-
Question 1
Correct
-
You are the F2 in general practice. You see a 75-year-old man who is complaining of changes in the appearance of his legs. On examination, you can see areas of brown on the legs, dry skin, and the calves appear significantly wider at the knee than the ankle.
What is the man most at risk of?Your Answer: Venous ulcers
Explanation:Chronic venous insufficiency is indicated by brown pigmentation (haemosiderin), lipodermatosclerosis (resembling champagne bottle legs), and eczema. These symptoms increase the likelihood of developing venous ulcers, which typically appear above the medial malleolus. Arterial ulcers are more commonly associated with peripheral arterial disease, while neuropathic ulcers are prevalent in individuals with diabetes.
Venous leg ulcers are the most common and are caused by venous hypertension. Arterial ulcers occur on the toes and heel and are painful without palpable pulses. Neuropathic ulcers commonly occur over the plantar surface and can lead to amputation in diabetic patients. Marjolin’s ulcers are squamous cell carcinomas that occur at sites of chronic inflammation. Pyoderma gangrenosum is associated with inflammatory bowel disease and presents as erythematosus nodules or pustules that ulcerate. Management varies depending on the type of ulcer.
-
This question is part of the following fields:
- Surgery
-
-
Question 2
Incorrect
-
A 40-year-old woman was admitted to the psychiatric ward with paranoid delusions, auditory hallucinations and violent behaviour. There was no past medical history. She was diagnosed with schizophrenia and given intramuscular haloperidol regularly. Four days later, she became febrile and confused. The haloperidol was stopped, but 2 days later, she developed marked rigidity, sweating and drowsiness. She had a variable blood pressure and pulse rate. Creatine phosphokinase was markedly raised.
What is the most likely diagnosis?Your Answer: Serotonin syndrome
Correct Answer: Neuroleptic malignant syndrome
Explanation:Understanding Neuroleptic Malignant Syndrome: A Potentially Life-Threatening Reaction to Neuroleptic Medication
Neuroleptic malignant syndrome (NMS) is a rare but serious reaction to neuroleptic medication. It is characterized by hyperpyrexia (high fever), autonomic dysfunction, rigidity, altered consciousness, and elevated creatine phosphokinase levels. Treatment involves stopping the neuroleptic medication and cooling the patient. Medications such as bromocriptine, dantrolene, and benzodiazepines may also be used.
It is important to note that other conditions, such as cerebral abscess, meningitis, and phaeochromocytoma, do not typically present with the same symptoms as NMS. Serotonin syndrome, while similar, usually presents with different symptoms such as disseminated intravascular coagulation, renal failure, tachycardia, hypertension, and tachypnea.
If you or someone you know is taking neuroleptic medication and experiences symptoms of NMS, seek medical attention immediately. Early recognition and treatment can be life-saving.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 3
Correct
-
A radiologist examines the ankle and foot X-rays of an elderly man with a suspected ankle fracture. A fracture of the talus is noted, with the fracture line interrupting the subtalar joint.
With which of the following bones does the talus articulate at the subtalar joint?Your Answer: Calcaneus
Explanation:Articulations of the Talus Bone in the Foot
The talus bone is a key component of the foot, connecting to several other bones through various joints. Here are the articulations of the talus bone in the foot:
Subtalar Joint with Calcaneus
The subtalar joint connects the talus bone to the calcaneus bone. This joint allows for inversion and eversion of the foot.Talocalcaneonavicular Joint with Calcaneus and Navicular
The talocalcaneonavicular joint is a ball-and-socket joint that connects the talus bone to the calcaneus and navicular bones. The plantar calcaneonavicular ligament completes this joint, connecting the sustentaculum tali of the calcaneus to the plantar surface of the navicular bone.Medial Malleoli of Tibia
The talus bone also articulates with the medial malleoli of the tibia bone. This joint allows for dorsiflexion and plantarflexion of the foot.Lateral Malleoli of Fibula
The lateral malleoli of the fibula bone also articulate with the talus bone. This joint allows for lateral stability of the ankle.No Direct Articulation with Lateral Cuneiform
The talus bone does not directly articulate with the lateral cuneiform bone. -
This question is part of the following fields:
- Orthopaedics
-
-
Question 4
Incorrect
-
A 70-year-old nulliparous female presents with post menopausal bleeding. She reports that her last cervical screening was 12 years ago. On examination she is found to be overweight and hypertensive. What is the most crucial diagnosis to exclude?
Your Answer: Cervical squamous cell carcinoma
Correct Answer: Endometrial adenocarcinoma
Explanation:When a woman experiences postmenopausal bleeding (PMB), the primary concern is the possibility of endometrial cancer. This is because endometrial adenocarcinoma is strongly linked to PMB and early detection is crucial for better prognosis. The patient in this scenario has two risk factors for endometrial adenocarcinoma – obesity and hypertension. Other risk factors include high levels of oestrogen, late menopause, polycystic ovarian syndrome, diabetes mellitus, and tamoxifen use.
Endometrial cancer is a type of cancer that is commonly found in women who have gone through menopause, but it can also occur in around 25% of cases before menopause. The prognosis for this type of cancer is usually good due to early detection. There are several risk factors associated with endometrial cancer, including obesity, nulliparity, early menarche, late menopause, unopposed estrogen, diabetes mellitus, tamoxifen, polycystic ovarian syndrome, and hereditary non-polyposis colorectal carcinoma. Postmenopausal bleeding is the most common symptom of endometrial cancer, which is usually slight and intermittent initially before becoming more heavy. Pain is not common and typically signifies extensive disease, while vaginal discharge is unusual.
When investigating endometrial cancer, women who are 55 years or older and present with postmenopausal bleeding should be referred using the suspected cancer pathway. The first-line investigation is trans-vaginal ultrasound, which has a high negative predictive value for a normal endometrial thickness (< 4 mm). Hysteroscopy with endometrial biopsy is also commonly used for investigation. The management of localized disease involves total abdominal hysterectomy with bilateral salpingo-oophorectomy, while patients with high-risk disease may have postoperative radiotherapy. progesterone therapy is sometimes used in frail elderly women who are not considered suitable for surgery. It is important to note that the combined oral contraceptive pill and smoking are protective against endometrial cancer.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 5
Incorrect
-
As the F2 in the paediatric clinic, a mother comes in with concerns about her 7-month-old daughter. She shows you a video on her phone of the baby crying, stopping abruptly, drawing her chin into her chest, throwing her arms out, relaxing, and then starting to cry again. This cycle is repeated around 10 times over the course of the minute-long video. The mother also mentions that the child has been referred to the community paediatric clinic due to a slight delay in reaching developmental milestones. What is the most appropriate test for you to order to help confirm your diagnosis?
