00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 33-year-old male presents to the ED with coughing and wheezing following an...

    Correct

    • A 33-year-old male presents to the ED with coughing and wheezing following an episode of alcohol intoxication. Upon examination, decreased breath sounds are noted on one side. Imaging reveals a foreign body obstructing an airway structure. What is the most probable location for this foreign body to be lodged?

      Your Answer: Right mainstem bronchus

      Explanation:

      It is rare for a foreign object to become lodged in the left mainstem bronchus due to its greater angle compared to the right mainstem bronchus. A tracheal obstruction would cause reduced breath sounds bilaterally, not just on one side. The right superior lobar bronchus is also unlikely to be affected due to its angle and direction. Therefore, foreign bodies typically get stuck in the right mainstem bronchus in adults because of its wider diameter and lesser angle.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      16.8
      Seconds
  • Question 2 - A 27-year-old male admitted to the ICU after a car accident has a...

    Incorrect

    • A 27-year-old male admitted to the ICU after a car accident has a pneumothorax. Using a bedside spirometer, his inspiratory and expiratory volumes were measured. What is the typical tidal volume for a male of his age?

      Your Answer: 400ml

      Correct Answer: 500ml

      Explanation:

      The amount of air that is normally breathed in and out without any extra effort is called tidal volume, which is 500ml in males and 350ml in females.

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      11.7
      Seconds
  • Question 3 - An 80-year-old man has been referred to the respiratory clinic due to a...

    Incorrect

    • An 80-year-old man has been referred to the respiratory clinic due to a persistent dry cough and hoarse voice for the last 5 months. He reports feeling like he has lost some weight as his clothes feel loose. Although he has no significant past medical history, he has a 30-pack-year smoking history. During the examination, left-sided miosis and ptosis are noted. What is the probable location of the lung lesion?

      Your Answer: In the pleura

      Correct Answer: Lung apex

      Explanation:

      The patient’s persistent cough, significant smoking history, and weight loss are red flag symptoms of lung cancer. Additionally, the hoarseness of voice suggests that the recurrent laryngeal nerve is being suppressed, likely due to a Pancoast tumor located in the apex of the lung. The presence of Horner’s syndrome further supports this diagnosis. Mesothelioma, which is more common in patients with a history of asbestos exposure, typically presents with shortness of breath, chest wall pain, and finger clubbing. A hamartoma, a benign tumor made up of tissue such as cartilage, connective tissue, and fat, is unlikely given the patient’s red flags for malignant disease. Small cell carcinomas, typically found in the center of the lungs, may present with a perihilar mass and paraneoplastic syndromes due to ectopic hormone secretion. Lung cancers within the bronchi can obstruct airways and cause respiratory symptoms such as cough and shortness of breath, but not hoarseness.

      Lung Cancer Symptoms and Complications

      Lung cancer is a serious condition that can cause a range of symptoms and complications. Some of the most common symptoms include a persistent cough, haemoptysis (coughing up blood), dyspnoea (shortness of breath), chest pain, weight loss and anorexia, and hoarseness. In some cases, patients may also experience supraclavicular lymphadenopathy or persistent cervical lymphadenopathy, as well as clubbing and a fixed, monophonic wheeze.

      In addition to these symptoms, lung cancer can also cause a range of paraneoplastic features. These may include the secretion of ADH, ACTH, or parathyroid hormone-related protein (PTH-rp), which can cause hypercalcaemia, hypertension, hyperglycaemia, hypokalaemia, alkalosis, muscle weakness, and other complications. Other paraneoplastic features may include Lambert-Eaton syndrome, hypertrophic pulmonary osteoarthropathy (HPOA), hyperthyroidism due to ectopic TSH, and gynaecomastia.

      Complications of lung cancer may include hoarseness, stridor, and superior vena cava syndrome. Patients may also experience a thrombocytosis, which can be detected through blood tests. Overall, it is important to be aware of the symptoms and complications of lung cancer in order to seek prompt medical attention and receive appropriate treatment.

    • This question is part of the following fields:

      • Respiratory System
      22.8
      Seconds
  • Question 4 - A 50-year-old female presents to her GP with complaints of shortness of breath...

    Incorrect

    • A 50-year-old female presents to her GP with complaints of shortness of breath and weakness during mild-moderate exercise. She reports that these episodes have been getting progressively worse and now often result in dizziness. The patient has no significant medical history but was a previous smoker for 15 years, smoking 15 cigarettes per day. Spirometry testing reveals a restrictive lung pattern. What is the most probable diagnosis?

      Your Answer: Alpha-1 antitrypsin deficiency

      Correct Answer: Myasthenia gravis

      Explanation:

      Myasthenia gravis can result in a restrictive pattern of lung disease due to weakness of the respiratory muscles, which causes difficulty in breathing air in. Asthma and COPD are incorrect as they cause an obstructive pattern on spirometry, with asthma being characterized by small bronchiole obstruction from inflammation and increased mucus production, and COPD causing small airway inflammation and emphysema that restricts outward airflow. Alpha-1 antitrypsin deficiency also leads to an obstructive pattern, as it results in pulmonary tissue degradation and panlobular emphysema.

      Understanding the Differences between Obstructive and Restrictive Lung Diseases

      Obstructive and restrictive lung diseases are two distinct categories of respiratory conditions that affect the lungs in different ways. Obstructive lung diseases are characterized by a reduction in the flow of air through the airways due to narrowing or blockage, while restrictive lung diseases are characterized by a decrease in lung volume or capacity, making it difficult to breathe in enough air.

      Spirometry is a common diagnostic tool used to differentiate between obstructive and restrictive lung diseases. In obstructive lung diseases, the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is less than 80%, indicating a reduced ability to exhale air. In contrast, restrictive lung diseases are characterized by an FEV1/FVC ratio greater than 80%, indicating a reduced ability to inhale air.

      Examples of obstructive lung diseases include chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema, while asthma and bronchiectasis are also considered obstructive. Restrictive lung diseases include intrapulmonary conditions such as idiopathic pulmonary fibrosis, extrinsic allergic alveolitis, and drug-induced fibrosis, as well as extrapulmonary conditions such as neuromuscular diseases, obesity, and scoliosis.

