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  • Question 1 - A 67-year-old man arrives at the emergency department with a sudden onset of...

    Correct

    • A 67-year-old man arrives at the emergency department with a sudden onset of visual disturbance. He has a medical history of hypertension and takes amlodipine. He smokes 10 cigarettes daily.

      During the eye examination, a field defect is observed in the right lower quadrant of both eyes. Apart from this, the examination is unremarkable.

      What is the anatomical location of the lesion causing the vision problem?

      Your Answer: Left superior optic radiation

      Explanation:

      Lesions in the parietal lobe affecting the superior optic radiations result in inferior homonymous quadrantanopias.

      Understanding Visual Field Defects

      Visual field defects can occur due to various reasons, including lesions in the optic tract, optic radiation, or occipital cortex. A left homonymous hemianopia indicates a visual field defect to the left, which is caused by a lesion in the right optic tract. On the other hand, homonymous quadrantanopias can be categorized into PITS (Parietal-Inferior, Temporal-Superior) and can be caused by lesions in the inferior or superior optic radiations in the temporal or parietal lobes.

      When it comes to congruous and incongruous defects, the former refers to complete or symmetrical visual field loss, while the latter indicates incomplete or asymmetric visual field loss. Incongruous defects are caused by optic tract lesions, while congruous defects are caused by optic radiation or occipital cortex lesions. In cases where there is macula sparing, it is indicative of a lesion in the occipital cortex.

      Bitemporal hemianopia, on the other hand, is caused by a lesion in the optic chiasm. The type of defect can indicate the location of the compression, with an upper quadrant defect being more common in inferior chiasmal compression, such as a pituitary tumor, and a lower quadrant defect being more common in superior chiasmal compression, such as a craniopharyngioma.

      Understanding visual field defects is crucial in diagnosing and treating various neurological conditions. By identifying the type and location of the defect, healthcare professionals can provide appropriate interventions to improve the patient’s quality of life.

    • This question is part of the following fields:

      • Neurological System
      93.1
      Seconds
  • Question 2 - A 7-year-old girl is brought to the General Practitioner (GP) by her father....

    Incorrect

    • A 7-year-old girl is brought to the General Practitioner (GP) by her father. The girl has distinct ‘elfin’ facies and is well known for her friendliness to all the practice staff. On examination, an ejection systolic murmur is heard. A Fluorescent in-situ hybridisation study confirms the diagnosis.

      What is the most probable cause of her condition?

      Your Answer: Chromosomal trisomy

      Correct Answer: Microdeletion on chromosome 7

      Explanation:

      William’s syndrome is caused by a microdeletion on chromosome 7 and is characterised by distinct facial features and extreme friendliness. Trinucleotide repeats are associated with Fragile X, Huntington’s, and Myotonic Dystrophy, while chromosomal trisomy can cause Down syndrome, Edwards syndrome, and Patau syndrome. Turner syndrome is caused by a karyotype of 46 XO. Viral infections at birth are not specifically associated with these conditions. Diagnosis for William’s syndrome is made with a FISH study.

      Understanding William’s Syndrome

      William’s syndrome is a genetic disorder that affects neurodevelopment and is caused by a microdeletion on chromosome 7. The condition is characterized by a range of physical and cognitive symptoms, including elfin-like facial features, short stature, learning difficulties, and transient neonatal hypercalcaemia. One of the most notable features of William’s syndrome is the individual’s friendly and social demeanor, which is often described as characteristic-like affect. Additionally, many individuals with William’s syndrome may also experience supravalvular aortic stenosis, a narrowing of the aorta that can lead to heart problems.

      Diagnosis of William’s syndrome is typically made through FISH studies, which can detect the microdeletion on chromosome 7. While there is no cure for William’s syndrome, early intervention and support can help individuals with the condition to manage their symptoms and lead fulfilling lives. With proper care and attention, individuals with William’s syndrome can thrive and make meaningful contributions to their communities.

    • This question is part of the following fields:

      • General Principles
      72.7
      Seconds
  • Question 3 - Samantha is a 65-year-old alcoholic who has come to her doctor with worries...

    Incorrect

    • Samantha is a 65-year-old alcoholic who has come to her doctor with worries about the feeling in her legs. She is experiencing decreased light-touch sensation and proprioception in both legs. Her blood work reveals a deficiency in vitamin B12.

