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  • Question 1 - A 25-year-old patient is undergoing routine pulmonary function testing to assess her chronic...

    Correct

    • A 25-year-old patient is undergoing routine pulmonary function testing to assess her chronic condition. The results are compared to a standardised predicted value and presented in the table below:

      FEV1 75% of predicted
      FVC 70% of predicted
      FEV1/FVC 105%

      What is the probable condition that this patient is suffering from, which can account for the above findings?

      Your Answer: Neuromuscular disorder

      Explanation:

      The patient’s pulmonary function tests indicate a restrictive pattern, as both FEV1 and FVC are reduced. This suggests a possible neuromuscular disorder, as all other options would result in an obstructive pattern on the tests. Asthma, bronchiectasis, and COPD are unlikely diagnoses for a 20-year-old and would not match the test results. Pneumonia may affect the patient’s ability to perform the tests, but it is typically an acute condition that requires immediate treatment with antibiotics.

      Understanding Pulmonary Function Tests

      Pulmonary function tests are a useful tool in determining whether a respiratory disease is obstructive or restrictive. These tests measure various aspects of lung function, such as forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). By analyzing the results of these tests, doctors can diagnose and monitor conditions such as asthma, COPD, pulmonary fibrosis, and neuromuscular disorders.

      In obstructive lung diseases, such as asthma and COPD, the FEV1 is significantly reduced, while the FVC may be reduced or normal. The FEV1% (FEV1/FVC) is also reduced. On the other hand, in restrictive lung diseases, such as pulmonary fibrosis and asbestosis, the FEV1 is reduced, but the FVC is significantly reduced. The FEV1% (FEV1/FVC) may be normal or increased.

      It is important to note that there are many conditions that can affect lung function, and pulmonary function tests are just one tool in diagnosing and managing respiratory diseases. However, understanding the results of these tests can provide valuable information for both patients and healthcare providers.

    • This question is part of the following fields:

      • Respiratory System
      19.2
      Seconds
  • Question 2 - A 20-year-old man presents to the emergency department with diabetic ketoacidosis. After early...

    Incorrect

    • A 20-year-old man presents to the emergency department with diabetic ketoacidosis. After early treatment, an arterial blood gas is taken, which shows the following results.

      ABG result - temperature 35.0 ºC:

      pH 7.30 (7.35 - 7.45)
      PaCO2 3.5 kPa (4.7 - 6.0)
      PaO2 10 kPa (11 - 13)
      HCO3- 16 mEq/L (22 - 26)
      Na+ 138 mmol/L (135 - 145)
      K+ 3.3 mmol/L (3.5 - 5.0)

      What physiological change is occurring in this patient?

      Your Answer: Decrease in HCO3- is causing an increased affinity of haemoglobin for oxygen

      Correct Answer: Metabolic acidosis is causing a decreased affinity of haemoglobin for oxygen

      Explanation:

      In acidosis, the oxyhaemoglobin dissociation curve shifts to the right, indicating a decrease in affinity of haemoglobin for oxygen. This is due to an increase in the number of [H+] ions, reflecting greater metabolic activity. Low [H+] levels cause a shift to the left. The low HCO3- in this patient can be explained by metabolic acidosis, but it does not cause a shift in the oxyhaemoglobin dissociation curve. Hypokalaemia may be a result of treatment for diabetic ketoacidosis, but it does not cause a shift in the oxygen dissociation curve. When temperature increases, the oxyhaemoglobin dissociation curve also shifts to the right, causing a decrease in haemoglobin affinity for oxygen. Hypothermia causes a shift to the left, indicating an increased affinity of haemoglobin for oxygen.

      Understanding the Oxygen Dissociation Curve

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      51
      Seconds
  • Question 3 - During a schoolyard brawl a boy is hit in the chest. The stick...

    Incorrect

    • During a schoolyard brawl a boy is hit in the chest. The stick passes through the posterior mediastinum (from left to right). Which one of the following structures is least likely to be injured?

      Your Answer: Vagus nerve

      Correct Answer: Arch of the azygos vein

      Explanation:

      The azygos vein’s arch is located within the middle mediastinum.

