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  • Question 1 - A pediatrician is considering whether or not to prescribe a new medication for...

    Incorrect

    • A pediatrician is considering whether or not to prescribe a new medication for a young patient.

      Upon researching, the pediatrician discovers that a reputable medical journal had rejected a well-conducted study that found no significant difference between the medication and a placebo.

      However, the same journal later published a study that showed positive results for the medication.

      What type of bias is demonstrated in this scenario?

      Your Answer: Selection bias

      Correct Answer: Publication bias

      Explanation:

      Publication bias refers to the tendency of journals to prioritize the publication of studies with positive results, leading to the failure to publish valid studies that show negative or uninteresting results. In this case, the original study was not published due to its negative outcome.

      Expectation bias, on the other hand, occurs when observers unconsciously report or measure data in a way that supports the expected outcome of the study. This is only a concern in non-blinded trials.

      Selection bias arises when individuals are assigned to groups in a way that may influence the study’s outcome.

      The Hawthorne effect is a phenomenon where a group alters its behavior due to the knowledge that it is being studied.

      Understanding Bias in Clinical Trials

      Bias refers to the systematic favoring of one outcome over another in a clinical trial. There are various types of bias, including selection bias, recall bias, publication bias, work-up bias, expectation bias, Hawthorne effect, late-look bias, procedure bias, and lead-time bias. Selection bias occurs when individuals are assigned to groups in a way that may influence the outcome. Sampling bias, volunteer bias, and non-responder bias are subtypes of selection bias. Recall bias refers to the difference in accuracy of recollections retrieved by study participants, which may be influenced by whether they have a disorder or not. Publication bias occurs when valid studies are not published, often because they showed negative or uninteresting results. Work-up bias is an issue in studies comparing new diagnostic tests with gold standard tests, where clinicians may be reluctant to order the gold standard test unless the new test is positive. Expectation bias occurs when observers subconsciously measure or report data in a way that favors the expected study outcome. The Hawthorne effect describes a group changing its behavior due to the knowledge that it is being studied. Late-look bias occurs when information is gathered at an inappropriate time, and procedure bias occurs when subjects in different groups receive different treatment. Finally, lead-time bias occurs when two tests for a disease are compared, and the new test diagnoses the disease earlier, but there is no effect on the outcome of the disease. Understanding these types of bias is crucial in designing and interpreting clinical trials.

    • This question is part of the following fields:

      • General Principles
      15.2
      Seconds
  • Question 2 - In what location can Leydig cells be found? ...

    Correct

    • In what location can Leydig cells be found?

      Your Answer: Between testicular seminiferous tubules

      Explanation:

      Cell Types and Functions in Male Reproductive System

      The male reproductive system is composed of various organs that work together to produce and transport sperm. Two main types of epithelial cells are present in the testes: Sertoli cells and Leydig cells. Leydig cells are located between the seminiferous tubules and produce androgens, including testosterone. On the other hand, Sertoli cells are arranged in tubular structures and have a basal and luminal compartment where spermatogonia divide and spermatids mature, respectively. Testosterone diffuses into Sertoli cells and is converted into a more active form called 5-hydroxytestosterone.

      The epididymis is lined by tall columnar epithelial cells with long microvilli. These cells phagocytose dead spermatozoa and produce substances that aid in sperm maturation. The prostate gland is an exocrine gland composed of acinar and ductal cells. Its secretory products are essential for the stability of spermatozoa. Lastly, the seminal vesicles have a convoluted lining of secretory epithelial cells that produce the majority of the volume of seminal fluid, including fructose, which serves as the energy source for spermatozoa. the functions of these cells and organs is crucial in comprehending the male reproductive system’s overall function.

    • This question is part of the following fields:

      • Histology
      9.8
      Seconds
  • Question 3 - A 25-year-old male patient visits his general practitioner complaining of abdominal pain, diarrhea,...

    Correct

    • A 25-year-old male patient visits his general practitioner complaining of abdominal pain, diarrhea, and painful aphthous ulcers that have been bothering him for the last four weeks. He has also observed that his clothes have become loose lately.

      What is the typical disease pattern associated with his condition?

      Your Answer: Inflammation anywhere from the mouth to anus

      Explanation:

      Crohn’s disease is characterized by inflammation that can occur anywhere from the mouth to the anus. This patient’s symptoms, including weight loss, abdominal pain, and diarrhea, suggest inflammatory bowel disease (IBD). The presence of mouth ulcers indicates Crohn’s disease, as it is known for causing discontinuous inflammation throughout the gastrointestinal tract. Ulcerative colitis, on the other hand, does not cause mouth ulcers and typically involves continuous inflammation that extends from the rectum. While colorectal polyposis can be a complication of IBD, it alone does not explain the patient’s symptoms. Ulcerative colitis is characterized by continuous inflammation that is limited to the submucosa and originates in the rectum, which is not the case for this patient.

      Inflammatory bowel disease (IBD) is a condition that includes two main types: Crohn’s disease and ulcerative colitis. Although they share many similarities in terms of symptoms, diagnosis, and treatment, there are some key differences between the two. Crohn’s disease is characterized by non-bloody diarrhea, weight loss, upper gastrointestinal symptoms, mouth ulcers, perianal disease, and a palpable abdominal mass in the right iliac fossa. On the other hand, ulcerative colitis is characterized by bloody diarrhea, abdominal pain in the left lower quadrant, tenesmus, gallstones, and primary sclerosing cholangitis. Complications of Crohn’s disease include obstruction, fistula, and colorectal cancer, while ulcerative colitis has a higher risk of colorectal cancer than Crohn’s disease. Pathologically, Crohn’s disease lesions can be seen anywhere from the mouth to anus, while ulcerative colitis inflammation always starts at the rectum and never spreads beyond the ileocaecal valve. Endoscopy and radiology can help diagnose and differentiate between the two types of IBD.

    • This question is part of the following fields:

      • Gastrointestinal System
      10.4
      Seconds
  • Question 4 - A 35-year-old woman presents with sudden onset of shortness of breath 3 hours...

    Incorrect

    • A 35-year-old woman presents with sudden onset of shortness of breath 3 hours after giving birth. The delivery was uncomplicated. On examination, her pulse is 120/min, blood pressure is 160/100 mmHg, and respirations are 24/min. Diffuse crackles are heard in all lung fields and pulse oximetry shows 85%. A chest x-ray reveals a peripheral wedge-shaped opacity. Despite appropriate interventions, she passes away. Autopsy findings reveal fetal squamous cells in the pulmonary blood vessels.