      What signs are most probable for you to observe in Samantha?

      Your Answer: Hypotonia in both legs

      Correct Answer: Positive Babinski sign

      Explanation:

      The presence of a positive Babinski sign may indicate subacute degeneration of the spinal cord, which is typically caused by a deficiency in vitamin B12. This condition primarily affects the dorsal columns of the spinal cord, which are responsible for fine-touch, proprioception, and vibration sensation. In addition to the Babinski sign, patients may also experience spastic paresis. However, hypotonia is not typically observed, as this is a characteristic of lower motor neuron lesions. It is also important to note that temperature sensation is not affected by subacute degeneration of the spinal cord, as this function is mediated by the spinothalamic tract.

      Subacute Combined Degeneration of Spinal Cord

      Subacute combined degeneration of spinal cord is a condition that occurs due to a deficiency of vitamin B12. The dorsal columns and lateral corticospinal tracts are affected, leading to the loss of joint position and vibration sense. The first symptoms are usually distal paraesthesia, followed by the development of upper motor neuron signs in the legs, such as extensor plantars, brisk knee reflexes, and absent ankle jerks. If left untreated, stiffness and weakness may persist.

      This condition is a serious concern and requires prompt medical attention. It is important to maintain a healthy diet that includes sufficient amounts of vitamin B12 to prevent the development of subacute combined degeneration of spinal cord.

    • This question is part of the following fields:

      • Neurological System
      44.7
      Seconds
  • Question 4 - A woman in her 50s presents to the emergency department with an upper...

    Incorrect

    • A woman in her 50s presents to the emergency department with an upper gastrointestinal bleed. The coeliac trunk supplies the arterial blood to the upper gastrointestinal tract. However, which gastrointestinal structure receives its primary blood supply from the superior mesenteric artery instead of the coeliac trunk?

      Your Answer: Gallbladder

      Correct Answer: Proximal jejunum

      Explanation:

      The coeliac trunk provides blood supply to the foregut, which includes all structures from the gastro-oesophageal junction to the duodenal-jejunal flexure. However, the superior mesenteric artery’s jejunal branches supply blood to the entire jejunum.

      Branches of the Abdominal Aorta

      The abdominal aorta is a major blood vessel that supplies oxygenated blood to the abdominal organs and lower extremities. It gives rise to several branches that supply blood to various organs and tissues. These branches can be classified into two types: parietal and visceral.

      The parietal branches supply blood to the walls of the abdominal cavity, while the visceral branches supply blood to the abdominal organs. The branches of the abdominal aorta include the inferior phrenic, coeliac, superior mesenteric, middle suprarenal, renal, gonadal, lumbar, inferior mesenteric, median sacral, and common iliac arteries.

      The inferior phrenic artery arises from the upper border of the abdominal aorta and supplies blood to the diaphragm. The coeliac artery supplies blood to the liver, stomach, spleen, and pancreas. The superior mesenteric artery supplies blood to the small intestine, cecum, and ascending colon. The middle suprarenal artery supplies blood to the adrenal gland. The renal arteries supply blood to the kidneys. The gonadal arteries supply blood to the testes or ovaries. The lumbar arteries supply blood to the muscles and skin of the back. The inferior mesenteric artery supplies blood to the descending colon, sigmoid colon, and rectum. The median sacral artery supplies blood to the sacrum and coccyx. The common iliac arteries are the terminal branches of the abdominal aorta and supply blood to the pelvis and lower extremities.

      Understanding the branches of the abdominal aorta is important for diagnosing and treating various medical conditions that affect the abdominal organs and lower extremities.

    • This question is part of the following fields:

      • Gastrointestinal System
      103.1
      Seconds
  • Question 5 - A 25-year-old is suffering from tonsillitis and experiencing significant pain. Which nerve is...

    Correct

    • A 25-year-old is suffering from tonsillitis and experiencing significant pain. Which nerve is responsible for providing sensory innervation to the tonsillar fossa?

      Your Answer: Glossopharyngeal nerve

      Explanation:

      The tonsillar fossa is primarily innervated by the glossopharyngeal nerve, with a smaller contribution from the lesser palatine nerve. As a result, patients may experience ear pain (otalgia) after undergoing a tonsillectomy.

