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  • Question 1 - You are evaluating a patient with Dupuytren's contracture in a pre-operative orthopaedic clinic....

    Correct

    • You are evaluating a patient with Dupuytren's contracture in a pre-operative orthopaedic clinic. You request the patient to flex their fingers at the distal interphalangeal joints.

      Which muscle's function is being evaluated in this case?

      Your Answer: Flexor digitorum profundus

      Explanation:

      The function of flexor digitorum profundus is to flex the fingers at both interphalangeal joints and the metacarpophalangeal joints, with a specific responsibility for flexing the distal interphalangeal joint. In contrast, flexor digitorum superficialis only flexes the metacarpophalangeal and proximal interphalangeal joints of the fingers, and must be isolated from the action of flexor digitorum profundus to assess its function. Flexor hallucis longus, on the other hand, flexes the joints of the great toe but not the distal interphalangeal joints.

      The forearm flexor muscles include the flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus. These muscles originate from the common flexor origin and surrounding fascia, and are innervated by the median and ulnar nerves. Their actions include flexion and abduction of the carpus, wrist flexion, adduction of the carpus, and flexion of the metacarpophalangeal and interphalangeal joints.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      39.3
      Seconds
  • Question 2 - A 56-year-old woman visits the clinic complaining of swelling and heaviness in her...

    Correct

    • A 56-year-old woman visits the clinic complaining of swelling and heaviness in her right leg. She is concerned about the appearance of her leg and attributes the worsening of the heaviness to her job as a security officer, which requires her to stand for extended periods. The patient's height is 160 centimetres, and her weight is 85 kilograms. During the examination, the doctor observes spidery swellings on the inside of her thigh that extend to the back of her leg. Palpation reveals mild tenderness. The doctor has ordered a duplex ultrasound for further assessment and advised the patient to wear graduated compression stockings. What is the most probable cause of this patient's condition?

      Your Answer: Incompetency of superficial venous valves

      Explanation:

      Varicose veins occur when the valves in the superficial veins become incompetent, leading to dilated and twisted veins. Risk factors include aging, prolonged standing, and obesity. Symptoms may include pain, itching, and cosmetic concerns, and severe cases can lead to complications such as ulcers and bleeding. Diagnosis is confirmed by duplex ultrasound, and treatment includes lifestyle modifications and compression stockings. Heart failure, deep venous valve incompetency, and leg skin infection are not causes of varicose veins.

      Understanding Varicose Veins

      Varicose veins are enlarged and twisted veins that occur when the valves in the veins become weak or damaged, causing blood to flow backward and pool in the veins. They are most commonly found in the legs and can be caused by various factors such as age, gender, pregnancy, obesity, and genetics. While many people seek treatment for cosmetic reasons, others may experience symptoms such as aching, throbbing, and itching. In severe cases, varicose veins can lead to skin changes, bleeding, superficial thrombophlebitis, and venous ulceration.

      To diagnose varicose veins, a venous duplex ultrasound is typically performed to detect retrograde venous flow. Treatment options vary depending on the severity of the condition. Conservative treatments such as leg elevation, weight loss, regular exercise, and compression stockings may be recommended for mild cases. However, patients with significant or troublesome symptoms, skin changes, or a history of bleeding or ulcers may require referral to a specialist for further evaluation and treatment. Possible treatments include endothermal ablation, foam sclerotherapy, or surgery.

      In summary, varicose veins are a common condition that can cause discomfort and cosmetic concerns. While many cases do not require intervention, it is important to seek medical attention if symptoms or complications arise. With proper diagnosis and treatment, patients can manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Cardiovascular System
      51.3
      Seconds
  • Question 3 - A 12-day-old infant named Max is brought to the paediatric assessment unit due...

    Correct

    • A 12-day-old infant named Max is brought to the paediatric assessment unit due to yellowing of the skin that started 3 days ago. Max is currently in a bright and alert state and has not experienced any fever. The baby has been passing urine and stool normally, and the mother has not noticed any changes in this regard.

      Apart from the jaundice, the mother has no other concerns, and Max has been thriving since birth. Max was born at term, is breastfed, and there are no other children in the house.

      Hb: 140 g/L Male: (135-180) Female: (115 - 160)

      Bilirubin: 30 µmol/L (3 - 17)

      Upon further testing, it is revealed that Max's unconjugated bilirubin levels are 26 µmol/L. Based on these findings, what is the most likely cause of the jaundice in Max's case?

      Your Answer: Hepatic immaturity

      Explanation:

      Neonatal jaundice caused by physiological factors is a result of the liver’s immaturity and the breakdown of fetal hemoglobin. To determine the cause of jaundice, both clinical symptoms and laboratory findings are crucial. In this case, the presence of isolated unconjugated hyperbilirubinemia without any clinical signs is indicative of physiological jaundice. This type of jaundice is common in the first few weeks of life and is caused by the immaturity of the liver and increased breakdown of hemoglobin. The fact that the baby is being breastfed also supports this diagnosis. Obstructive jaundice, on the other hand, would present with an obstructive picture and an elevated conjugated bilirubin level, which is not the case here. In MCQs, the history often provides clues, such as pale stools and dark urine.

      Understanding Jaundice in Newborns

      Jaundice is a common condition in newborns that occurs due to the accumulation of bilirubin in the blood. The severity and duration of jaundice can vary depending on the cause and age of the baby. Jaundice in the first 24 hours is always considered pathological and can be caused by conditions such as rhesus haemolytic disease, ABO haemolytic disease, hereditary spherocytosis, and glucose-6-phosphodehydrogenase deficiency.

      Jaundice in the neonate from 2-14 days is usually physiological and affects up to 40% of babies. It is more commonly seen in breastfed babies and is due to a combination of factors such as more red blood cells, fragile red blood cells, and less developed liver function. However, if jaundice persists after 14 days (21 days if premature), a prolonged jaundice screen is performed to identify the cause. This includes tests for conjugated and unconjugated bilirubin, direct antiglobulin test, TFTs, FBC and blood film, urine for MC&S and reducing sugars, and U&Es and LFTs.

      Prolonged jaundice can be caused by conditions such as biliary atresia, hypothyroidism, galactosaemia, urinary tract infection, breast milk jaundice, prematurity, and congenital infections like CMV and toxoplasmosis. Breast milk jaundice is more common in breastfed babies and is thought to be due to high concentrations of beta-glucuronidase, which increases the intestinal absorption of unconjugated bilirubin. It is important to identify the cause of prolonged jaundice as some conditions like biliary atresia require urgent surgical intervention, while others like hypothyroidism can lead to developmental delays if left untreated.