Your Answer: Genetic Testing
Correct Answer: EEG
Explanation:The child’s distress pattern can help differentiate between infantile spasms and colic. Additionally, the child’s history suggests developmental delay and infantile spasms, making an abdominal x-ray unnecessary. An EEG is necessary to check for hypsarrhythmia, commonly found in West’s syndrome, while genetic testing and MRI of the head and spine are not required.
Understanding Infantile Colic
Infantile colic is a common condition that affects infants under three months old. It is characterized by excessive crying and pulling up of the legs, which is often worse in the evening. This condition affects up to 20% of infants, and its cause is unknown.
Despite its prevalence, there is no known cure for infantile colic. However, there are some remedies that parents can try to alleviate the symptoms. NICE Clinical Knowledge Summaries advise against the use of simethicone or lactase drops, such as Infacol® and Colief®, respectively. These remedies have not been proven to be effective in treating infantile colic.
Parents can try other methods to soothe their baby, such as holding them close, rocking them gently, or using a pacifier. Some parents also find that white noise or music can help calm their baby. It is important to remember that infantile colic is a temporary condition that usually resolves on its own by the time the baby is three to four months old.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 6
Incorrect
-
A 28-year-old man visits his General Practitioner on the advice of the Community Psychiatric Nurse. He has been experiencing a fever and sore throat lately. He is currently on clozapine for treatment-resistant schizophrenia.
What would be the most crucial investigation to conduct, considering his recent symptoms?Your Answer: Urea and electrolytes
Correct Answer: Full blood count
Explanation:When treating patients with clozapine, it is important to monitor for agranulocytosis, a rare but potentially fatal side-effect. Patients should report flu-like symptoms and undergo regular blood tests. In this case, the patient’s sore throat and fever may indicate agranulocytosis, so a full blood count is necessary. While an ECG should be done before starting antipsychotic treatment, it is not the most important test in this scenario. Blood glucose should be monitored to exclude organic causes and hyperglycemia caused by antipsychotics. Liver function and urea/electrolytes should also be monitored regularly, but are not the most important tests to conduct immediately in this case.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 7
Correct
-
A 57-year-old retired nurse is receiving palliative care for terminal metastatic lung cancer. Her pain has been well managed until recently, when she started experiencing discomfort about an hour before her next dose of pain medication. This is causing her to feel anxious and concerned about her ability to cope with the pain.
What are the advantages of treating pain during palliative care?Your Answer: All of the above
Explanation:The Importance of Pain Control in Palliative Care
Pain is a crucial aspect of palliative care management. It is a multifaceted symptom that can impact a patient’s mobility, appetite, sleep, and overall quality of life. Addressing pain may involve improving mobility, which can help patients get out of bed and move around more easily. Pain control is also associated with better appetite and sleep, as well as reducing anxiety and improving general quality of life. Therefore, pain control is an essential component of palliative care that can significantly enhance a patient’s well-being.
-
This question is part of the following fields:
- Palliative Care
-
-
Question 8
Incorrect
-
A 6 year old boy with worsening dry, itchy skin, mainly affecting the flexor surfaces on his arms, attends a routine GP clinic with his mother. Despite regular liberal use of emollient cream, the symptoms have not improved significantly. What would be the most suitable course of action for managing the child's eczema?
Your Answer: Refer to the dermatology clinic
Correct Answer: Prescribe hydrocortisone cream 1%
Explanation:Managing Eczema in Children: Treatment Options and Referral Considerations
When a child presents with eczema, the first step is often to use emollient cream to manage the symptoms. However, if the eczema persists or worsens, a topical corticosteroid cream may be necessary. It is important to use this sparingly and in conjunction with emollients. While oral corticosteroids may be considered in severe cases, they should be used with caution and ideally under the guidance of a dermatologist. Emollient ointments may also be helpful, but a short course of topical corticosteroids is often more effective for managing flare-ups. If symptoms continue to worsen despite treatment, referral to a dermatology clinic may be necessary. Watchful waiting is not appropriate in this situation.
-
This question is part of the following fields:
- Dermatology
-
-
Question 9
Incorrect
-
An 82-year-old woman arrives at the emergency department complaining of sudden vision loss in her right eye. She reports experiencing painless vision loss without prior symptoms two hours ago, which has not improved. The left eye has a visual acuity of 6/12 (corrected with a pinhole), while the right eye has undetectable visual acuity. Upon fundoscopic examination, prominent retinal haemorrhages are observed. What is the probable diagnosis?
Your Answer: Central retinal artery occlusion
Correct Answer: Central retinal vein occlusion
Explanation:A sudden painless loss of vision with severe retinal haemorrhages on fundoscopy is indicative of central retinal vein occlusion. This is a common cause of monocular vision loss seen in emergency departments. Acute glaucoma, on the other hand, presents with a painful eye, fixed pupil, hazy cornea, and increased ocular pressures. Central retinal artery occlusion can be difficult to distinguish from venous occlusion, but a ‘cherry red spot’ in the macula is often seen on fundoscopy. However, the absence of this finding and the presence of retinal haemorrhages suggest that arterial occlusion is less likely in this case. Optic neuritis, which presents with eye pain and pain on eye movements, is another possible cause of vision loss.
Understanding Central Retinal Vein Occlusion
Central retinal vein occlusion (CRVO) is a possible cause of sudden, painless loss of vision. It is more common in older individuals and those with hypertension, cardiovascular disease, glaucoma, or polycythemia. The condition is characterized by a sudden reduction or loss of visual acuity, usually affecting only one eye. Fundoscopy reveals widespread hyperemia and severe retinal hemorrhages, which are often described as a stormy sunset.
Branch retinal vein occlusion (BRVO) is a similar condition that affects a smaller area of the fundus. It occurs when a vein in the distal retinal venous system is blocked, usually at arteriovenous crossings.
Most patients with CRVO are managed conservatively, but treatment may be necessary in some cases. For instance, intravitreal anti-vascular endothelial growth factor (VEGF) agents may be used to manage macular edema, while laser photocoagulation may be necessary to treat retinal neovascularization.
