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  • Question 1 - Which one of the following is not a content of the posterior triangle...

    Correct

    • Which one of the following is not a content of the posterior triangle of the neck?

      Your Answer: Phrenic nerve

      Explanation:

      The contents of the posterior triangle include the phrenic nerve, while the carotid sheath and its contents are found in the anterior triangle.

      The Anterior Triangle of the Neck: Boundaries and Contents

      The anterior triangle of the neck is a region that is bounded by the anterior border of the sternocleidomastoid muscle, the lower border of the mandible, and the anterior midline. It is further divided into three sub-triangles by the digastric muscle and the omohyoid muscle. The muscular triangle contains the neck strap muscles, while the carotid triangle contains the carotid sheath, which houses the common carotid artery, the vagus nerve, and the internal jugular vein. The submandibular triangle, located below the digastric muscle, contains the submandibular gland, submandibular nodes, facial vessels, hypoglossal nerve, and other structures.

      The digastric muscle, which separates the submandibular triangle from the muscular triangle, is innervated by two different nerves. The anterior belly of the digastric muscle is supplied by the mylohyoid nerve, while the posterior belly is supplied by the facial nerve.

      Overall, the anterior triangle of the neck is an important anatomical region that contains many vital structures, including blood vessels, nerves, and glands. Understanding the boundaries and contents of this region is essential for medical professionals who work in this area.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      18.6
      Seconds
  • Question 2 - A 58-year-old female patient with chronic rheumatoid arthritis visits her GP complaining of...

    Correct

    • A 58-year-old female patient with chronic rheumatoid arthritis visits her GP complaining of symptoms related to keratoconjunctivitis sicca. What is a straightforward test that can be performed to confirm this diagnosis?

      Your Answer: Schirmer's test

      Explanation:

      Secondary Sjögren’s Syndrome in Rheumatological Patients

      It is not uncommon for patients with rheumatological disease to develop secondary Sjögren’s syndrome, which is also known as keratoconjunctivitis sicca. This condition is characterized by a reduction in secretions, particularly in the salivary and lacrimal glands. One of the diagnostic tests used to identify this condition is the Schirmer’s test. This test is a simple procedure that measures the production of tears in the eyes. During the test, a strip of paper is placed under the eyelid of the patient, and after five minutes, the amount of moistness on the paper is measured. If the moistness is less than 5 mm, it is suggestive of Sjögren’s syndrome.

      Overall, secondary Sjögren’s syndrome is a common condition that can occur in patients with rheumatological disease. The Schirmer’s test is a simple and effective way to diagnose this condition, and it can help healthcare professionals provide appropriate treatment to patients.

    • This question is part of the following fields:

      • Rheumatology
      24.1
      Seconds
  • Question 3 - A 45-year-old man with a history of Crohn's disease complains of fatigue and...

    Correct

    • A 45-year-old man with a history of Crohn's disease complains of fatigue and a burning sensation in his mouth. His blood work shows:

      Hb 11.2 g/dl
      MCV 110 fl
      Plt 190 * 10^9/l
      WBC 6.2 * 10^9/l

      What could be the possible reason for these symptoms and abnormal blood results?

      Your Answer: Vitamin B12 deficiency

      Explanation:

      If a patient has a history of gastrectomy and is experiencing macrocytic anaemia, it is likely that they are suffering from B12 deficiency.

      Vitamin B12 is essential for the development of red blood cells and the maintenance of the nervous system. It is absorbed through the binding of intrinsic factor, which is secreted by parietal cells in the stomach, and actively absorbed in the terminal ileum. A deficiency in vitamin B12 can be caused by pernicious anaemia, post gastrectomy, a vegan or poor diet, disorders or surgery of the terminal ileum, Crohn’s disease, or metformin use.

      Symptoms of vitamin B12 deficiency include macrocytic anaemia, a sore tongue and mouth, neurological symptoms, and neuropsychiatric symptoms such as mood disturbances. The dorsal column is usually affected first, leading to joint position and vibration issues before distal paraesthesia.

      Management of vitamin B12 deficiency involves administering 1 mg of IM hydroxocobalamin three times a week for two weeks, followed by once every three months if there is no neurological involvement. If a patient is also deficient in folic acid, it is important to treat the B12 deficiency first to avoid subacute combined degeneration of the cord.

    • This question is part of the following fields:

      • Haematology And Oncology
      51.6
      Seconds
  • Question 4 - Which of the following anatomical planes separates the prostate from the rectum? ...

    Incorrect

    • Which of the following anatomical planes separates the prostate from the rectum?

      Your Answer: Levator ani muscle

      Correct Answer: Denonvilliers fascia

      Explanation:

      The rectum is separated from the prostate by the Denonvilliers fascia, while the sacrum is separated from the rectum by Waldeyer’s fascia.

      Anatomy of the Prostate Gland

      The prostate gland is a small, walnut-shaped gland located below the bladder and separated from the rectum by Denonvilliers fascia. It receives its blood supply from the internal iliac vessels, specifically the inferior vesical artery. The gland has an internal sphincter at its apex, which can be damaged during surgery and result in retrograde ejaculation.

      The prostate gland has four lobes: the posterior lobe, median lobe, and two lateral lobes. It also has an isthmus and three zones: the peripheral zone, central zone, and transition zone. The peripheral zone, which is the subcapsular portion of the posterior prostate, is where most prostate cancers occur.

      The gland is surrounded by various structures, including the pubic symphysis, prostatic venous plexus, Denonvilliers fascia, rectum, ejaculatory ducts, lateral venous plexus, and levator ani. Its lymphatic drainage is to the internal iliac nodes, and its innervation comes from the inferior hypogastric plexus.

      In summary, the prostate gland is a small but important gland in the male reproductive system. Its anatomy includes lobes, zones, and various surrounding structures, and it plays a crucial role in ejaculation and prostate health.

    • This question is part of the following fields:

      • Gastrointestinal System
      15.2
      Seconds
  • Question 5 - A 28-year-old woman, who is 10 weeks pregnant with twins, presents to the...

