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  • Question 1 - A 9-year-old boy presents to the paediatric outpatient clinic with a history of...

    Incorrect

    • A 9-year-old boy presents to the paediatric outpatient clinic with a history of duodenal atresia, clinodactyly, a wide nasal bridge, and a large tongue. What malignancy is he at an elevated risk for?

      Your Answer: Soft tissue tumours

      Correct Answer: Acute leukaemias

      Explanation:

      Down’s Syndrome and Associated Conditions

      Down’s syndrome, also known as trisomy 21, is characterized by several physical features such as a wide, flat nasal bridge, macroglossia, and clinodactyly. Other common features include a round face, hypothyroidism, a sandal gap between the toes, and a single palmar crease. Individuals with Down’s syndrome are predisposed to certain conditions such as Alzheimer’s disease and acute leukaemias. However, nephroblastomas, primary bone malignancies, soft tissue tumours, and solid CNS tumours are not directly related to Down’s syndrome. Nephroblastomas are associated with an absent iris, while primary bone malignancies have few predisposing factors except for rare cancer syndromes. Soft tissue tumours, such as rhabdomyosarcomas, are linked to familial retinoblastoma, while solid CNS tumours are increased in cancer syndromes like Li-Fraumeni. the associated conditions of Down’s syndrome can aid in early detection and treatment of these conditions.

    • This question is part of the following fields:

      • Haematology And Oncology
      24.5
      Seconds
  • Question 2 - An 80-year-old patient is initiated on warfarin after being diagnosed with atrial fibrillation....

    Correct

    • An 80-year-old patient is initiated on warfarin after being diagnosed with atrial fibrillation. The patient has a medical history of a metallic heart valve.

      The patient is informed that INR levels will be used to monitor the effects of warfarin. INR is a ratio of the value during warfarin treatment to the normal value, which is used to measure a specific aspect of clotting.

      What is the value that is utilized during this monitoring process?

      Your Answer: Prothrombin time

      Explanation:

      Warfarin leads to an extended prothrombin time, which is the correct answer. The prothrombin time assesses the extrinsic and common pathways of the clotting cascade, and warfarin affects factor VII from the extrinsic pathway, as well as factor II (prothrombin) and factor X from the common pathway. This results in a prolonged prothrombin time, and the INR is a ratio of the prothrombin time during warfarin treatment to the normal prothrombin time.

      The activated partial thromboplastin time is an incorrect answer. Although high levels of warfarin may prolong the activated partial thromboplastin time, the INR is solely based on the prothrombin time.

      Bleeding time is also an incorrect answer. While warfarin can cause a prolonged bleeding time, the INR measures the prothrombin time.

      Fibrinogen levels are another incorrect answer. Fibrinogen is necessary for blood clotting, and warfarin can decrease fibrinogen levels after prolonged use. However, fibrinogen levels are not used in the INR measurement.

      Understanding Warfarin: Mechanism of Action, Indications, Monitoring, Factors, and Side-Effects

      Warfarin is an oral anticoagulant that has been widely used for many years to manage venous thromboembolism and reduce stroke risk in patients with atrial fibrillation. However, it has been largely replaced by direct oral anticoagulants (DOACs) due to their ease of use and lack of need for monitoring. Warfarin works by inhibiting epoxide reductase, which prevents the reduction of vitamin K to its active hydroquinone form. This, in turn, affects the carboxylation of clotting factor II, VII, IX, and X, as well as protein C.

      Warfarin is indicated for patients with mechanical heart valves, with the target INR depending on the valve type and location. Mitral valves generally require a higher INR than aortic valves. It is also used as a second-line treatment after DOACs for venous thromboembolism and atrial fibrillation, with target INRs of 2.5 and 3.5 for recurrent cases. Patients taking warfarin are monitored using the INR, which may take several days to achieve a stable level. Loading regimes and computer software are often used to adjust the dose.

      Factors that may potentiate warfarin include liver disease, P450 enzyme inhibitors, cranberry juice, drugs that displace warfarin from plasma albumin, and NSAIDs that inhibit platelet function. Warfarin may cause side-effects such as haemorrhage, teratogenic effects, skin necrosis, temporary procoagulant state, thrombosis, and purple toes.

      In summary, understanding the mechanism of action, indications, monitoring, factors, and side-effects of warfarin is crucial for its safe and effective use in patients. While it has been largely replaced by DOACs, warfarin remains an important treatment option for certain patients.

    • This question is part of the following fields:

      • Cardiovascular System
      148
      Seconds
  • Question 3 - A 58-year-old woman, previously healthy, visited her doctor complaining of a growing rubbery...

    Incorrect

    • A 58-year-old woman, previously healthy, visited her doctor complaining of a growing rubbery lump in her neck and night sweats. She was quickly referred to a haematologist who diagnosed her with lymphoma. The patient is currently undergoing chemotherapy for the lymphoma and has come to your clinic with glove-and-stocking distribution paraesthesia.

      What medication is the most probable cause of this symptom in this patient?

      Your Answer: Ondansetron

      Correct Answer: Vincristine

      Explanation:

      Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and potential adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.

    • This question is part of the following fields:

      • Haematology And Oncology
      136.4
      Seconds
  • Question 4 - A 39-year-old woman presents to the endocrine clinic after being referred by her...

    Incorrect

    • A 39-year-old woman presents to the endocrine clinic after being referred by her GP due to a blood pressure reading of 178/101 mm Hg. Upon blood tests, it is discovered that she has hypernatremia and hypokalaemia, along with an elevated aldosterone level. An inconclusive CT scan of the abdomen has been performed to determine if there is an adenoma present.