      Tonsil Anatomy and Tonsillitis

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

    • This question is part of the following fields:

      • Cardiovascular System
      30.1
      Seconds
  • Question 6 - A 65-year-old patient arrives at the emergency department with persistent watery diarrhea. Upon...

    Incorrect

    • A 65-year-old patient arrives at the emergency department with persistent watery diarrhea. Upon examination, the patient's blood work reveals hypokalemia and an increased level of serum vasoactive intestinal peptide (VIP). The physician informs the patient that the elevated VIP levels in their blood may be the cause of their diarrhea. As a medical student, the patient asks you about the functions of VIP. Can you identify one of its functions?

      Your Answer: Promotes acid secretion by stimulating somatostatin release

      Correct Answer: Inhibits acid secretion by stimulating somatostatin production

      Explanation:

      VIPoma, also known as Verner-Morrison syndrome, can be diagnosed based on symptoms such as prolonged diarrhea, hypokalemia, dehydration, and elevated levels of VIP. VIP is produced by the small intestines and pancreas and works by stimulating the release of somatostatin, which in turn inhibits acid secretion. On the other hand, gastrin promotes the release of acid from parietal cells. The other answers provided are incorrect.

      Overview of Gastrointestinal Hormones

      Gastrointestinal hormones play a crucial role in the digestion and absorption of food. These hormones are secreted by various cells in the stomach and small intestine in response to different stimuli such as the presence of food, pH changes, and neural signals.

      One of the major hormones involved in food digestion is gastrin, which is secreted by G cells in the antrum of the stomach. Gastrin increases acid secretion by gastric parietal cells, stimulates the secretion of pepsinogen and intrinsic factor, and increases gastric motility. Another hormone, cholecystokinin (CCK), is secreted by I cells in the upper small intestine in response to partially digested proteins and triglycerides. CCK increases the secretion of enzyme-rich fluid from the pancreas, contraction of the gallbladder, and relaxation of the sphincter of Oddi. It also decreases gastric emptying and induces satiety.

      Secretin is another hormone secreted by S cells in the upper small intestine in response to acidic chyme and fatty acids. Secretin increases the secretion of bicarbonate-rich fluid from the pancreas and hepatic duct cells, decreases gastric acid secretion, and has a trophic effect on pancreatic acinar cells. Vasoactive intestinal peptide (VIP) is a neural hormone that stimulates secretion by the pancreas and intestines and inhibits acid secretion.

      Finally, somatostatin is secreted by D cells in the pancreas and stomach in response to fat, bile salts, and glucose in the intestinal lumen. Somatostatin decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, and decreases insulin and glucagon secretion. It also inhibits the trophic effects of gastrin and stimulates gastric mucous production.

      In summary, gastrointestinal hormones play a crucial role in regulating the digestive process and maintaining homeostasis in the gastrointestinal tract.

    • This question is part of the following fields:

      • Gastrointestinal System
      98.6
      Seconds
  • Question 7 - A 29-year-old pregnant woman is admitted to the hospital and delivers a baby...

    Incorrect

    • A 29-year-old pregnant woman is admitted to the hospital and delivers a baby girl at 32 weeks gestation. The newborn displays signs of distress including tachypnoea, tachycardia, expiratory grunting, nasal flaring, and chest wall recession.

      What is the cell type responsible for producing the substance that the baby is lacking?

      Your Answer: Goblet cells

      Correct Answer: Type 2 pneumocytes

      Explanation:

      Types of Pneumocytes and Their Functions

      Pneumocytes are specialized cells found in the lungs that play a crucial role in gas exchange. There are two main types of pneumocytes: type 1 and type 2. Type 1 pneumocytes are very thin squamous cells that cover around 97% of the alveolar surface. On the other hand, type 2 pneumocytes are cuboidal cells that secrete surfactant, a substance that reduces surface tension in the alveoli and prevents their collapse during expiration.

      Type 2 pneumocytes start to develop around 24 weeks gestation, but adequate surfactant production does not take place until around 35 weeks. This is why premature babies are prone to respiratory distress syndrome. In addition, type 2 pneumocytes can differentiate into type 1 pneumocytes during lung damage, helping to repair and regenerate damaged lung tissue.

