a genetic disorder that affects the way bilirubin is processed in the body. It is caused by a deficiency of UDP glucuronosyltransferase, which leads to unconjugated hyperbilirubinemia. This means that bilirubin is not properly broken down and eliminated from the body, resulting in jaundice. However, jaundice may only be visible during certain conditions such as fasting, exercise, or illness. The prevalence of Gilbert’s syndrome is around 1-2% in the general population.

      To diagnose Gilbert’s syndrome, doctors may look for a rise in bilirubin levels after prolonged fasting or the administration of IV nicotinic acid. However, treatment is not necessary for this condition. While the exact mode of inheritance is still debated, it is known to be an autosomal recessive disorder.

    • This question is part of the following fields:

      • Gastrointestinal System
      58.8
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  • Question 21 - A 36 year old man presents with sudden onset of abdominal pain. He...

    Incorrect

    • A 36 year old man presents with sudden onset of abdominal pain. He reports experiencing colicky pain for the past 12 hours along with nausea. He also mentions that he has not had a bowel movement and cannot recall passing gas.

      The patient has a history of undergoing an emergency laparotomy due to a stabbing incident 8 years ago.

      Upon examination, the abdomen is tender throughout but feels soft to the touch and produces a tympanic sound when percussed. High-pitched bowel sounds are audible upon auscultation.

      An abdominal X-ray reveals multiple dilated small bowel loops.

      What is the most probable cause of this patient's bowel obstruction?

      Your Answer: Meckel's diverticulum

      Correct Answer: Small bowel adhesions

      Explanation:

      Intussusception is a common cause of bowel obstruction in children under the age of two. Although most cases are asymptomatic, symptoms may occur and include rectal bleeding, volvulus, intussusception, bowel obstruction, or a presentation similar to acute appendicitis.

      While a malignancy in the small bowel is a potential cause of obstruction in this age group, it is extremely rare and therefore less likely in this particular case.

      Imaging for Bowel Obstruction

      Bowel obstruction is a condition that requires immediate medical attention. One of the key indications for performing an abdominal film is to look for small and large bowel obstruction. The maximum normal diameter for the small bowel is 35 mm, while for the large bowel, it is 55 mm. The valvulae conniventes extend all the way across the small bowel, while the haustra extend about a third of the way across the large bowel.

      A small bowel obstruction can be identified through distension of small bowel loops proximally, such as the duodenum and jejunum, with an abrupt transition to an intestinal segment of normal caliber. There may also be a small amount of free fluid intracavity. On the other hand, a large bowel obstruction can be identified through the presence of haustra extending about a third of the way across and a maximum normal diameter of 55 mm.

      Imaging for bowel obstruction is crucial in diagnosing and treating the condition promptly. It is important to note that early detection and intervention can prevent complications and improve patient outcomes.

    • This question is part of the following fields:

      • Gastrointestinal System
      183.3
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  • Question 22 - A gynaecologist is performing a laparoscopic hysterectomy on a 45-year-old patient. He is...

    Correct

    • A gynaecologist is performing a laparoscopic hysterectomy on a 45-year-old patient. He is being careful to avoid damaging a structure that runs close to the vaginal fornices.

      What is the structure that the gynaecologist is most likely being cautious of?

      Your Answer: Ureter

      Explanation:

      The correct statements are:

      – The ureter enters the bladder trigone after passing only 1 cm away from the vaginal fornices, which is closer than other structures.
      – The ilioinguinal nerve originates from the first lumbar nerve (L1).
      – The femoral artery is a continuation of the external iliac artery.
      – The descending colon starts at the splenic flexure and ends at the beginning of the sigmoid colon.
      – The obturator nerve arises from the ventral divisions of the second, third, and fourth lumbar nerves.

      Anatomy of the Ureter

      The ureter is a muscular tube that measures 25-35 cm in length and is lined by transitional epithelium. It is surrounded by a thick muscular coat that becomes three muscular layers as it crosses the bony pelvis. This retroperitoneal structure overlies the transverse processes L2-L5 and lies anterior to the bifurcation of iliac vessels. The blood supply to the ureter is segmental and includes the renal artery, aortic branches, gonadal branches, common iliac, and internal iliac. It is important to note that the ureter lies beneath the uterine artery.

      In summary, the ureter is a vital structure in the urinary system that plays a crucial role in transporting urine from the kidneys to the bladder. Its unique anatomy and blood supply make it a complex structure that requires careful consideration in any surgical or medical intervention.

    • This question is part of the following fields:

      • Gastrointestinal System
      22.1
      Seconds
  • Question 23 - Which one of the following structures does not pass behind the piriformis muscle...

    Correct

    • Which one of the following structures does not pass behind the piriformis muscle in the greater sciatic foramen?

      Your Answer: Obturator nerve

      Explanation:

      The greater sciatic foramen does not serve as a pathway for the obturator nerve.