      What is the most suitable investigation to identify if one of the adrenal glands is producing an excess of hormones?

      Your Answer: Abdominal X-ray with contrast

      Correct Answer: Adrenal venous sampling (AVS)

      Explanation:

      Adrenal venous sampling (AVS) is the most appropriate investigation to differentiate between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism. This method involves catheterizing the adrenal veins and collecting blood samples from each, which can be tested for hormone levels. The affected side can then be surgically removed if necessary. Other options such as surgical removal of adrenals and immunohistochemistry, adrenal biopsy, or repeat CT scan are not as suitable or effective in this scenario.

      Primary hyperaldosteronism is a condition characterized by hypertension, hypokalaemia, and alkalosis. It was previously believed that adrenal adenoma, also known as Conn’s syndrome, was the most common cause of this condition. However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is responsible for up to 70% of cases. It is important to differentiate between the two causes as it determines the appropriate treatment. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism.

      To diagnose primary hyperaldosteronism, the 2016 Endocrine Society recommends a plasma aldosterone/renin ratio as the first-line investigation. This test should show high aldosterone levels alongside low renin levels due to negative feedback from sodium retention caused by aldosterone. If the results are positive, a high-resolution CT abdomen and adrenal vein sampling are used to differentiate between unilateral and bilateral sources of aldosterone excess. If the CT is normal, adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia.

      The management of primary hyperaldosteronism depends on the underlying cause. Adrenal adenoma is treated with surgery, while bilateral adrenocortical hyperplasia is managed with an aldosterone antagonist such as spironolactone. It is important to accurately diagnose and manage primary hyperaldosteronism to prevent complications such as cardiovascular disease and stroke.

    • This question is part of the following fields:

      • Endocrine System
      34.7
      Seconds
  • Question 5 - What is the more commonly recognized name for the compound referred to as...

    Incorrect

    • What is the more commonly recognized name for the compound referred to as vitamin E?

      Your Answer: Thiamine

      Correct Answer: Alpha tocopherol

      Explanation:

      Vitamin E and Other Essential Nutrients

      Vitamin E is a group of compounds that includes alpha tocopherol, beta tocopherol, gamma tocopherol, and delta tocopherol. While each of these compounds contains vitamin E activity, alpha tocopherol is the most biologically active and abundant form of vitamin E in the diet. Vitamin E plays a crucial role in protecting cells and proteins from oxidative damage by removing free radicals. It also has antithrombotic effects, which means it impairs the action of thromboxane and thrombin, reducing blood clotting and platelet aggregation.

      Adults are recommended to consume at least 15 mg of vitamin E daily, but larger quantities may also be beneficial. Good sources of vitamin E in the diet include sunflower oil, wheatgerm, and unprocessed cereals. In addition to vitamin E, other essential nutrients include alpha 1 antitrypsin, which prevents alveolar damage and lung dysfunction, beta carotene, which is responsible for vision development, boron, which is important for bone health, and thiamine, which can lead to polyneuropathy and heart failure if deficient. these essential nutrients and their roles in the body can help individuals make informed decisions about their diet and overall health.

    • This question is part of the following fields:

      • Clinical Sciences
      14
      Seconds
  • Question 6 - At their yearly diabetic check-up, a 65-year-old individual is discovered to have insufficient...

    Incorrect

    • At their yearly diabetic check-up, a 65-year-old individual is discovered to have insufficient glycaemic management despite being treated with metformin and pioglitazone. As a result, it is determined to initiate an SGLT-2 inhibitor alongside their current medication.

      What is the site of action for this newly prescribed drug?

      Your Answer: Pancreatic β cells

      Correct Answer: Renal proximal convoluted tubules

      Explanation:

      SGLT-2 inhibitors work by reversibly blocking the activity of sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule. This is the correct answer.

      Understanding SGLT-2 Inhibitors

      SGLT-2 inhibitors are medications that work by blocking the reabsorption of glucose in the kidneys, leading to increased excretion of glucose in the urine. This mechanism of action helps to lower blood sugar levels in patients with type 2 diabetes mellitus. Examples of SGLT-2 inhibitors include canagliflozin, dapagliflozin, and empagliflozin.

      However, it is important to note that SGLT-2 inhibitors can also have adverse effects. Patients taking these medications may be at increased risk for urinary and genital infections due to the increased glucose in the urine. Fournier’s gangrene, a rare but serious bacterial infection of the genital area, has also been reported. Additionally, there is a risk of normoglycemic ketoacidosis, a condition where the body produces high levels of ketones even when blood sugar levels are normal. Finally, patients taking SGLT-2 inhibitors may be at increased risk for lower-limb amputations, so it is important to closely monitor the feet.

      Despite these potential risks, SGLT-2 inhibitors can also have benefits. Patients taking these medications often experience weight loss, which can be beneficial for those with type 2 diabetes mellitus. Overall, it is important for patients to discuss the potential risks and benefits of SGLT-2 inhibitors with their healthcare provider before starting treatment.

    • This question is part of the following fields:

      • Endocrine System
      25.7
      Seconds
  • Question 7 - A 25-year-old athlete is collaborating with the cardiovascular physiology department to enhance their...

    Correct

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

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

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

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Cardiovascular System
      117.2
      Seconds
  • Question 8 - A woman in her 30s has suffered a stab wound to her back,...

