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Question 1
Correct
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The pathophysiology of Addison's disease is as follows:
Your Answer: Adrenocortical insufficiency
Explanation:Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands cannot produce an adequate amount of hormones despite a normal or increased corticotropin (ACTH) level.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 2
Correct
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A 25-year old male is brought to the emergency room after a traffic accident. Upon examination, there was tenderness and erythema on the right acromioclavicular joint, with notable step deformity. On radiographic imaging, there is a superior elevation of the clavicle, a twice than normal coracoclavicular distance, and absence of fracture.Which of the following structure/s is/are likely to have ruptured?
Your Answer: Acromioclavicular ligament, coracoclavicular ligament and joint capsule
Explanation:Acromioclavicular joint injuries account for more than forty percent of all shoulder injuries. Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.The AC joint is a diarthrodial joint defined by the lateral process of the clavicle articulating with the acromion process as it projects anteriorly off the scapula. The joint is primarily stabilized by the acromioclavicular ligament, which is composed of an anterior, posterior, inferior, and superior component. Of note, the superior portion of the AC ligament is the most important component for the stability of the AC joint. Supporting structures include two coracoclavicular ligaments (trapezoid and conoid ligaments), which provide vertical stability, as well as the coracoacromial ligament.Patients with an AC joint injury typically present with anterosuperior shoulder pain and will describe a mechanism of injury of blunt trauma to the abducted shoulder or landing on an outstretched arm, suggestive of this type of injury. They may describe pain radiating to the neck or shoulder, which is often worse with movement or when they try to sleep on the affected shoulder. On examination, the clinician may observe swelling, bruising, or a deformity of the AC joint, depending on the degree of injury. The patient will be tender at that location. They may have a restriction in the active and passive range of motion secondary to pain. Piano key sign may be seen, with an elevation of the clavicle that rebounds after inferior compression.Standard X-rays are adequate to make a diagnosis of acromioclavicular joint injury and should be used to evaluate for other causes of traumatic shoulder pain.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Incorrect
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Regarding renal clearance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.
Explanation:Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.
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This question is part of the following fields:
- Physiology
- Renal
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Question 4
Incorrect
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Which of the following statements concerning hepatitis D is TRUE:
Your Answer:
Correct Answer: It can only be transmitted with, or to somebody who is infected with, Hepatitis B.
Explanation:Hepatitis D virus (HDV) is an RNA virus that was discovered in 1977 and is structurally unrelated to the hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) viruses. HDV causes a unique infection that requires the assistance of HBV viral particles to replicate and infect hepatocytes. Its clinical course is varied and ranges from acute, self-limited infection to acute, fulminant liver failure. Chronic liver infection can lead to end-stage liver disease and associated complications (including accelerated fibrosis, liver decompensation, and hepatocellular carcinoma).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Incorrect
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Langhans giant cells, seen in granulomatous inflammation. are:
Your Answer:
Correct Answer: Multinucleated cells formed from fusion of epithelioid cells
Explanation:A granuloma is a collection of five or more epithelioid macrophages, with or without attendant lymphocytes and fibroblasts; epithelioid macrophages are altered macrophages which have turned themselves over to becoming giant phagocytosing and killing machines, they often fuse to become multinucleate (Langhans) giant cells.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 6
Incorrect
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A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A diagnosis of a brain tumour has been established.Which of the following anatomical points in the visual pathway has the lesion occurred?
Your Answer:
Correct Answer: Lower optic radiation
Explanation:Homonymous quadrantanopia is not a disease; it is a clinical finding that points towards a lesion of the optic radiations coursing through the temporal lobe.Homonymous superior quadrantanopia is caused by damage to the contralateral inferior parts of the posterior visual pathway: the inferior optic radiation (temporal Meyer loop), or the inferior part of the occipital visual cortex below the calcarine fissure.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 7
Incorrect
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The 'pump handle' movement of the thoracic wall describes which of the following movements:
Your Answer:
Correct Answer: The anterior ends of the ribs moving upwards and forwards
Explanation:Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Incorrect
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Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer:
Correct Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes. Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors. When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 9
Incorrect
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A 55-year-old woman with history of gastritis and reflux esophagitis tested positive for Helicobacter pylori infection. Which of the following statements regarding Helicobacter pylori is considered true?
Your Answer:
Correct Answer: It is helix shaped
Explanation:Helicobacter pylori is a curved or helix-shaped, non-spore forming, Gram-negative, microaerophilic bacteria. It is motile, having multiple flagella at one pole. It has a lipopolysaccharide component in its outer membrane.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
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This question is part of the following fields:
- Infections
- Pharmacology
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