00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 58-year-old man, previously diagnosed with small cell lung cancer, visits his GP...

    Incorrect

    • A 58-year-old man, previously diagnosed with small cell lung cancer, visits his GP complaining of a recent onset headache, nausea, and vomiting that have been worsening over the past week. He reports feeling dizzy when the headache starts and an unusual increase in appetite, resulting in weight gain. Despite his history of little appetite due to his lung cancer, he has been insatiable lately. Which part of the hypothalamus is likely affected by the metastasis of his lung cancer, causing these symptoms?

      Your Answer: Paraventricular nucleus

      Correct Answer: Ventromedial nucleus

      Explanation:

      The ventromedial nucleus of the hypothalamus is responsible for regulating satiety, and therefore, damage to this area can result in hyperphagia.

      The posterior nucleus plays a role in stimulating the sympathetic nervous system and body heat, and lesions in this area can lead to autonomic dysfunction and poikilothermia.

      The lateral nucleus is responsible for stimulating appetite, and damage to this area can cause a decrease in appetite and anorexia.

      The paraventricular nucleus produces oxytocin and ADH, and lesions in this area can result in diabetes insipidus.

      The dorsomedial nucleus is responsible for stimulating aggressive behavior and can lead to savage behavior if damaged.

      The hypothalamus is a part of the brain that plays a crucial role in maintaining the body’s internal balance, or homeostasis. It is located in the diencephalon and is responsible for regulating various bodily functions. The hypothalamus is composed of several nuclei, each with its own specific function. The anterior nucleus, for example, is involved in cooling the body by stimulating the parasympathetic nervous system. The lateral nucleus, on the other hand, is responsible for stimulating appetite, while lesions in this area can lead to anorexia. The posterior nucleus is involved in heating the body and stimulating the sympathetic nervous system, and damage to this area can result in poikilothermia. Other nuclei include the septal nucleus, which regulates sexual desire, the suprachiasmatic nucleus, which regulates circadian rhythm, and the ventromedial nucleus, which is responsible for satiety. Lesions in the paraventricular nucleus can lead to diabetes insipidus, while lesions in the dorsomedial nucleus can result in savage behavior.

    • This question is part of the following fields:

      • Neurological System
      29.3
      Seconds
  • Question 2 - A 25-year-old female patient visits her general practitioner due to ongoing investigations for...

    Incorrect

    • A 25-year-old female patient visits her general practitioner due to ongoing investigations for infertility. She has a BMI of 32 kg/m² and noticeable facial hair on her upper lip. A recent transvaginal ultrasound scan revealed the presence of numerous cystic lesions on her ovaries.

      What is the probable reason behind her infertility?

      Your Answer: Hypogonadotropic hypogonadal anovulation

      Correct Answer: Normogonadotropic normoestrogenic anovulation

      Explanation:

      The most common type of ovulatory disorder is normogonadotropic normoestrogenic anovulation, which is often associated with polycystic ovarian syndrome (PCOS). This condition is characterized by normal levels of gonadotropin and estrogen, but low levels of FSH during the follicular phase can lead to anovulation. It is important to perform a thorough evaluation of both male and female factors when investigating infertility. Hypogonadotropic hypogonadal anovulation, which is characterized by low levels of GnRH or pituitary unresponsiveness to GnRH, resulting in low gonadotropins and low estrogen, is seen in conditions such as amenorrhea due to low weight, stress, or Sheehan syndrome. Uterine abnormalities, such as fibroids, may also contribute to infertility, but this is not consistent with the clinical findings in this case. Hypergonadotropic hypoestrogenic anovulation, which is characterized by high levels of gonadotropins but unresponsive ovaries and low estrogen levels, is more commonly seen in conditions such as Turner’s syndrome, primary ovarian failure, or ovary damage.

      Understanding Ovulation Induction and Its Categories

      Ovulation induction is a common treatment for couples who have difficulty conceiving naturally due to ovulation disorders. The process of ovulation requires a balance of hormones and feedback loops between the hypothalamus, pituitary gland, and ovaries. Anovulation can occur due to alterations in this balance, which can be classified into three categories: hypogonadotropic hypogonadal anovulation, normogonadotropic normoestrogenic anovulation, and hypergonadotropic hypoestrogenic anovulation. The goal of ovulation induction is to induce mono-follicular development and subsequent ovulation, leading to a singleton pregnancy.

      There are various forms of ovulation induction, starting with the least invasive and simplest management option first. Exercise and weight loss are typically the first-line treatment for patients with polycystic ovarian syndrome, as ovulation can spontaneously return with even a modest 5% weight loss. Letrozole is now considered the first-line medical therapy for patients with PCOS due to its reduced risk of adverse effects on endometrial and cervical mucous compared to clomiphene citrate. Clomiphene citrate is a selective estrogen receptor modulator that acts primarily at the hypothalamus, blocking the negative feedback effect of estrogens. Gonadotropin therapy tends to be the treatment used mostly for women with hypogonadotropic hypogonadism.

      One potential side effect of ovulation induction is ovarian hyperstimulation syndrome (OHSS), which can be life-threatening if not identified and managed promptly. OHSS occurs when ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space. The severity of OHSS varies, with the risk of severe OHSS occurring in less than 1% of all women undergoing ovarian induction. Management includes fluid and electrolyte replacement, anticoagulation therapy, abdominal ascitic paracentesis, and pregnancy termination to prevent further hormonal imbalances.

    • This question is part of the following fields:

      • Reproductive System
      34.6
      Seconds
  • Question 3 - A 32-year-old woman is referred for amniocentesis after her 12-week ultrasound scan revealed...

    Correct

    • A 32-year-old woman is referred for amniocentesis after her 12-week ultrasound scan revealed increased fetal nuchal translucency. Her combined test results indicate a diagnosis of Down's syndrome. She expresses her desire to terminate the pregnancy but is worried about the possibility of the condition being genetic and recurring in future pregnancies.

      What is the probable cytogenetic basis for this disorder?

      Your Answer: Maternal non-disjunction

      Explanation:

      Down’s syndrome is primarily caused by non-disjunction during maternal meiosis, which accounts for the majority of cases. Paternal errors contribute to only a small fraction of cases of Down’s syndrome. In rare cases, Robertsonian translocation can also be attributed to paternal DNA.

      Down’s Syndrome: Epidemiology and Genetics

      Down’s syndrome is a genetic disorder that is caused by the presence of an extra copy of chromosome 21. The risk of having a child with Down’s syndrome increases with maternal age, with a 1 in 1,500 chance at age 20 and a 1 in 50 or greater chance at age 45. This can be remembered by dividing the denominator by 3 for every extra 5 years of age starting at 1/1,000 at age 30.