    Correct

    • A 28-year-old woman, who is 10 weeks pregnant with twins, presents to the emergency department with worsening nausea and vomiting over the last 3 weeks. This is her second pregnancy. Her first pregnancy had several complications, including hypertension of pregnancy and delivering a large for gestational age baby. What is a significant risk factor for developing HG based on this history?

      Your Answer: Multiple pregnancy

      Explanation:

      Hyperemesis gravidarum (HG) is a condition characterized by persistent vomiting, dehydration, weight loss, and electrolyte imbalance, often accompanied by ketosis. Women with multiple pregnancies are at an increased risk of developing HG due to the higher concentrations of pregnancy-related hormones.

      Other risk factors for HG include trophoblastic disease, molar pregnancy, and a history of previous hyperemesis. Hypertension of pregnancy typically occurs after 16 weeks and is not associated with an increased risk of HG.

      Large for gestational age is not a risk factor for HG as it is usually diagnosed later in pregnancy during growth scans. Multiparity alone is not a risk factor, but a history of previous hyperemesis or nausea and vomiting during pregnancy increases the risk.

      Hyperemesis gravidarum is a severe form of nausea and vomiting that affects around 1% of pregnancies. It is usually experienced between 8 and 12 weeks of pregnancy but can persist up to 20 weeks. The condition is thought to be related to raised beta hCG levels and is more common in women who are obese, nulliparous, or have multiple pregnancies, trophoblastic disease, or hyperthyroidism. Smoking is associated with a decreased incidence of hyperemesis.

      The Royal College of Obstetricians and Gynaecologists recommend that a woman must have a 5% pre-pregnancy weight loss, dehydration, and electrolyte imbalance before a diagnosis of hyperemesis gravidarum can be made. Validated scoring systems such as the Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of NVP.

      Management of hyperemesis gravidarum involves using antihistamines as a first-line treatment, with oral cyclizine or oral promethazine being recommended by Clinical Knowledge Summaries. Oral prochlorperazine is an alternative, while ondansetron and metoclopramide may be used as second-line treatments. Ginger and P6 (wrist) acupressure can be tried, but there is little evidence of benefit. Admission may be needed for IV hydration.

      Complications of hyperemesis gravidarum can include Wernicke’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, acute tubular necrosis, and fetal growth restriction, pre-term birth, and cleft lip/palate (if ondansetron is used during the first trimester). The NICE Clinical Knowledge Summaries recommend considering admission if a woman is unable to keep down liquids or oral antiemetics, has ketonuria and/or weight loss (greater than 5% of body weight), or has a confirmed or suspected comorbidity that may be adversely affected by nausea and vomiting.

    • This question is part of the following fields:

      • Reproductive System
      94.5
      Seconds
  • Question 6 - What is the most effective test for differentiating between an upper and lower...

    Correct

    • What is the most effective test for differentiating between an upper and lower motor neuron lesion of the facial nerve in clinical practice, particularly in older patients?

      Your Answer: Raise eyebrow

      Explanation:

      Facial nerve upper motor neuron lesions result in paralysis of the lower half of the face, while lower motor neuron lesions cause paralysis of the entire face on the same side.

      The facial nerve has a nucleus located in the ventrolateral pontine tegmentum, and its axons exit the ventral pons medial to the spinal trigeminal nucleus. Lesions affecting the corticobulbar tract are known as upper motor neuron lesions, while those affecting the individual branches of the facial nerve are lower motor neuron lesions. The lower motor neurons of the facial nerve can leave from either the left or right posterior or anterior facial motor nucleus, with the temporal branch receiving input from both hemispheres of the cerebral cortex, while the zygomatic, buccal, mandibular, and cervical branches receive input from only the contralateral hemisphere.

      In the case of an upper motor neuron lesion in the left hemisphere, the right mid- and lower-face would be paralyzed, while the forehead would remain unaffected. This is because the anterior facial motor nucleus receives only contralateral cortical input, while the posterior component receives input from both hemispheres. However, a lower motor neuron lesion affecting either the left or right side would paralyze the entire side of the face, as both the anterior and posterior routes on that side would be affected. This is because the nerves no longer have a means to receive compensatory contralateral input at a downstream decussation.

    • This question is part of the following fields:

      • Neurological System
      9
      Seconds
  • Question 7 - As a third year medical student in an outpatient department with a dermatology...

    Incorrect

    • As a third year medical student in an outpatient department with a dermatology consultant, you are evaluating a 27-year-old patient who is unresponsive to current hyperhidrosis treatment. The consultant suggests starting botox injections to prevent sweating. Can you explain the mechanism of action of botulinum toxin at the neuromuscular junction?

      Your Answer: Blocks acetylcholine receptors on postsynaptic membrane

      Correct Answer: Inhibits vesicles containing acetylcholine binding to presynaptic membrane

      Explanation:

      Botulinum Toxin and its Mechanism of Action

      Botulinum toxin is becoming increasingly popular in the medical field for treating various conditions such as cervical dystonia and achalasia. The toxin works by binding to the presynaptic cleft on the neurotransmitter and forming a complex with the attached receptor. This complex then invaginates the plasma membrane of the presynaptic cleft around the attached toxin. Once inside the cell, the toxin cleaves an important cytoplasmic protein that is required for efficient binding of the vesicles containing acetylcholine to the presynaptic membrane. This prevents the release of acetylcholine across the neurotransmitter.

      It is important to note that the blockage of Ca2+ channels on the presynaptic membrane occurs in Lambert-Eaton syndrome, which is associated with small cell carcinoma of the lung and is a paraneoplastic syndrome. However, this is not related to the mechanism of action of botulinum toxin.

      The effects of botox typically last for two to six months. Once complete denervation has occurred, the synapse produces new axonal terminals which bind to the motor end plate in a process called neurofibrillary sprouting. This allows for interrupted release of acetylcholine. Overall, botulinum toxin is a powerful tool in the medical field for treating various conditions by preventing the release of acetylcholine across the neurotransmitter.