      Apart from pneumocytes, there are also club cells (previously termed Clara cells) found in the bronchioles. These non-ciliated dome-shaped cells have a varied role, including protecting against the harmful effects of inhaled toxins and secreting glycosaminoglycans and lysozymes. Understanding the different types of pneumocytes and their functions is essential in comprehending the complex mechanisms involved in respiration.

    • This question is part of the following fields:

      • Respiratory System
      44
      Seconds
  • Question 8 - A 36-year-old female patient presents with persistent dyspepsia of 6 months duration. She...

    Incorrect

    • A 36-year-old female patient presents with persistent dyspepsia of 6 months duration. She failed multiple trials of conservative treatment by her GP, therefore, she was referred for the gastroenterologist for further review.

      Investigations were done and her urea breath test was negative for Helicobacter pylori. Gastroscopy revealed multiple gastroduodenal ulcers. What type of cells are affected by the high levels of fasting gastrin detected?

      Your Answer: Goblet cells

      Correct Answer: Gastric parietal cells

      Explanation:

      The secretion of gastrin hormone from G cells in the antrum of the stomach is responsible for increasing the secretion of H+ by gastric parietal cells. Additionally, chief cells secrete pepsin, which is a proteolytic enzyme, while D cells in the pancreas and stomach secrete somatostatin hormone. Gastrin hormone is released in response to distension of the stomach and vagal stimulation.

      Overview of Gastrointestinal Hormones

      Gastrointestinal hormones play a crucial role in the digestion and absorption of food. These hormones are secreted by various cells in the stomach and small intestine in response to different stimuli such as the presence of food, pH changes, and neural signals.

      One of the major hormones involved in food digestion is gastrin, which is secreted by G cells in the antrum of the stomach. Gastrin increases acid secretion by gastric parietal cells, stimulates the secretion of pepsinogen and intrinsic factor, and increases gastric motility. Another hormone, cholecystokinin (CCK), is secreted by I cells in the upper small intestine in response to partially digested proteins and triglycerides. CCK increases the secretion of enzyme-rich fluid from the pancreas, contraction of the gallbladder, and relaxation of the sphincter of Oddi. It also decreases gastric emptying and induces satiety.

      Secretin is another hormone secreted by S cells in the upper small intestine in response to acidic chyme and fatty acids. Secretin increases the secretion of bicarbonate-rich fluid from the pancreas and hepatic duct cells, decreases gastric acid secretion, and has a trophic effect on pancreatic acinar cells. Vasoactive intestinal peptide (VIP) is a neural hormone that stimulates secretion by the pancreas and intestines and inhibits acid secretion.

      Finally, somatostatin is secreted by D cells in the pancreas and stomach in response to fat, bile salts, and glucose in the intestinal lumen. Somatostatin decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, and decreases insulin and glucagon secretion. It also inhibits the trophic effects of gastrin and stimulates gastric mucous production.

      In summary, gastrointestinal hormones play a crucial role in regulating the digestive process and maintaining homeostasis in the gastrointestinal tract.

    • This question is part of the following fields:

      • Gastrointestinal System
      35.4
      Seconds
  • Question 9 - A 32-year-old man comes to you complaining of persistent diarrhoea for the past...

    Incorrect

    • A 32-year-old man comes to you complaining of persistent diarrhoea for the past 10 days. He describes his diarrhoea as watery and foul-smelling, but denies any blood. He feels exhausted and asks for a prescription for an antidiarrhoeal medication. He has no notable medical history.

      The stool cultures come back negative, and you contemplate starting the patient on diphenoxylate. Can you explain the mechanism of action of this drug?

      Your Answer: Inhibits peristalsis by acting on delta-opioid in the GI tract

      Correct Answer: Inhibits peristalsis by acting on μ-opioid in the GI tract

      Explanation:

      Diphenoxylate slows down peristalsis in the GI tract by acting on μ-opioid receptors.

      Increased gut motility can be achieved through the positive cholinergic effect of muscarinic receptor activation.

      All other options are inaccurate.

      Antidiarrhoeal Agents: Opioid Agonists

      Antidiarrhoeal agents are medications used to treat diarrhoea. Opioid agonists are a type of antidiarrhoeal agent that work by slowing down the movement of the intestines, which reduces the frequency and urgency of bowel movements. Two common opioid agonists used for this purpose are loperamide and diphenoxylate.