Overall, understanding the risk factors, features, and management options for CRVO is essential for prompt diagnosis and appropriate treatment. Proper management can help prevent further vision loss and improve the patient’s quality of life.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 10
Incorrect
-
A 27-year-old woman is eight weeks pregnant in her first pregnancy. She has had clinical hypothyroidism for the past four years and takes 50 micrograms of levothyroxine daily. She reports feeling well and denies any symptoms. You order thyroid function tests, which reveal the following results:
Free thyroxine (fT4) 20 pmol/l (11–22 pmol/l)
Thyroid-stimulating hormone (TSH) 2.1 μu/l (0.17–3.2 μu/l)
What is the most appropriate next step in managing this patient?Your Answer: Continue on the same dose of levothyroxine at present as the patient is euthyroid
Correct Answer: Increase levothyroxine by 25 mcg and repeat thyroid function tests in two weeks
Explanation:Managing Hypothyroidism in Pregnancy: Importance of Levothyroxine Dosing and Thyroid Function Tests
Hypothyroidism is a common condition in pregnancy that requires careful management to ensure optimal fetal development and maternal health. Levothyroxine is the mainstay of treatment for hypothyroidism, and its dosing needs to be adjusted during pregnancy to account for the physiological changes that occur. Here are some key recommendations for managing hypothyroidism in pregnancy:
Increase Levothyroxine by 25 mcg and Repeat Thyroid Function Tests in Two Weeks
As soon as pregnancy is confirmed, levothyroxine treatment should be increased by 25 mcg, even if the patient is currently euthyroid. This is because women without thyroid disease experience a physiological increase in serum fT4 until the 12th week of pregnancy, which is not observed in patients with hypothyroidism. Increasing levothyroxine dose mimics this surge and ensures adequate fetal development. Thyroid function tests should be repeated two weeks later to ensure a euthyroid state.
Perform Thyroid Function Tests in the First and Second Trimesters
Regular thyroid function tests should be performed in pregnancy, starting in the preconception period if possible. Tests should be done at least once per trimester and two weeks after any changes in levothyroxine dose.
Continue on the Same Dose of Levothyroxine at Present if Euthyroid
If the patient is currently euthyroid, continue on the same dose of levothyroxine. However, as soon as pregnancy is confirmed, increase the dose by 25 mcg as described above.
Return to Pre-Pregnancy Dosing Immediately Post-Delivery
After delivery, thyroid function tests should be performed 2-6 weeks postpartum, and levothyroxine dose should be adjusted to return to pre-pregnancy levels based on the test results.
In summary, managing hypothyroidism in pregnancy requires careful attention to levothyroxine dosing and regular thyroid function testing. By following these recommendations, we can ensure the best outcomes for both mother and baby.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 11
Incorrect
-
A 45-year-old accountant presents with right upper quadrant pain and abnormal liver function tests. An ultrasound scan reveals a dilated common bile duct. The patient undergoes an endoscopic retrograde cholangiopancreatography (ERCP) procedure. During the procedure, the consultant asks you to identify the location of the Ampulla of Vater, which is cannulated. Can you tell me where the Ampulla of Vater enters the bowel?
Your Answer: Inferior (third part) duodenum
Correct Answer: Descending (second part) duodenum
Explanation:The Parts of the Duodenum: A Brief Overview
The duodenum is the first part of the small intestine and is divided into four parts. Each part has its own unique characteristics and functions.
Superior (first part) duodenum: This is the first part of the duodenum that connects the stomach to the small intestine.
Descending (second part) duodenum: The ampulla of Vater, where the common bile duct and pancreatic duct enter the duodenum, is located in this part. It is cannulated during ERCP to access the biliary tree.
Inferior (third part) duodenum: The ampulla of Vater does not join this part, but rather the second part.
Ascending (fourth part) duodenum: This is the last part of the duodenum that joins the jejunum, the second part of the small intestine.
Understanding the different parts of the duodenum is important for diagnosing and treating gastrointestinal disorders.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 12
Incorrect
-
A 45-year-old woman with a known tumour in the superior (first) part of the duodenum complains of right upper quadrant pain and jaundice. A CT scan of the abdomen reveals that the tumour is causing obstruction of the biliary tree by pressing against it. Which segment of the biliary tree is most likely to be impacted?
Your Answer: Left hepatic duct
Correct Answer: Common bile duct
Explanation:Anatomy of the Biliary Tree: Location and Function of the Common Bile Duct, Common Hepatic Duct, Left Hepatic Duct, Cystic Duct, and Right Hepatic Duct
The biliary tree is a network of ducts that transport bile from the liver and gallbladder to the small intestine. Understanding the anatomy of the biliary tree is important for diagnosing and treating conditions that affect the liver, gallbladder, and pancreas. Here is a breakdown of the location and function of the common bile duct, common hepatic duct, left hepatic duct, cystic duct, and right hepatic duct:
Common Bile Duct: The common bile duct is the most likely to be occluded in cases of biliary obstruction. It descends posteriorly to the superior part of the duodenum before meeting the pancreatic duct at the ampulla of Vater in the descending part of the duodenum. The gastroduodenal artery, portal vein, and inferior vena cava are also located in this area.
Common Hepatic Duct: The common hepatic duct is formed by the junction of the left and right main hepatic ducts and is located in the free margin of the lesser omentum. It is found at a further superior location than the duodenum.
Left Hepatic Duct: The left hepatic duct drains the left lobe of the liver and is found above the superior part of the duodenum.
Cystic Duct: The cystic duct extends from the gallbladder to the common hepatic duct, which it joins to form the common bile duct. It lies further superior than the superior part of the duodenum.
Right Hepatic Duct: The right hepatic duct drains the right functional lobe of the liver. It joins the left hepatic duct to form the common hepatic duct. It is found superior to the level of the superior part of the duodenum.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 13
Correct
-
A 40-year-old intravenous drug user (ivDU) presents with fever, cough, and SOB. Upon echocardiogram, severe tricuspid regurgitation and two vegetations on the valve are observed. What is the most probable organism to be cultured from the patient's blood?
Your Answer: Staphylococcus aureus
Explanation:Infective Endocarditis: Causes, Microbiology, and Clinical Features
Infective endocarditis is a serious condition that can affect individuals with certain predisposing factors, such as a previous episode of endocarditis, rheumatic heart disease, intravenous drug use, prosthetic valves, congenital heart disease, and hypertrophic cardiomyopathy. The most common causative organisms include viridans streptococci, Streptococcus bovis, Staphylococcus aureus (especially in intravenous drug users), enterococcal, gram-negative bacteria, and Staphylococcus epidermidis (in patients with prosthetic valves).
