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  • Question 1 - A young woman presents with a claw-like appearance of her right hand. She...

    Incorrect

    • A young woman presents with a claw-like appearance of her right hand. She is subsequently diagnosed with cubital tunnel syndrome. Which nerve has been affected?

      Your Answer: Median nerve

      Correct Answer: Ulnar nerve

      Explanation:

      The symptoms displayed in this presentation are indicative of cubital tunnel syndrome, which occurs when the ulnar nerve is damaged as it passes through the medial epicondyle. This nerve is responsible for innervating the intrinsic muscles of the hand, and its damage can result in a claw-like appearance of the affected hand’s ulnar side. None of the other nerves listed would cause this specific symptom, as they do not innervate the same muscles.

      If the median nerve were damaged, it would result in an inability to abduct and oppose the thumb due to paralysis of the thenar muscles.

      Damage to the axillary nerve would affect the deltoid muscle, leading to dysfunction in arm abduction.

      Impaired biceps brachii muscle function, affecting arm flexion, would result from damage to the musculocutaneous nerve.

      Paralysis of the extensor muscles, leading to a wrist drop, would be caused by damage to the radial nerve.

      Understanding Cubital Tunnel Syndrome

      Cubital tunnel syndrome is a condition that occurs when the ulnar nerve is compressed as it passes through the cubital tunnel. This can cause tingling and numbness in the fourth and fifth fingers, which may start off as intermittent but eventually become constant. Over time, patients may also experience weakness and muscle wasting. Pain is often worse when leaning on the affected elbow, and there may be a history of osteoarthritis or prior trauma to the area.

      Diagnosis of cubital tunnel syndrome is usually made based on clinical features, but nerve conduction studies may be used in selected cases. Management of the condition involves avoiding aggravating activities, undergoing physiotherapy, and receiving steroid injections. In resistant cases, surgery may be necessary. By understanding the symptoms and treatment options for cubital tunnel syndrome, patients can take steps to manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      12.2
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  • Question 2 - Which one of the following statements relating to osteomyelitis is not true? ...

    Correct

    • Which one of the following statements relating to osteomyelitis is not true?

      Your Answer: Should be treated by aggressive surgical debridement initially

      Explanation:

      The initial management involves medical treatment with an antistaphylococcal antibiotic, as opposed to septic joints where prompt joint washout is necessary.

      Understanding Osteomyelitis: Types, Causes, and Treatment

      Osteomyelitis is a bone infection that can be classified into two types: haematogenous and non-haematogenous. Haematogenous osteomyelitis is caused by bacteria in the bloodstream and is usually monomicrobial. It is more common in children and can be caused by risk factors such as sickle cell anaemia, intravenous drug use, immunosuppression, and infective endocarditis. On the other hand, non-haematogenous osteomyelitis is caused by the spread of infection from adjacent soft tissues or direct injury to the bone. It is often polymicrobial and more common in adults, with risk factors such as diabetic foot ulcers, pressure sores, diabetes mellitus, and peripheral arterial disease.

      Staphylococcus aureus is the most common cause of osteomyelitis, except in patients with sickle-cell anaemia where Salmonella species are more prevalent. To diagnose osteomyelitis, MRI is the imaging modality of choice, with a sensitivity of 90-100%.

      The treatment for osteomyelitis involves a course of antibiotics for six weeks. Flucloxacillin is the preferred antibiotic, but clindamycin can be used for patients who are allergic to penicillin. Understanding the types, causes, and treatment of osteomyelitis is crucial in managing this bone infection.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      25.9
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  • Question 3 - A 39-year-old woman with a personal history of diabetes visits her General Practitioner...

    Correct

    • A 39-year-old woman with a personal history of diabetes visits her General Practitioner (GP) with complaints of tingling sensations in her thumb, index, and middle fingers of the right hand. She also reports difficulty gripping objects at times. After conducting a nerve conduction test, the GP confirms the diagnosis of carpal tunnel syndrome (CPS). Which nerve is likely affected by her condition, leading to these symptoms?