      Loperamide is available over-the-counter and is often used to treat acute diarrhoea. It works by binding to opioid receptors in the intestines, which reduces the contractions of the muscles in the intestinal wall. This slows down the movement of food and waste through the intestines, allowing more time for water to be absorbed and resulting in firmer stools.

      Diphenoxylate is a prescription medication that is often used to treat chronic diarrhoea. It works in a similar way to loperamide, but is often combined with atropine to discourage abuse and overdose.

      Overall, opioid agonists are effective at treating diarrhoea, but should be used with caution and under the guidance of a healthcare professional. They can cause side effects such as constipation, dizziness, and nausea, and may interact with other medications.

    • This question is part of the following fields:

      • Gastrointestinal System
      102.3
      Seconds
  • Question 10 - A 49-year-old woman visits the clinic complaining of occasional palpitations over the last...

    Incorrect

    • A 49-year-old woman visits the clinic complaining of occasional palpitations over the last 7 days. The palpitations occur without any physical exertion and are not accompanied by chest pain. Upon examination, her heart appears to be functioning normally. An ECG is conducted, revealing indications of hyperkalaemia. What is an ECG indicator of hyperkalaemia?

      Your Answer: ST segment depression

      Correct Answer: Small or absent P waves

      Explanation:

      The presence of small or inverted T waves on an ECG can indicate hyperkalaemia, along with other signs such as absent or reduced P waves, broad and bizarre QRS complexes, and tall-tented T waves. In severe cases, hyperkalaemia can lead to asystole.

      Hyperkalaemia is a condition where there is an excess of potassium in the blood. The levels of potassium in the plasma are regulated by various factors such as aldosterone, insulin levels, and acid-base balance. When there is metabolic acidosis, hyperkalaemia can occur as hydrogen and potassium ions compete with each other for exchange with sodium ions across cell membranes and in the distal tubule. The ECG changes that can be seen in hyperkalaemia include tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern, and asystole.

      There are several causes of hyperkalaemia, including acute kidney injury, drugs such as potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, and heparin, metabolic acidosis, Addison’s disease, rhabdomyolysis, and massive blood transfusion. Foods that are high in potassium include salt substitutes, bananas, oranges, kiwi fruit, avocado, spinach, and tomatoes.

      It is important to note that beta-blockers can interfere with potassium transport into cells and potentially cause hyperkalaemia in renal failure patients. In contrast, beta-agonists such as Salbutamol are sometimes used as emergency treatment. Additionally, both unfractionated and low-molecular weight heparin can cause hyperkalaemia by inhibiting aldosterone secretion.

    • This question is part of the following fields:

      • Renal System
      72.7
      Seconds
  • Question 11 - A 60-year-old woman complains of persistent diarrhoea, wheezing, and flushing. During the physical...

    Incorrect

    • A 60-year-old woman complains of persistent diarrhoea, wheezing, and flushing. During the physical examination, an irregular pulsatile hepatomegaly and a pansystolic murmur that is most pronounced during inspiration are detected. What diagnostic test could provide insight into the probable underlying condition?

      Your Answer: ECG

      Correct Answer: Urinary 5-HIAA (5-hydroxyindole acetic acid)

      Explanation:

      Carcinoid Syndrome and its Diagnosis

      Carcinoid syndrome is characterized by the presence of vasoactive amines such as serotonin in the bloodstream, leading to various clinical features. The primary carcinoid tumor is usually found in the small intestine or appendix, but it may not cause significant symptoms as the liver detoxifies the blood of these amines. However, systemic effects occur when malignant cells spread to other organs, such as the lungs, which are not part of the portal circulation. One of the complications of carcinoid syndrome is damage to the right heart valves, which can cause tricuspid regurgitation, as evidenced by a pulsatile liver and pansystolic murmur.

      To diagnose carcinoid syndrome, the 5-HIAA test is usually performed, which measures the breakdown product of serotonin in a 24-hour urine collection. If the test is positive, imaging and histology are necessary to confirm malignancy.

    • This question is part of the following fields:

      • Endocrine System
      49.3
      Seconds
  • Question 12 - What is the anatomical distribution of ulcerative colitis? ...