    • This question is part of the following fields:

      • Neurological System
      40.7
      Seconds
  • Question 8 - What function does high density lipoprotein (HDL) serve? ...

    Correct

    • What function does high density lipoprotein (HDL) serve?

      Your Answer: To move lipids from the arterial walls to the liver

      Explanation:

      The Role of HDL in Reverse Cholesterol Transport

      HDL, also known as good cholesterol, is initially secreted by the liver into the bloodstream as immature or nascent HDL. This nascent HDL contains apoplipoprotein A-I, C, and E but has very little triglyceride or cholesterol ester content. However, upon secretion, it undergoes modification to form the mature form of HDL.

      The mature HDL particle plays a crucial role in reverse cholesterol transport. It receives triglycerides and cholesterol esters from VLDL and IDL particles and picks up excess cholesterol from body cells. As it does so, it loses apoC and E to form the mature HDL particle, which contains only apoA-I.

      The primary function of HDL is to remove excess triglycerides from arterial walls and body cells via VLDL and IDL and to return the excess lipid to the liver for repackaging or excretion in bile. This process is known as reverse cholesterol transport and is essential in maintaining healthy cholesterol levels in the body.

    • This question is part of the following fields:

      • Clinical Sciences
      59.1
      Seconds
  • Question 9 - A 23-year-old man visits a GUM clinic due to painful swelling of lymph...

    Incorrect

    • A 23-year-old man visits a GUM clinic due to painful swelling of lymph nodes in his groin. He has no medical history and is not taking any medications. He admits to having unprotected sex with a casual partner. The diagnosis is LGV. What is the probable pathogen responsible for this condition?

      Your Answer: Chlamydia trachomatis serovars D-K

      Correct Answer: Chlamydia trachomatis serovars L1-3

      Explanation:

      Lymphogranuloma venereum is caused by Chlamydia trachomatis serovars L1, L2 and L3. It presents with three stages, starting with a painless pustule and progressing to painful inguinal lymphadenopathy, and later, proctocolitis may develop. The causative organism is not Chlamydia trachomatis serovars D-K, Treponema pallidum, or Herpes simplex virus.

      Understanding Lymphogranuloma Venereum

      Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis serovars L1, L2, and L3. This infection is commonly found in men who have sex with men and those who have HIV. While historically it was more prevalent in tropical regions, it is now seen in developed countries as well.

      The infection typically progresses through three stages. The first stage involves a small, painless pustule that later forms an ulcer. In the second stage, painful inguinal lymphadenopathy occurs, which may occasionally form fistulating buboes. The third stage involves proctocolitis.

      LGV is treated using doxycycline.

    • This question is part of the following fields:

      • General Principles
      58.2
      Seconds
  • Question 10 - A 32-year-old woman injures her sympathetic trunk and experiences Horner's syndrome. When sympathetic...

    Incorrect

    • A 32-year-old woman injures her sympathetic trunk and experiences Horner's syndrome. When sympathetic pathways are damaged, Horner's syndrome can occur. Which receptors are associated with her symptoms?

      Your Answer: Muscarinic acetylcholine receptors from the vagus nerve to the heart

      Correct Answer: Muscarinic acetylcholine receptors of sudomotor neurons to the sweat gland

      Explanation:

      Acetylcholine is exclusively present in the postganglionic sympathetic fibers that lead to sweat glands.

      Although muscarinic receptors can be activated by the vagus nerve to the heart, this is a component of the parasympathetic nervous system.

      Muscarinic acetylcholine receptors in the salivary glands and the eye are both instances of muscarinic acetylcholine receptors in the parasympathetic nervous system.

      The neuromuscular junction employs nicotinic acetylcholine receptors, but this is not a part of the sympathetic nervous system.

      Acetylcholine (ACh) is a crucial neurotransmitter in the somatic nervous system and plays a significant role in the autonomic nervous system. It is the primary neurotransmitter in all pre- and postganglionic parasympathetic neurons, all preganglionic sympathetic neurons, and postganglionic sympathetic fibers, including sudomotor neurons that regulate sweat glands. Acetylcholinesterase is an enzyme that breaks down acetylcholine. In conditions such as myasthenia gravis, where there is a deficiency of functioning acetylcholine receptors, acetylcholinesterase inhibitors are used.

      In the central nervous system, acetylcholine is synthesized in the basal nucleus of Meynert. Alzheimer’s disease is associated with decreased levels of acetylcholine in the basal nucleus of Meynert. Therefore, acetylcholine plays a crucial role in the functioning of the nervous system, and its deficiency can lead to various neurological disorders.

    • This question is part of the following fields:

      • General Principles
      39.5
      Seconds
  • Question 11 - How many fissures can be found in the right lung?

    At what age...

    Incorrect

    • How many fissures can be found in the right lung?

      At what age do these fissures typically develop?

      Your Answer: Three

      Correct Answer: Two

      Explanation:

      The oblique and horizontal fissures are present in the right lung. The lower lobe is separated from the middle and upper lobes by the upper oblique fissure. The superior and middle lobes are separated by the short horizontal fissure.

      Anatomy of the Lungs

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

    • This question is part of the following fields:

      • Respiratory System
      16.7
      Seconds
  • Question 12 - A 68-year-old male visits his doctor complaining of weight loss and difficulty breathing...

    Incorrect

    • A 68-year-old male visits his doctor complaining of weight loss and difficulty breathing for the past 8 months. Upon physical examination, no abnormalities are found, but the doctor orders a chest x-ray.

      The radiograph reveals: 'Central trachea. Bilateral hilar lymph nodes are visible, along with a lesion in the left middle zone. The mass measures approximately 5cm in diameter and has a center of caseation. No other clinical findings are present.'

      What is the probable diagnosis for this patient?

