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Question 1
Correct
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A 6-year-old girl is playing with some small ball bearings. Regrettably, she inhales one. In which of the following lung regions is the ball expected to settle?
Your Answer: Right lower lobe
Explanation:Due to the angle of the right main bronchus from the trachea, small objects are more likely to get stuck in the most dependent part of the right lung. This makes the right lung the preferred location for most objects to enter.
Anatomy of the Lungs
The lungs are a pair of organs located in the chest cavity that play a vital role in respiration. The right lung is composed of three lobes, while the left lung has two lobes. The apex of both lungs is approximately 4 cm superior to the sternocostal joint of the first rib. The base of the lungs is in contact with the diaphragm, while the costal surface corresponds to the cavity of the chest. The mediastinal surface contacts the mediastinal pleura and has the cardiac impression. The hilum is a triangular depression above and behind the concavity, where the structures that form the root of the lung enter and leave the viscus. The right main bronchus is shorter, wider, and more vertical than the left main bronchus. The inferior borders of both lungs are at the 6th rib in the mid clavicular line, 8th rib in the mid axillary line, and 10th rib posteriorly. The pleura runs two ribs lower than the corresponding lung level. The bronchopulmonary segments of the lungs are divided into ten segments, each with a specific function.
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This question is part of the following fields:
- Respiratory System
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Question 2
Incorrect
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A 38-year-old woman has made the decision to have a thyroidectomy for her Graves' disease. During the procedure, one of the blood vessels supplying the thyroid gland, the superior thyroid artery, will be ligated.
What is the correct description of the superior thyroid artery?Your Answer:
Correct Answer: A branch of the external carotid artery that supplies the superior portion of the thyroid gland
Explanation:The superior thyroid artery is the initial branch of the external carotid artery and is responsible for supplying the upper pole of the thyroid gland. It descends towards the gland after arising and generally provides blood to the superior and anterior regions. On the other hand, the inferior thyroid artery originates from the thyrocervical trunk, which is a branch of the subclavian artery. It travels in a superomedial direction to reach the inferior pole of the thyroid and typically supplies the postero-inferior aspect.
Anatomy of the Thyroid Gland
The thyroid gland is a butterfly-shaped gland located in the neck, consisting of two lobes connected by an isthmus. It is surrounded by a sheath from the pretracheal layer of deep fascia and is situated between the base of the tongue and the fourth and fifth tracheal rings. The apex of the thyroid gland is located at the lamina of the thyroid cartilage, while the base is situated at the fourth and fifth tracheal rings. In some individuals, a pyramidal lobe may extend from the isthmus and attach to the foramen caecum at the base of the tongue.
The thyroid gland is surrounded by various structures, including the sternothyroid, superior belly of omohyoid, sternohyoid, and anterior aspect of sternocleidomastoid muscles. It is also related to the carotid sheath, larynx, trachea, pharynx, oesophagus, cricothyroid muscle, and parathyroid glands. The superior and inferior thyroid arteries supply the thyroid gland with blood, while the superior and middle thyroid veins drain into the internal jugular vein, and the inferior thyroid vein drains into the brachiocephalic veins.
In summary, the thyroid gland is a vital gland located in the neck, responsible for producing hormones that regulate metabolism. Its anatomy is complex, and it is surrounded by various structures that are essential for its function. Understanding the anatomy of the thyroid gland is crucial for the diagnosis and treatment of thyroid disorders.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 3
Incorrect
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A 50-year-old woman presents to her GP with a complaint of generalised puffiness. She has been feeling lethargic and noticed swelling in her hands, feet, and face over the past few weeks. Additionally, she has been experiencing shortness of breath on exertion and cannot lie flat, frequently waking up at night gasping for air. She also reports tingling and loss of sensation in both feet, which has now extended to her knees. She has no regular medications and is otherwise healthy.
Upon examination, the patient has decreased sensation over the distal lower limbs and hepatomegaly. Urine dipstick reveals protein +++ and urinalysis reveals hyperalbuminuria. Serology shows hypoalbuminaemia and hyperlipidaemia. An outpatient echocardiogram reveals both systolic and diagnostic heart failure, with a restrictive filling pattern. The Mantoux skin test was negative.
What is the probable mechanism behind this patient's condition?Your Answer:
Correct Answer: Deposition of light chain fragments
Explanation:The deposition of light chain fragments in various tissues is the most common cause of amyloidosis (AL), which can present with symptoms such as nephrotic syndrome, heart failure, and peripheral neuropathy.
Symptoms in the upper respiratory tract and kidneys are typically seen in granulomatosis with polyangiitis (GPA), which is caused by anti-neutrophil cytoplasmic antibody-induced inflammation. Therefore, this answer is not applicable.
Tuberculosis is caused by Mycobacterium, but the absence of pulmonary features and negative Mantoux skin test make it unlikely in this case. Therefore, this answer is not applicable.
Amyloidosis is a condition that can occur in different forms. The most common type is AL amyloidosis, which is caused by the accumulation of immunoglobulin light chain fragments. This can be due to underlying conditions such as myeloma, Waldenstrom’s, or MGUS. Symptoms of AL amyloidosis can include nephrotic syndrome, cardiac and neurological issues, macroglossia, and periorbital eccymoses.
Another type of amyloidosis is AA amyloid, which is caused by the buildup of serum amyloid A protein, an acute phase reactant. This form of amyloidosis is often seen in patients with chronic infections or inflammation, such as TB, bronchiectasis, or rheumatoid arthritis. The most common symptom of AA amyloidosis is renal involvement.
Beta-2 microglobulin amyloidosis is another form of the condition, which is caused by the accumulation of beta-2 microglobulin, a protein found in the major histocompatibility complex. This type of amyloidosis is often seen in patients who are on renal dialysis.
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This question is part of the following fields:
- Renal System
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Question 4
Incorrect
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A study is proposed to determine if adolescent obesity in girls increases the likelihood of developing polycystic ovarian syndrome. What study design would be most suitable?
Your Answer:
Correct Answer: Cohort study
Explanation:A cohort study is a more reliable source of evidence compared to a case-control study as it involves selecting two groups based on their exposure to a specific agent and monitoring their development of a disease or outcome.