      Understanding the differences between obstructive and restrictive lung diseases is important for accurate diagnosis and appropriate treatment. While both types of conditions can cause difficulty breathing, the underlying causes and treatment approaches can vary significantly.

    • This question is part of the following fields:

      • Respiratory System
      21.7
      Seconds
  • Question 5 - An 80-year-old woman visits her doctor complaining of a persistent cough. She has...

    Incorrect

    • An 80-year-old woman visits her doctor complaining of a persistent cough. She has been smoking 20 cigarettes a day for the past 30 years and is worried that this might be the reason for her symptom. The doctor diagnoses her with chronic obstructive pulmonary disease (COPD) which is likely caused by chronic bronchitis. Can you provide the definition of chronic bronchitis?

      Your Answer: Enlargement of air spaces distal to the terminal bronchioles

      Correct Answer: Chronic productive cough for at least 3 months in at least 2 years

      Explanation:

      Chronic bronchitis is characterized by a persistent cough with sputum production for a minimum of 3 months in two consecutive years, after excluding other causes of chronic cough. Emphysema, on the other hand, is defined by the enlargement of air spaces beyond the terminal bronchioles. None of the remaining options are considered as definitions of COPD.

      COPD, or chronic obstructive pulmonary disease, can be caused by a variety of factors. The most common cause is smoking, which can lead to inflammation and damage in the lungs over time. Another potential cause is alpha-1 antitrypsin deficiency, a genetic condition that can result in lung damage. Additionally, exposure to certain substances such as cadmium (used in smelting), coal, cotton, cement, and grain can also contribute to the development of COPD. It is important to identify and address these underlying causes in order to effectively manage and treat COPD.

    • This question is part of the following fields:

      • Respiratory System
      52.5
      Seconds
  • Question 6 - A 78-year-old man comes to your clinic with a complaint of hoarseness in...

    Incorrect

    • A 78-year-old man comes to your clinic with a complaint of hoarseness in his voice for the past 2 months. He is unsure if he had a viral infection prior to this and has attempted using over-the-counter remedies with no improvement. How would you approach managing this patient?

      Your Answer: Tell her it is probably viral and to come back in 3 weeks

      Correct Answer: Red flag referral to ENT

      Explanation:

      An urgent referral to an ENT specialist is necessary when a person over the age of 45 experiences persistent hoarseness without any apparent cause. In this case, the patient has been suffering from a hoarse voice for 8 weeks, which warrants an urgent referral. A routine referral would not be sufficient as it may not be quick enough to address the issue. Although it could be a viral or bacterial infection, the duration of the hoarseness suggests that there may be an underlying serious condition. Merely informing the patient that their voice may not return is not helpful and may overlook the possibility of a more severe problem.

      Hoarseness can be caused by various factors such as overusing the voice, smoking, viral infections, hypothyroidism, gastro-oesophageal reflux, laryngeal cancer, and lung cancer. It is important to investigate the underlying cause of hoarseness, and a chest x-ray may be necessary to rule out any apical lung lesions.

      If laryngeal cancer is suspected, it is recommended to refer the patient to an ENT specialist through a suspected cancer pathway. This referral should be considered for individuals who are 45 years old and above and have persistent unexplained hoarseness or an unexplained lump in the neck. Early detection and treatment of laryngeal cancer can significantly improve the patient’s prognosis.

    • This question is part of the following fields:

      • Respiratory System
      5.6
      Seconds
  • Question 7 - A 65-year-old male with a diagnosis of lung cancer presents with fatigue and...

    Incorrect

    • A 65-year-old male with a diagnosis of lung cancer presents with fatigue and lightheadedness. Upon examination, the following results are obtained:

      Plasma sodium concentration 115 mmol/L (137-144)
      Potassium 3.5 mmol/L (3.5-4.9)
      Urea 3.2 mmol/L (2.5-7.5)
      Creatinine 67 ”mol/L (60-110)

      What is the probable reason for his symptoms based on these findings?

      Your Answer: Hypoadrenalism due to adrenal metastases

      Correct Answer: Syndrome of inappropriate ADH secretion

      Explanation:

      Syndrome of Inappropriate ADH Secretion

      Syndrome of inappropriate ADH secretion (SIADH) is a condition characterized by low levels of sodium in the blood. This is caused by the overproduction of antidiuretic hormone (ADH) by the posterior pituitary gland. Tumors such as bronchial carcinoma can cause the ectopic elaboration of ADH, leading to dilutional hyponatremia. The diagnosis of SIADH is one of exclusion, but it can be supported by a high urine sodium concentration with high urine osmolality.

      Hypoadrenalism is less likely to cause hyponatremia, as it is usually associated with hyperkalemia and mild hyperuricemia. On the other hand, diabetes insipidus is a condition where the kidneys are unable to reabsorb water, leading to excessive thirst and urination.

      It is important to diagnose and treat SIADH promptly to prevent complications such as seizures, coma, and even death. Treatment options include fluid restriction, medications to block the effects of ADH, and addressing the underlying cause of the condition.

      In conclusion, SIADH is a condition that can cause low levels of sodium in the blood due to the overproduction of ADH. It is important to differentiate it from other conditions that can cause hyponatremia and to treat it promptly to prevent complications.

    • This question is part of the following fields:

      • Respiratory System
      44.2
      Seconds
  • Question 8 - Which one of the following statements relating to the root of the spine...

    Incorrect

    • Which one of the following statements relating to the root of the spine is false?

      Your Answer:

      Correct Answer: The subclavian artery arches over the first rib anterior to scalenus anterior

      Explanation:

      The suprapleural membrane, also known as Sibson’s fascia, is located above the pleural cavity. The scalenus anterior muscle is positioned in front of the subclavian vein, while the subclavian artery is situated behind it.