      Your Answer: Renal cell carcinoma lung metastases

      Correct Answer: Tuberculosis

      Explanation:

      The presence of caseating granulomatous inflammation in the lungs is a clear indication of tuberculosis (TB). If a radiograph shows a caseating lesion in the middle zone, it should raise suspicion of TB. It is important to note that mesothelioma, Pancoast tumors, and renal cell carcinoma lung metastases have their own distinct radiographic features and are not associated with caseating granulomas. Sarcoidosis, on the other hand, is a condition characterized by non-caseating granulomas and is not related to TB.

      Types of Tuberculosis

      Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis that primarily affects the lungs. There are two types of TB: primary and secondary. Primary TB occurs when a non-immune host is exposed to the bacteria and develops a small lung lesion called a Ghon focus. This focus is made up of macrophages containing tubercles and is accompanied by hilar lymph nodes, forming a Ghon complex. In immunocompetent individuals, the lesion usually heals through fibrosis. However, those who are immunocompromised may develop disseminated disease, also known as miliary tuberculosis.

      Secondary TB, also called post-primary TB, occurs when the initial infection becomes reactivated in an immunocompromised host. Reactivation typically occurs in the apex of the lungs and can spread locally or to other parts of the body. Factors that can cause immunocompromise include immunosuppressive drugs, HIV, and malnutrition. While the lungs are still the most common site for secondary TB, it can also affect other areas such as the central nervous system, vertebral bodies, cervical lymph nodes, renal system, and gastrointestinal tract. Tuberculous meningitis is the most serious complication of extra-pulmonary TB. Understanding the differences between primary and secondary TB is crucial in diagnosing and treating the disease.

    • This question is part of the following fields:

      • General Principles
      84.3
      Seconds
  • Question 13 - A 54-year-old man visits his GP for a routine check-up and physical examination....

    Incorrect

    • A 54-year-old man visits his GP for a routine check-up and physical examination. He has a medical history of hypertension and asthma but currently has no immediate concerns. He reports feeling healthy.

      During the examination, the man appears to be in good health, with normal vital signs except for a high blood pressure reading of 160/90 mmHg. While listening to his heart, the GP detects an S4 heart sound and orders an ECG.

      Which segment of the ECG corresponds to the S4 heart sound?

      Your Answer: ST segment

      Correct Answer: P wave

      Explanation:

      The S4 heart sound coincides with the P wave on an ECG. This is because the S4 sound is caused by the contraction of the atria against a stiff ventricle, which occurs just before the S1 sound. It is commonly heard in conditions such as aortic stenosis, hypertrophic cardiomyopathy, or hypertension. As the P wave represents atrial depolarization, it is the ECG wave that coincides with the S4 heart sound.

      It is important to note that the QRS complex, which represents ventricular depolarization, is not associated with the S4 heart sound. Similarly, the ST segment, which is the interval between ventricular depolarization and repolarization, and T waves, which indicate ventricular repolarization, are not linked to the S4 heart sound.

      Heart sounds are the sounds produced by the heart during its normal functioning. The first heart sound (S1) is caused by the closure of the mitral and tricuspid valves, while the second heart sound (S2) is due to the closure of the aortic and pulmonary valves. The intensity of these sounds can vary depending on the condition of the valves and the heart. The third heart sound (S3) is caused by the diastolic filling of the ventricle and is considered normal in young individuals. However, it may indicate left ventricular failure, constrictive pericarditis, or mitral regurgitation in older individuals. The fourth heart sound (S4) may be heard in conditions such as aortic stenosis, HOCM, and hypertension, and is caused by atrial contraction against a stiff ventricle. The different valves can be best heard at specific sites on the chest wall, such as the left second intercostal space for the pulmonary valve and the right second intercostal space for the aortic valve.

    • This question is part of the following fields:

      • Cardiovascular System
      28.2
      Seconds
  • Question 14 - A 50-year-old woman comes to the Emergency Department with facial drooping and slurred...

    Incorrect

    • A 50-year-old woman comes to the Emergency Department with facial drooping and slurred speech. You perform a cranial nerves examination and find that her oculomotor nerve has been affected. What sign would you anticipate observing in this patient?

      Your Answer: Bitemporal hemianopia

      Correct Answer: Ptosis

      Explanation:

      The correct answer is ptosis. Issues with the oculomotor nerve can cause ptosis, a drooping of the eyelid, as well as a dilated, fixed pupil and a down and out eye. The oculomotor nerve is responsible for various functions, including eye movements (such as those controlled by the MR, IO, SR, and IR muscles), pupil constriction, accommodation, and eyelid opening. Arcuate scotoma is an incorrect answer. This condition is caused by damage to the optic nerve, resulting in a blind spot that appears as an arc shape in the visual field. It does not affect extraocular movements. Bitemporal hemianopia is also an incorrect answer. This visual field defect affects the outer halves of both eyes and is caused by lesions of the optic chiasm, such as those resulting from a pituitary adenoma. Horizontal diplopia is another incorrect answer. This condition is caused by problems with the abducens nerve, which controls the lateral rectus muscle responsible for eye abduction. Defective abduction leads to horizontal diplopia, or double vision.

      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
      16.7
      Seconds
  • Question 15 - 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
      99.6
      Seconds
  • Question 16 - A 50-year-old man visits his GP complaining of haematuria. He has experienced two...

    Incorrect

    • A 50-year-old man visits his GP complaining of haematuria. He has experienced two episodes of haematuria in the past week and has not experienced any abdominal pain or fevers. He is asymptomatic, but did have a cough and runny nose that resolved about a week ago. Upon examination, nothing unusual is found.

      The GP refers the patient to a nephrologist and performs an ultrasound and cystoscopy, both of which come back negative. However, the patient continues to experience microscopic haematuria, prompting the decision to perform a renal biopsy. The biopsy results reveal mesangial hypercellularity.

      What is the most likely diagnosis?

