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  • Question 1 - A 20-year-old patient visits their GP complaining of non-specific malaise. The patient has...

    Incorrect

    • A 20-year-old patient visits their GP complaining of non-specific malaise. The patient has a medical history of recurrent haematuria during childhood with infections and fever, as well as bilateral mild sensorineural hearing loss. Due to frequent moves between countries, the patient has never had continuous medical care. Further investigations reveal proteinuria and haematuria, leading to a referral to secondary care and a subsequent renal biopsy. The biopsy results show splitting of the lamina densa on electron microscopy.

      What is the most common mode of inheritance for this likely diagnosis?

      Your Answer: Autosomal recessive

      Correct Answer: X-linked dominant

      Explanation:

      Alport’s syndrome is a genetic disorder that is typically inherited in an X-linked dominant pattern. It is caused by a defect in the gene responsible for producing type IV collagen, which leads to an abnormal glomerular-basement membrane (GBM). The disease is more severe in males, with females rarely developing renal failure. Symptoms usually present in childhood and may include microscopic haematuria, progressive renal failure, bilateral sensorineural deafness, lenticonus, retinitis pigmentosa, and splitting of the lamina densa seen on electron microscopy. In some cases, an Alport’s patient with a failing renal transplant may have anti-GBM antibodies, leading to a Goodpasture’s syndrome-like picture. Diagnosis can be made through molecular genetic testing, renal biopsy, or electron microscopy. In around 85% of cases, the syndrome is inherited in an X-linked dominant pattern, while 10-15% of cases are inherited in an autosomal recessive fashion, with rare autosomal dominant variants existing.

    • This question is part of the following fields:

      • Renal System
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  • Question 2 - A patient in their mid-thirties visits their GP with worries about a family...

    Correct

    • A patient in their mid-thirties visits their GP with worries about a family history of a neurological disorder. The GP refers them to a geneticist who diagnoses the patient with a mutation in the presenilin-1 gene. What disease is the patient at increased risk of developing?

      Your Answer: Alzheimer's Disease

      Explanation:

      Familial Alzheimer’s disease that occurs at an early age is caused by mutations in the genes for amyloid precursor protein (APP), presenilin 1 (PSEN1), or presenilin 2 (PSEN2). The presenilin gene produces a transmembrane protein that, when mutated, is crucial in the creation of amyloid beta (A) from APP. The buildup of amyloid beta outside of neurons is linked to the onset of Alzheimer’s disease.

      Alzheimer’s disease is a type of dementia that gradually worsens over time and is caused by the degeneration of the brain. There are several risk factors associated with Alzheimer’s disease, including increasing age, family history, and certain genetic mutations. The disease is also more common in individuals of Caucasian ethnicity and those with Down’s syndrome.

      The pathological changes associated with Alzheimer’s disease include widespread cerebral atrophy, particularly in the cortex and hippocampus. Microscopically, there are cortical plaques caused by the deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein. The hyperphosphorylation of the tau protein has been linked to Alzheimer’s disease. Additionally, there is a deficit of acetylcholine due to damage to an ascending forebrain projection.

      Neurofibrillary tangles are a hallmark of Alzheimer’s disease and are partly made from a protein called tau. Tau is a protein that interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules. In Alzheimer’s disease, tau proteins are excessively phosphorylated, impairing their function.

    • This question is part of the following fields:

      • Neurological System
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  • Question 3 - A 72-year-old male with a history of severe aortic stenosis undergoes valve replacement...

    Incorrect

    • A 72-year-old male with a history of severe aortic stenosis undergoes valve replacement surgery. Following the procedure, he is prescribed dipyridamole. What is the mechanism of action of this medication?

      Your Answer:

      Correct Answer: Non-specific phosphodiesterase antagonist

      Explanation:

      Dipyridamole is a non-specific phosphodiesterase antagonist that inhibits platelet aggregation and thrombus formation by elevating platelet cAMP levels. It also reduces cellular uptake of adenosine and inhibits thromboxane synthase.

      Understanding the Mechanism of Action of Dipyridamole

      Dipyridamole is a medication that is commonly used in combination with aspirin to prevent the formation of blood clots after a stroke or transient ischemic attack. The drug works by inhibiting phosphodiesterase, which leads to an increase in the levels of cyclic adenosine monophosphate (cAMP) in platelets. This, in turn, reduces the levels of intracellular calcium, which is necessary for platelet activation and aggregation.

      Apart from its antiplatelet effects, dipyridamole also reduces the cellular uptake of adenosine, a molecule that plays a crucial role in regulating blood flow and oxygen delivery to tissues. By inhibiting the uptake of adenosine, dipyridamole can increase its levels in the bloodstream, leading to vasodilation and improved blood flow.

      Another mechanism of action of dipyridamole is the inhibition of thromboxane synthase, an enzyme that is involved in the production of thromboxane A2, a potent platelet activator. By blocking this enzyme, dipyridamole can further reduce platelet activation and aggregation, thereby preventing the formation of blood clots.

      In summary, dipyridamole exerts its antiplatelet effects through multiple mechanisms, including the inhibition of phosphodiesterase, the reduction of intracellular calcium levels, the inhibition of thromboxane synthase, and the modulation of adenosine uptake. These actions make it a valuable medication for preventing thrombotic events in patients with a history of stroke or transient ischemic attack.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 4 - During your 3rd-year neurology placement, you visit a nursing home where you conduct...

    Incorrect

    • During your 3rd-year neurology placement, you visit a nursing home where you conduct an interview with a 93-year-old male who has advanced dementia. Upon assessment, you observe that he has an intact short-term memory but impaired long-term memory. Which specific brain region is responsible for the conversion of short-term memory into long-term memory?

      Your Answer:

      Correct Answer: Hippocampus

      Explanation:

      The Role of the Hippocampus in Long-Term Memory

      Long-term memories are stored in the brain through permanent changes in neural connections that are widely distributed throughout the brain. The hippocampus plays a crucial role in the consolidation of information from short-term to long-term memories. However, it does not store information itself. Instead, it acts as a gateway for new memories to be transferred from short-term to long-term memory storage.

      Without the hippocampus, new memories cannot be stored in long-term memory. This is because the hippocampus is responsible for encoding and consolidating new information into a form that can be stored in long-term memory. Once the information has been consolidated, it is distributed throughout the brain, where it is stored in various regions.