      There are three main types of Down’s syndrome: nondisjunction, Robertsonian translocation, and mosaicism. Nondisjunction accounts for 94% of cases and occurs when the chromosomes fail to separate properly during cell division. Robertsonian translocation, which usually involves chromosome 14, accounts for 5% of cases and occurs when a piece of chromosome 21 attaches to another chromosome. Mosaicism, which accounts for 1% of cases, occurs when there are two genetically different populations of cells in the body.

      The risk of recurrence for Down’s syndrome varies depending on the type of genetic abnormality. If the trisomy 21 is a result of nondisjunction, the chance of having another child with Down’s syndrome is approximately 1 in 100 if the mother is less than 35 years old. If the trisomy 21 is a result of Robertsonian translocation, the risk is much higher, with a 10-15% chance if the mother is a carrier and a 2.5% chance if the father is a carrier.

    • This question is part of the following fields:

      • General Principles
      65.8
      Seconds
  • Question 4 - A 42-year-old woman visits the clinic to discuss her treatment options after being...

    Incorrect

    • A 42-year-old woman visits the clinic to discuss her treatment options after being diagnosed with Huntington's disease. The physician informs her that excess triplets of nucleotides are responsible for causing this condition. Can you identify the biochemical makeup of these DNA units?

      Your Answer: Two sugar, one amine and one phosphate molecules

      Correct Answer: One sugar, one amine and one phosphate molecules

      Explanation:

      A man with Kearns-Sayer syndrome, a mitochondrial disease, will not pass on the condition to any of his children. This disease is characterized by ptosis, external ophthalmoplegia, retinitis pigmentosa, cardiac conduction defects, and a proximal myopathy. Diagnosis is confirmed through muscle biopsy and polymerase chain reaction analysis of mitochondrial DNA. Mitochondrial diseases are inherited through defects in DNA present in the mitochondria, which are only passed down through the maternal line. Other examples of mitochondrial diseases include MERRF, MELAS, and MIDD.

      Mitochondrial diseases are caused by a small amount of double-stranded DNA present in the mitochondria, which encodes protein components of the respiratory chain and some special types of RNA. These diseases are inherited only via the maternal line, as the sperm contributes no cytoplasm to the zygote. None of the children of an affected male will inherit the disease, while all of the children of an affected female will inherit it. Mitochondrial diseases generally encode rare neurological diseases, and there is poor genotype-phenotype correlation due to heteroplasmy, which means that within a tissue or cell, there can be different mitochondrial populations. Muscle biopsy typically shows red, ragged fibers due to an increased number of mitochondria. Examples of mitochondrial diseases include Leber’s optic atrophy, MELAS syndrome, MERRF syndrome, Kearns-Sayre syndrome, and sensorineural hearing loss.

    • This question is part of the following fields:

      • General Principles
      43.1
      Seconds
  • Question 5 - 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
      48.1
      Seconds
  • Question 6 - In which type of liver cells do oxygen-dependent metabolic reactions occur mostly? ...

    Incorrect

    • In which type of liver cells do oxygen-dependent metabolic reactions occur mostly?

      Your Answer: Zone 2 hepatocytes

      Correct Answer: Zone 1 hepatocytes

      Explanation:

      The Liver’s Dual Blood Supply and Cell Zones

      The liver is composed of small units called acini, each with a dual blood supply from the hepatic artery and portal vein. The blood flows through the hepatic sinusoids, allowing solutes and oxygen to move freely into the hepatocytes. The blood eventually drains into the hepatic vein and back into the systemic circulation.

      The hepatocytes in the periportal region, closest to the hepatic arterial and portal vein supply, are called zone 1 hepatocytes. They are highly metabolically active due to their oxygen-rich and solute-rich supply, but are also more susceptible to damage from toxins. Zone 1 hepatocytes are responsible for oxygen-requiring reactions such as the electron transport chains, Krebs’ cycle, fatty acid oxidation, and urea synthesis.

      Zone 2 and 3 hepatocytes receive less oxygen and are involved in reactions requiring little or no oxygen, such as glycolysis. Ito cells store fats and vitamin A and are involved in the production of connective tissue. Kupffer cells, specialized macrophages, are part of the reticuloendothelial system and are involved in the breakdown of haemoglobulin and the removal of haem for further metabolism in the hepatocytes. Kupffer cells also play a role in immunity. In liver disease, Ito cells are thought to be fundamental in the development of fibrosis and cirrhosis.

      Overall, the liver’s dual blood supply and cell zones play important roles in the metabolic and immune functions of the liver.

    • This question is part of the following fields:

      • Clinical Sciences
      10.3
      Seconds
  • Question 7 - A 68-year-old male with a three year history of type 2 diabetes complains...

    Incorrect

    • A 68-year-old male with a three year history of type 2 diabetes complains of feeling dizzy, sweaty and confused. Upon checking his glucose levels, it is found that he is experiencing hypoglycaemia which is resolved with a glucose drink. Which medication is the most probable cause of this hypoglycaemic episode?

      Your Answer: Metformin

      Correct Answer: Glibenclamide

      Explanation:

      Mechanisms of Hypoglycaemia in Sulphonylurea Therapies

      Sulphonylurea therapies, including gliclazide, glimepiride, and glibenclamide, are known to cause hypoglycaemia. This is due to their ability to increase pancreatic insulin secretion, which can lead to a drop in blood glucose levels. On the other hand, metformin and pioglitazone work differently to control blood glucose levels. Metformin reduces the amount of glucose produced by the liver, while pioglitazone improves the body’s sensitivity to insulin. Neither of these medications typically causes hypoglycaemia.

      Overall, it is important for healthcare providers to be aware of the potential for hypoglycaemia when prescribing sulphonylurea therapies and to monitor patients closely for any signs or symptoms of low blood glucose levels. Additionally, patients should be educated on the importance of monitoring their blood glucose levels regularly and seeking medical attention if they experience any symptoms of hypoglycaemia.

    • This question is part of the following fields:

      • Pharmacology
      28.7
      Seconds
  • Question 8 - A 14-year-old boy is brought to the hospital due to severe nausea and...

    Incorrect

    • A 14-year-old boy is brought to the hospital due to severe nausea and vomiting. He has been unable to eat or drink for the past 48 hours and has not urinated in the last 24 hours. The doctor prescribes an antiemetic, but which antiemetic should be avoided in this situation?

      Your Answer: Cyclizine

      Correct Answer: Metoclopramide

      Explanation:

      The effectiveness of antiemetics depends on their ability to interact with different receptors. Therefore, the selection of an appropriate antiemetic will depend on the patient and the underlying cause of nausea.