      The Greater Sciatic Foramen and its Contents

      The greater sciatic foramen is a space in the pelvis that is bounded by various ligaments and bones. It serves as a passageway for several important structures, including nerves and blood vessels. The piriformis muscle is a landmark for identifying these structures as they pass through the sciatic notch. Above the piriformis muscle, the superior gluteal vessels can be found, while below it are the inferior gluteal vessels, the sciatic nerve (which passes through it in only 10% of cases), and the posterior cutaneous nerve of the thigh.

      The boundaries of the greater sciatic foramen include the greater sciatic notch of the ilium, the sacrotuberous ligament, the sacrospinous ligament, and the ischial spine. The anterior sacroiliac ligament forms the superior boundary. Structures passing through the greater sciatic foramen include the pudendal nerve, the internal pudendal artery, and the nerve to the obturator internus.

      In contrast, the lesser sciatic foramen is a smaller space that contains the tendon of the obturator internus, the pudendal nerve, the internal pudendal artery and vein, and the nerve to the obturator internus. Understanding the contents and boundaries of these foramina is important for clinicians who may need to access or avoid these structures during surgical procedures or other interventions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.9
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  • Question 24 - You are developing a research project investigating the pathophysiology of abetalipoproteinemia. You determine...

    Incorrect

    • You are developing a research project investigating the pathophysiology of abetalipoproteinemia. You determine that a viable focus would be the rate-limiting enzyme involved in lipogenesis.

      Which enzyme will be the target of your investigation?

      Your Answer: Isocitrate dehydrogenase

      Correct Answer: Acetyl CoA carboxylase

      Explanation:

      The enzyme that limits the rate of lipogenesis is acetyl CoA carboxylase.

      During lipogenesis, fatty acids are produced from acetyl-CoA. Acetyl CoA carboxylase is the enzyme that controls the rate of this process.

      Carbamoyl phosphate synthetase I is the enzyme that limits the rate of the urea cycle.

      Glycogen phosphorylase is the enzyme that controls the rate of glycogenolysis.

      Isocitrate dehydrogenase is the enzyme that limits the rate of the citric acid cycle.

      Rate-Determining Enzymes in Metabolic Processes

      Metabolic processes involve a series of chemical reactions that occur in living organisms to maintain life. Enzymes play a crucial role in these processes by catalyzing the reactions. However, not all enzymes have the same impact on the rate of the reaction. Some enzymes are rate-determining, meaning that they control the overall rate of the process. The table above lists the rate-determining enzymes involved in common metabolic processes.

      For example, in the TCA cycle, isocitrate dehydrogenase is the rate-determining enzyme. In glycolysis, phosphofructokinase-1 controls the rate of the process. In gluconeogenesis, fructose-1,6-bisphosphatase is the rate-determining enzyme. Similarly, glycogen synthase controls the rate of glycogenesis, while glycogen phosphorylase controls the rate of glycogenolysis.

      Other metabolic processes, such as lipogenesis, lipolysis, cholesterol synthesis, and ketogenesis, also have rate-determining enzymes. Acetyl-CoA carboxylase controls the rate of lipogenesis, while carnitine-palmitoyl transferase I controls the rate of lipolysis. HMG-CoA reductase is the rate-determining enzyme in cholesterol synthesis, while HMG-CoA synthase controls the rate of ketogenesis.

      The urea cycle, de novo pyrimidine synthesis, and de novo purine synthesis also have rate-determining enzymes. Carbamoyl phosphate synthetase I controls the rate of the urea cycle, while carbamoyl phosphate synthetase II controls the rate of de novo pyrimidine synthesis. Glutamine-PRPP amidotransferase is the rate-determining enzyme in de novo purine synthesis.

      Understanding the rate-determining enzymes in metabolic processes is crucial for developing treatments for metabolic disorders and diseases. By targeting these enzymes, researchers can potentially regulate the rate of the process and improve the health outcomes of individuals with these conditions.

    • This question is part of the following fields:

      • General Principles
      69.8
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  • Question 25 - A middle-aged man is informed of his hypertension during routine check-ups. The physician...

    Incorrect

    • A middle-aged man is informed of his hypertension during routine check-ups. The physician clarifies that his age increases the likelihood of a secondary cause for his hypertension. What is the primary cause of secondary hypertension?

      Your Answer: Malignancy

      Correct Answer: Renal disease

      Explanation:

      Secondary hypertension is primarily caused by renal disease, while other endocrine diseases like hyperaldosteronism, phaeochromocytoma, and acromegaly are less common culprits. Malignancy and pregnancy typically do not lead to hypertension, although pregnancy can result in pre-eclampsia, which is characterized by high blood pressure. Certain medications, such as NSAIDs and glucocorticoids, can also induce hypertension.