      In summary, the hippocampus is essential for the formation of long-term memories. It acts as a gateway for new memories to be transferred from short-term to long-term memory storage. Without the hippocampus, new memories cannot be stored in long-term memory, and the ability to form new memories is severely impaired.

    • This question is part of the following fields:

      • General Principles
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  • Question 5 - A patient develops a broad complex tachycardia three days following a myocardial infarction....

    Incorrect

    • A patient develops a broad complex tachycardia three days following a myocardial infarction. What is the primary mechanism of action of intravenous amiodarone in this case?

      Your Answer:

      Correct Answer: Blocks voltage-gated potassium channels

      Explanation:

      Amiodarone’s mechanism of action involves the inhibition of potassium channels.

      Amiodarone is a medication used to treat various types of abnormal heart rhythms. It works by blocking potassium channels, which prolongs the action potential and helps to regulate the heartbeat. However, it also has other effects, such as blocking sodium channels. Amiodarone has a very long half-life, which means that loading doses are often necessary. It should ideally be given into central veins to avoid thrombophlebitis. Amiodarone can cause proarrhythmic effects due to lengthening of the QT interval and can interact with other drugs commonly used at the same time. Long-term use of amiodarone can lead to various adverse effects, including thyroid dysfunction, corneal deposits, pulmonary fibrosis/pneumonitis, liver fibrosis/hepatitis, peripheral neuropathy, myopathy, photosensitivity, a ‘slate-grey’ appearance, thrombophlebitis, injection site reactions, and bradycardia. Patients taking amiodarone should be monitored regularly with tests such as TFT, LFT, U&E, and CXR.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 6 - A 10-year-old male presents to the doctor with recurrent episodes of difficulty breathing....

    Incorrect

    • A 10-year-old male presents to the doctor with recurrent episodes of difficulty breathing. These episodes tend to occur more frequently in the winter and after physical activity. The patient also has a history of eczema and seasonal allergies. After evaluation, the doctor diagnoses the patient with asthma and prescribes beclomethasone and salbutamol. During the appointment, the patient's mother inquires about the cause of asthma. The doctor explains that while the underlying mechanism is complex, it is generally associated with an antibody known as IgE. Which of the following cells express receptors for IgE on their cell surface?

      Your Answer:

      Correct Answer: Mast cells

      Explanation:

      Both mast cells and basophils have IgE receptors on their cell surface, which makes them key players in type 1 hypersensitivity reactions. T cell receptors exhibit significant variability, while neutrophils are primarily phagocytic.

      Innate Immune Response: Cells Involved

      The innate immune response is the first line of defense against invading pathogens. It involves a variety of cells that work together to quickly recognize and eliminate foreign invaders. The following cells are primarily involved in the innate immune response:

      Neutrophils are the most common type of white blood cell and are the primary phagocytic cell in acute inflammation. They contain granules that contain myeloperoxidase and lysozyme, which help to break down and destroy pathogens.

      Basophils and mast cells are similar in function and both release histamine during an allergic response. They also contain granules that contain histamine and heparin, and express IgE receptors on their cell surface.

      Eosinophils defend against protozoan and helminthic infections, and have a bi-lobed nucleus.

      Monocytes differentiate into macrophages, which are involved in phagocytosis of cellular debris and pathogens. They also act as antigen-presenting cells and are a major source of IL-1.

      Natural killer cells induce apoptosis in virally infected and tumor cells, while dendritic cells act as antigen-presenting cells.

      Overall, these cells work together to provide a rapid and effective response to invading pathogens, helping to protect the body from infection and disease.

    • This question is part of the following fields:

      • General Principles
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  • Question 7 - A 25-year-old woman presents with a sudden and severe headache, which is indicative...

    Incorrect

    • A 25-year-old woman presents with a sudden and severe headache, which is indicative of a possible subarachnoid hemorrhage. Upon conducting a head CT scan, the results appear normal. As a result, a lumbar puncture is performed. What is the next structure that the spinal needle will pass through after piercing the interspinous ligament?

      Your Answer:

      Correct Answer: Ligamentum flavum

      Explanation:

      Lumbar Puncture Landmarks and Needle Pathway

      A lumbar puncture is a medical procedure that involves inserting a needle into the lower back to collect cerebrospinal fluid for diagnostic purposes. The landmarks for this procedure are the iliac crests, which are the bony protrusions at the top of the hip bones. The fourth lumbar vertebrae is located in line with these crests and is the target for the needle insertion. It is important to note that the spinal cord ends at the level of the first lumbar vertebrae, which is several levels above the site of the puncture.

      The needle pathway for a lumbar puncture involves passing through several layers of tissue. These layers, from most superficial to most deep, include the skin, fascia, supraspinous ligament, interspinous ligament, ligamentum flavum, areolar tissue, dura, and arachnoid mater. Each of these layers serves a different purpose in protecting the spinal cord and surrounding structures, and the needle must be carefully guided through each layer to avoid complications.

      In summary, a lumbar puncture is a procedure that requires precise placement of the needle in order to collect cerebrospinal fluid for diagnostic purposes. The landmarks for the procedure are the iliac crests and the target vertebrae is the fourth lumbar vertebrae. The needle pathway involves passing through several layers of tissue, each of which serves a different protective function.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 8 - A 50-year-old man presents with a sudden exacerbation of arthralgia affecting his hands...

    Incorrect

    • A 50-year-old man presents with a sudden exacerbation of arthralgia affecting his hands and wrists. He also complains of feeling excessively fatigued lately. The patient has a medical history of hypertension and type 2 diabetes mellitus. Upon examination, his BMI is found to be 35 kg/m2. Laboratory tests reveal:

      - Na+ 140 mmol/l
      - K+ 4.2 mmol/l
      - Urea 3.8 mmol/l
      - Creatinine 100 µmol/l
      - Plasma glucose 11.8 mmol/l
      - ALT 150 u/l
      - Serum ferritin 2000 ng/ml

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Haemochromatosis

      Explanation:

      Hereditary haemochromatosis is a genetic disorder that affects how the body processes iron. It is inherited in an autosomal recessive pattern. The symptoms in the early stages can be vague and non-specific, such as feeling tired and experiencing joint pain. As the condition progresses, it can lead to chronic liver disease and a condition known as bronze diabetes, which is characterized by iron buildup in the pancreas causing diabetes, and a bronze or grey pigmentation of the skin. Based on the patient’s symptoms of joint pain, elevated ALT levels, and significantly high ferritin levels, it is highly likely that they have haemochromatosis.

