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  • Question 1 - A 65-year-old man is set to undergo a surgical procedure to drain an...

    Incorrect

    • A 65-year-old man is set to undergo a surgical procedure to drain an abscess situated on the medial side of his lower leg. The anaesthetist plans to administer a saphenous nerve block by injecting a local anaesthetic through the adductor canal's roof. What is the muscular structure that the needle for the local anaesthetic must pass through?

      Your Answer:

      Correct Answer: Sartorius

      Explanation:

      The Adductor Canal: Anatomy and Contents

      The adductor canal, also known as Hunter’s or the subsartorial canal, is a structure located in the middle third of the thigh, immediately distal to the apex of the femoral triangle. It is bordered laterally by the vastus medialis muscle and posteriorly by the adductor longus and adductor magnus muscles. The roof of the canal is formed by the sartorius muscle. The canal terminates at the adductor hiatus.

      The adductor canal contains three important structures: the saphenous nerve, the superficial femoral artery, and the superficial femoral vein. The saphenous nerve is a sensory nerve that supplies the skin of the medial leg and foot. The superficial femoral artery is a major artery that supplies blood to the lower limb. The superficial femoral vein is a large vein that drains blood from the lower limb.

      In order to expose the contents of the adductor canal, the sartorius muscle must be removed. Understanding the anatomy and contents of the adductor canal is important for medical professionals who perform procedures in this area, such as nerve blocks or vascular surgeries.

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      • Musculoskeletal System And Skin
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  • Question 2 - You are the junior doctor working in the emergency department. A 30-year-old male...

    Incorrect

    • 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:

      Correct 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.

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      • Musculoskeletal System And Skin
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  • Question 3 - A basketball enthusiast in his early twenties visits his GP complaining of discomfort...

    Incorrect

    • A basketball enthusiast in his early twenties visits his GP complaining of discomfort in his right shoulder and neck, and also reports an unusual appearance on the right side of his upper back.

      To assess the condition, the GP asks the patient to stand facing a wall and extend his arms straight in front of him, with his palms flat against the wall. The GP then instructs the patient to bend his arms and push away from the wall. During the movement, the patient's right shoulder blade protrudes from his back.

      Based on the symptoms, which nerve is most likely to be affected?

      Your Answer:

      Correct Answer: Long thoracic nerve

      Explanation:

      The correct nerve that supplies the serratus anterior muscle is the long thoracic nerve. This muscle is responsible for pulling the scapula around the thorax, and damage to this nerve can cause medial winging of the scapula.

      The axillary nerve is not the correct answer as it supplies the deltoid muscle, which is responsible for shoulder abduction. Damage to this nerve results in a flattened deltoid muscle, not winging of the scapula.

      The musculocutaneous nerve supplies the biceps brachii muscle, which is responsible for elbow flexion. Damage to this nerve does not affect the scapulae.

      The spinal accessory nerve supplies the sternocleidomastoid and trapezius muscles, and injury to this nerve may result in difficulty turning the head from side to side or shrugging the shoulders. It does not affect the scapulae.

      Trauma to the thoracodorsal nerve may cause atrophy of the latissimus dorsi muscle and difficulty moving the affected shoulder, but it does not cause winging of the scapula.

      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.

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  • Question 4 - A 29-year-old man presents to the hospital with sudden chest pain while playing...

    Incorrect

    • A 29-year-old man presents to the hospital with sudden chest pain while playing football. He reports no prior history of such pain but is concerned as one of his uncles died young due to a heart problem. On examination, the doctor notes that his fingers are longer than normal and that his little finger and thumb overlap when he holds his opposite wrist. He has no significant medical or surgical history and denies illicit drug use but has been smoking half a pack of cigarettes daily since he was 17. What is the most likely disease mechanism in this patient?

      Your Answer:

      Correct Answer: A defect of the glycoprotein structure which usually wraps around elastin

      Explanation:

      The patient is exhibiting signs and symptoms of aortic dissection, which occurs when there is a tear in the inner wall of the aorta. This can be caused by chronic uncontrolled hypertension or a weakening of the aortic wall. However, in this case, the patient has a family history of Marfan syndrome, a genetically inherited condition that affects the glycoprotein fibrillin and leads to a range of symptoms such as joint hypermobility and chest deformities. Menkes disease, on the other hand, is a genetically inherited condition that involves an accumulation of copper in some body tissues and is inherited in an X-linked recessive pattern. Alpha-1-antitrypsin deficiency is characterized by a deficiency of the enzyme alpha-1-antitrypsin, which normally inhibits elastase and can lead to pan-acinar emphysema and liver impairment. Wrinkles and decreased skin elasticity in the elderly population are a result of normal aging, while scurvy is caused by vitamin C deficiency.