    • This question is part of the following fields:

      • General Principles
      51.7
      Seconds
  • Question 4 - 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
      95.1
      Seconds
  • Question 5 - In scientific experimentation, what is the term used to describe the movement of...

    Correct

    • In scientific experimentation, what is the term used to describe the movement of charged particles or solutes in a liquid medium due to an electric field?

      Your Answer: Electrophoresis

      Explanation:

      Electrophoresis: Separating Molecules Based on Charge and Mass

      Electrophoresis is a technique that separates solutes, molecules, or nucleic acids based on their mass and charge. It involves the migration of charged particles in a liquid medium under the influence of an electric field. The apparatus consists of two electrodes placed at either end of a support medium, or gel, which is suspended in a buffer solution. The sample is inserted into a well and a current is applied. Over time, positively charged solutes move towards the negative electrode, while negatively charged substances move towards the positive electrode. Once the migration is complete, the gel is removed and stained to color the substance being tested for, such as protein.

      This technique is widely used in medical testing, but it requires a higher degree of operational and interpretive skill than many other tests, which is why it often takes longer to get a result. Electrophoresis has various uses and adaptations, such as standard electrophoresis for protein detection in the diagnosis of myeloma, identification of unusual lipid fractions in patients with inherited diseases, and detection of viral DNA through Southern Blotting. There is also Northern blotting, primarily a research technique at present, which uses electrophoresis to separate RNA. Additionally, Western blotting is used to test for the presence of antibodies to DNA through protein separation.

    • This question is part of the following fields:

      • Basic Sciences
      8.2
      Seconds
  • Question 6 - Does the external branch of the superior laryngeal nerve innervate the cricothyroid muscle?...

    Incorrect

    • Does the external branch of the superior laryngeal nerve innervate the cricothyroid muscle?

      Your Answer: Transverse arytenoid

      Correct Answer: Cricothyroid

      Explanation:

      The intrinsic muscles of the larynx, with the exception of the cricothyroid muscle, are innervated by the innervation. The cricothyroid muscle is innervated by the external branch of the superior laryngeal nerve.

      The Recurrent Laryngeal Nerve: Anatomy and Function

      The recurrent laryngeal nerve is a branch of the vagus nerve that plays a crucial role in the innervation of the larynx. It has a complex path that differs slightly between the left and right sides of the body. On the right side, it arises anterior to the subclavian artery and ascends obliquely next to the trachea, behind the common carotid artery. It may be located either anterior or posterior to the inferior thyroid artery. On the left side, it arises left to the arch of the aorta, winds below the aorta, and ascends along the side of the trachea.

      Both branches pass in a groove between the trachea and oesophagus before entering the larynx behind the articulation between the thyroid cartilage and cricoid. Once inside the larynx, the recurrent laryngeal nerve is distributed to the intrinsic larynx muscles (excluding cricothyroid). It also branches to the cardiac plexus and the mucous membrane and muscular coat of the oesophagus and trachea.

      Damage to the recurrent laryngeal nerve, such as during thyroid surgery, can result in hoarseness. Therefore, understanding the anatomy and function of this nerve is crucial for medical professionals who perform procedures in the neck and throat area.

    • This question is part of the following fields:

      • Neurological System
      28.7
      Seconds
  • Question 7 - Which one of the following statements is true regarding interferon? ...

    Incorrect

    • Which one of the following statements is true regarding interferon?

      Your Answer: Interferon-gamma has stronger antiviral action than interferon-alpha

      Correct Answer: Interferon-alpha and interferon-beta bind to the same type of receptor

      Explanation:

      Understanding Interferons

      Interferons are a type of cytokine that the body produces in response to viral infections and neoplasia. They are categorized based on the type of receptor they bind to and their cellular origin. IFN-alpha and IFN-beta bind to type 1 receptors, while IFN-gamma binds only to type 2 receptors.

      IFN-alpha is produced by leucocytes and has antiviral properties. It is commonly used to treat hepatitis B and C, Kaposi’s sarcoma, metastatic renal cell cancer, and hairy cell leukemia. However, it can cause flu-like symptoms and depression as side effects.

      IFN-beta is produced by fibroblasts and also has antiviral properties. It is particularly useful in reducing the frequency of exacerbations in patients with relapsing-remitting multiple sclerosis.

      IFN-gamma is mainly produced by natural killer cells and T helper cells. It has weaker antiviral properties but plays a significant role in immunomodulation, particularly in macrophage activation. It may be beneficial in treating chronic granulomatous disease and osteopetrosis.

      Understanding the different types of interferons and their functions can help in the development of targeted treatments for various diseases.

    • This question is part of the following fields:

      • General Principles
      27.9
      Seconds
  • Question 8 - A study investigating the effectiveness of a new medication to reduce agitation in...

    Incorrect

    • A study investigating the effectiveness of a new medication to reduce agitation in 30 participants aged 65 and above with dementia measures the number of episodes of agitation in a four hour period before and after treatment. The data collected is not normally distributed.

      Which statistical test would be most suitable for analyzing the results of this study?

      Your Answer: Mann-Whitney U test

      Correct Answer: Wilcoxon signed-rank test

      Explanation:

      Types of Significance Tests

      Significance tests are used to determine whether the results of a study are statistically significant or simply due to chance. The type of significance test used depends on the type of data being analyzed. Parametric tests are used for data that can be measured and are usually normally distributed, while non-parametric tests are used for data that cannot be measured in this way.

      Parametric tests include the Student’s t-test, which can be paired or unpaired, and Pearson’s product-moment coefficient, which is used for correlation analysis. Non-parametric tests include the Mann-Whitney U test, which compares ordinal, interval, or ratio scales of unpaired data, and the Wilcoxon signed-rank test, which compares two sets of observations on a single sample. The chi-squared test is used to compare proportions or percentages, while Spearman and Kendall rank are used for correlation analysis.

      It is important to choose the appropriate significance test for the type of data being analyzed in order to obtain accurate and reliable results. By understanding the different types of significance tests available, researchers can make informed decisions about which test to use for their particular study.

    • This question is part of the following fields:

      • General Principles
      51.3
      Seconds
  • Question 9 - A 95-year-old man is discovered collapsed in his residence and is transported to...

    Correct

    • A 95-year-old man is discovered collapsed in his residence and is transported to the hospital. Upon examination, he is diagnosed with dehydration and hypotension, prompting the release of renin by the juxtaglomerular cells. What is the mechanism of action of renin?

      Your Answer: Hydrolyse angiotensinogen to form angiotensin I

      Explanation:

      Angiotensin I is formed when renin breaks down angiotensinogen, which is a process that occurs within the renin-angiotensin-aldosterone system and is facilitated by juxtaglomerular cells.