      Your Answer: Median nerve

      Explanation:

      The median nerve is responsible for providing sensation to the palmar side of the lateral three and a half digits of the hand. When this nerve is compressed inside the carpal tunnel, it can lead to carpal tunnel syndrome, which is the most common cause of median nerve entrapment. This condition can cause tingling sensations in the thumb, index, and middle fingers.

      The superficial radial nerve is not affected by carpal tunnel syndrome as it does not pass through the carpal tunnel.

      The ulnar nerve supplies sensation to the palmar side of the medial one and a half digits of the hand and does not explain the symptoms experienced on the lateral side of the hand. Additionally, it travels through the ulnar canal instead of the carpal tunnel, so it is not affected by carpal tunnel syndrome.

      The deep radial nerve is not impacted by carpal tunnel syndrome as it does not travel through the carpal tunnel.

      The musculocutaneous nerve is not involved in hand sensation and has motor and sensory functions in the arm and forearm. Therefore, it cannot be responsible for the patient’s symptoms.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      16.7
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  • Question 4 - A 76-year-old man is experiencing symptoms suggestive of intermittent claudication. You plan to...

    Incorrect

    • A 76-year-old man is experiencing symptoms suggestive of intermittent claudication. You plan to evaluate the extent of his condition by measuring his ankle brachial pressure index. In order to do so, you need to locate the dorsalis pedis artery. Which of the following statements regarding this artery is incorrect?

      Your Answer: The tendon of extensor hallucis longus lies medial to it.

      Correct Answer: It originates from the peroneal artery

      Explanation:

      The anterior tibial artery continues directly into the dorsalis pedis artery.

      The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 5 - A 25-year-old man gets into a brawl and receives a cut on the...

    Correct

    • A 25-year-old man gets into a brawl and receives a cut on the back of his right arm, about 2 cm above the olecranon process. Upon examination at the ER, he is unable to straighten his elbow. Which tendon is the most probable one to have been severed?

      Your Answer: Triceps

      Explanation:

      The elbow joint is extended by the triceps muscle, while the remaining muscles listed are responsible for flexion of the elbow joint.

      Anatomy of the Triceps Muscle

      The triceps muscle is a large muscle located on the back of the upper arm. It is composed of three heads: the long head, lateral head, and medial head. The long head originates from the infraglenoid tubercle of the scapula, while the lateral head originates from the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve. The medial head originates from the posterior surface of the humerus on the inferomedial side of the radial groove and both of the intermuscular septae.

      All three heads of the triceps muscle insert into the olecranon process of the ulna, with some fibers inserting into the deep fascia of the forearm and the posterior capsule of the elbow. The triceps muscle is innervated by the radial nerve and supplied with blood by the profunda brachii artery.

      The primary action of the triceps muscle is elbow extension. The long head can also adduct the humerus and extend it from a flexed position. The radial nerve and profunda brachii vessels lie between the lateral and medial heads of the triceps muscle. Understanding the anatomy of the triceps muscle is important for proper diagnosis and treatment of injuries or conditions affecting this muscle.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 6 - A 28-year-old woman comes in with a pigmented lesion measuring 1.5cm on her...

    Incorrect

    • A 28-year-old woman comes in with a pigmented lesion measuring 1.5cm on her back. The surgeon suspects it may be a melanoma. What would be the best course of action?

      Your Answer: 2mm punch biopsy from the centre of the lesion

      Correct Answer: Excisional biopsy of the lesion

      Explanation:

      It is not recommended to partially sample suspicious naevi as this can greatly compromise the accuracy of histological interpretation. Complete excision is necessary for lesions that meet diagnostic criteria. However, it may be acceptable to delay wide excision for margins until definitive histology results are available.

      When dealing with suspicious melanomas, it is important to excise them with complete margins. Radical excision is not typically performed for diagnostic purposes, so if subsequent histopathological analysis confirms the presence of melanoma, further excision of margins may be necessary. Incisional punch biopsies of potential melanomas can make histological interpretation challenging and should be avoided whenever possible.

