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  • Question 1 - What is the position of the hyoid bone? ...

    Correct

    • What is the position of the hyoid bone?

      Your Answer: C3

      Explanation:

      Surface Anatomy of the Neck: Identifying Structures and Corresponding Levels

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

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

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      15.5
      Seconds
  • Question 2 - A 50-year-old male patient arrives at the emergency department with abrupt chest pain...

    Incorrect

    • A 50-year-old male patient arrives at the emergency department with abrupt chest pain that worsens with deep breathing. The patient appears visibly agitated and short of breath, and coughs up a small quantity of blood while waiting. During the examination, the patient displays tachypnea and a red, swollen left leg. An ECG shows sinus tachycardia.

      What is the most significant risk factor for this patient's presentation?

      Your Answer: Upper respiratory tract infection

      Correct Answer: Prostate malignancy

      Explanation:

      Having a malignancy increases the likelihood of developing pulmonary embolism, as all types of cancer are known to increase the risk of venous thromboembolism. However, bronchiectasis, despite causing breathlessness and haemoptysis, is less likely to result in an acute attack and is not a common risk factor for PE. Contrary to popular belief, individuals with a high BMI are more likely to develop blood clots than those with a low BMI. Finally, conditions 4 and 5 are not typically associated with an increased risk of pulmonary embolism.

      Risk Factors for Venous Thromboembolism

      Venous thromboembolism (VTE) is a condition where blood clots form in the veins, which can lead to serious complications such as pulmonary embolism (PE). While some common predisposing factors include malignancy, pregnancy, and the period following an operation, there are many other factors that can increase the risk of VTE. These include underlying conditions such as heart failure, thrombophilia, and nephrotic syndrome, as well as medication use such as the combined oral contraceptive pill and antipsychotics. It is important to note that around 40% of patients diagnosed with a PE have no major risk factors. Therefore, it is crucial to be aware of all potential risk factors and take appropriate measures to prevent VTE.

    • This question is part of the following fields:

      • Haematology And Oncology
      197.5
      Seconds
  • Question 3 - A 14-year-old girl presents to the clinic with worsening left knee pain over...

    Incorrect

    • A 14-year-old girl presents to the clinic with worsening left knee pain over the past six weeks and fever for the past two weeks. She has a heart rate of 100/min, respiratory rate of 18/min, temperature of 39.2ºC, blood pressure of 95/60 mmHg, and oxygen saturation of 97%. A pink rash is visible on her chest. Canakinumab is prescribed for suspected systemic juvenile idiopathic arthritis.

      What is the mode of action of canakinumab?

      Your Answer: Blocks CD20 receptor

      Correct Answer: Targets IL-1β

      Explanation:

      Canakinumab is an IL-1β antagonist monoclonal antibody that targets IL-1 beta. It is approved for use in systemic juvenile idiopathic arthritis and adult-onset Still’s disease.

      The Role of Interleukin 1 in the Immune Response

      Interleukin 1 (IL-1) is a crucial mediator of the immune response, secreted primarily by macrophages and monocytes. Its main function is to act as a costimulator of T cell and B cell proliferation. Additionally, IL-1 increases the expression of adhesion molecules on the endothelium, leading to vasodilation and increased vascular permeability. This can cause shock in sepsis, making IL-1 one of the mediators of this condition. Along with IL-6 and TNF, IL-1 also acts on the hypothalamus, causing pyrexia.

      Due to its significant role in the immune response, IL-1 inhibitors are increasingly used in medicine. Examples of these inhibitors include anakinra, an IL-1 receptor antagonist used in the management of rheumatoid arthritis, and canakinumab, a monoclonal antibody targeted at IL-1 beta used in systemic juvenile idiopathic arthritis and adult-onset Still’s disease. These inhibitors help to regulate the immune response and manage conditions where IL-1 plays a significant role.

    • This question is part of the following fields:

      • General Principles
      14995.8
      Seconds
  • Question 4 - A child with severe hydrocephalus is exhibiting a lack of upward gaze. What...