    Incorrect

    • A woman in her 30s has suffered a stab wound to her back, resulting in a complete severance of the right side of her spinal cord at the T12 vertebrae. What are the expected symptoms of a hemisection of the spinal cord in this case?

      Your Answer: Ipsilaterally - weakness, loss of touch and proprioception

      Contralaterally - loss of pain and temperature sensation

      Correct Answer:

      Explanation:

      The symptoms mentioned are indicative of Brown-Sequard syndrome. This condition would lead to a loss of pain and temperature sensation on the opposite side of the lesion, along with weakness, loss of touch, and proprioception on the same side of the lesion. This occurs because the fibers supplying the latter three functions have not yet crossed over.

      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
      45.5
      Seconds
  • Question 9 - Which of the following is accountable for the swift depolarization phase of the...

    Correct

    • Which of the following is accountable for the swift depolarization phase of the cardiac action potential?

      Your Answer: Rapid sodium influx

      Explanation:

      Understanding the Cardiac Action Potential and Conduction Velocity

      The cardiac action potential is a series of electrical events that occur in the heart during each heartbeat. It is responsible for the contraction of the heart muscle and the pumping of blood throughout the body. The action potential is divided into five phases, each with a specific mechanism. The first phase is rapid depolarization, which is caused by the influx of sodium ions. The second phase is early repolarization, which is caused by the efflux of potassium ions. The third phase is the plateau phase, which is caused by the slow influx of calcium ions. The fourth phase is final repolarization, which is caused by the efflux of potassium ions. The final phase is the restoration of ionic concentrations, which is achieved by the Na+/K+ ATPase pump.

      Conduction velocity is the speed at which the electrical signal travels through the heart. The speed varies depending on the location of the signal. Atrial conduction spreads along ordinary atrial myocardial fibers at a speed of 1 m/sec. AV node conduction is much slower, at 0.05 m/sec. Ventricular conduction is the fastest in the heart, achieved by the large diameter of the Purkinje fibers, which can achieve velocities of 2-4 m/sec. This allows for a rapid and coordinated contraction of the ventricles, which is essential for the proper functioning of the heart. Understanding the cardiac action potential and conduction velocity is crucial for diagnosing and treating heart conditions.

    • This question is part of the following fields:

      • Cardiovascular System
      14.6
      Seconds
  • Question 10 - A 40-year-old male presents with mild intermittent diarrhoea over the last 3 months....

    Incorrect

    • A 40-year-old male presents with mild intermittent diarrhoea over the last 3 months. He has also noticed 4kg of unintentional weight loss over this time. On further review, he has not noticed any night sweats or fever, and he has not changed his diet recently. There is no blood in his stools, and he is otherwise well, with no past medical conditions.

      On examination he has;
      Normal vital signs
      Ulcerations in his mouth
      Pain on rectal examination

      What is the most likely finding on endoscopy?

      Your Answer: Mucosal friability

      Correct Answer: cobblestone appearance

      Explanation:

      The patient is likely suffering from Crohn’s disease as indicated by the presence of skip lesions/mouth ulcerations, weight loss, and non-bloody diarrhea. The cobblestone appearance observed on endoscopy is a typical feature of Crohn’s disease. Pseudopolyps, on the other hand, are commonly seen in patients with ulcerative colitis. Additionally, pANCA is more frequently found in ulcerative colitis, while ASCA is present in Crohn’s disease. Ulcerative colitis is characterized by continuous inflammation of the mucosa.

      Inflammatory bowel disease (IBD) is a condition that includes two main types: Crohn’s disease and ulcerative colitis. Although they share many similarities in terms of symptoms, diagnosis, and treatment, there are some key differences between the two. Crohn’s disease is characterized by non-bloody diarrhea, weight loss, upper gastrointestinal symptoms, mouth ulcers, perianal disease, and a palpable abdominal mass in the right iliac fossa. On the other hand, ulcerative colitis is characterized by bloody diarrhea, abdominal pain in the left lower quadrant, tenesmus, gallstones, and primary sclerosing cholangitis. Complications of Crohn’s disease include obstruction, fistula, and colorectal cancer, while ulcerative colitis has a higher risk of colorectal cancer than Crohn’s disease. Pathologically, Crohn’s disease lesions can be seen anywhere from the mouth to anus, while ulcerative colitis inflammation always starts at the rectum and never spreads beyond the ileocaecal valve. Endoscopy and radiology can help diagnose and differentiate between the two types of IBD.

    • This question is part of the following fields:

      • Gastrointestinal System
      41.4
      Seconds
  • Question 11 - A 23-year-old man gets into a brawl and is stabbed in the back...

    Incorrect

    • A 23-year-old man gets into a brawl and is stabbed in the back of his right leg, with the knife piercing through the popliteal fossa. As a result, he suffers damage to his tibial nerve. Which muscle is the least likely to be affected by this injury?

      Your Answer: Soleus

      Correct Answer: Peroneus tertius

      Explanation:

      The Tibial Nerve: Muscles Innervated and Termination

      The tibial nerve is a branch of the sciatic nerve that begins at the upper border of the popliteal fossa. It has root values of L4, L5, S1, S2, and S3. This nerve innervates several muscles, including the popliteus, gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, and flexor digitorum brevis. These muscles are responsible for various movements in the lower leg and foot, such as plantar flexion, inversion, and flexion of the toes.

