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Question 1
Correct
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Which of the following fields is primarily focused on regulating body temperature?
Your Answer: Hypothalamus
Explanation:The main function of the hypothalamus is to regulate body temperature. It can communicate with the cerebral cortex to prompt changes in behavior that aid in the regulation of body temperature.
Thermoregulation and the Role of the Hypothalamus
Thermoregulation is the process by which the body maintains its core temperature within a narrow range. The hypothalamus is the primary center for thermoregulation, receiving input from both peripheral and central thermoreceptors. Central thermoreceptors play a crucial role in maintaining core temperature, while peripheral vasodilation and vasoconstriction are autonomic responses that regulate heat loss.
The hypothalamus can initiate involuntary motor responses, such as shivering, to raise body temperature. It can also stimulate the sympathetic nervous system to produce peripheral vasoconstriction and release adrenaline from the adrenal medulla. Behavioral responses also play a role in heat loss regulation. The thermoneutral zone, which is the range of temperatures where heat loss can be maintained, is between 25 to 30 degrees Celsius, but the absolute value depends on atmospheric humidity.
In cases of sepsis, cytokines are released, which can reset the thermoregulatory center, resulting in fever. Understanding the role of the hypothalamus in thermoregulation is essential in maintaining a healthy body temperature and preventing complications associated with temperature dysregulation.
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This question is part of the following fields:
- Neurological System
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Question 2
Incorrect
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A 60-year-old male presents with fatigue, pallor and a tingling sensation in both hands. Screening blood tests reveal:
Hb 110 g/l (115-160 g/l)
MCV 112 fl (82-100 fl)
B12 140 ng/l (200-900 ng/l)
What is the most frequent reason for this patient's macrocytic anaemia?Your Answer: Vegan diet
Correct Answer: Pernicious anaemia
Explanation:The primary cause of vitamin B12 deficiency is pernicious anaemia. This condition occurs when the stomach lining is destroyed by autoimmune factors, leading to reduced production of intrinsic factor. Intrinsic factor is responsible for binding B12 in the gut, and without it, B12 absorption is impaired. This can result in a deficiency of vitamin B12 and macrocytic anaemia, as well as neurological symptoms due to damage to spinal cord myelination.
While a strict vegan diet and alcoholism can also lead to B12 deficiency, they are not the most common causes.
Microcytic sideroblastic anaemia, on the other hand, is caused by lead poisoning, which impairs haem production.
Vitamin B12 is essential for the development of red blood cells and the maintenance of the nervous system. It is absorbed through the binding of intrinsic factor, which is secreted by parietal cells in the stomach, and actively absorbed in the terminal ileum. A deficiency in vitamin B12 can be caused by pernicious anaemia, post gastrectomy, a vegan or poor diet, disorders or surgery of the terminal ileum, Crohn’s disease, or metformin use.
Symptoms of vitamin B12 deficiency include macrocytic anaemia, a sore tongue and mouth, neurological symptoms, and neuropsychiatric symptoms such as mood disturbances. The dorsal column is usually affected first, leading to joint position and vibration issues before distal paraesthesia.
Management of vitamin B12 deficiency involves administering 1 mg of IM hydroxocobalamin three times a week for two weeks, followed by once every three months if there is no neurological involvement. If a patient is also deficient in folic acid, it is important to treat the B12 deficiency first to avoid subacute combined degeneration of the cord.
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This question is part of the following fields:
- Haematology And Oncology
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Question 3
Incorrect
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A 10-year-old boy comes to the genetics clinic with a history of poor coordination and speech difficulties that have been getting worse over the past year, indicating a possible inherited ataxia disorder.
Despite testing for known ataxia genes, no mutations are found. As a result, a whole exome sequence is conducted to search for less common mutations, which reveals a silent mutation in a codon on chromosome 11.
How would you best describe this mutation?Your Answer: A single base mutation that does not change the amino acid, but may affect transcription or translation of the gene
Correct Answer: A single base mutation that does not change the amino acid, and does not affect the phenotype or transcription of that gene
Explanation:A silent mutation is a type of mutation where a single base is altered, but the resulting amino acid remains the same. This is often due to the degeneracy of the genetic code, where multiple codons can code for the same amino acid. This type of mutation is considered silent because it does not affect the downstream processing or phenotype of the gene.
On the other hand, a synonymous mutation is also a single base change that does not alter the amino acid, but it can cause changes in downstream processing or phenotype. This type of mutation can lead to conditions such as Phenylketonuria and von Hippel-Lindau disease.
A missense mutation is a single base change that alters the resulting amino acid, leading to changes in protein function and potentially causing disease. Meanwhile, a neutral missense mutation is a single base change that alters the amino acid but does not affect protein function or phenotype.
Types of DNA Mutations
There are different types of DNA mutations that can occur in an organism’s genetic material. One type is called a silent mutation, which does not change the amino acid sequence of a protein. This type of mutation often occurs in the third position of a codon, where the change in the DNA base does not affect the final amino acid produced.
Another type of mutation is called a nonsense mutation, which results in the formation of a stop codon. This means that the protein being produced is truncated and may not function properly.
A missense mutation is a point mutation that changes the amino acid sequence of a protein. This can have significant effects on the protein’s function, as the altered amino acid may not be able to perform its intended role.
Finally, a frameshift mutation occurs when a number of nucleotides are inserted or deleted from the DNA sequence. This can cause a shift in the reading frame of the DNA, resulting in a completely different amino acid sequence downstream. These mutations can have serious consequences for the organism, as the resulting protein may be non-functional or even harmful.
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This question is part of the following fields:
- General Principles
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Question 4
Incorrect
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Which enzyme is likely to be dysfunctional in patients with chronic granulomatous disease, resulting in their inability to efficiently eliminate bacteria after ingestion by macrophages?
Your Answer: Terminal deoxynucleotidyl transferase (TDT)
Correct Answer: NADPH oxidase
Explanation:Granulocyte Bacterial Killing Mechanisms
Granulocytes have a unique way of killing bacteria. Although it is a rare condition, it exemplifies the bacterial killing mechanisms of granulocytes. Once a bacterium is ingested, granulocytes fuse the phagosome with lysosomes that contain proteolytic enzymes. Additionally, they produce oxygen radicals (O2-) that can react with nitric oxide (forming ONOO-), both of which are harmful to bacteria. This process is known as the respiratory burst and utilises the enzyme NADPH oxidase. Patients who have a loss of function of NADPH oxidase are unable to effectively kill bacteria, which leads to the formation of granulomas, sealing off the infection. These patients are immunosuppressed.