      What is the most likely diagnosis?

      Your Answer: Pulmonary thromboembolism

      Correct Answer: Amniotic fluid embolism

      Explanation:

      The presence of fetal squamous cells in the maternal blood vessels of a woman who died during or after labor suggests that she had amniotic fluid embolism instead of pulmonary thromboembolism.

      The patient displayed symptoms of pulmonary embolism shortly after giving birth, including acute shortness of breath, tachycardia, and tachypnea, as well as a wedge-shaped infarction on her chest x-ray. The resulting hypoventilation caused hypoxia. Given that pregnancy is a hypercoagulable state, there is an increased risk of thrombus formation and subsequent embolization, making pulmonary thromboembolism the primary differential diagnosis.

      However, the histological findings during autopsy confirmed that the woman had amniotic fluid embolism, as fetal squamous cells were found in her maternal blood vessels. The risk of fetal and maternal blood mixing is highest during the third trimester and delivery, and fetal cells can act as thrombogenic factors. Although rare, this condition has a high mortality rate, and even those who survive often experience severe deficits, including neurological damage.

      Fat embolism typically occurs after long bone fractures or orthopedic surgeries, while air embolism is very rare but can cause immediate death. Cholesterol embolization is a common scenario after cannulation, such as angiography, where the catheter mechanically displaces the cholesterol thrombus, leading to emboli.

      Amniotic Fluid Embolism: A Rare but Life-Threatening Complication of Pregnancy

      Amniotic fluid embolism is a rare but potentially fatal complication of pregnancy that occurs when fetal cells or amniotic fluid enter the mother’s bloodstream, triggering a severe reaction. Although many risk factors have been associated with this condition, such as maternal age and induction of labor, the exact cause remains unknown. It is believed that exposure of maternal circulation to fetal cells or amniotic fluid is necessary for the development of an amniotic fluid embolism, but the underlying pathology is not well understood.

      The majority of cases occur during labor, but they can also occur during cesarean section or in the immediate postpartum period. Symptoms of amniotic fluid embolism include chills, shivering, sweating, anxiety, and coughing, while signs include cyanosis, hypotension, bronchospasms, tachycardia, arrhythmia, and myocardial infarction. However, there are no definitive diagnostic tests for this condition, and diagnosis is usually made by excluding other possible causes of the patient’s symptoms.

      Management of amniotic fluid embolism requires immediate critical care by a multidisciplinary team, as the condition can be life-threatening. Treatment is primarily supportive, and the focus is on stabilizing the patient’s vital signs and providing respiratory and cardiovascular support as needed. Despite advances in medical care, the mortality rate associated with amniotic fluid embolism remains high, underscoring the need for continued research into the underlying causes and potential treatments for this rare but serious complication of pregnancy.

    • This question is part of the following fields:

      • Reproductive System
      52.3
      Seconds
  • Question 5 - A teenage boy starts preparing for the 400 m fun run in his...

    Incorrect

    • A teenage boy starts preparing for the 400 m fun run in his neighborhood. At the beginning, he relies solely on anaerobic respiration. What is the drawback of using anaerobic respiration?

      Your Answer: It causes an increase in intracellular pH

      Correct Answer: It is a low efficiency process for the production of energy

      Explanation:

      Types of Energy Generation in Exercise

      Energy generation during exercise can be categorized into four types. The first type is impulse energy, which is the energy already present in the cell as ATP. This energy is used quickly and anaerobically, and must be regenerated rapidly to allow for sustained exercise. The second type is immediate energy, which is an anaerobic process that allows for rapid regeneration of ATP by using the creatine phosphate buffer system. This system can supply 6-7 seconds of maximal activity and can be improved through training and creatine supplementation.

      The third type of energy generation is short-term energy, which is ATP generated anaerobically through glycolysis. This process rapidly creates an ATP supply from existing fuel stores to produce pyruvate. However, if oxygen is unavailable, lactic acid is formed, and intracellular pH will fall, reducing enzyme function and interfering with muscle cell function. This process is also an inefficient way of producing energy from glucose, as much less ATP is generated compared to aerobic methods.

      Finally, any form of physical activity that requires sustained exertion for minutes or hours requires oxygen for aerobic respiration, which is the fourth type of energy generation. ATP can be produced from glucose and free fatty acids through metabolism using oxygen via the Krebs’ cycle and electron transfer chain, which is a highly efficient means of producing ATP. Each molecule of glucose produces 38 molecules of ATP.

    • This question is part of the following fields:

      • Clinical Sciences
      41.5
      Seconds
  • Question 6 - An 80-year-old woman comes to the clinic complaining of fatigue, indigestion, and weight...

    Incorrect

    • An 80-year-old woman comes to the clinic complaining of fatigue, indigestion, and weight loss that has been going on for 3 months. During the examination, the doctor notices jaundice in the conjunctival sclera and mild tenderness in the right upper quadrant upon palpation. After conducting scans and biopsy, the results suggest gallbladder cancer.

      What is the most likely lymph node to be the first site of metastasis for the cancer cells?

      Your Answer: Virchow's node (left-sided supraclavicular lymph node)

      Correct Answer: Lund's node (cystic lymph node)

      Explanation:

      Lund’s node serves as the first lymph node to be affected by cancer cells draining from the gallbladder, making it the sentinel lymph node for this organ. This suggests that Lund’s node is the primary target for metastasis in gallbladder cancer.

      Cloquet’s node is classified as one of the deep inguinal nodes, while Virchow’s node is a sentinel lymph node located on the left supraclavicular region. Virchow’s node is associated with certain abdominal cancers, such as gastric cancer.

      Peyer’s patches are clusters of lymphoid follicles that can be found throughout the ileum.

      The gallbladder is a sac made of fibromuscular tissue that can hold up to 50 ml of fluid. Its lining is made up of columnar epithelium. The gallbladder is located in close proximity to various organs, including the liver, transverse colon, and the first part of the duodenum. It is covered by peritoneum and is situated between the right lobe and quadrate lobe of the liver. The gallbladder receives its arterial supply from the cystic artery, which is a branch of the right hepatic artery. Its venous drainage is directly to the liver, and its lymphatic drainage is through Lund’s node. The gallbladder is innervated by both sympathetic and parasympathetic nerves. The common bile duct originates from the confluence of the cystic and common hepatic ducts and is located in the hepatobiliary triangle, which is bordered by the common hepatic duct, cystic duct, and the inferior edge of the liver. The cystic artery is also found within this triangle.