Clinical features of infective endocarditis include fever, anorexia and weight loss, new or changing murmur, splinter hemorrhages, clubbing, splenomegaly, petechiae, Osler’s nodes, Janeway’s lesions, Roth’s spots, systemic emboli, and hematuria. While 50% of cases occur in previously normal valves (native valve endocarditis), it is typically an acute presentation.
Mycoplasma pneumoniae, Pneumocystis carinii (now known as Pneumocystis jirovecii), and Legionella pneumophila are not common causes of infective endocarditis. While Pseudomonas aeruginosa can cause infective endocarditis, it is less likely than S. aureus, especially in intravenous drug users.
-
This question is part of the following fields:
- Microbiology
-
-
Question 14
Incorrect
-
An 80-year-old man has been experiencing severe, throbbing headaches for a few months, focused on the right side. A tender cord-like area can be felt over his right temple. Upon examination, his heart rate is regular without murmurs, gallops, or rubs. His pulses are equal and full in all extremities, and his blood pressure is 110/85 mmHg. A biopsy of the lesion is taken, revealing a muscular artery with luminal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. The patient responds well to high-dose corticosteroid therapy. What laboratory test finding is most likely to be present with this disease?
Your Answer: Rheumatoid factor titre of 80 IU/mL
Correct Answer: Erythrocyte sedimentation rate of 50 mm/hr
Explanation:Temporal arthritis and its Consequences
Temporal arthritis, also known as giant cell arthritis, is a condition that commonly affects the temporal artery. Its classic symptoms include headache, scalp tenderness, and jaw claudication. If left untreated, it can lead to involvement of other branches of the external carotid artery, with the ophthalmic branch being the worst affected. This can cause blindness due to ischaemic optic neuropathy, central retinal artery occlusion, or cortical infarction. Although corticosteroid therapy can reduce symptoms, established blindness is irreversible. Therefore, it is crucial to diagnose and treat temporal arthritis promptly to prevent severe consequences.
-
This question is part of the following fields:
- Miscellaneous
-
-
Question 15
Correct
-
A 42-year-old woman presents with blood-tinged diarrhoea that has a foul smell. She had been feeling well until three days ago when she started experiencing abdominal discomfort and frequent bowel movements. Her vital signs are stable with a blood pressure of 105/70 mmHg, pulse rate of 90 bpm, respiratory rate of 14 breaths/min, and body temperature of 38.1 °C. She is alert and oriented. Mild abdominal tenderness is present, particularly in the right lower quadrant, without rigidity or guarding. A tender mass is palpable in the right lower quadrant. The anterior lower leg has multiple erythematous and tender patches. A stool sample is sent for examination of red cells, leukocytes, bacteria, ova and parasites, and culture.
Which of the following microorganisms is most likely responsible for this condition?Your Answer: Yersinia enterocolitica
Explanation:Bacterial Causes of Gastroenteritis: Yersinia, Vibrio, E. coli, Campylobacter, and Salmonella
Gastroenteritis is a common condition caused by various bacterial pathogens. Yersinia enterocolitica is one such pathogen that can cause invasive gastroenteritis, leading to mesenteric lymphadenitis and erythema nodosum. Vibrio vulnificus is another Gram-negative bacterium that causes gastroenteritis and skin blisters after consuming contaminated oysters, with chronic liver disease patients at higher risk. Escherichia coli has several pathogenic strains, including enterotoxigenic, enteropathogenic, enteroinvasive, and enterohaemorrhagic, each causing different types of gastroenteritis. Campylobacter is the most common cause of bacterial gastroenteritis worldwide, with invasive symptoms and often bloody stool. Salmonella, a non-lactose fermenter, can also cause gastroenteritis and diarrhea, usually non-bloody. Understanding the different bacterial causes of gastroenteritis is crucial for proper diagnosis and treatment.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 16
Incorrect
-
A 29-year-old woman with Crohn’s disease complained of abdominal pain and foul-smelling stools. She was diagnosed with anaemia and a 'very low' serum vitamin B12 level. In the past, she had undergone surgery for an enterocolic fistula caused by Crohn's disease. The medical team suspected small intestinal bacterial overgrowth and decided to perform a hydrogen breath test.
What precautions should be taken before conducting this test?Your Answer: Avoid brushing your teeth with high fluoride toothpaste before the test
Correct Answer: Avoid smoking
Explanation:Preparing for a Hydrogen Breath Test: What to Avoid and What to Do
A hydrogen breath test is a common diagnostic tool used to detect small intestinal bacterial overgrowth (SIBO). However, certain precautions must be taken before the test to ensure accurate results. Here are some things to avoid and things to do before taking a hydrogen breath test:
Avoid smoking: Smoking interferes with the hydrogen assay, which can lead to inaccurate results.
Avoid exercise for 2 hours prior to the test: Exercise-induced hyperventilation can cause a washout of hydrogen, leading to false low baseline values.
Avoid non-fermentable carbohydrates the night before: Non-fermentable carbohydrates, like bread and pasta, can raise baseline hydrogen levels.
Consider using an antibacterial mouth rinse: Oral bacteria can ferment glucose and lead to falsely high breath hydrogen levels. Using an antibacterial mouth rinse before the test can help prevent this.
Do not take bronchodilators before the test: Bronchodilators are not routinely used before the test and can make the test invalid in patients with severe lung problems.
It is important to note that the gold standard for diagnosing SIBO is culture of small intestinal fluid aspirate. However, a hydrogen breath test can be a useful tool in detecting SIBO. By following these precautions, you can ensure accurate results from your hydrogen breath test.
-
This question is part of the following fields:
- Gastroenterology
-
-
Question 17
Correct
-
A 3-month-old previously healthy boy is brought into the pediatrician's office by his father who is concerned about a change in his behavior. The father suspects his child has a fever. During the examination, the baby is found to have a temperature of 38.5 ºC but no other notable findings.
What should be the next course of action?Your Answer: Urgent referral for paediatric assessment at the hospital
Explanation:If a child under 3 months old has a fever above 38ºC, it is considered a high-risk situation and requires urgent assessment. This is a crucial factor to consider when evaluating a child with a fever. The NICE guidelines use a traffic light system to categorize the risk level of children under 5 with a fever, taking into account various factors such as the child’s appearance, activity level, respiratory function, circulation, hydration, and temperature. If the child falls under the green category, they can be managed at home with appropriate care advice. If they fall under the amber category, parents should be given advice and provided with a safety net, or the child should be referred for pediatric assessment. Children in the red category must be referred urgently to a pediatric specialist. In children under 3 months with fever, NICE recommends performing various investigations such as blood culture, full blood count, c-reactive protein, urine testing for urinary tract infections, stool culture if diarrhea is present, and chest x-ray if there are respiratory signs. Lumbar puncture should be performed in infants under 1 month old, all infants aged 1-3 months who appear unwell, and infants aged 1-3 months with a white blood cell count (WBC) less than 5 × 109/liter or greater than 15 × 109/liter. NICE also recommends administering parenteral antibiotics to this group of patients.