      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
      23.3
      Seconds
  • Question 10 - A 67-year-old man with a history of heart failure visits the clinic complaining...

    Incorrect

    • A 67-year-old man with a history of heart failure visits the clinic complaining of breathlessness for the past four weeks. The breathlessness worsens with activity or when lying down, and he needs to sleep on three large pillows at night. He is currently taking ramipril, bisoprolol, furosemide, and bendroflumethiazide. You are contemplating adding a low dose of spironolactone to his current treatment. What accurately describes the mechanism of action of spironolactone?

      Your Answer: Inhibit Na+ Cl- cotransporter

      Correct Answer: Aldosterone antagonist

      Explanation:

      Spironolactone is classified as an aldosterone antagonist, which is a type of potassium-sparing diuretic. It works by blocking the action of aldosterone on aldosterone receptors, which inhibits the Na+/K+ exchanger in the cortical collecting ducts. Amiloride is another potassium-sparing diuretic that inhibits the epithelial sodium channels in the cortical collecting ducts. Thiazide diuretics work by inhibiting the Na+ Cl- cotransporter in the distal convoluted tubule, while loop diuretics inhibit Na+ K+ 2Cl- cotransporters in the thick ascending loop of Henle. ACE inhibitors like ramipril, on the other hand, produce an antihypertensive effect by inhibiting ACE in the renin-angiotensin-aldosterone-system. In heart failure, diuretics are commonly used to reduce fluid overload and improve heart function. However, caution should be taken when using potassium-sparing diuretics like spironolactone in patients already at risk of hyperkalemia due to treatment with ACE inhibitors. Serum potassium levels should be monitored before and after starting spironolactone.

      Spironolactone is a medication that works as an aldosterone antagonist in the cortical collecting duct. It is used to treat various conditions such as ascites, hypertension, heart failure, nephrotic syndrome, and Conn’s syndrome. In patients with cirrhosis, spironolactone is often prescribed in relatively large doses of 100 or 200 mg to counteract secondary hyperaldosteronism. It is also used as a NICE ‘step 4’ treatment for hypertension. In addition, spironolactone has been shown to reduce all-cause mortality in patients with NYHA III + IV heart failure who are already taking an ACE inhibitor, according to the RALES study.

      However, spironolactone can cause adverse effects such as hyperkalaemia and gynaecomastia, although the latter is less common with eplerenone. It is important to monitor potassium levels in patients taking spironolactone to prevent hyperkalaemia, which can lead to serious complications such as cardiac arrhythmias. Overall, spironolactone is a useful medication for treating various conditions, but its potential adverse effects should be carefully considered and monitored.

    • This question is part of the following fields:

      • Renal System
      35.9
      Seconds
  • Question 11 - A 50-year-old man visits his GP with concerns about weight gain, decreased energy,...

    Incorrect

    • A 50-year-old man visits his GP with concerns about weight gain, decreased energy, low libido, and difficulty maintaining erections. The doctor orders a blood test to check his serum testosterone levels. What is responsible for stimulating testosterone secretion in the body?

      Your Answer:

      Correct Answer: Luteinising Hormone

      Explanation:

      Understanding Androgens and Male Hormones

      Androgens are the primary male sex hormones that play a crucial role in the development and functioning of reproductive organs and secondary sex characteristics. Testosterone is the main androgen, while dihydrotestosterone and androstenedione are other types. These hormones are also essential in maintaining bone density and mass to prevent osteoporosis.

      The regulation of hormone levels in the body relies on negative feedback. Luteinising hormone (LH) stimulates the Leydig cells in the testes to produce testosterone, which is synthesized from cholesterol. When testosterone levels are high, LH is suppressed through negative feedback. A small amount of testosterone is also produced in the adrenal glands.

      Other important male hormones include follicle-stimulating hormone (FSH) and dihydrotestosterone (DHT). DHT and testosterone bind to the same androgen receptors, contributing to the development of external genitalia in the fetus, secondary sex characteristics during puberty, and sperm production. DHT is a form of endogenous testosterone converted by the enzyme 5 alpha-reductase in the prostate.

      FSH and testosterone work together to stimulate the Sertoli cells in the testes to secrete androgen-binding protein, which binds to testosterone to maintain high levels. Androgen-binding protein is secreted into the lumen of the seminiferous tubules and interstitial fluid around spermatogenic cells. Once the required level of spermatogenesis is achieved, inhibin prevents the release of more FSH.

      In summary, understanding the role of androgens and male hormones is crucial in comprehending male reproductive health and development.

      Disorders of sex hormones can have various effects on the body, as shown in the table below. Primary hypogonadism, also known as Klinefelter’s syndrome, is characterized by high levels of gonadotrophins and low levels of testosterone. Patients with this condition often have small, firm testes, lack secondary sexual characteristics, and are infertile. They may also experience gynaecomastia, which increases their risk of breast cancer. Diagnosis is made through chromosomal analysis.

      Hypogonadotrophic hypogonadism, or Kallmann syndrome, is a cause of delayed puberty due to low levels of sex hormones. It is usually inherited as an X-linked recessive trait and is caused by the failure of GnRH-secreting neurons to migrate to the hypothalamus. Patients with this condition may have hypogonadism, cryptorchidism, anosmia, and low sex hormone levels. However, their LH and FSH levels are inappropriately low or normal. They are typically of normal or above-average height, but may also have cleft lip/palate and visual/hearing defects.

      Androgen insensitivity syndrome is an X-linked recessive condition that causes end-organ resistance to testosterone, resulting in genotypically male children (46XY) having a female phenotype. This condition is also known as complete androgen insensitivity syndrome or testicular feminisation syndrome. Patients with this condition may experience primary amenorrhoea, undescended testes causing groin swellings, and breast development due to the conversion of testosterone to oestradiol. Diagnosis is made through a buccal smear or chromosomal analysis to reveal a 46XY genotype. Management involves counselling to raise the child as female, bilateral orchidectomy to reduce the risk of testicular cancer due to undescended testes, and oestrogen therapy.

    • This question is part of the following fields:

      • Endocrine System
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  • Question 12 - A 67-year-old man with a stable angina history for two years visits his...

    Incorrect

    • A 67-year-old man with a stable angina history for two years visits his cardiologist for a regular check-up. During the review, the cardiologist observes that the patient's heart rate is low at 46 bpm. As a result, the cardiologist decides to replace his beta-blocker with a new anti-anginal drug called nicorandil.

      What is the mode of action of the patient's new medication?