    • This question is part of the following fields:

      • Gastrointestinal System
      20.5
      Seconds
  • Question 7 - A teenage girl with suspected sensorineural hearing loss is being educated by her...

    Incorrect

    • A teenage girl with suspected sensorineural hearing loss is being educated by her physician about the anatomy of the auditory system. The doctor informs her that there are three bones responsible for transmitting sound waves to the eardrum. Can you identify the correct sequence in which these bones are present?

      Your Answer: Incus, malleus, stapes

      Correct Answer: Malleus, incus, stapes

      Explanation:

      The order in which sound waves are transmitted to the oval window, the entrance to the inner ear, is through the bones known as malleus, incus, and stapes. The vestibulocochlear nerve plays a significant role in the process of sensorineural hearing.

      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
      36.2
      Seconds
  • Question 8 - Which one of the following forms the medial wall of the femoral canal?...

    Incorrect

    • Which one of the following forms the medial wall of the femoral canal?

      Your Answer: Sartorius

      Correct Answer: Lacunar ligament

      Explanation:

      It is important to differentiate between the femoral canal and the femoral triangle, particularly during exams when time is limited.

      Understanding the Femoral Canal

      The femoral canal is a fascial tunnel located at the medial aspect of the femoral sheath. It contains both the femoral artery and femoral vein, with the canal lying medial to the vein. The borders of the femoral canal include the femoral vein laterally, the lacunar ligament medially, the inguinal ligament anteriorly, and the pectineal ligament posteriorly.

      The femoral canal plays a significant role in allowing the femoral vein to expand, which facilitates increased venous return to the lower limbs. However, it can also be a site of femoral hernias, which occur when abdominal contents protrude through the femoral canal. The relatively tight neck of the femoral canal places these hernias at high risk of strangulation, making it important to understand the anatomy and function of this structure. Overall, understanding the femoral canal is crucial for medical professionals in diagnosing and treating potential issues related to this area.

    • This question is part of the following fields:

      • Gastrointestinal System
      47.9
      Seconds
  • Question 9 - A woman in her late 40s experiences kidney failure and receives a transplant....

    Correct

    • A woman in her late 40s experiences kidney failure and receives a transplant. However, she develops a fever and ceases urine output shortly after. Is hyperacute organ rejection the cause, and which cells are responsible for this reaction?

      Your Answer: B Cells

      Explanation:

      Hyperacute organ rejection is mediated by B cells.

      The adaptive immune response involves several types of cells, including helper T cells, cytotoxic T cells, B cells, and plasma cells. Helper T cells are responsible for the cell-mediated immune response and recognize antigens presented by MHC class II molecules. They express CD4, CD3, TCR, and CD28 and are a major source of IL-2. Cytotoxic T cells also participate in the cell-mediated immune response and recognize antigens presented by MHC class I molecules. They induce apoptosis in virally infected and tumor cells and express CD8 and CD3. Both helper T cells and cytotoxic T cells mediate acute and chronic organ rejection.

      B cells are the primary cells of the humoral immune response and act as antigen-presenting cells. They also mediate hyperacute organ rejection. Plasma cells are differentiated from B cells and produce large amounts of antibody specific to a particular antigen. Overall, these cells work together to mount a targeted and specific immune response to invading pathogens or abnormal cells.

    • This question is part of the following fields:

      • General Principles
      57.3
      Seconds
  • Question 10 - A 65-year-old male visits his GP complaining of feeling unwell for the past...

    Correct

    • A 65-year-old male visits his GP complaining of feeling unwell for the past 5 days. He reports experiencing fatigue, myalgia, fevers, and overall malaise. After examination, the doctor diagnoses him with influenzae. The patient expresses disbelief, stating that he received the flu vaccine last year and should be immune. What is the reason for the need for annual flu vaccinations?

      Your Answer: Antigenic drift

      Explanation:

      The reason why an annual flu vaccine is necessary is because of the antigenic drift process. The influenzae virus has an enzyme called RNA-dependent RNA polymerase, which does not have the ability to proofread. As a result, errors accumulate during RNA replication, leading to a constantly evolving antigenic site that the immune response is less effective against. This is why the influenzae vaccine needs to be updated with new strains every year.

      On the other hand, antigenic shift refers to a sudden and drastic change in one of the antigenic proteins, such as neuraminidase or haemagglutinin. This abrupt change creates a new subtype that the population has very little immunity against, potentially causing a pandemic.

      Respiratory Pathogens and Associated Conditions

      Respiratory pathogens are microorganisms that cause infections in the respiratory system. The most common respiratory pathogens include respiratory syncytial virus, parainfluenza virus, rhinovirus, influenzae virus, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, Legionella pneumophilia, and Pneumocystis jiroveci. Each of these pathogens is associated with specific respiratory conditions, such as bronchiolitis, croup, common cold, flu, community-acquired pneumonia, acute epiglottitis, atypical pneumonia, and tuberculosis.

      Flu-like symptoms are often the first sign of respiratory infections caused by these pathogens, followed by a dry cough. Complications may include haemolytic anaemia, erythema multiforme, lymphopenia, deranged liver function tests, and hyponatraemia. Patients with Pneumocystis jiroveci infections typically have few chest signs and develop exertional dyspnoea. Mycobacterium tuberculosis can cause a wide range of presentations, from asymptomatic to disseminated disease, and may be accompanied by cough, night sweats, and weight loss.

      Overall, understanding the different respiratory pathogens and their associated conditions is crucial for proper diagnosis and treatment of respiratory infections.

    • This question is part of the following fields:

      • General Principles
      15.3
      Seconds
  • Question 11 - A 60-year-old man complains of excessive urination and increased thirst. You want to...

    Correct

    • A 60-year-old man complains of excessive urination and increased thirst. You want to examine for diabetes insipidus.

      What is the most suitable test to conduct?

      Your Answer: Water deprivation test

      Explanation:

      The water deprivation test is a diagnostic tool for investigating diabetes insipidus. The Short Synacthen test is utilized to diagnose Addison’s disease. Cranial diabetes insipidus can be treated with Desmopressin, while nephrogenic diabetes insipidus can be treated with thiazide diuretics.