      Malignant melanoma is a type of skin cancer that has four main subtypes: superficial spreading, nodular, lentigo maligna, and acral lentiginous. Nodular melanoma is the most aggressive, while the other forms spread more slowly. Superficial spreading melanoma typically affects young people on sun-exposed areas such as the arms, legs, back, and chest. Nodular melanoma appears as a red or black lump that bleeds or oozes and affects middle-aged people. Lentigo maligna affects chronically sun-exposed skin in older people, while acral lentiginous melanoma appears on nails, palms, or soles in people with darker skin pigmentation. Other rare forms of melanoma include desmoplastic melanoma, amelanotic melanoma, and melanoma arising in other parts of the body such as ocular melanoma.

      The main diagnostic features of melanoma are changes in size, shape, and color. Secondary features include a diameter of 7mm or more, inflammation, oozing or bleeding, and altered sensation. Suspicious lesions should undergo excision biopsy, and the lesion should be completely removed to facilitate subsequent histopathological assessment. Once the diagnosis is confirmed, the pathology report should be reviewed to determine whether further re-excision of margins is required. The margins of excision are related to Breslow thickness, with lesions 0-1mm thick requiring a margin of 1 cm, lesions 1-2mm thick requiring a margin of 1-2 cm (depending on site and pathological features), lesions 2-4mm thick requiring a margin of 2-3 cm (depending on site and pathological features), and lesions over 4mm thick requiring a margin of 3 cm. Further treatments such as sentinel lymph node mapping, isolated limb perfusion, and block dissection of regional lymph node groups should be selectively applied.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 7 - Oliver, a 6-year-old boy, arrives at the emergency department with his mother after...

    Incorrect

    • Oliver, a 6-year-old boy, arrives at the emergency department with his mother after falling from a swing and landing on his outstretched hand. He is experiencing intense pain in his left arm. An X-ray is conducted.

      He has a weak radial pulse.

      What is the frequently occurring fracture in children that raises the likelihood of Volkmaan's ischemic contractures?

      Your Answer: Colles fracture

      Correct Answer: Supracondylar fracture of the humerus

      Explanation:

      Volkmaan’s ischemic contractures can be caused by a supracondylar fracture of the humerus, which poses a risk of damage to the brachial artery and subsequent ischemia distal to the fracture. This type of fracture is more common in children, while a Colles fracture, which can also lead to Volkmaan’s ischemic contractures, is more common in adults. Another fracture that can result in Volkmaan’s ischemic contractures is a Monteggia fracture, which involves a fracture of the proximal third of the ulna and dislocation of the proximal head of the radius.

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      14.4
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  • Question 8 - An 80-year-old man with symptoms of intermittent claudication needs to have his ankle...

    Incorrect

    • An 80-year-old man with symptoms of intermittent claudication needs to have his ankle brachial pressure indices checked. However, the dorsalis pedis artery cannot be felt. What tendinous structure, located medially, could aid in its identification?

      Your Answer: Extensor digitorum brevis tendon

      Correct Answer: Extensor hallucis longus tendon

      Explanation:

      The dorsalis pedis artery is located lateral to the extensor hallucis longus tendon.

      The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      39.4
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  • Question 9 - A 79-year-old man comes to your clinic with a protruding lump in his...

    Correct

    • A 79-year-old man comes to your clinic with a protruding lump in his upper arm that he noticed while gardening last week. He experienced a dull ache in the front of his shoulder at the time, but he is now pain-free and has full use of his arm. During the examination, you observe an asymmetry in the patient's arms, with a circular mass on the lower portion of his left arm. When you ask him to flex his biceps muscles, you notice that the affected arm displays the 'popeye sign.' Based on the patient's history and physical examination, it appears that he has a rupture of the long head of biceps brachii tendon. What is the origin of the long head of biceps brachii tendon?