    Incorrect

    • A child with severe hydrocephalus is exhibiting a lack of upward gaze. What specific area of the brain is responsible for this impairment?

      Your Answer: Lateral geniculate body

      Correct Answer: Superior colliculi

      Explanation:

      The superior colliculi play a crucial role in upward gaze and are located on both sides of the tectal or quadrigeminal plate. Damage or compression of the superior colliculi, such as in severe hydrocephalus, can result in the inability to look up, known as sunsetting of the eyes.

      The optic chiasm serves as the connection between the anterior and posterior optic pathways. The nasal fibers of the optic nerves cross over at the chiasm, leading to monocular visual field deficits with anterior pathway lesions and binocular visual field deficits with posterior pathway lesions.

      The lateral geniculate body in the thalamus is where the optic tract connects with the optic radiations, while the inferior colliculi and medial geniculate bodies are responsible for processing auditory stimuli.

      Understanding the Diencephalon: An Overview of Brain Anatomy

      The diencephalon is a part of the brain that is located between the cerebral hemispheres and the brainstem. It is composed of several structures, including the thalamus, hypothalamus, epithalamus, and subthalamus. Each of these structures plays a unique role in regulating various bodily functions and behaviors.

      The thalamus is responsible for relaying sensory information from the body to the cerebral cortex, which is responsible for processing and interpreting this information. The hypothalamus, on the other hand, is involved in regulating a wide range of bodily functions, including hunger, thirst, body temperature, and sleep. It also plays a role in regulating the release of hormones from the pituitary gland.

      The epithalamus is a small structure that is involved in regulating the sleep-wake cycle and the production of melatonin, a hormone that helps to regulate sleep. The subthalamus is involved in regulating movement and is part of the basal ganglia, a group of structures that are involved in motor control.

      Overall, the diencephalon plays a crucial role in regulating many of the body’s essential functions and behaviors. Understanding its anatomy and function can help us better understand how the brain works and how we can maintain optimal health and well-being.

    • This question is part of the following fields:

      • Neurological System
      107.2
      Seconds
  • Question 5 - What is measured to obtain renal plasma flow if the patient is a...

    Correct

    • What is measured to obtain renal plasma flow if the patient is a few years older?

      Your Answer: Para-amino hippuric acid (PAH)

      Explanation:

      The normal value for renal plasma flow is 660ml/min, which is calculated by dividing the amount of PAH in urine per unit time by the difference in PAH concentration in the renal artery or vein.

      The Loop of Henle and its Role in Renal Physiology

      The Loop of Henle is a crucial component of the renal system, located in the juxtamedullary nephrons and running deep into the medulla. Approximately 60 litres of water containing 9000 mmol sodium enters the descending limb of the loop of Henle in 24 hours. The osmolarity of fluid changes and is greatest at the tip of the papilla. The thin ascending limb is impermeable to water, but highly permeable to sodium and chloride ions. This loss means that at the beginning of the thick ascending limb the fluid is hypo osmotic compared with adjacent interstitial fluid. In the thick ascending limb, the reabsorption of sodium and chloride ions occurs by both facilitated and passive diffusion pathways. The loops of Henle are co-located with vasa recta, which have similar solute compositions to the surrounding extracellular fluid, preventing the diffusion and subsequent removal of this hypertonic fluid. The energy-dependent reabsorption of sodium and chloride in the thick ascending limb helps to maintain this osmotic gradient. Overall, the Loop of Henle plays a crucial role in regulating the concentration of solutes in the renal system.

    • This question is part of the following fields:

      • Renal System
      16.4
      Seconds
  • Question 6 - A 25-year-old man arrives at the emergency department after experiencing multiple episodes of...

    Incorrect

    • A 25-year-old man arrives at the emergency department after experiencing multiple episodes of vomiting following a night of heavy drinking. During the clinical examination, the doctor observes dry mucous membranes and reduced skin turgidity. As part of the diagnostic process, an arterial blood gas test is conducted, and the results are as follows:

      pH 7.49
      PaO2 9 kPa
      PaCO2 5.5kPa
      Bicarbonate 30mM

      What could be the possible cause of this patient's arterial blood gas findings?