      Thoracic Outlet: Where the Subclavian Artery and Vein and Brachial Plexus Exit the Thorax

      The thoracic outlet is the area where the subclavian artery and vein and the brachial plexus exit the thorax and enter the arm. This passage occurs over the first rib and under the clavicle. The subclavian vein is the most anterior structure and is located immediately in front of scalenus anterior and its attachment to the first rib. Scalenus anterior has two parts, and the subclavian artery leaves the thorax by passing over the first rib and between these two portions of the muscle. At the level of the first rib, the lower cervical nerve roots combine to form the three trunks of the brachial plexus. The lowest trunk is formed by the union of C8 and T1, and this trunk lies directly posterior to the artery and is in contact with the superior surface of the first rib.

      Thoracic outlet obstruction can cause neurovascular compromise.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 9 - What is the carrier rate of cystic fibrosis in the United Kingdom? ...

    Incorrect

    • What is the carrier rate of cystic fibrosis in the United Kingdom?

      Your Answer:

      Correct Answer: 1 in 25

      Explanation:

      Understanding Cystic Fibrosis

      Cystic fibrosis is a genetic disorder that causes thickened secretions in the lungs and pancreas. It is an autosomal recessive condition that occurs due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which regulates a chloride channel. In the UK, 80% of CF cases are caused by delta F508 on chromosome 7, and the carrier rate is approximately 1 in 25.

      CF patients are at risk of colonization by certain organisms, including Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia (previously known as Pseudomonas cepacia), and Aspergillus. These organisms can cause infections and exacerbate symptoms in CF patients. It is important for healthcare providers to monitor and manage these infections to prevent further complications.

      Overall, understanding cystic fibrosis and its associated risks can help healthcare providers provide better care for patients with this condition.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 10 - A 24-year-old female arrives at the emergency department in a state of panic...

    Incorrect

    • A 24-year-old female arrives at the emergency department in a state of panic following a recent breakup with her partner. She complains of chest tightness and dizziness, fearing that she may be experiencing a heart attack. Upon examination, her vital signs are stable except for a respiratory rate of 34 breaths per minute. What compensatory mechanism is expected in response to the change in her oxyhaemoglobin dissociation curve, and what is the underlying cause?

      Your Answer:

      Correct Answer: Left shift, respiratory alkalosis

      Explanation:

      The patient’s oxygen dissociation curve has shifted to the left, indicating respiratory alkalosis. This is likely due to the patient experiencing a panic attack and hyperventilating, leading to a decrease in carbon dioxide levels and an increase in the affinity of haemoglobin for oxygen. Respiratory acidosis, hypercapnia, and a right shift of the curve are not appropriate explanations for this patient’s condition.

      Understanding the Oxygen Dissociation Curve

      The oxygen dissociation curve is a graphical representation of the relationship between the percentage of saturated haemoglobin and the partial pressure of oxygen in the blood. It is not influenced by the concentration of haemoglobin. The curve can shift to the left or right, indicating changes in oxygen delivery to tissues. When the curve shifts to the left, there is increased saturation of haemoglobin with oxygen, resulting in decreased oxygen delivery to tissues. Conversely, when the curve shifts to the right, there is reduced saturation of haemoglobin with oxygen, leading to enhanced oxygen delivery to tissues.

      The L rule is a helpful mnemonic to remember the factors that cause a shift to the left, resulting in lower oxygen delivery. These factors include low levels of hydrogen ions (alkali), low partial pressure of carbon dioxide, low levels of 2,3-diphosphoglycerate, and low temperature. On the other hand, the mnemonic ‘CADET, face Right!’ can be used to remember the factors that cause a shift to the right, leading to raised oxygen delivery. These factors include carbon dioxide, acid, 2,3-diphosphoglycerate, exercise, and temperature.

      Understanding the oxygen dissociation curve is crucial in assessing the oxygen-carrying capacity of the blood and the delivery of oxygen to tissues. By knowing the factors that can shift the curve to the left or right, healthcare professionals can make informed decisions in managing patients with respiratory and cardiovascular diseases.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 11 - A 65-year-old man presents with respiratory symptoms and is referred to his primary...

    Incorrect

    • A 65-year-old man presents with respiratory symptoms and is referred to his primary care physician for pulmonary function testing. The estimated vital capacity is 3.5 liters. What does the measurement of vital capacity involve?

      Your Answer:

      Correct Answer: Inspiratory reserve volume + Tidal volume + Expiratory reserve volume

      Explanation:

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 12 - A 75-year-old man is having a left pneumonectomy for bronchial carcinoma. When the...

    Incorrect

    • A 75-year-old man is having a left pneumonectomy for bronchial carcinoma. When the surgeons reach the root of the lung, which structure will be the most anterior in the anatomical plane?

      Your Answer:

      Correct Answer: Phrenic nerve

      Explanation:

      The lung root contains two nerves, with the phrenic nerve positioned in the most anterior location and the vagus nerve situated in the most posterior location.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 13 - During a consultant-led ward round in the early morning, a patient recovering from...

    Incorrect

    • During a consultant-led ward round in the early morning, a patient recovering from endovascular thrombectomy for acute mesenteric ischemia is examined. The reports indicate an embolus in the superior mesenteric artery.

      What is the correct description of the plane at which the superior mesenteric artery branches off the abdominal aorta and its corresponding vertebral body?

      Your Answer:

      Correct Answer: Transpyloric plane - L1

      Explanation:

      The superior mesenteric artery originates from the abdominal aorta at the transpyloric plane, which is an imaginary axial plane located at the level of the L1 vertebral body and midway between the jugular notch and superior border of the pubic symphysis. Another transverse plane commonly used in anatomy is the subcostal plane, which passes through the 10th costal margin and the vertebral body L3. Additionally, the trans-tubercular plane, which is a horizontal plane passing through the iliac tubercles and in line with the 5th lumbar vertebrae, is often used to delineate abdominal regions in surface anatomy.

      The Transpyloric Plane and its Anatomical Landmarks

      The transpyloric plane is an imaginary horizontal line that passes through the body of the first lumbar vertebrae (L1) and the pylorus of the stomach. It is an important anatomical landmark used in clinical practice to locate various organs and structures in the abdomen.