      Secondary Causes of Hypertension

      Hypertension, or high blood pressure, can be caused by various factors. While primary hypertension has no identifiable cause, secondary hypertension is caused by an underlying medical condition. The most common cause of secondary hypertension is primary hyperaldosteronism, which accounts for 5-10% of cases. Other causes include renal diseases such as glomerulonephritis, pyelonephritis, adult polycystic kidney disease, and renal artery stenosis. Endocrine disorders like phaeochromocytoma, Cushing’s syndrome, Liddle’s syndrome, congenital adrenal hyperplasia, and acromegaly can also result in increased blood pressure. Certain medications like steroids, monoamine oxidase inhibitors, the combined oral contraceptive pill, NSAIDs, and leflunomide can also cause hypertension. Pregnancy and coarctation of the aorta are other possible causes. Identifying and treating the underlying condition is crucial in managing secondary hypertension.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 26 - A teenage boy is in a car crash and experiences a spinal cord...

    Correct

    • A teenage boy is in a car crash and experiences a spinal cord injury resulting in a hemisection of his spinal cord. What clinical features will he exhibit on examination below the level of injury?

      Your Answer: Weakness and loss of light touch sensation on the same side and loss of pain on the opposite side

      Explanation:

      When a hemisection of the spinal cord occurs, it results in a condition known as Brown-Sequard syndrome. This condition is characterized by sensory and motor loss on the same side of the injury, as well as pain loss on the opposite side. The loss of motor function on the same side is due to damage to the corticospinal tract, which does not cross over within the spinal cord but instead decussates in the brainstem. Similarly, the loss of light touch on the same side is due to damage to the dorsal column, which also decussates in the brainstem. In contrast, the loss of pain on the opposite side is due to damage to the spinothalamic tract, which decussates at the level of sensory input. As a result, pain signals are always carried on the opposite side of the spinal cord, while motor and light touch signals are carried on the same side as the injury.

      Understanding Brown-Sequard Syndrome

      Brown-Sequard syndrome is a condition that occurs when there is a lateral hemisection of the spinal cord. This condition is characterized by a combination of symptoms that affect the body’s ability to sense and move. Individuals with Brown-Sequard syndrome experience weakness on the same side of the body as the lesion, as well as a loss of proprioception and vibration sensation on that side. On the opposite side of the body, there is a loss of pain and temperature sensation.

      It is important to note that the severity of Brown-Sequard syndrome can vary depending on the location and extent of the spinal cord injury. Some individuals may experience only mild symptoms, while others may have more severe impairments. Treatment for Brown-Sequard syndrome typically involves a combination of physical therapy, medication, and other supportive measures to help manage symptoms and improve overall quality of life.

    • This question is part of the following fields:

      • Neurological System
      129
      Seconds
  • Question 27 - A 43-year-old man is seeking information about the COVID-19 vaccine. He has heard...

    Incorrect

    • A 43-year-old man is seeking information about the COVID-19 vaccine. He has heard that the vaccine may not provide complete protection and wants to know how effective it is. As his healthcare provider, you provide him with the following data for this specific vaccine:

      Vaccinated Not vaccinated Total
      COVID-19 occurred 10 90 100
      COVID-19 did not occur 90 10 100
      Column totals 100 100 200

      What is the most appropriate response to this patient's inquiry?

      Your Answer: 90/100 - 10/100 = 80%

      Correct Answer: (10/100 - 90/100) / 90/100 = -90%

      Explanation:

      Understanding Relative Risk in Clinical Trials

      Relative risk (RR) is a measure used in clinical trials to compare the risk of an event occurring in the experimental group to the risk in the control group. It is calculated by dividing the experimental event rate (EER) by the control event rate (CER). If the resulting ratio is greater than 1, it means that the event is more likely to occur in the experimental group than in the control group. Conversely, if the ratio is less than 1, the event is less likely to occur in the experimental group.

      To calculate the relative risk reduction (RRR) or relative risk increase (RRI), the absolute risk change is divided by the control event rate. This provides a percentage that indicates the magnitude of the difference between the two groups. Understanding relative risk is important in evaluating the effectiveness of interventions and treatments in clinical trials. By comparing the risk of an event in the experimental group to the control group, researchers can determine whether the intervention is beneficial or not.

    • This question is part of the following fields:

      • General Principles
      191.2
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  • Question 28 - A 55-year-old man with uncontrolled type 2 diabetes is hospitalized and presents with...

    Incorrect

    • A 55-year-old man with uncontrolled type 2 diabetes is hospitalized and presents with elevated inflammatory markers, metabolic acidosis, leukocytosis, and an amylase level of 3480 U/L. Which medication is the probable cause?

      Your Answer: Metformin

      Correct Answer: Exenatide

      Explanation:

      Exenatide and Pancreatitis: A Review of the Evidence

      Exenatide is a medication that mimics the effects of the hormone GLP-1, which triggers insulin secretion in response to food intake. However, there is a rare but concerning association between exenatide and acute pancreatitis. A recent case-control study found that patients taking GLP-1 mimetics like exenatide had a higher risk of developing pancreatitis compared to those taking other diabetes drugs. As a result, patients starting on exenatide should be informed about the symptoms of pancreatitis and monitored closely for abdominal pain.