      Your Answer: Methanol toxicity

      Correct Answer: Hypokalaemia

      Explanation:

      Metabolic alkalosis can be caused by hypokalaemia, which occurs when there is a low level of potassium in the blood. Vomiting is another cause of metabolic alkalosis, as it leads to the loss of acid from the stomach. However, vomiting was not provided as an option. On the other hand, hypokalemia can also cause metabolic acidosis, as the body tries to replace potassium by exchanging it for hydrogen ions through the H+K+ATPase transporter in the alpha-intercalated cells of the cortical collecting duct. Uraemia, methanol toxicity, and aspirin toxicity are known causes of metabolic acidosis with raised anion gap. Aspirin can also cause respiratory alkalosis by directly stimulating the respiratory centres in the brainstem.

      Understanding Metabolic Alkalosis and Its Causes

      Metabolic alkalosis is a condition that occurs when there is a loss of hydrogen ions or a gain of bicarbonate in the body. This condition is mainly caused by problems in the kidney or gastrointestinal tract. Some of the common causes of metabolic alkalosis include vomiting, diuretics, liquorice, carbenoxolone, primary hyperaldosteronism, Cushing’s syndrome, and Bartter’s syndrome.

      The mechanism of metabolic alkalosis is primarily due to the activation of the renin-angiotensin II-aldosterone (RAA) system. This system is responsible for the reabsorption of sodium ions in exchange for hydrogen ions in the distal convoluted tubule. When there is a loss of sodium and chloride ions due to vomiting or diuretics, the RAA system is activated, leading to an increase in aldosterone levels.

      In cases of hypokalaemia, where there is a shift of potassium ions from cells to the extracellular fluid, alkalosis occurs due to the shift of hydrogen ions into cells to maintain neutrality. Understanding the causes and mechanisms of metabolic alkalosis is crucial in diagnosing and treating this condition.

    • This question is part of the following fields:

      • General Principles
      391.5
      Seconds
  • Question 7 - A 25-year-old man presents to his GP with a complaint of loss of...

    Incorrect

    • A 25-year-old man presents to his GP with a complaint of loss of sensation in the 1st webspace of his left hand after a night of heavy drinking at a party. During the examination, the GP observes that the patient is unable to extend his left wrist and also reports a loss of sensation in the dorsal aspect of the 1st webspace. What is the most probable location of the lesion?

      Your Answer:

      Correct Answer: Radial nerve

      Explanation:

      The radial nerve supplies the skin on the dorsal aspect of the hand, while the axillary nerve innervates teres minor and deltoid muscle and provides sensory innervation to the badge area. The median nerve is the main nerve of the anterior compartment of the forearm, and the ulnar nerve innervates muscles in the forearm and intrinsic muscles of the hand. The musculocutaneous nerve supplies muscles in the upper arm and terminates as the lateral cutaneous nerve of the forearm.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      0
      Seconds
  • Question 8 - A 67-year-old man with Parkinson's disease is experiencing persistent dyskinesia symptoms despite receiving...

    Incorrect

    • A 67-year-old man with Parkinson's disease is experiencing persistent dyskinesia symptoms despite receiving optimal treatment with levodopa and a dopamine agonist. His physician prescribes amantadine, a drug that stimulates dopamine release from nerve endings. Originally developed as an antiviral medication, what is the most accurate description of its antiviral activity?

      Your Answer:

      Correct Answer: Inhibits uncoating of the Matrix-2 (M2) viral protein

      Explanation:

      Antiviral agents are drugs used to treat viral infections. They work by targeting specific mechanisms of the virus, such as inhibiting viral DNA polymerase or neuraminidase. Some common antiviral agents include acyclovir, ganciclovir, ribavirin, amantadine, oseltamivir, foscarnet, interferon-α, and cidofovir. Each drug has its own mechanism of action and indications for use, but they all aim to reduce the severity and duration of viral infections.