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      24.1
      Seconds
  • Question 4 - A 67-year-old man with a suspected ruptured abdominal aortic aneurysm is brought to...

    Correct

    • A 67-year-old man with a suspected ruptured abdominal aortic aneurysm is brought to the emergency department. Upon arrival, the patient appears pale, cold, and clammy. His vital signs are as follows: temperature 35.3 degrees Celsius, respiratory rate 40, heart rate 116bpm, and blood pressure 90/65mmHg.

      When there is a decrease in the concentration of oxygen in the blood, the inspiratory center is stimulated, and any voluntary cortical control of breathing pattern is overridden. Where are the peripheral chemoreceptors located that detect these changes?

      Your Answer: Aortic arch

      Explanation:

      The peripheral chemoreceptors, found in the aortic and carotid bodies, are capable of detecting alterations in the levels of carbon dioxide in the arterial blood. These receptors are located in the aortic arch and at the bifurcation of the common carotid artery. However, they are not as sensitive as the central chemoreceptors in the medulla oblongata, which monitor the cerebrospinal fluid. It is important to note that there are no peripheral chemoreceptors present in veins.

      The Control of Ventilation in the Human Body

      The control of ventilation in the human body is a complex process that involves various components working together to regulate the respiratory rate and depth of respiration. The respiratory centres, chemoreceptors, lung receptors, and muscles all play a role in this process. The automatic, involuntary control of respiration occurs from the medulla, which is responsible for controlling the respiratory rate and depth of respiration.

      The respiratory centres consist of the medullary respiratory centre, apneustic centre, and pneumotaxic centre. The medullary respiratory centre has two groups of neurons, the ventral group, which controls forced voluntary expiration, and the dorsal group, which controls inspiration. The apneustic centre, located in the lower pons, stimulates inspiration and activates and prolongs inhalation. The pneumotaxic centre, located in the upper pons, inhibits inspiration at a certain point and fine-tunes the respiratory rate.

      Ventilatory variables, such as the levels of pCO2, are the most important factors in ventilation control, while levels of O2 are less important. Peripheral chemoreceptors, located in the bifurcation of carotid arteries and arch of the aorta, respond to changes in reduced pO2, increased H+, and increased pCO2 in arterial blood. Central chemoreceptors, located in the medulla, respond to increased H+ in brain interstitial fluid to increase ventilation. It is important to note that the central receptors are not influenced by O2 levels.

      Lung receptors also play a role in the control of ventilation. Stretch receptors respond to lung stretching, causing a reduced respiratory rate, while irritant receptors respond to smoke, causing bronchospasm. J (juxtacapillary) receptors are also involved in the control of ventilation. Overall, the control of ventilation is a complex process that involves various components working together to regulate the respiratory rate and depth of respiration.

    • This question is part of the following fields:

      • Respiratory System
      24.7
      Seconds
  • Question 5 - A 20-year-old female presented to the hospital with a complaint of a sore...

    Correct

    • A 20-year-old female presented to the hospital with a complaint of a sore throat. She reported having a high-grade fever and severe pain on the right side of her throat for the past four days. The patient also experienced difficulty in swallowing and had restricted mouth opening. Additionally, she complained of bilateral ear pain and headache. Despite receiving oral antibiotics, her symptoms had worsened.

      Upon examination, the patient had a fever of 38.5ºC and prominent cervical lymphadenopathy. Swelling of the right soft palate was observed, and the uvula was deviated to the left.

      What is the most probable diagnosis?

      Your Answer: Peritonsillar abscess (quinsy)

      Explanation:

      Trismus, which is difficulty in opening the mouth, is a common symptom of peritonsillar abscess (also known as quinsy). It is important to note that quinsy is a complication of tonsillitis, not acute tonsillitis itself. Epiglottitis may present with muffled voice, drooling, and difficulty in breathing, while infectious mononucleosis is associated with other symptoms such as weight loss, fatigue, and enlarged lymph nodes and organs.