      Diabetes insipidus is a medical condition that can be caused by either a decreased secretion of antidiuretic hormone (ADH) from the pituitary gland (cranial DI) or an insensitivity to ADH (nephrogenic DI). Cranial DI can be caused by various factors such as head injury, pituitary surgery, and infiltrative diseases like sarcoidosis. On the other hand, nephrogenic DI can be caused by genetic factors, electrolyte imbalances, and certain medications like lithium and demeclocycline. The common symptoms of DI are excessive urination and thirst. Diagnosis is made through a water deprivation test and checking the osmolality of the urine. Treatment options include thiazides and a low salt/protein diet for nephrogenic DI, while central DI can be treated with desmopressin.

    • This question is part of the following fields:

      • Renal System
      10.9
      Seconds
  • Question 12 - A 57-year-old woman visits the rheumatology clinic for her rheumatoid arthritis diagnosis. She...

    Correct

    • A 57-year-old woman visits the rheumatology clinic for her rheumatoid arthritis diagnosis. She has been prescribed a new medication to prevent joint destruction and disease progression. However, she needs to take folic acid daily and undergo frequent blood tests. What medication is she likely taking?

      Your Answer: Methotrexate

      Explanation:

      Methotrexate is a commonly used first-line drug for rheumatoid arthritis. It belongs to the group of disease modifying anti-rheumatic drugs, which also includes sulfasalazine, rituximab, and etanercept.

      This medication is taken once a week and works by acting on the immune system. It is effective in treating RA and psoriatic arthritis, as it functions as both an anti-inflammatory and immunosuppressant.

      Before starting treatment with methotrexate, blood tests are required to check for FBC, U&Es, LFTs, and protein and blood in the urine.

      During treatment, regular monitoring is necessary. FBC should be checked every other week until six weeks after the last dose increase, then monthly for a year, and thereafter as clinically indicated. LFTs should be tested every three months due to the potential impact of methotrexate on the liver, while U&Es should be checked every 6-12 months.

      As methotrexate is a folate antagonist, patients may experience side effects such as hair loss and mouth ulcers. To mitigate these effects, patients are often advised to take folate supplements on the days they are not taking methotrexate.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      14
      Seconds
  • Question 13 - Which one of the following is not a pathological response to extensive burns...

    Incorrect

    • Which one of the following is not a pathological response to extensive burns in elderly patients?

      Your Answer: Plasma leakage into interstitial space

      Correct Answer: Absolute polycythaemia

      Explanation:

      The primary pathological response is haemolysis.

      Pathology of Burns

      Extensive burns can cause various pathological changes in the body. The heat and microangiopathy can damage erythrocytes, leading to haemolysis. The loss of capillary membrane integrity can cause plasma leakage into the interstitial space, resulting in hypovolaemic shock. This shock can occur up to 48 hours after the injury and can cause a decrease in blood volume and an increase in haematocrit. Additionally, protein loss and secondary infections, such as Staphylococcus aureus, can occur. There is also a risk of acute peptic stress ulcers, known as Curling’s ulcers. Furthermore, full-thickness circumferential burns in an extremity can lead to compartment syndrome.

      The healing process of burns depends on the severity of the burn. Superficial burns can heal through the migration of keratinocytes to form a new layer over the burn site. However, full-thickness burns can result in dermal scarring, which may require skin grafts to provide optimal coverage. It is important to understand the pathology of burns to provide appropriate treatment and prevent further complications.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      767.9
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  • Question 14 - An 80-year-old patient who recently had a TIA is admitted to the vascular...

    Incorrect

    • An 80-year-old patient who recently had a TIA is admitted to the vascular ward in preparation for a carotid endarterectomy tomorrow. During her pre-operative consultation, the surgeon explained that the artery will be tied during the procedure. The patient asks about the different arteries and their functions. You inform her that the internal carotid artery supplies the brain, while the external carotid artery divides into two arteries after ascending the neck. One of these arteries is the superficial temporal artery, but what is the other?

      Your Answer: Facial artery

      Correct Answer: Maxillary artery

      Explanation:

      The correct answer is the maxillary artery, which is one of the two terminal branches of the external carotid artery. It supplies deep structures of the face and usually bifurcates within the parotid gland to form the superficial temporal artery and maxillary artery. The facial artery supplies superficial structures in the face, while the lingual artery supplies the tongue. The middle meningeal artery is a branch of the maxillary artery and supplies the dura mater and calvaria. There are also two deep temporal arteries that arise from the maxillary artery and supply the temporalis muscle. The patient is scheduled to undergo carotid endarterectomy, a surgical procedure that involves removing atherosclerotic plaque from the common carotid artery to reduce the risk of subsequent ischaemic strokes or transient ischaemic attacks.

      Anatomy of the External Carotid Artery

      The external carotid artery begins on the side of the pharynx and runs in front of the internal carotid artery, behind the posterior belly of digastric and stylohyoid muscles. It is covered by sternocleidomastoid muscle and passed by hypoglossal nerves, lingual and facial veins. The artery then enters the parotid gland and divides into its terminal branches within the gland.

      To locate the external carotid artery, an imaginary line can be drawn from the bifurcation of the common carotid artery behind the angle of the jaw to a point in front of the tragus of the ear.

      The external carotid artery has six branches, with three in front, two behind, and one deep. The three branches in front are the superior thyroid, lingual, and facial arteries. The two branches behind are the occipital and posterior auricular arteries. The deep branch is the ascending pharyngeal artery. The external carotid artery terminates by dividing into the superficial temporal and maxillary arteries within the parotid gland.

    • This question is part of the following fields:

      • Cardiovascular System
      26
      Seconds
  • Question 15 - A woman in her early fifties comes in with a painful shoulder and...

    Correct

    • A woman in her early fifties comes in with a painful shoulder and limited range of motion. The shoulder is sensitive to touch, and there is no record of injury. During the examination, both active and passive movement are restricted due to pain. Based on these symptoms, you suspect the patient has a frozen shoulder. What is the primary location of inflammation in this condition?

      Your Answer: Shoulder capsule

      Explanation:

      Frozen shoulder is caused by inflammation of the shoulder capsule, leading to pain and reduced range of movement. Other conditions that can cause shoulder pain include biceps tendonitis, shoulder arthritis, and glenoid labrum tears.