      The tibial nerve terminates by dividing into the medial and lateral plantar nerves. These nerves continue to innervate muscles in the foot, such as the abductor hallucis, flexor digitorum brevis, and quadratus plantae. The tibial nerve plays a crucial role in the movement and function of the lower leg and foot, and any damage or injury to this nerve can result in significant impairments in mobility and sensation.

    • This question is part of the following fields:

      • Neurological System
      117.7
      Seconds
  • Question 12 - A researcher is investigating the function of regulatory proteins in intracellular trafficking. He...

    Incorrect

    • A researcher is investigating the function of regulatory proteins in intracellular trafficking. He has discovered several intracellular proteins marked with significant ubiquitination.

      To which organelles are these proteins targeted?

      Your Answer: Rough endoplasmic reticulum

      Correct Answer: Proteasome

      Explanation:

      Proteins are marked with ubiquitin for degradation in both proteasomes and lysosomes.

      Functions of Cell Organelles

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

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

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

    • This question is part of the following fields:

      • General Principles
      35.3
      Seconds
  • Question 13 - A 10-year-old boy comes to the clinic complaining of an itchy right ear...

    Incorrect

    • A 10-year-old boy comes to the clinic complaining of an itchy right ear that has been bothering him for the past five days. During the examination, he winces in pain when the outer ear is touched. Can you identify which part of the ear is considered the outer ear?

      Your Answer:

      Correct Answer: Pinna

      Explanation:

      Earache: Types and Anatomy of the Ear

      Earache can be categorized into two types: otitis media and otitis externa. Otitis media refers to the inflammation of the middle ear, while otitis externa is the inflammation of the outer ear and/or canal. Pain on touch or gentle pulling of the outer ear is commonly associated with otitis externa.

      The outer ear is composed of the visible part of the ear, called the pinna, and the external auditory meatus near the tragus. The external auditory meatus extends from the pinna around 26 mm to the tympanic membrane. On the other hand, the middle ear reaches from the tympanic membrane to the oval window of the cochlea. This space contains three ossicles, namely the malleus, incus, and stapes, which transmit sound waves to the inner ear.

      The inner ear is made up of the cochlea, which is responsible for hearing, and the vestibular apparatus, which helps maintain balance. The vestibular apparatus consists of three semicircular canals and the vestibule.

      the anatomy of the ear and the different types of earache can help in identifying and treating ear problems. It is important to seek medical attention if experiencing ear pain or discomfort.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 14 - A 45-year-old pig farmer presents to the GP with complaints of abdominal discomfort...

    Incorrect

    • A 45-year-old pig farmer presents to the GP with complaints of abdominal discomfort and diarrhoea. Upon initial investigations, the patient is diagnosed with a tapeworm infection. Which immunoglobulin plays a primary role in eliminating this organism?

      Your Answer:

      Correct Answer: IgE

      Explanation:

      IgE provides protection against parasitic infections, particularly helminths, by providing immunity. It also triggers the release of histamine. IgA fights off various infections but not primarily parasites, and is found in saliva, tears, and breast milk. IgD plays a role in activating B cells. IgG protects against a range of pathogens and aids in the phagocytosis of viruses and bacteria. It is also involved in rhesus disease as it can cross the placenta.

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Principles
      0
      Seconds
  • Question 15 - A 70-year-old woman is suspected of having a femoral hernia. Where is it...

    Incorrect

    • A 70-year-old woman is suspected of having a femoral hernia. Where is it most likely to be clinically identifiable?

      Your Answer:

      Correct Answer: Below and lateral to the pubic tubercle

      Explanation:

      Femoral hernias emerge from the femoral canal situated below and to the side of the pubic tubercle. These hernias are more common in women due to their unique pelvic anatomy. Repairing femoral hernias is crucial as they pose a significant risk of strangulation.

      Understanding the Femoral Canal

      The femoral canal is a fascial tunnel located at the medial aspect of the femoral sheath. It contains both the femoral artery and femoral vein, with the canal lying medial to the vein. The borders of the femoral canal include the femoral vein laterally, the lacunar ligament medially, the inguinal ligament anteriorly, and the pectineal ligament posteriorly.

      The femoral canal plays a significant role in allowing the femoral vein to expand, which facilitates increased venous return to the lower limbs. However, it can also be a site of femoral hernias, which occur when abdominal contents protrude through the femoral canal. The relatively tight neck of the femoral canal places these hernias at high risk of strangulation, making it important to understand the anatomy and function of this structure. Overall, understanding the femoral canal is crucial for medical professionals in diagnosing and treating potential issues related to this area.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
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  • Question 16 - A 65-year-old woman visits the rheumatology clinic complaining of fatigue that has lasted...

    Incorrect

    • A 65-year-old woman visits the rheumatology clinic complaining of fatigue that has lasted for 6 weeks. She reports sleeping more than usual and feeling easily tired while walking her dog. The patient has a medical history of rheumatoid arthritis and is currently taking methotrexate. She smokes 2-3 cigarettes per day and drinks half a bottle of wine per week.

      The following investigations are ordered:

      - Haemoglobin: 88 g/L (normal range: 115 - 160)
      - Mean cell volume (MCV): 105 fL (normal range: 80 - 100)

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

      Your Answer:

      Correct Answer: Folate deficiency

      Explanation:

      Methotrexate treatment can lead to megaloblastic macrocytic anemia due to a deficiency of folate.

      The patient’s low hemoglobin and high MCV indicate macrocytic anemia, which can be caused by various factors such as alcohol abuse, hypothyroidism, aplastic anemia, and megaloblastic anemia due to a deficiency of vitamin B12 and/or folate. In this case, the patient has a history of rheumatoid arthritis and takes methotrexate weekly, which inhibits dihydrofolate reductase and causes a deficiency of folate. Therefore, folate deficiency is the most probable cause of the patient’s anemia.