    Incorrect

    • What is the anatomical distribution of ulcerative colitis?

      Your Answer: Affects any part of the gastrointestinal tract from mouth to anus + skip lesions

      Correct Answer: Starts at rectum + rarely spreads beyond ileocaecal valve + continuous

      Explanation:

      Understanding Ulcerative Colitis

      Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation in the rectum and spreads continuously without going beyond the ileocaecal valve. It is most commonly seen in people aged 15-25 years and 55-65 years. The symptoms of ulcerative colitis are insidious and intermittent, including bloody diarrhea, urgency, tenesmus, abdominal pain, and extra-intestinal features. Diagnosis is done through colonoscopy and biopsy, but in severe cases, a flexible sigmoidoscopy is preferred to avoid the risk of perforation. The typical findings include red, raw mucosa that bleeds easily, widespread ulceration with preservation of adjacent mucosa, and inflammatory cell infiltrate in lamina propria. Extra-intestinal features of inflammatory bowel disease include arthritis, erythema nodosum, episcleritis, osteoporosis, uveitis, pyoderma gangrenosum, clubbing, and primary sclerosing cholangitis. Ulcerative colitis is linked with sacroiliitis, and a barium enema can show the whole colon affected by an irregular mucosa with loss of normal haustral markings.

    • This question is part of the following fields:

      • Gastrointestinal System
      39.9
      Seconds
  • Question 13 - A 45-year-old businessman comes to his GP complaining of fever, headache, and diarrhoea....

    Incorrect

    • A 45-year-old businessman comes to his GP complaining of fever, headache, and diarrhoea. He denies having any coughs, nausea, or vomiting. He has a good health history. However, he recently returned from a business trip to India three weeks ago. He has been consuming the same food and drinks as his family since his return, and they are all healthy. During the examination, the man seems dehydrated and has tenderness in the right upper quadrant.

      What do you think is the probable diagnosis?

      Your Answer: Traveller's diarrhoea

      Correct Answer: Hepatitis A

      Explanation:

      Understanding Hepatitis A: Symptoms, Transmission, and Prevention

      Hepatitis A is a viral infection that affects the liver. It is usually a mild illness that resolves on its own, with serious complications being rare. The virus is transmitted through the faecal-oral route, often in institutions. The incubation period is typically 2-4 weeks, and symptoms include a flu-like prodrome, abdominal pain (usually in the right upper quadrant), tender hepatomegaly, jaundice, and deranged liver function tests.

      While complications are rare, there is no increased risk of hepatocellular cancer. An effective vaccine is available, and it is recommended for people travelling to or residing in areas of high or intermediate prevalence, those with chronic liver disease, patients with haemophilia, men who have sex with men, injecting drug users, and individuals at occupational risk (such as laboratory workers, staff of large residential institutions, sewage workers, and people who work with primates).

      It is important to note that the vaccine requires a booster dose 6-12 months after the initial dose. By understanding the symptoms, transmission, and prevention of hepatitis A, individuals can take steps to protect themselves and others from this viral infection.

    • This question is part of the following fields:

      • General Principles
      53.9
      Seconds
  • Question 14 - What is the position of the hyoid bone? ...

    Correct

    • What is the position of the hyoid bone?

      Your Answer: C3

      Explanation:

      Surface Anatomy of the Neck: Identifying Structures and Corresponding Levels

      The neck is a complex region of the body that contains numerous structures and landmarks. By understanding the surface anatomy of the neck, healthcare professionals can accurately identify and locate important structures during physical examinations and medical procedures.

      In the midline of the neck, several structures can be felt from top to bottom. These include the hyoid at the level of C3, the notch of the thyroid cartilage at C4, and the cricoid cartilage at C6. The lower border of the cricoid cartilage is particularly significant as it corresponds to several important structures, including the junction of the larynx and trachea, the junction of the pharynx and esophagus, and the level at which the inferior thyroid artery enters the thyroid gland. Additionally, the vertebral artery enters the transverse foramen in the 6th cervical vertebrae at this level, and the superior belly of the omohyoid muscle crosses the carotid sheath. The middle cervical sympathetic ganglion is also located at this level, as well as the carotid tubercle, which can be used to compress the carotid artery.