      Your Answer:

      Correct Answer: Potassium channel activator through activation of guanylyl cyclase

      Explanation:

      Nicorandil activates potassium channels, leading to vasodilation. This activation triggers guanylyl cyclase, which increases the production of cyclic GMP (cGMP) and activates protein kinase G (PKG). PKG phosphorylates and inhibits GTPase RhoA, reducing Rho-kinase activity and increasing myosin phosphatase activity. As a result, the smooth muscle becomes less sensitive to calcium, leading to dilation of the large coronary arteries and improved perfusion. Nicorandil does not significantly affect calcium or sodium channels. This mechanism helps alleviate anginal symptoms.

      Nicorandil is a medication that is commonly used to treat angina. It works by activating potassium channels, which leads to vasodilation. This process is achieved through the activation of guanylyl cyclase, which results in an increase in cGMP. However, there are some adverse effects associated with the use of nicorandil, including headaches, flushing, and the development of ulcers on the skin, mucous membranes, and eyes. Additionally, gastrointestinal ulcers, including anal ulceration, may also occur. It is important to note that nicorandil should not be used in patients with left ventricular failure.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 13 - A 38-year-old woman visits her GP after being prescribed carbimazole for Grave's disease....

    Incorrect

    • A 38-year-old woman visits her GP after being prescribed carbimazole for Grave's disease. The GP must inform her of crucial side effects that require immediate medical attention if they occur. What is the most significant side effect?

      Your Answer:

      Correct Answer: Sore throat

      Explanation:

      Carbimazole, although generally safe, can have a rare but severe side effect of bone marrow suppression. This can lead to a weakened immune system due to low white blood cells, specifically neutrophils, resulting in neutropenia and agranulocytosis. The most common symptom of this is a sore throat, and if this occurs, treatment with carbimazole should be discontinued.

      Hair loss and headaches are common side effects but are not considered harmful to the patient’s health. Other reported side effects include nausea, stomach pains, itchy skin, rashes, and muscle and joint pain.

      It is important to note that chest pain and changes in vision are not known side effects of carbimazole.

      Carbimazole is a medication used to treat thyrotoxicosis, a condition where the thyroid gland produces too much thyroid hormone. It is usually given in high doses for six weeks until the patient’s thyroid hormone levels become normal, after which the dosage is reduced. The drug works by blocking thyroid peroxidase, an enzyme that is responsible for coupling and iodinating the tyrosine residues on thyroglobulin, which ultimately leads to a reduction in thyroid hormone production. In contrast, propylthiouracil has a dual mechanism of action, inhibiting both thyroid peroxidase and 5′-deiodinase, which reduces the peripheral conversion of T4 to T3.

      However, carbimazole is not without its adverse effects. One of the most serious side effects is agranulocytosis, a condition where the body’s white blood cell count drops significantly, making the patient more susceptible to infections. Additionally, carbimazole can cross the placenta and affect the developing fetus, although it may be used in low doses during pregnancy under close medical supervision. Overall, carbimazole is an effective medication for managing thyrotoxicosis, but its potential side effects should be carefully monitored.

    • This question is part of the following fields:

      • Endocrine System
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  • Question 14 - A geriatric medicine trainee has developed a research project that they aim to...

    Incorrect

    • A geriatric medicine trainee has developed a research project that they aim to publish in a high impact factor journal.

      Two groups of elderly patients with hypertension are randomly assigned to receive treatment with amlodipine or lisinopril for a six week period.

      At the end of the six week trial period, each participant is asked to rate the effectiveness of their specific treatment on lowering their blood pressure. The rating scale is from 1-5, where 1 indicates 'very ineffective' and 5 indicates 'very effective'.

      As the data is not normally distributed, what statistical test should be utilized to determine if there is a significant difference between the two treatments?

      Your Answer:

      Correct Answer: Mann-Whitney U test

      Explanation:

      The appropriate statistical test for comparing ordinal, interval, or ratio scales of unpaired data is the Mann-Whitney U test. This test is necessary when dealing with non-normally distributed data, such as Likert items. In contrast, the chi-squared test is used to compare percentages, while the student’s t-test (paired or unpaired) requires normally distributed data and/or paired observations. As the data in this scenario involves two different groups receiving different interventions, the Mann-Whitney U test is the most appropriate choice.

      Types of Significance Tests

      Significance tests are used to determine whether the results of a study are statistically significant or simply due to chance. The type of significance test used depends on the type of data being analyzed. Parametric tests are used for data that can be measured and are usually normally distributed, while non-parametric tests are used for data that cannot be measured in this way.

      Parametric tests include the Student’s t-test, which can be paired or unpaired, and Pearson’s product-moment coefficient, which is used for correlation analysis. Non-parametric tests include the Mann-Whitney U test, which compares ordinal, interval, or ratio scales of unpaired data, and the Wilcoxon signed-rank test, which compares two sets of observations on a single sample. The chi-squared test is used to compare proportions or percentages, while Spearman and Kendall rank are used for correlation analysis.

      It is important to choose the appropriate significance test for the type of data being analyzed in order to obtain accurate and reliable results. By understanding the different types of significance tests available, researchers can make informed decisions about which test to use for their particular study.

    • This question is part of the following fields:

      • General Principles
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  • Question 15 - A 75-year-old man presents to the emergency department with shortness of breath. He...

    Incorrect

    • A 75-year-old man presents to the emergency department with shortness of breath. He has no known medical conditions but is known to have a 80 pack-year smoking history. He reports that he has had a cough for the past six months, bringing up white sputum. An arterial blood gas reveals the following:

      pH 7.30 mmol/L (7.35-7.45)
      PaO2 9.1 kPa (10.5 - 13.5)
      PaCO2 6.2 kPa (5.1 - 5.6)
      Bicarbonate 34 mmol/L (22 - 29)

      What process is likely to occur in this patient?

      Your Answer:

      Correct Answer: Increased secretion of erythropoietin

      Explanation:

      Erythropoietin is produced by the kidney when there is a lack of oxygen in the body’s cells. Based on the patient’s smoking history and symptoms, it is probable that she has chronic obstructive pulmonary disorder (COPD). The type II respiratory failure and respiratory acidosis partially compensated by metabolic alkalosis suggest long-term changes. This chronic hypoxia triggers the secretion of erythropoietin, which increases the production of red blood cells, leading to polycythemia.

      The accumulation of digestive enzymes in the pancreas is a characteristic of cystic fibrosis, but it is unlikely to be a new diagnosis in a 73-year-old woman. Moreover, cystic fibrosis patients typically have an isolated/compensated metabolic alkalosis on ABG, not a metabolic alkalosis attempting to correct a respiratory acidosis.

      Excretion of bicarbonate is incorrect because bicarbonate would be secreted to further correct the respiratory acidosis, making this option incorrect.