      Understanding Marfan’s Syndrome

      Marfan’s syndrome is a genetic disorder that affects the connective tissue in the body. It is caused by a defect in the FBN1 gene on chromosome 15, which codes for the protein fibrillin-1. This disorder is inherited in an autosomal dominant pattern and affects approximately 1 in 3,000 people.

      Individuals with Marfan’s syndrome often have a tall stature with an arm span to height ratio greater than 1.05. They may also have a high-arched palate, arachnodactyly (long, slender fingers), pectus excavatum (sunken chest), pes planus (flat feet), and scoliosis (curvature of the spine). In addition, they may experience cardiovascular problems such as dilation of the aortic sinuses, mitral valve prolapse, and aortic aneurysm, which can lead to aortic dissection and aortic regurgitation. Other symptoms may include repeated pneumothoraces (collapsed lung), upwards lens dislocation, blue sclera, myopia, and ballooning of the dural sac at the lumbosacral level.

      In the past, the life expectancy of individuals with Marfan’s syndrome was around 40-50 years. However, with regular echocardiography monitoring and medication such as beta-blockers and ACE inhibitors, the life expectancy has significantly improved. Despite this, cardiovascular problems remain the leading cause of death in individuals with Marfan’s syndrome.

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  • Question 5 - Which one of the following structures does not pass anterior to the lateral...

    Incorrect

    • Which one of the following structures does not pass anterior to the lateral malleolus?

      Your Answer:

      Correct Answer: Peroneus brevis

      Explanation:

      The lateral malleolus is located posterior to the path of the peroneus brevis.

      Anatomy of the Lateral Malleolus

      The lateral malleolus is a bony prominence on the outer side of the ankle joint. Posterior to the lateral malleolus and superficial to the superior peroneal retinaculum are the sural nerve and short saphenous vein. These structures are important for sensation and blood flow to the lower leg and foot.

      On the other hand, posterior to the lateral malleolus and deep to the superior peroneal retinaculum are the peroneus longus and peroneus brevis tendons. These tendons are responsible for ankle stability and movement.

      Additionally, the calcaneofibular ligament is attached at the lateral malleolus. This ligament is important for maintaining the stability of the ankle joint and preventing excessive lateral movement.

      Understanding the anatomy of the lateral malleolus is crucial for diagnosing and treating ankle injuries and conditions. Proper care and management of these structures can help prevent long-term complications and improve overall ankle function.

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  • Question 6 - Samantha, a 65-year-old female, visits a vascular clinic and complains of leg pain...

    Incorrect

    • Samantha, a 65-year-old female, visits a vascular clinic and complains of leg pain while walking, which subsides when she rests. However, she has recently experienced night pain in her leg that wakes her up. She has a medical history of hypertension, diabetes, and hypercholesterolemia, and her BMI is 29kg/m².

      The surgeon suspects peripheral vascular disease and conducts a peripheral vascular exam. During the exam, the surgeon finds it difficult to palpate the posterior tibial pulse.

      Where is the posterior tibial pulse located anatomically?

      Your Answer:

      Correct Answer: Inferior posteriorly to the medial malleolus

      Explanation:

      The posterior tibial pulse is located inferiorly and posteriorly to the medial malleolus. It is not found superiorly or anteriorly to the medial malleolus, nor is it located posterior to the lateral malleolus. It is important to accurately locate the pulse for proper assessment and diagnosis.

      Anatomy of the Posterior Tibial Artery

      The posterior tibial artery is a major branch of the popliteal artery that terminates by dividing into the medial and lateral plantar arteries. It is accompanied by two veins throughout its length and its position corresponds to a line drawn from the lower angle of the popliteal fossa to a point midway between the medial malleolus and the most prominent part of the heel.

      The artery is located anteriorly to the tibialis posterior and flexor digitorum longus muscles, and posteriorly to the surface of the tibia and ankle joint. The posterior tibial nerve is located 2.5 cm distal to its origin. The proximal part of the artery is covered by the gastrocnemius and soleus muscles, while the distal part is covered by skin and fascia. The artery is also covered by the fascia overlying the deep muscular layer.