      Metoclopramide is a dopamine antagonist that also has peripheral 5HT3 agonist and muscarinic antagonist effects, which help to promote gastric emptying. However, it is not recommended for use in children and young adults due to the potential risk of oculogyric crisis.

      Understanding the Mechanism and Uses of Metoclopramide

      Metoclopramide is a medication primarily used to manage nausea, but it also has other uses such as treating gastro-oesophageal reflux disease and gastroparesis secondary to diabetic neuropathy. It is often combined with analgesics for the treatment of migraines. However, it is important to note that metoclopramide has adverse effects such as extrapyramidal effects, acute dystonia, diarrhoea, hyperprolactinaemia, tardive dyskinesia, and parkinsonism. It should also be avoided in bowel obstruction but may be helpful in paralytic ileus.

      The mechanism of action of metoclopramide is quite complicated. It is primarily a D2 receptor antagonist, but it also has mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist activity. Its antiemetic action is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone, and at higher doses, the 5-HT3 receptor antagonist also has an effect. The gastroprokinetic activity is mediated by D2 receptor antagonist activity and 5-HT4 receptor agonist activity.

      In summary, metoclopramide is a medication with multiple uses, but it also has adverse effects that should be considered. Its mechanism of action is complex, involving both D2 receptor antagonist and 5-HT3 receptor antagonist/5-HT4 receptor agonist activity. Understanding the uses and mechanism of action of metoclopramide is important for its safe and effective use.

    • This question is part of the following fields:

      • Gastrointestinal System
      25.2
      Seconds
  • Question 9 - A 44-year-old woman visits her general practitioner with concerns about her weight. With...

    Incorrect

    • A 44-year-old woman visits her general practitioner with concerns about her weight. With a BMI of 46kg/m², she is worried about being severely overweight and wants to start shedding some pounds. The doctor provides her with general lifestyle advice, including dietary and exercise recommendations. Later that day, the doctor reflects on the limited pharmaceutical options available for weight loss and wonders which receptors could be targeted to create a weight loss drug.

      Which receptors could potentially be targeted to develop a medication for weight loss?

      Your Answer: Beta-2 receptors

      Correct Answer: Beta-3 receptors

      Explanation:

      The activation of beta-3 receptors is linked to the breakdown of fat cells, which may aid in weight loss. Beta-1 receptors, on the other hand, stimulate the heart rate and the release of renin by the kidneys. Beta-2 receptors are involved in the body’s response to stress. Alpha-1 receptors primarily cause smooth muscle contraction, while alpha-2 receptors suppress insulin production and promote glucagon release.

      Adrenoceptors are a type of receptor found in the body that respond to the hormone adrenaline. There are four main types of adrenoceptors: alpha-1, alpha-2, beta-1, and beta-2. Each type of adrenoceptor is responsible for different physiological responses in the body.

      Alpha-1 adrenoceptors are found in various tissues throughout the body and are responsible for vasoconstriction, relaxation of GI smooth muscle, salivary secretion, and hepatic glycogenolysis. On the other hand, alpha-2 adrenoceptors are mainly presynaptic and inhibit the release of neurotransmitters such as norepinephrine and acetylcholine from autonomic nerves. They also inhibit insulin and promote platelet aggregation.

      Beta-1 adrenoceptors are mainly located in the heart and are responsible for increasing heart rate and force. Beta-2 adrenoceptors, on the other hand, are found in various tissues such as the lungs, blood vessels, and GI tract. They are responsible for vasodilation, bronchodilation, and relaxation of GI smooth muscle. Lastly, beta-3 adrenoceptors are found in adipose tissue and promote lipolysis.

      All adrenoceptors are G-protein coupled, meaning they activate intracellular signaling pathways when activated by adrenaline. Alpha-1 adrenoceptors activate phospholipase C, which leads to the production of inositol triphosphate (IP3) and diacylglycerol (DAG). Alpha-2 adrenoceptors inhibit adenylate cyclase, while beta-1 and beta-2 adrenoceptors stimulate adenylate cyclase. Beta-3 adrenoceptors also stimulate adenylate cyclase.

      In summary, adrenoceptors play a crucial role in regulating various physiological responses in the body. Understanding their functions and signaling pathways can help in the development of drugs that target these receptors for therapeutic purposes.

    • This question is part of the following fields:

      • General Principles
      36.1
      Seconds
  • Question 10 - During your placement in a neurology team, you observe a clinic session with...

    Incorrect

    • During your placement in a neurology team, you observe a clinic session with a consultant who is seeing a 7-year-old girl and her parents. They are trying out a ketogenic diet to manage the girl's epilepsy. Can you explain what this diet entails?

      Your Answer: High-protein, low-fat

      Correct Answer: High-fat, low-carbohydrate

      Explanation:

      A diet that is high in fat and low in carbohydrates is known as a ketogenic diet. It is believed that this type of diet, with a normal amount of protein, can be helpful in managing epileptic seizures in children, particularly when traditional treatments are not effective. The other dietary combinations mentioned are not associated with a ketogenic diet.

      Epilepsy is a neurological condition that causes recurrent seizures. In the UK, around 500,000 people have epilepsy, and two-thirds of them can control their seizures with antiepileptic medication. While epilepsy usually occurs in isolation, certain conditions like cerebral palsy, tuberous sclerosis, and mitochondrial diseases have an association with epilepsy. It’s important to note that seizures can also occur due to other reasons like infection, trauma, or metabolic disturbance.

      Seizures can be classified into focal seizures, which start in a specific area of the brain, and generalised seizures, which involve networks on both sides of the brain. Patients who have had generalised seizures may experience biting their tongue or incontinence of urine. Following a seizure, patients typically have a postictal phase where they feel drowsy and tired for around 15 minutes.

      Patients who have had their first seizure generally undergo an electroencephalogram (EEG) and neuroimaging (usually a MRI). Most neurologists start antiepileptics following a second epileptic seizure. Antiepileptics are one of the few drugs where it is recommended that we prescribe by brand, rather than generically, due to the risk of slightly different bioavailability resulting in a lowered seizure threshold.

      Patients who drive, take other medications, wish to get pregnant, or take contraception need to consider the possible interactions of the antiepileptic medication. Some commonly used antiepileptics include sodium valproate, carbamazepine, lamotrigine, and phenytoin. In case of a seizure that doesn’t terminate after 5-10 minutes, medication like benzodiazepines may be administered to terminate the seizure. If a patient continues to fit despite such measures, they are said to have status epilepticus, which is a medical emergency requiring hospital treatment.

    • This question is part of the following fields:

      • Neurological System
      27.3
      Seconds
  • Question 11 - A pharmaceutical company is developing a drug to treat atherosclerosis by blocking the...

    Correct

    • A pharmaceutical company is developing a drug to treat atherosclerosis by blocking the enzymatic conversion of phospholipids to arachidonic acid.