      Mucociliary system damage is the process that occurs in bronchiectasis, which would likely present with purulent sputum rather than white sputum. Additionally, there is no medical history to suggest the development of bronchiectasis.

      Understanding Erythropoietin and its Side-Effects

      Erythropoietin is a type of growth factor that stimulates the production of red blood cells. It is produced by the kidneys in response to low oxygen levels in the body. Erythropoietin is commonly used to treat anemia associated with chronic kidney disease and chemotherapy. However, it is important to note that there are potential side-effects associated with its use.

      Some of the side-effects of erythropoietin include accelerated hypertension, bone aches, flu-like symptoms, skin rashes, and urticaria. In some cases, patients may develop pure red cell aplasia, which is caused by antibodies against erythropoietin. Additionally, erythropoietin can increase the risk of thrombosis due to raised PCV levels. Iron deficiency may also occur as a result of increased erythropoiesis.

      There are several reasons why patients may not respond to erythropoietin therapy, including iron deficiency, inadequate dosage, concurrent infection or inflammation, hyperparathyroid bone disease, and aluminum toxicity. It is important for healthcare providers to monitor patients closely for these potential side-effects and adjust treatment as necessary.

    • This question is part of the following fields:

      • Renal System
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  • Question 16 - You are working on a pediatric ward. The mother of a young patient...

    Incorrect

    • You are working on a pediatric ward. The mother of a young patient has recently had some blood tests performed in hospital. She says that her child was referred to a pediatrician by their general practitioner. She is anxious to find out the results.

      Whilst you are sitting at the nurses' station doing some paperwork she asks if you would mind looking up the results for her on the hospital reporting system.

      What should you do next?

      Your Answer:

      Correct Answer: Apologise that you cannot look up the results as you are not involved in her care and do not have the information and knowledge needed to interpret the results

      Explanation:

      Why Checking a Colleague’s Medical Test Results Could Do More Harm Than Good

      Whilst it may seem helpful to check a colleague’s medical test results and reassure them that everything is normal, there are several potential risks involved. Firstly, without specialist knowledge and access to the patient’s medical history, it may be difficult to accurately interpret the results. Additionally, if the results are reported as normal, there may still be pending results that you are not aware of, which could falsely reassure the patient.

      Furthermore, checking a colleague’s medical test results without a legitimate interest in their care could breach their confidentiality. This could result in inadvertently learning more about their medical history than they were willing to disclose.

      Therefore, the best course of action would be to politely decline the request and encourage the colleague to liaise with their consultant about the results. It is important to prioritize patient confidentiality and avoid potentially causing more harm than good.

    • This question is part of the following fields:

      • Ethics And Law
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  • Question 17 - A 24-year-old male arrives at the Emergency Department after sustaining a head injury...

    Incorrect

    • A 24-year-old male arrives at the Emergency Department after sustaining a head injury while playing football. He was struck on the back of his head and lost consciousness for a brief period before regaining it. According to his friend, he appeared to be fine after regaining consciousness except for a headache. However, he has lost consciousness again unexpectedly.

      A biconvex blood collection is revealed on a head CT scan. It does not seem to cross the suture lines.

      Where is the probable location of the bleed?

      Your Answer:

      Correct Answer: Between the dura mater and the skull

      Explanation:

      The outermost layer of the meninges is known as the dura mater. If a patient loses consciousness briefly after a head injury and then suddenly becomes unconscious again, it is likely that they have an extra-dural haematoma. This type of bleed is often caused by the middle meningeal artery, which supplies blood to the dura mater. The resulting blood collection between the skull and dura mater creates a biconvex shape on a CT scan that does not cross suture lines. In contrast, subdural haematomas occur in the potential space beneath the dura mater and are crescent-shaped on a CT scan that crosses suture lines. Subarachnoid bleeds typically cause a sudden, severe headache and appear as a lighter grey/white area in the subarachnoid space on a CT scan. A superficial scalp bleed would not be visible on a CT scan and is unlikely to cause loss of consciousness.

      The Three Layers of Meninges

      The meninges are a group of membranes that cover the brain and spinal cord, providing support to the central nervous system and the blood vessels that supply it. These membranes can be divided into three distinct layers: the dura mater, arachnoid mater, and pia mater.

      The outermost layer, the dura mater, is a thick fibrous double layer that is fused with the inner layer of the periosteum of the skull. It has four areas of infolding and is pierced by small areas of the underlying arachnoid to form structures called arachnoid granulations. The arachnoid mater forms a meshwork layer over the surface of the brain and spinal cord, containing both cerebrospinal fluid and vessels supplying the nervous system. The final layer, the pia mater, is a thin layer attached directly to the surface of the brain and spinal cord.

      The meninges play a crucial role in protecting the brain and spinal cord from injury and disease. However, they can also be the site of serious medical conditions such as subdural and subarachnoid haemorrhages. Understanding the structure and function of the meninges is essential for diagnosing and treating these conditions.

    • This question is part of the following fields:

      • Neurological System
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  • Question 18 - 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:

      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
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  • Question 19 - A young farmer suffers an accident with crop-spraying equipment and is drenched with...

    Incorrect

    • A young farmer suffers an accident with crop-spraying equipment and is drenched with insecticide. Upon arrival at the emergency department, he presents with severe bradycardia, shortness of breath, and excessive salivation. What are the possible mechanisms of poisoning in this case?

      Your Answer:

      Correct Answer: Acetylcholinesterase inhibition

      Explanation:

      Excessive salivation, dyspnea, and bradycardia are some of the symptoms that may result from anticholinesterase poisoning.

      Organophosphorus insecticides are potent and long-acting anticholinesterases that cause overactivity at parasympathetic receptors, leading to clinical features. Bronchospasm may cause breathlessness. Respiratory muscle paralysis and coma are the main acute effects of massive exposure.

      To counteract excessive acetylcholinergic activity in the autonomic nervous system, atropine is used. Pralidoxime is used to regenerate acetylcholinesterase.

      Salicylate poisoning occurs due to an overdose of aspirin. Symptoms after drug ingestion include abdominal pain, nausea, tinnitus, deafness, vertigo, and hyperpnea. Rehydration is crucial for general care. In severe cases, drug elimination can be enhanced by hemodialysis.

      Lithium is a mood stabilizing drug commonly used in bipolar depression. Acute lithium toxicity results in various neurological effects, progressing from confusion and motor impairment to coma, convulsions, and death. As lithium is excreted renally, fluid therapy is the mainstay of treatment.

      Paracetamol poisoning results in glutathione depletion. N-acetylcysteine, a glutathione precursor, is used as an antidote.