      Some of the structures that lie on the transpyloric plane include the left and right kidney hilum (with the left one being at the same level as L1), the fundus of the gallbladder, the neck of the pancreas, the duodenojejunal flexure, the superior mesenteric artery, and the portal vein. The left and right colic flexure, the root of the transverse mesocolon, and the second part of the duodenum also lie on this plane.

      In addition, the upper part of the conus medullaris (the tapered end of the spinal cord) and the spleen are also located on the transpyloric plane. Knowing the location of these structures is important for various medical procedures, such as abdominal surgeries and diagnostic imaging.

      Overall, the transpyloric plane serves as a useful reference point for clinicians to locate important anatomical structures in the abdomen.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 14 - A 25-year-old woman visits the outpatient department with concerns of eyelid drooping, double...

    Incorrect

    • A 25-year-old woman visits the outpatient department with concerns of eyelid drooping, double vision, shortness of breath, and rapid breathing. These symptoms typically occur in the evening or after physical activity.

      What respiratory condition could be causing her symptoms?

      Your Answer:

      Correct Answer: Restrictive lung disease

      Explanation:

      The presence of myasthenia gravis can result in a restrictive pattern of lung disease due to weakened chest wall muscles, leading to incomplete expansion during inhalation.

      Occupational lung disease, also known as pneumoconioses, is caused by inhaling specific types of dust particles in the workplace, resulting in a restrictive pattern of lung disease. However, symptoms such as drooping eyelids and double vision are typically not associated with this condition.

      Pneumonia is an infection of the lung tissue that typically presents with symptoms such as coughing, chest pain, fever, and difficulty breathing.

      Pulmonary embolism is an acute condition that presents with symptoms such as chest pain, shortness of breath, and coughing up blood.

      Understanding the Differences between Obstructive and Restrictive Lung Diseases

      Obstructive and restrictive lung diseases are two distinct categories of respiratory conditions that affect the lungs in different ways. Obstructive lung diseases are characterized by a reduction in the flow of air through the airways due to narrowing or blockage, while restrictive lung diseases are characterized by a decrease in lung volume or capacity, making it difficult to breathe in enough air.

      Spirometry is a common diagnostic tool used to differentiate between obstructive and restrictive lung diseases. In obstructive lung diseases, the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is less than 80%, indicating a reduced ability to exhale air. In contrast, restrictive lung diseases are characterized by an FEV1/FVC ratio greater than 80%, indicating a reduced ability to inhale air.

      Examples of obstructive lung diseases include chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema, while asthma and bronchiectasis are also considered obstructive. Restrictive lung diseases include intrapulmonary conditions such as idiopathic pulmonary fibrosis, extrinsic allergic alveolitis, and drug-induced fibrosis, as well as extrapulmonary conditions such as neuromuscular diseases, obesity, and scoliosis.

      Understanding the differences between obstructive and restrictive lung diseases is important for accurate diagnosis and appropriate treatment. While both types of conditions can cause difficulty breathing, the underlying causes and treatment approaches can vary significantly.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 15 - A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During...

    Incorrect

    • A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During examination, granulation tissue is observed in the external auditory meatus. What is the probable causative agent of the infection?

      Your Answer:

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      The primary cause of malignant otitis externa is typically Pseudomonas aeruginosa. Symptoms of this condition include intense pain, headaches, and the presence of granulation tissue in the external auditory meatus. Individuals with diabetes mellitus are at a higher risk for developing this condition.

      Malignant Otitis Externa: A Rare but Serious Infection

      Malignant otitis externa is a type of ear infection that is uncommon but can be serious. It is typically found in individuals who are immunocompromised, with 90% of cases occurring in diabetics. The infection starts in the soft tissues of the external auditory meatus and can progress to involve the soft tissues and bony ear canal, eventually leading to temporal bone osteomyelitis.

      Key features in the patient’s history include diabetes or immunosuppression, severe and persistent ear pain, temporal headaches, and purulent otorrhea. In some cases, patients may also experience dysphagia, hoarseness, and facial nerve dysfunction.

      Diagnosis is typically done through a CT scan, and non-resolving otitis externa with worsening pain should be referred urgently to an ENT specialist. Treatment involves intravenous antibiotics that cover pseudomonal infections.

      In summary, malignant otitis externa is a rare but serious infection that requires prompt diagnosis and treatment. Patients with diabetes or immunosuppression should be particularly vigilant for symptoms and seek medical attention if they experience persistent ear pain or other related symptoms.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 16 - A 25-year-old man is receiving an endotracheal intubation. At which vertebral level does...

    Incorrect

    • A 25-year-old man is receiving an endotracheal intubation. At which vertebral level does the trachea originate?

      Your Answer:

      Correct Answer: C6

      Explanation:

      The trachea starts at the sixth cervical vertebrae and ends at the fifth thoracic vertebrae (or sixth in individuals with a tall stature during deep inhalation).

      Anatomy of the Trachea

      The trachea, also known as the windpipe, is a tube-like structure that extends from the C6 vertebrae to the upper border of the T5 vertebrae where it bifurcates into the left and right bronchi. It is supplied by the inferior thyroid arteries and the thyroid venous plexus, and innervated by branches of the vagus, sympathetic, and recurrent nerves.

      In the neck, the trachea is anterior to the isthmus of the thyroid gland, inferior thyroid veins, and anastomosing branches between the anterior jugular veins. It is also surrounded by the sternothyroid, sternohyoid, and cervical fascia. Posteriorly, it is related to the esophagus, while laterally, it is in close proximity to the common carotid arteries, right and left lobes of the thyroid gland, inferior thyroid arteries, and recurrent laryngeal nerves.

      In the thorax, the trachea is anterior to the manubrium, the remains of the thymus, the aortic arch, left common carotid arteries, and the deep cardiac plexus. Laterally, it is related to the pleura and right vagus on the right side, and the left recurrent nerve, aortic arch, and left common carotid and subclavian arteries on the left side.