      Overall, understanding the surface anatomy of the neck is crucial for healthcare professionals to accurately identify and locate important structures during physical examinations and medical procedures.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      24.2
      Seconds
  • Question 15 - A 27-year-old individual diagnosed with schizophrenia has a history of cannabis misuse and...

    Correct

    • A 27-year-old individual diagnosed with schizophrenia has a history of cannabis misuse and has discontinued their medication. They are currently experiencing auditory hallucinations where multiple voices are conversing about them. The voices are making derogatory comments, accusing the individual of being a paedophile and deserving punishment.

      What is the best description of this hallucination?

      Your Answer: Third person hallucination

      Explanation:

      Types of Auditory Hallucinations

      There are different types of auditory hallucinations that individuals may experience. One type is third person hallucinations, where patients hear voices talking about them in the third person. This is considered a first rank symptom of schizophrenia, but it can also occur in other psychiatric disorders such as mania. Another type is extra-campine hallucinations, which are perceived as coming from outside of the normal sensory field, such as from several miles away. Functional hallucinations, on the other hand, are triggered by stimuli within the same sensory field, such as hearing a phone ring that triggers a voice. Lastly, imperative hallucinations involve the auditory hallucination giving instructions to the patient.

      the Different Types of Auditory Hallucinations

      Auditory hallucinations can be a distressing experience for individuals who hear voices that are not there. It is important to note that there are different types of auditory hallucinations, each with their own unique characteristics. Third person hallucinations involve hearing voices talking about the individual in the third person, while extra-campine hallucinations are perceived as coming from outside of the normal sensory field. Functional hallucinations are triggered by stimuli within the same sensory field, and imperative hallucinations involve the auditory hallucination giving instructions to the patient. the different types of auditory hallucinations can help individuals and healthcare professionals better identify and manage these experiences.

    • This question is part of the following fields:

      • Psychiatry
      52.5
      Seconds
  • Question 16 - A middle-aged woman expresses concerns about her baby not receiving enough blood supply....

    Incorrect

    • A middle-aged woman expresses concerns about her baby not receiving enough blood supply. Her physician assures her that her blood volume will rise during pregnancy, resulting in a sufficient blood supply for her baby. What is the cause of this increased blood volume?

      Your Answer: Increased ADH

      Correct Answer: Renin-angiotensin system

      Explanation:

      The renin-angiotensin system is responsible for increasing plasma volume by converting angiotensinogen to angiotensin 2, which causes vasoconstriction and fluid retention. While increased ADH could theoretically raise plasma volume, it typically maintains the hypothalamic plasma volume set-point and reduces micturition rate, which is not consistent with pregnancy. Conversely, decreased ADH could increase micturition and decrease plasma volume. It is important to note that decreased GFR is not a factor in increasing plasma volume during pregnancy, as it actually increases.

      The renin-angiotensin-aldosterone system is a complex system that regulates blood pressure and fluid balance in the body. The adrenal cortex is divided into three zones, each producing different hormones. The zona glomerulosa produces mineralocorticoids, mainly aldosterone, which helps regulate sodium and potassium levels in the body. Renin is an enzyme released by the renal juxtaglomerular cells in response to reduced renal perfusion, hyponatremia, and sympathetic nerve stimulation. It hydrolyses angiotensinogen to form angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme in the lungs. Angiotensin II has various actions, including causing vasoconstriction, stimulating thirst, and increasing proximal tubule Na+/H+ activity. It also stimulates aldosterone and ADH release, which causes retention of Na+ in exchange for K+/H+ in the distal tubule.

    • This question is part of the following fields:

      • Renal System
      75.5
      Seconds
  • Question 17 - Which of the structures listed below articulates with the head of the radius...

    Incorrect

    • Which of the structures listed below articulates with the head of the radius superiorly?

      Your Answer: Medial epicondyle

      Correct Answer: Capitulum

      Explanation:

      The capitulum of the humerus forms a joint with the head of the radius.

      Anatomy of the Radius Bone

      The radius bone is one of the two long bones in the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. It has two expanded ends, with the distal end being the larger one. The upper end of the radius bone has articular cartilage that covers the medial to lateral side and articulates with the radial notch of the ulna by the annular ligament. The biceps brachii muscle attaches to the tuberosity of the upper end.