      Peritonsillar Abscess: Symptoms and Treatment

      A peritonsillar abscess, also known as quinsy, is a complication that can arise from bacterial tonsillitis. This condition is characterized by severe throat pain that is localized to one side, along with difficulty opening the mouth and reduced neck mobility. Additionally, the uvula may be deviated to the unaffected side. It is important to seek urgent medical attention from an ENT specialist if these symptoms are present.

      The treatment for a peritonsillar abscess typically involves needle aspiration or incision and drainage, along with intravenous antibiotics. In some cases, a tonsillectomy may be recommended to prevent recurrence of the abscess. It is important to follow the recommended treatment plan and attend all follow-up appointments to ensure proper healing and prevent complications.

    • This question is part of the following fields:

      • Respiratory System
      18.7
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  • Question 6 - You are clerking a 45-year-old patient on the neurosurgery ward who is scheduled...

    Correct

    • You are clerking a 45-year-old patient on the neurosurgery ward who is scheduled to undergo a pituitary tumour removal surgery. During your conversation, the patient inquires about the procedure. As you are aware, the neurosurgeon gains access to the pituitary gland through the patient's nasal cavity, specifically through one of the paranasal sinuses. Can you identify which of the paranasal sinuses is situated on the roof of the posterior nasal cavity, below the pituitary gland?

      Your Answer: Sphenoid sinus

      Explanation:

      Paranasal Air Sinuses and Carotid Sinus

      The paranasal air sinuses are air-filled spaces found in the bones of the skull. They are named after the bone in which they are located and all communicate with the nasal cavity. The four paired paranasal air sinuses are the frontal sinuses, maxillary sinuses, ethmoid air cells, and sphenoid sinuses. The frontal sinuses are located above each eye on the forehead, while the maxillary sinuses are the largest and found in the maxillary bone below the orbit. The ethmoidal air cells are a collection of smaller air cells located lateral to the anterior superior nasal cavity, while the sphenoid sinuses are found in the posterior portion of the roof of the nasal cavity.

      On the other hand, the carotid sinus is not a paranasal air sinus. It is a dilatation of the internal carotid artery, located just beyond the bifurcation of the common carotid artery. It contains baroreceptors that enable it to detect changes in arterial pressure.

      Overall, understanding the location and function of these sinuses and the carotid sinus is important in various medical procedures and conditions.

    • This question is part of the following fields:

      • Respiratory System
      19.6
      Seconds
  • Question 7 - A 70-year-old man with lung cancer is having a left pneumonectomy. The left...

    Correct

    • A 70-year-old man with lung cancer is having a left pneumonectomy. The left main bronchus is being divided. Which thoracic vertebrae is located behind this structure?

      Your Answer: T6

      Explanation:

      Anatomy of the Lungs

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

    • This question is part of the following fields:

      • Respiratory System
      15.1
      Seconds
  • Question 8 - A 50-year-old man visits the GP clinic for a routine hearing examination. He...

    Correct

    • A 50-year-old man visits the GP clinic for a routine hearing examination. He reports no issues with his hearing and has no significant medical history or medication use. After conducting Rinne and Weber tests on the patient, you determine that his hearing is within normal limits.

      What are the test findings for this patient?

      Your Answer: Rinne: air conduction > bone conduction bilaterally; Weber: equal in both ears

      Explanation:

      The patient’s hearing exam results indicate normal hearing. The Rinne test showed more air conduction than bone conduction in both ears, which is typical for normal hearing. The Weber test also showed equal results in both ears, indicating no significant difference in hearing between the ears.

      Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

      Rinne’s and Weber’s tests are used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test indicates that BC is better than AC, suggesting conductive deafness.

      Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking the patient which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

      The table below summarizes the interpretation of Rinne and Weber tests. A normal result indicates that AC is greater than BC bilaterally and the sound is midline. Conductive hearing loss is indicated by BC being greater than AC in the affected ear and AC being greater than BC in the unaffected ear, with the sound lateralizing to the affected ear. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, with the sound lateralizing to the unaffected ear.

      Overall, Rinne’s and Weber’s tests are useful tools for differentiating between conductive and sensorineural deafness, allowing for appropriate management and treatment.