      Adhesive capsulitis, also known as frozen shoulder, is a common cause of shoulder pain that is more prevalent in middle-aged women. The exact cause of this condition is not fully understood. It is associated with diabetes mellitus, with up to 20% of diabetics experiencing an episode of frozen shoulder. Symptoms typically develop over a few days and affect external rotation more than internal rotation or abduction. Both active and passive movement are affected, and patients usually experience a painful freezing phase, an adhesive phase, and a recovery phase. Bilateral frozen shoulder occurs in up to 20% of patients, and the episode typically lasts between 6 months and 2 years.

      The diagnosis of frozen shoulder is usually made based on clinical presentation, although imaging may be necessary for atypical or persistent symptoms. There is no single intervention that has been proven to improve long-term outcomes. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, oral corticosteroids, and intra-articular corticosteroids. It is important to note that the management of frozen shoulder should be tailored to the individual patient, and a multidisciplinary approach may be necessary for optimal outcomes.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      15.2
      Seconds
  • Question 16 - A 9-month-old baby girl is brought to the clinic by her parents who...

    Incorrect

    • A 9-month-old baby girl is brought to the clinic by her parents who recently moved from the Philippines. The baby has a noticeable mass in her abdomen, resembling a sausage shape. During questioning, the father mentions that the baby had vomited green substance a few hours ago. The baby is immediately referred to the hospital. What is the probable diagnosis?

      Your Answer: Meckel's diverticulum

      Correct Answer: Intussusception

      Explanation:

      Understanding Intussusception

      Intussusception is a medical condition where one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileocecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. Symptoms of intussusception include severe, crampy abdominal pain, inconsolable crying, vomiting, and bloodstained stool, which is a late sign. During a paroxysm, the infant will draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.

      To diagnose intussusception, ultrasound is now the preferred method of investigation, which may show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used first-line compared to the traditional barium enema. If this method fails, or the child has signs of peritonitis, surgery is performed. Understanding the symptoms and treatment options for intussusception is crucial for parents and healthcare professionals to ensure prompt and effective management of this condition.

    • This question is part of the following fields:

      • Gastrointestinal System
      41.7
      Seconds
  • Question 17 - Samantha is a 55-year-old woman who has presented to her doctor with a...

    Incorrect

    • Samantha is a 55-year-old woman who has presented to her doctor with a persistent pain in her neck over the past 6 months. She has also noticed a lump on the anterolateral aspect of her neck and has been experiencing a persistent cough. Upon conducting blood tests, her doctor has found that she has hypocalcaemia and hypophosphataemia. Following an ultrasound and biopsy, Samantha has been diagnosed with medullary thyroid carcinoma. The tumour studies have shown that there has been no spread to local lymph nodes. Can you explain the reason for Samantha's abnormal blood results?

      Your Answer: Metastasis

      Correct Answer: Inhibition of osteoclasts by calcitonin

      Explanation:

      Calcitonin inhibits osteoclasts, leading to a decrease in plasma calcium and phosphate levels.

      Understanding Calcitonin and Its Role in Regulating Calcium Levels

      Calcitonin is a hormone that is produced by the parafollicular cells or C cells of the thyroid gland. It is released in response to high levels of calcium in the blood, which can occur due to various factors such as bone resorption, vitamin D toxicity, or certain cancers. The main function of calcitonin is to decrease the levels of calcium and phosphate in the blood by inhibiting the activity of osteoclasts, which are cells that break down bone tissue and release calcium into the bloodstream.

      Calcitonin works by binding to specific receptors on the surface of osteoclasts, which reduces their ability to resorb bone. This leads to a decrease in the release of calcium and phosphate into the bloodstream, which helps to restore normal levels of these minerals. In addition to its effects on bone metabolism, calcitonin also has other physiological functions such as regulating kidney function and modulating the immune system.

      Overall, calcitonin plays an important role in maintaining calcium homeostasis in the body and preventing the development of conditions such as hypercalcemia, which can have serious health consequences. By inhibiting osteoclast activity and promoting bone formation, calcitonin helps to maintain the structural integrity of bones and prevent fractures. Understanding the mechanisms of calcitonin action can provide insights into the pathophysiology of bone diseases and inform the development of new treatments for these conditions.

    • This question is part of the following fields:

      • General Principles
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      Seconds
  • Question 18 - Which of the following is not secreted by the islets of Langerhans? ...

    Incorrect

    • Which of the following is not secreted by the islets of Langerhans?

      Your Answer: Somatostatin

      Correct Answer: Secretin

      Explanation:

      Mucosal cells in the duodenum and jejunum release secretin.

      Hormones Released from the Islets of Langerhans

      The islets of Langerhans in the pancreas are responsible for the production and secretion of several hormones that play a crucial role in regulating blood glucose levels. The beta cells in the islets of Langerhans are responsible for producing insulin, which accounts for 70% of the total secretions. Insulin helps to lower blood glucose levels by promoting the uptake of glucose by cells and tissues throughout the body.

      The alpha cells in the islets of Langerhans produce glucagon, which has the opposite effect of insulin. Glucagon raises blood glucose levels by stimulating the liver to release stored glucose into the bloodstream. The delta cells in the islets of Langerhans produce somatostatin, which helps to regulate the release of insulin and glucagon.

      Finally, the F cells in the islets of Langerhans produce pancreatic polypeptide, which plays a role in regulating pancreatic exocrine function and appetite. Together, these hormones work to maintain a delicate balance of blood glucose levels in the body.

    • This question is part of the following fields:

      • Endocrine System
      21.5
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  • Question 19 - A 16-year-old girl has missed her period by 6 days, which is unusual...

    Incorrect

    • A 16-year-old girl has missed her period by 6 days, which is unusual given her regular 30-day cycle. She purchases a pregnancy test and receives a positive result. What substance is released upon fertilization of the egg to prevent polyspermy?