      Understanding Haemochromatosis: Symptoms and Complications

      Haemochromatosis is a genetic disorder that affects iron absorption and metabolism, leading to iron accumulation in the body. It is caused by mutations in the HFE gene on both copies of chromosome 6. This disorder is prevalent in people of European descent, with 1 in 10 carrying a mutation in the genes affecting iron metabolism. Early symptoms of haemochromatosis are often non-specific, such as lethargy and arthralgia, and may go unnoticed. However, as the disease progresses, patients may experience fatigue, erectile dysfunction, and skin pigmentation.

      Other complications of haemochromatosis include diabetes mellitus, liver disease, cardiac failure, hypogonadism, and arthritis. While some symptoms are reversible with treatment, such as cardiomyopathy, skin pigmentation, diabetes mellitus, hypogonadotrophic hypogonadism, and arthropathy, liver cirrhosis is irreversible.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 9 - A 47-year-old man is given a significant amount of whole blood transfusion that...

    Incorrect

    • A 47-year-old man is given a significant amount of whole blood transfusion that is three weeks old. How will the blood handle oxygen?

      Your Answer:

      Correct Answer: It will have an increased affinity for oxygen

      Explanation:

      Blood that has been stored has a decreased level of 2,3 DPG, resulting in a greater attraction to oxygen and a reduced capacity to release it at tissues that are undergoing metabolism.

      Oxygen Transport and Factors Affecting Haemoglobin Saturation

      Oxygen transport in the body is mainly carried out by erythrocytes, with only 1% of oxygen being transported as a solution due to its limited solubility. The amount of oxygen transported depends on the concentration of haemoglobin and its degree of saturation. Haemoglobin is a globular protein composed of four subunits, with two alpha and two beta subunits forming globin. Haem, which surrounds an iron atom in its ferrous state, can form two additional bonds with oxygen and a polypeptide chain. The oxygenation of haemoglobin is a reversible reaction, and the molecular shape of haemoglobin facilitates the binding of subsequent oxygen molecules.

      The oxygen dissociation curve describes the relationship between the percentage of saturated haemoglobin and partial pressure of oxygen in the blood, and it is not affected by haemoglobin concentration. The curve can be shifted to the right or left by various factors. Chronic anaemia, for example, causes an increase in 2,3 DPG levels, which shifts the curve to the right, resulting in lower oxygen delivery. The Haldane effect causes a shift to the left, resulting in decreased oxygen delivery to tissues, while the Bohr effect causes a shift to the right, resulting in enhanced oxygen delivery to tissues. Factors that shift the curve to the left include low levels of H+, pCO2, 2,3-DPG, and temperature, as well as the presence of HbF, methaemoglobin, and carboxyhaemoglobin. Factors that shift the curve to the right include raised levels of H+, pCO2, and 2,3-DPG, as well as increased temperature.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 10 - A 67-year-old female is hospitalized with acute pancreatitis. What factor would indicate a...

    Incorrect

    • A 67-year-old female is hospitalized with acute pancreatitis. What factor would indicate a poor prognosis?

      Your Answer:

      Correct Answer: Glucose 15.8mmol/l

      Explanation:

      The Glasgow Prognostic Score is a useful tool for assessing the severity of acute pancreatitis. If three or more of the following criteria are present within the first 48 hours, it is likely that the patient is experiencing severe pancreatitis and should be referred to the High Dependency Unit or Intensive Care Unit. Conversely, if the score is less than three, severe pancreatitis is unlikely. The criteria include: age over 55 years, white blood cell count over 15 x 109/L, urea over 16 mmol/L, glucose over 10 mmol/L, pO2 less than 8 kPa (60 mm Hg), albumin less than 32 g/L, calcium less than 2 mmol/L, LDH over 600 units/L, and AST/ALT over 200 units. Based on these criteria, the only option that meets the threshold for severe pancreatitis is a glucose level of 15.8 mmol/L.

      Acute pancreatitis is a condition that is primarily caused by gallstones and alcohol consumption in the UK. However, there are other factors that can contribute to the development of this condition. A popular mnemonic used to remember these factors is GET SMASHED, which stands for gallstones, ethanol, trauma, steroids, mumps, autoimmune diseases, scorpion venom, hypertriglyceridaemia, hyperchylomicronaemia, hypercalcaemia, hypothermia, ERCP, and certain drugs. It is important to note that pancreatitis is seven times more common in patients taking mesalazine than sulfasalazine. CT scans can show diffuse parenchymal enlargement with oedema and indistinct margins in patients with acute pancreatitis.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 11 - A 65-year-old male with a diagnosis of lung cancer presents with fatigue and...

    Incorrect

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

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

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

      Your Answer:

      Correct Answer: Syndrome of inappropriate ADH secretion

      Explanation:

      Syndrome of Inappropriate ADH Secretion

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

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

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

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

    • This question is part of the following fields:

      • Endocrine System
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  • Question 12 - A 27-year-old patient, Sarah, suffered severe left-sided craniofacial trauma in a car accident....

    Incorrect

    • A 27-year-old patient, Sarah, suffered severe left-sided craniofacial trauma in a car accident. Following a period in the ICU, Sarah has been discharged to the ward and requires rehabilitation therapy due to suspected cranial nerve damage. Sarah experiences numbness on the left side of her face and struggles with chewing. However, she can still smile and reports no alteration in her sense of taste. The left eye lacks the corneal reflex, while the right eye has it. What other symptom is likely present in Sarah?

      Your Answer:

      Correct Answer: Jaw deviation to the left

      Explanation:

      Tom’s jaw deviation towards the left is consistent with trigeminal nerve damage from his accident. The trigeminal nerve controls facial sensation and the muscles of mastication. His ability to smile and report no change in taste suggests that his facial nerve is intact, and he is not experiencing upper motor neuron lesion. Jaw deviation to the right, tongue deviation to the left or right, and inability to wrinkle the forehead are not consistent with trigeminal nerve palsy.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
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  • Question 13 - An academic clinician is conducting research into the 12-month effects of a new...

    Incorrect

    • An academic clinician is conducting research into the 12-month effects of a new medication on blood pressure levels in patients over the age of 60. As part of their data analysis, they want to determine if there is a significant difference between blood pressure levels at baseline and after 12 months of treatment with the new medication. However, the data is non-normally distributed.

      What would be the most appropriate method to assess for a significant difference between the two groups?