      Understanding the anatomy of the posterior tibial artery is important for medical professionals, as it plays a crucial role in the blood supply to the foot and ankle. Any damage or blockage to this artery can lead to serious complications, such as peripheral artery disease or even amputation.

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  • Question 7 - At what level does the inferior thyroid artery penetrate the thyroid gland? ...

    Incorrect

    • At what level does the inferior thyroid artery penetrate the thyroid gland?

      Your Answer:

      Correct Answer: C6

      Explanation:

      Surface Anatomy of the Neck: Identifying Structures and Corresponding Levels

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

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

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

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  • Question 8 - A 33-year-old man presents to the emergency department with lateral knee pain. He...

    Incorrect

    • A 33-year-old man presents to the emergency department with lateral knee pain. He reports that the pain began two hours ago while playing hockey, and he was struck on the anteromedial aspect of his extended knee by a hockey stick. An x-ray of the knee reveals an avulsion fracture of the fibular head. Which muscle is the probable culprit for this patient's avulsion fracture?

      Your Answer:

      Correct Answer: Biceps femoris

      Explanation:

      The fibular head serves as the insertion point for both the long and short head of the biceps femoris muscle. However, sudden contractions of the biceps femoris can lead to an avulsion fracture of the fibular head, where the fracture fragment may be attached to the lateral collateral ligament or biceps femoris tendon.

      The fibularis brevis muscle originates from the distal two-thirds of the fibular bone. If the ankle joint suddenly inverts, it can pull on the fibularis tendon and cause an avulsion of the tuberosity at the base of the fifth metatarsal.

      The flexor hallucis longus muscle originates from the distal two-thirds of the posterior surface of the fibular bone. This muscle not only allows for flexion of the big toe but also contributes to plantarflexion and inversion of the foot.

      The soleus muscle originates from the proximal one-third of the posterior surface of the fibular bone. It is a large muscle covered in thick fascia, which aids in its secondary function of pumping venous blood back into the heart through the skeletal muscle pump.

      The Biceps Femoris Muscle

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

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

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

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  • Question 9 - In a confrontation, a 35-year-old woman was stabbed in the medial aspect of...

    Incorrect

    • In a confrontation, a 35-year-old woman was stabbed in the medial aspect of her left thigh. Upon examination, there is a noticeable decrease in knee extension. Additionally, there is a reduction in sensation over the anterior thigh.

      Which anatomical structure has been affected by the stabbing?

      Your Answer:

      Correct Answer: Femoral nerve

      Explanation:

      The femoral nerve is responsible for loss of knee extension and sensory loss to the anterior and medial aspect of the thigh following a stab injury. The muscles innervated by the femoral nerve are responsible for hip flexion and knee extension, while the nerve is responsible for sensation over the anterior thigh. Injury to the inferior gluteal nerve would result in loss of hip extension, while injury to the obturator nerve would result in a loss of sensation to the medial thigh and impaired hip adduction. Although the quadriceps tendon is vital to knee extension, it would not explain the sensory deficit and the location of the injury.

      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.

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  • Question 10 - Which nerve provides innervation to the interossei of the fifth finger? ...

    Incorrect

    • Which nerve provides innervation to the interossei of the fifth finger?

      Your Answer:

      Correct Answer: Deep ulnar

      Explanation:

      PAD and DAB can be remembered as a mnemonic for the actions of the palmar and dorsal interossei muscles. The palmar interossei muscles ADduct the fingers towards the midline of the hand, while the dorsal interossei muscles ABduct the fingers away from the midline.

      Interossei: Muscles of the Hand

      Interossei are a group of muscles located in the hand that occupy the spaces between the metacarpal bones. There are three palmar and four dorsal interossei, each with a specific origin and insertion point. Palmar interossei originate from the metacarpal of the digit on which it acts, while dorsal interossei come from the surface of the adjacent metacarpal on which it acts. The interosseous tendons, except the first palmar, pass to one or other side of the metacarpophalangeal joint posterior to the deep transverse metacarpal ligament. They become inserted into the base of the proximal phalanx and partly into the extensor hood.

      All interossei are innervated by the ulnar nerve and have specific actions. Dorsal interossei abduct the fingers, while palmar interossei adduct the fingers. Along with the lumbricals, the interossei flex the metacarpophalangeal joints and extend the proximal and distal interphalangeal joints. They are responsible for fine-tuning these movements.

      In cases where the interossei and lumbricals are paralyzed, the digits are pulled into hyperextension by extensor digitorum, resulting in a claw hand. Understanding the function and innervation of the interossei is important in diagnosing and treating hand injuries and conditions.