In contrast, a C5-convertase is a complex of proteins involved in the complement cascade. Carbonic anhydrase catalyses the formation of carbonic acid from water and CO2. Lactate dehydrogenase converts pyruvate into lactic acid. TDT is an enzyme that is used to insert mutations into somatic DNA during the formation of the B cell and T cell receptor. Each of these processes has a unique function in the body, but the granulocyte bacterial killing mechanism is particularly fascinating due to its ability to effectively combat bacterial infections.
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This question is part of the following fields:
- Clinical Sciences
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Question 5
Incorrect
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A 79-year-old woman with a history of heart failure visits the clinic complaining of swollen ankles and difficulty walking. She has previously experienced fluid retention due to her heart failure. During the examination, soft heart sounds are heard and pitting edema is observed in both lower limbs up to 15 cm above the ankles. The decision is made to increase her daily furosemide dose from 40mg to 80 mg. Which part of the nephron does furosemide target?
Your Answer: Distal convoluted tubule
Correct Answer: Ascending limb of the loop of Henle
Explanation:Furosemide is a loop diuretic that works by inhibiting the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle. It is commonly used to treat fluid retention in patients with heart failure. Other diuretic agents work on different parts of the nephron, such as carbonic anhydrase inhibitors in the proximal and distal tubules, thiazide diuretics in the distal convoluted tubule, and potassium-sparing diuretics like amiloride and spironolactone in the cortical collecting ducts. Understanding the mechanism of action of diuretics can help clinicians choose the most appropriate medication for their patients.
Loop Diuretics: Mechanism of Action and Clinical Applications
Loop diuretics, such as furosemide and bumetanide, are medications that inhibit the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle. By doing so, they reduce the absorption of NaCl, resulting in increased urine output. Loop diuretics act on NKCC2, which is more prevalent in the kidneys. These medications work on the apical membrane and must first be filtered into the tubules by the glomerulus before they can have an effect. Patients with poor renal function may require higher doses to ensure sufficient concentration in the tubules.
Loop diuretics are commonly used in the treatment of heart failure, both acutely (usually intravenously) and chronically (usually orally). They are also indicated for resistant hypertension, particularly in patients with renal impairment. However, loop diuretics can cause adverse effects such as hypotension, hyponatremia, hypokalemia, hypomagnesemia, hypochloremic alkalosis, ototoxicity, hypocalcemia, renal impairment, hyperglycemia (less common than with thiazides), and gout. Therefore, careful monitoring of electrolyte levels and renal function is necessary when using loop diuretics.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Incorrect
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Look at the following DNA sequence and identify the mutation that has occurred:
DNA sequence Amino Acid Sequence
Original AAA GCC AAA lys, ala, lys
Mutation AAA ACC ATT lys, thr, lys,
Has the mutation occurred due to a genetic error?Your Answer: Insertion
Correct Answer: Missense
Explanation:Missense mutations are point mutations that result in a change in the amino acid sequence, potentially rendering the protein non-functional. Deletions involve the loss of at least one base, while insertions involve the addition of at least one base. Inversions reverse a section of the genetic code. Missense mutations occur when a single base is changed, resulting in the production of a different amino acid than in the original sequence. Nonsense mutations code for a stop codon, halting the production of amino acids beyond that point.
Types of DNA Mutations
There are different types of DNA mutations that can occur in an organism’s genetic material. One type is called a silent mutation, which does not change the amino acid sequence of a protein. This type of mutation often occurs in the third position of a codon, where the change in the DNA base does not affect the final amino acid produced.
Another type of mutation is called a nonsense mutation, which results in the formation of a stop codon. This means that the protein being produced is truncated and may not function properly.
A missense mutation is a point mutation that changes the amino acid sequence of a protein. This can have significant effects on the protein’s function, as the altered amino acid may not be able to perform its intended role.
Finally, a frameshift mutation occurs when a number of nucleotides are inserted or deleted from the DNA sequence. This can cause a shift in the reading frame of the DNA, resulting in a completely different amino acid sequence downstream. These mutations can have serious consequences for the organism, as the resulting protein may be non-functional or even harmful.
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This question is part of the following fields:
- General Principles
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Question 7
Incorrect
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A 25-year-old male has come to the clinic complaining of a low-grade fever and a small, painless lesion on his penis that is red and raw. He also has inguinal lymphadenopathy. He admits to having unprotected vaginal sex while on vacation four weeks ago. What is the probable diagnosis?
Your Answer: Herpes simplex virus
Correct Answer: Primary syphilis
Explanation:Syphilis and its Symptoms
Syphilis is a sexually transmitted infection caused by Treponema pallidum. The primary stage of syphilis is characterized by a painless chancre that appears three to six weeks after contact. This ulcer is highly infectious and continuously sheds motile spirochetes. After six weeks, the lesion may resolve, leading the patient to believe they are cured. However, without treatment, the spirochaete remains in the body and can lead to secondary syphilis.
It is important to note that painful genital ulcers are typically caused by herpes simplex virus and H. ducreyi, while painless ulcers are caused by T. pallidum and Chlamydia trachomatis. HPV, on the other hand, typically causes genital warts, with strains six and 11 causing warts and strains 16 and 18 being associated with cervical cancer.
Secondary syphilis is a disseminated disease that can cause a maculopapular rash, which may involve the palms and soles. This rash is known as keratoderma blennorrhagicum (KB) and can sometimes present in patients with reactive arthritis. Additionally, patients with secondary syphilis may present with condylomata lata, which are white fleshy lesions on the genitals and signify the most infectious stage.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Incorrect
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A 48-year-old male visits his GP with blister-like skin alterations that have been bothering him for a few months on his body and inside his mouth. Upon biopsy, it is revealed that there are intra-epithelial blisters containing acantholytic keratinocytes.