      Which specific enzyme is responsible for this conversion process?

      Your Answer: Phospholipase A2

      Explanation:

      Phospholipase A2 is the enzyme responsible for converting phospholipids into arachidonic acid, which is then utilized to produce additional inflammatory mediators. COX-1 and COX-2, both members of the COX enzyme family, transform arachidonic acid into various inflammatory mediators, including prostaglandins and thromboxane.

      Arachidonic Acid Metabolism: The Role of Leukotrienes and Endoperoxides

      Arachidonic acid is a fatty acid that plays a crucial role in the body’s inflammatory response. The metabolism of arachidonic acid involves the production of various compounds, including leukotrienes and endoperoxides. Leukotrienes are produced by leukocytes and can cause constriction of the lungs. LTB4 is produced before leukocytes arrive, while the rest of the leukotrienes (A, C, D, and E) cause lung constriction.

      Endoperoxides, on the other hand, are produced by the cyclooxygenase enzyme and can lead to the formation of thromboxane and prostacyclin. Thromboxane is associated with platelet aggregation and vasoconstriction, which can lead to thrombosis. Prostacyclin, on the other hand, has the opposite effect and can cause vasodilation and inhibit platelet aggregation.

      Understanding the metabolism of arachidonic acid and the role of these compounds can help in the development of treatments for inflammatory conditions and cardiovascular diseases.

    • This question is part of the following fields:

      • General Principles
      19.7
      Seconds
  • Question 12 - A study investigated the effectiveness of a new statin therapy in preventing ischaemic...

    Incorrect

    • A study investigated the effectiveness of a new statin therapy in preventing ischaemic heart disease in a diabetic population aged 60 and above. Over a period of five years, 1000 patients were randomly assigned to receive the new therapy and 1000 were given a placebo. The results showed that there were 150 myocardial infarcts (MI) in the placebo group and 100 in the group treated with the new statin. What is the number needed to treat to prevent one MI during the study period?

      Your Answer: 50

      Correct Answer: 20

      Explanation:

      The Glycaemic Index Method is a commonly used tool by dieticians and patients to determine the impact of different foods on blood glucose levels. This method involves calculating the area under a curve that shows the rise in blood glucose after consuming a test portion of food containing 50 grams of carbohydrate. The rationale behind using the GI index is that foods that cause a rapid and significant increase in blood glucose levels can lead to an increase in insulin production. This can put individuals at a higher risk of hyperinsulinaemia and weight gain.

      High GI foods are typically those that contain refined sugars and processed cereals, such as white bread and white rice. These foods can cause a rapid increase in blood glucose levels, leading to a surge in insulin production. On the other hand, low GI foods, such as vegetables, legumes, and beans, are less likely to cause a significant increase in blood glucose levels.

      Overall, the Glycaemic Index Method can be helpful in making informed food choices and managing blood glucose levels. By choosing low GI foods, individuals can reduce their risk of hyperinsulinaemia and weight gain, while still enjoying a healthy and balanced diet.

    • This question is part of the following fields:

      • Clinical Sciences
      63.3
      Seconds
  • Question 13 - A 78-year-old man presents with symptoms of claudication. It is decided to assess...

    Incorrect

    • A 78-year-old man presents with symptoms of claudication. It is decided to assess his ankle brachial pressure index. Using a handheld doppler device, the signal from the dorsalis pedis artery is detected. Which vessel does this artery continue from?

      Your Answer: Posterior tibial artery

      Correct Answer: Anterior tibial artery

      Explanation:

      The anterior tibial artery continues as the dorsalis pedis.

      The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      26.5
      Seconds
  • Question 14 - What are the true statements about the musculocutaneous nerve, except for those that...

    Incorrect

    • What are the true statements about the musculocutaneous nerve, except for those that are false?

      Your Answer: It supplies the biceps muscle

      Correct Answer: If damaged, then extension of the elbow joint will be impaired

      Explanation:

      The muscles supplied by it include the biceps, brachialis, and coracobrachialis. If it is injured, the ability to flex the elbow may be affected.

      The Musculocutaneous Nerve: Function and Pathway

      The musculocutaneous nerve is a nerve branch that originates from the lateral cord of the brachial plexus. Its pathway involves penetrating the coracobrachialis muscle and passing obliquely between the biceps brachii and the brachialis to the lateral side of the arm. Above the elbow, it pierces the deep fascia lateral to the tendon of the biceps brachii and continues into the forearm as the lateral cutaneous nerve of the forearm.

      The musculocutaneous nerve innervates the coracobrachialis, biceps brachii, and brachialis muscles. Injury to this nerve can cause weakness in flexion at the shoulder and elbow. Understanding the function and pathway of the musculocutaneous nerve is important in diagnosing and treating injuries or conditions that affect this nerve.

    • This question is part of the following fields:

      • Neurological System
      24.1
      Seconds
  • Question 15 - A 30-year-old male presents with massive haematemesis and is diagnosed with splenomegaly. What...

    Incorrect

    • A 30-year-old male presents with massive haematemesis and is diagnosed with splenomegaly. What is the probable origin of the bleeding?

      Your Answer: Portal Vein Thrombosis

      Correct Answer: Oesophageal varices

      Explanation:

      Portal Hypertension and its Manifestations

      Portal hypertension is a condition that often leads to splenomegaly and upper gastrointestinal (GI) bleeding. The primary cause of bleeding is oesophageal varices, which are dilated veins in the oesophagus. In addition to these symptoms, portal hypertension can also cause ascites, a buildup of fluid in the abdomen, and acute or chronic hepatic encephalopathy, a neurological disorder that affects the brain. Another common manifestation of portal hypertension is splenomegaly with hypersplenism, which occurs when the spleen becomes enlarged and overactive, leading to a decrease in the number of blood cells in circulation. the various symptoms of portal hypertension is crucial for early diagnosis and effective management of the condition.

    • This question is part of the following fields:

      • Gastrointestinal System
      45.6
      Seconds
  • Question 16 - A 29-year-old man is admitted to the haematology ward for acute lymphocytic leukaemia...

    Incorrect

    • A 29-year-old man is admitted to the haematology ward for acute lymphocytic leukaemia treatment. You are consulted due to his complaint of supra-pubic pain and frank haematuria. Upon checking his medication, you observe that he is taking cyclophosphamide and suspect that he may have developed haemorrhagic cystitis from this drug.

      What is the primary mode of action of cyclophosphamide?