      Overall, understanding the anatomy of the trachea is important for various medical procedures and interventions, such as intubation and tracheostomy.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 17 - A 25-year-old man who is an avid cyclist has been admitted to the...

    Incorrect

    • A 25-year-old man who is an avid cyclist has been admitted to the hospital with a severe asthma attack. He is currently in the hospital for two days and is able to speak in complete sentences. His bedside oxygen saturation is at 98%, and he has a heart rate of 58 bpm, blood pressure of 110/68 mmHg, and a respiratory rate of 14 bpm. He is not experiencing any fever. Upon physical examination, there are no notable findings. The blood gas results show a PaO2 of 5.4 kPa (11.3-12.6), PaCO2 of 6.0 kPa (4.7-6.0), pH of 7.38 (7.36-7.44), and HCO3 of 27 mmol/L (20-28). What could be the possible explanation for these results?

      Your Answer:

      Correct Answer: Venous sample

      Explanation:

      Suspecting Venous Blood Sample with Low PaO2 and Good Oxygen Saturation

      A low PaO2 level accompanied by a good oxygen saturation reading may indicate that the blood sample was taken from a vein rather than an artery. This suspicion is further supported if the patient appears to be in good health. It is unlikely that a faulty pulse oximeter is the cause of the discrepancy in readings. Therefore, it is important to consider the possibility of a venous blood sample when interpreting these results. Proper identification of the type of blood sample is crucial in accurately diagnosing and treating the patient’s condition.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 18 - Mrs. Johnson is an 82-year-old woman who visited her General practitioner complaining of...

    Incorrect

    • Mrs. Johnson is an 82-year-old woman who visited her General practitioner complaining of gradual worsening shortness of breath over the past two months. During the medical history, it was discovered that she has had Chronic Obstructive Pulmonary Disease (COPD) for 20 years.

      Upon examination, there are no breath sounds at both lung bases and a stony dull note to percussion over the same areas. Based on this clinical scenario, what is the probable cause of her recent exacerbation of shortness of breath?

      Your Answer:

      Correct Answer: Pleural transudate effusion secondary to cor pulmonale

      Explanation:

      The most likely cause of a pleural transudate is heart failure. This is due to the congestion of blood into the systemic venous circulation, which can result from long-standing COPD and increase in pulmonary vascular resistance leading to right-sided heart failure or cor pulmonale. Other options such as infective exacerbation of COPD or pulmonary edema secondary to heart failure are less likely to explain the clinical signs. Pleural exudate effusion secondary to cor pulmonale is also not the most appropriate answer as it would cause a transudate pleural effusion, not an exudate.

      Understanding the Causes and Features of Pleural Effusion

      Pleural effusion is a medical condition characterized by the accumulation of fluid in the pleural space, which is the area between the lungs and the chest wall. The causes of pleural effusion can be classified into two types: transudate and exudate. Transudate is characterized by a protein concentration of less than 30g/L and is commonly caused by heart failure, hypoalbuminemia, liver disease, and other conditions. On the other hand, exudate is characterized by a protein concentration of more than 30g/L and is commonly caused by infections, pneumonia, tuberculosis, and other conditions.

      The symptoms of pleural effusion may include dyspnea, non-productive cough, and chest pain. Upon examination, patients may exhibit dullness to percussion, reduced breath sounds, and reduced chest expansion. It is important to identify the underlying cause of pleural effusion to determine the appropriate treatment plan. Early diagnosis and treatment can help prevent complications and improve the patient’s overall health.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 19 - A 25-year-old man presents to the Emergency department with acute onset of shortness...

    Incorrect

    • A 25-year-old man presents to the Emergency department with acute onset of shortness of breath during a basketball game. He reports no history of trauma and is typically healthy. Upon examination, he appears tall and lean, and respiratory assessment reveals reduced breath sounds and hyper-resonant percussion notes on the right side. The trachea remains centrally located. A chest x-ray confirms a diagnosis of a collapsed lung due to a right-sided pneumothorax. What is the reason for the lung's failure to re-expand?

      Your Answer:

      Correct Answer: Increase in intrapleural pressure

      Explanation:

      The process of lung expansion relies on the negative pressure in the intrapleural space between the visceral and parietal pleura, which is present throughout respiration. This negative pressure pulls the lung towards the chest wall, allowing it to expand. However, if air enters the intrapleural space, the negative pressure is lost and the lung cannot fully reinflate. It is important to note that the intrapleural space is a potential space between the pleural surfaces, and there is typically no actual space present under normal circumstances.

      Management of Pneumothorax: BTS Guidelines

      Pneumothorax is a condition where air accumulates in the pleural space, causing the lung to collapse. The British Thoracic Society (BTS) has published guidelines for the management of spontaneous pneumothorax, which can be primary or secondary. Primary pneumothorax occurs without any underlying lung disease, while secondary pneumothorax is associated with lung disease.

      The BTS recommends that patients with a rim of air less than 2 cm and no shortness of breath may be discharged, while those with a larger rim of air or shortness of breath should undergo aspiration or chest drain insertion. For secondary pneumothorax, patients over 50 years old with a rim of air greater than 2 cm or shortness of breath should undergo chest drain insertion. Aspiration may be attempted for those with a rim of air between 1-2 cm, but chest drain insertion is recommended if aspiration fails.

      Patients with iatrogenic pneumothorax, which is caused by medical procedures, have a lower likelihood of recurrence than those with spontaneous pneumothorax. Observation is usually sufficient, but chest drain insertion may be required in some cases. Ventilated patients and those with chronic obstructive pulmonary disease (COPD) may require chest drain insertion.

      Patients with pneumothorax should be advised to avoid smoking to reduce the risk of further episodes. They should also be aware of restrictions on air travel and scuba diving. The CAA recommends a waiting period of two weeks after successful drainage before air travel, while the BTS advises against scuba diving unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.

      In summary, the BTS guidelines provide a comprehensive approach to the management of pneumothorax, taking into account the type of pneumothorax and the patient’s individual circumstances. Early intervention and appropriate follow-up can help prevent complications and improve outcomes.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 20 - A 54-year-old man comes to the emergency department complaining of difficulty breathing. The...