      While there is some controversy surrounding the association between gliptins and pancreatitis, the British National Formulary recommends discontinuing sitagliptin if acute pancreatitis is suspected. It is important to note that lactic acidosis, a potential side effect of metformin, should not be confused with pancreatitis, which is characterized by elevated levels of amylase. Overall, healthcare providers should be aware of the potential risk of pancreatitis in patients taking exenatide and other GLP-1 mimetics, and take appropriate precautions to monitor and manage this condition.

    • This question is part of the following fields:

      • Pharmacology
      50.5
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  • Question 29 - A 3-month-old infant is seen by their pediatrician due to their mother's concern...

    Incorrect

    • A 3-month-old infant is seen by their pediatrician due to their mother's concern about their hand being fixed in an unusual position. The infant had a difficult delivery with shoulder dystocia, but has been healthy since birth and meeting developmental milestones.

      During the exam, the pediatrician observes that the infant's fingers on the left hand are permanently flexed, resembling a claw. There is also muscle wasting in the left forearm. Additionally, the pediatrician notes left-sided miosis, ptosis, and anhidrosis.

      What is the most probable cause of these symptoms in this infant?

      Your Answer: Erb-Duchenne paralysis

      Correct Answer: Klumpke paralysis

      Explanation:

      The correct diagnosis for this patient is Klumpke paralysis, which is often caused by shoulder dystocia during birth or traction injuries. The patient presents with a claw-like deformity in their hand, indicating damage to the C8 and T1 branches of the brachial plexus. This condition is also associated with Horner’s syndrome, which the patient is experiencing.

      Bell’s palsy, C8 radiculopathy, and Erb-Duchenne paralysis are all incorrect diagnoses for this patient. Bell’s palsy only affects the facial nerve and would not cause the other symptoms seen in this patient. C8 radiculopathy would not result in the claw-like deformity or T1 dermatome involvement. Erb-Duchenne paralysis affects a different part of the brachial plexus and presents differently from this patient’s symptoms.

      Horner’s syndrome is a condition characterized by several features, including a small pupil (miosis), drooping of the upper eyelid (ptosis), a sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The cause of Horner’s syndrome can be determined by examining additional symptoms. For example, congenital Horner’s syndrome may be identified by a difference in iris color (heterochromia), while anhidrosis may be present in central or preganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can also be helpful in confirming the diagnosis and identifying the location of the lesion. Central lesions may be caused by conditions such as stroke or multiple sclerosis, while postganglionic lesions may be due to factors like carotid artery dissection or cluster headaches. It is important to note that the appearance of enophthalmos in Horner’s syndrome is actually due to a narrow palpebral aperture rather than true enophthalmos.

    • This question is part of the following fields:

      • Neurological System
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  • Question 30 - A 50-year-old woman with a recent diagnosis of COPD is admitted to the...

    Correct

    • A 50-year-old woman with a recent diagnosis of COPD is admitted to the hospital for treatment of an exacerbation caused by infection. She reports smoking 10 cigarettes per day and has a family history of lung cancer. Her chest x-ray shows signs of emphysema, and she mentions that her parents and siblings also have the disease. She asks for advice on the best course of action to improve her prognosis.

      Your Answer: Stop smoking

      Explanation:

      The most crucial step to enhance the patient’s prognosis is to assist them in quitting smoking. While lung reduction surgery and long-term oxygen therapy may benefit certain patient groups, smoking cessation remains the top priority. Proper inhaler technique and adherence, as well as the use of home nebulizers, can provide symptomatic relief for the patient.

      The National Institute for Health and Care Excellence (NICE) updated its guidelines on the management of chronic obstructive pulmonary disease (COPD) in 2018. The guidelines recommend general management strategies such as smoking cessation advice, annual influenzae vaccination, and one-off pneumococcal vaccination. Pulmonary rehabilitation is also recommended for patients who view themselves as functionally disabled by COPD.

      Bronchodilator therapy is the first-line treatment for patients who remain breathless or have exacerbations despite using short-acting bronchodilators. The next step is determined by whether the patient has asthmatic features or features suggesting steroid responsiveness. NICE suggests several criteria to determine this, including a previous diagnosis of asthma or atopy, a higher blood eosinophil count, substantial variation in FEV1 over time, and substantial diurnal variation in peak expiratory flow.

      If the patient does not have asthmatic features or features suggesting steroid responsiveness, a long-acting beta2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) should be added. If the patient is already taking a short-acting muscarinic antagonist (SAMA), it should be discontinued and switched to a short-acting beta2-agonist (SABA). If the patient has asthmatic features or features suggesting steroid responsiveness, a LABA and inhaled corticosteroid (ICS) should be added. If the patient remains breathless or has exacerbations, triple therapy (LAMA + LABA + ICS) should be offered.