      Your Answer: Inhibits formation of microtubules

      Correct Answer: Cross-linking in DNA

      Explanation:

      Cyclophosphamide is a medication that is used to treat various types of cancer and induce immunosuppression in patients before stem cell transplantation. It works by causing cross-linking in DNA. However, one of the complications of cyclophosphamide treatment is haemorrhagic cystitis. This occurs because when the liver breaks down cyclophosphamide, it releases a toxic metabolite called acrolein. Acrolein is concentrated in the bladder and triggers an inflammatory response that can lead to haemorrhagic cystitis.

      To reduce the risk of haemorrhagic cystitis, doctors can administer MESNA, a drug that conjugates acrolein and reduces the inflammatory response.

      Bleomycin, on the other hand, degrades preformed DNA instead of causing cross-linking. Hydroxyurea inhibits ribonucleotide reductase, which decreases DNA synthesis. 5-Fluorouracil (5-FU) is a pyrimidine analogue that arrests the cell cycle and induces apoptosis. Vincristine inhibits the formation of microtubules.

      Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and potential adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.

    • This question is part of the following fields:

      • Haematology And Oncology
      58.9
      Seconds
  • Question 17 - A 67-year-old man visits his primary care physician complaining of excessive thirst and...

    Correct

    • A 67-year-old man visits his primary care physician complaining of excessive thirst and frequent urination. He has no medical history and is not on any medications. He is a non-smoker and does not consume alcohol.

      His HbA1c level is 50 mmol/mol (<48). Despite attempting to manage his condition through diet and exercise, his HbA1c level remains unchanged.

      What is the probable mechanism of action of the medication that will likely be prescribed?

      Your Answer: Activation of AMP-activated protein kinase (AMPK)

      Explanation:

      Metformin is a medication commonly used to treat type 2 diabetes mellitus, as well as polycystic ovarian syndrome and non-alcoholic fatty liver disease. Unlike other medications, such as sulphonylureas, metformin does not cause hypoglycaemia or weight gain, making it a first-line treatment option, especially for overweight patients. Its mechanism of action involves activating the AMP-activated protein kinase, increasing insulin sensitivity, decreasing hepatic gluconeogenesis, and potentially reducing gastrointestinal absorption of carbohydrates. However, metformin can cause gastrointestinal upsets, reduced vitamin B12 absorption, and in rare cases, lactic acidosis, particularly in patients with severe liver disease or renal failure. It is contraindicated in patients with chronic kidney disease, recent myocardial infarction, sepsis, acute kidney injury, severe dehydration, and those undergoing iodine-containing x-ray contrast media procedures. When starting metformin, it should be titrated up slowly to reduce the incidence of gastrointestinal side-effects, and modified-release metformin can be considered for patients who experience unacceptable side-effects.

    • This question is part of the following fields:

      • General Principles
      52.5
      Seconds
  • Question 18 - A 25-year-old male is brought in after a possible heroin overdose. His friend...

    Correct

    • A 25-year-old male is brought in after a possible heroin overdose. His friend discovered him on the floor of his apartment, where he may have been for a full day. The patient is groggy but responsive and reports experiencing muscle soreness. The medical team suspects rhabdomyolysis and wants to conduct a blood test to assess muscle damage. What specific blood test would be helpful in this evaluation?

      Your Answer: Creatine kinase

      Explanation:

      Rhabdomyolysis: Causes and Consequences

      Rhabdomyolysis is a serious medical condition that occurs when muscle cells break down and release their contents into the interstitial space. This can lead to a range of symptoms, including muscle pain and weakness, hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and brown discoloration of the urine. In severe cases, rhabdomyolysis can cause cardiac arrhythmias, renal failure, and disseminated intravascular coagulation (DIC).

      There are many different factors that can trigger rhabdomyolysis, including crush injuries, toxic damage, drugs and medications, severe electrolyte disturbances, reduced blood supply, ischemia, electric shock, heat stroke, and burns. One of the key diagnostic markers for rhabdomyolysis is elevated levels of creatine kinase in the blood.

      Treatment may involve addressing the underlying cause of the muscle breakdown, managing electrolyte imbalances, and providing supportive care to prevent complications. By the causes and consequences of rhabdomyolysis, individuals can take steps to protect their health and seek prompt medical attention if necessary.

    • This question is part of the following fields:

      • Clinical Sciences
      34.5
      Seconds
  • Question 19 - As a medical student on a general surgical team, I am currently treating...

    Incorrect

    • As a medical student on a general surgical team, I am currently treating an 82-year-old female who is scheduled for a mastectomy due to breast cancer. Can you inform me of the most prevalent form of breast cancer?

      Your Answer: Tubular carcinoma

      Correct Answer: Invasive ductal carcinoma

      Explanation:

      Breast Cancer Pathology: Understanding the Histological Features

      Breast cancer pathology involves examining the histological features of the cancer cells to determine the underlying diagnosis. The invasive component of breast cancer is typically made up of ductal cells, although invasive lobular cancer may also occur. In situ lesions, such as DCIS, may also be present.

      When examining breast cancer pathology, several typical changes are seen in conjunction with invasive breast cancer. These include nuclear pleomorphism, coarse chromatin, angiogenesis, invasion of the basement membrane, dystrophic calcification (which may be seen on mammography), abnormal mitoses, vascular invasion, and lymph node metastasis.

      To grade the primary tumor, a scale of 1-3 is used, with 1 being the most benign lesion and 3 being the most poorly differentiated. Immunohistochemistry for estrogen receptor and herceptin status is routinely performed to further understand the cancer’s characteristics.

      The grade, lymph node stage, and size are combined to provide the Nottingham prognostic index, which helps predict the patient’s prognosis and guide treatment decisions. Understanding the histological features of breast cancer is crucial in determining the best course of treatment for patients.

    • This question is part of the following fields:

      • Haematology And Oncology
      28.4
      Seconds
  • Question 20 - A 10-day-old breastfed boy is discovered to have severe jaundice. The pregnancy and...

    Correct

    • A 10-day-old breastfed boy is discovered to have severe jaundice. The pregnancy and delivery were uneventful, and he is almost back to his birth weight. What is the initial course of action in managing his condition?

      Your Answer: Measure total and conjugated bilirubin

      Explanation:

      Neonatal Jaundice and Bilirubin Levels

      Neonatal jaundice is a common condition that affects newborn babies, and it is important to measure bilirubin levels to differentiate between causes and provide appropriate management. Bilirubin levels can be divided into unconjugated and conjugated hyperbilirubinaemias, with the former being the most common cause of jaundice. However, the presence of a raised conjugated bilirubin fraction is always pathological and requires further investigation.

      Unconjugated hyperbilirubinaemia is often physiological or caused by breast milk, but it is important to exclude other causes such as haemolysis and Crigler-Najjar if the baby has severe unconjugated hyperbilirubinaemia. The absolute level of unconjugated bilirubin is crucial to measure, as high concentrations can lead to toxic build-up in the brain known as kernicterus. This can cause deafness, movement disorders, and mental impairment. Phototherapy and exchange transfusion may be required in extreme cases.