There are different types of studies that researchers can use to investigate various phenomena. One of the most rigorous types of study is the randomised controlled trial, where participants are randomly assigned to either an intervention or control group. However, practical or ethical issues may limit the use of this type of study. Another type of study is the cohort study, which is observational and prospective. Researchers select two or more groups based on their exposure to a particular agent and follow them up to see how many develop a disease or other outcome. The usual outcome measure is the relative risk. Examples of cohort studies include the Framingham Heart Study.
On the other hand, case-control studies are observational and retrospective. Researchers identify patients with a particular condition (cases) and match them with controls. Data is then collected on past exposure to a possible causal agent for the condition. The usual outcome measure is the odds ratio. Case-control studies are inexpensive and produce quick results, making them useful for studying rare conditions. However, they are prone to confounding. Lastly, cross-sectional surveys provide a snapshot of a population and are sometimes called prevalence studies. They provide weak evidence of cause and effect.
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This question is part of the following fields:
- General Principles
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Question 5
Incorrect
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A 2-year-old girl presents with recurrent urinary tract infections. During the diagnostic work-up, abnormal renal function is noted and an ultrasound scan reveals bilateral hydronephrosis.
What could be the probable underlying diagnosis?Your Answer:
Correct Answer: Posterior urethral valves
Explanation:A developmental uropathy known as a posterior urethral valve typically affects male infants with an incidence of 1 in 8000. The condition is characterized by bladder wall hypertrophy, hydronephrosis, and bladder diverticula, which are used as diagnostic features.
Posterior urethral valves are a frequent cause of blockage in the lower urinary tract in males. They can be detected during prenatal ultrasound screenings. Due to the high pressure required for bladder emptying during fetal development, the child may experience damage to the renal parenchyma, resulting in renal impairment in 70% of boys upon diagnosis. Treatment involves the use of a bladder catheter, and endoscopic valvotomy is the preferred definitive treatment. Cystoscopic and renal follow-up is necessary.
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This question is part of the following fields:
- Renal System
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Question 6
Incorrect
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You have been asked to review a 63-year-old man on the medical ward who was recently treated for an exacerbation of pulmonary oedema. His past medical history includes heart failure. He is currently on a course of antibiotics for prostatitis.
His blood results from yesterday are shown below:
Na+ 141 mmol/l
K+ 4.3 mmol/l
Urea 6 mmol/l
Creatinine 60 µmol/l
His blood results from today are shown below:
Na+ 140 mmol/l
K+ 4.6 mmol/l
Urea 15 mmol/l
Creatinine 180 µmol/l
What is the most probable reason for the change in kidney function?Your Answer:
Correct Answer: Concomitant use of furosemide and gentamicin resulting in renal failure
Explanation:The risk of renal failure increases when furosemide and gentamicin are used together. Furosemide is the primary diuretic for treating acute pulmonary edema, but its concurrent use with gentamicin can lead to kidney failure. The patient’s blood test results indicate acute kidney injury, which is likely caused by gentamicin toxicity.
Acute kidney injury can result from pre-renal causes such as sepsis and dehydration, and in such cases, the blood test would show a significant increase in urea levels disproportionate to the rise in creatinine.
Bendroflumethiazide is not a commonly used medication for managing acute pulmonary edema.
Metronidazole is not significantly associated with nephrotoxicity.
Gentamicin is a type of antibiotic known as an aminoglycoside. It is not easily dissolved in lipids, so it is typically administered through injection or topical application. It is commonly used to treat infections such as infective endocarditis and otitis externa. However, gentamicin can have adverse effects on the body, such as ototoxicity, which can cause damage to the auditory or vestibular nerves. This damage is irreversible. Gentamicin can also cause nephrotoxicity, which can lead to acute tubular necrosis. The risk of toxicity increases when gentamicin is used in conjunction with furosemide. Lower doses and more frequent monitoring are necessary to prevent these adverse effects. Gentamicin is contraindicated in patients with myasthenia gravis. To ensure safe dosing, plasma concentrations of gentamicin are monitored. Peak levels are measured one hour after administration, and trough levels are measured just before the next dose. If the trough level is high, the interval between doses should be increased. If the peak level is high, the dose should be decreased.
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This question is part of the following fields:
- General Principles
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Question 7
Incorrect
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A 75-year-old male presents to his GP with a four week history of shortness of breath when he walks for approximately two minutes on level ground. There is also an associated central chest pain which resolves when he rests. The pain is localised and does not radiate.
On examination, there were obvious signs of ankle and sacral pitting oedema. A left ventricular heave was palpated but the apex beat was not displaced. A systolic murmur was heard best at the second intercostal space just right of the sternum. This murmur also radiated to the carotid arteries.
Which investigation is most likely to confirm the underlying cause of his symptoms?Your Answer:
Correct Answer: Echocardiogram
Explanation:Diagnosis of Valvular Heart Disease
Echocardiography is the most sensitive and specific way to diagnose valvular heart disease (VHD). It involves observing the valvular leaflets and degree of calcified stenosis of the aortic valve, as well as calculating cardiac output and ejection fraction for prognostic information. Chest x-ray may reveal a calcified aortic valve and left ventricular hypertrophy, while bilateral ankle edema is a minor sign for congestive heart failure. To assess the severity of heart failure, an x-ray, ECG, and BNP should be performed, but echocardiogram remains the most reliable diagnostic tool for VHD.
A myocardial infarction is unlikely in this patient due to her age and the duration of symptoms. Instead, her angina-type pain is likely due to her underlying aortic valve disease. An angiogram of the coronary arteries alone cannot diagnose valvular defects. Cardiac enzymes such as troponin I and T are markers for myocardial necrosis and will not aid in the diagnosis of VHD. While ECG should be performed in a patient presenting with these symptoms, it alone is insufficient to diagnose VHD. The ECG may show left axis deviation due to left ventricular hypertrophy.
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This question is part of the following fields:
- Cardiovascular System
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Question 8
Incorrect
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A 55-year-old man comes in for his regular check-up with his GP. He has a medical history of chronic pancreatitis and diabetes mellitus and is currently taking the maximum doses of metformin and gliclazide. During a random plasma glucose test, his levels show 18.0 mmol/l and his urinalysis reveals glycosuria with minimal ketones. The GP suspects that his body is not producing enough insulin and decides to initiate insulin therapy. Can you identify the location in the body where insulin is produced?