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  • Question 11 - Into which of the following veins does the middle thyroid vein drain?

    Rewritten: At...

    Incorrect

    • Into which of the following veins does the middle thyroid vein drain?

      Rewritten: At what age does the middle thyroid vein drain into one of the following veins?

      Your Answer:

      Correct Answer: Internal jugular

      Explanation:

      If a ligature slips, the copious bleeding is due to the fact that it drains to the internal jugular vein.

      Anatomy of the Thyroid Gland

      The thyroid gland is a butterfly-shaped gland located in the neck, consisting of two lobes connected by an isthmus. It is surrounded by a sheath from the pretracheal layer of deep fascia and is situated between the base of the tongue and the fourth and fifth tracheal rings. The apex of the thyroid gland is located at the lamina of the thyroid cartilage, while the base is situated at the fourth and fifth tracheal rings. In some individuals, a pyramidal lobe may extend from the isthmus and attach to the foramen caecum at the base of the tongue.

      The thyroid gland is surrounded by various structures, including the sternothyroid, superior belly of omohyoid, sternohyoid, and anterior aspect of sternocleidomastoid muscles. It is also related to the carotid sheath, larynx, trachea, pharynx, oesophagus, cricothyroid muscle, and parathyroid glands. The superior and inferior thyroid arteries supply the thyroid gland with blood, while the superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic veins.

      In summary, the thyroid gland is a vital gland located in the neck, responsible for producing hormones that regulate metabolism. Its anatomy is complex, and it is surrounded by various structures that are essential for its function. Understanding the anatomy of the thyroid gland is crucial for the diagnosis and treatment of thyroid disorders.

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  • Question 12 - You are the physician attending to a 32-year-old expectant mother who is experiencing...

    Incorrect

    • You are the physician attending to a 32-year-old expectant mother who is experiencing discomfort in her thumb and index finger. She reports paraesthesia in the palmar region of her thumb and index finger, which worsens at night.

      What nerve is likely to be impacted?

      Your Answer:

      Correct Answer: Median

      Explanation:

      The patient is experiencing pins and needles and pain in the thumb and index finger, which worsens at night. These symptoms are indicative of carpal tunnel syndrome, which occurs when the median nerve is compressed due to increased pressure in the carpal tunnel. The distribution of the patient’s symptoms aligns with the area supplied by the median nerve.

      The inferior lateral cutaneous nerve does not innervate the thumb and index finger, so it cannot explain the patient’s symptoms. Damage to the musculocutaneous nerve would cause weakness in the upper arm flexors and impaired sensation in the lateral forearm, but not in the thumb and index finger.

      The radial nerve is responsible for wrist extension, and damage to it would result in wrist drop and altered sensation in the dorsum of the hand. The ulnar nerve causes clawing of the hand and paraesthesia in the medial two fingers when damaged, which is not consistent with 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.

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  • Question 13 - A 67-year-old female presents to her primary healthcare provider with painful blisters on...

    Incorrect

    • A 67-year-old female presents to her primary healthcare provider with painful blisters on her gingival and buccal mucosa and skin that easily rupture and cause ulcers. The oral blisters began three months ago and the cutaneous lesions just a week ago. She has a medical history of hypertension, vitiligo, and type 2 diabetes mellitus. Upon examination of the oral cavity and skin, scattered shallow ulcerations ranging from 8 mm to 1 cm in diameter were observed. A biopsy of the lesions revealed acantholysis. The patient has been prescribed corticosteroids.

      What is the most likely cause of this condition in the patient?

      Your Answer:

      Correct Answer: Antibodies against desmoglein 3

      Explanation:

      Pemphigus vulgaris is an autoimmune condition that occurs when the body’s immune system attacks desmoglein 3, a type of cell adhesion molecule found in epithelial cells. This disease is more prevalent in the Ashkenazi Jewish population. The most common symptom is mucosal ulceration, which can be the first sign of the disease. Oral involvement is seen in 50-70% of patients. Skin blistering is also a common symptom, with easily ruptured vesicles and bullae. These lesions are typically painful but not itchy and may appear months after the initial mucosal symptoms. Nikolsky’s sign is a characteristic feature of pemphigus vulgaris, where bullae spread following the application of horizontal, tangential pressure to the skin. Biopsy results often show acantholysis.

      The first-line treatment for pemphigus vulgaris is steroids, which help to reduce inflammation and suppress the immune system. Immunosuppressants may also be used to manage the disease.