      NICE only recommends theophylline after trials of short and long-acting bronchodilators or to people who cannot use inhaled therapy. Azithromycin prophylaxis is recommended in select patients who have optimised standard treatments and continue to have exacerbations. Mucolytics should be considered in patients with a chronic productive cough and continued if symptoms improve.

      Cor pulmonale features include peripheral oedema, raised jugular venous pressure, systolic parasternal heave, and loud P2. Loop diuretics should be used for oedema, and long-term oxygen therapy should be considered. Smoking cessation, long-term oxygen therapy in eligible patients, and lung volume reduction surgery in selected patients may improve survival in patients with stable COPD. NICE does not recommend the use of ACE-inhibitors, calcium channel blockers, or alpha blockers

    • This question is part of the following fields:

      • Respiratory System
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  • Question 31 - A 65-year-old woman is preparing for surgery to remove her submandibular gland due...

    Incorrect

    • A 65-year-old woman is preparing for surgery to remove her submandibular gland due to recurrent sialadenitis. What is a significant structure that is located medially to the gland?

      Your Answer: Lateral pterygoid muscle

      Correct Answer: Mylohyoid muscle

      Explanation:

      Muscles and Arteries of the Head and Neck

      The mylohyoid muscle is situated close to the superficial part of the submandibular gland. Meanwhile, the genioglossus muscle originates from the mandible and attaches to the tongue and hyoid bone. This muscle is responsible for tongue movement and swallowing. Another muscle in the head and neck region is the lateral pterygoid muscle, which is located in the infratemporal fossa of the skull. It is a two-headed muscle that aids in chewing and movement of the temporomandibular joint. Lastly, the maxillary artery arises posterior to the mandibular neck and passes between the sphenomandibular ligament and ramus of the mandible. This artery supplies blood to the deep structures of the face and maxilla. the anatomy of these muscles and arteries is crucial in diagnosing and treating various head and neck conditions.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 32 - A patient in his late 60s presents with dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea,...

    Incorrect

    • A patient in his late 60s presents with dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, cyanosis. A diagnosis of acute heart failure is made. He is started on diuretics, ACE inhibitors, beta-blockers but shows minimal improvement with medications.

      What should be considered if he continues to fail to improve?

      Your Answer: High-flow oxygen

      Correct Answer: Continuous positive airway pressure

      Explanation:

      If a patient with acute heart failure does not show improvement with appropriate medication, CPAP should be considered as a viable treatment option.

      Heart failure requires acute management, with recommended treatments including IV loop diuretics such as furosemide or bumetanide. Oxygen may also be given in accordance with British Thoracic Society guidelines to maintain oxygen saturations between 94-98%. Vasodilators such as nitrates should not be routinely given to all patients, but may be considered for those with concomitant myocardial ischaemia, severe hypertension, or regurgitant aortic or mitral valve disease. However, hypotension is a major side-effect and contraindication.

      For patients with respiratory failure, CPAP may be used. In cases of hypotension or cardiogenic shock, treatment can be challenging as loop diuretics and nitrates may exacerbate hypotension. Inotropic agents like dobutamine may be considered for patients with severe left ventricular dysfunction and potentially reversible cardiogenic shock. Vasopressor agents like norepinephrine are typically only used if there is insufficient response to inotropes and evidence of end-organ hypoperfusion. Mechanical circulatory assistance such as intra-aortic balloon counterpulsation or ventricular assist devices may also be used.

      While opiates were previously used routinely to reduce dyspnoea/distress in patients, NICE now advises against routine use due to studies suggesting increased morbidity in patients given opiates. Regular medication for heart failure such as beta-blockers and ACE-inhibitors should be continued, with beta-blockers only stopped if the patient has a heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock.

    • This question is part of the following fields:

      • Cardiovascular System
      52.8
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  • Question 33 - A 69 year old patient is admitted to the emergency department with a...

    Incorrect

    • A 69 year old patient is admitted to the emergency department with a suspected digoxin overdose. The individual has a medical history of hypertension, hyperthyroidism, atrial fibrillation, and eczema. The ECG reveals sinus bradycardia. The medical team administers IV digibind and implements measures to safeguard the heart against any electrolyte imbalances.

      What is the correct application of digoxin in this scenario?

      Your Answer: Digoxin is a negative inotropic agent

      Correct Answer: Digoxin overdose can cause hyperkalaemia

      Explanation:

      Hyperkalaemia can be caused by an overdose of digoxin.

      Digoxin is known to inhibit the Na+/K+ ATPase, which is responsible for transporting sodium ions out of cells and promoting potassium influx. This inhibition leads to an accumulation of sodium inside the cell, which is then exchanged for calcium via the Na+/Ca2+ exchanger. In the heart, this increased intracellular calcium results in more calcium being released by the sarcoplasmic reticulum, making more calcium available to bind to troponin-C and increasing contractility (inotropy).