      Your Answer: Potassium ions

      Correct Answer: Calcium ions

      Explanation:

      Fertilization happens when a sperm reaches an egg that has been released during ovulation. The process begins with the sperm penetrating the outer layer of the egg, called the corona radiata, using enzymes in the plasma membrane of its head. These enzymes bind to receptors on the next inner layer of the egg, called the zona pellucida, triggering the acrosome reaction. This reaction causes the acrosomal hydrolytic enzymes to digest the zona pellucida, creating a pathway to the egg’s plasma membrane. The sperm then enters the egg’s cytoplasm, and the two cells fuse together to form a diploid zygote. The sperm also stimulates the release of calcium ions from the cortical granules of the egg, which inactivate the receptors on the zona pellucida to prevent polyspermy. After fertilization, the zygote undergoes rapid mitotic cell divisions to form an embryo.

      The Process of Fertilisation

      Fertilisation is the process by which a sperm cell reaches and penetrates an egg cell that has been released during ovulation. The first step involves the sperm penetrating the corona radiata, which is the outer layer of the ovum, using enzymes in the plasma membrane of the sperm’s head. These enzymes bind to the ZP3 receptors on the zona pellucida, which is the next inner layer of the ovum, triggering the acrosome reaction. This reaction involves the acrosomal hydrolytic enzymes digesting the zona pellucida, creating a pathway to the ovum plasma membrane.

      Once the sperm enters the ovum cytoplasm, the two cells fuse together, resulting in the formation of a diploid zygote. The sperm also stimulates the release of calcium ions from the cortical granules of the ovum, which inactivate the ZP3 receptors to prevent polyspermy. After fertilisation, rapid mitotic cell divisions occur, resulting in the production of an embryo.

      In summary, fertilisation is a complex process that involves the penetration of the ovum by the sperm, the fusion of the two cells, and the subsequent development of the zygote into an embryo.

    • This question is part of the following fields:

      • Reproductive System
      28.3
      Seconds
  • Question 20 - Which one of the following statements regarding hepatitis C is accurate? ...

    Incorrect

    • Which one of the following statements regarding hepatitis C is accurate?

      Your Answer: The average prognosis following a new diagnosis of hepatitis C is around 4-5 years

      Correct Answer: A combination of protease inhibitors with or without ribavirin is the treatment of choice

      Explanation:

      Hepatitis C is a virus that is expected to become a significant public health issue in the UK in the coming years, with around 200,000 people believed to be chronically infected. Those at risk include intravenous drug users and individuals who received a blood transfusion before 1991, such as haemophiliacs. The virus is an RNA flavivirus with an incubation period of 6-9 weeks. Transmission can occur through needle stick injuries, vertical transmission from mother to child, and sexual intercourse, although the risk is relatively low. There is currently no vaccine for hepatitis C.

      After exposure to the virus, only around 30% of patients will develop symptoms such as a transient rise in serum aminotransferases, jaundice, fatigue, and arthralgia. HCV RNA is the preferred diagnostic test for acute infection, although patients who spontaneously clear the virus will continue to have anti-HCV antibodies. Chronic hepatitis C is defined as the persistence of HCV RNA in the blood for 6 months and can lead to complications such as rheumatological problems, cirrhosis, hepatocellular cancer, and cryoglobulinaemia.

      The management of chronic hepatitis C depends on the viral genotype and aims to achieve sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy. Interferon-based treatments are no longer recommended, and a combination of protease inhibitors with or without ribavirin is currently used. However, these treatments can have side effects such as haemolytic anaemia, cough, flu-like symptoms, depression, fatigue, leukopenia, and thrombocytopenia. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic.

    • This question is part of the following fields:

      • General Principles
      63.9
      Seconds
  • Question 21 - A new antibody test is being researched to aid in the early diagnosis...

    Incorrect

    • A new antibody test is being researched to aid in the early diagnosis of juvenile rheumatoid arthritis. It has a specificity of 97%.

      Which of the following statements is accurate?

      Your Answer: 97% of patients who have a positive result will have rheumatoid arthritis

      Correct Answer: 97% of patients without the condition will have a negative test

      Explanation:

      Precision refers to the consistency of a test in producing the same results when repeated multiple times. It is an important aspect of test reliability and can impact the accuracy of the results. In order to assess precision, multiple tests are performed on the same sample and the results are compared. A test with high precision will produce similar results each time it is performed, while a test with low precision will produce inconsistent results. It is important to consider precision when interpreting test results and making clinical decisions.

    • This question is part of the following fields:

      • General Principles
      41.5
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  • Question 22 - A 65-year-old man visits his doctor with complaints of a painful rash on...

    Incorrect

    • A 65-year-old man visits his doctor with complaints of a painful rash on his face after experiencing lethargy and headache for 3 days. The man's vital signs are within normal limits. Upon examination, a distinct line of blisters is observed on the upper left side of his face.

      What is the most frequent complication associated with this condition in the elderly population?

      Your Answer: Vision loss

      Correct Answer: Neuralgia

      Explanation:

      The most common complication of shingles is post-herpetic neuralgia, which is characterized by a burning pain in the affected dermatome. This condition is likely to occur in older individuals, who are also at risk of experiencing more severe and prolonged pain. While bacterial superinfection of cutaneous lesions can occur, it is typically caused by Staphylococcus aureus or group A streptococcal species. Shingles can also lead to complications such as pneumonia, meningoencephalitis, hepatitis, and acute retinal necrosis if it affects internal organs.

      Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.4
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  • Question 23 - A 25-year-old male with Gilbert's syndrome (GS) visits his doctor worried about a...

    Incorrect

    • A 25-year-old male with Gilbert's syndrome (GS) visits his doctor worried about a recent change in skin tone. During the examination, his skin appears to be normal, but he insists that it was yellow earlier today.

      What is true about Gilbert's syndrome?

      Your Answer: GS may progress to chronic liver disease

      Correct Answer: Transient jaundice after physiological stress such as exercise and fasting is seen in Gilbert’s syndrome

      Explanation:

      Gilbert’s syndrome is a harmless liver condition that is characterized by increased levels of bilirubin in the blood. While some individuals may not experience any symptoms, others may develop temporary jaundice following physical stressors such as fasting or exercise. Treatment and regular monitoring are not necessary for this condition. It is important to reassure patients that Gilbert’s syndrome does not progress to chronic liver disease. The condition is caused by a mutation in the UGT1A1 gene, which leads to reduced activity of the UGT1A1 enzyme. Gilbert’s syndrome is more prevalent in males.