      Your Answer:

      Correct Answer: Wilcoxon signed-rank test

      Explanation:

      Types of Significance Tests

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

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

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

    • This question is part of the following fields:

      • General Principles
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  • Question 14 - A 25-year-old woman is distressed about the acne on her face and arms...

    Incorrect

    • A 25-year-old woman is distressed about the acne on her face and arms and seeks the advice of a dermatologist. She expresses interest in trying accutane (isotretinoin) after reading positive reviews online. The dermatologist informs her of the potential adverse effects of the medication.

      What is a recognized side effect of accutane?

      Your Answer:

      Correct Answer: Photosensitivity

      Explanation:

      Isotretinoin use can cause photosensitivity, which is a known adverse effect. The statement that it is associated with low HDL and raised triglycerides is incorrect. Additionally, patients taking Isotretinoin are at risk of benign intracranial hypertension, not hypotension, and this risk is further increased by taking tetracyclines. Therefore, tetracyclines such as doxycycline should not be prescribed to patients on Isotretinoin.

      Understanding Isotretinoin and its Adverse Effects

      Isotretinoin is a type of oral retinoid that is commonly used to treat severe acne. It has been found to be effective in providing long-term remission or cure for two-thirds of patients who undergo a course of treatment. However, it is important to note that isotretinoin also comes with several adverse effects that patients should be aware of.

      One of the most significant adverse effects of isotretinoin is its teratogenicity, which means that it can cause birth defects in fetuses if taken during pregnancy. For this reason, females who are taking isotretinoin should ideally be using two forms of contraception to prevent pregnancy. Other common adverse effects of isotretinoin include dry skin, eyes, and lips/mouth, low mood, raised triglycerides, hair thinning, nose bleeds, and photosensitivity.

      It is also worth noting that there is some controversy surrounding the potential link between isotretinoin and depression or other psychiatric problems. While these adverse effects are listed in the British National Formulary (BNF), further research is needed to fully understand the relationship between isotretinoin and mental health.

      Overall, while isotretinoin can be an effective treatment for severe acne, patients should be aware of its potential adverse effects and discuss any concerns with their healthcare provider.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 15 - A 25-year-old regular gym attendee has been using growth hormone injections to enhance...

    Incorrect

    • A 25-year-old regular gym attendee has been using growth hormone injections to enhance his muscle mass. What potential risks is he now more susceptible to?

      Your Answer:

      Correct Answer: Diabetes mellitus type II

      Explanation:

      Excessive growth hormone can elevate the likelihood of developing type II diabetes mellitus. This is due to the hormone’s ability to release glucose from fat reserves, which raises its concentration in the bloodstream. As a result, the pancreas must produce more insulin to counteract the heightened glucose levels.

      Additional indications of surplus growth hormone may involve thickened skin, enlarged extremities, a protruding jaw, carpal tunnel syndrome, fatigue, muscle frailty, and high blood pressure.

      Understanding Growth Hormone and Its Functions

      Growth hormone (GH) is a hormone produced by the somatotroph cells in the anterior pituitary gland. It plays a crucial role in postnatal growth and development, as well as in regulating protein, lipid, and carbohydrate metabolism. GH acts on a transmembrane receptor for growth factor, leading to receptor dimerization and direct or indirect effects on tissues via insulin-like growth factor 1 (IGF-1), which is primarily secreted by the liver.

      GH secretion is regulated by various factors, including growth hormone releasing hormone (GHRH), fasting, exercise, and sleep. Conversely, glucose and somatostatin can decrease GH secretion. Disorders associated with GH include acromegaly, which results from excess GH, and GH deficiency, which can lead to short stature.

      In summary, GH is a vital hormone that plays a significant role in growth and metabolism. Understanding its functions and regulation can help in the diagnosis and treatment of GH-related disorders.

    • This question is part of the following fields:

      • Endocrine System
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  • Question 16 - A 14-year-old female presents to her GP with worries about never having had...

    Incorrect

    • A 14-year-old female presents to her GP with worries about never having had a menstrual period. She notes that she is noticeably shorter than her peers, despite her parents being of average height.

      After ruling out pregnancy, the GP orders additional tests, which show:

      FSH 15 IU/L (1-9)
      LH 14 IU/L (1-12)

      What is the most probable diagnosis in this scenario?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      If a patient with primary amenorrhea has elevated FSH/LH levels, it may indicate the presence of gonadal dysgenesis.

      Understanding Amenorrhoea: Causes, Investigations, and Management

      Amenorrhoea is a condition characterized by the absence of menstrual periods. It can be classified into two types: primary and secondary. Primary amenorrhoea occurs when menstruation fails to start by the age of 15 in girls with normal secondary sexual characteristics or by the age of 13 in girls with no secondary sexual characteristics. On the other hand, secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses or 6-12 months in women with previous oligomenorrhoea.

      The causes of amenorrhoea vary depending on the type. Primary amenorrhoea may be caused by gonadal dysgenesis, testicular feminization, congenital malformations of the genital tract, functional hypothalamic amenorrhoea, congenital adrenal hyperplasia, imperforate hymen, hypothalamic amenorrhoea, polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, and thyrotoxicosis. Meanwhile, secondary amenorrhoea may be caused by stress, excessive exercise, PCOS, Sheehan’s syndrome, Asherman’s syndrome, and other underlying medical conditions.

      To diagnose amenorrhoea, initial investigations may include pregnancy tests, full blood count, urea & electrolytes, coeliac screen, thyroid function tests, gonadotrophins, prolactin, and androgen levels. Management of amenorrhoea involves treating the underlying cause. For primary amenorrhoea, it is important to investigate and treat any underlying cause. For secondary amenorrhoea, it is important to exclude pregnancy, lactation, and menopause and treat the underlying cause accordingly. Women with primary ovarian insufficiency due to gonadal dysgenesis may benefit from hormone replacement therapy to prevent osteoporosis and other complications.

      In conclusion, amenorrhoea is a condition that requires proper diagnosis and management. Understanding the causes and appropriate investigations can help in providing the necessary treatment and care for women experiencing this condition.

    • This question is part of the following fields:

      • Reproductive System
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  • Question 17 - An 80-year-old man comes to the emergency department after experiencing a fall. He...

    Incorrect

    • An 80-year-old man comes to the emergency department after experiencing a fall. He reports a recent decline in his vision, including distortion of lines and loss of central vision, which was particularly noticeable tonight.

      During the eye examination, you observe the presence of drusen and new vessel formation around the macula.