      Cholinergic receptors are proteins found in the body that are activated by the neurotransmitter acetylcholine. They are present in both the central and peripheral nervous systems and can be divided into two groups: nicotinic and muscarinic receptors. Nicotinic receptors are ligand-gated ion channels that allow the movement of sodium into the cell and potassium out, resulting in an inward flow of positive ions. Muscarinic receptors, on the other hand, are G-protein coupled receptors that exert their downstream effect by linking with different G-proteins.

      Nicotinic receptors are named after their binding capacity for nicotine, but they respond to acetylcholine. They are found in preganglionic neurons of the autonomic nervous system and at neuromuscular junctions. At preganglionic neurons, they create a local membrane depolarization through the movement of sodium into the cell, while at neuromuscular junctions, they initiate a wave of depolarization across the muscle cell. Muscarinic receptors are found in effector organs of the parasympathetic autonomic nervous system and are divided into five classes. They mediate various effects through different G-protein systems.

      Cholinergic receptors can be targeted pharmacologically using agonists and antagonists. For example, muscarinic antagonist ipratropium can be used to induce bronchodilation in asthma or chronic obstructive pulmonary disease. In myasthenia gravis, an autoimmune disease, antibodies are directed against the nicotinic receptor on the neuromuscular junction, resulting in skeletal muscle weakness. Understanding the effects associated with each type of cholinergic receptor is important in understanding physiological responses to drugs and disease.

    • This question is part of the following fields:

      • General Principles
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  • Question 20 - A middle-aged woman with myasthenia gravis experiences a myasthenic crisis leading to respiratory...

    Incorrect

    • A middle-aged woman with myasthenia gravis experiences a myasthenic crisis leading to respiratory failure. Which nerve root is most commonly affected in this scenario?

      Your Answer:

      Correct Answer: C4

      Explanation:

      The phrenic nerve receives input from C3, C4, and C5, which is essential for keeping the diaphragm functioning properly. In cases of medical emergencies, mechanical ventilation is often the first-line management. C2 primarily innervates muscles in the neck, while C7 and T1 are part of the brachial plexus and contribute to the formation of nerves in the upper limb.

      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
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  • Question 21 - What category of hallucination does Jane experience when she hears someone calling her...

    Incorrect

    • What category of hallucination does Jane experience when she hears someone calling her name while being alone in the house?

      Your Answer:

      Correct Answer: Hypnogogic hallucination

      Explanation:

      Types of Hallucinations

      Hypnogogic and hypnopompic hallucinations are two types of hallucinations that occur during the sleep cycle. Hypnogogic hallucinations happen when a person is falling asleep and can be auditory, visual, tactile, or kinaesthetic. On the other hand, hypnopompic hallucinations occur when a person is waking up, and the hallucination continues even after the person opens their eyes. These types of hallucinations are not indicative of any psychopathology and can occur in individuals with narcolepsy.

      Reflex hallucinations are another type of hallucination that occurs when a true sensory stimulus causes an hallucination in another sensory modality. Autoscopy is a unique experience where an individual sees themselves and knows that it is themselves. This experience is visual and is sometimes referred to as the ‘phantom mirror image.’ Finally, auditory illusions occur when an auditory stimulus is misrepresented or misinterpreted by the listener.

      In summary, there are various types of hallucinations that can occur in different stages of the sleep cycle or due to sensory stimuli. While these experiences may seem unusual, they do not necessarily indicate any underlying mental health issues.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 22 - A 13-year-old boy comes to the clinic with his mother complaining of ear...

    Incorrect

    • A 13-year-old boy comes to the clinic with his mother complaining of ear pain. He experienced the pain last night and was unable to sleep. As a result, he stayed home from school today. He reports that sounds are muffled on the affected side. During the examination, he has a fever. Otoscopy reveals a bulging tympanic membrane with visible fluid level, indicating a middle ear infection. The nerve to tensor tympani arises from which nerve?

      Your Answer:

      Correct Answer: Mandibular nerve

      Explanation:

      The mandibular nerve is the correct answer. It is the only division of the trigeminal nerve that carries motor fibers. The vestibulocochlear nerve is the eighth cranial nerve and has two components for balance and hearing. The glossopharyngeal nerve is the ninth cranial nerve and has various functions, including taste and sensation from the tongue, pharyngeal wall, and tonsils. The maxillary nerve carries only sensory fibers. The facial nerve is the seventh cranial nerve and supplies the muscles of facial expression and taste from the anterior two-thirds of the tongue. Tensor tympani is a muscle that dampens loud noises and is innervated through the nerve to tensor tympani, which arises from the mandibular nerve. The patient’s ear pain is likely due to otitis media, which is confirmed on otoscopy.

      The trigeminal nerve is the main sensory nerve of the head and also innervates the muscles of mastication. It has sensory distribution to the scalp, face, oral cavity, nose and sinuses, and dura mater, and motor distribution to the muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, and tensor palati. The nerve originates at the pons and has three branches: ophthalmic, maxillary, and mandibular. The ophthalmic and maxillary branches are sensory only, while the mandibular branch is both sensory and motor. The nerve innervates various muscles, including the masseter, temporalis, and pterygoids.

    • This question is part of the following fields:

      • Neurological System
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  • Question 23 - You assess a 40-year-old woman who underwent a renal transplant 10 months ago...

    Incorrect

    • You assess a 40-year-old woman who underwent a renal transplant 10 months ago for focal segmental glomerulosclerosis. She is currently taking a combination of tacrolimus, mycophenolate, and prednisolone. She complains of feeling unwell for the past five days with fatigue, jaundice, and joint pain. Upon examination, you note hepatomegaly, widespread lymphadenopathy, and jaundice. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Epstein-Barr virus

      Explanation:

      Complications that may arise after a transplant include CMV and EBV. CMV usually presents within the first 4 weeks to 6 months post transplant, while EBV can lead to post transplant lymphoproliferative disease, which typically occurs more than 6 months after the transplant. This disorder is often linked to high doses of immunosuppressant medication.

      The HLA system, also known as the major histocompatibility complex (MHC), is located on chromosome 6 and is responsible for human leucocyte antigens. Class 1 antigens include A, B, and C, while class 2 antigens include DP, DQ, and DR. When matching for a renal transplant, the importance of HLA antigens is ranked as DR > B > A.

      Graft survival rates for renal transplants are high, with a 90% survival rate at one year and a 60% survival rate at ten years for cadaveric transplants. Living-donor transplants have even higher survival rates, with a 95% survival rate at one year and a 70% survival rate at ten years. However, postoperative problems can occur, such as acute tubular necrosis of the graft, vascular thrombosis, urine leakage, and urinary tract infections.