    Incorrect

    • A 54-year-old man comes to the emergency department complaining of difficulty breathing. The results of his pulmonary function tests are as follows:

      Reference Range
      FVC (% predicted) 102 80-120
      FEV1 (% predicted) 62 80-120
      FEV1/FVC (%) 60.1 >70
      TCLO (% predicted) 140 60-120

      What is the probable reason for his symptoms?

      Your Answer:

      Correct Answer: Asthma exacerbation

      Explanation:

      The raised transfer factor suggests that the patient is experiencing an exacerbation of asthma. This condition can cause obstructive patterns on pulmonary function tests, leading to reduced FEV1 and FEV1/FVC, as well as hypoxia and wheezing. However, other conditions such as COPD exacerbation, idiopathic pulmonary fibrosis, and pulmonary embolism would result in a low transfer factor, and are therefore unlikely explanations for the patient’s symptoms.

      Understanding Transfer Factor in Lung Function Testing

      The transfer factor is a measure of how quickly a gas diffuses from the alveoli into the bloodstream. This is typically tested using carbon monoxide, and the results can be given as either the total gas transfer (TLCO) or the transfer coefficient corrected for lung volume (KCO). A raised TLCO may be caused by conditions such as asthma, pulmonary haemorrhage, left-to-right cardiac shunts, polycythaemia, hyperkinetic states, male gender, or exercise. On the other hand, a lower TLCO may be indicative of pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary oedema, emphysema, anaemia, or low cardiac output.

      KCO tends to increase with age, and certain conditions may cause an increased KCO with a normal or reduced TLCO. These conditions include pneumonectomy/lobectomy, scoliosis/kyphosis, neuromuscular weakness, and ankylosis of costovertebral joints (such as in ankylosing spondylitis). Understanding transfer factor is important in lung function testing, as it can provide valuable information about a patient’s respiratory health and help guide treatment decisions.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 21 - A 35-year-old man is stabbed in the right chest and requires a thoracotomy....

    Incorrect

    • A 35-year-old man is stabbed in the right chest and requires a thoracotomy. During the procedure, the right lung is mobilized and the pleural reflection at the lung hilum is opened. Which of the following structures is not located in this area?

      Your Answer:

      Correct Answer: Azygos vein

      Explanation:

      The pulmonary ligament extends from the pleural reflections surrounding the hilum of the lung and covers the pulmonary vessels and bronchus. However, it does not contain the azygos vein.

      Anatomy of the Lungs

      The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 22 - A 75-year-old man visits his doctor complaining of weight loss and feeling full...

    Incorrect

    • A 75-year-old man visits his doctor complaining of weight loss and feeling full quickly. During the abdominal examination, the doctor notices a swollen lymph node in the left supraclavicular region. The doctor suspects that this could be a sign of gastric cancer with the spread of tumor emboli through the thoracic duct as it ascends from the abdomen into the mediastinum. Can you name the two other structures that pass through the diaphragm along with the thoracic duct?

      Your Answer:

      Correct Answer: Aorta and azygous vein

      Explanation:

      The point at which the aorta, thoracic duct, and azygous vein cross the diaphragm is at T12, specifically at the aortic opening. This is also where the oesophageal branches of the left gastric veins, the vagal trunk, and the oesophagus pass through the diaphragm, at the oesophageal opening located at T10. The left phrenic nerve and sympathetic trunk have their own separate openings in the diaphragm. A lymph node in the left supraclavicular fossa, known as Virchow’s node, is a characteristic sign of early gastric carcinoma.

      Structures Perforating the Diaphragm

      The diaphragm is a dome-shaped muscle that separates the thoracic and abdominal cavities. It plays a crucial role in breathing by contracting and relaxing to create negative pressure in the lungs. However, there are certain structures that perforate the diaphragm, allowing them to pass through from the thoracic to the abdominal cavity. These structures include the inferior vena cava at the level of T8, the esophagus and vagal trunk at T10, and the aorta, thoracic duct, and azygous vein at T12.

      To remember these structures and their corresponding levels, a helpful mnemonic is I 8(ate) 10 EGGS AT 12. This means that the inferior vena cava is at T8, the esophagus and vagal trunk are at T10, and the aorta, thoracic duct, and azygous vein are at T12. Knowing these structures and their locations is important for medical professionals, as they may need to access or treat them during surgical procedures or diagnose issues related to them.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 23 - A 12-year-old girl is referred to a respiratory specialist due to persistent episodes...

    Incorrect

    • A 12-year-old girl is referred to a respiratory specialist due to persistent episodes of shortness of breath. She also suffers from severe hay fever and eczema. After undergoing a peak expiratory flow test, signs of outflow obstruction of her lungs are detected. The doctor prescribes beclomethasone and salbutamol for her and advises her mother to keep her away from dust, as asthma is often linked to hypersensitivity to dust. Which type of hypersensitivity is associated with asthma?

      Your Answer:

      Correct Answer: Type 1 hypersensitivity

      Explanation:

      Asthma is linked to type 1 hypersensitivity, which is caused by the binding of IgE to Mast cells, resulting in an inflammatory reaction. Other types of hypersensitivity include type 2, which involves the binding of IgG or IgM to cell surface antigens, type 3, which is immune complex-mediated, and type 4, which is T-cell mediated.

      Asthma is a common respiratory disorder that affects both children and adults. It is characterized by chronic inflammation of the airways, resulting in reversible bronchospasm and airway obstruction. While asthma can develop at any age, it typically presents in childhood and may improve or resolve with age. However, it can also persist into adulthood and cause significant morbidity, with around 1,000 deaths per year in the UK.

      Several risk factors can increase the likelihood of developing asthma, including a personal or family history of atopy, antenatal factors such as maternal smoking or viral infections, low birth weight, not being breastfed, exposure to allergens and air pollution, and the hygiene hypothesis. Patients with asthma may also suffer from other atopic conditions such as eczema and hay fever, and some may be sensitive to aspirin. Occupational asthma is also a concern for those exposed to allergens in the workplace.