      As part of his discharge plan, you schedule a follow-up appointment with an ophthalmologist, suspecting that monoclonal antibody treatment targeting vascular endothelial growth factor (VEGF) may be necessary.

      What type of monoclonal antibody functions through this mechanism of action?

      Your Answer:

      Correct Answer: Bevacizumab

      Explanation:

      Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF). It is used to slow down the progression of wet age-related macular degeneration (ARMD), which is the condition described in this case. Treatment with bevacizumab should begin within the first two months of diagnosis of wet ARMD.

      Abciximab is a monoclonal antibody that targets platelet IIb/IIIa receptors, preventing platelet aggregation. It is used to prevent blood clots in unstable angina or after coronary artery stenting.

      Adalimumab is a monoclonal antibody that targets tumor necrosis factor (TNF) and is primarily used to treat inflammatory arthritis.

      Omalizumab is a monoclonal antibody that targets the IgE receptor, reducing the IgE response. It is used to treat severe allergic asthma.

      Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by degeneration of the central retina (macula) and the formation of drusen. The risk of ARMD increases with age, smoking, family history, and conditions associated with an increased risk of ischaemic cardiovascular disease. ARMD is classified into dry and wet forms, with the latter carrying the worst prognosis. Clinical features include subacute onset of visual loss, difficulties in dark adaptation, and visual hallucinations. Signs include distortion of line perception, the presence of drusen, and well-demarcated red patches in wet ARMD. Investigations include slit-lamp microscopy, colour fundus photography, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Treatment options include a combination of zinc with anti-oxidant vitamins for dry ARMD and anti-VEGF agents for wet ARMD. Laser photocoagulation is also an option, but anti-VEGF therapies are usually preferred.

    • This question is part of the following fields:

      • Neurological System
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  • Question 18 - A 23-year-old man presents to the emergency department after a car accident with...

    Incorrect

    • A 23-year-old man presents to the emergency department after a car accident with complaints of shortness of breath and right shoulder pain. Upon examination, his vital signs are as follows: temperature of 36.5ºC, heart rate of 96 bpm, respiratory rate of 36 breaths per minute, and blood pressure of 125/95 mmHg. The right clavicle is tender and deformed, and there is hyper resonance over the right thorax. A chest x-ray is ordered, which reveals a right-sided apical pneumothorax. Which part of the clavicle is most likely fractured?

      Your Answer:

      Correct Answer: Middle third of the clavicle

      Explanation:

      The correct answer is the middle third of the clavicle. The apex of the pleural cavity is located behind this area, with its tip situated in the supraclavicular fossa.

      The acromioclavicular junction, lateral third of the clavicle, medial third of the clavicle, and sternoclavicular junction are all incorrect answers. These areas have different anatomical structures and functions.

      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.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 19 - A 25-year-old patient presents at 22 weeks gestation with an abnormal ultrasound scan....

    Incorrect

    • A 25-year-old patient presents at 22 weeks gestation with an abnormal ultrasound scan. The scan shows hydrops fetalis. Upon questioning, the woman reveals that her 6-year-old daughter was recently diagnosed with parvovirus B19 by their family doctor.

      What could be the probable cause of hydrops fetalis in this scenario?

      Your Answer:

      Correct Answer: Suppression of foetal erythropoiesis

      Explanation:

      Hydrops fetalis is a condition where the fetus has fluid accumulation in at least two compartments, such as the kidneys and polyhydramnios. One cause of this condition is infection with parvovirus B19, which suppresses fetal erythropoiesis and leads to fetal anemia and heart failure. This, in turn, causes fluid accumulation seen on ultrasound. Parvovirus B19 commonly affects children and can cause erythema infectiosum, also known as slapped cheek disease.

      While autoimmune hemolysis can also cause hydrops fetalis, it is typically associated with ABO or rhesus incompatibility. This occurs when maternal antibodies attack fetal red blood cells, leading to immune-mediated hemolysis and hydrops fetalis. This is not the same mechanism as that caused by parvovirus B19 infection.

      Cardiac malformations and exposure to teratogens during pregnancy can also cause heart failure and hydrops fetalis, but this is not typically associated with parvovirus B19 infection. Similarly, fetal kidney failure can lead to fluid accumulation and hydrops fetalis, but it is not caused by antenatal parvovirus B19 infection. Pulmonary hypertension is another cause of heart failure, but it is not common in fetuses and is more commonly seen in the elderly population. It is not caused by parvovirus B19 infection in fetuses.

      Parvovirus B19: A Virus with Various Clinical Presentations

      Parvovirus B19 is a type of DNA virus that can cause different clinical presentations. One of the most common is erythema infectiosum, also known as fifth disease or slapped-cheek syndrome. This illness may manifest as a mild feverish condition or a noticeable rash that appears after a few days. The rash is characterized by rose-red cheeks, which is why it is called slapped-cheek syndrome. It may spread to other parts of the body but rarely involves the palms and soles. The rash usually peaks after a week and then fades, but it may recur for some months after exposure to triggers such as warm baths, sunlight, heat, or fever. Most children recover without specific treatment, and school exclusion is unnecessary as the child is no longer infectious once the rash emerges. However, in adults, the virus may cause acute arthritis.

      Aside from erythema infectiosum, parvovirus B19 can also present as asymptomatic, pancytopenia in immunosuppressed patients, or aplastic crises in sickle-cell disease. The virus suppresses erythropoiesis for about a week, so aplastic anemia is rare unless there is a chronic hemolytic anemia. In pregnant women, the virus can cross the placenta and cause severe anemia due to viral suppression of fetal erythropoiesis, which may lead to heart failure secondary to severe anemia and the accumulation of fluid in fetal serous cavities such as ascites, pleural and pericardial effusions. This condition is called hydrops fetalis and is treated with intrauterine blood transfusions.

      It is important to note that parvovirus B19 can affect an unborn baby in the first 20 weeks of pregnancy. If a woman is exposed early in pregnancy, she should seek prompt advice from her antenatal care provider as maternal IgM and IgG will need to be checked. The virus is spread by the respiratory route, and a person is infectious 3 to 5 days before the appearance of the rash. Children are no longer infectious once the rash appears, and there is no specific treatment. Therefore, school exclusion is unnecessary.

    • This question is part of the following fields:

      • General Principles
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  • Question 20 - A 32-year-old man with a history of cystic fibrosis presents to the respiratory...