Your Answer:
Correct Answer: Pancreatic beta cells
Explanation:Diabetes mellitus in this patient is most likely caused by chronic pancreatitis, which has resulted in the destruction of the pancreatic endocrine cells responsible for producing endogenous insulin. These cells are located in the Islets of Langerhans and are known as pancreatic beta cells (β-cells). Other cells in the pancreas, such as alpha cells (which secrete glucagon) and delta cells (which secrete somatostatin), do not produce insulin. Similarly, gastric G cells secrete gastrin and are not involved in insulin production.
Insulin is a hormone produced by the pancreas that plays a crucial role in regulating the metabolism of carbohydrates and fats in the body. It works by causing cells in the liver, muscles, and fat tissue to absorb glucose from the bloodstream, which is then stored as glycogen in the liver and muscles or as triglycerides in fat cells. The human insulin protein is made up of 51 amino acids and is a dimer of an A-chain and a B-chain linked together by disulfide bonds. Pro-insulin is first formed in the rough endoplasmic reticulum of pancreatic beta cells and then cleaved to form insulin and C-peptide. Insulin is stored in secretory granules and released in response to high levels of glucose in the blood. In addition to its role in glucose metabolism, insulin also inhibits lipolysis, reduces muscle protein loss, and increases cellular uptake of potassium through stimulation of the Na+/K+ ATPase pump.
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This question is part of the following fields:
- Endocrine System
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Question 9
Incorrect
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A teenage boy comes to the clinic with a winged scapula on his right side after sustaining an injury while playing rugby. The physician informs him that a nerve has been affected. Which specific nerve is responsible for this?
Your Answer:
Correct Answer: Long thoracic nerve
Explanation:A mastectomy patient experiences winged scapula due to paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. This nerve is often affected by rib injuries. The other nerves mentioned do not play a role in this disorder as they do not innervate this muscle. Damage to the musculocutaneous nerve would affect arm flexion, while damage to the axillary nerve would affect arm abduction. Damage to the thoracodorsal nerve would affect raising the trunk with the upper limb, and damage to the accessory nerve would affect neck movement.
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.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 10
Incorrect
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A 9-year-old girl has come to your clinic complaining of fatigue and widespread aches. She describes the pain as 'burning'. During the examination, you notice small, painless bumps on her abdomen, and she also has proteinuria. Based on these symptoms, you suspect that she may have Fabry disease.
What is the mode of inheritance for this condition?Your Answer:
Correct Answer: X-linked recessive
Explanation:Understanding Fabry Disease
Fabry disease is a genetic disorder that is inherited in an X-linked recessive manner. It is caused by a deficiency of alpha-galactosidase A, an enzyme that breaks down a type of fat called globotriaosylceramide. This leads to the accumulation of this fat in various organs and tissues, causing a range of symptoms.
One of the earliest symptoms of Fabry disease is burning pain or paraesthesia in childhood, particularly in the hands and feet. Other common features include angiokeratomas, which are small red or purple spots on the skin, and lens opacities, which can cause vision problems. Proteinuria, or the presence of excess protein in the urine, is also a common finding in people with Fabry disease.
Perhaps the most serious complication of Fabry disease is early cardiovascular disease, which can lead to heart attacks and strokes. This is thought to be due to the accumulation of globotriaosylceramide in the walls of blood vessels, causing them to become stiff and narrow.
Overall, Fabry disease is a complex condition that can affect many different parts of the body. Early diagnosis and treatment are important for managing symptoms and preventing complications.
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This question is part of the following fields:
- General Principles
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Question 11
Incorrect
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As a junior doctor at a general practice, you have an appointment with a 58-year-old man who has been diagnosed with atrial fibrillation. Upon reviewing his notes, you see that he has been prescribed a class three antiarrhythmic medication that blocks potassium channels. Which of the following drugs functions via this mechanism?
Your Answer:
Correct Answer: Sotalol
Explanation:Sotalol is classified as a beta-blocker, but it also blocks potassium channels, which slows down the heart rate by delaying ventricular relaxation. This makes it a class three antiarrhythmic agent, along with amiodarone. However, it can also cause a life-threatening type of ventricular tachycardia called torsades de pointes due to its effects on potassium channels.
Digoxin, on the other hand, is a cardiac glycoside that works by reducing conduction through the atrioventricular node, slowing down the ventricular rate in atrial fibrillation and flutter. It also has positive inotropic effects, meaning it can increase the heart’s contractility. It does not fit into the Vaughan Williams classification.
Flecainide is a class one antiarrhythmic agent that blocks fast inward sodium channels and prolongs the refractory period of the heart during diastole.
Propranolol is a beta-blocker and falls under category two of the Vaughan-Williams classification. It is non-selective and used to treat various conditions such as hypertension, thyrotoxicosis, pheochromocytoma, anxiety, angina, essential tremor, and migraine prophylaxis. However, caution should be exercised when using it in patients with asthma as it can cause bronchospasm.
The Vaughan Williams Classification of Antiarrhythmics
The Vaughan Williams classification is a widely used system for categorizing antiarrhythmic drugs based on their mechanism of action. The classification system is divided into four classes, each with a different mechanism of action. Class I drugs block sodium channels, Class II drugs are beta-adrenoceptor antagonists, Class III drugs block potassium channels, and Class IV drugs are calcium channel blockers.
Class Ia drugs, such as quinidine and procainamide, increase the duration of the action potential by blocking sodium channels. However, quinidine toxicity can cause cinchonism, which is characterized by symptoms such as headache, tinnitus, and thrombocytopenia. Procainamide may also cause drug-induced lupus.
Class Ib drugs, such as lidocaine and mexiletine, decrease the duration of the action potential by blocking sodium channels. Class Ic drugs, such as flecainide and propafenone, have no effect on the duration of the action potential but still block sodium channels.
Class II drugs, such as propranolol and metoprolol, are beta-adrenoceptor antagonists that decrease the heart rate and contractility of the heart.
Class III drugs, such as amiodarone and sotalol, block potassium channels, which prolongs the duration of the action potential.
Class IV drugs, such as verapamil and diltiazem, are calcium channel blockers that decrease the influx of calcium ions into the heart, which slows down the heart rate and reduces contractility.
It should be noted that some common antiarrhythmic drugs, such as adenosine, atropine, digoxin, and magnesium, are not included in the Vaughan Williams classification.
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This question is part of the following fields:
- General Principles
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Question 12
Incorrect
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Which statement about the internal jugular vein and its relations is correct?