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  • Question 14 - A 65-year-old male with a history of hypertension, obesity, and chronic kidney disease...

    Incorrect

    • A 65-year-old male with a history of hypertension, obesity, and chronic kidney disease complains of acute pain and redness in his right ankle, making it difficult for him to bear weight. He denies any recent injury and reports feeling generally well. Laboratory results reveal:

      - Hemoglobin: 134 g/L
      - Platelets: 312 * 10^9/L
      - White blood cells: 9.1 * 10^9/L
      - C-reactive protein: 49 mg/L
      - Serum urate: 0.3 mmol/L

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Gout

      Explanation:

      Once the inflammation has subsided, it is recommended to test the serum urate in suspected cases of gout, as its levels may vary from high to low or normal during an acute attack. Additionally, the patient’s overall good health and moderately elevated CRP levels suggest that septic arthritis is less probable.

      Understanding Gout: Symptoms and Diagnosis

      Gout is a type of arthritis that causes inflammation and pain in the joints. Patients experience episodes of intense pain that can last for several days, followed by periods of no symptoms. The acute episodes usually reach their peak within 12 hours and can affect various joints, with the first metatarsophalangeal joint being the most commonly affected. Swelling and redness are also common symptoms of gout.

      If left untreated, repeated acute episodes of gout can lead to joint damage and chronic joint problems. To diagnose gout, doctors may perform synovial fluid analysis to look for needle-shaped, negatively birefringent monosodium urate crystals under polarised light. Uric acid levels may also be checked once the acute episode has subsided, as they can be high, normal, or low during the attack.

      Radiological features of gout include joint effusion, well-defined punched-out erosions with sclerotic margins, and eccentric erosions. Unlike rheumatoid arthritis, gout does not cause periarticular osteopenia. Soft tissue tophi may also be visible.

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  • Question 15 - A 50-year-old woman presents with two months of lower back pain. The pain...

    Incorrect

    • A 50-year-old woman presents with two months of lower back pain. The pain worsens during prolonged periods of sitting and shoots down her left leg. She is still able to perform all of her usual activities but has noticed that she has been catching her left foot on stairs when walking.

      On examination, power is normal in all myotomes of the right leg. In the left leg, dorsiflexion is slightly weak. The sensation is intact to touch and pin-prick on the right leg but there is a subjective loss of sensation along the sole of the left foot. Reflexes are normal. Hip abduction is assessed, which shows reduced power on the left compared to the right.

      An MRI is organised to assess for pathology.

      What spinal level corresponds to the symptoms?

      Your Answer:

      Correct Answer: Fifth lumbar vertebrae (L5)

      Explanation:

      Understanding Prolapsed Disc and its Features

      A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

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  • Question 16 - A 25-year-old patient arrives at the emergency department half an hour after experiencing...

    Incorrect

    • A 25-year-old patient arrives at the emergency department half an hour after experiencing severe burns in a house fire. According to a Lund and Browder chart, approximately 42% of the patient's body is affected, with significant areas of full-thickness burns and oedema. During examination, the patient's heart rate is recorded at 124/min and blood pressure at 92/48 mmHg. What is the probable reason for the patient's vital signs?

      Your Answer:

      Correct Answer: Third space fluid loss

      Explanation:

      Third space fluid loss is a common occurrence in patients with severe burns. This happens when fluid leaks into the area surrounding cells, leading to symptoms such as edema, tachycardia, and hypotension.

      It is unlikely that neurogenic shock is the cause of these symptoms. Neurogenic shock is typically caused by damage to the autonomic pathways in the central nervous system, which is usually the result of spinal cord or central nervous system trauma.

      While secondary bacterial infections and sepsis are important considerations in patients with major burns, it is unlikely that this patient has an infection since the burns occurred only 30 minutes ago.

      Severe pain may explain the tachycardia, but it does not account for the hypotension.

      Smoke inhalation can cause coughing, shortness of breath, and burns around the airway, but it is unlikely to be the cause of the hypotension and tachycardia in this patient.

      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.

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  • Question 17 - A 30-year-old construction worker presents to the GP with a complaint of right...

    Incorrect

    • 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:

      Correct 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.

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  • Question 18 - Which one of the following is not closely related to the capitate bone?...

    Incorrect

    • Which one of the following is not closely related to the capitate bone?

      Your Answer:

      Correct Answer: Ulnar nerve

      Explanation:

      The pisiform bone is in close proximity to both the ulnar nerve and artery. Additionally, the capitate bone is in articulation with the lunate, scaphoid, hamate, and trapezoid bones, indicating a close relationship between them.