    Incorrect

    • A 32-year-old man with a history of cystic fibrosis presents to the respiratory ward after feeling unwell for 4 days. He reports experiencing pleuritic chest pain, shortness of breath, and producing more purulent sputum than usual. Upon examination, his heart rate is 110 beats per minute, his temperature is 38.2ºC, and his blood pressure is 126/86mmHg.

      A sputum sample is collected and reveals the presence of gram-negative encapsulated bacilli, which are negative on Ziehl-Neelsen stain.

      What is the most likely pathogen responsible for this patient's symptoms?

      Your Answer:

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      The organism responsible for causing lower respiratory tract infections in cystic fibrosis patients is Pseudomonas aeruginosa.

      Pseudomonas aeruginosa: A Gram-negative Rod Causing Various Infections

      Pseudomonas aeruginosa is a type of bacteria that is commonly found in the environment. It is a Gram-negative rod that can cause a range of infections in humans. Some of the infections it causes include chest infections, skin infections such as burns and wound infections, otitis externa, and urinary tract infections.

      In the laboratory, Pseudomonas aeruginosa is identified as a Gram-negative rod that does not ferment lactose and is oxidase positive. The bacteria produce both an endotoxin and exotoxin A. The endotoxin causes fever and shock, while exotoxin A inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2.

      Overall, Pseudomonas aeruginosa is a pathogenic bacteria that can cause a variety of infections in humans. Its ability to produce toxins makes it particularly dangerous and difficult to treat. Proper hygiene and infection control measures can help prevent the spread of this bacteria.

    • This question is part of the following fields:

      • General Principles
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  • Question 21 - Which of the following is the least probable outcome associated with severe atrophic...

    Incorrect

    • Which of the following is the least probable outcome associated with severe atrophic gastritis in elderly patients?

      Your Answer:

      Correct Answer: Duodenal ulcers

      Explanation:

      A duodenal ulcer is unlikely to occur as a result of the decrease in gastric acid. However, it should be noted that gastric polyps may develop (refer to below).

      Types of Gastritis and Their Features

      Gastritis is a condition characterized by inflammation of the stomach lining. There are different types of gastritis, each with its own unique features. Type A gastritis is an autoimmune condition that results in the reduction of parietal cells and hypochlorhydria. This type of gastritis is associated with circulating antibodies to parietal cells and can lead to B12 malabsorption. Type B gastritis, on the other hand, is antral gastritis that is caused by infection with Helicobacter pylori. This type of gastritis can lead to peptic ulceration and intestinal metaplasia in the stomach, which requires surveillance endoscopy.

      Reflux gastritis occurs when bile refluxes into the stomach, either post-surgical or due to the failure of pyloric function. This type of gastritis is characterized by chronic inflammation and foveolar hyperplasia. Erosive gastritis is caused by agents that disrupt the gastric mucosal barrier, such as NSAIDs and alcohol. Stress ulceration occurs as a result of mucosal ischemia during hypotension or hypovolemia. The stomach is the most sensitive organ in the GI tract to ischemia following hypovolemia, and prophylaxis with acid-lowering therapy and sucralfate may minimize complications. Finally, Menetrier’s disease is a pre-malignant condition characterized by gross hypertrophy of the gastric mucosal folds, excessive mucous production, and hypochlorhydria.

      In summary, gastritis is a condition that can have different types and features. It is important to identify the type of gastritis to provide appropriate management and prevent complications.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 22 - A 32-year-old woman gave birth to a healthy baby at 39+2 through vaginal...

    Incorrect

    • A 32-year-old woman gave birth to a healthy baby at 39+2 through vaginal delivery without any complications. Although she was determined to breastfeed, she is struggling to get her baby to latch on. What is the hormone responsible for stimulating milk production in the breast's alveolar epithelial cells?

      Your Answer:

      Correct Answer: Prolactin

      Explanation:

      The process of preparing for lactation involves the hormones oestrogen, progesterone, and human placental lactogen. Oestrogen promotes the development of ducts, while high levels of progesterone stimulate the formation of lobules. Human placental lactogen prepares the mammary glands for lactation.

      The two hormones responsible for stimulating lactation are prolactin and oxytocin. Prolactin stimulates milk production, while oxytocin causes the contraction of myoepithelial cells surrounding the mammary alveoli, resulting in milk ejection from the breast.

      When the baby suckles, the mechanoreceptors in the nipple are stimulated, leading to the release of both prolactin and oxytocin from the anterior and posterior parts of the pituitary gland, respectively.

      Endocrine Changes During Pregnancy

      During pregnancy, there are several physiological changes that occur in the body, including endocrine changes. Progesterone, which is produced by the fallopian tubes during the first two weeks of pregnancy, stimulates the secretion of nutrients required by the zygote/blastocyst. At six weeks, the placenta takes over the production of progesterone, which inhibits uterine contractions by decreasing sensitivity to oxytocin and inhibiting the production of prostaglandins. Progesterone also stimulates the development of lobules and alveoli.

      Oestrogen, specifically oestriol, is another major hormone produced during pregnancy. It stimulates the growth of the myometrium and the ductal system of the breasts. Prolactin, which increases during pregnancy, initiates and maintains milk secretion of the mammary gland. It is essential for the expression of the mammotropic effects of oestrogen and progesterone. However, oestrogen and progesterone directly antagonize the stimulating effects of prolactin on milk synthesis.

      Human chorionic gonadotropin (hCG) is secreted by the syncitiotrophoblast and can be detected within nine days of pregnancy. It mimics LH, rescuing the corpus luteum from degenerating and ensuring early oestrogen and progesterone secretion. It also stimulates the production of relaxin and may inhibit contractions induced by oxytocin. Other hormones produced during pregnancy include relaxin, which suppresses myometrial contractions and relaxes the pelvic ligaments and pubic symphysis, and human placental lactogen (hPL), which has lactogenic actions and enhances protein metabolism while antagonizing insulin.

    • This question is part of the following fields:

      • Reproductive System
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  • Question 23 - An 84-year-old man is referred to the memory clinic with progressive memory loss...

    Incorrect

    • An 84-year-old man is referred to the memory clinic with progressive memory loss and difficulty with activities of daily living. He attends the clinic with his son, who provides further collateral history, and a diagnosis of Alzheimer's disease is made. With the patient's consent, he is recruited to a study investigating the link between Alzheimer's disease and cellular processes. He is randomised to the arm of the trial investigating microtubule dysfunction.

      What is the normal function of these cell components?