      The shaft of the radius bone has several muscle attachments. The upper third of the body has the supinator, flexor digitorum superficialis, and flexor pollicis longus muscles. The middle third of the body has the pronator teres muscle, while the lower quarter of the body has the pronator quadratus muscle and the tendon of supinator longus.

      The lower end of the radius bone is quadrilateral in shape. The anterior surface is covered by the capsule of the wrist joint, while the medial surface has the head of the ulna. The lateral surface ends in the styloid process, and the posterior surface has three grooves that contain the tendons of extensor carpi radialis longus and brevis, extensor pollicis longus, and extensor indicis. Understanding the anatomy of the radius bone is crucial in diagnosing and treating injuries and conditions that affect this bone.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.6
      Seconds
  • Question 18 - What is the most frequent reason for mesenteric infarction to occur? ...

    Correct

    • What is the most frequent reason for mesenteric infarction to occur?

      Your Answer: Acute embolism affecting the superior mesenteric artery

      Explanation:

      Mesenteric infarcts can be caused by various factors such as prolonged atrial fibrillation, ventricular aneurysms, and post myocardial infarction.

      Understanding Mesenteric Vessel Disease

      Mesenteric vessel disease is a condition that affects the blood vessels supplying the intestines. It is primarily caused by arterial embolism, which can result in infarction of the colon. The most common type of mesenteric vessel disease is acute mesenteric embolus, which is characterized by sudden onset abdominal pain followed by profuse diarrhea. Other types include acute on chronic mesenteric ischemia, mesenteric vein thrombosis, and low flow mesenteric infarction.

      Diagnosis of mesenteric vessel disease involves serological tests such as WCC, lactate, CRP, and amylase, as well as CT angiography scanning in the arterial phase with thin slices. Management of the condition depends on the severity of symptoms, with overt signs of peritonism requiring laparotomy and mesenteric vein thrombosis being treated with medical management using IV heparin. In cases where surgery is necessary, limited resection of necrotic bowel may be performed with the aim of relooking laparotomy at 24-48 hours.

      The prognosis for mesenteric vessel disease is generally poor, with the best outlook being for acute ischaemia from an embolic event where surgery occurs within 12 hours. Survival rates may be as high as 50%, but this falls to 30% with treatment delay. It is important to seek medical attention promptly if symptoms of mesenteric vessel disease are present.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 19 - A 14-month-old boy is presented to the surgical clinic by his mother due...

    Incorrect

    • 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: External inguinal ring

      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.

    • This question is part of the following fields:

      • Renal System
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  • Question 20 - What is the name of the process where glucose is used as a...

    Correct

    • What is the name of the process where glucose is used as a fuel to produce pyruvate and yield ATP in most body cells?

      Your Answer: Glycolysis

      Explanation:

      The Process of Energy Production from Glucose in the Human Body

      The breakdown of fuel molecules, particularly glucose, is a crucial process in the human body. While fat and protein can also be used for fuel, glucose has the simplest method of metabolism. For this process to occur, nutrients from the diet must be absorbed and distributed to individual cells. Most cells in the body have the necessary machinery for producing ATP from glucose.

      The process of producing energy from glucose involves three main steps. First, glycolysis occurs, where the 6-carbon glucose molecule is split into two 3-carbon particles. Next, the Kreb cycle, also known as the tricarboxylic acid cycle, modifies 3-carbon containing acids in a series of steps to produce NADH. Finally, the electron transfer chain takes place inside mitochondria, where the NADH generated during the Kreb cycle is used to produce energy in the form of ATP through a series of redox reactions.

      In summary, the process of energy production from glucose is a fundamental process in the human body. It involves the breakdown of glucose into smaller particles, modification of these particles to produce NADH, and the use of NADH to produce ATP through a series of redox reactions.

    • This question is part of the following fields:

      • Clinical Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY

Neurological System (1/2) 50%
General Principles (0/2) 0%
Gastrointestinal System (1/6) 17%
Cardiovascular System (1/1) 100%
Respiratory System (0/1) 0%
Renal System (0/3) 0%
Endocrine System (0/1) 0%
Musculoskeletal System And Skin (1/2) 50%
Psychiatry (1/1) 100%
Clinical Sciences (1/1) 100%
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