      Your Answer: Supraglenoid tubercle of the scapula

      Explanation:

      The long head of biceps tendon runs from the supraglenoid tubercle of the scapula. A ruptured tendon of the long head of biceps brachii is more common in older individuals and may present with the ‘Popeye’ sign. Management is dependent on the patient, with surgical repair for younger patients or those with co-existing rotator cuff tears, and a conservative approach for most patients.

      The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.2
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  • Question 10 - Which one of the following cells secretes the majority of tumour necrosis factor?...

    Correct

    • Which one of the following cells secretes the majority of tumour necrosis factor?

      Your Answer: Macrophages

      Explanation:

      Understanding Tumour Necrosis Factor and its Inhibitors

      Tumour necrosis factor (TNF) is a cytokine that plays a crucial role in the immune system. It is mainly secreted by macrophages and has various effects on the immune system, such as activating macrophages and neutrophils, acting as a costimulator for T cell activation, and mediating the body’s response to Gram-negative septicaemia. TNF also has anti-tumour effects and binds to both the p55 and p75 receptor, inducing apoptosis and activating NFkB.

      TNF has endothelial effects, including increased expression of selectins and production of platelet activating factor, IL-1, and prostaglandins. It also promotes the proliferation of fibroblasts and their production of protease and collagenase. TNF inhibitors are used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Examples of TNF inhibitors include infliximab, etanercept, adalimumab, and golimumab.

      Infliximab is also used to treat active Crohn’s disease unresponsive to steroids. However, TNF blockers can have adverse effects such as reactivation of latent tuberculosis and demyelination. Understanding TNF and its inhibitors is crucial in the treatment of various inflammatory conditions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 11 - A 23-year-old man acquires an infection in the pulp of his pinky finger....

    Incorrect

    • A 23-year-old man acquires an infection in the pulp of his pinky finger. What is the closest location to which this infection can spread?

      Your Answer: The distal interphalangeal joint

      Correct Answer: Proximal to the flexor retinaculum

      Explanation:

      The tendon sheath that runs from the little finger to the proximal part of the carpal tunnel poses a considerable risk of facilitating the spread of infections towards the proximal direction.

      Anatomy of the Hand: Fascia, Compartments, and Tendons

      The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

      The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

      The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 12 - A 25-year-old male has been struggling with anger issues for a while. Following...

    Incorrect

    • A 25-year-old male has been struggling with anger issues for a while. Following a disagreement with a relative, he vents his frustration by punching the wall, resulting in a cut on his hand. At the hospital, the medical team orders an x-ray to rule out any fractures and discovers a 'boxer's fracture.'

      What bone did this young man break?

      Your Answer: Lunate

      Correct Answer: 5th metacarpal

      Explanation:

      A fracture of the 5th metacarpal, known as a ‘Boxer fracture’, is commonly caused by punching a hard surface. This type of fracture is typically minimally displaced. Fracture of the scaphoid bone in the wrist can lead to avascular necrosis. The 2nd metacarpal is not typically fractured in punching injuries, while the lunate and hamate bones in the wrist are not commonly affected by this type of injury.

      Boxer fracture is a type of fracture that occurs in the fifth metacarpal bone. It is usually caused by punching a hard surface, such as a wall. The fracture is typically minimally displaced, meaning that the bone is still in its proper position but has a small crack or break. This injury is commonly seen in boxers, hence the name, but can also occur in other individuals who engage in activities that involve punching or striking objects. The treatment for a boxer fracture may involve immobilization of the affected hand with a cast or splint, and in some cases, surgery may be necessary.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 13 - A 28-year-old man visits his GP with complaints of ongoing stiffness and pain...

    Incorrect

    • A 28-year-old man visits his GP with complaints of ongoing stiffness and pain in his lower back for the past 6 months. He reports no specific injury that could have caused his symptoms and mentions that he leads an active lifestyle. The pain is particularly severe in the morning but improves with physical activity. Following imaging tests, he is diagnosed with ankylosing spondylitis. What is the gene linked to this condition?