      Your Answer: Lupus nephritis

      Correct Answer: IgA nephropathy

      Explanation:

      The patient’s symptoms and renal biopsy findings are consistent with IgA nephropathy, which is characterized by mesangial hypercellularity and positive immunofluorescence for IgA and C3. The patient experienced episodes of macroscopic hematuria with ongoing microscopic hematuria, which were preceded by recent infection within 1-2 days. In contrast, acute proliferative glomerulonephritis typically presents with hematuria weeks after an upper respiratory or cutaneous infection with Streptococcus pyogenes, and histology shows enlarged glomeruli and the presence of IgG and IgM on immunofluorescence. Alport syndrome, a genetic disorder that causes hematuria, is characterized by frank hematuria from early adolescence, and kidney biopsy findings are usually non-specific. Henoch-Schonlein purpura, also known as IgA vasculitis, can present with hematuria following infection and can be similar to IgA nephropathy on kidney biopsy, but it also involves palpable purpura, abdominal pain, and arthritis. Lupus nephritis, which is glomerulonephritis secondary to systemic lupus erythematosus, is unlikely in the absence of other symptoms or signs of systemic lupus erythematosus.

      Understanding IgA Nephropathy

      IgA nephropathy, also known as Berger’s disease, is the most common cause of glomerulonephritis worldwide. It typically presents as macroscopic haematuria in young people following an upper respiratory tract infection. The condition is thought to be caused by mesangial deposition of IgA immune complexes, and there is considerable pathological overlap with Henoch-Schonlein purpura (HSP). Histology shows mesangial hypercellularity and positive immunofluorescence for IgA and C3.

      Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis is important. Post-streptococcal glomerulonephritis is associated with low complement levels and the main symptom is proteinuria, although haematuria can occur. There is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis.

      Management of IgA nephropathy depends on the severity of the condition. If there is isolated hematuria, no or minimal proteinuria, and a normal glomerular filtration rate (GFR), no treatment is needed other than follow-up to check renal function. If there is persistent proteinuria and a normal or only slightly reduced GFR, initial treatment is with ACE inhibitors. If there is active disease or failure to respond to ACE inhibitors, immunosuppression with corticosteroids may be necessary.

      The prognosis for IgA nephropathy varies. 25% of patients develop ESRF. Markers of good prognosis include frank haematuria, while markers of poor prognosis include male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, and ACE genotype DD.

      Overall, understanding IgA nephropathy is important for proper diagnosis and management of the condition. Proper management can help improve outcomes and prevent progression to ESRF.

    • This question is part of the following fields:

      • Renal System
      77.7
      Seconds
  • Question 17 - A 59-year-old woman visits the respiratory clinic for spirometry testing. As part of...

    Correct

    • A 59-year-old woman visits the respiratory clinic for spirometry testing. As part of the testing, what is the definition of functional residual capacity?

      Your Answer: Functional residual capacity = expiratory reserve volume + residual volume

      Explanation:

      To calculate the volume of air in the lungs after a normal relaxed expiration, one can use the formula for functional residual capacity (FRC), which is determined by the balance between the lungs’ tendency to recoil inwards and the chest wall’s tendency to pull outwards. FRC can be calculated by adding the expiratory reserve volume and the residual volume. In individuals with tetraplegia, decreases in FRC are primarily caused by a reduction in the outward pull of the chest wall, which occurs over time due to the inability to regularly expand the chest wall to large lung volumes. This reduction in FRC can increase the risk of atelectasis.

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      53
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  • Question 18 - A pharmaceutical company is conducting tests on a new insulin formulation. As part...

    Correct

    • A pharmaceutical company is conducting tests on a new insulin formulation. As part of their analysis, they have verified that tyrosine kinase receptors are activated by insulin. What is the impact of these receptors on the target molecules?

      Your Answer: Target molecule phosphorylation

      Explanation:

      Activation of tyrosine kinase receptors leads to the phosphorylation of target molecules, which can result in various effects such as cell growth and differentiation. Insulin is an example of a drug that acts through tyrosine kinase receptors. It is important to note that target molecule oxidation, lysis, and reduction are not processes typically associated with tyrosine kinase receptor activation.

      Pharmacodynamics refers to the effects of drugs on the body, as opposed to pharmacokinetics which is concerned with how the body processes drugs. Drugs typically interact with a target, which can be a protein located either inside or outside of cells. There are four main types of cellular targets: ion channels, G-protein coupled receptors, tyrosine kinase receptors, and nuclear receptors. The type of target determines the mechanism of action of the drug. For example, drugs that work on ion channels cause the channel to open or close, while drugs that activate tyrosine kinase receptors lead to cell growth and differentiation.

      It is also important to consider whether a drug has a positive or negative impact on the receptor. Agonists activate the receptor, while antagonists block the receptor preventing activation. Antagonists can be competitive or non-competitive, depending on whether they bind at the same site as the agonist or at a different site. The binding affinity of a drug refers to how readily it binds to a specific receptor, while efficacy measures how well an agonist produces a response once it has bound to the receptor. Potency is related to the concentration at which a drug is effective, while the therapeutic index is the ratio of the dose of a drug resulting in an undesired effect compared to that at which it produces the desired effect.

      The relationship between the dose of a drug and the response it produces is rarely linear. Many drugs saturate the available receptors, meaning that further increased doses will not cause any more response. Some drugs do not have a significant impact below a certain dose and are considered sub-therapeutic. Dose-response graphs can be used to illustrate the relationship between dose and response, allowing for easy comparison of different drugs. However, it is important to remember that dose-response varies between individuals.

    • This question is part of the following fields:

      • General Principles
      22.5
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  • Question 19 - A 65-year-old man visits the clinic with a complaint of experiencing blue vision....

    Correct

    • A 65-year-old man visits the clinic with a complaint of experiencing blue vision. He has started taking a high dose of Viagra to treat his erectile dysfunction, and you suspect that this medication may be the reason behind his visual changes. Which enzyme inhibition is primarily responsible for this side effect?