Your Answer:
Correct Answer: Lies lateral to the common carotid artery
Explanation:The Path of the Internal Jugular Vein
The internal jugular vein begins at the jugular foramen and is initially located behind the carotid artery. As it descends in the carotid sheath, it moves to the side of the internal and common carotid arteries. Eventually, it passes in front of the subclavian artery and joins with the subclavian vein to form the brachiocephalic vein. The left and right brachiocephalic veins then come together to create the superior vena cava. At the point where the internal jugular vein meets the subclavian vein, it receives a lymphatic trunk. The external jugular vein, on the other hand, drains into the subclavian vein.
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This question is part of the following fields:
- Clinical Sciences
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Question 13
Incorrect
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Samantha is a 65-year-old alcoholic who has come to her doctor with worries about the feeling in her legs. She is experiencing decreased light-touch sensation and proprioception in both legs. Her blood work reveals a deficiency in vitamin B12.
What signs are most probable for you to observe in Samantha?Your Answer:
Correct Answer: Positive Babinski sign
Explanation:The presence of a positive Babinski sign may indicate subacute degeneration of the spinal cord, which is typically caused by a deficiency in vitamin B12. This condition primarily affects the dorsal columns of the spinal cord, which are responsible for fine-touch, proprioception, and vibration sensation. In addition to the Babinski sign, patients may also experience spastic paresis. However, hypotonia is not typically observed, as this is a characteristic of lower motor neuron lesions. It is also important to note that temperature sensation is not affected by subacute degeneration of the spinal cord, as this function is mediated by the spinothalamic tract.
Subacute Combined Degeneration of Spinal Cord
Subacute combined degeneration of spinal cord is a condition that occurs due to a deficiency of vitamin B12. The dorsal columns and lateral corticospinal tracts are affected, leading to the loss of joint position and vibration sense. The first symptoms are usually distal paraesthesia, followed by the development of upper motor neuron signs in the legs, such as extensor plantars, brisk knee reflexes, and absent ankle jerks. If left untreated, stiffness and weakness may persist.
This condition is a serious concern and requires prompt medical attention. It is important to maintain a healthy diet that includes sufficient amounts of vitamin B12 to prevent the development of subacute combined degeneration of spinal cord.
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This question is part of the following fields:
- Neurological System
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Question 14
Incorrect
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What factor triggers a direct rise in the production of aldosterone?
Your Answer:
Correct Answer: Increased levels of angiotensin II
Explanation:The Renin-Angiotensin-Aldosterone System
The renin-angiotensin-aldosterone system (RAAS) is a series of events that occur in response to a fall in renal perfusion. When the kidneys do not receive enough blood flow, renin is released from the juxtaglomerular apparatus and stimulates the activation of angiotensin I into angiotensin II, a potent vasoconstrictor. Angiotensin II then triggers the production of aldosterone in the adrenal cortex. Although aldosterone is a hormone of the adrenal cortex, it is secreted in response to angiotensin II.
Aldosterone acts via the mineralocorticoid receptor (MR) and has several actions. It prevents the loss of sodium in the kidney, leading to sodium retention. It promotes renal potassium excretion, causing potassium loss. Additionally, it promotes renal loss of hydrogen ions, leading to a tendency towards alkalosis. Aldosterone plays a crucial role in regulating blood pressure and electrolyte balance in the body.
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This question is part of the following fields:
- Clinical Sciences
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Question 15
Incorrect
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A 67-year-old man presents to the emergency department after collapsing while shopping. He is experiencing profuse sweating and has a blood pressure of 98/63 mmHg. The patient reports severe epigastric pain as his only complaint.
The suspected cause of his symptoms is peptic ulcer disease, which may have caused erosion into a blood vessel. Upon endoscopy, a perforation is discovered in the posterior medial wall of the second part of the duodenum.
What is the most likely blood vessel that has been affected?Your Answer:
Correct Answer: Gastroduodenal artery
Explanation:The gastroduodenal artery is a potential source of significant gastrointestinal bleeding that can occur as a complication of peptic ulcer disease. The most likely diagnosis based on the given clinical information is peptic ulcer disease, which can cause the ulcer to penetrate through the posteromedial wall of the second part of the duodenum and into the gastroduodenal artery. This can result in a severe gastrointestinal bleed, leading to shock, which may present with symptoms such as low blood pressure, sweating, and collapse.
The answers Splenic artery, Left gastric artery, and Coeliac trunk are incorrect. The splenic artery runs behind the stomach and connects the coeliac trunk to the spleen, and does not pass near the second part of the duodenum. The left gastric artery runs along the small curvature of the stomach and supplies that region, and does not pass through the posteromedial wall of the duodenum. The coeliac trunk arises from the abdominal aorta at the level of T12 and gives rise to the splenic, left gastric, and common hepatic arteries, but does not lie near the second part of the duodenum.
Managing Acute Bleeding in Peptic Ulcer Disease
Peptic ulcer disease is a condition that can lead to acute bleeding, which is the most common complication of the disease. In fact, bleeding accounts for about three-quarters of all problems associated with peptic ulcer disease. The gastroduodenal artery is often the source of significant gastrointestinal bleeding in patients with this condition. The most common symptom of acute bleeding in peptic ulcer disease is haematemesis, but patients may also experience melaena, hypotension, and tachycardia.
When managing acute bleeding in peptic ulcer disease, an ABC approach should be taken, as with any upper gastrointestinal haemorrhage. Intravenous proton pump inhibitors are the first-line treatment, and endoscopic intervention is typically the preferred approach. However, if endoscopic intervention fails (which occurs in approximately 10% of patients), urgent interventional angiography with transarterial embolization or surgery may be necessary. By following these management strategies, healthcare providers can effectively address acute bleeding in patients with peptic ulcer disease.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Incorrect
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What is the primary means of transportation for vitamin D in the human body?
Your Answer:
Correct Answer: In blood, bound to the group specific component
Explanation:The Role of UV Light and Vitamin D in Calcium and Phosphate Regulation
In order for the body to produce Vitamin D3, UV light at a specific wavelength is required to convert cholesterol in the skin. Vitamin D2 and D3 are then transported in the bloodstream bound to the Vitamin-D Binding Protein and undergo further modifications in the liver and kidney to become the active form, 1,25 (OH)2Vitamin D. This active form plays a crucial role in regulating calcium and phosphate concentrations in the body.