What skin condition is known to present with these features?Your Answer: Actinic keratosis
Correct Answer: Pemphigus vulgaris
Explanation:Pemphigus vulgaris is likely the condition that a middle-aged man with acantholytic keratinocytes and involvement of the mouth (mucous membranes) would present with. This is because this condition is characterised by intra-epithelial blisters containing acantholytic keratinocytes.
Bullous pemphigoid, on the other hand, is characterised by damage to the hemidesmosomes and infiltration of white blood cells such as lymphocytes into the affected area. It does not demonstrate acantholytic keratinocytes and does not affect mucous membranes like the mouth.
Actinic keratosis does not cause blistering, and bullous impetigo typically affects babies.
Pemphigus vulgaris is an autoimmune condition that occurs when the body’s immune system attacks desmoglein 3, a type of cell adhesion molecule found in epithelial cells. This disease is more prevalent in the Ashkenazi Jewish population. The most common symptom is mucosal ulceration, which can be the first sign of the disease. Oral involvement is seen in 50-70% of patients. Skin blistering is also a common symptom, with easily ruptured vesicles and bullae. These lesions are typically painful but not itchy and may appear months after the initial mucosal symptoms. Nikolsky’s sign is a characteristic feature of pemphigus vulgaris, where bullae spread following the application of horizontal, tangential pressure to the skin. Biopsy results often show acantholysis.
The first-line treatment for pemphigus vulgaris is steroids, which help to reduce inflammation and suppress the immune system. Immunosuppressants may also be used to manage the disease.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 9
Correct
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What is the compound that results from the skin's exposure to sunlight and serves as the active form of vitamin D?
Your Answer: 1,25(OH)2 Vitamin D3
Explanation:The Activation of Vitamin D
Vitamin D is essential for maintaining healthy bones and can be obtained through exposure to sunlight or from the diet. The body can activate either vitamin D2 or vitamin D3 through the same pathway. The activation process involves hydroxylation, which adds a hydroxyl group to the vitamin D molecule at position 25 in the liver. This step is not rate limiting and occurs rapidly.
The next step in activation is further hydroxylation at carbon number 1 on the vitamin D molecule, which creates 1,25(OH)2 vitamin D. This step is rate limiting and requires the enzyme 1-alpha hydroxylase. If there is an abundance of activated vitamin D, the activity of the 1-alpha hydroxylase enzyme will decrease to prevent excessive activation of vitamin D. Instead, an inactive form called 24,25(OH)2 vitamin D can be produced. the activation process of vitamin D is crucial for maintaining healthy bones and overall health.
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This question is part of the following fields:
- Clinical Sciences
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Question 10
Incorrect
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These thyroid function tests were obtained on a 55-year-old female who has recently been treated for hypertension:
Free T4 28.5 pmol/L (9.8-23.1)
TSH <0.02 mU/L (0.35-5.5)
Free T3 10.8 pmol/L (3.5-6.5)
She now presents with typical symptoms of hyperthyroidism.
Which medication is likely to have caused this?Your Answer: Disopyramide
Correct Answer: Amiodarone
Explanation:Amiodarone and its Effects on Thyroid Function
Amiodarone is a medication that can have an impact on thyroid function, resulting in both hypo- and hyperthyroidism. This is due to the high iodine content in the drug, which contributes to its antiarrhythmic effects. Atenolol, on the other hand, is a beta blocker that is commonly used to treat thyrotoxicosis. Warfarin is another medication that is used to treat atrial fibrillation.
There are two types of thyrotoxicosis that can be caused by amiodarone. Type 1 results in excess thyroxine synthesis, while type 2 leads to the release of excess thyroxine but normal levels of synthesis. It is important for healthcare professionals to monitor thyroid function in patients taking amiodarone and adjust treatment as necessary to prevent complications.
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This question is part of the following fields:
- Pharmacology
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Question 11
Incorrect
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A 68-year-old man presents to the emergency department after experiencing a syncopal episode. His ECG reveals a prolonged PR interval, with every other QRS complex being dropped. The QRS complex width is within normal limits.
From which area of the heart is the conduction delay most likely originating?Your Answer: Left Ventricle
Correct Answer: Atrio-Ventricular node
Explanation:The PR interval is the duration between the depolarization of the atria and the depolarization of the ventricles. In this case, the man is experiencing a 2:1 block, which is a type of second-degree heart block. Since his PR interval is prolonged, the issue must be occurring in the pathway between the atria and ventricles. However, since his QRS complex is normal, it is likely that the problem is in the AV node rather than the bundles of His. If the issue were in the sino-atrial node, it would not cause a prolonged PR interval with dropped QRS complexes. Similarly, if there were a slowing of conduction in the ventricles, it would cause a wide QRS complex but not a prolonged PR interval.
Understanding the Normal ECG
The electrocardiogram (ECG) is a diagnostic tool used to assess the electrical activity of the heart. The normal ECG consists of several waves and intervals that represent different phases of the cardiac cycle. The P wave represents atrial depolarization, while the QRS complex represents ventricular depolarization. The ST segment represents the plateau phase of the ventricular action potential, and the T wave represents ventricular repolarization. The Q-T interval represents the time for both ventricular depolarization and repolarization to occur.
The P-R interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization. The duration of the QRS complex is normally 0.06 to 0.1 seconds, while the duration of the P wave is 0.08 to 0.1 seconds. The Q-T interval ranges from 0.2 to 0.4 seconds depending upon heart rate. At high heart rates, the Q-T interval is expressed as a ‘corrected Q-T (QTc)’ by taking the Q-T interval and dividing it by the square root of the R-R interval.
Understanding the normal ECG is important for healthcare professionals to accurately interpret ECG results and diagnose cardiac conditions. By analyzing the different waves and intervals, healthcare professionals can identify abnormalities in the electrical activity of the heart and provide appropriate treatment.
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This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A 25-year-old woman has a total thyroidectomy to treat papillary carcinoma of the thyroid. During examination of histological sections of the thyroid gland, the pathologist discovers the presence of psammoma bodies. What is the primary composition of these bodies?
Your Answer:
Correct Answer: Clusters of calcification
Explanation:Clusters of microcalcification, known as psammoma bodies, are frequently observed in papillary carcinomas.