      Admission to the hospital depends on bilirubin levels, and a full neonatal jaundice screen is only necessary if there is suspicion of pathological jaundice. The TORCH infection screen, which includes toxoplasmosis, rubella, cytomegalovirus, herpes, and HIV, is part of a neonatal jaundice screen. It is essential to exclude pathological jaundice before reassuring the mother.

    • This question is part of the following fields:

      • Paediatrics
      59.5
      Seconds
  • Question 21 - What is another term for the pre-test probability? ...

    Incorrect

    • What is another term for the pre-test probability?

      Your Answer: Post-test odds / likelihood ratio

      Correct Answer: The prevalence of a condition

      Explanation:

      The prevalence refers to the percentage of individuals in a population who currently have a particular condition, while the incidence refers to the frequency at which new cases of the condition arise within a specific timeframe.

      Understanding Pre- and Post-Test Odds and Probability

      When it comes to medical testing, it’s important to understand the concepts of pre-test and post-test probability and odds. Pre-test probability refers to the proportion of people with a particular disorder in a given population before any testing is done. For example, the prevalence of rheumatoid arthritis in the UK is 1%. Post-test probability, on the other hand, refers to the proportion of patients with a particular test result who actually have the target disorder.

      To calculate post-test probability, you need to know the post-test odds, which is the odds that the patient has the target disorder after the test is carried out. To calculate post-test odds, you first need to know the pre-test odds, which is the odds that the patient has the target disorder before the test is carried out. Pre-test odds can be calculated by dividing the pre-test probability by 1 minus the pre-test probability.

      To calculate post-test odds, you need to know the likelihood ratio for a positive test result, which is the sensitivity divided by 1 minus the specificity. Once you have the likelihood ratio, you can multiply it by the pre-test odds to get the post-test odds. Finally, to get the post-test probability, you divide the post-test odds by 1 plus the post-test odds. Understanding these concepts can help healthcare professionals interpret test results and make informed decisions about patient care.

    • This question is part of the following fields:

      • General Principles
      20.3
      Seconds
  • Question 22 - A 46-year-old man presents to the emergency department with symptoms of alcohol abuse....

    Incorrect

    • A 46-year-old man presents to the emergency department with symptoms of alcohol abuse. Upon further inquiry, he acknowledges having a persistent issue with excessive drinking. He reports no difficulties in maintaining a well-rounded diet.

      Which vitamin should be emphasized as the most crucial for him to supplement regularly?

      Your Answer: Vitamin E

      Correct Answer: Vitamin B1

      Explanation:

      Alcoholics are at risk of developing a thiamine deficiency, which can lead to serious health issues such as Wernicke’s encephalopathy. Therefore, it is recommended that they supplement with thiamine to prevent this deficiency. Vitamin A supplementation is not necessary for individuals with alcohol issues, and there are few medical indications for vitamin A supplementation in general. While alcoholics may be at risk of vitamin B12 deficiency, it is typically possible to obtain enough of this vitamin from the diet unless they follow a vegan diet. Similarly, vitamin B3 deficiency is rare in alcoholics unless they also become malnourished.

      The Importance of Vitamin B1 (Thiamine) in the Body

      Vitamin B1, also known as thiamine, is a water-soluble vitamin that belongs to the B complex group. It plays a crucial role in the body as one of its phosphate derivatives, thiamine pyrophosphate (TPP), acts as a coenzyme in various enzymatic reactions. These reactions include the catabolism of sugars and amino acids, such as pyruvate dehydrogenase complex, alpha-ketoglutarate dehydrogenase complex, and branched-chain amino acid dehydrogenase complex.

      Thiamine deficiency can lead to clinical consequences, particularly in highly aerobic tissues like the brain and heart. The brain can develop Wernicke-Korsakoff syndrome, which presents symptoms such as nystagmus, ophthalmoplegia, and ataxia. Meanwhile, the heart can develop wet beriberi, which causes dilated cardiomyopathy. Other conditions associated with thiamine deficiency include dry beriberi, which leads to peripheral neuropathy, and Korsakoff’s syndrome, which causes amnesia and confabulation.

      The primary causes of thiamine deficiency are alcohol excess and malnutrition. Alcoholics are routinely recommended to take thiamine supplements to prevent deficiency. Overall, thiamine is an essential vitamin that plays a vital role in the body’s metabolic processes.

    • This question is part of the following fields:

      • General Principles
      18.1
      Seconds
  • Question 23 - A 65-year-old male is recovering from a community acquired pneumonia in hospital. He...

    Correct

    • A 65-year-old male is recovering from a community acquired pneumonia in hospital. He has undergone some blood tests that morning which indicate that he is experiencing AKI stage 2. The results are as follows:

      - Na+ 133 mmol/L (135 - 145)
      - K+ 3.6 mmol/L (3.5 - 5.0)
      - Bicarbonate 23 mmol/L (22 - 29)
      - Urea 6.0 mmol/L (2.0 - 7.0)
      - Creatinine 150 µmol/L (55 - 120)

      Over the past 12 hours, he has only produced 360ml of urine. In light of this, what is the most crucial medication to discontinue from his drug chart?

      Your Answer: Diclofenac

      Explanation:

      In cases of acute kidney injury (AKI), it is crucial to discontinue the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as they can potentially worsen renal function. Ibuprofen, being an NSAID, falls under this category.

      NSAIDs work by reducing the production of prostaglandins, which are responsible for vasodilation. Inhibiting their production can lead to vasoconstriction of the afferent arteriole, resulting in decreased renal perfusion and a decline in estimated glomerular filtration rate (eGFR).

      To prevent further damage to the kidneys, all nephrotoxic medications, including NSAIDs, ACE inhibitors, gentamicin, vancomycin, and metformin (which should be discussed with the diabetic team), should be discontinued in cases of AKI.

      Acute kidney injury (AKI) is a condition where there is a reduction in renal function following an insult to the kidneys. It was previously known as acute renal failure and can result in long-term impaired kidney function or even death. AKI can be caused by prerenal, intrinsic, or postrenal factors. Patients with chronic kidney disease, other organ failure/chronic disease, a history of AKI, or who have used drugs with nephrotoxic potential are at an increased risk of developing AKI. To prevent AKI, patients at risk may be given IV fluids or have certain medications temporarily stopped.

      The kidneys are responsible for maintaining fluid balance and homeostasis, so a reduced urine output or fluid overload may indicate AKI. Symptoms may not be present in early stages, but as renal failure progresses, patients may experience arrhythmias, pulmonary and peripheral edema, or features of uraemia. Blood tests such as urea and electrolytes can be used to detect AKI, and urinalysis and imaging may also be necessary.