      Your Answer: PDE-6

      Explanation:

      The Role of Phosphodiesterase-6 in Vision and the Side Effects of Viagra

      Phosphodiesterase-6 plays a crucial role in the transmission of visual signals from rod cells in the retina to electrical signals in the brain. This enzyme is activated by changes in rhodopsin, which occur in response to exposure to light. However, high doses of Viagra, which is an inhibitor of PDE-5, can also inhibit PDE-6, leading to side effects such as blue vision. Patients may choose to reduce their dosage or tolerate these side effects in exchange for the improved sexual function that Viagra provides.

      Overall, the role of PDE-6 in vision and the potential side effects of Viagra is important for both medical professionals and patients. By weighing the benefits and risks of this medication, individuals can make informed decisions about their sexual health and overall well-being.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 20 - A 31-year-old male visits his doctor with complaints of feeling unwell for several...

    Incorrect

    • A 31-year-old male visits his doctor with complaints of feeling unwell for several months. He reports a weight loss of 9kg and chronic diarrhea. During a skin examination, the doctor observes purple skin lesions on the tip of his nose, inside his mouth, and bleeding around his gums. The doctor suspects Kaposi's sarcoma and wonders which Human Herpes Virus (HHV) is responsible for this condition?

      Your Answer: HHV-2

      Correct Answer: HHV-8

      Explanation:

      Kaposi’s sarcoma is a type of cancer that is caused by the human herpes virus 8 (HHV-8). It is characterized by the appearance of purple papules or plaques on the skin or mucosa, such as in the gastrointestinal and respiratory tract. These skin lesions may eventually ulcerate, while respiratory involvement can lead to massive haemoptysis and pleural effusion. Treatment options for Kaposi’s sarcoma include radiotherapy and resection. It is commonly seen in patients with HIV.

    • This question is part of the following fields:

      • General Principles
      440.1
      Seconds
  • Question 21 - A 48 month study compared two treatments for hypertension in patients over the...

    Incorrect

    • A 48 month study compared two treatments for hypertension in patients over the age of 60.
      The null hypothesis was that there was no difference between the two treatments.
      The primary outcome was reduction of systolic blood pressure below 140 mmHg. This outcome was reached in 75% of patients taking treatment A and 80% of patients taking treatment B. The results were reported as being significant with a p-value of 0.05.
      What is the correct interpretation of the P value?

      Your Answer: There is a 5% chance that regimen B is better than regimen A

      Correct Answer: There is a 5% probability of finding this result if there is no difference between the regimens

      Explanation:

      The Misunderstood P Value

      The P value is often misunderstood and over-interpreted. It is important to note that the P value only indicates the probability of obtaining the results by chance if there was no difference between the regimens being compared. It does not provide information on the actual difference between the regimens or the likelihood of one being better than the other. This confusion has led to the increased use of confidence intervals as a more informative measure.

      Goodman SN’s article Toward Evidence-Based Medical Statistics delves deeper into this issue and highlights the fallacy of relying solely on P values. It is crucial to understand the limitations of the P value and to use it in conjunction with other statistical measures to draw accurate conclusions. By doing so, we can ensure that our research is evidence-based and reliable.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 22 - Surgery can trigger a significant stress response in individuals, leading to the release...

    Correct

    • Surgery can trigger a significant stress response in individuals, leading to the release of high levels of adrenaline from the adrenal glands. This adrenaline has the potential to activate various adrenergic receptors, including the α1 receptor. What happens when this receptor is activated?

      Your Answer: Systemic vasoconstriction

      Explanation:

      Adrenergic receptors are a type of G protein-coupled receptors that respond to the catecholamines epinephrine and norepinephrine. These receptors are primarily involved in the sympathetic nervous system. There are four types of adrenergic receptors: α1, α2, β1, and β2. Each receptor has a different potency order and primary action. The α1 receptor responds equally to norepinephrine and epinephrine, causing smooth muscle contraction. The α2 receptor has mixed effects and responds equally to both catecholamines. The β1 receptor responds equally to epinephrine and norepinephrine, causing cardiac muscle contraction. The β2 receptor responds much more strongly to epinephrine than norepinephrine, causing smooth muscle relaxation.

    • This question is part of the following fields:

      • General Principles
      25.4
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  • Question 23 - Which one of the following would cause a rise in the carbon monoxide...

    Incorrect

    • Which one of the following would cause a rise in the carbon monoxide transfer factor (TLCO)?

      Your Answer: Pulmonary embolism

      Correct Answer: Pulmonary haemorrhage

      Explanation:

      When alveolar haemorrhage takes place, the TLCO typically rises as a result of the increased absorption of carbon monoxide by haemoglobin within the alveoli.

      Understanding Transfer Factor in Lung Function Testing

      The transfer factor is a measure of how quickly a gas diffuses from the alveoli into the bloodstream. This is typically tested using carbon monoxide, and the results can be given as either the total gas transfer (TLCO) or the transfer coefficient corrected for lung volume (KCO). A raised TLCO may be caused by conditions such as asthma, pulmonary haemorrhage, left-to-right cardiac shunts, polycythaemia, hyperkinetic states, male gender, or exercise. On the other hand, a lower TLCO may be indicative of pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary oedema, emphysema, anaemia, or low cardiac output.

      KCO tends to increase with age, and certain conditions may cause an increased KCO with a normal or reduced TLCO. These conditions include pneumonectomy/lobectomy, scoliosis/kyphosis, neuromuscular weakness, and ankylosis of costovertebral joints (such as in ankylosing spondylitis). Understanding transfer factor is important in lung function testing, as it can provide valuable information about a patient’s respiratory health and help guide treatment decisions.

    • This question is part of the following fields:

      • Respiratory System
      16.2
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  • Question 24 - A 55-year-old man comes to the clinic complaining of black tarry stools. Upon...

    Correct

    • A 55-year-old man comes to the clinic complaining of black tarry stools. Upon endoscopy, he is found to have a peptic ulcer. What is the primary risk factor for developing peptic ulcers?