      Gilbert’s syndrome is a genetic disorder that affects the way bilirubin is processed in the body. It is caused by a deficiency of UDP glucuronosyltransferase, which leads to unconjugated hyperbilirubinemia. This means that bilirubin is not properly broken down and eliminated from the body, resulting in jaundice. However, jaundice may only be visible during certain conditions such as fasting, exercise, or illness. The prevalence of Gilbert’s syndrome is around 1-2% in the general population.

      To diagnose Gilbert’s syndrome, doctors may look for a rise in bilirubin levels after prolonged fasting or the administration of IV nicotinic acid. However, treatment is not necessary for this condition. While the exact mode of inheritance is still debated, it is known to be an autosomal recessive disorder.

    • This question is part of the following fields:

      • Gastrointestinal System
      32.7
      Seconds
  • Question 24 - Mary, an 82-year-old female, arrives at the emergency department after experiencing a minor...

    Incorrect

    • Mary, an 82-year-old female, arrives at the emergency department after experiencing a minor fall. She reports discomfort in her left leg.

      A radiograph is ordered and reveals a left intracapsular neck of femur fracture. As a result, Mary is scheduled for a hemiarthroplasty to avoid avascular necrosis of the femoral head.

      In this particular fracture, which blood vessel is the primary source of blood supply to the femoral head and is most susceptible to damage?

      Your Answer: Posterior branch of the obturator artery

      Correct Answer: Medial femoral circumflex artery

      Explanation:

      The medial femoral circumflex artery is a significant supplier of blood to the femoral head, while the perforating branches of the profunda femoris artery supply the medial and posterior thigh. The lateral femoral circumflex artery provides blood to some muscles of the lateral thigh and a portion of the femoral head. Additionally, the anterior branch of the obturator artery supplies blood to the obturator externus, pectineus, adductor muscles, and gracilis muscles.

      Anatomy of the Femur: Structure and Blood Supply

      The femur is the longest and strongest bone in the human body, extending from the hip joint to the knee joint. It consists of a rounded head that articulates with the acetabulum and two large condyles at its inferior aspect that articulate with the tibia. The superior aspect of the femur comprises a head and neck that pass inferolaterally to the body and the two trochanters. The neck meets the body of the femur at an angle of 125o and is demarcated from it by a wide rough intertrochanteric crest. The greater trochanter has discernible surfaces that form the site of attachment of the gluteal muscles, while the linea aspera forms part of the origin of the attachments of the thigh adductors.

      The femur has a rich blood supply, with numerous vascular foramina existing throughout its length. The blood supply to the femoral head is clinically important and is provided by the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head. It is important to note that the neck is covered by synovial membrane up to the intertrochanteric line, and the posterior aspect of the neck is demarcated from the shaft by the intertrochanteric crest. Understanding the anatomy of the femur, including its structure and blood supply, is crucial for medical professionals in diagnosing and treating injuries and conditions related to this bone.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      32.1
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  • Question 25 - A teenage girl with cystic fibrosis has been neglecting her pancreatic enzyme supplements,...

    Incorrect

    • A teenage girl with cystic fibrosis has been neglecting her pancreatic enzyme supplements, leading to steatorrhea.

      As a consequence, which of the following is she most likely to be deficient in?

      Your Answer: Vitamin C

      Correct Answer: Vitamin K

      Explanation:

      Understanding Vitamin K

      Vitamin K is a type of fat-soluble vitamin that plays a crucial role in the carboxylation of clotting factors such as II, VII, IX, and X. This vitamin acts as a cofactor in the process, which is essential for blood clotting. In clinical settings, vitamin K is used to reverse the effects of warfarinisation, a process that inhibits blood clotting. However, it may take up to four hours for the INR to change after administering vitamin K.

      Vitamin K deficiency can occur in conditions that affect fat absorption since it is a fat-soluble vitamin. Additionally, prolonged use of broad-spectrum antibiotics can eliminate gut flora, leading to a deficiency in vitamin K. It is essential to maintain adequate levels of vitamin K to ensure proper blood clotting and prevent bleeding disorders.

    • This question is part of the following fields:

      • General Principles
      18.4
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  • Question 26 - A 44-year-old man has been diagnosed with type II diabetes mellitus but cannot...

    Incorrect

    • A 44-year-old man has been diagnosed with type II diabetes mellitus but cannot tolerate metformin therapy. What is the mechanism of action of alogliptin, which has been prescribed as an alternative?

      Your Answer: Increases production of glucagon-like-peptide-1

      Correct Answer: Reduce the peripheral breakdown of incretins

      Explanation:

      Gliptins (DPP-4 inhibitors) work by inhibiting the enzyme DPP-4, which reduces the breakdown of incretin hormones such as GLP-1. This leads to a glucose-dependent increase in insulin secretion and a reduction in glucagon secretion, ultimately regulating glucose homeostasis. However, gliptins do not increase the production of GLP-1, directly stimulate the release of insulin from pancreatic beta cells, inhibit the SGLT2 receptor, or reduce insulin resistance.

      Diabetes mellitus is a condition that has seen the development of several drugs in recent years. One hormone that has been the focus of much research is glucagon-like peptide-1 (GLP-1), which is released by the small intestine in response to an oral glucose load. In type 2 diabetes mellitus (T2DM), insulin resistance and insufficient B-cell compensation occur, and the incretin effect, which is largely mediated by GLP-1, is decreased. GLP-1 mimetics, such as exenatide and liraglutide, increase insulin secretion and inhibit glucagon secretion, resulting in weight loss, unlike other medications. They are sometimes used in combination with insulin in T2DM to minimize weight gain. Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as vildagliptin and sitagliptin, increase levels of incretins by decreasing their peripheral breakdown, are taken orally, and do not cause weight gain. Nausea and vomiting are the major adverse effects of GLP-1 mimetics, and the Medicines and Healthcare products Regulatory Agency has issued specific warnings on the use of exenatide, reporting that it has been linked to severe pancreatitis in some patients. NICE guidelines suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated, or the person has had a poor response to a thiazolidinedione.

    • This question is part of the following fields:

      • Endocrine System
      88.4
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  • Question 27 - A 12-year-old male patient has been diagnosed with Friedreich's ataxia, an autosomal recessive...

    Correct

    • A 12-year-old male patient has been diagnosed with Friedreich's ataxia, an autosomal recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs and impaired speech that worsens over time. What condition should this patient be screened for as a result of having this disease?