      Your Answer: Human leucocyte antigen- B47

      Correct Answer: Human leucocyte antigen- B27

      Explanation:

      Ankylosing spondylitis is associated with the HLA-B27 serotype, with approximately 90% of patients with the condition testing positive for it. Adrenal 21-hydroxylase deficiency is thought to be linked to HLA-B47, while HLA-DQ2 is associated with coeliac disease and the development of autoimmune diseases. HLA-DR4 is primarily linked to rheumatoid arthritis, while HLA-DR2 is associated with systemic lupus erythematosus, multiple sclerosis, and leprosy, but not ankylosing spondylitis.

      Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more common in males aged 20-30 years old. Inflammatory markers such as ESR and CRP are often elevated, but normal levels do not rule out ankylosing spondylitis. HLA-B27 is not very useful in making the diagnosis as it is positive in 90% of patients with ankylosing spondylitis and 10% of normal patients. The most useful diagnostic tool is a plain x-ray of the sacroiliac joints, which may show subchondral erosions, sclerosis, squaring of lumbar vertebrae, bamboo spine, and syndesmophytes. If the x-ray is negative but suspicion for AS remains high, an MRI may be obtained to confirm the diagnosis. Spirometry may show a restrictive defect due to pulmonary fibrosis, kyphosis, and ankylosis of the costovertebral joints.

      Management of ankylosing spondylitis includes regular exercise such as swimming, NSAIDs as first-line treatment, physiotherapy, and disease-modifying drugs such as sulphasalazine if there is peripheral joint involvement. Anti-TNF therapy such as etanercept and adalimumab may be given to patients with persistently high disease activity despite conventional treatments, according to the 2010 EULAR guidelines. Research is ongoing to determine whether anti-TNF therapies should be used earlier in the course of the disease.

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      • Musculoskeletal System And Skin
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  • Question 14 - You are the junior doctor working in the emergency department. A 30-year-old male...

    Correct

    • You are the junior doctor working in the emergency department. A 30-year-old male is brought in by ambulance after being caught in a house fire. He has significant burns spreading across his left arm, chest, abdomen and left thigh. During the A to E assessment, the consultant working with you asks you to give the patient aggressive fluid resuscitation using 1L of 0.9% sodium chloride over 30 minutes.

      What is the rationale behind administering aggressive fluid resuscitation to this patient?

      Your Answer: Burns cause fluid loss via third spacing

      Explanation:

      To determine the severity of a burn, a thorough examination is necessary. A superficial burn only affects the epidermis, while a partial thickness burn affects the dermis, and a full-thickness burn affects all layers of skin, including subcutaneous tissues, muscle, and bone if severe.

      Third spacing occurs when fluid moves from the intravascular space to the interstitial or third space due to increased capillary permeability and loss of albumin. This can cause hypotension, making it crucial to replace intravascular volume in the management of severe burns.

      While burns can cause fluid loss through evaporation, it is minimal and can be stopped by removing the source of the burn.

      While adequate hydration is important for healing any injury, it is not the reason for aggressive fluid resuscitation. It is worth noting that a patient’s energy requirement increases during burn recovery, and they may require up to 6000 calories per day.

      Maintenance fluids are given to patients who cannot drink enough to stay hydrated, such as those who are cognitively impaired or nil by mouth before surgery. Unlike resuscitation fluids, maintenance fluids provide the body with the necessary water, electrolytes, and glucose to function normally in a day based on weight.

      Fluids do not affect the inflammatory process and therefore cannot reduce inflammation caused by burns.

      First Aid and Management of Burns

      Burns can be caused by heat, electricity, or chemicals. Immediate first aid involves removing the person from the source of the burn and irrigating the affected area with cool water. The extent of the burn can be assessed using Wallace’s Rule of Nines or the Lund and Browder chart. The depth of the burn can be determined by its appearance, with full-thickness burns being the most severe. Referral to secondary care is necessary for deep dermal and full-thickness burns, as well as burns involving certain areas of the body or suspicion of non-accidental injury.