      However, an overdose of digoxin can cause widespread inhibition of the Na+/K+ ATPase, leading to reduced potassium influx into cells and resulting in hyperkalaemia. This is a common occurrence in cases of acute digoxin toxicity.

      In addition, digoxin has been found to increase vagal efferent activity to the heart, which has a parasympathomimetic effect and reduces the firing rate of the sinoatrial node, resulting in a decrease in heart rate (negative chronotropy).

      It is important to note that digoxin has a long half-life of 40 hours.

      Understanding Digoxin and Its Toxicity

      Digoxin is a medication used for rate control in atrial fibrillation and for improving symptoms in heart failure patients. It works by decreasing conduction through the atrioventricular node and increasing the force of cardiac muscle contraction. However, it has a narrow therapeutic index and can cause toxicity even when the concentration is within the therapeutic range.

      Toxicity may present with symptoms such as lethargy, nausea, vomiting, confusion, and yellow-green vision. Arrhythmias and gynaecomastia may also occur. Hypokalaemia is a classic precipitating factor as it increases the inhibitory effects of digoxin. Other factors include increasing age, renal failure, myocardial ischaemia, and various electrolyte imbalances. Certain drugs, such as amiodarone and verapamil, can also contribute to toxicity.

      If toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose. However, plasma concentration alone does not determine toxicity. Management includes the use of Digibind, correcting arrhythmias, and monitoring potassium levels.

      In summary, understanding the mechanism of action, monitoring, and potential toxicity of digoxin is crucial for its safe and effective use in clinical practice.

    • This question is part of the following fields:

      • General Principles
      40.1
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  • Question 34 - A 25-year-old soldier sustains a gunshot wound to the abdomen resulting in severe...

    Incorrect

    • A 25-year-old soldier sustains a gunshot wound to the abdomen resulting in severe damage to the abdominal aorta. The surgeons opt to place a vascular clamp just below the diaphragm to control the bleeding. What is the potential risk of injury to one of the vessels during this procedure?

      Your Answer: Superior phrenic arteries

      Correct Answer: Inferior phrenic arteries

      Explanation:

      The inferior phrenic arteries, which are the first branches of the abdominal aorta, are most vulnerable. On the other hand, the superior phrenic arteries are located in the thorax. The area around the diaphragmatic hiatus could be a valuable location for aortic occlusion, but keeping the clamp on for more than 10-15 minutes typically results in unfavorable results.

      The abdominal aorta is a major blood vessel that originates from the 12th thoracic vertebrae and terminates at the fourth lumbar vertebrae. It is located in the abdomen and is surrounded by various organs and structures. The posterior relations of the abdominal aorta include the vertebral bodies of the first to fourth lumbar vertebrae. The anterior relations include the lesser omentum, liver, left renal vein, inferior mesenteric vein, third part of the duodenum, pancreas, parietal peritoneum, and peritoneal cavity. The right lateral relations include the right crus of the diaphragm, cisterna chyli, azygos vein, and inferior vena cava (which becomes posterior distally). The left lateral relations include the fourth part of the duodenum, duodenal-jejunal flexure, and left sympathetic trunk. Overall, the abdominal aorta is an important blood vessel that supplies oxygenated blood to various organs in the abdomen.

    • This question is part of the following fields:

      • Gastrointestinal System
      36.1
      Seconds
  • Question 35 - A 63-year-old woman comes to the rheumatology clinic with a recent diagnosis of...

    Correct

    • A 63-year-old woman comes to the rheumatology clinic with a recent diagnosis of rheumatoid arthritis. She is prescribed a brief course of steroids and a disease modifying anti-rheumatic drug. Which joint is predominantly impacted by rheumatoid arthritis?

      Your Answer: Synovial

      Explanation:

      There are three main types of joints: synovial, cartilaginous, and fibrous. Synovial joints have a fibrous capsule with ligaments that check excessive movements. Some synovial joints have an intra-articular disc made of fibrocartilage. Cartilaginous joints can grow while resisting forces and eventually become synostoses. Fibrous joints include sutures, which slowly become rigid synostoses, syndesmoses, which allow some movement, and gomphoses, which anchor teeth into alveolar sockets.

      Rheumatoid arthritis can be diagnosed clinically, which is considered more important than using specific criteria. However, the American College of Rheumatology has established classification criteria for rheumatoid arthritis. These criteria require the presence of at least one joint with definite clinical synovitis that cannot be explained by another disease. A score of 6 out of 10 is needed for a definite diagnosis of rheumatoid arthritis. The score is based on factors such as the number and type of joints involved, serology (presence of rheumatoid factor or anti-cyclic citrullinated peptide antibody), acute-phase reactants (such as CRP and ESR), and duration of symptoms. These criteria are used to classify patients with rheumatoid arthritis for research and clinical purposes.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.3
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  • Question 36 - A 65-year-old man presents to the Emergency Department with a 60-minute history of...