    • This question is part of the following fields:

      • Respiratory System
      10.5
      Seconds
  • Question 9 - A 45-year-old woman is undergoing consent for a thyroidectomy due to failed medical...

    Correct

    • A 45-year-old woman is undergoing consent for a thyroidectomy due to failed medical treatment for Grave's disease. Radioiodine was not an option as she is the sole caregiver for her three young children. During the consent process, she is informed of the potential complications of thyroidectomy, including the risk of injury to the sensory branch of the superior laryngeal nerve. Can you identify which nerve branches off from the superior laryngeal nerve and is responsible for sensory function?

      Your Answer: Internal laryngeal nerve

      Explanation:

      The superior laryngeal nerve, a branch of the vagus nerve, has two branches: the external laryngeal nerve, which is a motor nerve, and the internal laryngeal nerve, which is a sensory nerve. The recurrent laryngeal nerve, also a branch of the vagus nerve, supplies all intrinsic muscles of the larynx except for the cricothyroid muscles.

      Anatomy of the Larynx

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

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

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      53.2
      Seconds
  • Question 10 - A 67-year-old man visits his doctor complaining of dyspnoea. He experiences shortness of...

    Incorrect

    • A 67-year-old man visits his doctor complaining of dyspnoea. He experiences shortness of breath after walking just a few meters, whereas he can usually walk up to 200m. The man appears cyanosed in his extremities and his pulse oximeter shows a reading of 83%. What is the primary mode of carbon dioxide transportation in the bloodstream?

      Your Answer: Unbound and physically dissolved in the blood

      Correct Answer: Bound to haemoglobin as bicarbonate ions

      Explanation:

      Understanding the Oxygen Dissociation Curve

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      16.2
      Seconds
  • Question 11 - A premature baby is born and the anaesthetists are struggling to ventilate the...

    Incorrect

    • A premature baby is born and the anaesthetists are struggling to ventilate the lungs because of insufficient surfactant. How does Laplace's law explain the force pushing inwards on the walls of the alveolus caused by surface tension between two static fluids, such as air and water in the alveolus?

      Your Answer: Proportional to the square of the radius of the alveolus

      Correct Answer: Inversely proportional to the radius of the alveolus

      Explanation:

      The Relationship between Alveolar Size and Surface Tension in Respiratory Physiology

      In respiratory physiology, the alveolus is often represented as a perfect sphere to apply Laplace’s law. According to this law, there is an inverse relationship between the size of the alveolus and the surface tension. This means that smaller alveoli experience greater force than larger alveoli for a given surface tension, and they will collapse first. This phenomenon explains why, when two balloons are attached together by their ends, the smaller balloon will empty into the bigger balloon.

      In the lungs, this same principle applies to lung units, causing atelectasis and collapse when surfactant is not present. Surfactant is a substance that reduces surface tension, making it easier to expand the alveoli and preventing smaller alveoli from collapsing. Therefore, surfactant plays a crucial role in maintaining the proper functioning of the lungs and preventing respiratory distress. the relationship between alveolar size and surface tension is essential in respiratory physiology and can help in the development of treatments for lung diseases.

    • This question is part of the following fields:

      • Respiratory System
      16.4
      Seconds
  • Question 12 - A 49-year-old woman of African descent visits her primary care physician with concerns...

    Incorrect

    • A 49-year-old woman of African descent visits her primary care physician with concerns about a lump in her neck that has been present for a week. She reports no significant increase in size and denies any pain or difficulty swallowing. The patient has no notable medical history, except for a visit to the eye doctor last year for a red-eye that required treatment with topical steroid drops. During the examination, the doctor observes some red, tender nodules on the patient's shin, which the patient says come and go and do not cause much discomfort. A chest x-ray reveals bilateral hilar lymphadenopathy with no other significant findings. What is typically linked to this patient's condition?