      Alcohol excess is an incorrect option as it usually requires larger quantities of alcohol to cause macrocytic anemia.

      Anaemia of chronic disease is an incorrect option as it typically results in normocytic or microcytic anemia, not macrocytic anemia.

      Iron deficiency anemia is an incorrect option as it causes microcytic anemia, and the MCV value would be lower than expected.

      Understanding Macrocytic Anaemia

      Macrocytic anaemia is a type of anaemia that can be classified into two categories: megaloblastic and normoblastic. Megaloblastic anaemia is caused by a deficiency in vitamin B12 or folate, which leads to the production of abnormally large red blood cells in the bone marrow. This type of anaemia can also be caused by certain medications, alcohol, liver disease, hypothyroidism, pregnancy, and myelodysplasia.

      On the other hand, normoblastic anaemia is caused by an increase in the number of immature red blood cells, known as reticulocytes, in the bone marrow. This can occur as a result of certain medications, such as methotrexate, or in response to other underlying medical conditions.

      It is important to identify the underlying cause of macrocytic anaemia in order to provide appropriate treatment. This may involve addressing any nutritional deficiencies, managing underlying medical conditions, or adjusting medications. With proper management, most cases of macrocytic anaemia can be successfully treated.

    • This question is part of the following fields:

      • Haematology And Oncology
      0
      Seconds
  • Question 17 - Which of the structures listed below are not located within the mediastinum? ...

    Incorrect

    • Which of the structures listed below are not located within the mediastinum?

      Your Answer:

      Correct Answer: Vertebral bodies

      Explanation:

      Both the lungs and vertebral bodies are located outside of the mediastinum.

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

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

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

    • This question is part of the following fields:

      • Respiratory System
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  • Question 18 - A 69-year-old man is admitted to the medical assessment unit with reduced urine...

    Incorrect

    • A 69-year-old man is admitted to the medical assessment unit with reduced urine output and nausea. He has a complex medical history, including heart failure, hypercholesterolemia, hypertension, type 1 diabetes mellitus, and hypothyroidism. Among his regular medications are bisoprolol, furosemide, simvastatin, insulin, and levothyroxine. The medical team suspects that he is currently experiencing an acute kidney injury.

      Which of his usual medications should be discontinued?

      Your Answer:

      Correct Answer: Furosemide

      Explanation:

      In cases of AKI, it is advisable to discontinue the use of diuretics as they may aggravate renal function. Loop diuretics like Furosemide should be stopped. Additionally, drugs that have the potential to harm the kidneys, such as aminoglycoside antibiotics (e.g. gentamicin), non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors (e.g. ramipril), angiotensin II receptor antagonists (e.g. losartan), and diuretics, should also be discontinued.

      Fortunately, the remaining drugs are generally safe to continue as they are not typically considered nephrotoxic. Insulin, a peptide hormone drug used in treating type 1 and type 2 diabetes mellitus, is cleared from the body through enzymatic breakdown in the liver and kidneys and is not usually harmful to the kidneys.

      Acute kidney injury (AKI) is a condition where there is a reduction in renal function following an insult to the kidneys. It was previously known as acute renal failure and can result in long-term impaired kidney function or even death. AKI can be caused by prerenal, intrinsic, or postrenal factors. Patients with chronic kidney disease, other organ failure/chronic disease, a history of AKI, or who have used drugs with nephrotoxic potential are at an increased risk of developing AKI. To prevent AKI, patients at risk may be given IV fluids or have certain medications temporarily stopped.

      The kidneys are responsible for maintaining fluid balance and homeostasis, so a reduced urine output or fluid overload may indicate AKI. Symptoms may not be present in early stages, but as renal failure progresses, patients may experience arrhythmias, pulmonary and peripheral edema, or features of uraemia. Blood tests such as urea and electrolytes can be used to detect AKI, and urinalysis and imaging may also be necessary.

      Management of AKI is largely supportive, with careful fluid balance and medication review. Loop diuretics and low-dose dopamine are not recommended, but hyperkalaemia needs prompt treatment to avoid life-threatening arrhythmias. Renal replacement therapy may be necessary in severe cases. Patients with suspected AKI secondary to urinary obstruction require prompt review by a urologist, and specialist input from a nephrologist is required for cases where the cause is unknown or the AKI is severe.

    • This question is part of the following fields:

      • Renal System
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  • Question 19 - A 54-year-old man presents to the emergency department with pleuritic chest pain and...

    Incorrect

    • A 54-year-old man presents to the emergency department with pleuritic chest pain and shortness of breath. He is a construction worker who has a history of smoking. After diagnosis and treatment, the consultant recommends placement of a filter to reduce the risk of future incidents. A needle is inserted into the femoral vein and advanced up into the abdomen, where a filter is placed.

      Based on the likely location of the filter, which of the following statements is true regarding the organ?

      - It is attached to the posterior wall via a mesentery
      - It is located posteriorly to the peritoneum
      - It is attached to the liver via multiple ligaments
      - It is wrapped in a double fold of peritoneal fat
      - It is attached to the liver via an omentum

      Additionally, it is important to note that the inferior vena cava is a retroperitoneal organ, and damage to it can result in a collection of blood in the retroperitoneal space.