The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013. These guidelines use a ‘traffic light’ system to assess the risk of children under 5 years old presenting with a fever. It is important to note that these guidelines only apply until a clinical diagnosis of the underlying condition has been made. When assessing a febrile child, their temperature, heart rate, respiratory rate, and capillary refill time should be recorded. Signs of dehydration should also be looked for. Measuring temperature should be done with an electronic thermometer in the axilla if the child is under 4 weeks old or with an electronic/chemical dot thermometer in the axilla or an infrared tympanic thermometer.
The risk stratification table includes green for low risk, amber for intermediate risk, and red for high risk. The table includes categories such as color, activity, respiratory, circulation and hydration, and other symptoms. If a child is categorized as green, they can be managed at home with appropriate care advice. If they are categorized as amber, parents should be provided with a safety net or referred to a pediatric specialist for further assessment. If a child is categorized as red, they should be urgently referred to a pediatric specialist. It is important to note that oral antibiotics should not be prescribed to children with fever without an apparent source, and a chest x-ray does not need to be routinely performed if a pneumonia is suspected but the child is not going to be referred to the hospital.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 18
Incorrect
-
A 32-year-old basketball player collapsed during a game and died from a ruptured aortic aneurysm. The athlete died from the consequences of a genetic defect called Marfan’s syndrome.
Which extracellular matrix protein is altered in this disease?Your Answer: Type I collagen
Correct Answer: Fibrillin-1
Explanation:Fibrillin-1 is a glycoprotein that forms microfibrils in the extracellular matrix. These microfibrils can create elastic fibers, providing support for tissues like vessels, ligaments, and skin. Mutations in the FIB-1 gene can cause Marfan’s syndrome, which is characterized by inelastic connective tissue and increased risk of aortic dissection. Integrins are transmembrane proteins that anchor the cell cytoskeleton to the extracellular matrix. Mutations in integrin genes can lead to leukocyte adhesion deficiency type I. Mutations in type I collagen can cause osteogenesis imperfecta and Ehlers-Danlos syndrome. Fibronectin mutations can cause fibronectin glomerulopathy, a kidney disease. Laminins are proteins in the basement membrane of epithelial cells, and mutations in some types can cause muscular dystrophy and junctional epidermolysis bullosa.
-
This question is part of the following fields:
- Genetics
-
-
Question 19
Correct
-
A 25-year-old African woman has an open appendicectomy. Eight months later, she is examined for an unrelated issue. During abdominal examination, it is observed that the wound area is covered by shiny dark raised scar tissue that extends beyond the boundaries of the skin incision. What is the most probable underlying process?
Your Answer: Keloid scar
Explanation:Keloid scars surpass the boundaries of the initial cut.
Understanding the Stages of Wound Healing
Wound healing is a complex process that involves several stages. The type of wound, whether it is incisional or excisional, and its level of contamination will affect the contributions of each stage. The four main stages of wound healing are haemostasis, inflammation, regeneration, and remodeling.
Haemostasis occurs within minutes to hours following injury and involves the formation of a platelet plug and fibrin-rich clot. Inflammation typically occurs within the first five days and involves the migration of neutrophils into the wound, the release of growth factors, and the replication and migration of fibroblasts. Regeneration occurs from day 7 to day 56 and involves the stimulation of fibroblasts and epithelial cells, the production of a collagen network, and the formation of granulation tissue. Remodeling is the longest phase and can last up to one year or longer. During this phase, collagen fibers are remodeled, and microvessels regress, leaving a pale scar.
However, several diseases and conditions can distort the wound healing process. For example, vascular disease, shock, and sepsis can impair microvascular flow and healing. Jaundice can also impair fibroblast synthetic function and immunity, which can have a detrimental effect on the healing process.
Hypertrophic and keloid scars are two common problems that can occur during wound healing. Hypertrophic scars contain excessive amounts of collagen within the scar and may develop contractures. Keloid scars also contain excessive amounts of collagen but extend beyond the boundaries of the original injury and do not regress over time.
Several drugs can impair wound healing, including non-steroidal anti-inflammatory drugs, steroids, immunosuppressive agents, and anti-neoplastic drugs. Closure of the wound can be achieved through delayed primary closure or secondary closure, depending on the timing and extent of granulation tissue formation.
-
This question is part of the following fields:
- Surgery
-
-
Question 20
Incorrect
-
A 5-year-old girl is brought to the pediatrician by her father who reports a 'barking' cough that has occurred a few times daily for the past two days. The child's appetite and behavior remain unchanged. Upon examination, the pediatrician finds no abnormalities. What is the recommended first-line treatment for mild croup?
Your Answer: Oral benzylpenicillin
Correct Answer: Oral dexamethasone
Explanation:Regardless of severity, a single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately for mild croup, which is characterized by a barking cough and the absence of stridor or systemic symptoms.
Understanding Croup: A Respiratory Infection in Infants and Toddlers
Croup is a type of upper respiratory tract infection that commonly affects infants and toddlers. It is characterized by a barking cough, fever, and coryzal symptoms, and is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses are the most common cause of croup. The condition typically peaks between 6 months and 3 years of age, and is more prevalent during the autumn season.
The severity of croup can be graded based on the presence of symptoms such as stridor, cough, and respiratory distress. Mild cases may only have occasional barking cough and no audible stridor at rest, while severe cases may have frequent barking cough, prominent inspiratory stridor at rest, and marked sternal wall retractions. Children with moderate or severe croup, those under 6 months of age, or those with known upper airway abnormalities should be admitted to the hospital.
Diagnosis of croup is usually made based on clinical presentation, but a chest x-ray may show subglottic narrowing, commonly referred to as the steeple sign. Treatment for croup typically involves a single dose of oral dexamethasone or prednisolone, regardless of severity. In emergency situations, high-flow oxygen and nebulized adrenaline may be necessary.