Thyroid cancer rarely causes hyperthyroidism or hypothyroidism as it does not usually secrete thyroid hormones. The most common type of thyroid cancer is papillary carcinoma, which is often found in young females and has an excellent prognosis. Follicular carcinoma is less common, while medullary carcinoma is a cancer of the parafollicular cells that secrete calcitonin and is associated with multiple endocrine neoplasia type 2. Anaplastic carcinoma is rare and not responsive to treatment, causing pressure symptoms. Lymphoma is also rare and associated with Hashimoto’s thyroiditis.
Management of papillary and follicular cancer involves a total thyroidectomy followed by radioiodine to kill residual cells. Yearly thyroglobulin levels are monitored to detect early recurrent disease. Papillary carcinoma usually contains a mixture of papillary and colloidal filled follicles, while follicular adenoma presents as a solitary thyroid nodule and malignancy can only be excluded on formal histological assessment. Follicular carcinoma may appear macroscopically encapsulated, but microscopically capsular invasion is seen. Medullary carcinoma is associated with raised serum calcitonin levels and familial genetic disease in up to 20% of cases. Anaplastic carcinoma is most common in elderly females and is treated by resection where possible, with palliation achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective.
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This question is part of the following fields:
- Endocrine System
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Question 13
Incorrect
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A 35-year-old woman presents to your clinic complaining of increased joint pain and fatigue. She reports no significant medical history but mentions that her sister was recently diagnosed with systemic lupus erythematosus (SLE). On examination, there are no notable findings. Laboratory tests reveal the following results:
- Hemoglobin: 118 g/L (normal range for females: 115-160 g/L)
- Platelets: 260 * 109/L (normal range: 150-400 * 109/L)
- White blood cells: 7.5 * 109/L (normal range: 4.0-11.0 * 109/L)
- ANA: Negative
- ANCA: Negative
- Anti-La antibody: Negative
- Rheumatoid factor: Positive
Which blood test result is the most reliable indicator that SLE is unlikely in this patient?Your Answer:
Correct Answer: ANA (antinuclear antibodies)
Explanation:Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive and useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%) but less sensitive (70%). Anti-Smith testing is also highly specific (>99%) but has a lower sensitivity (30%). Other antibody tests that can be used include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).
Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, and a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Overall, these investigations can help diagnose and monitor SLE, allowing for appropriate management and treatment.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 14
Incorrect
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A 25-year-old female comes to the clinic concerned about her risk of developing cancer due to her family history. Her grandfather recently passed away from lung cancer, and there are other cases of prostate, breast, and malignant melanoma in her family. She asks which type of cancer has the highest mortality rate in the UK. What is the correct answer?
Your Answer:
Correct Answer: Lung cancer
Explanation:The leading cause of cancer deaths in the UK is lung cancer, while malignant melanoma does not rank in the top 10. Prostate cancer is the most prevalent cancer in men and the second most common cause of cancer-related deaths in men. Breast cancer is the second most common cause of cancer deaths in women.
Cancer in the UK: Common Types and Causes of Death
Cancer is a major health concern in the UK, with several types of cancer affecting a significant number of people. The most common types of cancer in the UK are breast, lung, colorectal, prostate, bladder, non-Hodgkin’s lymphoma, melanoma, stomach, oesophagus, and pancreas. However, when it comes to causes of death from cancer, lung cancer tops the list, followed by colorectal, breast, prostate, and pancreatic cancer. Other types of cancer that contribute to cancer-related deaths in the UK include oesophageal, stomach, bladder, non-Hodgkin’s lymphoma, and ovarian cancer. It is important to note that non-melanoma skin cancer is not included in these statistics. Despite the prevalence of cancer in the UK, there are various treatments and support available for those affected by the disease.
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This question is part of the following fields:
- Haematology And Oncology
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Question 15
Incorrect
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A 30-year-old female arrives at the Emergency Department complaining of eye pain and an unusual posture. During the examination, it is observed that her neck is fixed in a backward and lateral position, and her eyes are deviated upwards. She is unable to control her gaze. The patient has a history of paranoid schizophrenia and is currently taking olanzapine. What is the probable reason behind her symptoms?
Your Answer:
Correct Answer: Acute dystonic reaction
Explanation:Antipsychotics have the potential to cause acute dystonic reactions, with oculogyric crisis being a significant form. Symptoms may include jaw spasm, tongue protrusion, and the eyes rolling upwards.
The recommended treatment for an oculogyric crisis is typically the administration of IV procyclidine and discontinuation of the medication responsible for the reaction.
Akathisia is another side effect of antipsychotics, characterized by restlessness and an inability to remain still.
Tardive dyskinesia is a long-term side effect of antipsychotics that can manifest after several years of use. It often affects the face and involves involuntary, repetitive movements such as lip smacking, tongue protrusion, and grimacing.
Parkinsonism is a term used to describe antipsychotic side effects that mimic Parkinson’s disease, including cogwheel rigidity, bradykinesia, and a shuffling gait.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 16
Incorrect
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A 3-year-old girl visits her pediatrician with a chest infection. She has been experiencing recurrent chest infections for the past year and has been failing to grow, with her weight and height below the fourth percentile. Her mother reports that she has been having frequent bowel movements that appear greasy and have an unpleasant odor. A sweat test is ordered and comes back positive.
In the probable condition, what is the function of leukotriene B4 (LTB4)?Your Answer:
Correct Answer: Neutrophil chemotaxis
Explanation:The correct answer is neutrophil chemotaxis. This child’s symptoms and positive sweat test indicate a diagnosis of cystic fibrosis, which leads to recurrent infections and activation of LTB4. LTB4 then recruits neutrophils, causing airway inflammation and eventual lung damage. LTC4, LTD4, and LTE4 are known for their role in bronchial smooth muscle contraction, while thromboxane A2 (TXA2) is responsible for platelet aggregation and vasoconstriction.
Arachidonic Acid Metabolism: The Role of Leukotrienes and Endoperoxides
Arachidonic acid is a fatty acid that plays a crucial role in the body’s inflammatory response. The metabolism of arachidonic acid involves the production of various compounds, including leukotrienes and endoperoxides. Leukotrienes are produced by leukocytes and can cause constriction of the lungs. LTB4 is produced before leukocytes arrive, while the rest of the leukotrienes (A, C, D, and E) cause lung constriction.