      Severe burns can lead to tissue loss, fluid loss, and a catabolic response. Intravenous fluids and analgesia are necessary for resuscitation and pain relief. Smoke inhalation can result in airway edema, and early intubation may be necessary. Circumferential burns may require escharotomy to relieve compartment syndrome and improve ventilation. Conservative management is appropriate for superficial burns, while more complex burns may require excision and skin grafting. There is no evidence to support the use of antimicrobial prophylaxis or topical antibiotics in burn patients.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 15 - A 12-year-old boy presents to the orthopaedic clinic with complaints of right knee...

    Correct

    • A 12-year-old boy presents to the orthopaedic clinic with complaints of right knee pain. He has been experiencing pain for the past 4 months, which usually lasts for a few hours. During examination, he displays an antalgic gait and appears to have a shortened right leg. While the right knee appears normal, he experiences pain on internal and external rotation of the right hip. Imaging reveals flattening of the femoral head. What is the most probable underlying diagnosis?

      Your Answer: Perthes disease

      Explanation:

      Understanding Perthes’ Disease

      Perthes’ disease is a condition that affects the hip joints of children between the ages of 4-8 years. It is caused by a lack of blood supply to the femoral head, leading to bone infarction and degeneration. Boys are five times more likely to develop this condition, and around 10% of cases are bilateral. Symptoms include hip pain, limping, stiffness, and reduced range of hip movement. Early changes can be seen on x-rays, such as widening of the joint space, while later changes include decreased femoral head size and flattening.

      Diagnosis is typically made through a plain x-ray, but a technetium bone scan or magnetic resonance imaging may be necessary if symptoms persist despite a normal x-ray. Complications of Perthes’ disease can include osteoarthritis and premature fusion of the growth plates.

      The Catterall staging system is used to classify the severity of the disease, with Stage 1 being the mildest and Stage 4 being the most severe. Management options include casting or bracing to keep the femoral head within the acetabulum, observation for children under 6 years old, and surgical intervention for severe deformities in older children.

      Overall, most cases of Perthes’ disease will resolve with conservative management, and early diagnosis can improve outcomes. It is important for parents and healthcare providers to be aware of the symptoms and seek medical attention if they suspect a child may be affected by this condition.

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      • Musculoskeletal System And Skin
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  • Question 16 - A 55-year-old male with a history of gout presents with a suspected septic...

    Correct

    • A 55-year-old male with a history of gout presents with a suspected septic ankle joint. A diagnostic aspiration is performed and sent to microbiology. Which of the organisms below is most likely to be responsible?

      Your Answer: Staphylococcus aureus

      Explanation:

      The most frequently encountered organism in cases of septic arthritis is Staphylococcus aureus.

      Septic Arthritis in Adults: Causes, Symptoms, and Treatment

      Septic arthritis is a condition that occurs when bacteria infect a joint, leading to inflammation and swelling. The most common organism that causes septic arthritis in adults is Staphylococcus aureus, while Neisseria gonorrhoeae is the most common organism in sexually active young adults. The infection is usually spread through the bloodstream, often from distant bacterial infections such as abscesses. The knee is the most commonly affected joint in adults.

      Symptoms of septic arthritis include acute joint swelling, restricted movement, warmth to the touch, and fever. To diagnose the condition, synovial fluid sampling is necessary and should be done before administering antibiotics if needed. Blood cultures and joint imaging may also be necessary.

      Treatment for septic arthritis involves intravenous antibiotics that cover Gram-positive cocci, such as flucloxacillin or clindamycin if the patient is allergic to penicillin. Antibiotics are typically given for several weeks, and patients may be switched to oral antibiotics after two weeks. Needle aspiration is used to decompress the joint, and arthroscopic lavage may be required. Overall, prompt diagnosis and treatment are essential to prevent joint damage and other complications.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      41.3
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  • Question 17 - A patient with a history of multiple deep vein thromboses presents with pain...

    Correct

    • A patient with a history of multiple deep vein thromboses presents with pain around the medial side of their leg. On examination, venous eczema, lipodermatosclerosis, and overlying erythema are noted around the medial malleolus.