      Your Answer: Hypertrophic obstructive cardiomyopathy

      Explanation:

      Friedreich’s ataxia is a genetic disorder caused by a deficiency of the frataxin protein, which can lead to cardiac neuropathy and hypertrophic obstructive cardiomyopathy. This condition is not associated with haemophilia, coarctation of the aorta, streptococcal pharyngitis, Kawasaki disease, or coronary artery aneurysm. However, Group A streptococcal infections can cause acute rheumatic fever and chronic rheumatic heart disease, which are autoimmune diseases that affect the heart.

      Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder that affects muscle tissue and is inherited in an autosomal dominant manner. It is caused by mutations in genes that encode contractile proteins, with the most common defects involving the β-myosin heavy chain protein or myosin-binding protein C. HOCM is characterized by left ventricle hypertrophy, which leads to decreased compliance and cardiac output, resulting in predominantly diastolic dysfunction. Biopsy findings show myofibrillar hypertrophy with disorganized myocytes and fibrosis. HOCM is often asymptomatic, but exertional dyspnea, angina, syncope, and sudden death can occur. Jerky pulse, systolic murmurs, and double apex beat are also common features. HOCM is associated with Friedreich’s ataxia and Wolff-Parkinson White. ECG findings include left ventricular hypertrophy, non-specific ST segment and T-wave abnormalities, and deep Q waves. Atrial fibrillation may occasionally be seen.

    • This question is part of the following fields:

      • Cardiovascular System
      23.3
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  • Question 28 - Which one of the following structures does not pass behind the piriformis muscle...

    Correct

    • Which one of the following structures does not pass behind the piriformis muscle in the greater sciatic foramen?

      Your Answer: Obturator nerve

      Explanation:

      The greater sciatic foramen does not serve as a pathway for the obturator nerve.

      The Greater Sciatic Foramen and its Contents

      The greater sciatic foramen is a space in the pelvis that is bounded by various ligaments and bones. It serves as a passageway for several important structures, including nerves and blood vessels. The piriformis muscle is a landmark for identifying these structures as they pass through the sciatic notch. Above the piriformis muscle, the superior gluteal vessels can be found, while below it are the inferior gluteal vessels, the sciatic nerve (which passes through it in only 10% of cases), and the posterior cutaneous nerve of the thigh.

      The boundaries of the greater sciatic foramen include the greater sciatic notch of the ilium, the sacrotuberous ligament, the sacrospinous ligament, and the ischial spine. The anterior sacroiliac ligament forms the superior boundary. Structures passing through the greater sciatic foramen include the pudendal nerve, the internal pudendal artery, and the nerve to the obturator internus.

      In contrast, the lesser sciatic foramen is a smaller space that contains the tendon of the obturator internus, the pudendal nerve, the internal pudendal artery and vein, and the nerve to the obturator internus. Understanding the contents and boundaries of these foramina is important for clinicians who may need to access or avoid these structures during surgical procedures or other interventions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      62.6
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  • Question 29 - A patient with intricate mental health issues and multiple medications presents at the...

    Incorrect

    • A patient with intricate mental health issues and multiple medications presents at the clinic with concerns about weight gain. Which of the following medications is probable to be the cause of this side effect?

      Your Answer: Sodium Valproate

      Correct Answer: Olanzapine

      Explanation:

      Weight gain is a prevalent side effect of antipsychotics.

      While antipsychotics are successful in treating schizophrenia, they often lead to weight gain and an increased likelihood of developing type 2 diabetes. The most rapid weight gain typically occurs within the first six months of starting antipsychotic treatment.

      In particular, Olanzapine and Clozapine are associated with a high risk of weight gain. They stimulate appetite and result in overeating, as well as disrupt glucose regulation.

      Schizophrenia management guidelines were published by NICE in 2009. The guidelines recommend that first-line treatment for schizophrenia should involve oral atypical antipsychotics. Additionally, cognitive behavioural therapy should be offered to all patients. It is important to pay close attention to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients, which is linked to antipsychotic medication and high smoking rates. Therefore, healthcare professionals should take necessary measures to reduce the risk of cardiovascular disease in these patients.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 30 - Sarah is a 65-year-old patient with decompensated liver cirrhosis. Two years ago she...

    Incorrect

    • Sarah is a 65-year-old patient with decompensated liver cirrhosis. Two years ago she had variceal bleed, for which she has been taking propranolol and received endoscopic variceal ligation. Sarah presents to the emergency department with haematemesis and a recurrent oesophageal variceal bleed is suspected.

      What emergency surgery is necessary in this case?

      Your Answer:

      Correct Answer: Transjugular intrahepatic portosystemic shunt (TIPS) procedure

      Explanation:

      To address recurrent variceal haemorrhage despite optimal medical therapy, a TIPS procedure may be performed. This involves linking the hepatic vein to the portal vein, which helps to alleviate the complications associated with portal hypertension.

      Variceal haemorrhage is a serious condition that requires prompt and effective management. The initial treatment involves resuscitation of the patient, correction of clotting abnormalities, and administration of vasoactive agents such as terlipressin or octreotide. Prophylactic IV antibiotics are also recommended to reduce mortality in patients with liver cirrhosis. Endoscopic variceal band ligation is the preferred method for controlling bleeding, and the use of a Sengstaken-Blakemore tube or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) may be necessary if bleeding cannot be controlled. However, TIPSS can lead to exacerbation of hepatic encephalopathy, which is a common complication.

      To prevent variceal haemorrhage, prophylactic measures such as propranolol and endoscopic variceal band ligation (EVL) are recommended. Propranolol has been shown to reduce rebleeding and mortality compared to placebo. EVL is superior to endoscopic sclerotherapy and should be performed at two-weekly intervals until all varices have been eradicated. Proton pump inhibitor cover is given to prevent EVL-induced ulceration. NICE guidelines recommend offering endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices.

    • This question is part of the following fields:

      • Gastrointestinal System
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SESSION STATS - PERFORMANCE PER SPECIALTY

General Principles (3/7) 43%
Histology (1/1) 100%
Gastrointestinal System (2/6) 33%
Reproductive System (0/2) 0%
Clinical Sciences (0/1) 0%
Neurological System (0/1) 0%
Renal System (1/1) 100%
Musculoskeletal System And Skin (4/5) 80%
Cardiovascular System (1/2) 50%
Endocrine System (2/2) 100%
Psychiatry (1/1) 100%
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