      Your Answer: Helicobacter pylori colonisation of the stomach

      Explanation:

      Causes of Peptic Ulcers

      Peptic ulcers are a common condition that can cause discomfort and pain in the stomach. The most common cause of peptic ulcers is the presence of Helicobacter pylori bacteria in the stomach. This bacteria can cause inflammation and damage to the lining of the stomach, leading to the formation of ulcers. Another common cause of peptic ulcers is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs can suppress the production of prostaglandins in the stomach, which can lead to inflammation and damage to the stomach lining.

      In addition to these causes, smoking can also increase the risk of developing peptic ulcers. Smoking can suppress the production of prostaglandins in the stomach, impair mucosal blood flow, and increase gastric acid secretion. However, it is important to note that being female is not a risk factor for peptic ulcers. In fact, men are more likely to be affected by this condition. Overall, the causes of peptic ulcers can help individuals take steps to prevent and manage this condition.

    • This question is part of the following fields:

      • Clinical Sciences
      7.5
      Seconds
  • Question 25 - A 16-year-old girl arrives at the Emergency Department complaining of dizziness and pain...

    Correct

    • A 16-year-old girl arrives at the Emergency Department complaining of dizziness and pain in her right iliac fossa. She had taken a home pregnancy test the day before, which came back positive. After a diagnosis of ectopic pregnancy, the patient's condition worsens, and she undergoes an emergency salpingectomy. What is the most common site of fertilization in the excised structure?

      Your Answer: Ampulla

      Explanation:

      Fertilisation typically takes place in the ampulla of the fallopian tube. Salpingectomy involves removing the fallopian tube and is often performed in cases of a ruptured ectopic pregnancy. It is rare for fertilisation to occur in the uterus, which is not removed during salpingectomy. The infundibulum, located closest to the ovary, is the third most common site of fertilisation, while the isthmus, the narrowest part of the fallopian tube, is the second most common site. The myometrium refers to the muscular wall of the uterus.

      Anatomy of the Uterus

      The uterus is a female reproductive organ that is located within the pelvis and is covered by the peritoneum. It is supplied with blood by the uterine artery, which runs alongside the uterus and anastomoses with the ovarian artery. The uterus is supported by various ligaments, including the central perineal tendon, lateral cervical, round, and uterosacral ligaments. The ureter is located close to the uterus, and injuries to the ureter can occur when there is pathology in the area.

      The uterus is typically anteverted and anteflexed in most women. Its topography can be visualized through imaging techniques such as ultrasound or MRI. Understanding the anatomy of the uterus is important for diagnosing and treating various gynecological conditions.

    • This question is part of the following fields:

      • Reproductive System
      24.7
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  • Question 26 - A 76-year-old male is undergoing treatment for pancytopenia with an unknown cause. His...

    Incorrect

    • A 76-year-old male is undergoing treatment for pancytopenia with an unknown cause. His recent blood test revealed a decreased platelet count.

      What are the typical factors that stimulate the production of platelets?

      Your Answer: Interleukin-4

      Correct Answer: Thrombopoietin

      Explanation:

      Platelets, also known as thrombocytes, are derived from myeloid stem cells, similar to red blood cells. The process involves the development of a megakaryocyte from a common myeloid progenitor cell. Megakaryocytes are large cells with multilobulated nuclei that grow to become massive before breaking up to form platelets.

      The primary signal responsible for megakaryocyte and platelet production is thrombopoietin.

      Erythropoietin initiates the signal for red blood cell production, while granulocyte-colony stimulating factor stimulates the bone marrow to produce granulocytes. Interleukin-5 is a cytokine that stimulates the proliferation and activation of eosinophils.

      Haematopoiesis: The Generation of Immune Cells

      Haematopoiesis is the process by which immune cells are produced from haematopoietic stem cells in the bone marrow. These stem cells give rise to two main types of progenitor cells: myeloid and lymphoid progenitor cells. All immune cells are derived from these progenitor cells.

      The myeloid progenitor cells generate cells such as macrophages/monocytes, dendritic cells, neutrophils, eosinophils, basophils, and mast cells. On the other hand, lymphoid progenitor cells give rise to T cells, NK cells, B cells, and dendritic cells.

      This process is essential for the proper functioning of the immune system. Without haematopoiesis, the body would not be able to produce the necessary immune cells to fight off infections and diseases. Understanding haematopoiesis is crucial in developing treatments for diseases that affect the immune system.

    • This question is part of the following fields:

      • Haematology And Oncology
      13.3
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  • Question 27 - A 10-year-old boy comes to your clinic with a complaint of ear pain...

    Incorrect

    • A 10-year-old boy comes to your clinic with a complaint of ear pain that started last night and kept him awake. He missed school today because of the pain and reports muffled sounds on the affected side. During otoscopy, you observe a bulging tympanic membrane with visible fluid behind it, indicating a middle ear infection. Can you identify which nerves pass through the middle ear?

      Your Answer: Vestibulocochlear nerve

      Correct Answer: Chorda tympani

      Explanation:

      The chorda tympani is the correct answer. It is a branch of the seventh cranial nerve, the facial nerve, and carries parasympathetic and taste fibers. It passes through the middle ear before exiting and joining with the lingual nerve to reach the tongue and salivary glands.

      The vestibulocochlear nerve is the eighth cranial nerve and carries balance and hearing information.

      The maxillary nerve is the second division of the fifth cranial nerve and carries sensation from the upper teeth, nasal cavity, and skin.

      The mandibular nerve is the third division of the fifth cranial nerve and carries sensation from the lower teeth, tongue, mandible, and skin. It also carries motor fibers to certain muscles.

      The glossopharyngeal nerve is the ninth cranial nerve and carries taste and sensation from the posterior one-third of the tongue, as well as sensation from various areas. It also carries motor and parasympathetic fibers.

      The patient in the question has ear pain, likely due to otitis media, as evidenced by a bulging tympanic membrane and fluid level on otoscopy.