    Correct

    • A 65-year-old man presents to the Emergency Department with a 60-minute history of central chest pain that extends to his jaw. An ECG reveals an inferior ST-segment elevation myocardial infarction (STEMI). The QRS is positive in leads I and aVL but negative in leads II and aVF. What type of axis deviation is indicated by this finding?

      Your Answer: Left

      Explanation:

      To estimate the heart’s axis, one method is the quadrant method, which involves analyzing leads I and aVF. If lead I is positive and lead aVF is negative, this suggests a possible left axis deviation. To confirm left axis deviation, a second method using lead II can be used. If lead II is also negative, then left axis deviation is confirmed. Other types of axis deviation can be determined by analyzing the polarity of leads I and aVF.

      ECG Axis Deviation: Causes of Left and Right Deviation

      Electrocardiogram (ECG) axis deviation refers to the direction of the electrical activity of the heart. A normal axis is between -30 and +90 degrees. Deviation from this range can indicate underlying cardiac or pulmonary conditions.

      Left axis deviation (LAD) can be caused by left anterior hemiblock, left bundle branch block, inferior myocardial infarction, Wolff-Parkinson-White syndrome with a right-sided accessory pathway, hyperkalaemia, congenital heart defects such as ostium primum atrial septal defect (ASD) and tricuspid atresia, and minor LAD in obese individuals.

      On the other hand, right axis deviation (RAD) can be caused by right ventricular hypertrophy, left posterior hemiblock, lateral myocardial infarction, chronic lung disease leading to cor pulmonale, pulmonary embolism, ostium secundum ASD, Wolff-Parkinson-White syndrome with a left-sided accessory pathway, and minor RAD in tall individuals. It is also normal in infants less than one year old.

      It is important to note that Wolff-Parkinson-White syndrome is a common cause of both LAD and RAD, depending on the location of the accessory pathway. Understanding the causes of ECG axis deviation can aid in the diagnosis and management of underlying conditions.

    • This question is part of the following fields:

      • Cardiovascular System
      45.4
      Seconds
  • Question 37 - A 27-year-old man visits his doctor reporting persistent fatigue, weight loss, and intermittent...

    Correct

    • A 27-year-old man visits his doctor reporting persistent fatigue, weight loss, and intermittent non-bloody diarrhea. He also has a blistering skin rash on his abdomen. His recent blood tests reveal low hemoglobin levels, high mean corpuscular volume, and low vitamin B12 levels. The doctor inquires about the man's diet and finds it to be sufficient, leading to a suspicion of malabsorption. What is the probable cause of the malabsorption?

      Your Answer: Villous atrophy

      Explanation:

      Malabsorption is a common consequence of coeliac disease, which is caused by the destruction of epithelial cells on the villi of the small intestine due to an immune response to gluten. This results in villous atrophy, reducing the surface area of the gastrointestinal tract and impairing absorption. Coeliac disease often leads to B12 deficiency, particularly in the terminal ileum where villous damage is most severe. While decreased gut motility can cause constipation, it does not contribute to malabsorption in coeliac disease. Similarly, down-regulation of brush-border enzymes is not responsible for malabsorption in this condition, although it can occur in response to other immune responses or infections. Although increased gut motility can lead to malabsorption, it is not a mechanism of malnutrition in coeliac disease. Finally, it is important to note that coeliac disease reduces surface area rather than increasing it, which would actually enhance nutrient absorption.

      Understanding Coeliac Disease

      Coeliac disease is an autoimmune disorder that affects approximately 1% of the UK population. It is caused by sensitivity to gluten, a protein found in wheat, barley, and rye. Repeated exposure to gluten leads to villous atrophy, which causes malabsorption. Coeliac disease is associated with various conditions, including dermatitis herpetiformis and autoimmune disorders such as type 1 diabetes mellitus and autoimmune hepatitis. It is strongly linked to HLA-DQ2 and HLA-DQ8.

      To diagnose coeliac disease, NICE recommends screening patients who exhibit signs and symptoms such as chronic or intermittent diarrhea, failure to thrive or faltering growth in children, persistent or unexplained gastrointestinal symptoms, prolonged fatigue, recurrent abdominal pain, sudden or unexpected weight loss, unexplained anemia, autoimmune thyroid disease, dermatitis herpetiformis, irritable bowel syndrome, type 1 diabetes, and first-degree relatives with coeliac disease.

      Complications of coeliac disease include anemia, hyposplenism, osteoporosis, osteomalacia, lactose intolerance, enteropathy-associated T-cell lymphoma of the small intestine, subfertility, and unfavorable pregnancy outcomes. In rare cases, it can lead to esophageal cancer and other malignancies.

      The diagnosis of coeliac disease is confirmed through a duodenal biopsy, which shows complete atrophy of the villi with flat mucosa and marked crypt hyperplasia, intraepithelial lymphocytosis, and dense mixed inflammatory infiltrate in the lamina propria. Treatment involves a lifelong gluten-free diet.