      Your Answer:

      Correct Answer: It is located posteriorly to the peritoneum

      Explanation:

      The IVC is situated in the retroperitoneal space and any damage to it can result in the accumulation of blood in this area. The woman’s symptoms suggest that she may have a pulmonary embolism, which is a common complication of frequent travel. To prevent future occurrences, a filter can be inserted into the IVC. This is done by inserting a needle into the femoral vein and advancing the filter up to the level of the retroperitoneal IVC.

      In contrast, intraperitoneal organs such as the small bowel are connected to the posterior wall through a mesentery. The liver is attached to both the diaphragm and the posterior abdominal wall by ligaments. The term double fold of peritoneal fat pertains to intraperitoneal organs. Finally, the lesser omentum serves as the attachment between the stomach and the liver.

      The retroperitoneal structures are those that are located behind the peritoneum, which is the membrane that lines the abdominal cavity. These structures include the duodenum (2nd, 3rd, and 4th parts), ascending and descending colon, kidneys, ureters, aorta, and inferior vena cava. They are situated in the back of the abdominal cavity, close to the spine. In contrast, intraperitoneal structures are those that are located within the peritoneal cavity, such as the stomach, duodenum (1st part), jejunum, ileum, transverse colon, and sigmoid colon. It is important to note that the retroperitoneal structures are not well demonstrated in the diagram as the posterior aspect has been removed, but they are still significant in terms of their location and function.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 20 - Which organ is the least probable to exhibit cells or glands that secrete...

    Incorrect

    • Which organ is the least probable to exhibit cells or glands that secrete mucus?

      Your Answer:

      Correct Answer: Vagina

      Explanation:

      Epithelial Tissue in Different Parts of the Body

      The lining of the vagina and oesophagus is made up of stratified squamous non-keratinising epithelium. However, mucus glands are present at the lower end of the oesophagus. The intestines, on the other hand, are lined by a simple columnar epithelium throughout the small and large intestine. Lastly, the cervix is lined by simple columnar epithelium.

      In summary, the type of epithelial tissue that lines different parts of the body varies. The vagina and oesophagus have a stratified squamous non-keratinising epithelium, while the intestines have a simple columnar epithelium. The cervix is also lined by simple columnar epithelium. It is important to note that mucus glands are present at the lower end of the oesophagus. the different types of epithelial tissue in the body is crucial in identifying and treating various medical conditions.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 21 - A 25-year-old female has received a pan proctocolectomy and ileoanal pouch due to...

    Incorrect

    • A 25-year-old female has received a pan proctocolectomy and ileoanal pouch due to familial adenomatous polyposis coli. What is the most frequent non-colonic manifestation of this condition?

      Your Answer:

      Correct Answer: Duodenal polyps

      Explanation:

      Polyposis syndromes are a group of genetic disorders that cause the development of multiple polyps in the colon and other parts of the gastrointestinal tract. These polyps can increase the risk of developing cancer, and therefore, early detection and management are crucial. There are several types of polyposis syndromes, each with its own genetic defect, features, and associated disorders.

      Familial adenomatous polyposis (FAP) is caused by a mutation in the APC gene and is characterized by the development of over 100 colonic adenomas, with a 100% risk of cancer. Screening and management involve regular colonoscopies and resectional surgery if polyps are found. FAP is also associated with gastric and duodenal polyps and abdominal desmoid tumors.

      MYH-associated polyposis is caused by a biallelic mutation of the MYH gene and is associated with multiple colonic polyps and an increased risk of right-sided cancers. Attenuated phenotype can be managed with regular colonoscopies, while resection and ileoanal pouch reconstruction are recommended for those with multiple polyps.

      Peutz-Jeghers syndrome is caused by a mutation in the STK11 gene and is characterized by multiple benign intestinal hamartomas, episodic obstruction, and an increased risk of GI cancers. Screening involves annual examinations and pan-intestinal endoscopy every 2-3 years.

      Cowden disease is caused by a mutation in the PTEN gene and is characterized by macrocephaly, multiple intestinal hamartomas, and an increased risk of cancer at any site. Targeted individualized screening is recommended, with extra surveillance for breast, thyroid, and uterine cancers.

      HNPCC (Lynch syndrome) is caused by germline mutations of DNA mismatch repair genes and is associated with an increased risk of colorectal, endometrial, and gastric cancers. Colonoscopies every 1-2 years from age 25 and consideration of prophylactic surgery are recommended, along with extra colonic surveillance.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 22 - A 65-year-old male with a history of prostate cancer visits the neurology clinic...

    Incorrect

    • A 65-year-old male with a history of prostate cancer visits the neurology clinic to receive the results of his recent brain MRI. He had been experiencing severe headaches for the past four months, which is unusual for him, and has had five episodes of vomiting in the past month. The MRI scan reveals a lesion in the lateral nucleus of the hypothalamus.

      What other symptom is he likely to exhibit?

      Your Answer:

      Correct Answer: Anorexia

      Explanation:

      Anorexia can result from lesions in the lateral nucleus of the hypothalamus.

      It is likely that the patient in question has a metastatic lesion from her breast in the lateral nucleus of the hypothalamus. Stimulation of this area of the thalamus increases appetite, while a lesion can lead to anorexia.

      Lesions in the posterior nucleus of the hypothalamus can cause poikilothermia. This region is responsible for regulating body temperature.

      The paraventricular nucleus of the hypothalamus produces oxytocin and antidiuretic hormone. Lesions in this area can result in diabetes insipidus.