      Anatomy of the Ear

      The ear is divided into three distinct regions: the external ear, middle ear, and internal ear. The external ear consists of the auricle and external auditory meatus, which are innervated by the greater auricular nerve and auriculotemporal branch of the trigeminal nerve. The middle ear is the space between the tympanic membrane and cochlea, and is connected to the nasopharynx by the eustachian tube. The tympanic membrane is composed of three layers and is approximately 1 cm in diameter. The middle ear is innervated by the glossopharyngeal nerve. The ossicles, consisting of the malleus, incus, and stapes, transmit sound vibrations from the tympanic membrane to the inner ear. The internal ear contains the cochlea, which houses the organ of corti, the sense organ of hearing. The vestibule accommodates the utricule and saccule, which contain endolymph and are surrounded by perilymph. The semicircular canals, which share a common opening into the vestibule, lie at various angles to the petrous temporal bone.

    • This question is part of the following fields:

      • Respiratory System
      140.1
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  • Question 28 - A 12-year-old girl is referred to a respiratory specialist due to persistent episodes...

    Correct

    • A 12-year-old girl is referred to a respiratory specialist due to persistent episodes of shortness of breath. She also suffers from severe hay fever and eczema. After undergoing a peak expiratory flow test, signs of outflow obstruction of her lungs are detected. The doctor prescribes beclomethasone and salbutamol for her and advises her mother to keep her away from dust, as asthma is often linked to hypersensitivity to dust. Which type of hypersensitivity is associated with asthma?

      Your Answer: Type 1 hypersensitivity

      Explanation:

      Asthma is linked to type 1 hypersensitivity, which is caused by the binding of IgE to Mast cells, resulting in an inflammatory reaction. Other types of hypersensitivity include type 2, which involves the binding of IgG or IgM to cell surface antigens, type 3, which is immune complex-mediated, and type 4, which is T-cell mediated.

      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.

    • This question is part of the following fields:

      • Respiratory System
      29.7
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  • Question 29 - A patient with moderate gastro-oesophageal reflux disease undergoes upper gastrointestinal endoscopy and biopsy....

    Correct

    • A patient with moderate gastro-oesophageal reflux disease undergoes upper gastrointestinal endoscopy and biopsy. Upon examination of the biopsy specimen, the pathologist observes that the original epithelium of the oesophagus (A) has been substituted by a distinct type of epithelium (B) that is typically present in the intestine.

      What is the epithelium (B) that the pathologist is most likely to have identified?

      Your Answer: Columnar epithelium

      Explanation:

      Barrett’s oesophagus is characterized by the replacement of the original stratified squamous epithelium with columnar epithelium, which is typically found lining the intestines. Simple cuboidal epithelium is present in small gland ducts, kidney tubules, and secretory portions. Pseudostratified columnar epithelium is found in the upper respiratory tract and trachea, while stratified squamous epithelium lines areas that experience tension, such as the mouth, oesophagus, and vagina.

      Barrett’s oesophagus is a condition where the lower oesophageal mucosa is replaced by columnar epithelium, which increases the risk of oesophageal adenocarcinoma by 50-100 fold. It is usually identified during an endoscopy for upper gastrointestinal symptoms such as dyspepsia, as there are no screening programs for it. The length of the affected segment determines the chances of identifying metaplasia, with short (<3 cm) and long (>3 cm) subtypes. The prevalence of Barrett’s oesophagus is estimated to be around 1 in 20, and it is identified in up to 12% of those undergoing endoscopy for reflux.

      The columnar epithelium in Barrett’s oesophagus may resemble that of the cardiac region of the stomach or that of the small intestine, with goblet cells and brush border. The single strongest risk factor for Barrett’s oesophagus is gastro-oesophageal reflux disease (GORD), followed by male gender, smoking, and central obesity. Alcohol is not an independent risk factor for Barrett’s, but it is associated with both GORD and oesophageal cancer. Patients with Barrett’s oesophagus often have coexistent GORD symptoms.

      The management of Barrett’s oesophagus involves high-dose proton pump inhibitor, although the evidence base for its effectiveness in reducing the progression to dysplasia or inducing regression of the lesion is limited. Endoscopic surveillance with biopsies is recommended every 3-5 years for patients with metaplasia but not dysplasia. If dysplasia of any grade is identified, endoscopic intervention is offered, such as radiofrequency ablation, which is the preferred first-line treatment, particularly for low-grade dysplasia, or endoscopic mucosal resection.

    • This question is part of the following fields:

      • Gastrointestinal System
      36.3
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  • Question 30 - A 50-year-old patient who had a kidney transplant two years ago is currently...

    Incorrect

    • A 50-year-old patient who had a kidney transplant two years ago is currently taking ciclosporin. However, due to a manufacturing issue, the patient cannot obtain their prescribed medication, Sandimmune, for the next five days. What should be done in this situation?

      Your Answer: Switch him to generic cyclosporine to prevent this problem occurring in future

      Correct Answer: Switch him to another formulation and monitor his renal function, ciclosporin level and blood pressure whilst the changeover is being made

      Explanation:

      Ciclosporin is an immunosuppressant used to prevent graft rejection and treat various conditions. Different formulations have varying pharmacokinetic properties, so it is important to prescribe by brand and monitor patients closely when switching formulations. Consultation with a renal unit is recommended before switching therapy.

    • This question is part of the following fields:

      • Pharmacology
      30
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SESSION STATS - PERFORMANCE PER SPECIALTY

Musculoskeletal System And Skin (1/1) 100%
Rheumatology (1/1) 100%
Haematology And Oncology (1/2) 50%
Gastrointestinal System (1/2) 50%
Reproductive System (2/2) 100%
Neurological System (1/3) 33%
Clinical Sciences (3/4) 75%
General Principles (2/7) 29%
Respiratory System (2/5) 40%
Cardiovascular System (0/1) 0%
Renal System (0/1) 0%
Pharmacology (0/1) 0%
Passmed