Endoperoxides, on the other hand, are produced by the cyclooxygenase enzyme and can lead to the formation of thromboxane and prostacyclin. Thromboxane is associated with platelet aggregation and vasoconstriction, which can lead to thrombosis. Prostacyclin, on the other hand, has the opposite effect and can cause vasodilation and inhibit platelet aggregation.
Understanding the metabolism of arachidonic acid and the role of these compounds can help in the development of treatments for inflammatory conditions and cardiovascular diseases.
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This question is part of the following fields:
- General Principles
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Question 17
Incorrect
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As a junior doctor in orthopaedics, you come across a patient during a ward round who had a hemiarthroplasty 6 days ago for a broken hip. Regrettably, the patient has now contracted a bacterial infection at the surgical site. Can you identify which immune-mediated processes are at play to combat this infection?
Your Answer:
Correct Answer: B cell antigen-presentation
Explanation:The correct answer is B cell antigen presentation. This process helps the body produce a large number of antibodies that are specific to the invading pathogen. It’s important to note that B cells mature into plasma cells, which are responsible for antibody production.
The other options are incorrect. Eosinophils coordinate the body’s response to parasites, while macrophages do not produce antibodies. Megakaryocytes are the precursor cells to platelets and do not participate in antigen presentation. Neutrophils do not coordinate the destruction of parasites; this is primarily the role of eosinophils.
The adaptive immune response involves several types of cells, including helper T cells, cytotoxic T cells, B cells, and plasma cells. Helper T cells are responsible for the cell-mediated immune response and recognize antigens presented by MHC class II molecules. They express CD4, CD3, TCR, and CD28 and are a major source of IL-2. Cytotoxic T cells also participate in the cell-mediated immune response and recognize antigens presented by MHC class I molecules. They induce apoptosis in virally infected and tumor cells and express CD8 and CD3. Both helper T cells and cytotoxic T cells mediate acute and chronic organ rejection.
B cells are the primary cells of the humoral immune response and act as antigen-presenting cells. They also mediate hyperacute organ rejection. Plasma cells are differentiated from B cells and produce large amounts of antibody specific to a particular antigen. Overall, these cells work together to mount a targeted and specific immune response to invading pathogens or abnormal cells.
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This question is part of the following fields:
- General Principles
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Question 18
Incorrect
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A 22-year-old man suffers a depressed skull fracture at the vertex after being struck with a hammer. Which of the following sinuses is in danger due to this injury?
Your Answer:
Correct Answer: Superior sagittal sinus
Explanation:The pattern of injury poses the highest threat to the superior sagittal sinus, which starts at the crista galli’s front and runs along the falx cerebri towards the back. It merges with the right transverse sinus close to the internal occipital protuberance.
Overview of Cranial Venous Sinuses
The cranial venous sinuses are a series of veins located within the dura mater, the outermost layer of the brain. Unlike other veins in the body, they do not have valves, which can increase the risk of sepsis spreading. These sinuses eventually drain into the internal jugular vein.
There are several cranial venous sinuses, including the superior sagittal sinus, inferior sagittal sinus, straight sinus, transverse sinus, sigmoid sinus, confluence of sinuses, occipital sinus, and cavernous sinus. Each of these sinuses has a specific location and function within the brain.
To better understand the topography of the cranial venous sinuses, it is helpful to visualize them as a map. The superior sagittal sinus runs along the top of the brain, while the inferior sagittal sinus runs along the bottom. The straight sinus connects the two, while the transverse sinus runs horizontally across the back of the brain. The sigmoid sinus then curves downward and connects to the internal jugular vein. The confluence of sinuses is where several of these sinuses meet, while the occipital sinus is located at the back of the head. Finally, the cavernous sinus is located on either side of the pituitary gland.
Understanding the location and function of these cranial venous sinuses is important for diagnosing and treating various neurological conditions.
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This question is part of the following fields:
- Neurological System
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Question 19
Incorrect
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A 56-year-old patient has presented with symptoms of polydipsia, polyuria, and fatigue. His doctor ordered a fasting glucose test, which revealed an abnormal result consistent with a diagnosis of type II diabetes mellitus. The patient has a history of hypertension and is a chronic alcoholic.
The doctor advises the patient to make lifestyle modifications and prescribes a 3-month course of metformin. However, the doctor warns the patient that there is an increased risk of complications when alcohol interacts with metformin. What specific complication is the doctor referring to?Your Answer:
Correct Answer: Lactic acidosis
Explanation:Metformin can rarely cause lactic acidosis, which is a significant side-effect. The risk of lactic acidosis is further increased when alcohol is consumed with metformin.
When alcohol is taken with drugs such as metronidazole, disulfiram-like reactions may occur. These reactions are characterized by symptoms such as flushing, nausea, vomiting, and sweating after alcohol consumption.
Alcohol has a mild sedative effect, and when combined with sedative drugs like central nervous system depressants or sedating antihistamines, it can cause severe drowsiness.
Metformin is a medication commonly used to treat type 2 diabetes mellitus, as well as polycystic ovarian syndrome and non-alcoholic fatty liver disease. Unlike other medications, such as sulphonylureas, metformin does not cause hypoglycaemia or weight gain, making it a first-line treatment option, especially for overweight patients. Its mechanism of action involves activating the AMP-activated protein kinase, increasing insulin sensitivity, decreasing hepatic gluconeogenesis, and potentially reducing gastrointestinal absorption of carbohydrates. However, metformin can cause gastrointestinal upsets, reduced vitamin B12 absorption, and in rare cases, lactic acidosis, particularly in patients with severe liver disease or renal failure. It is contraindicated in patients with chronic kidney disease, recent myocardial infarction, sepsis, acute kidney injury, severe dehydration, and those undergoing iodine-containing x-ray contrast media procedures. When starting metformin, it should be titrated up slowly to reduce the incidence of gastrointestinal side-effects, and modified-release metformin can be considered for patients who experience unacceptable side-effects.