      Hyperphagia can be caused by lesions in the ventromedial nucleus of the thalamus. This region of the hypothalamus functions as the satiety center.

      The hypothalamus is a part of the brain that plays a crucial role in maintaining the body’s internal balance, or homeostasis. It is located in the diencephalon and is responsible for regulating various bodily functions. The hypothalamus is composed of several nuclei, each with its own specific function. The anterior nucleus, for example, is involved in cooling the body by stimulating the parasympathetic nervous system. The lateral nucleus, on the other hand, is responsible for stimulating appetite, while lesions in this area can lead to anorexia. The posterior nucleus is involved in heating the body and stimulating the sympathetic nervous system, and damage to this area can result in poikilothermia. Other nuclei include the septal nucleus, which regulates sexual desire, the suprachiasmatic nucleus, which regulates circadian rhythm, and the ventromedial nucleus, which is responsible for satiety. Lesions in the paraventricular nucleus can lead to diabetes insipidus, while lesions in the dorsomedial nucleus can result in savage behavior.

    • This question is part of the following fields:

      • Neurological System
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  • Question 23 - A 16-year-old male patient is experiencing an acute asthma attack and is struggling...

    Incorrect

    • A 16-year-old male patient is experiencing an acute asthma attack and is struggling to breathe. Which of the following options is not a correct description of anatomical dead space?

      Your Answer:

      Correct Answer: Poorly perfused alveoli

      Explanation:

      Anatomical and Physiological Dead Space

      Anatomical dead space refers to the parts of the respiratory system that do not participate in gaseous exchange. These include the pharynx, larynx, trachea, bronchi, and bronchioles. Although these structures fill with air during inhalation, the air is exhaled without ever being available for circulation. On the other hand, physiological dead space includes not only the anatomical dead space but also regions of alveoli that do not participate in gaseous exchange due to a ventilation/perfusion mismatch.

      In simpler terms, anatomical dead space is the portion of the respiratory system that does not contribute to gas exchange, while physiological dead space includes both the anatomical dead space and areas of the lungs that are not functioning properly. these concepts is important in diagnosing and treating respiratory disorders, as well as in monitoring the effectiveness of respiratory therapies. By identifying and addressing dead space, healthcare professionals can help improve a patient’s breathing and overall respiratory function.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 24 - As an investigator, you will be participating in a clinical trial of a...

    Incorrect

    • As an investigator, you will be participating in a clinical trial of a new antihypertensive agent. The drug has already been tested on healthy volunteers, but this trial will be the first to involve patients. The aim of the trial is to determine the optimal dosage for therapy, which will be used in future studies. Are you ready to take part in this clinical trial?

      Your Answer:

      Correct Answer: Phase 2 study

      Explanation:

      Phases of Clinical Trials

      Clinical trials are conducted in several phases to determine the safety and efficacy of a new drug. The first phase, known as phase 1, involves testing the drug on healthy volunteers to determine its safety. In phase 2, the drug is tested on patients across a range of doses to establish the most effective dose with respect to clinical efficacy and adverse events. The third phase, known as phase 3, involves expanding the number of patients to confirm the drug’s efficacy and adverse event profile. This phase is conducted prior to registration. Finally, in phase 4, the drug is tested post-marketing to support clinical endpoints for reimbursement or to support marketing messages. These phases are crucial in determining the safety and efficacy of a new drug before it is made available to the public.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 25 - A 25-year-old man is scheduled for a mitral valve repair to address mitral...

    Incorrect

    • A 25-year-old man is scheduled for a mitral valve repair to address mitral regurgitation. What characteristic is associated with the mitral valve?

      Your Answer:

      Correct Answer: Its closure is marked by the first heart sound

      Explanation:

      To hear the mitral valve clearly, it is recommended to listen over the cardiac apex, as its closure produces the initial heart sound. The valve comprises two cusps that are connected to the ventricle wall by papillary muscles through chordae tendinae.

      The walls of each cardiac chamber are made up of the epicardium, myocardium, and endocardium. The heart and roots of the great vessels are related anteriorly to the sternum and the left ribs. The coronary sinus receives blood from the cardiac veins, and the aortic sinus gives rise to the right and left coronary arteries. The left ventricle has a thicker wall and more numerous trabeculae carnae than the right ventricle. The heart is innervated by autonomic nerve fibers from the cardiac plexus, and the parasympathetic supply comes from the vagus nerves. The heart has four valves: the mitral, aortic, pulmonary, and tricuspid valves.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 26 - A 50-year-old male presents to the emergency department after sustaining a high-impact golf...

    Incorrect

    • A 50-year-old male presents to the emergency department after sustaining a high-impact golf ball injury to his foot while playing golf. Upon examination, there is bruising around the lateral malleolus and loss of sensation to the lateral foot. Palpation reveals tenderness in the lateral malleolus. An X-ray confirms a posteriorly displaced fracture of the lateral malleolus. What structure is likely to have been affected by this displacement?

      Your Answer:

      Correct Answer: Sural nerve

      Explanation:

      The sural nerve is situated behind the lateral malleolus, which is commonly fractured due to direct trauma. In this patient, the lateral malleolus fracture is displaced posteriorly, posing a risk of direct compression and potential injury to the sural nerve. Other structures located behind the lateral malleolus include the short saphenous vein, peroneus longus tendon, and peroneus brevis tendon. The anterior talofibular ligament is a flat band that extends from the front edge of the lateral malleolus to the neck of the talus, just ahead of the fibular facet. The remaining options are incorrect.