      Hyperacute rejection can occur within minutes to hours after a transplant and is caused by pre-existing antibodies against ABO or HLA antigens. This type of rejection is an example of a type II hypersensitivity reaction and leads to widespread thrombosis of graft vessels, resulting in ischemia and necrosis of the transplanted organ. Unfortunately, there is no treatment available for hyperacute rejection, and the graft must be removed.

      Acute graft failure, which occurs within six months of a transplant, is usually due to mismatched HLA and is caused by cell-mediated cytotoxic T cells. This type of failure is usually asymptomatic and is detected by a rising creatinine, pyuria, and proteinuria. Other causes of acute graft failure include cytomegalovirus infection, but it may be reversible with steroids and immunosuppressants.

      Chronic graft failure, which occurs after six months of a transplant, is caused by both antibody and cell-mediated mechanisms that lead to fibrosis of the transplanted kidney, known as chronic allograft nephropathy. The recurrence of the original renal disease, such as MCGN, IgA, or FSGS, can also cause chronic graft failure.

    • This question is part of the following fields:

      • Renal System
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  • Question 24 - A clinical research group is conducting a study on diabetes epidemiology. As part...

    Incorrect

    • A clinical research group is conducting a study on diabetes epidemiology. As part of the study, researchers are collecting data on the age profile of a sample population in India.

      Among the various data collected, one of the variables was the age of a person. This was divided into four categories: under 18, 18-30, 30-50, and over 50. Respondents were asked to select one of these four options.

      What is this type of variable called?

      Your Answer:

      Correct Answer: Ordinal categorical variable

      Explanation:

      Different Types of Data

      When analyzing data, it is important to understand the different types of variables that can be encountered. One such variable is socio-economic status, which is not a numerical value but can be categorized into four ordinal categories. Ordinal categorical data has a logical order to its categorization, but mathematical functions cannot be performed with the numbers assigned to each category.

      Continuous metric data, on the other hand, can take any value and allows for mathematical functions to be performed. Examples of continuous data include height and weight. Discrete metric data is numerical but only takes certain values, such as the number of children in a family. Nominal categorical data has no hierarchy or gradation, such as blood group or yes/no questions.

      Normal parametric data assumes that variables are normally distributed, but this may not be the case for small sample populations. It is important to note that data can often fall into multiple categories. For example, systolic blood pressure can be considered continuous metric data, but in practice, it is often recorded as integers, making it somewhat like a discrete variable. Additionally, if a cut-off point is used, such as 140 mmHg, the data may become dichotomous and fall into the nominal category. the different types of data is crucial for accurate analysis and interpretation.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 25 - A 25-year-old woman who is 36 weeks pregnant presents to the hospital with...

    Incorrect

    • A 25-year-old woman who is 36 weeks pregnant presents to the hospital with a blood pressure reading of 160/110 mmHg, proteinuria, headache, blurred vision, and abdominal pain. What typical feature would be anticipated in this scenario?

      Your Answer:

      Correct Answer: Haemolysis, elevated liver enzymes and low platelets

      Explanation:

      The patient’s medical history suggests pre-eclampsia, which is characterized by high blood pressure and protein in the urine after 20 weeks of pregnancy. antihypertensive medication should be used to manage blood pressure. Women with this condition may also develop HELLP syndrome, which is characterized by low platelets, elevated liver enzymes, and haemolysis (indicated by raised LDH levels). If left untreated, pre-eclampsia can progress to eclampsia, which can be prevented by administering magnesium sulphate. Delivery is the only definitive treatment for pre-eclampsia.

      Symptoms of shock include tachycardia and hypotension, while Cushing’s triad (bradycardia, hypertension, and respiratory irregularity) is indicative of raised intracranial pressure. Anaphylaxis is characterized by facial swelling, rash, and stridor, while sepsis may present with warm extremities, rigors, and a strong pulse.

      Jaundice During Pregnancy

      During pregnancy, jaundice can occur due to various reasons. One of the most common liver diseases during pregnancy is intrahepatic cholestasis of pregnancy, which affects around 1% of pregnancies and is usually seen in the third trimester. Symptoms include itching, especially in the palms and soles, and raised bilirubin levels. Ursodeoxycholic acid is used for symptomatic relief, and women are typically induced at 37 weeks. However, this condition can increase the risk of stillbirth.

      Acute fatty liver of pregnancy is a rare complication that can occur in the third trimester or immediately after delivery. Symptoms include abdominal pain, nausea, vomiting, headache, jaundice, and hypoglycemia. ALT levels are typically elevated. Supportive care is the initial management, and delivery is the definitive management once the patient is stabilized.

      Gilbert’s and Dubin-Johnson syndrome may also be exacerbated during pregnancy. Additionally, HELLP syndrome, which stands for Haemolysis, Elevated Liver enzymes, Low Platelets, can also cause jaundice during pregnancy. It is important to monitor liver function tests and seek medical attention if any symptoms of jaundice occur during pregnancy.

    • This question is part of the following fields:

      • Reproductive System
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  • Question 26 - A 65-year-old man visits the haemofiltration unit thrice a week for treatment. What...

    Incorrect

    • A 65-year-old man visits the haemofiltration unit thrice a week for treatment. What is responsible for detecting alterations in salt concentrations, such as sodium chloride, in normally functioning kidneys and adjusting the glomerular filtration rate accordingly?

      Your Answer:

      Correct Answer: Macula densa

      Explanation:

      The macula densa is a specialized area of columnar tubule cells located in the final part of the ascending loop of Henle. These cells are in contact with the afferent arteriole and play a crucial role in detecting the concentration of sodium chloride in the convoluted tubules and ascending loop of Henle. This detection is affected by the glomerular filtration rate (GFR), which is increased by an increase in blood pressure. When the macula densa detects high sodium chloride levels, it releases ATP and adenosine, which constrict the afferent arteriole and lower GFR. Conversely, when low sodium chloride levels are detected, the macula densa releases nitric oxide, which acts as a vasodilator. The macula densa can also increase renin production from the juxtaglomerular cells.

      Juxtaglomerular cells are smooth muscle cells located mainly in the walls of the afferent arteriole. They act as baroreceptors to detect changes in blood pressure and can secrete renin.

      Mesangial cells are located at the junction of the afferent and efferent arterioles and, together with the juxtaglomerular cells and the macula densa, form the juxtaglomerular apparatus.

      Podocytes, which are modified simple squamous epithelial cells with foot-like projections, make up the innermost layer of the Bowman’s capsule surrounding the glomerular capillaries. They assist in glomerular filtration.