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This question is part of the following fields:
- General Principles
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Question 20
Incorrect
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A 14-month-old boy is presented to the surgical clinic by his mother due to the absence of his left testicle in the scrotum. If the testicle were ectopic, where would it be located?
Your Answer:
Correct Answer: Superficial inguinal pouch
Explanation:Testes that are located outside of their normal embryological descent range are known as ectopic testes. These can be found in various locations such as the superficial inguinal pouch, base of the penis, femoral triangle, and perineum.
Common Testicular Disorders in Paediatric Urology
Testicular disorders are frequently encountered in paediatric urological practice. One of the most common conditions is cryptorchidism, which refers to the failure of the testicle to descend from the abdominal cavity into the scrotum. It is important to differentiate between a non-descended testis and a retractile testis. Ectopic testes are those that lie outside the normal path of embryological descent. Undescended testes occur in approximately 1% of male infants and should be placed in the scrotum after one year of age. Magnetic resonance imaging (MRI) may be used to locate intra-abdominal testes, but laparoscopy is often necessary in this age group. Testicular torsion is another common condition that presents with sudden onset of severe scrotal pain. Surgical exploration is the management of choice, and delay beyond six hours is associated with low salvage rates. Hydroceles, which are fluid-filled sacs in the scrotum or spermatic cord, may be treated with surgical ligation of the patent processus vaginalis or scrotal exploration in older children with cystic hydroceles.
Overall, prompt diagnosis and appropriate management of testicular disorders are crucial in paediatric urology to prevent long-term complications and ensure optimal outcomes for patients.
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This question is part of the following fields:
- Renal System
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Question 21
Incorrect
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What is the most frequent chromosomal abnormality seen in individuals with Down's syndrome, and how does it occur?
Your Answer:
Correct Answer: Nondisjunction
Explanation:Down’s Syndrome: Epidemiology and Genetics
Down’s syndrome is a genetic disorder that is caused by the presence of an extra copy of chromosome 21. The risk of having a child with Down’s syndrome increases with maternal age, with a 1 in 1,500 chance at age 20 and a 1 in 50 or greater chance at age 45. This can be remembered by dividing the denominator by 3 for every extra 5 years of age starting at 1/1,000 at age 30.
There are three main types of Down’s syndrome: nondisjunction, Robertsonian translocation, and mosaicism. Nondisjunction accounts for 94% of cases and occurs when the chromosomes fail to separate properly during cell division. Robertsonian translocation, which usually involves chromosome 14, accounts for 5% of cases and occurs when a piece of chromosome 21 attaches to another chromosome. Mosaicism, which accounts for 1% of cases, occurs when there are two genetically different populations of cells in the body.
The risk of recurrence for Down’s syndrome varies depending on the type of genetic abnormality. If the trisomy 21 is a result of nondisjunction, the chance of having another child with Down’s syndrome is approximately 1 in 100 if the mother is less than 35 years old. If the trisomy 21 is a result of Robertsonian translocation, the risk is much higher, with a 10-15% chance if the mother is a carrier and a 2.5% chance if the father is a carrier.
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This question is part of the following fields:
- General Principles
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Question 22
Incorrect
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A 45-year-old man complains of dyspepsia and is scheduled for an upper GI endoscopy. The procedure reveals diffuse gastric and duodenal ulcers. Upon conducting a Clo test, Helicobacter pylori infection is confirmed. What is the probable cause of the ulcers?
Your Answer:
Correct Answer: Increased acid production
Explanation:H-Pylori is capable of causing both gastric and duodenal ulcers, but the mechanism behind this is not fully understood. One theory suggests that the organism induces gastric metaplasia in the duodenum by increasing acid levels. This metaplastic transformation is necessary for H-Pylori to colonize the duodenal mucosa and cause ulcers. Therefore, only individuals who have undergone this transformation are at risk for duodenal ulcers caused by H-Pylori.
Helicobacter pylori: A Bacteria Associated with Gastrointestinal Problems
Helicobacter pylori is a type of Gram-negative bacteria that is commonly associated with various gastrointestinal problems, particularly peptic ulcer disease. This bacterium has two primary mechanisms that allow it to survive in the acidic environment of the stomach. Firstly, it uses its flagella to move away from low pH areas and burrow into the mucous lining to reach the epithelial cells underneath. Secondly, it secretes urease, which converts urea to NH3, leading to an alkalinization of the acidic environment and increased bacterial survival.
The pathogenesis mechanism of Helicobacter pylori involves the release of bacterial cytotoxins, such as the CagA toxin, which can disrupt the gastric mucosa. This bacterium is associated with several gastrointestinal problems, including peptic ulcer disease, gastric cancer, B cell lymphoma of MALT tissue, and atrophic gastritis. However, its role in gastro-oesophageal reflux disease (GORD) is unclear, and there is currently no role for the eradication of Helicobacter pylori in GORD.
The management of Helicobacter pylori infection involves a 7-day course of treatment with a proton pump inhibitor, amoxicillin, and either clarithromycin or metronidazole. For patients who are allergic to penicillin, a proton pump inhibitor, metronidazole, and clarithromycin are used instead.
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This question is part of the following fields:
- Gastrointestinal System
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Question 23
Incorrect
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A 67-year-old male, John, visits his doctor with complaints of right-sided facial weakness. He reports no other symptoms. Upon further examination and imaging, John is diagnosed with a unilateral parotid tumor. What cranial nerve lesion could be responsible for John's presentation?
Your Answer:
Correct Answer: Extracranial lesion of right facial nerve
Explanation:Facial nerve palsy can be caused by a tumour in the parotid gland, which is an example of an extracranial lesion of the facial nerve.
The facial nerve is responsible for controlling the muscles of facial expression, so any damage to the nerve can result in weakness or paralysis of these muscles. Although the trigeminal nerve does not pass through the parotid gland, the facial nerve does.
When the facial nerve is affected outside of the cranium, it is considered an extracranial lesion. Since the parotid gland is located outside of the cranium, a tumour in this gland that causes facial nerve damage is classified as an extracranial lesion.
An extracranial palsy on the same side as the lesion is caused by a parotid gland lesion. Therefore, June’s right-sided facial weakness indicates that she has an extracranial lesion of the right facial nerve.