1,25 (OH)2Vitamin D increases calcium absorption in the duodenum and inhibits the secretion and synthesis of PTH, which helps to maintain calcium concentrations. It also increases phosphate absorption in the jejunum and ileum, which is important for maintaining phosphate concentrations. Additionally, 1,25 (OH)2Vitamin D promotes bone turnover by stimulating both osteoblast and osteoclast activity.
Overall, the production and activation of Vitamin D through UV light and dietary sources is essential for proper calcium and phosphate regulation in the body.
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This question is part of the following fields:
- Basic Sciences
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Question 17
Incorrect
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A 3-year-old male is brought to the clinician for evaluation of recurrent seizures. He has a history of frequent infections. During chest examination, a heart murmur is detected on the left sternal edge and he presents with abnormal facial features. Laboratory tests show hypocalcemia, hyperphosphatemia, and low levels of parathyroid hormone. The diagnosis is DiGeorge syndrome. Which pharyngeal pouch gives rise to the thymus in this condition?
Your Answer:
Correct Answer: Third pharyngeal pouch
Explanation:The 3rd pharyngeal pouch gives rise to the thymus. Other structures derived from different pharyngeal pouches include the Eustachian tube, middle ear cavity, and mastoid antrum from the 1st pouch, the Palatine tonsils from the 2nd pouch, the superior parathyroid glands from the 4th pouch, and the thyroid C-cells from the 5th pouch which eventually becomes part of the 4th pouch.
Embryology of Branchial (Pharyngeal) Pouches
During embryonic development, the branchial (pharyngeal) pouches give rise to various structures in the head and neck region. The first pharyngeal pouch forms the Eustachian tube, middle ear cavity, and mastoid antrum. The second pharyngeal pouch gives rise to the palatine tonsils. The third pharyngeal pouch divides into dorsal and ventral wings, with the dorsal wings forming the inferior parathyroid glands and the ventral wings forming the thymus. Finally, the fourth pharyngeal pouch gives rise to the superior parathyroid glands.
Understanding the embryology of the branchial pouches is important in the diagnosis and treatment of certain congenital abnormalities and diseases affecting these structures. By knowing which structures arise from which pouches, healthcare professionals can better understand the underlying pathophysiology and develop appropriate management strategies. Additionally, knowledge of the embryology of these structures can aid in the development of new treatments and therapies for related conditions.
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This question is part of the following fields:
- General Principles
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Question 18
Incorrect
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Oliver, a 6-year-old boy, arrives at the emergency department with his mother after falling from a swing and landing on his outstretched hand. He is experiencing intense pain in his left arm. An X-ray is conducted.
He has a weak radial pulse.
What is the frequently occurring fracture in children that raises the likelihood of Volkmaan's ischemic contractures?Your Answer:
Correct Answer: Supracondylar fracture of the humerus
Explanation:Volkmaan’s ischemic contractures can be caused by a supracondylar fracture of the humerus, which poses a risk of damage to the brachial artery and subsequent ischemia distal to the fracture. This type of fracture is more common in children, while a Colles fracture, which can also lead to Volkmaan’s ischemic contractures, is more common in adults. Another fracture that can result in Volkmaan’s ischemic contractures is a Monteggia fracture, which involves a fracture of the proximal third of the ulna and dislocation of the proximal head of the radius.
The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 19
Incorrect
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A 15-year-old girl arrives at the Emergency Department after ingesting a handful of her father's anxiety medication. He takes lorazepam 1 mg TID for generalized anxiety disorder which has not responded well to other treatments.
She has consumed 8 mg lorazepam and is now unresponsive, with a respiratory rate of eight per minute and oxygen saturation of 90% on room air.
The patient does not react to verbal stimuli, but responds to a painful sternal rub and attempts to push the examiner's hand away.
Given that the half-life of lorazepam is approximately 10-20 hours, how long will it take for the medication to be eliminated from her system?Your Answer:
Correct Answer: 200 hours
Explanation:Clonazepam and Flumazenil in Benzodiazepine Overdose
Conventionally, a drug is considered to be eliminated from the system after four or five half-lives, leaving only a small fraction of the original amount. However, this does not necessarily mean that the drug’s clinical effects have disappeared. For instance, a person who has taken clonazepam, a potent benzodiazepine used to treat certain seizure disorders, may still feel relatively alert even after only one half-life has passed.
Clonazepam is a long-acting benzodiazepine that is approximately 20 times more potent than diazepam. In cases of benzodiazepine overdose, flumazenil may be a useful antidote. Flumazenil is particularly effective in uncomplicated cases of benzodiazepine overdose, and it works by reversing the effects of benzodiazepines on the central nervous system. Therefore, it may be considered as a treatment option for individuals who have taken an excessive amount of clonazepam or other benzodiazepines.
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This question is part of the following fields:
- Pharmacology
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Question 20
Incorrect
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A 78-year-old man arrives at the emergency department with eczema and diarrhoea. His daughter, who accompanies him, reports that he has been experiencing memory loss. Upon conducting blood tests, it is revealed that he is suffering from niacin deficiency. Upon further examination, it is discovered that he has a carcinoid tumour in his appendix. How has this tumour led to his deficiency?
Your Answer:
Correct Answer: Increased metabolism of tryptophan causing decreased biosynthesis of niacin
Explanation:The metabolism of tryptophan is increased in carcinoid syndrome, leading to a deficiency of niacin. However, the presence of a tumour in the appendix is unlikely to affect the absorption of niacin. Niacin is produced in the liver from tryptophan, and a decrease in tryptophan availability would result in a reduction of niacin biosynthesis. There is no indication of excessive niacin metabolism or excretion.
The Importance of Vitamin B3 (Niacin) in the Body
Vitamin B3, also known as niacin, is a type of water-soluble vitamin that belongs to the B complex group. It is a crucial nutrient that serves as a precursor to NAD+ and NADP+, which are essential for various metabolic processes in the body. Niacin is synthesized in the body from tryptophan, an amino acid found in protein-rich foods. However, certain conditions such as Hartnup’s disease and carcinoid syndrome can reduce the absorption of tryptophan or increase its metabolism to serotonin, leading to niacin deficiency.