      Management of AKI is largely supportive, with careful fluid balance and medication review. Loop diuretics and low-dose dopamine are not recommended, but hyperkalaemia needs prompt treatment to avoid life-threatening arrhythmias. Renal replacement therapy may be necessary in severe cases. Patients with suspected AKI secondary to urinary obstruction require prompt review by a urologist, and specialist input from a nephrologist is required for cases where the cause is unknown or the AKI is severe.

    • This question is part of the following fields:

      • Renal System
      44.9
      Seconds
  • Question 24 - Which section of the ECG indicates atrial depolarization? ...

    Correct

    • Which section of the ECG indicates atrial depolarization?

      Your Answer: P wave

      Explanation:

      The depolarization of the atria is represented by the P wave. It should be noted that the QRS complex makes it difficult to observe the repolarization of the atria.

      Understanding the Normal ECG

      The electrocardiogram (ECG) is a diagnostic tool used to assess the electrical activity of the heart. The normal ECG consists of several waves and intervals that represent different phases of the cardiac cycle. The P wave represents atrial depolarization, while the QRS complex represents ventricular depolarization. The ST segment represents the plateau phase of the ventricular action potential, and the T wave represents ventricular repolarization. The Q-T interval represents the time for both ventricular depolarization and repolarization to occur.

      The P-R interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization. The duration of the QRS complex is normally 0.06 to 0.1 seconds, while the duration of the P wave is 0.08 to 0.1 seconds. The Q-T interval ranges from 0.2 to 0.4 seconds depending upon heart rate. At high heart rates, the Q-T interval is expressed as a ‘corrected Q-T (QTc)’ by taking the Q-T interval and dividing it by the square root of the R-R interval.

      Understanding the normal ECG is important for healthcare professionals to accurately interpret ECG results and diagnose cardiac conditions. By analyzing the different waves and intervals, healthcare professionals can identify abnormalities in the electrical activity of the heart and provide appropriate treatment.

    • This question is part of the following fields:

      • Cardiovascular System
      6.2
      Seconds
  • Question 25 - A 46-year-old woman visits her GP complaining of pins and needles in her...

    Correct

    • A 46-year-old woman visits her GP complaining of pins and needles in her right hand, which worsen at night and improve when she hangs her hand over the bed's edge. She has a medical history of hypothyroidism. On examination, there is atrophy of the thenar aspect of her right hand, and Tinel's test is positive on the right side only. Despite conservative management, the patient returns to the practice with no improvement in symptoms and is referred for surgery. What is the surgical procedure that can alleviate this patient's symptoms?

      Your Answer: Flexor retinaculum

      Explanation:

      The surgical management of carpal tunnel syndrome involves dividing the flexor retinaculum, which is the structure spanning the anteromedial surface of the ulna and the distal interphalangeal joints of the phalanges. This procedure is indicated by symptoms such as thenar wasting and a positive Tinel’s test. It is important to note that the cubital retinaculum, Osborne’s ligament, palmar aponeurosis, and pisometacarpal ligament are not involved in the treatment of carpal tunnel syndrome.

      Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

      There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      46
      Seconds
  • Question 26 - A 13-year-old girl presents to the paediatric emergency department with neck stiffness, photophobia...

    Incorrect

    • A 13-year-old girl presents to the paediatric emergency department with neck stiffness, photophobia and a systemic, purpuric rash. She has a fever of 39.2ºC. Paracetamol is administered and intravenous fluids are initiated.

      What is the recommended course of action for the most probable diagnosis?

      Your Answer: Antibiotics based on culture and sensitivity results

      Correct Answer: Intravenous ceftriaxone

      Explanation:

      The most likely diagnosis for this boy is meningococcal septicaemia and bacterial meningitis caused by Neisseria meningitidis, which is the most dangerous form of meningitis. The initial empirical therapy for meningitis in patients over 3 months of age is IV 3rd generation cephalosporin, such as ceftriaxone, which is effective against Neisseria meningitidis. Delaying treatment until culture and sensitivity results are available can be dangerous, as it can take 3-5 days to obtain these results. Intravenous acyclovir is used if viral meningitis is suspected or confirmed, but it is not sufficient in this case, especially in the presence of a purpuric rash, which indicates a high possibility of meningococcal septicaemia. Intravenous benzylpenicillin may be appropriate if sensitivities to any culture taken suggest it, but a third-generation cephalosporin would be the most appropriate choice to cover for meningococcal infection.

      Investigation and Management of Meningitis in Children

      Meningitis is a serious condition that can affect children. It is important to investigate and manage it promptly to prevent complications. When investigating meningitis, a lumbar puncture is usually done to obtain cerebrospinal fluid (CSF) for analysis. However, there are contraindications to lumbar puncture, such as signs of raised intracranial pressure, focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, and signs of cerebral herniation. In such cases, blood cultures and PCR for meningococcus should be obtained for patients with meningococcal septicaemia.

      The management of meningitis involves administering antibiotics, such as IV amoxicillin (or ampicillin) + IV cefotaxime for children under 3 months and IV cefotaxime (or ceftriaxone) for those over 3 months. Steroids may also be given, but NICE advises against giving corticosteroids in children younger than 3 months. Dexamethasone should be considered if the lumbar puncture reveals purulent CSF, a CSF white blood cell count greater than 1000/microlitre, raised CSF white blood cell count with protein concentration greater than 1 g/litre, or bacteria on Gram stain.

      Fluids should also be given to treat any shock, such as with colloid. Cerebral monitoring is necessary, and mechanical ventilation may be required if there is respiratory impairment. Public health notification and antibiotic prophylaxis of contacts are also important. Ciprofloxacin is now preferred over rifampicin for prophylaxis. By following these guidelines, meningitis in children can be effectively managed and treated.

    • This question is part of the following fields:

      • General Principles
      48.6
      Seconds
  • Question 27 - A 48-year-old woman presents to the clinic with complaints of abdominal pain and...

    Incorrect

    • A 48-year-old woman presents to the clinic with complaints of abdominal pain and constipation. During the examination, you observe blue lines on the gum margin. She also reports experiencing weakness in her legs over the past few days. What is the probable diagnosis?

      Your Answer: Guillain Barre syndrome

      Correct Answer: Lead poisoning

      Explanation:

      Lead poisoning is a condition that should be considered when a patient presents with abdominal pain and neurological symptoms, along with acute intermittent porphyria. This condition is caused by defective ferrochelatase and ALA dehydratase function. Symptoms of lead poisoning include abdominal pain, peripheral neuropathy (mainly motor), neuropsychiatric features, fatigue, constipation, and blue lines on the gum margin (which is rare in children and only present in 20% of adult patients).