Cranial nerve palsies can present with diplopia, or double vision, which is most noticeable in the direction of the weakened muscle. Additionally, covering the affected eye will cause the outer image to disappear. False localising signs can indicate a pathology that is not in the expected anatomical location. One common example is sixth nerve palsy, which is often caused by increased intracranial pressure due to conditions such as brain tumours, abscesses, meningitis, or haemorrhages. Papilloedema may also be present in these cases.
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This question is part of the following fields:
- Neurological System
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Question 24
Incorrect
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A 26-year-old Afro-Caribbean woman comes to the Emergency Department complaining of dyspnoea and fatigue that has been going on for 2 days. She reports experiencing similar episodes repeatedly over the past few years. She has no other medical history.
During the examination, you observe sporadic erythematous lesions on her shins and detect a pansystolic murmur. You request a chest x-ray, which reveals bilateral hilar lymphadenopathy and an enlarged heart.
What additional symptom is linked to this ailment?Your Answer:
Correct Answer: Reduced ventricular ejection fraction
Explanation:Patients with reduced ejection fraction heart failure (HF-rEF) usually experience systolic dysfunction, which refers to the impaired ability of the myocardium to contract during systole.
Types of Heart Failure
Heart failure is a clinical syndrome where the heart cannot pump enough blood to meet the body’s metabolic needs. It can be classified in multiple ways, including by ejection fraction, time, and left/right side. Patients with heart failure may have a normal or abnormal left ventricular ejection fraction (LVEF), which is measured using echocardiography. Reduced LVEF is typically defined as < 35 to 40% and is termed heart failure with reduced ejection fraction (HF-rEF), while preserved LVEF is termed heart failure with preserved ejection fraction (HF-pEF). Heart failure can also be described as acute or chronic, with acute heart failure referring to an acute exacerbation of chronic heart failure. Left-sided heart failure is more common and may be due to increased left ventricular afterload or preload, while right-sided heart failure is caused by increased right ventricular afterload or preload. High-output heart failure is another type of heart failure that occurs when a normal heart is unable to pump enough blood to meet the body's metabolic needs. By classifying heart failure in these ways, healthcare professionals can better understand the underlying causes and tailor treatment plans accordingly. It is important to note that many guidelines for the management of heart failure only cover HF-rEF patients and do not address the management of HF-pEF patients. Understanding the different types of heart failure can help healthcare professionals provide more effective care for their patients.
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This question is part of the following fields:
- Cardiovascular System
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Question 25
Incorrect
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A 45-year-old man visits a neurology clinic due to difficulty eating and wasting of the left masseter. He has been experiencing these symptoms for the past 4 months since he fell from scaffolding at work and suffered a basal skull fracture.
During the examination, the left masseter is visibly atrophied compared to the right, and the mandible deviates towards the left side. The patient also reports decreased sensation around the body of the mandible.
Which area of the skull base is likely responsible for the patient's symptoms?Your Answer:
Correct Answer: Foramen ovale
Explanation:The mandibular nerve passes through the foramen ovale, which is the correct answer. The patient’s left masseter wasting suggests a lesion of the mandibular nerve, specifically CN V3, which is responsible for the sensation and motor innervation of the lower face, mandible, temporomandibular joint, and mucous membranes. As the patient has a history of skull base trauma and new-onset masseteric wasting, it is likely that the lesion is located at the foramen ovale.
The foramen rotundum, which transmits the maxillary nerve, CN V2, is an incorrect answer as damage to this nerve would not cause the patient’s symptoms.
The foramen spinosum, which transmits the middle meningeal artery and vein, is also an incorrect answer as damage to this foramen or its contents would not cause masseteric wasting or difficulty eating.
The internal acoustic meatus, which transmits the facial and vestibulocochlear nerve, is also an incorrect answer as damage to this foramen or its contents would not cause masseteric wasting and the patient would likely have additional symptoms such as facial droop and hearing loss.
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.
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This question is part of the following fields:
- Neurological System
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Question 26
Incorrect
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What is the apoptotic event that occurs just before the formation of an apoptosome?
Your Answer:
Correct Answer: Release of cytochrome c from mitochondria
Explanation:Apoptosis and the Role of the Apoptosome
Apoptosis, also known as programmed cell death, is a natural process that occurs in all multicellular organisms. It involves a series of changes in cell morphology, including membrane blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation. The formation of the apoptosome is a crucial part of the apoptosis cascade. It is a large protein structure that is triggered by the release of cytochrome c from the mitochondria in response to various stimuli, such as DNA damage, infections, or developmental signals.
The apoptosome is formed when cytochrome c binds to Apaf-1, a cytosolic protein, in a 1:1 ratio. This triggers the recruitment and activation of the initiator pro-caspase-9, which then activates effector caspases, a family of apoptotic proteases, to initiate the apoptotic cascade. It is important to note that the activation of caspase-9 occurs only after the formation of the apoptosome.
In summary, apoptosis is a natural process that occurs in multicellular organisms, and the apoptosome plays a crucial role in triggering the apoptotic cascade. the mechanisms behind apoptosis and the formation of the apoptosome can provide insights into various diseases and developmental processes.
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This question is part of the following fields:
- Basic Sciences
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Question 27
Incorrect
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A 28-year-old female patient presents to your clinic seeking help to quit smoking. Despite several attempts in the past, she has been unsuccessful. She has a medical history of bipolar disorder and well-managed epilepsy, for which she takes lamotrigine. She currently smokes 15 cigarettes per day and is especially interested in the health benefits of quitting smoking since she has recently found out that she is pregnant. As her physician, you decide to prescribe a suitable medication to assist her in her efforts. What would be the most appropriate treatment option?
Your Answer:
Correct Answer: Nicotine gum
Explanation:Standard treatments for nicotine dependence do not include amitriptyline, fluoxetine, or gabapentin. Nicotine replacement therapy (NRT) can be helpful for motivated patients, but it is not a cure for addiction and may require multiple attempts. Bupropion and varenicline are other smoking cessation aids, but they have multiple side effects and may not be suitable for all patients. NICE guidelines recommend discussing the best method of smoking cessation with the patient, but NRT is considered safer in pregnancy.