      The Capitate Bone: Largest of the Carpal Bones

      The capitate bone is the largest of the carpal bones and is located centrally in the wrist. It has a rounded head that fits into the cavities of the lunate and scaphoid bones. The bone also has flatter articular surfaces for the hamate medially and the trapezoid laterally. At the distal end, the capitate bone primarily articulates with the middle metacarpal. Overall, the capitate bone plays an important role in the structure and function of the wrist joint.

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  • Question 19 - Which one of the following relationship descriptions regarding the scalene muscles is incorrect?...

    Incorrect

    • Which one of the following relationship descriptions regarding the scalene muscles is incorrect?

      Your Answer:

      Correct Answer: The subclavian artery passes posterior to the middle scalene

      Explanation:

      The middle scalene is located posterior to the subclavian artery.

      The Scalene Muscles and Thoracic Outlet Syndrome

      The scalene muscles are a group of three paired muscles located in the neck that play a role in elevating the ribs and tilting the neck. The scalenus anterior and medius muscles elevate the first rib and laterally flex the neck to the same side, while the scalenus posterior muscle elevates the second rib and tilts the neck to the opposite side. These muscles are innervated by spinal nerves C4-6 and originate from the transverse processes of C2 to C7, inserting into the first and second ribs.

      The scalene muscles are important because the brachial plexus and subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus or fissure. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as it crosses over the first rib. However, the scalenes are at risk of adhering to the fascia surrounding the brachial plexus or shortening, which can cause compression of the brachial plexus when it passes between the clavicle and first rib. This condition is known as thoracic outlet syndrome.

      In summary, the scalene muscles play an important role in the neck and chest, but can also cause issues if they become adhered or shortened, leading to thoracic outlet syndrome. It is important to be aware of this condition and seek medical attention if experiencing symptoms such as pain, numbness, or tingling in the arm or hand.

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  • Question 20 - You are observing a tarsal tunnel release surgery on a patient you had...

    Incorrect

    • You are observing a tarsal tunnel release surgery on a patient you had interviewed earlier that afternoon. Upon incision of the flexor retinaculum, you notice several structures that are visible.

      Can you list the structural contents in order from anterior to posterior?

      Your Answer:

      Correct Answer: Tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery and vein, tibial nerve, flexor hallucis longus tendon

      Explanation:

      The correct order of contents in the tarsal tunnel, from anterior to posterior, is as follows: tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial artery and vein, tibial nerve, and flexor hallucis longus tendon. Therefore, the correct answer is 3. Answers 1 and 2 are incorrect as they include the tibialis anterior tendon, which is not located in the tarsal tunnel.

      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.

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  • Question 21 - Which of the following structures divides the subclavian artery and vein? ...

    Incorrect

    • Which of the following structures divides the subclavian artery and vein?

      Your Answer:

      Correct Answer: Anterior scalene muscle

      Explanation:

      The subclavian vein (anterior) and subclavian artery (posterior) are separated by the significant anatomical feature known as the anterior scalene muscle.

      The Scalene Muscles and Thoracic Outlet Syndrome

      The scalene muscles are a group of three paired muscles located in the neck that play a role in elevating the ribs and tilting the neck. The scalenus anterior and medius muscles elevate the first rib and laterally flex the neck to the same side, while the scalenus posterior muscle elevates the second rib and tilts the neck to the opposite side. These muscles are innervated by spinal nerves C4-6 and originate from the transverse processes of C2 to C7, inserting into the first and second ribs.

      The scalene muscles are important because the brachial plexus and subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus or fissure. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as it crosses over the first rib. However, the scalenes are at risk of adhering to the fascia surrounding the brachial plexus or shortening, which can cause compression of the brachial plexus when it passes between the clavicle and first rib. This condition is known as thoracic outlet syndrome.

      In summary, the scalene muscles play an important role in the neck and chest, but can also cause issues if they become adhered or shortened, leading to thoracic outlet syndrome. It is important to be aware of this condition and seek medical attention if experiencing symptoms such as pain, numbness, or tingling in the arm or hand.

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  • Question 22 - Which of the following bones is associated with the distal articular surface of...

    Incorrect

    • Which of the following bones is associated with the distal articular surface of the cuboid?

      Your Answer:

      Correct Answer: 5th metatarsal

      Explanation:

      The cuboid bone is situated on the outer side of the foot, positioned between the heel bone at the back and the fourth and fifth toe bones towards the front.