Understanding croup is important for parents and healthcare providers alike, as prompt recognition and treatment can help prevent complications and improve outcomes for affected children.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 21
Incorrect
-
You are with the on-call anaesthetist who is asked to assist with a distressed elderly patient who has just walked into the Emergency Department. The anaesthetist is in the middle of an epidural but sends you down to see what is going on. The patient has been stung by a wasp while gardening, and her arm has become very swollen and red. She kept gardening, but within a few minutes she began feeling light-headed and experienced difficulty breathing. The nurses are getting some monitoring set up. She looks flushed and has stridor and tachypnoea. Her first blood pressure is 76/40 mmHg and she is tachycardic at 150 bpm.
What is the best initial treatment?Your Answer: Intravenous (IV) adrenaline 50 mg
Correct Answer: 500 micrograms intramuscular (IM) 1 : 1000 adrenaline
Explanation:Understanding the Different Treatment Options for Anaphylaxis
Anaphylaxis is a life-threatening condition that requires prompt and appropriate management. When faced with a patient experiencing anaphylaxis, it is important to know the different treatment options available and when to use them.
The initial management for anaphylaxis is 500 micrograms IM 1 : 1000 adrenaline. This should be administered as soon as possible, even before equipment or IV access is available. Delaying the administration of adrenaline can be fatal.
While waiting for expertise and equipment, the airway should be stabilized, high-flow oxygen should be given, and the patient should be fluid-challenged. IV hydrocortisone and chlorphenamine should also be given.
It is important to note that ephedrine has no role in anaphylaxis and should not be used. IV adrenaline should only be used by those experienced in its use, and there may be a delay in obtaining IV access.
Emergency intubation may be necessary, but it will take time to gain IV access, call the anaesthetist, and intubate. IM adrenaline is quick to give and can start working while you continue with the algorithm.
Nebulised adrenaline may help with airway swelling and can work as a stopgap before intubation and while systemic adrenaline starts to work. However, it will not treat the underlying immunological phenomenon.
In summary, prompt administration of IM adrenaline is crucial in the management of anaphylaxis. While waiting for expertise and equipment, other supportive measures can be taken. IV adrenaline and emergency intubation may be necessary, but IM adrenaline should be given first. Nebulised adrenaline can be used as a stopgap measure.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 22
Correct
-
What would be the natural response to hypocalcaemia in a normal and healthy individual, considering the various factors that influence serum calcium levels, including hormones?
Your Answer: Decreased kidney phosphate reabsorption, high PTH, low calcitonin
Explanation:The likely cause of haematemesis in IHD patients is crucial in providing appropriate treatment and management. The history of patients with Ischemic Heart Disease (IHD) is crucial in determining the cause of their current presentation with haematemesis. As most of these patients are receiving aspirin, it is important to consider the possibility of non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulceration as the likely cause. To confirm this, an endoscopy should be performed, and the patient should be started on proton pump inhibition.
It is important to note that gastric carcinoma typically presents with dysphagia and weight loss, while gastritis and oesophagitis present with a burning sensation in the chest and epigastric area, worsened by lying flat and triggered by certain foods or drinks. On the other hand, a Mallory-Weiss tear usually presents with haematemesis after multiple vomiting episodes due to abrasion and trauma to the oesophageal endothelium.
The likely cause of haematemesis in IHD patients is crucial in providing appropriate treatment and management. By considering the patient’s medical history and conducting necessary tests, healthcare professionals can accurately diagnose and treat the underlying condition, ensuring the best possible outcome for the patient.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 23
Incorrect
-
You are a GP in a local surgery and the next patient is a 25-year-old type 1 diabetic who is interested in getting pregnant. She discontinued the use of the combined oral contraceptive pill (Microgynon) two weeks ago. Her body mass index is 23 kg/m² and she is only taking insulin as medication. What other advice should you give her?
Your Answer: Start folic acid 2.5mg once she has a positive pregnancy test
Correct Answer: Start folic acid 5mg now
Explanation:To prevent neural tube defects, it is recommended that women who are at risk start taking folic acid before conception. The standard dose of 0.4mg should be taken daily until 13 weeks of pregnancy. It is important to start taking folic acid before conception because the neural tube is formed within the first 28 days of embryo development. If a woman waits until after her missed period, any defects may already be present. Women who are at an increased risk of neural tube defects, such as those who have had a previous child with NTD, diabetes mellitus, are on antiepileptic medication, are obese (with a body mass index over 30 kg/m²), are HIV positive and taking co-trimoxazole, or have sickle cell disease, should take an increased dose of 5mg folic acid.
Folic Acid: Importance, Deficiency, and Prevention
Folic acid is a vital nutrient that is converted to tetrahydrofolate (THF) in the body. It is found in green, leafy vegetables and plays a crucial role in the transfer of 1-carbon units to essential substrates involved in the synthesis of DNA and RNA. However, certain factors such as phenytoin, methotrexate, pregnancy, and alcohol excess can cause a deficiency in folic acid. This deficiency can lead to macrocytic, megaloblastic anemia and neural tube defects.
To prevent neural tube defects during pregnancy, it is recommended that all women take 400mcg of folic acid until the 12th week of pregnancy. Women at higher risk of conceiving a child with a neural tube defect should take 5mg of folic acid from before conception until the 12th week of pregnancy. Women are considered higher risk if they or their partner has a neural tube defect, they have had a previous pregnancy affected by a neural tube defect, or they have a family history of a neural tube defect. Additionally, women with certain medical conditions such as coeliac disease, diabetes, or thalassaemia trait, or those taking antiepileptic drugs, or who are obese (BMI of 30 kg/m2 or more) are also considered higher risk.
In summary, folic acid is an essential nutrient that plays a crucial role in DNA and RNA synthesis. Deficiency in folic acid can lead to serious health consequences, including neural tube defects. However, taking folic acid supplements during pregnancy can prevent these defects and ensure a healthy pregnancy.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 24
Incorrect
-
A 26-year-old man presents to your clinic six months after he was assaulted on his way home from work. He was mugged and punched in the stomach by his attacker before he fled. Six months later, the patient continues to have severe and incapacitating periumbilical pain where he was punched. He denies any gastrointestinal symptoms or any other issues. Previous investigations and imaging have been unremarkable for any underlying anatomical, neurological or vascular abnormality.
What is the most appropriate description of the patient's current complaints during the clinic visit?Your Answer: Somatization disorder
Correct Answer: Pain disorder
Explanation:Differentiating between Psychiatric Disorders: Pain Disorder, Conversion Disorder, Somatization Disorder, PTSD, and Acute Stress Disorder
When evaluating a patient with unexplained physical symptoms, it is important to consider various psychiatric disorders that may be contributing to their presentation. In this case, the patient’s symptoms do not fit the criteria for somatization disorder, PTSD, or acute stress disorder. However, there are other disorders that should be considered.