      Your Answer: Hypocalcemia

      Correct Answer: Elevated angiotensin-converting enzyme levels

      Explanation:

      Sarcoidosis is likely in this patient based on their symptoms and examination findings, including a neck lump, tender nodules on the shin, and a history of red-eye. Bilateral lymphadenopathy on chest X-ray further supports the diagnosis, as does the presence of elevated angiotensin-converting enzyme levels, which are commonly seen in sarcoidosis. Hypercalcemia, fatigue, and uveitis are also associated with sarcoidosis, while exposure to silica is not supported by this patient’s presentation.

      Investigating Sarcoidosis

      Sarcoidosis is a disease that does not have a single diagnostic test, and therefore, diagnosis is mainly based on clinical observations. Although ACE levels may be used to monitor disease activity, they are not reliable in diagnosing sarcoidosis due to their low sensitivity and specificity. Routine blood tests may show hypercalcemia and a raised ESR.

      A chest x-ray is a common investigation for sarcoidosis and may reveal different stages of the disease. Stage 0 is normal, stage 1 shows bilateral hilar lymphadenopathy (BHL), stage 2 shows BHL and interstitial infiltrates, stage 3 shows diffuse interstitial infiltrates only, and stage 4 shows diffuse fibrosis. Other investigations, such as spirometry, may show a restrictive defect, while a tissue biopsy may reveal non-caseating granulomas. However, the Kveim test, which involves injecting part of the spleen from a patient with known sarcoidosis under the skin, is no longer performed due to concerns about cross-infection.

      In addition, a gallium-67 scan is not routinely used to investigate sarcoidosis. CT scans may also be used to investigate sarcoidosis, and they may show diffuse areas of nodularity predominantly in a peribronchial distribution with patchy areas of consolidation, particularly in the upper lobes. Ground glass opacities may also be present, but there are no gross reticular changes to suggest fibrosis.

      Overall, investigating sarcoidosis involves a combination of clinical observations, blood tests, chest x-rays, and other investigations such as spirometry and tissue biopsy. CT scans may also be used to provide more detailed information about the disease.

    • This question is part of the following fields:

      • Respiratory System
      22.2
      Seconds
  • Question 13 - A 26-year-old male is brought to the emergency department by his mother. He...

    Incorrect

    • A 26-year-old male is brought to the emergency department by his mother. He is agitated, restless, and anxious.

      Upon examination, dilated pupils are observed, and an ECG reveals sinus tachycardia.

      The patient has a medical history of chronic asthma and is currently taking modified-release theophylline tablets.

      According to his mother, he returned from a trip to Pakistan last night and has been taking antibiotics for bacterial gastroenteritis for the past four days. He has three days left on his antibiotic course.

      What could be the cause of his current presentation?

      Your Answer: Terbinafine

      Correct Answer: Ciprofloxacin

      Explanation:

      Terbinafine is frequently prescribed for the treatment of fungal nail infections as an antifungal medication.

      Theophylline and its Poisoning

      Theophylline is a naturally occurring methylxanthine that is commonly used as a bronchodilator in the management of asthma and COPD. Its exact mechanism of action is still unknown, but it is believed to be a non-specific inhibitor of phosphodiesterase, resulting in an increase in cAMP. Other proposed mechanisms include antagonism of adenosine and prostaglandin inhibition.

      However, theophylline poisoning can occur and is characterized by symptoms such as acidosis, hypokalemia, vomiting, tachycardia, arrhythmias, and seizures. In such cases, gastric lavage may be considered if the ingestion occurred less than an hour prior. Activated charcoal is also recommended, while whole-bowel irrigation can be performed if theophylline is in sustained-release form. Charcoal hemoperfusion is preferable to hemodialysis in managing theophylline poisoning.

    • This question is part of the following fields:

      • Respiratory System
      15.4
      Seconds
  • Question 14 - A 36-year-old male patient complains of fever, malaise, weight loss, dyspnoea, and shoulder...

    Correct

    • A 36-year-old male patient complains of fever, malaise, weight loss, dyspnoea, and shoulder & hip joint pain. He has raised erythematous lesions on both legs. His blood tests reveal elevated calcium levels and serum ACE levels. A chest x-ray shows bilateral hilar lymphadenopathy.