      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.

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  • Question 23 - Roughly what percentage of saliva production comes from the submandibular glands? ...

    Incorrect

    • Roughly what percentage of saliva production comes from the submandibular glands?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      Anatomy of the Submandibular Gland

      The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

      The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

      The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

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  • Question 24 - A 42-year-old man has been experiencing mechanical back pain for a few years....

    Incorrect

    • A 42-year-old man has been experiencing mechanical back pain for a few years. Upon waking up one morning, he experiences a sudden onset of pain in his back that travels down his left leg. What is the most probable cause of his symptoms?

      Your Answer:

      Correct Answer: Prolapse of nucleus pulposus

      Explanation:

      The cause of the symptoms is likely to be intervertebral disk prolapse, which occurs when the nucleus pulposus herniates.

      Intervertebral Discs

      Intervertebral discs are composed of two main parts: the outer annulus fibrosus and the inner nucleus pulposus. The annulus fibrosus is made up of multiple layers of fibrocartilage, while the nucleus pulposus contains loose fibers suspended in a mucoprotein gel with a jelly-like consistency. The nucleus of the disc acts as a shock absorber, and pressure on the disc can cause the posterior protrusion of the nucleus pulposus. This is most commonly seen in the lumbrosacral and lower cervical areas.

      The discs are separated by hyaline cartilage, and there is one disc between each pair of vertebrae, except for C1/2 and the sacrococcygeal vertebrae. Understanding the structure and function of intervertebral discs is important in the diagnosis and treatment of spinal conditions. By providing support and cushioning to the spine, these discs play a crucial role in maintaining spinal health and mobility.

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  • Question 25 - A 25-year-old woman is stabbed in the buttock and receives sutures in the...

    Incorrect

    • A 25-year-old woman is stabbed in the buttock and receives sutures in the emergency department. When she visits the clinic eight weeks later, she presents with a waddling gait and difficulty with thigh abduction. Upon examination, she exhibits buttock muscle wasting. Which nerve was damaged in the injury?

      Your Answer:

      Correct Answer: Superior gluteal nerve

      Explanation:

      If the superior gluteal nerve is damaged, it will cause a Trendelenburg gait.

      The Trendelenburg Test: Assessing Gluteal Nerve Function

      The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.

      When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.

      To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.

      It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.

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  • Question 26 - A physician is evaluating a 25-year-old male who came to the ER with...

    Incorrect

    • A physician is evaluating a 25-year-old male who came to the ER with wrist drop and weakened extension of his left elbow. The physician determines that the radial nerve, which innervates the tricep brachii, has been affected.

      What is the insertion point of this muscle?

      Your Answer:

      Correct Answer: Olecranon process of the ulna

      Explanation:

      The tricep muscle, which gets its name from the Latin word for three-headed muscles, is responsible for extending the elbow. It is made up of three heads: the long head, which originates from the infraglenoid tubercle of the scapular; the lateral head, which comes from the dorsal surface of the humerus; and the medial head, which originates from the posterior surface of the humerus. These three heads come together to form a single tendon that inserts onto the olecranon process of the ulna.

      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.

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  • Question 27 - The following statements regarding the rectus abdominis muscle are true except: ...

    Incorrect

    • The following statements regarding the rectus abdominis muscle are true except:

      Your Answer:

      Correct Answer: It lies in a muscular aponeurosis throughout its length

      Explanation:

      The rectus abdominis muscle originates from the pubis and inserts into the 5th, 6th, and 7th costal cartilages. It is located within the rectus sheath, which also contains the superior and inferior epigastric artery and vein. The muscle is responsible for flexing the thoracic and lumbar spine and is innervated by the anterior primary rami of T7-12. The aponeurosis of the rectus abdominis is incomplete below the arcuate line.

      Muscles and Layers of the Abdominal Wall

      The abdominal wall is composed of various muscles and layers that provide support and protection to the organs within the abdominal cavity. The two main muscles of the abdominal wall are the rectus abdominis and the quadratus lumborum. The rectus abdominis is located anteriorly, while the quadratus lumborum is located posteriorly.