      Symptoms of asthma include coughing, dyspnea, wheezing, and chest tightness, with coughing often worse at night. Signs may include expiratory wheezing on auscultation and reduced peak expiratory flow rate. Diagnosis is typically made through spirometry, which measures the volume and speed of air during exhalation and inhalation.

      Management of asthma typically involves the use of inhalers to deliver drug therapy directly to the airways. Short-acting beta-agonists such as salbutamol are the first-line treatment for relieving symptoms, while inhaled corticosteroids like beclometasone dipropionate and fluticasone propionate are used for daily maintenance therapy. Long-acting beta-agonists like salmeterol and leukotriene receptor antagonists like montelukast may also be used in combination with other medications. Maintenance and reliever therapy (MART) is a newer approach that combines ICS and a fast-acting LABA in a single inhaler for both daily maintenance and symptom relief. Recent guidelines recommend offering a leukotriene receptor antagonist instead of a LABA for patients on SABA + ICS whose asthma is not well controlled, and considering MART for those with poorly controlled asthma.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 24 - A 49-year-old man experiences blunt force trauma to the head and subsequently experiences...

    Incorrect

    • A 49-year-old man experiences blunt force trauma to the head and subsequently experiences respiratory distress, leading to hypercapnia. What is the most probable consequence of this condition?

      Your Answer:

      Correct Answer: Cerebral vasodilation

      Explanation:

      Cerebral vasodilation is a common result of hypercapnia, which can be problematic for patients with cranial trauma due to the potential increase in intracranial pressure.

      Understanding the Monro-Kelly Doctrine and Autoregulation in the CNS

      The Monro-Kelly doctrine governs the pressure within the cranium by considering the skull as a closed box. The loss of cerebrospinal fluid (CSF) can accommodate increases in mass until a critical point is reached, usually at 100-120ml of CSF lost. Beyond this point, intracranial pressure (ICP) rises sharply, and pressure will eventually equate with mean arterial pressure (MAP), leading to neuronal death and herniation.

      The central nervous system (CNS) has the ability to autoregulate its own blood supply through vasoconstriction and dilation of cerebral blood vessels. However, extreme blood pressure levels can exceed this capacity, increasing the risk of stroke. Additionally, metabolic factors such as hypercapnia can cause vasodilation, which is crucial in ventilating head-injured patients.

      It is important to note that the brain can only metabolize glucose, and a decrease in glucose levels can lead to impaired consciousness. Understanding the Monro-Kelly doctrine and autoregulation in the CNS is crucial in managing intracranial pressure and preventing neurological damage.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 25 - A 55-year-old man visits his GP complaining of shortness of breath, haemoptysis, and...

    Incorrect

    • A 55-year-old man visits his GP complaining of shortness of breath, haemoptysis, and unintentional weight loss over the past 3 months. The GP refers him to the respiratory clinic for suspected lung cancer, and further investigations reveal a stage 2 squamous cell carcinoma of the lung. What is the most frequently associated paraneoplastic phenomenon with this type of cancer?

      Your Answer:

      Correct Answer: Parathyroid hormone-related protein (PTHrP)

      Explanation:

      The correct answer is PTHrP, which is a paraneoplastic syndrome often associated with squamous cell lung cancer. PTHrP is a protein that functions similarly to parathyroid hormone and can cause hypercalcaemia when secreted by cancer cells.

      Acanthosis nigricans is another paraneoplastic phenomenon that is commonly associated with gastric adenocarcinoma. This condition causes hyperpigmentation of skin folds, such as the armpits.

      The syndrome of inappropriate ADH secretion is often linked to small cell lung cancer. This condition involves the hypersecretion of ADH, which leads to dilutional hyponatraemia and its associated symptoms.

      Carcinoid syndrome is a paraneoplastic syndrome that is typically associated with neuroendocrine tumours that have metastasised to the liver. This condition causes hypersecretion of serotonin and other substances, resulting in facial flushing, palpitations, and gastrointestinal upset.

      Lung cancer can present with paraneoplastic features, which are symptoms caused by the cancer but not directly related to the tumor itself. Small cell lung cancer can cause the secretion of ADH and, less commonly, ACTH, which can lead to hypertension, hyperglycemia, hypokalemia, alkalosis, and muscle weakness. Lambert-Eaton syndrome is also associated with small cell lung cancer. Squamous cell lung cancer can cause the secretion of parathyroid hormone-related protein, leading to hypercalcemia, as well as clubbing and hypertrophic pulmonary osteoarthropathy. Adenocarcinoma can cause gynecomastia and hypertrophic pulmonary osteoarthropathy. Hypertrophic pulmonary osteoarthropathy is a painful condition involving the proliferation of periosteum in the long bones. Although traditionally associated with squamous cell carcinoma, some studies suggest that adenocarcinoma is the most common cause.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 26 - A 30-year-old female complains of weakness, weight gain, and cold intolerance. You suspect...

    Incorrect

    • A 30-year-old female complains of weakness, weight gain, and cold intolerance. You suspect hypothyroidism. What vocal change would you anticipate to have occurred, increasing the probability of this potential diagnosis?

      Your Answer:

      Correct Answer: Hoarse voice

      Explanation:

      Hoarseness is a symptom that can be caused by hypothyroidism.

      When a patient presents with hoarseness, it can be difficult to determine the underlying cause. However, if the hoarseness is accompanied by other symptoms commonly associated with hypothyroidism, it can help narrow down the diagnosis.

      The reason for the voice change in hypothyroidism is due to the thickening of the vocal cords caused by the accumulation of mucopolysaccharide. This substance, also known as glycosaminoglycans, is found throughout the body in mucus and joint fluid. When it builds up in the vocal cords, it can lower the pitch of the voice. The thyroid hormone plays a role in preventing this buildup.