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This question is part of the following fields:
- Respiratory System
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Question 28
Incorrect
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A 21-year-old man is participating in a rugby game when he experiences a sharp pain in the posterolateral area of his right thigh. Which muscle group is the most probable source of the injury?
Your Answer:
Correct Answer: Long head of biceps femoris
Explanation:The hamstring muscle group consists of three muscles: the biceps femoris, which is located on the lateral side, and the semitendinosus and semimembranosus, which are located on the medial side. While less common, it is possible for the gastrocnemius and soleus muscles to also experience a rupture.
The Biceps Femoris Muscle
The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.
On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.
Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 29
Incorrect
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A 3-year-old child presents to their pediatrician with severe perianal itching that is particularly worse at night. The child has no known medical conditions and has been healthy up until this point. The birth history was unremarkable, and the child is up to date with their vaccinations. There have been no developmental concerns.
After taking a thorough history, including asking about symptoms in other family members, the pediatrician uses the 'tape test' to make a diagnosis and prescribes appropriate treatment.
What is the most probable cause of the child's pruritus in this scenario?Your Answer:
Correct Answer: Enterobius vermicularis infection
Explanation:The most likely diagnosis for a 2-year-old child with perianal itching, especially at night, is Enterobius vermicularis infection, commonly known as pinworms. This is a common condition in young children and can cause discomfort and restlessness due to the itching around the anus.
The diagnosis can be confirmed through the tape test, where adhesive tape is applied around the anus of the child upon waking and then examined under a microscope for the presence of worms or their eggs. While haemorrhoids can also cause peri-anal itching, they are not the most probable diagnosis in this case, especially given the age of the child.
Echinococcus granulosus infection, which causes hydatid disease and cysts, is not a likely diagnosis for perianal itching. Perianal eczema is another possibility, but it would typically present with visible signs upon inspection, and the tape test would not be used for diagnosis.
Helminths are a group of parasitic worms that can infect humans and cause various diseases. Nematodes, also known as roundworms, are one type of helminth. Strongyloides stercoralis is a type of roundworm that enters the body through the skin and can cause symptoms such as diarrhea, abdominal pain, and skin lesions. Treatment for this infection typically involves the use of ivermectin or benzimidazoles. Enterobius vermicularis, also known as pinworm, is another type of roundworm that can cause perianal itching and other symptoms. Diagnosis is made by examining sticky tape applied to the perianal area. Treatment typically involves benzimidazoles.
Hookworms, such as Ancylostoma duodenale and Necator americanus, are another type of roundworm that can cause gastrointestinal infections and anemia. Treatment typically involves benzimidazoles. Loa loa is a type of roundworm that is transmitted by deer fly and mango fly and can cause red, itchy swellings called Calabar swellings. Treatment involves the use of diethylcarbamazine. Trichinella spiralis is a type of roundworm that can develop after eating raw pork and can cause fever, periorbital edema, and myositis. Treatment typically involves benzimidazoles.
Onchocerca volvulus is a type of roundworm that causes river blindness and is spread by female blackflies. Treatment involves the use of ivermectin. Wuchereria bancrofti is another type of roundworm that is transmitted by female mosquitoes and can cause blockage of lymphatics and elephantiasis. Treatment involves the use of diethylcarbamazine. Toxocara canis, also known as dog roundworm, is transmitted through ingestion of infective eggs and can cause visceral larva migrans and retinal granulomas. Treatment involves the use of diethylcarbamazine. Ascaris lumbricoides, also known as giant roundworm, can cause intestinal obstruction and occasionally migrate to the lung. Treatment typically involves benzimidazoles.
Cestodes, also known as tapeworms, are another type of helminth. Echinococcus granulosus is a tapeworm that is transmitted through ingestion of eggs in dog feces and can cause liver cysts and anaphylaxis if the cyst ruptures
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This question is part of the following fields:
- General Principles
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Question 30
Incorrect
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A 28-year-old woman comes to your clinic. She is in her 12th week of pregnancy and is worried about her baby's health. Her friend had a premature baby who had to stay in the neonatal intensive care unit for several weeks. The patient wants to know what she can do to decrease the chances of having a premature baby.
Some advice you can give her to reduce the risk of having a premature baby includes:
- Avoiding smoking, alcohol, and drugs during pregnancy
- Eating a healthy and balanced diet
- Getting regular prenatal care
- Managing chronic conditions such as diabetes or high blood pressure
- Avoiding infections by washing hands frequently and avoiding sick people
- Reducing stress through relaxation techniques or counseling
- Avoiding certain activities such as hot tubs or saunas
- Getting enough rest and sleep.
It is important to reassure the patient that not all premature births can be prevented, but taking these steps can help reduce the risk.Your Answer:
Correct Answer: Smoking cessation
Explanation:Low Birth Weight and Intrauterine Growth Retardation
Low birth weight (LBW) is defined as a birth weight of less than 2500 g, regardless of gestational age. Intrauterine growth retardation (IUGR), also known as small-for-gestational-age (SGA) or small-for-dates, has no universally accepted definition. However, it is commonly defined as a birth weight less than the 10th or 5th percentile for gestational age, a birth weight less than 2500 g with a gestational age of 37 weeks or more, or a birth weight less than two standard deviations below the mean value for gestational age.
Smoking is a significant modifiable risk factor for IUGR. Babies born to women who smoke weigh an average of 200 g less than those born to non-smokers. The incidence of low birth weight is twice as high among smokers as non-smokers. However, evidence shows that women who quit smoking during pregnancy can reduce the risk of having a low birth weight infant by around 20%.
There are various support systems available to help smoking cessation during pregnancy, including routine antenatal care, community smoking cessation clinics, psychological therapies, and nicotine replacement therapies. Folate supplementation is recommended for reducing neural tube defects in pregnancy, but it has no proven role in preventing LBW. Iron supplementation is recommended for pregnant women who are anaemic but has no role in preventing LBW in non-anaemic women. Gentle exercise is recommended throughout pregnancy but has no proven role in reducing LBW births. A high protein diet is not thought to be beneficial in pregnancy and may even cause harm.
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This question is part of the following fields:
- Paediatrics
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