      What is the probable diagnosis?

      Your Answer: Sarcoidosis

      Explanation:

      If a patient presents with raised serum ACE levels, sarcoidosis should be considered as a possible diagnosis. The combination of erythema nodosum and bilateral hilar lymphadenopathy on a chest x-ray is pathognomonic of sarcoidosis. Lung cancer is unlikely in a young patient without a significant smoking history, and tuberculosis would require recent foreign travel to a TB endemic country. Multiple myeloma would not cause the same symptoms as sarcoidosis. Exposure to organic material would not be a likely cause of raised serum ACE levels.

      Understanding Sarcoidosis: A Multisystem Disorder

      Sarcoidosis is a condition that affects multiple systems in the body and is characterized by the presence of non-caseating granulomas. The exact cause of this disorder is unknown, but it is more commonly seen in young adults and individuals of African descent.

      The symptoms of sarcoidosis can vary depending on the severity of the condition. Acute symptoms may include erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, and polyarthralgia. On the other hand, insidious symptoms may include dyspnea, non-productive cough, malaise, and weight loss. Additionally, some individuals may develop skin symptoms such as lupus pernio, while others may experience hypercalcemia due to increased conversion of vitamin D to its active form.

      Sarcoidosis is also associated with several syndromes, including Lofgren’s syndrome, Mikulicz syndrome, and Heerfordt’s syndrome. Lofgren’s syndrome is an acute form of the disease that typically presents with bilateral hilar lymphadenopathy, erythema nodosum, fever, and polyarthralgia. Mikulicz syndrome is characterized by enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis, or lymphoma. Finally, Heerfordt’s syndrome, also known as uveoparotid fever, presents with parotid enlargement, fever, and uveitis secondary to sarcoidosis.

      In conclusion, sarcoidosis is a complex disorder that can affect multiple systems in the body. While the exact cause is unknown, early diagnosis and treatment can help manage symptoms and improve outcomes.

    • This question is part of the following fields:

      • Respiratory System
      19.6
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  • Question 15 - Which of the following paraneoplastic manifestations is the LEAST frequent in individuals diagnosed...

    Incorrect

    • Which of the following paraneoplastic manifestations is the LEAST frequent in individuals diagnosed with squamous cell lung carcinoma?

      Your Answer: Hyperthyroidism

      Correct Answer: Lambert-Eaton syndrome

      Explanation:

      Small cell lung cancer is strongly associated with Lambert-Eaton syndrome, while squamous cell lung cancer is more commonly associated with paraneoplastic features such as PTHrp, clubbing, and HPOA.

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

    • This question is part of the following fields:

      • Respiratory System
      15
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  • Question 16 - A 55-year-old woman comes to your clinic seeking help to quit smoking. She...

    Correct

    • A 55-year-old woman comes to your clinic seeking help to quit smoking. She has been using nicotine patches for 6 months but has not been successful in her attempts. You decide to prescribe bupropion.

      What is a typical side effect of bupropion?

      Your Answer: Gastrointestinal disturbance

      Explanation:

      Side Effects of Buproprion

      Buproprion is a medication that can cause aggression and hallucination in some patients. However, the more common side effects are gastrointestinal disturbances such as diarrhoea, nausea, and dry mouth. These side effects are often experienced by patients taking buproprion. It is important to be aware of the potential side effects of any medication and to speak with a healthcare provider if any concerns arise. Additional information on buproprion and its potential side effects can be found in the electronic Medicines Compendium and Medicines Complete.

    • This question is part of the following fields:

      • Respiratory System
      9.7
      Seconds
  • Question 17 - A 25-year-old woman visits the outpatient department with concerns of eyelid drooping, double...

    Incorrect

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

      What respiratory condition could be causing her symptoms?

      Your Answer: Pneumoconioses

      Correct Answer: Restrictive lung disease

      Explanation:

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

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

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

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

      Understanding the Differences between Obstructive and Restrictive Lung Diseases

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

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      19
      Seconds
  • Question 18 - A 26-year-old man presents to the emergency department with a feeling of food...