      What is the most appropriate first-line treatment for this condition in a slightly older patient?

      Your Answer: Four-layer compression bandaging

      Explanation:

      Venous ulcers typically develop in the gaiter region, specifically around the medial malleolus. The ankle-brachial pressure index and venous duplex ultrasound are diagnostic tools used to investigate ulcers, not treat them. The primary conservative treatment for venous ulcers is four-layer compression bandaging. If conservative measures fail, surgical debridgement may be considered. There is limited evidence supporting the use of intermittent pneumatic compression devices for venous ulcers.

      Venous ulceration is a type of ulcer that is commonly found above the medial malleolus. To determine the cause of non-healing ulcers, it is important to conduct an ankle-brachial pressure index (ABPI) test. A normal ABPI value is between 0.9 to 1.2, while values below 0.9 indicate arterial disease. However, values above 1.3 may also indicate arterial disease due to arterial calcification, especially in diabetic patients.

      The most effective treatment for venous ulceration is compression bandaging, specifically four-layer bandaging. Oral pentoxifylline, a peripheral vasodilator, can also improve the healing rate of venous ulcers. While there is some evidence supporting the use of flavonoids, there is little evidence to suggest the benefit of hydrocolloid dressings, topical growth factors, ultrasound therapy, and intermittent pneumatic compression.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 18 - A 30-year-old construction worker presents to the GP with a complaint of right...

    Correct

    • A 30-year-old construction worker presents to the GP with a complaint of right forearm pain that started 2 days ago. He reports that the pain began suddenly after lifting heavy equipment and has been progressively worsening. Upon examination, there is noticeable swelling in the forearm, and the pain intensifies with flexion of the elbow. The GP suspects a possible injury to the brachioradialis muscle.

      Which nerve could have been impacted by this injury?

      Your Answer: Radial nerve

      Explanation:

      The correct nerve that supplies innervation to the brachioradialis muscle is the radial nerve.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 19 - A 70-year-old man is recuperating from a fall that resulted in a fracture...

    Correct

    • A 70-year-old man is recuperating from a fall that resulted in a fracture of his left fibular neck. He has observed that his left foot drags on the ground when he attempts to walk. Which nerve is the most probable to have been affected?

      Your Answer: Common peroneal nerve

      Explanation:

      The patient is likely to have suffered damage to their common peroneal nerve, resulting in foot drop, following a fibular neck fracture. This is a common occurrence in such cases.

      It is important to note that damage to the lateral cutaneous nerve of the thigh, obturator nerve, or pudendal nerve is unlikely to cause foot drop. These nerves are associated with different symptoms and conditions.

      Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 20 - A 21-year-old man is participating in a rugby game when he experiences a...

    Correct

    • A 21-year-old man is participating in a rugby game when he experiences a sharp pain in the posterolateral area of his right thigh. Which muscle group is the most probable source of the injury?

      Your Answer: Long head of biceps femoris

      Explanation:

      The hamstring muscle group consists of three muscles: the biceps femoris, which is located on the lateral side, and the semitendinosus and semimembranosus, which are located on the medial side. While less common, it is possible for the gastrocnemius and soleus muscles to also experience a rupture.

      The Biceps Femoris Muscle

      The biceps femoris is a muscle located in the posterior upper thigh and is part of the hamstring group of muscles. It consists of two heads: the long head and the short head. The long head originates from the ischial tuberosity and inserts into the fibular head. Its actions include knee flexion, lateral rotation of the tibia, and extension of the hip. It is innervated by the tibial division of the sciatic nerve and supplied by the profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery.

      On the other hand, the short head originates from the lateral lip of the linea aspera and the lateral supracondylar ridge of the femur. It also inserts into the fibular head and is responsible for knee flexion and lateral rotation of the tibia. It is innervated by the common peroneal division of the sciatic nerve and supplied by the same arteries as the long head.

      Understanding the anatomy and function of the biceps femoris muscle is important in the diagnosis and treatment of injuries and conditions affecting the posterior thigh.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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