      Your Answer:

      Correct Answer: Guide intracellular organelle transport

      Explanation:

      Microtubules play a crucial role in guiding intracellular transport and binding internal organelles. However, their function can be disrupted in neurodegenerative diseases like Alzheimer’s due to the hyperphosphorylation of tau proteins. Attachment proteins move up and down the microtubules, facilitating the transport of various organelles, making this the correct answer.

      Lysosomes are responsible for breaking down large proteins and polysaccharides, not microtubules.

      The Golgi apparatus modifies and packages secretory molecules, and proteins may be tagged with mannose-6-phosphate for transport to lysosomes.

      The nucleolus is where ribosome production occurs, not the microtubules.

      Microtubules: Components of the Cytoskeleton

      Microtubules are cylindrical structures found in the cytoplasm of all cells except red blood cells. They are composed of alternating α and β tubulin subunits that polymerize to form protofilaments. Microtubules are polarized, having a positive and negative end. They play a crucial role in guiding movement during intracellular transport and binding internal organelles.

      Molecular transport is facilitated by attachment proteins called dynein and kinesin, which move up and down the microtubules. Dynein moves in a retrograde fashion, down the microtubule towards the centre of the cell (+ve → -ve), while kinesin moves in an anterograde fashion, up the microtubule away from the centre, towards the periphery (-ve → +ve).

      In summary, microtubules are essential components of the cytoskeleton that help maintain cell shape and facilitate intracellular transport. Dynein and kinesin play a crucial role in molecular transport by moving up and down the microtubules.

    • This question is part of the following fields:

      • General Principles
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  • Question 24 - A child was born prematurely at 34 weeks gestation with no labor complications....

    Incorrect

    • A child was born prematurely at 34 weeks gestation with no labor complications. 24 hours after birth, the child seems lethargic and refuses to eat. The temperature is 38.2 ºC. The blood and cerebrospinal fluid cultures are negative, but the urine culture is positive for gram-negative rods. There are no other children in the hospital with similar symptoms. What is the most probable organism responsible for this infection?

      Your Answer:

      Correct Answer: Escherichia coli

      Explanation:

      Escherichia coli is a gram-negative rod and is frequently implicated in neonatal infections, with urine cultures being the most common method of detection.

      Staphylococcus aureus, a gram-positive cocci, does not align with the results of the urine culture.

      While group B streptococci, particularly Streptococcus agalactiae, are often responsible for postpartum neonatal infections, they stain as gram-positive.

      Listeria monocytogenes, a gram-positive anaerobe, also contradicts the findings of the urine culture.

      Answer 5 needs to be revised.

      Escherichia coli: A Common Gut Commensal with Various Disease Manifestations

      Escherichia coli is a type of Gram-negative rod that is commonly found in the gut as a normal commensal. It is a facultative anaerobe and can ferment lactose. However, E. coli infections can lead to various diseases in humans, including diarrhoeal illnesses, urinary tract infections (UTIs), and neonatal meningitis. The classification of E. coli is based on the antigens that can trigger an immune response. These antigens include the lipopolysaccharide layer (O), capsule (K), and flagellin (H). For instance, neonatal meningitis caused by E. coli is usually due to a serotype that contains the capsular antigen K-1.

      One particular strain of E. coli, O157:H7, is associated with severe, haemorrhagic, watery diarrhoea. It has a high mortality rate and can lead to haemolytic uraemic syndrome. This strain is often transmitted through contaminated ground beef. Despite being a common gut commensal, E. coli can cause various diseases that can be life-threatening. Therefore, proper hygiene and food safety practices are essential in preventing E. coli infections.

    • This question is part of the following fields:

      • General Principles
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  • Question 25 - Which one of the following statements relating to the respiratory system is false?...

    Incorrect

    • Which one of the following statements relating to the respiratory system is false?

      Your Answer:

      Correct Answer: The spinous process is formed by the junction of the pedicles posteriorly

      Explanation:

      The spinous process is created by the fusion of two laminae at the back.

      Anatomy of the Vertebral Column

      The vertebral column is composed of 33 vertebrae, which are divided into four regions: cervical, thoracic, lumbar, and sacral. The cervical region has seven vertebrae, the thoracic region has twelve, the lumbar region has five, and the sacral region has five. However, the spinal cord segmental levels do not always correspond to the vertebral segments. For example, the C8 cord is located at the C7 vertebrae, and the T12 cord is situated at the T8 vertebrae.

      The cervical vertebrae are located in the neck and are responsible for controlling the muscles of the upper extremities. The C3 cord contains the phrenic nucleus, which controls the diaphragm. The thoracic vertebrae are defined by those that have a rib and control the intercostal muscles and associated dermatomes. The lumbosacral vertebrae are located in the lower back and control the hip and leg muscles, as well as the buttocks and anal regions.

      The spinal cord ends at the L1-L2 vertebral level, and below this level is a spray of spinal roots called the cauda equina. Injuries below L2 represent injuries to spinal roots rather than the spinal cord proper. Understanding the anatomy of the vertebral column is essential for diagnosing and treating spinal cord injuries and other related conditions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 26 - A 10-year-old male presents with recurrent swollen joints which are painful. His parents...

    Incorrect

    • A 10-year-old male presents with recurrent swollen joints which are painful. His parents have noticed this is usually precipitated by minor accidents while playing on the playground. A plasma factor assay is requested which reveals a diagnosis of haemophilia A.

      Which of the following tests is most likely to be normal in this patient?

      Your Answer:

      Correct Answer: Bleeding time

      Explanation:

      Bleeding time is typically unaffected by haemophilia as it is a disorder of secondary haemostasis and does not impact platelets. However, APTT is likely to be prolonged due to a deficiency in factor VIII, which is reduced in haemophilia A. The disruption of the coagulation cascade is a result of this factor VIII deficiency. In cases of severe haemophilia A with significant blood loss, haemoglobin levels may be low.

      Haemophilia is a genetic disorder that affects blood coagulation and is inherited in an X-linked recessive manner. It is possible for up to 30% of patients to have no family history of the condition. Haemophilia A is caused by a deficiency of factor VIII, while haemophilia B, also known as Christmas disease, is caused by a lack of factor IX.

      The symptoms of haemophilia include haemoarthroses, haematomas, and prolonged bleeding after surgery or trauma. Blood tests can reveal a prolonged APTT, while the bleeding time, thrombin time, and prothrombin time are normal. However, up to 10-15% of patients with haemophilia A may develop antibodies to factor VIII treatment.