Pain disorder is characterized by intense, long-standing pain without a somatic explanation. The patient’s pain is out of proportion to the injury and is not explained by any underlying somatic pathology. This disorder is restricted to physical pain and does not include other somatic complaints.
Conversion disorder, on the other hand, presents as a neurological deficit in the absence of a somatic cause. Patients are usually unconcerned about the symptom, unlike this patient. It usually follows a psychosocial stressor.
Somatization disorder refers to patients with a constellation of physical complaints that are not explained by a somatic process. This would include odd distributions of pain, numbness, GI upset, headache, nausea, vomiting, shortness of breath, palpitations, etc. However, this patient is fixated on a particular disease and does not fit the criteria for somatization.
PTSD presents with persistent re-experiencing of the trauma, nightmares, flashbacks, intense fear, avoidant behaviour and/or increased arousal. Symptoms must persist for at least 1 month and impair his quality of life. There are no clear signs of PTSD in this patient.
Acute stress disorder is an anxiety condition precipitated by an acute stress that resolves within a month. This is well beyond the window for acute stress, and it does not fit the symptomatology of acute stress.
In conclusion, it is important to consider various psychiatric disorders when evaluating a patient with unexplained physical symptoms. By ruling out certain disorders, a proper diagnosis and treatment plan can be established.
-
This question is part of the following fields:
- Psychiatry
-
-
Question 25
Incorrect
-
A 35-year-old woman with a history of ulcerative colitis visits her General Practitioner (GP) complaining of a painful ulcer on her right shin that is rapidly increasing in size. The patient noticed a small blister in the area a few days ago, which has now broken down into an ulcer that is continuing to enlarge. The doctor suspects that the skin lesion may be pyoderma gangrenosum. What is the most commonly associated condition with pyoderma gangrenosum?
Your Answer: Multiple myeloma
Correct Answer: Rheumatoid arthritis
Explanation:Skin Conditions Associated with Various Diseases
Pyoderma gangrenosum is a skin condition characterized by a painful ulcer that rapidly enlarges. It is commonly associated with inflammatory bowel disease, hepatitis, rheumatoid arthritis, and certain types of leukemia. However, it is not commonly associated with HIV infection or coeliac disease. Dermatitis herpetiformis is a skin condition associated with coeliac disease, while patients with rheumatoid arthritis are at higher risk of developing pyoderma gangrenosum compared to those with osteoarthritis. Haematological malignancies commonly associated with pyoderma gangrenosum include acute myeloid leukemia and hairy cell leukemia, while cutaneous lesions in multiple myeloma are uncommon.
-
This question is part of the following fields:
- Dermatology
-
-
Question 26
Incorrect
-
A 42-year-old woman comes to the Neurology Clinic with complaints of painful unilateral visual disturbance, ataxia, and sensory deficit. She is diagnosed with multiple sclerosis (MS) after undergoing magnetic resonance imaging (MRI) and is started on steroid treatment, followed by disease-modifying therapy. Her disease is stable after six months, and she can manage her daily activities without significant problems. She used to drive a car but has not done so since her diagnosis. She is now curious about her driving situation.
What are the most appropriate steps to take regarding her driving circumstances?Your Answer: She must inform the DVLA and cannot drive for one year since her most recent relapse
Correct Answer: She must inform the DVLA and may continue to drive
Explanation:Driving with Multiple Sclerosis: Informing the DVLA
Multiple Sclerosis (MS) is a chronic neurological disorder that may affect vehicle control due to impaired coordination and muscle strength. It is essential to inform the Driver and Vehicle Licensing Agency (DVLA) upon diagnosis. The official guidance states that patients with MS may continue to drive as long as safe vehicle control is maintained. However, it is necessary to update the DVLA if circumstances change. There is no arbitrary timeframe for inability to drive, and it is assessed individually based on the state of the patient’s chronic disease. It is not appropriate to base this on relapses as patients may relapse at different time periods and tend not to return to baseline function in relapsing-remitting MS. Failure to inform the DVLA can result in legal consequences. Therefore, it is crucial to inform the DVLA and follow their guidelines to ensure safe driving.
-
This question is part of the following fields:
- Neurology
-
-
Question 27
Correct
-
A 33-year-old male arrives at the emergency department following a car accident. He reports experiencing intense pain in his right ankle and is unable to put any weight on it. Upon examination, tenderness is noted over the distal tibia and there is an absence of the dorsalis pedis pulse on the right side. No neurological symptoms are observed. An X-ray confirms the presence of a displaced fracture in the ankle. What is the most appropriate initial course of action?
Your Answer: Reduce the fracture
Explanation:Prompt reduction of an ankle fracture is crucial to avoid skin damage, as pressure on the skin can result in skin necrosis.
Before contacting a vascular surgeon, it is essential to reduce the fracture to prevent bone displacement from compressing the artery. If the pulse remains absent after reduction, then it is appropriate to call a vascular surgeon.
Ankle Fractures and their Classification
Ankle fractures are a common reason for emergency department visits. To minimize the unnecessary use of x-rays, the Ottawa ankle rules are used to aid in clinical examination. These rules state that x-rays are only necessary if there is pain in the malleolar zone and an inability to weight bear for four steps, tenderness over the distal tibia, or bone tenderness over the distal fibula. There are several classification systems for describing ankle fractures, including the Potts, Weber, and AO systems. The Weber system is the simplest and is based on the level of the fibular fracture. Type A is below the syndesmosis, type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis, and type C is above the syndesmosis, which may itself be damaged. A subtype known as a Maisonneuve fracture may occur with a spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, requiring surgery.
Management of Ankle Fractures
The management of ankle fractures depends on the stability of the ankle joint and patient co-morbidities. Prompt reduction of all ankle fractures is necessary to relieve pressure on the overlying skin and prevent necrosis. Young patients with unstable, high velocity, or proximal injuries will usually require surgical repair, often using a compression plate. Elderly patients, even with potentially unstable injuries, usually fare better with attempts at conservative management as their thin bone does not hold metalwork well. It is important to consider the patient’s overall health and any other medical conditions when deciding on the best course of treatment.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 28
Incorrect
-
A 10-day old infant is brought to the emergency department by his mother due to poor feeding and drinking for the past 48 hours. The mother is concerned about the baby's weight gain and has noticed pale stools. During the examination, the baby appears jaundiced and has an enlarged liver. The medical team performs a newborn jaundice screen and considers biliary atresia as a possible diagnosis. What clinical finding would be most indicative of biliary atresia?