      In addition to these antiviral agents, there are also specific drugs used to treat HIV, a retrovirus. Nucleoside analogue reverse transcriptase inhibitors (NRTI), protease inhibitors (PI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) are all used to target different aspects of the HIV life cycle. NRTIs work by inhibiting the reverse transcriptase enzyme, which is needed for the virus to replicate. PIs inhibit a protease enzyme that is necessary for the virus to mature and become infectious. NNRTIs bind to and inhibit the reverse transcriptase enzyme, preventing the virus from replicating. These drugs are often used in combination to achieve the best possible outcomes for HIV patients.

    • This question is part of the following fields:

      • General Principles
      0
      Seconds
  • Question 9 - A 27-year-old man presents to the Emergency Department following a car accident. He...

    Incorrect

    • A 27-year-old man presents to the Emergency Department following a car accident. He has no visible wounds or head trauma, but he is experiencing left lower limb pain and is unable to walk. Upon examination, he displays a high stepping gait and there is swelling and deformity below the knee. An X-ray confirms a fractured neck of the fibula.

      Which function is most likely impacted in this patient?

      Your Answer:

      Correct Answer: Dorsiflexion of foot

      Explanation:

      A fibular neck fracture can result in foot drop due to common peroneal nerve injury. The nerve is often injured because it winds around the neck of the fibula. The common peroneal nerve is responsible for dorsiflexion of the foot, and an injury to this nerve can cause foot drop, which is characterized by a high stepping gait. In foot drop, the foot appears floppy, and the toes point downward, scraping the ground while walking. The patient tends to lift their foot very high to avoid dragging it on the ground. Eversion of the foot is not the correct answer, as it is controlled by the superficial peroneal nerve. Flexion of toes is also an incorrect answer, as it is controlled by the medial plantar nerve.

      Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteal lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      0
      Seconds
  • Question 10 - A 67-year-old female presents to a medical facility with a chief complaint of...

    Incorrect

    • A 67-year-old female presents to a medical facility with a chief complaint of tremors. Upon examination, the physician observes that the tremors are most noticeable when the patient is at rest. The patient does not display any specific neurological deficits, but does exhibit arm rigidity throughout the full range of motion and takes some time to initiate movements. Given the probable diagnosis, what histological finding would be anticipated?

      Your Answer:

      Correct Answer: Lewy bodies

      Explanation:

      When a patient presents with tremor, rigidity, and bradykinesia, Parkinson’s Disease should be considered as a possible diagnosis. The presence of Lewy Bodies, which are clumps of proteins within neurons, is a characteristic histological finding. These bodies are often found in the substantia nigra and have a cytoplasm that is rich in eosin.

      In males with Klinefelter syndrome, Barr bodies, which are inactivated X chromosomes, may be observed.

      Cholesterol clefts are a result of cholesterol emboli, which occur when material from an atherosclerotic plaque becomes dislodged and deposited elsewhere. This can happen during procedures such as angiography.

      Keratin pearls are a feature of squamous cell lung cancer, where squamous cells form concentric layers around keratin.

      The term kidney bean-shaped nuclei refers to the appearance of neutrophils.

      Parkinson’s disease is a progressive neurodegenerative disorder that occurs due to the degeneration of dopaminergic neurons in the substantia nigra. This leads to a classic triad of symptoms, including bradykinesia, tremor, and rigidity, which are typically asymmetrical. The disease is more common in men and is usually diagnosed around the age of 65. Bradykinesia is characterized by a poverty of movement, shuffling steps, and difficulty initiating movement. Tremors are most noticeable at rest and typically occur in the thumb and index finger. Rigidity can be either lead pipe or cogwheel, and other features include mask-like facies, flexed posture, and drooling of saliva. Psychiatric features such as depression, dementia, and sleep disturbances may also occur. Diagnosis is usually clinical, but if there is difficulty differentiating between essential tremor and Parkinson’s disease, 123I‑FP‑CIT single photon emission computed tomography (SPECT) may be considered.

    • This question is part of the following fields:

      • Neurological System
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal System And Skin (1/1) 100%
Haematology And Oncology (0/1) 0%
General Principles (0/2) 0%
Neurological System (0/1) 0%
Renal System (1/1) 100%
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