      The Loop of Henle and its Role in Renal Physiology

      The Loop of Henle is a crucial component of the renal system, located in the juxtamedullary nephrons and running deep into the medulla. Approximately 60 litres of water containing 9000 mmol sodium enters the descending limb of the loop of Henle in 24 hours. The osmolarity of fluid changes and is greatest at the tip of the papilla. The thin ascending limb is impermeable to water, but highly permeable to sodium and chloride ions. This loss means that at the beginning of the thick ascending limb the fluid is hypo osmotic compared with adjacent interstitial fluid. In the thick ascending limb, the reabsorption of sodium and chloride ions occurs by both facilitated and passive diffusion pathways. The loops of Henle are co-located with vasa recta, which have similar solute compositions to the surrounding extracellular fluid, preventing the diffusion and subsequent removal of this hypertonic fluid. The energy-dependent reabsorption of sodium and chloride in the thick ascending limb helps to maintain this osmotic gradient. Overall, the Loop of Henle plays a crucial role in regulating the concentration of solutes in the renal system.

    • This question is part of the following fields:

      • Renal System
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  • Question 27 - A 35-year-old man is in a car crash and is brought to the...

    Incorrect

    • A 35-year-old man is in a car crash and is brought to the emergency department. He is stable at first and a catheter is inserted. However, one minute later he experiences hypotension and develops angioedema around his penis. What is the probable cause of this occurrence?

      Your Answer:

      Correct Answer: Type I latex hypersensitivity reaction

      Explanation:

      Classification of Hypersensitivity Reactions

      Hypersensitivity reactions are classified into four types according to the Gell and Coombs classification. Type I, also known as anaphylactic hypersensitivity, occurs when an antigen reacts with IgE bound to mast cells. This type of reaction is commonly seen in atopic conditions such as asthma, eczema, and hay fever. Type II hypersensitivity occurs when cell-bound IgG or IgM binds to an antigen on the cell surface, leading to autoimmune conditions such as autoimmune hemolytic anemia, ITP, and Goodpasture’s syndrome. Type III hypersensitivity occurs when free antigen and antibody (IgG, IgA) combine to form immune complexes, leading to conditions such as serum sickness, systemic lupus erythematosus, and post-streptococcal glomerulonephritis. Type IV hypersensitivity is T-cell mediated and includes conditions such as tuberculosis, graft versus host disease, and allergic contact dermatitis.

      In recent times, a fifth category has been added to the classification of hypersensitivity reactions. Type V hypersensitivity occurs when antibodies recognize and bind to cell surface receptors, either stimulating them or blocking ligand binding. This type of reaction is seen in conditions such as Graves’ disease and myasthenia gravis. Understanding the classification of hypersensitivity reactions is important in the diagnosis and management of these conditions.

    • This question is part of the following fields:

      • General Principles
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  • Question 28 - An 80-year-old man is brought to the emergency department in respiratory arrest. According...

    Incorrect

    • An 80-year-old man is brought to the emergency department in respiratory arrest. According to his partner, he has a history of congestive heart failure and has recently been battling an infection. After being placed on mechanical ventilation, you observe that the patient has decreased lung compliance.

      What could be the cause of this observation?

      Your Answer:

      Correct Answer: Pulmonary oedema

      Explanation:

      Reduced lung compliance is a common consequence of pulmonary edema, which occurs when fluid accumulates in the alveoli and exerts mechanical stress on the air-filled alveoli. This can happen in patients with acute decompensation of congestive cardiac failure, often triggered by an infection. On the other hand, emphysema can increase compliance due to long-term damage that reduces the elastic recoil of the lungs. Additionally, lung surfactant produced by type II pneumocytes can increase lung compliance. Finally, aging can also lead to increased compliance as the loss of lung connective tissue can reduce elastic recoil.

      Understanding Lung Compliance in Respiratory Physiology

      Lung compliance refers to the extent of change in lung volume in response to a change in airway pressure. An increase in lung compliance can be caused by factors such as aging and emphysema, which is characterized by the loss of alveolar walls and associated elastic tissue. On the other hand, a decrease in lung compliance can be attributed to conditions such as pulmonary edema, pulmonary fibrosis, pneumonectomy, and kyphosis. These conditions can affect the elasticity of the lungs and make it more difficult for them to expand and contract properly. Understanding lung compliance is important in respiratory physiology as it can help diagnose and manage various respiratory conditions. Proper management of lung compliance can improve lung function and overall respiratory health.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 29 - Which of the following relates to a test's ability to produce similar results...

    Incorrect

    • Which of the following relates to a test's ability to produce similar results following repeated measurements?

      Your Answer:

      Correct Answer: Precision

      Explanation:

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • General Principles
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  • Question 30 - A 42-year-old man presents to the hospital with severe breathlessness and a productive...

    Incorrect

    • A 42-year-old man presents to the hospital with severe breathlessness and a productive cough. He has a known history of HIV but is otherwise healthy. On chest X-ray, diffuse ground-glass opacities and widespread pulmonary infiltrates are observed. Sputum cultures confirm the presence of Pneumocystis jiroveci. What is the combination of drugs used as first-line treatment for this condition?

      Your Answer:

      Correct Answer: Sulfamethoxazole and trimethoprim

      Explanation:

      The correct answer is sulfamethoxazole and trimethoprim, which are combined to create co-trimoxazole. This medication is the first line treatment for Pneumocystis jiroveci infections in immunocompromised patients and can also be used for other susceptible infections. Metronidazole is not a part of co-trimoxazole and is used to treat anaerobic bacteria. Trimipramine is a tricyclic antidepressant and sulfadiazine is an older antibiotic that is not commonly used due to increasing bacterial resistance, but neither of these medications are a part of co-trimoxazole.

      Understanding Sulfonamides and Their Adverse Effects

      Sulfonamides are a type of drug that work by inhibiting dihydropteroate synthetase. This class of drugs includes antibiotic sulfonamides such as sulfamethoxazole, sulfadiazine, and sulfisoxazole. Co-trimoxazole, a combination of sulfamethoxazole and trimethoprim, is commonly used in the management of Pneumocystis jiroveci pneumonia. Non-antibiotic sulfonamides like sulfasalazine and sulfonylureas also exist.

      However, the use of co-trimoxazole may lead to adverse effects such as hyperkalaemia, headache, and rash, including the potentially life-threatening Steven-Johnson Syndrome. It is important to understand the potential risks associated with sulfonamides and to consult with a healthcare professional before taking any medication.

    • This question is part of the following fields:

      • General Principles
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal System And Skin (1/1) 100%
Cardiovascular System (1/1) 100%
General Principles (1/4) 25%
Basic Sciences (1/1) 100%
Neurological System (0/1) 0%
Renal System (1/2) 50%
Passmed