      Hoarseness can be caused by various factors such as overusing the voice, smoking, viral infections, hypothyroidism, gastro-oesophageal reflux, laryngeal cancer, and lung cancer. It is important to investigate the underlying cause of hoarseness, and a chest x-ray may be necessary to rule out any apical lung lesions.

      If laryngeal cancer is suspected, it is recommended to refer the patient to an ENT specialist through a suspected cancer pathway. This referral should be considered for individuals who are 45 years old and above and have persistent unexplained hoarseness or an unexplained lump in the neck. Early detection and treatment of laryngeal cancer can significantly improve the patient’s prognosis.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 27 - Which of the structures listed below are not located within the mediastinum? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Vertebral bodies

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 28 - A 40-year-old woman visits her GP after being treated at the Emergency Department...

    Incorrect

    • A 40-year-old woman visits her GP after being treated at the Emergency Department for a foreign body lodged in her throat for 2 days. Although the object has been removed, she is experiencing difficulty swallowing. Upon further questioning, she mentions altered sensation while swallowing, describing it as a sensation of 'not feeling like food is being swallowed' during meals.

      Which nerve or nerves are likely to have been affected?

      Your Answer:

      Correct Answer: Internal laryngeal nerve

      Explanation:

      The internal laryngeal nerve is responsible for providing sensory information to the supraglottis and branches off from the superior laryngeal nerve. It is important to note that the cervical plexus, external laryngeal nerve, recurrent laryngeal nerve, and superior laryngeal nerve do not perform the same function as the internal laryngeal nerve.

      Anatomy of the Larynx

      The larynx is located in the front of the neck, between the third and sixth cervical vertebrae. It is made up of several cartilaginous segments, including the paired arytenoid, corniculate, and cuneiform cartilages, as well as the single thyroid, cricoid, and epiglottic cartilages. The cricoid cartilage forms a complete ring. The laryngeal cavity extends from the laryngeal inlet to the inferior border of the cricoid cartilage and is divided into three parts: the laryngeal vestibule, the laryngeal ventricle, and the infraglottic cavity.

      The vocal folds, also known as the true vocal cords, control sound production. They consist of the vocal ligament and the vocalis muscle, which is the most medial part of the thyroarytenoid muscle. The glottis is composed of the vocal folds, processes, and rima glottidis, which is the narrowest potential site within the larynx.

      The larynx is also home to several muscles, including the posterior cricoarytenoid, lateral cricoarytenoid, thyroarytenoid, transverse and oblique arytenoids, vocalis, and cricothyroid muscles. These muscles are responsible for various actions, such as abducting or adducting the vocal folds and relaxing or tensing the vocal ligament.

      The larynx receives its arterial supply from the laryngeal arteries, which are branches of the superior and inferior thyroid arteries. Venous drainage is via the superior and inferior laryngeal veins. Lymphatic drainage varies depending on the location within the larynx, with the vocal cords having no lymphatic drainage and the supraglottic and subglottic parts draining into different lymph nodes.

      Overall, understanding the anatomy of the larynx is important for proper diagnosis and treatment of various conditions affecting this structure.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 29 - A 35-year-old man comes to the clinic complaining of worsening retrosternal chest pain...

    Incorrect

    • A 35-year-old man comes to the clinic complaining of worsening retrosternal chest pain that radiates to the neck and shoulders and is pleuritic in nature. During examination, a pericardial friction rub is heard at the end of expiration. The diagnosis is pericarditis. What nerve supplies this area?

      Your Answer:

      Correct Answer: Phrenic nerve

      Explanation:

      The correct answer is the phrenic nerve, which provides sensory innervation to the pericardium, the central part of the diaphragm, and the mediastinal part of the parietal pleura. It also supplies motor function to the diaphragm. The long thoracic nerve, medial pectoral nerve, thoracodorsal nerve, and vagus nerve are all incorrect answers.

      The Phrenic Nerve: Origin, Path, and Supplies

      The phrenic nerve is a crucial nerve that originates from the cervical spinal nerves C3, C4, and C5. It supplies the diaphragm and provides sensation to the central diaphragm and pericardium. The nerve passes with the internal jugular vein across scalenus anterior and deep to the prevertebral fascia of the deep cervical fascia.

      The right phrenic nerve runs anterior to the first part of the subclavian artery in the superior mediastinum and laterally to the superior vena cava. In the middle mediastinum, it is located to the right of the pericardium and passes over the right atrium to exit the diaphragm at T8. On the other hand, the left phrenic nerve passes lateral to the left subclavian artery, aortic arch, and left ventricle. It passes anterior to the root of the lung and pierces the diaphragm alone.

      Understanding the origin, path, and supplies of the phrenic nerve is essential in diagnosing and treating conditions that affect the diaphragm and pericardium.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 30 - A 14-year-old girl presents to her GP with complaints of earache and hearing...

    Incorrect

    • A 14-year-old girl presents to her GP with complaints of earache and hearing difficulty in her left ear. Upon examination, her GP observes a bulging tympanic membrane and diagnoses her with acute otitis media. The GP prescribes a course of oral antibiotics.

      However, after a few days, the girl's fever persists and her pain worsens, prompting her to visit the emergency department. Upon examination, the girl has a tender and erythematous retro-auricular swelling with a temperature of 38.9ÂșC. She has no ear discharge, and the rest of her examination is unremarkable.

      What complication has developed in this case?

      Your Answer:

      Correct Answer: Mastoiditis

      Explanation:

      Mastoiditis is a potential complication of acute otitis media, which can cause pain and swelling behind the ear over the mastoid bone. However, there is no evidence of tympanic membrane perforation, neurological symptoms or signs of meningitis or brain abscess, or facial nerve injury in this case.

      Acute otitis media is a common condition in young children, often caused by bacterial infections following viral upper respiratory tract infections. Symptoms include ear pain, fever, and hearing loss, and diagnosis is based on criteria such as the presence of a middle ear effusion and inflammation of the tympanic membrane. Antibiotics may be prescribed in certain cases, and complications can include perforation of the tympanic membrane, hearing loss, and more serious conditions such as meningitis and brain abscess.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory System (3/7) 43%
Passmed