      Anatomy of the Lateral Malleolus

      The lateral malleolus is a bony prominence on the outer side of the ankle joint. Posterior to the lateral malleolus and superficial to the superior peroneal retinaculum are the sural nerve and short saphenous vein. These structures are important for sensation and blood flow to the lower leg and foot.

      On the other hand, posterior to the lateral malleolus and deep to the superior peroneal retinaculum are the peroneus longus and peroneus brevis tendons. These tendons are responsible for ankle stability and movement.

      Additionally, the calcaneofibular ligament is attached at the lateral malleolus. This ligament is important for maintaining the stability of the ankle joint and preventing excessive lateral movement.

      Understanding the anatomy of the lateral malleolus is crucial for diagnosing and treating ankle injuries and conditions. Proper care and management of these structures can help prevent long-term complications and improve overall ankle function.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 27 - Linda is a 54-year-old woman who was admitted with a 3-day history of...

    Incorrect

    • Linda is a 54-year-old woman who was admitted with a 3-day history of worsening shortness of breath. On her last admission 6 months ago, she was treated for a ST-elevation myocardial infarction (STEMI).

      She does not experience any significant chest pain. A chest X-ray shows minor bibasal consolidation suggestive of mild pulmonary oedema. Her blood tests are as follow:

      Na+ 138 mmol/L (135 - 145)
      K+ 4.0 mmol/L (3.5 - 5.0)
      Urea 5.8 mmol/L (2.0 - 7.0)
      Creatinine 100 µmol/L (55 - 120)

      A 12-lead electrocardiogram shows sinus rhythm. An echocardiogram shows reduced left ventricular (LV) contraction with an LV ejection fraction of 40%.

      Which of the following treatments should be prescribed to reduce mortality?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      For patients diagnosed with heart failure with reduced LVEF, the initial treatment should involve administering a beta blocker and an ACE inhibitor. In the case of the patient in question, the symptoms and echocardiogram results indicate the onset of LV failure, which is likely due to their previous STEMI. Therefore, the recommended course of action is to prescribe an ACE inhibitor and beta-blocker as the primary therapy. This will help alleviate the symptoms of heart failure by reducing the after-load on the heart.

      Chronic heart failure can be managed through drug treatment, according to updated guidelines issued by NICE in 2018. While loop diuretics are useful in managing fluid overload, they do not reduce mortality in the long term. The first-line treatment for all patients is a combination of an ACE-inhibitor and a beta-blocker, with clinical judgement used to determine which one to start first. Aldosterone antagonists are recommended as second-line treatment, but potassium levels should be monitored as both ACE inhibitors and aldosterone antagonists can cause hyperkalaemia. Third-line treatment should be initiated by a specialist and may include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin, and cardiac resynchronisation therapy. Other treatments include annual influenzae and one-off pneumococcal vaccines. Those with asplenia, splenic dysfunction, or chronic kidney disease may require a booster every 5 years.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 28 - A 70-year-old man comes to the Parkinson clinic for a levodopa review. In...

    Incorrect

    • A 70-year-old man comes to the Parkinson clinic for a levodopa review. In Parkinson's disease, which region of the basal ganglia is most affected?

      Your Answer:

      Correct Answer: Substantia nigra pars compacta

      Explanation:

      Parkinson’s disease primarily affects the basal ganglia, which is responsible for movement. Within the basal ganglia, the substantia nigra is a crucial component that plays a significant role in movement and reward. The dopaminergic neurons in the substantia nigra, which contain high levels of neuromelanin, function through the indirect pathway to facilitate movement. However, these neurons are the ones most impacted by Parkinson’s disease. The substantia nigra gets its name from its dark appearance, which is due to the abundance of neuromelanin in its neurons.

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

    • This question is part of the following fields:

      • Neurological System
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  • Question 29 - A 65-year-old man with amyotrophic lateral sclerosis visits his primary care physician complaining...

    Incorrect

    • A 65-year-old man with amyotrophic lateral sclerosis visits his primary care physician complaining of difficulty swallowing and regurgitation. During the examination, the patient's uvula is observed to deviate to the left side of the mouth. The tongue remains unaffected, and taste perception is normal. No other abnormalities are detected upon examination of the oral cavity. Based on these findings, where is the lesion most likely located?

      Your Answer:

      Correct Answer: Left vagus nerve

      Explanation:

      The uvula deviating away from the side of the lesion indicates a problem with the left vagus nerve, as this nerve controls the muscles of the soft palate and can cause uvula deviation when damaged. In cases of vagus nerve lesions, the uvula deviates in the opposite direction of the lesion. As the patient’s uvula deviates towards the right, the underlying issue must be with the left vagus nerve.

      The left hypoglossal nerve cannot be the cause of the uvula deviation, as this nerve only provides motor innervation to the tongue muscles and cannot affect the uvula.

      Similarly, the right hypoglossal nerve and right trigeminal nerve cannot cause uvula deviation, as they do not have any control over the uvula. Trigeminal nerve lesions may cause different clinical signs depending on the location of the lesion, such as masseteric wasting in the case of mandibular nerve damage.

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

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

    • This question is part of the following fields:

      • Neurological System
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  • Question 30 - A 35-year-old man arrives at the emergency department following an assault with a...

    Incorrect

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

      Your Answer:

      Correct Answer: Maxillary sinus

      Explanation:

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

      Paranasal Air Sinuses and Carotid Sinus

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

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

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

    • This question is part of the following fields:

      • Respiratory System
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General Principles (0/1) 0%
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