    • This question is part of the following fields:

      • Gastrointestinal System
      24.3
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  • Question 38 - Can you provide a definition for pseudostratified epithelium? ...

    Correct

    • Can you provide a definition for pseudostratified epithelium?

      Your Answer: A single layer of epithelial cells with nuclei at different height

      Explanation:

      Types of Epithelial Tissue

      Epithelial tissue is a type of tissue that lines the surfaces of organs, glands, and body cavities. There are different types of epithelial tissue, including simple, stratified, and transitional epithelium. Pseudostratified epithelium is a type of simple epithelium that appears to be several cells deep due to the nuclei being at different heights. This gives the illusion of a stratified epithelium. The lining of the conducting airways, up to the respiratory bronchioles, is lined by ciliated, pseudostratified columnar epithelium.

      A simple epithelium is a single layer of epithelial cells with nuclei at the same height, while a stratified epithelium is multiple layers of epithelial cells upon each other, usually stratified squamous. The skin is an example of a stratified epithelium. A transitional epithelium is multiple layers of epithelial cells that stretch over each other. This type of epithelium is found in the ureters and bladder. When contracted, the epithelium is stratified, but when stretched, the epithelial cells slide to give a simple epithelium. This allows for expansion with a minimal increase in wall pressure.

    • This question is part of the following fields:

      • Clinical Sciences
      16.4
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  • Question 39 - A 3-year-old girl is brought to the emergency department due to severe abdominal...

    Incorrect

    • A 3-year-old girl is brought to the emergency department due to severe abdominal pain. She has tenderness throughout her abdomen, but it is especially painful in the right iliac fossa. Her parents are concerned because they noticed blood in her stool earlier today.

      The patient is admitted and receives appropriate treatment. Further investigations reveal the presence of ectopic ileal mucosa.

      What is the probable underlying condition?

      Your Answer: Ulcerative colitis

      Correct Answer: Meckel's diverticulum

      Explanation:

      Meckel’s diverticulum is the most likely diagnosis for this child’s symptoms. It is a congenital condition that affects about 2% of the population and typically presents with symptoms around the age of 2. Some children with Meckel’s diverticulum may develop diverticulitis, which can be mistaken for appendicitis. The presence of ectopic ileal mucosa is a key factor in diagnosing Meckel’s diverticulum.

      Appendicitis is an unlikely diagnosis as it would not explain the presence of ectopic ileal mucosa. Duodenal atresia is also unlikely as it typically presents in newborns and is associated with Down’s syndrome. Necrotising enterocolitis is another unlikely diagnosis as it primarily affects premature infants and would not explain the ectopic ileal mucosa.

      Meckel’s diverticulum is a congenital diverticulum of the small intestine that is a remnant of the omphalomesenteric duct. It occurs in 2% of the population, is 2 feet from the ileocaecal valve, and is 2 inches long. It is usually asymptomatic but can present with abdominal pain, rectal bleeding, or intestinal obstruction. Investigation includes a Meckel’s scan or mesenteric arteriography. Management involves removal if narrow neck or symptomatic, with options between wedge excision or formal small bowel resection and anastomosis. Meckel’s diverticulum is typically lined by ileal mucosa but ectopic gastric, pancreatic, and jejunal mucosa can also occur.

    • This question is part of the following fields:

      • Gastrointestinal System
      44.8
      Seconds
  • Question 40 - A 46-year-old woman visits her GP complaining of pins and needles in her...

    Correct

    • A 46-year-old woman visits her GP complaining of pins and needles in her right hand, which worsen at night and improve when she hangs her hand over the bed's edge. She has a medical history of hypothyroidism. On examination, there is atrophy of the thenar aspect of her right hand, and Tinel's test is positive on the right side only. Despite conservative management, the patient returns to the practice with no improvement in symptoms and is referred for surgery. What is the surgical procedure that can alleviate this patient's symptoms?

      Your Answer: Flexor retinaculum

      Explanation:

      The surgical management of carpal tunnel syndrome involves dividing the flexor retinaculum, which is the structure spanning the anteromedial surface of the ulna and the distal interphalangeal joints of the phalanges. This procedure is indicated by symptoms such as thenar wasting and a positive Tinel’s test. It is important to note that the cubital retinaculum, Osborne’s ligament, palmar aponeurosis, and pisometacarpal ligament are not involved in the treatment of carpal tunnel syndrome.

      Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

      There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      28.2
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal System And Skin (5/5) 100%
Clinical Sciences (2/3) 67%
Psychiatry (1/2) 50%
Reproductive System (1/3) 33%
Ethics And Law (0/1) 0%
Gastrointestinal System (6/9) 67%
Neurological System (3/5) 60%
Endocrine System (1/1) 100%
Haematology And Oncology (1/2) 50%
Cardiovascular System (1/4) 25%
General Principles (0/3) 0%
Pharmacology (0/1) 0%
Respiratory System (1/1) 100%
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