      The remaining abdominal wall is made up of three muscular layers, each passing from the lateral aspect of the quadratus lumborum to the lateral margin of the rectus sheath. These layers are muscular posterolaterally and aponeurotic anteriorly. The external oblique muscle lies most superficially and originates from the 5th to 12th ribs, inserting into the anterior half of the outer aspect of the iliac crest, linea alba, and pubic tubercle. The internal oblique arises from the thoracolumbar fascia, the anterior 2/3 of the iliac crest, and the lateral 2/3 of the inguinal ligament, while the transversus abdominis is the innermost muscle, arising from the inner aspect of the costal cartilages of the lower 6 ribs, the anterior 2/3 of the iliac crest, and the lateral 1/3 of the inguinal ligament.

      During abdominal surgery, it is often necessary to divide either the muscles or their aponeuroses. It is desirable to divide the aponeurosis during a midline laparotomy, leaving the rectus sheath intact above the arcuate line and the muscles intact below it. Straying off the midline can lead to damage to the rectus muscles, particularly below the arcuate line where they may be in close proximity to each other. The nerve supply for these muscles is the anterior primary rami of T7-12.

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  • Question 28 - A 27-year-old male arrives at the Emergency Department following a fall on the...

    Incorrect

    • A 27-year-old male arrives at the Emergency Department following a fall on the street. He reports experiencing difficulty breathing and sharp, stabbing pain upon inhalation. A chest X-ray reveals a pneumothorax located at the lung's apex. Which bone is most likely fractured, resulting in the pneumothorax?

      Your Answer:

      Correct Answer: Clavicle

      Explanation:

      The apex of the pleural cavity is situated behind the middle third of the clavicle, which can be susceptible to breaking if there is force applied through the shoulders. Unlike the clavicle, the 1st and 2nd ribs are not commonly broken except in severe trauma such as road traffic accidents. The acromion is also an uncommon site for fractures, typically occurring from falling on outstretched hands. Similarly, the coracoid process is rarely fractured and is usually associated with shoulder dislocation.

      Anatomy of the Clavicle

      The clavicle is a bone that runs from the sternum to the acromion and plays a crucial role in preventing the shoulder from falling forwards and downwards. Its inferior surface is marked by ligaments at each end, including the trapezoid line and conoid tubercle, which provide attachment to the coracoclavicular ligament. The costoclavicular ligament attaches to the irregular surface on the medial part of the inferior surface, while the subclavius muscle attaches to the intermediate portion’s groove.

      The superior part of the clavicle’s medial end has a raised surface that gives attachment to the clavicular head of sternocleidomastoid, while the posterior surface attaches to the sternohyoid. On the lateral end, there is an oval articular facet for the acromion, and a disk lies between the clavicle and acromion. The joint’s capsule attaches to the ridge on the margin of the facet.

      In summary, the clavicle is a vital bone that helps stabilize the shoulder joint and provides attachment points for various ligaments and muscles. Its anatomy is marked by distinct features that allow for proper function and movement.

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  • Question 29 - A 26-year-old male suffers a fall resulting in a scaphoid bone fracture. What...

    Incorrect

    • A 26-year-old male suffers a fall resulting in a scaphoid bone fracture. What is the primary source of blood supply for the scaphoid bone?

      Your Answer:

      Correct Answer: From the distal end

      Explanation:

      Due to the fact that the blood supply to the scaphoid enters from a small non-articular surface near its distal end, there is a risk of non-union with transverse fractures of the scaphoid.

      The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

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  • Question 30 - Which of the metastatic bone tumours mentioned below is most susceptible to pathological...

    Incorrect

    • Which of the metastatic bone tumours mentioned below is most susceptible to pathological fracture?

      Your Answer:

      Correct Answer: Peritrochanteric lesion from a carcinoma of the breast

      Explanation:

      Fracture risks are highest in peritrochanteric lesions due to loading. Lytic lesions from breast cancer are at greater risk of fracture compared to the sclerotic lesions from prostate cancer.

      Understanding the Risk of Fracture in Metastatic Bone Disease

      Metastatic bone disease is a condition where cancer cells spread to the bones from other parts of the body. The risk of fracture in this condition varies depending on the type of metastatic bone tumour. Osteoblastic metastatic disease has the lowest risk of spontaneous fracture compared to osteolytic lesions of a similar size. However, lesions affecting the peritrochanteric region are more prone to spontaneous fracture due to loading forces at that site. To stratify the risk of spontaneous fracture for bone metastasis of varying types, the Mirel Scoring system is used. This system takes into account the site of the lesion, radiographic appearance, width of bone involved, and pain. Depending on the score, the treatment plan may involve prophylactic fixation, consideration of fixation, or non-operative management. Understanding the risk of fracture in metastatic bone disease is crucial in determining the appropriate treatment plan for patients.

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