Niacin deficiency can result in a condition called pellagra, which is characterized by a triad of symptoms: dermatitis, diarrhea, and dementia. Pellagra is a serious condition that can lead to severe health complications if left untreated. Therefore, it is important to ensure that you are getting enough niacin in your diet or through supplements to maintain optimal health and prevent the risk of niacin deficiency.
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This question is part of the following fields:
- General Principles
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Question 21
Incorrect
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A 25-year-old male presents to the GP clinic complaining of persistent sneezing and eye irritation that worsens during the spring and summer seasons. Upon further inquiry, he reports experiencing an itchy rash on the flexor surface of his elbow. Which type of hypersensitivity reaction is exemplified by his allergic rhinitis?
Your Answer:
Correct Answer: Type 1
Explanation:The Gell and Coombs classification of hypersensitivity reactions categorizes them into four types. Allergic rhinitis is an instance of a type 1 (immediate) reaction that is IgE-mediated. It is a hypersensitivity response to a substance that was previously harmless.
Type 2 reactions are mediated by IgG and IgM, which attach to a cell and cause its destruction. Goodpasture syndrome is an example of a type 2 hypersensitivity reaction.
Type 3 reactions are mediated by immune complexes. Rheumatoid arthritis is an example of a type 3 hypersensitivity reaction.
Type 4 (delayed) reactions are mediated by T lymphocytes and cause contact dermatitis.
Classification of Hypersensitivity Reactions
Hypersensitivity reactions are classified into four types according to the Gell and Coombs classification. Type I, also known as anaphylactic hypersensitivity, occurs when an antigen reacts with IgE bound to mast cells. This type of reaction is commonly seen in atopic conditions such as asthma, eczema, and hay fever. Type II hypersensitivity occurs when cell-bound IgG or IgM binds to an antigen on the cell surface, leading to autoimmune conditions such as autoimmune hemolytic anemia, ITP, and Goodpasture’s syndrome. Type III hypersensitivity occurs when free antigen and antibody (IgG, IgA) combine to form immune complexes, leading to conditions such as serum sickness, systemic lupus erythematosus, and post-streptococcal glomerulonephritis. Type IV hypersensitivity is T-cell mediated and includes conditions such as tuberculosis, graft versus host disease, and allergic contact dermatitis.
In recent times, a fifth category has been added to the classification of hypersensitivity reactions. Type V hypersensitivity occurs when antibodies recognize and bind to cell surface receptors, either stimulating them or blocking ligand binding. This type of reaction is seen in conditions such as Graves’ disease and myasthenia gravis. Understanding the classification of hypersensitivity reactions is important in the diagnosis and management of these conditions.
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This question is part of the following fields:
- General Principles
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Question 22
Incorrect
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Where exactly can the vomiting center be found?
Your Answer:
Correct Answer: Medulla oblongata
Explanation:Here are the non-GI causes of vomiting, listed alphabetically:
– Acute renal failure
– Brain conditions that increase intracranial pressure
– Cardiac events, particularly inferior myocardial infarction
– Diabetic ketoacidosis
– Ear infections that affect the inner ear (labyrinthitis)
– Ingestion of foreign substances, such as Tylenol or theophylline
– Glaucoma
– Hyperemesis gravidarum, a severe form of morning sickness in pregnancy
– Infections such as pyelonephritis (kidney infection) or meningitis.Vomiting is the involuntary act of expelling the contents of the stomach and sometimes the intestines. This is caused by a reverse peristalsis and abdominal contraction. The vomiting center is located in the medulla oblongata and is activated by receptors in various parts of the body. These include the labyrinthine receptors in the ear, which can cause motion sickness, the over distention receptors in the duodenum and stomach, the trigger zone in the central nervous system, which can be affected by drugs such as opiates, and the touch receptors in the throat. Overall, vomiting is a reflex action that is triggered by various stimuli and is controlled by the vomiting center in the brainstem.
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This question is part of the following fields:
- Neurological System
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Question 23
Incorrect
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A 65-year-old obese male presents with recurrent episodes of colicky pain and bloating in the left iliac fossa. The patient has no significant medical history but has been a smoker for 25 years and does not consume alcohol. He works at a fast-food restaurant and usually eats his meals there.
Upon examination, the patient's vital signs are stable with a temperature of 37ºC, respiratory rate of 14 breaths per minute, oxygen saturations of 99% on air, heart rate of 60 beats per minute, and blood pressure of 125/70 mmHg. Abdominal and digital rectal examination reveal no significant findings. A colonoscopy was subsequently performed, which revealed multiple diverticula along the sigmoid colon.
What is the most appropriate course of management for this patient?Your Answer:
Correct Answer: Encourage high-fibre diet
Explanation:The development of intestinal diverticula is strongly linked to a low fibre diet, making it a major risk factor. To manage mild symptoms, patients are advised to modify their diet by gradually increasing fibre intake over several weeks and staying hydrated.
IV antibiotics and fluids are not necessary for diverticular disease, as it is not the same as diverticulitis.
Surgery is not recommended for uncomplicated diverticular disease.
While encouraging smoking cessation is important, dietary modification is the most suitable option for this patient.
Diverticulosis is a common condition where multiple outpouchings occur in the bowel wall, typically in the sigmoid colon. It is more accurate to use the term diverticulosis when referring to the presence of diverticula, while diverticular disease is reserved for symptomatic patients. Risk factors for this condition include a low-fibre diet and increasing age. Symptoms of diverticulosis can include altered bowel habits and colicky left-sided abdominal pain. A high-fibre diet is often recommended to alleviate these symptoms.
Diverticulitis is a complication of diverticulosis where one of the diverticula becomes infected. The typical presentation includes left iliac fossa pain and tenderness, anorexia, nausea, vomiting, diarrhea, and signs of infection such as pyrexia, raised WBC, and CRP. Mild attacks can be treated with oral antibiotics, while more severe episodes require hospitalization. Treatment involves nil by mouth, intravenous fluids, and intravenous antibiotics such as a cephalosporin and metronidazole. Complications of diverticulitis include abscess formation, peritonitis, obstruction, and perforation.
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This question is part of the following fields:
- Gastrointestinal System
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Question 24
Incorrect
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A 46-year-old male visits a tuberculosis clinic to discuss his medication as his disease has become resistant to one of the drugs he is taking. The doctor explains that the drug is metabolized differently in each person and it is possible that the patient metabolizes the drug too quickly, leading to its rapid clearance from his system. The drug in question is metabolized by N-acetyltransferase, an enzyme in the liver, and has three distinct phenotypes that determine the rate of clearance and clinical response. What is the name of the drug that the patient has developed resistance to?
Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid’s metabolism in the liver is influenced by acetylator status. Fast acetylators may develop resistance due to rapid clearance, while slow acetylators are at higher risk of hepatotoxicity due to delayed clearance. Ethambutol is metabolized through oxidation, pyrazinamide through oxidation in the liver, and rifampicin is activated through deacetylation in the liver before being excreted in bile and urine.
Understanding Drug Metabolism: Phase I and Phase II Reactions
Drug metabolism involves two types of biochemical reactions, namely phase I and phase II reactions. Phase I reactions include oxidation, reduction, and hydrolysis, which are mainly performed by P450 enzymes. However, some drugs are metabolized by specific enzymes such as alcohol dehydrogenase and xanthine oxidase. The products of phase I reactions are typically more active and potentially toxic. On the other hand, phase II reactions involve conjugation, where glucuronyl, acetyl, methyl, sulphate, and other groups are typically involved. The products of phase II reactions are typically inactive and excreted in urine or bile. The majority of phase I and phase II reactions take place in the liver.
First-Pass Metabolism and Drugs Affected by Zero-Order Kinetics and Acetylator Status
First-pass metabolism is a phenomenon where the concentration of a drug is greatly reduced before it reaches the systemic circulation due to hepatic metabolism. This effect is seen in many drugs, including aspirin, isosorbide dinitrate, glyceryl trinitrate, lignocaine, propranolol, verapamil, isoprenaline, testosterone, and hydrocortisone.
Zero-order kinetics describe metabolism that is independent of the concentration of the reactant. This is due to metabolic pathways becoming saturated, resulting in a constant amount of drug being eliminated per unit time. Drugs exhibiting zero-order kinetics include phenytoin, salicylates (e.g. high-dose aspirin), heparin, and ethanol.
Acetylator status is also an important consideration in drug metabolism. Approximately 50% of the UK population are deficient in hepatic N-acetyltransferase. Drugs affected by acetylator status include isoniazid, procainamide, hydralazine, dapsone, and sulfasalazine. Understanding these concepts is important in predicting drug efficacy and toxicity, as well as in optimizing drug dosing.
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This question is part of the following fields:
- General Principles
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Question 25
Incorrect
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An emergency medicine doctor has been called to verify the death of an 86-year-old male patient. After washing his hands, he carefully observes the patient for signs of pallor, rigour mortis, and lividity. He proceeds to palpate the carotid arteries and applies painful stimulus to the sternum around the sternal angle. The doctor completes his examination by auscultating the chest for 1 minute and notes the vertebral landmark that corresponds to the sternal angle as the site of painful stimulus application.
Can you correctly identify the location of the sternal angle based on the doctor's examination findings?Your Answer:
Correct Answer: Lower border of the T4 vertebrae
Explanation:The correct location of the sternal angle, also known as the angle of Louis, is at the lower border of the T4 vertebrae. While some sources may state that it lies between the 4th and 5th intercostal space, this still does not make the third answer correct as the sternal angle would then be located between the lower border of the 4th vertebrae and the upper border of the 5th vertebrae, which are the boundaries of the intercostal space between the two vertebral planes.
The sternal angle is a significant anatomical landmark located at the level of the upper sternum and manubrium. It is characterized by several structures, including the upper part of the manubrium, left brachiocephalic vein, brachiocephalic artery, left common carotid, left subclavian artery, lower part of the manubrium, and costal cartilages of the 2nd ribs. Additionally, the sternal angle marks the transition point between the superior and inferior mediastinum, and is also associated with the arch of the aorta, tracheal bifurcation, union of the azygos vein and superior vena cava, and the crossing of the thoracic duct to the midline. Overall, the sternal angle is a crucial anatomical structure that serves as a reference point for various medical procedures and diagnoses.
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This question is part of the following fields:
- Musculoskeletal System And Skin
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Question 26
Incorrect
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A 70-year-old male complains of increasing pain and swelling in his left knee over the past three days. He has a medical history of hypertension and takes bendroflumethiazide and lisinopril. Upon examination, his left knee is swollen, red, and tender, and he experiences limited mobility due to the pain. What is the most suitable test to perform for this patient?
Your Answer:
Correct Answer: Joint aspiration
Explanation:Differential Diagnosis of Monoarthropathy
Monoarthropathy can have various causes, and one of the possibilities is septic arthritis. To rule out this condition, joint aspiration is necessary, and the sample should be sent for microscopy and culture to detect the presence of crystals and organisms. Polymorphs and organisms are expected in septic arthritis, while negatively birefringent crystals are typical for gout, and positively birefringent crystals are seen in pseudogout. FBC and ESR are not useful for diagnosis, and although an x-ray may show osteoarthritis changes, it is not the primary investigation.
Bendroflumethiazide can increase urate levels and trigger acute gout, but urate concentrations may remain normal during an acute gout attack. Therefore, it is essential to consider all possible causes of monoarthropathy and perform the appropriate tests to make an accurate diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 27
Incorrect
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A 2-year-old girl is brought to the emergency department by her father, who reports that she has been unwell for a few weeks, refusing food and crying excessively. He mentions that she has lost weight and appears much paler than usual. Upon examination, a large mass is detected in the abdomen, crossing the midline.
A CT scan of the abdomen is scheduled after a urinalysis reveals elevated levels of homovanillic acid and vanillylmandelic acid. Based on the probable diagnosis, what is a common association?Your Answer:
Correct Answer: N-MYC proto-oncogene
Explanation:Neuroblastoma is a malignant tumor that arises from sympathetic nervous tissue, with the adrenal glands being the most common primary site. It typically affects children under the age of 2 and can grow and spread rapidly, causing symptoms such as faltering growth, nausea and vomiting, and a palpable abdominal mass that often crosses the midline. Urinalysis can detect catecholamine derivatives, which can aid in diagnosis, and imaging is necessary to identify the site of origin.