      To diagnose lead poisoning, doctors typically measure the patient’s blood lead level, with levels greater than 10 mcg/dl considered significant. A full blood count may also be performed, which can reveal microcytic anemia and red cell abnormalities such as basophilic stippling and clover-leaf morphology. Additionally, raised serum and urine levels of delta aminolaevulinic acid may be seen, which can sometimes make it difficult to differentiate from acute intermittent porphyria. Urinary coproporphyrin is also increased, while urinary porphobilinogen and uroporphyrin levels are normal to slightly increased. In children, lead can accumulate in the metaphysis of the bones, although x-rays are not typically part of the standard work-up.

      Various chelating agents are currently used to manage lead poisoning, including dimercaptosuccinic acid (DMSA), D-penicillamine, EDTA, and dimercaprol. These agents work to remove the lead from the body and can help alleviate symptoms.

    • This question is part of the following fields:

      • Haematology And Oncology
      27.6
      Seconds
  • Question 28 - What is the alternative name for vitamin A? ...

    Correct

    • What is the alternative name for vitamin A?

      Your Answer: Vitamin A

      Explanation:

      The Different Types and Roles of Vitamin A

      Vitamin A comes in various forms, including retinol, retinal, and retinoic acid. Retinol is found in food and is converted to retinal or retinoic acid in the body. It is commonly found in meat, milk, and dairy products. Retinal is crucial for vision, while retinoic acid plays a role in gene expression and protein production within cells. Beta carotene, which is present in foods like carrots, can also be converted to vitamin A by the body.

      Vitamin A has several important roles in the body. Retinal is highly concentrated in the rod and cone cells of the retina, where it plays a crucial role in vision. Vitamin A also boosts the immune system by increasing antibody production and T cell activity. It helps maintain the integrity of the skin and mucous membranes, creating a barrier against infection. High doses of vitamin A can even be used to treat certain skin conditions. Additionally, vitamin A is involved in the production of steroid hormones and is essential for growth and development in children.

      However, a deficiency in vitamin A can have negative consequences on nerve function, fertility, and fracture healing. It is important to consume enough vitamin A through a balanced diet or supplements to maintain optimal health.

    • This question is part of the following fields:

      • Clinical Sciences
      14.7
      Seconds
  • Question 29 - Which receptor is predominantly targeted by noradrenaline? ...

    Incorrect

    • Which receptor is predominantly targeted by noradrenaline?

      Your Answer: β 1 receptors

      Correct Answer: α 1 receptors

      Explanation:

      Adrenaline is derived from noradrenaline and has a potent effect on α 1 receptors, although it can also increase myocardial contractility. When administered through infusions, it causes vasoconstriction and a rise in overall peripheral resistance. Noradrenaline is the preferred inotrope for treating septic shock.

      Inotropes are drugs that primarily increase cardiac output and are different from vasoconstrictor drugs that are used for peripheral vasodilation. Catecholamine type agents are commonly used in inotropes and work by increasing cAMP levels through adenylate cyclase stimulation. This leads to intracellular calcium ion mobilisation and an increase in the force of contraction. Adrenaline works as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses. Dopamine causes dopamine receptor-mediated renal and mesenteric vascular dilatation and beta 1 receptor agonism at higher doses, resulting in increased cardiac output. Dobutamine is a predominantly beta 1 receptor agonist with weak beta 2 and alpha receptor agonist properties. Noradrenaline is a catecholamine type agent and predominantly acts as an alpha receptor agonist and serves as a peripheral vasoconstrictor. Milrinone is a phosphodiesterase inhibitor that acts specifically on the cardiac phosphodiesterase and increases cardiac output.

      The cardiovascular receptor action of inotropes varies depending on the drug. Adrenaline and noradrenaline act on alpha and beta receptors, with adrenaline acting as a beta adrenergic receptor agonist at lower doses and an alpha receptor agonist at higher doses. Dobutamine acts predominantly on beta 1 receptors with weak beta 2 and alpha receptor agonist properties. Dopamine acts on dopamine receptors, causing renal and spleen vasodilation and beta 1 receptor agonism at higher doses. The minor receptor effects are shown in brackets. The effects of receptor binding include vasoconstriction for alpha-1 and alpha-2 receptors, increased cardiac contractility and heart rate for beta-1 receptors, and vasodilation for beta-2 receptors. D-1 receptors cause renal and spleen vasodilation, while D-2 receptors inhibit the release of noradrenaline. Overall, inotropes are a class of drugs that increase cardiac output through various receptor actions.

    • This question is part of the following fields:

      • General Principles
      12.2
      Seconds
  • Question 30 - Sarah is a 28-year-old teacher who has presented to the emergency department with...

    Incorrect

    • Sarah is a 28-year-old teacher who has presented to the emergency department with a sudden onset of a severe headache and visual disturbances. Her medical history is significant only for asthma. She does not take any medications, does not smoke nor drink alcohol.

      Upon examination, Sarah is alert and oriented but in obvious pain. Neurological examination reveals a fixed, dilated, non-reactive left pupil that is hypersensitive to light. All extra ocular movements are intact and there is no relative afferent pupillary defect. Systematic enquiry reveals no other abnormalities.

      What is the most likely cause of Sarah's symptoms?

      Your Answer: Closed angle glaucoma

      Correct Answer: Posterior communicating artery aneurysm

      Explanation:

      Understanding Third Nerve Palsy: Causes and Features

      Third nerve palsy is a neurological condition that affects the third cranial nerve, which controls the movement of the eye and eyelid. The condition is characterized by the eye being deviated ‘down and out’, ptosis, and a dilated pupil. In some cases, it may be referred to as a ‘surgical’ third nerve palsy due to the dilation of the pupil.

      There are several possible causes of third nerve palsy, including diabetes mellitus, vasculitis (such as temporal arteritis or SLE), uncal herniation through tentorium if raised ICP, posterior communicating artery aneurysm, and cavernous sinus thrombosis. In some cases, it may also be a false localizing sign. Weber’s syndrome, which is characterized by an ipsilateral third nerve palsy with contralateral hemiplegia, is caused by midbrain strokes. Other possible causes include amyloid and multiple sclerosis.

    • This question is part of the following fields:

      • Neurological System
      296.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurological System (0/5) 0%
Reproductive System (0/1) 0%
General Principles (3/9) 33%
Clinical Sciences (2/4) 50%
Pharmacology (0/1) 0%
Gastrointestinal System (0/2) 0%
Musculoskeletal System And Skin (1/2) 50%
Haematology And Oncology (0/3) 0%
Paediatrics (1/1) 100%
Renal System (1/1) 100%
Cardiovascular System (1/1) 100%
Passmed