      Overall, haemophilia is a serious condition that can cause significant bleeding and other complications. It is important for individuals with haemophilia to receive appropriate medical care and treatment to manage their symptoms and prevent further complications.

    • This question is part of the following fields:

      • Haematology And Oncology
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  • Question 27 - A 55-year-old man visits his GP complaining of excessive thirst and urination for...

    Incorrect

    • A 55-year-old man visits his GP complaining of excessive thirst and urination for the past two weeks. Upon conducting various tests, it was determined that he has diabetes insipidus due to a hormone deficiency. Which gland is responsible for producing and releasing this hormone into the bloodstream?

      Your Answer:

      Correct Answer: Posterior pituitary

      Explanation:

      ADH and oxytocin are secreted by the posterior pituitary.

      When a person has diabetes insipidus, their kidneys are unable to concentrate urine due to a deficiency of antidiuretic hormone (ADH) or resistance to its action. This results in the production and excretion of a large volume of diluted urine.

      The posterior pituitary, also known as the neurohypophysis, is the back part of the pituitary gland and is involved in the endocrine system. Unlike the anterior pituitary, it is not glandular and has a direct neural connection to the hypothalamus. It releases oxytocin and vasopressin/ADH directly into the bloodstream.

      The pituitary gland is a small gland located within the sella turcica in the sphenoid bone of the middle cranial fossa. It weighs approximately 0.5g and is covered by a dural fold. The gland is attached to the hypothalamus by the infundibulum and receives hormonal stimuli from the hypothalamus through the hypothalamo-pituitary portal system. The anterior pituitary, which develops from a depression in the wall of the pharynx known as Rathkes pouch, secretes hormones such as ACTH, TSH, FSH, LH, GH, and prolactin. GH and prolactin are secreted by acidophilic cells, while ACTH, TSH, FSH, and LH are secreted by basophilic cells. On the other hand, the posterior pituitary, which is derived from neuroectoderm, secretes ADH and oxytocin. Both hormones are produced in the hypothalamus before being transported by the hypothalamo-hypophyseal portal system.

    • This question is part of the following fields:

      • Neurological System
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  • Question 28 - A 42-year-old man is brought to the GP by his wife. She reports...

    Incorrect

    • A 42-year-old man is brought to the GP by his wife. She reports that his behaviour has become increasingly erratic and that he often appears to be listening to something that she cannot hear.

      During the consultation, the GP notices that he keeps standing up and sitting down again. When questioned on these movements, the patient says, 'I can't help it, my neighbour is controlling my legs.'

      What symptom is the patient experiencing?

      Your Answer:

      Correct Answer: Passivity

      Explanation:

      Passivity is the belief that one’s movements or sensations are controlled by an external force. Grandiose delusion is a false belief in one’s own superiority. Avolition is a decrease in motivation for purposeful activities. Catatonia is a state of unresponsiveness with repetitive movements or abnormal postures.

      Schizophrenia: Symptoms and Features

      Schizophrenia is a mental disorder that is characterized by a range of symptoms. One of the most prominent classifications of these symptoms is Schneider’s first rank symptoms. These symptoms can be divided into four categories: auditory hallucinations, thought disorders, passivity phenomena, and delusional perceptions. Auditory hallucinations can include hearing two or more voices discussing the patient in the third person, thought echo, or voices commenting on the patient’s behavior. Thought disorders can include thought insertion, thought withdrawal, and thought broadcasting. Passivity phenomena can include bodily sensations being controlled by external influence or experiences that are imposed on the individual or influenced by others. Delusional perceptions can involve a two-stage process where a normal object is perceived, and then there is a sudden intense delusional insight into the object’s meaning for the patient.

      Other features of schizophrenia include impaired insight, incongruity/blunting of affect (inappropriate emotion for circumstances), decreased speech, neologisms (made-up words), catatonia, and negative symptoms such as anhedonia (inability to derive pleasure), alogia (poverty of speech), and avolition (poor motivation). It is important to note that not all individuals with schizophrenia will experience all of these symptoms, and the severity of symptoms can vary from person to person.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 29 - A 68-year-old man presented to the emergency department with sudden onset double vision...

    Incorrect

    • A 68-year-old man presented to the emergency department with sudden onset double vision on rightward gaze. He had a history of ischaemic heart disease and hypercholesterolemia, and smoked 10 cigarettes per day.

      Upon examination, his gait and peripheral neurological examination were normal. However, his left eye did not adduct on rightward gaze and his right eye exhibited nystagmus. The pupils were equal and reactive to light.

      To rule out a possible stroke, an urgent MRI of the brain was arranged. Where is the neurological lesion that could explain this clinical presentation?

      Your Answer:

      Correct Answer: Left medial longitudinal fasciculus

      Explanation:

      Internuclear ophthalmoplegia is caused by a lesion in the medial longitudinal fasciculus (MLF), which affects conjugate eye movements. The MLF connects the abducens nucleus to the contralateral oculomotor nucleus. A lesion in the MLF results in a failure of conjugate gaze and diplopia. Horizontal nystagmus of the affected eye is explained by Hering’s law of equal innervation. Lesions of the abducens or oculomotor nuclei would result in more profound ophthalmoplegias. The patient is at high risk for a stroke.

      Understanding Internuclear Ophthalmoplegia

      Internuclear ophthalmoplegia is a condition that affects the horizontal movement of the eyes. It is caused by a lesion in the medial longitudinal fasciculus (MLF), which is responsible for interconnecting the IIIrd, IVth, and VIth cranial nuclei. This area is located in the paramedian region of the midbrain and pons. The main feature of this condition is impaired adduction of the eye on the same side as the lesion, along with horizontal nystagmus of the abducting eye on the opposite side.

      The most common causes of internuclear ophthalmoplegia are multiple sclerosis and vascular disease. It is important to note that this condition can also be a sign of other underlying neurological disorders.

    • This question is part of the following fields:

      • Neurological System
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  • Question 30 - Into which of the following structures does the superior part of the fibrous...

    Incorrect

    • Into which of the following structures does the superior part of the fibrous capsule of the shoulder joint insert?

      Your Answer:

      Correct Answer: The anatomical neck of the humerus

      Explanation:

      Due to its shallow nature, the shoulder joint has a high degree of mobility, but this is achieved at the cost of stability. The fibrous capsule is connected to the anatomical neck in a superior position and the surgical neck in an inferior position.

      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
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