Treatment depends on the tumor’s risk stratification, which is determined by staging and N-MYC status. Mutations in the N-MYC proto-oncogene are associated with a worse prognosis. APC gene mutations, which cause familial adenomatous polyposis and increase the risk of bowel cancer, are not linked to neuroblastoma. Similarly, the BRCA gene, which is implicated in breast and ovarian cancers, is not associated with neuroblastoma. Elevated calcitonin levels may indicate medullary thyroid cancer but are not associated with neuroblastoma. Elevated Ca-19-9 levels are seen in pancreatic or cholangiocarcinoma and are not associated with neuroblastoma.
Oncogenes are genes that promote cancer and are derived from normal genes called proto-oncogenes. Proto-oncogenes play a crucial role in cellular growth and differentiation. However, a gain of function in oncogenes increases the risk of cancer. Only one mutated copy of the gene is needed for cancer to occur, making it a dominant effect. Oncogenes are responsible for up to 20% of human cancers and can become oncogenes through mutation, chromosomal translocation, or increased protein expression.
In contrast, tumor suppressor genes restrict or repress cellular proliferation in normal cells. Their inactivation through mutation or germ line incorporation is implicated in various cancers, including renal, colonic, breast, and bladder cancer. Tumor suppressor genes, such as p53, offer protection by causing apoptosis of damaged cells. Other well-known genes include BRCA1 and BRCA2. Loss of function in tumor suppressor genes results in an increased risk of cancer, while gain of function in oncogenes increases the risk of cancer.
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This question is part of the following fields:
- General Principles
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Question 28
Incorrect
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Where is troponin T located within the body?
Your Answer:
Correct Answer: Heart
Explanation:Troponin and Its Significance in Cardiac Health
Troponin is an enzyme that is specific to the heart and is used to detect injury to the heart muscle. It is commonly measured in patients who present with chest pain that may be related to heart problems. Elevated levels of troponin can indicate a heart attack or other acute coronary syndromes. However, it is important to note that troponin levels may also be slightly elevated in other conditions such as renal failure, cardiomyopathy, myocarditis, and large pulmonary embolism.
Troponin is a crucial marker in the diagnosis and management of cardiac conditions. It is a reliable indicator of heart muscle damage and can help healthcare professionals determine the best course of treatment for their patients. Additionally, troponin levels can provide prognostic information, allowing doctors to predict the likelihood of future cardiac events. It is important for individuals to understand the significance of troponin in their cardiac health and to seek medical attention if they experience any symptoms of heart problems.
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This question is part of the following fields:
- Cardiovascular System
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Question 29
Incorrect
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A couple attends a GP appointment following the birth of their second child. Their daughter is currently 8-months-old and has been seen in the paediatric team due to a possible diagnosis of Tay-Sachs disease. This diagnosis has recently been confirmed by genetic testing and the couple are keen to discuss how this diagnosis may affect future pregnancies.
Neither parent is known to be affected by this disease, so they are referred for genetic counselling.
What statement is true regarding the genetic inheritance of this disease?Your Answer:
Correct Answer: The probability that any future child will be affected is 25%
Explanation:Both parents must be carriers for an autosomal recessive condition to occur in their child, resulting in a 100% probability that both the mother and father are carriers.
Understanding Autosomal Recessive Inheritance
Autosomal recessive inheritance is a genetic pattern where a disorder is only expressed when an individual inherits two copies of a mutated gene, one from each parent. This means that only homozygotes, individuals with two copies of the mutated gene, are affected. Both males and females are equally likely to be affected, and the disorder may not manifest in every generation, as it can skip a generation.
When two heterozygote parents, carriers of the mutated gene, have children, there is a 25% chance of having an affected (homozygote) child, a 50% chance of having a carrier (heterozygote) child, and a 25% chance of having an unaffected child. On the other hand, if one parent is homozygote for the gene and the other is unaffected, all the children will be carriers.
Autosomal recessive disorders are often metabolic in nature and are generally more life-threatening compared to autosomal dominant conditions. It is important to understand the inheritance pattern of genetic disorders to provide appropriate genetic counseling and medical management.
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This question is part of the following fields:
- General Principles
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Question 30
Incorrect
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A 10-year-old girl has been diagnosed with asthma. Her father asks you about the cause of her symptoms. What is the best response?
Inflammation of the lining of the bronchioles causes obstruction of the flow of air out from the lungs. This inflammation is reversible so symptoms of asthma may be intermittent. There may also be increased mucus production and bronchial muscle constriction.Your Answer:
Correct Answer: Reversible inflammation of the lining of the small airways causing them to become narrower
Explanation:The bronchioles’ lining inflammation obstructs the outflow of air from the lungs, leading to asthma symptoms that may come and go. Additionally, there could be heightened mucus production and constriction of bronchial muscles.
Asthma is a common respiratory disorder that affects both children and adults. It is characterized by chronic inflammation of the airways, resulting in reversible bronchospasm and airway obstruction. While asthma can develop at any age, it typically presents in childhood and may improve or resolve with age. However, it can also persist into adulthood and cause significant morbidity, with around 1,000 deaths per year in the UK.
Several risk factors can increase the likelihood of developing asthma, including a personal or family history of atopy, antenatal factors such as maternal smoking or viral infections, low birth weight, not being breastfed, exposure to allergens and air pollution, and the hygiene hypothesis. Patients with asthma may also suffer from other atopic conditions such as eczema and hay fever, and some may be sensitive to aspirin. Occupational asthma is also a concern for those exposed to allergens in the workplace.
Symptoms of asthma include coughing, dyspnea, wheezing, and chest tightness, with coughing often worse at night. Signs may include expiratory wheezing on auscultation and reduced peak expiratory flow rate. Diagnosis is typically made through spirometry, which measures the volume and speed of air during exhalation and inhalation.
Management of asthma typically involves the use of inhalers to deliver drug therapy directly to the airways. Short-acting beta-agonists such as salbutamol are the first-line treatment for relieving symptoms, while inhaled corticosteroids like beclometasone dipropionate and fluticasone propionate are used for daily maintenance therapy. Long-acting beta-agonists like salmeterol and leukotriene receptor antagonists like montelukast may also be used in combination with other medications. Maintenance and reliever therapy (MART) is a newer approach that combines ICS and a fast-acting LABA in a single inhaler for both daily maintenance and symptom relief. Recent guidelines recommend offering a leukotriene receptor antagonist instead of a LABA for patients on SABA + ICS whose asthma is not well controlled, and considering MART for those with poorly controlled asthma.
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This question is part of the following fields:
- Respiratory System
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