Your Answer: Raised level of unconjugated bilirubin
Correct Answer: Raised level of conjugated bilirubin
Explanation:Elevated conjugated bilirubin is a characteristic feature of biliary atresia. This condition is often associated with prolonged jaundice, hepatomegaly, splenomegaly, abnormal growth, and cardiac murmurs in the presence of cardiac abnormalities. While liver transaminases and bile acids may also be elevated in biliary atresia, they are not specific to this condition and cannot distinguish it from other causes of neonatal cholestasis. Poor feeding and drinking are not helpful in making a diagnosis, as they can occur in many different conditions. While the age of presentation may suggest biliary atresia, there are several other potential causes of neonatal jaundice in a 15-day old infant, including congenital infections, urinary tract infections, breast milk jaundice, and hypothyroidism. Elevated unconjugated bilirubin is not a typical finding in biliary atresia, but may be seen in cases of hypothyroidism.
Understanding Biliary Atresia in Neonatal Children
Biliary atresia is a condition that affects the extrahepatic biliary system in neonatal children, resulting in an obstruction in the flow of bile. This condition is more common in females than males and occurs in 1 in every 10,000-15,000 live births. There are three types of biliary atresia, with type 3 being the most common. Patients typically present with jaundice, dark urine, pale stools, and abnormal growth.
To diagnose biliary atresia, doctors may perform various tests, including serum bilirubin, liver function tests, serum alpha 1-antitrypsin, sweat chloride test, and ultrasound of the biliary tree and liver. Surgical intervention is the only definitive treatment for biliary atresia, and medical intervention includes antibiotic coverage and bile acid enhancers following surgery.
Complications of biliary atresia include unsuccessful anastomosis formation, progressive liver disease, cirrhosis, and eventual hepatocellular carcinoma. However, the prognosis is good if surgery is successful. In cases where surgery fails, liver transplantation may be required in the first two years of life. Overall, understanding biliary atresia is crucial for early diagnosis and effective management in neonatal children.
-
This question is part of the following fields:
- Paediatrics
-
-
Question 29
Incorrect
-
A 23-year-old woman presents to the emergency department with complaints of hand clumsiness and photophobia that started a day ago. Her colleagues have noticed her struggling to find words for the past two weeks, but she hasn't noticed it herself. She had a dry cough two weeks ago, which has since resolved. She has no known allergies, no regular medications, and no past medical history.
During the examination, some double vision is observed when assessing the right peripheral visual field. Other than that, there are no significant findings. Due to her photophobia, limited fundoscopy is performed, which reveals blurring of the optic disc margin and venous engorgement.
What further tests or procedures should be conducted at this point?Your Answer: Administer broad-spectrum antibiotics
Correct Answer: CT head
Explanation:The presence of papilloedema in this patient suggests an increase in intracranial pressure, making a lumbar puncture contraindicated. Her symptoms, including hand clumsiness, difficulty with word-finding, and acute photophobia, are consistent with a space-occupying lesion. A CT or MRI scan of the head should be urgently performed, and the patient should be referred to a neurosurgeon. Acetazolamide, a carbonic anhydrase inhibitor used to treat idiopathic intracranial hypertension, is not appropriate for this patient as her symptoms are not consistent with IIH. Broad-spectrum antibiotics and blood cultures are not necessary as the patient does not exhibit any signs of infection. The focus should be on promptly identifying any potential space-occupying lesions causing mass effect.
Understanding Papilloedema: Optic Disc Swelling Caused by Increased Intracranial Pressure
Papilloedema is a condition characterized by swelling of the optic disc due to increased pressure within the skull. This condition is typically bilateral and can be identified through fundoscopy. During this examination, venous engorgement is usually the first sign observed, followed by loss of venous pulsation, blurring of the optic disc margin, elevation of the optic disc, loss of the optic cup, and the presence of Paton’s lines, which are concentric or radial retinal lines cascading from the optic disc.
There are several potential causes of papilloedema, including space-occupying lesions such as tumors or vascular abnormalities, malignant hypertension, idiopathic intracranial hypertension, hydrocephalus, and hypercapnia. In rare cases, papilloedema may also be caused by hypoparathyroidism and hypocalcaemia, or vitamin A toxicity.
Overall, understanding papilloedema is important for identifying potential underlying conditions and providing appropriate treatment to prevent further complications.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 30
Incorrect
-
A 25-year-old man has suffered a left-sided pneumothorax. A chest drain has been inserted through the left fifth intercostal space at the mid-axillary line.
As well as the intercostal muscles, which other muscle is likely to have been pierced?Your Answer: Pectoralis major
Correct Answer: Serratus anterior
Explanation:Muscles and Chest Drains: Understanding the Anatomy
The human body is a complex system of muscles, bones, and organs that work together to keep us alive and functioning. When it comes to chest drains, understanding the anatomy of the surrounding muscles is crucial for successful placement and management. Let’s take a closer look at some of the key muscles involved.
Serratus Anterior
The serratus anterior muscle is located on the lateral chest and plays a vital role in protracting the scapula and contributing to rotation. It is likely to be pierced with most chest drains due to its position, with its lower four segments attaching to the fifth to eighth ribs anterior to the mid-axillary line.Latissimus Dorsi
The latissimus dorsi muscle is a back muscle involved in adduction, medial rotation, and extension of the shoulder. It is not pierced by a chest drain.External Oblique
The external oblique muscle is located in the anterior abdomen and is not involved with a chest drain.Pectoralis Major
The pectoralis major muscle is situated in the anterior chest and is not affected by a chest drain, as it does not overlie the fifth intercostal space at the mid-axillary line. It flexes, extends, medially rotates, and adducts the shoulder.Pectoralis Minor
The pectoralis minor muscle lies inferior to the pectoralis major on the anterior chest. It is a small muscle and is not usually pierced with a chest drain, as it does not overlie the fifth intercostal space at the mid-clavicular line.In conclusion, understanding the anatomy of the muscles surrounding the chest is essential for successful chest drain placement and management. Knowing which muscles are likely to be pierced and which are not can help healthcare professionals provide the best possible care for their patients.
-
This question is part of the following fields:
- Respiratory
-
00
Correct
00
Incorrect
00
:
00
:
0
00
Session Time
00
:
00
Average Question Time (
Mins)