    Incorrect

    • A 26-year-old man presents to the emergency department with a feeling of food stuck in his throat. He experienced this sensation 2 hours ago after consuming fish at a nearby seafood restaurant. The patient reports no breathing difficulties. Upon laryngoscopy, a fish bone is found lodged in the left piriform recess. While removing the fish bone, a nerve located deep to the mucosa covering the recess is damaged.

      Which function is most likely to be affected in this individual?

      Your Answer: Pharyngeal reflex

      Correct Answer: Cough reflex

      Explanation:

      Foreign objects lodged in the piriform recess can cause damage to the internal laryngeal nerve, which is located just beneath a thin layer of mucosa covering the recess. This nerve plays a crucial role in the cough reflex, as it carries sensory information from the area above the vocal cords. Attempts to remove foreign objects from the piriform recess can also lead to nerve damage.

      Other functions, such as mastication, the pharyngeal reflex, salivation, and taste sensation, are mediated by different nerves and are not directly related to the piriform recess or the internal laryngeal nerve.

      Anatomy of the Larynx

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

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

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

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

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

    • This question is part of the following fields:

      • Respiratory System
      14
      Seconds
  • Question 19 - A middle-aged woman who is obese comes in with complaints of polyuria. She...

    Incorrect

    • A middle-aged woman who is obese comes in with complaints of polyuria. She has a history of squamous cell lung carcinoma. What could be the possible reason for her polyuria?

      Your Answer: Type 2 diabetes mellitus

      Correct Answer: Hyperparathyroidism

      Explanation:

      Polyuria is caused by all the options listed above, except for syndrome of inappropriate ADH secretion. However, the patient’s age does not match the typical onset of type 1 diabetes, which usually occurs in young individuals. Furthermore, squamous cell lung carcinoma is commonly associated with a paraneoplastic syndrome that results in the release of excess parathyroid hormone by the tumor, leading to hypercalcemia and subsequent polyuria, along with other symptoms such as renal and biliary stones, bone pain, abdominal discomfort, nausea, vomiting, depression, and anxiety.

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

    • This question is part of the following fields:

      • Respiratory System
      6.3
      Seconds
  • Question 20 - A seven-year-old boy who was born in Germany presents to paediatrics with a...

    Correct

    • A seven-year-old boy who was born in Germany presents to paediatrics with a history of recurrent chest infections, steatorrhoea, and poor growth. He has a significant medical history of meconium ileus. Following a thorough evaluation, the suspected diagnosis is confirmed through a chloride sweat test. The paediatrician informs the parents that their son will have an elevated risk of infertility in adulthood. What is the pathophysiological basis for the increased risk of infertility in this case?

      Your Answer: Absent vas deferens

      Explanation:

      Men with cystic fibrosis are at risk of infertility due to the absence of vas deferens. Unfortunately, this condition often goes undetected in infancy as Germany does not perform neonatal testing for it. Hypogonadism, which can cause infertility, is typically caused by genetic factors like Kallmann syndrome, but not cystic fibrosis. Retrograde ejaculation is most commonly associated with complicated urological surgery, while an increased risk of testicular cancer can be caused by factors like cryptorchidism. However, cystic fibrosis is also a risk factor for testicular cancer.

      Understanding Cystic Fibrosis: Symptoms and Other Features

      Cystic fibrosis is a genetic disorder that affects various organs in the body, particularly the lungs and digestive system. The symptoms of cystic fibrosis can vary from person to person, but some common presenting features include recurrent chest infections, malabsorption, and liver disease. In some cases, infants may experience meconium ileus or prolonged jaundice. It is important to note that while many patients are diagnosed during newborn screening or early childhood, some may not be diagnosed until adulthood.

      Aside from the presenting features, there are other symptoms and features associated with cystic fibrosis. These include short stature, diabetes mellitus, delayed puberty, rectal prolapse, nasal polyps, and infertility. It is important for individuals with cystic fibrosis to receive proper medical care and management to address these symptoms and improve their quality of life.

    • This question is part of the following fields:

      • Respiratory System
      16
      Seconds

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